Recovery from disability after stroke as a target for a behavioural intervention: Results of a randomized controlled trial

Johnston, Marie; Bonetti, Debbie; Joice, Sara; Pollard, Beth; Morrison, Val; Francis, Jill J; MacWalter, Ron

doi:10.1080/03323310600950411

Cited by 89 publications

(158 citation statements)

References 53 publications

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“…Psychological research has established strategies by which control related beliefs can be modified to effect positive change in behaviour (Bandura, 1997). Existing evidence indicates that activity limitations can be reduced in people with impairments, without reducing those impairments, by interventions which increase control beliefs (Fisher & Johnston, 1996;Johnston et al, 2007). These strategies could be incorporated into rehabilitation programmes and intervention protocols to bolster improvements in functional status.…”

Section: Discussionmentioning

confidence: 99%

Using the ICF and psychological models of behavior to predict mobility limitations.

Dixon¹,

Johnston²,

Rowley

et al. 2008

Rehabilitation Psychology

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Objective: To test the ability of a model that integrates the theory of planned behavior (TPB) into the International Classification of Functioning, Disability and Health (ICF), to predict walking limitations in adults awaiting hip or knee replacement surgery. Study Design and Participants: Cross-sectional structural equation modeling study of activity limitations in 190 adults. Method: A postal questionnaire measuring TPB, ICF, and walking limitations. Results: The integrated model accounted for more variance in activity limitations (57%) than did either TPB or ICF alone. Control beliefs (TPB) significantly mediated the relationship between impairment (ICF) and activity limitations. Conclusions:The integrated model provides an interdisciplinary, theoretical framework that identifies intervention targets to effect reductions in disability without the need for concomitant reductions in impairment.

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Section: Discussionmentioning

confidence: 99%

Using the ICF and psychological models of behavior to predict mobility limitations.

Dixon¹,

Johnston²,

Rowley

et al. 2008

Rehabilitation Psychology

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“…For example, chronic pain patients in Flor et al's (1992) review, who had improved functioning in everyday tasks despite little change in pain after multidisciplinary treatment, may have undergone changes in their perceived control. Interventions to enhance perceived control have been shown effective in reducing activity limitations in stroke (e.g., Johnston et al, 2007), and perceived control (as self-efficacy) has been targeted in the self-management groups of Lorig and her colleagues, who found that beneficial effects of attendance at their programs were not explained by increased exercise but by greater self-efficacy (Lorig et al, 1989;Lorig & Holman, 1993). …”

Section: Implications For Understanding and Managing Disabilitymentioning

confidence: 99%

“…In addition, while Johnston's (1996) model proposes causal relationships, because of our correlational data we cannot conclude that the relationships are causal. Experimental designs (e.g., Fisher & Johnston, 1996a) and randomized controlled trials (e.g., Johnston et al, 2007) are superior tests of causality.…”

Section: Strengths Limitations and Future Directionsmentioning

confidence: 99%

Testing the integration of ICF and behavioral models of disability in orthopedic patients: Replication and extension.

Quinn¹,

Johnston²,

Dixon³

et al. 2012

Rehabilitation Psychology

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Objective: Disability from chronic illness is a major problem for society, yet the study of its determinants lacks an overall theoretical paradigm. Johnston (1996) has proposed conceptualizing disability as behavior and integrating biomedical and behavioral predictors. Dixon, Johnston, Rowley, and Pollard (2008) tested a model including constructs from the International Classification of Functioning, Disability and Health (ICF) and the theory of planned behavior (TPB) using structural equation modeling; it fitted better and explained more variance than the ICF or TPB alone. We replicated their study with a new sample from the same population (orthopedic patients awaiting joint replacement) and also tested the model after the patients had surgery. Methods: Two weeks before surgery, 342 orthopedic patients who had joint pain (most with arthritis) completed a questionnaire, with 228 completing it again 1 year after surgery. The authors tested Dixon et al.'s best-fit models cross-sectionally (before and after surgery) and assessed the goodness of fit of these imposed models to our data using structural equation modeling. Results: Findings strongly supported those of Dixon et al. Before surgery, results were very similar to Dixon et al. with all models accounting for significant variance and fitting well, but the integrated model fitted better and accounted for more variance. One year after surgery, Dixon et al.'s models showed even stronger fit to the data. Conclusions: Although behavioral and biomedical (ICF) models were supported, the integrated model provided a better explanation of disability in this population than either of these models alone and suggests biopsychosocial interventions to reduce disability.

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“…However, there are examples of workbooks designed to improve self-efficacy in coronary heart disease 375 and following stroke. 376 In addition, a trial protocol has been published describing an intervention for patients with Huntington's disease that consists of an activity workbook combined with six home visits to promote physical activity and exercise. 377 …”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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Recovery from disability after stroke as a target for a behavioural intervention: Results of a randomized controlled trial

Cited by 89 publications

References 53 publications

Using the ICF and psychological models of behavior to predict mobility limitations.

Using the ICF and psychological models of behavior to predict mobility limitations.

Testing the integration of ICF and behavioral models of disability in orthopedic patients: Replication and extension.

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

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