Bangor University Projects
The OTCH trial is a pragmatic cluster randomised controlled trial aimed at assessing the impact of a targeted course of occupational therapy on people living in nursing and residential homes after suffering from a stroke (Sackley et al., 2004). This Health Technology Assessment (HTA) funded cluster trial compared the level of independence on activities of daily living achieved by stroke patients at control care homes with the level of independence of patients living at care homes that have had active occupational therapy input. To date this has been the largest cluster RCT looking at occupational therapy in care homes. It provided information not only on the impact that occupational therapy had on promoting independence in activities of daily living but also on other aspects such as depression and quality of life. The OTCH intervention was focused on mobility, transfers and seating assessments, task related interventions on self-care activities, and the provision of adaptive equipment and environmental adaptations (Sackley et al. 2006). The intervention also included a training package for care home staff working in participating care homes, which covered the principles underpinning occupational therapy interventions and decision-making.
Links to publications:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391137/Abstract (from protocol publication):
The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.
Bangor University – Top Stroke- related Publications
Masterson Algar, P., Rycroft-Malone, J. & Burton, C. (2016) Process evaluations in neurological rehabilitation: a mixed-evidence systematic review and recommendations for future research. BMJ Open 6: 11.
Sackley, C., Walker, M., Burton, C. et al., (2016) An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation. Health Technology Assessment 20: 15.
Sackley, C.M., Walker, M.F., Burton, C.R., Watkins, C.L., et al. (2015) An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial. BMJ Open 350:h246 | doi: 10.1136/bmj.h468.
Masterson-Algar, P., Burton, C. R., Rycroft-Malone, J., Sackley, C. M. & Walker, M. F. (2014) Towards a programme theory for fidelity in the evaluation of complex interventions. Journal of Evaluation in Clinical Practice 20(4): 445-452.
Holmes, E. A., Plumpton, C. O., Roberts, G. W., Burton, C. R., et al., (2014) Investigating preferences for support with life after stroke: a discreet choice experiment. BMC Health Services Research 14(63): 1-13.
Burton, C. R., Payne, S., Turner, M., Bucknall, T., Rycroft-Malone, J., Tyrrell, P., et al., (2014) The study protocol of: ‘Initiating end of life care in stroke: clinical decision-making around prognosis’. BMC Palliative Care 13: 1-8.
Thomas, L. H., French, B., Sutton, C. J. et al., (2015) ICONS: Identifying Continence OptioNs after Stroke: An evidence synthesis, case study and exploratory cluster randomised controlled trial of the introduction of a systematic voiding programme for patients with urinary incontinence after stroke in secondary care. Programme Grants for Applied Research 3: 1.
Sackley, C.M., Walker, M.F., Burton, C.R., Watkins, C.L., et al., (2015) An occupational therapy intervention for residents with stroke related disabilities in UK care homes (OTCH): cluster randomised controlled trial. BMJ Open 350:h246 | doi: 10.1136/bmj.h468.
Burton, C. R., Horne, M., Woodward-Nutt, K., Bowen, A. & Tyrrell, P. (2015) What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services. Disability and Rehabilitation. 37: 21, p. 1955-1960.
Thomas, L. H., Watkins, C. L., Sutton, C. J., Forshaw, D., Leathley, M. J., French, B., Burton, C. R., Cheater, F., Roe, B., Britt, D., Booth, J. & McColl, E. (2014) Identifying continence options after stroke (ICONS): a cluster randomised controlled feasibility trial. Trials 15: 509.
Thomas, L., French B., Burton, C., Forshaw, D., Booth, J., Britt, D., Cheater, F.C., Roe, B., and Watkins, C.L. (2014) Evaluating a systematic voiding programme for patients with urinary incontinence after stroke in secondary care using Soft Systems analysis and Normalisation Process Theory: findings from the ICONS case study phase. International Journal of Nursing Studies 51(10): 1308-1320.
Randerath, J., Valyear K.F., Philip, B.A., & Frey, S.H. (2017). Contributions of the parietal cortex to increased efficiency of planning-based action selection. Neuropsychologia, 105, 135-143.
Valyear, K.F,, & Frey, S.H. (2015). Human posterior parietal cortex mediates hand-specific planning. NeuroImage, 114, 226-238.
Valyear, K.F., & Frey, S.H. (2014). Hand selection for object grasping is influenced by recent motor history. Psychonomic Bulletin & Review, 21/2, 566-573.