Recent Submissions

  • Brain-In-Hand technology for adults with acquired brain injury: A convergence of mixed methods findings

    das Nair, Roshan (2022)
    INTRODUCTION: Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system. AIM: To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury. METHODS: A-B mixed-methods case-study design. Individuals with acquired brain injury (n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants (n = 9) and healthcare workers (n = 3) at 6 months. RESULTS: Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use. CONCLUSIONS: Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.
  • Psychological flexibility, distress, and quality of life in secondary progressive multiple sclerosis: A cross-sectional study

    das Nair, Roshan (2022)
    INTRODUCTION: One of the strongest predictors of successful coping in multiple sclerosis (MS) is the extent to which one can accept the diagnosis and limitations associated with the disease. Acceptance is also one of three core processes of psychological flexibility - a malleable treatment target of some psychological therapies. This is the ability to notice and accept the presence of thoughts and feelings without being swept along by them, engaging in the present moment, and making decisions in line with personal values. Poor psychological flexibility is associated with elevated levels of distress in the general population. However, we do not know the level of psychological flexibility in people with MS, or its relationship to distress or quality of life when the disease becomes more physically disabling. The aims of this study were to determine the level of psychological flexibility, and its relationship with distress and quality of life in secondary progressive multiple sclerosis (SPMS), a subtype of MS with increased severity of disability and distress. METHOD: This cross-sectional analytic study used data collected by the UK MS Register. Pre-existing data on distress, quality of life, disability, and demographics collected by the UK MS Register were combined with a psychological flexibility measure and its component parts, collected for the purpose of this study. Patient demographics and questionnaire data were recorded for distress, quality of life, and psychological flexibility. Pearson's correlations were used to examine bivariate relationships between distress, quality of life, disability and psychological flexibility. Whether psychological flexibility moderated the relationship between disability (predictor), distress and quality of life (outcomes) was also investigated. RESULTS: Between February and March 2020, 628 participants with SPMS completed the CompACT and had a recent (<12 months) HADS questionnaire (M(age) = 60.66, 70.90% women). On the HADS questionnaire subscales, 44% of the sample scored above the MS clinical cut-off (≥8) for anxiety (M = 7.09, SD = 4.57), and 30% above the clinical cut off (≥11) for depression (M = 8.35, SD = 4.21). Psychological flexibility (M = 81.94, SD = 22.60) and its components were each moderately negatively correlated with total distress (r = -0.65), anxiety (r = -0.58), and depression (r = -0.56). A second subsample (n = 434) completed the EQ-5D-5L health-related quality of life measure, which was moderately positively correlated with psychological flexibility (r = 0.47). A third subsample (n = 210) found a weak negative relationship between psychological flexibility and disability (r = -0.16), a weak positive relationship between distress and disability (r = 0.26), and a moderate negative relationship between quality of life and disability (r = -0.56). Psychological flexibility was not found to moderate the relationships between disability and anxiety, depression, or quality of life in SPMS. DISCUSSION: Greater psychological flexibility was associated with lower self-reported distress and higher quality of life in this SPMS sample. It was not shown to moderate the extent to which physical disability predicts distress or quality of life in SPMS. These findings demonstrate that greater psychological flexibility is related to better coping outcomes (lower distress, higher quality of life) in SPMS. If psychological flexibility can be increased in people with SPMS, this could lead to a reduction in distress and improvement in quality of life, although directionality could not be attributed with these methods. Further longitudinal evidence and trials of psychological flexibility-focussed interventions are needed.
  • Strengthening Mental Abilities with Relational Training (SMART) in multiple sclerosis (MS): study protocol for a feasibility randomised controlled trial

    Turton, James; Frost, Alexandra (2022)
    Multiple sclerosis (MS) is a chronic condition of the central nervous system, affecting around 1 in every 600 people in the UK, with 130 new diagnoses every week. Cognitive difficulties are common amongst people with MS, with up to 70% experiencing deficits in higher-level brain functions—such as planning and problem-solving, attention, and memory. Cognitive deficits make it difficult for people with MS to complete everyday tasks and limit their abilities to work, socialise, and live independently. There is a clear need—and recognised research priority—for treatments that can improve cognitive functioning in people with MS. The absence of effective cognitive interventions exacerbates burdens on the services accessed by people with MS—requiring these services to manage sequelae of untreated cognitive deficits, including reduced quality of life, greater disability and dependence, and poorer adherence to disease-modifying treatments. Our planned research will fill the evidence gap through developing—and examining the feasibility of trialling—a novel online cognitive rehabilitation programme for people with MS (SMART). The SMART programme directly trains relational skills (the ability to flexibly relate concepts to one another) based on theory that these skills are critical to broader cognitive functioning.
  • Smoking habits, awareness and support needs for cessation among people with multiple sclerosis in Australia: findings from an online survey

    das Nair, Roshan (2022)
    OBJECTIVES: To assess smoking habits, nicotine use, exposure to passive smoking, awareness of associated harms, and experiences with and preferences for smoking cessation support among people with multiple sclerosis (MS). DESIGN: Online survey, convenience sampling. SETTING: Community setting, Australia. PARTICIPANTS: Adults living in Australia with probable or diagnosed MS were recruited via social media and newsletters to participate in 2020. RESULTS: Of the 284 participants in our convenience sample, 25.7% were current smokers (n=73) and 38.0% were former smokers (n=108). Awareness of the harms of smoking on MS onset (n=68, 24.3%) and progression (n=116, 41.6%) was low. Almost a quarter (n=67, 23.8%) of participants were regularly exposed to passive smoke, and awareness of associated harm was also low (n=47, 16.8%). Among current smokers, 76.1% (n=54) had tried quitting and 73.2% considered quitting within 6 months (n=52). Many participants reported perceived short-term benefits of smoking, and long-term benefits of quitting, on MS symptoms and general well-being (short-term n=28, 40.0%; long-term n=28, 82.4%). While most participants reported that their neurologist (n=126, 75.4%) or other healthcare providers (n=125, 74.9%) had assessed smoking status, very few neurologists (n=3, 1.8%) or other healthcare providers (n=14, 8.4%) had provided help with quitting. Most current smokers preferred speaking about smoking to a neurologist (n=36, 52.2%) or general practitioner (n=41, 59.4%). Almost 60% of the current smokers wanted additional cessation information specific to MS (n=41, 59.4%), and 45.5% said this information would motivate them to quit smoking (n=30). CONCLUSIONS: Our convenience sample, which may not be representative, indicated an urgent need for regular evidence-based smoking cessation supports for people with MS. Most participants felt they would benefit from smoking cessation advice. MS clinicians, in collaboration with patient organisations, smoking cessation services and general practitioners, should make smoking cessation promotion with people with MS a priority.
  • Effectiveness of acceptance and commitment therapy for improving quality of life and mood in individuals with multiple sclerosis: A systematic review and meta-analysis

    Thompson, Bethany; das Nair, Roshan (2022)
    OBJECTIVETo review the evidence for the effectiveness of Acceptance and Commitment Therapy (ACT) intervention on quality of life and mood, for individuals with Multiple Sclerosis (MS).METHODA systematic search was conducted of PsycINFO, CINAHL, Embase, MEDLINE, Web of Science, Scopus and ContextualScience.org up to 13/01/2022. Grey literature was also searched via ProQuest Dissertations and Theses, and PROSPERO. We included Randomised Controlled Trials (RCTs) published in English, that examined the effectiveness of ACT for people with a diagnosis of MS. We were interested in outcomes of Quality of Life (QoL), mood (e.g., anxiety, depression and stress), and ACT-targeted processes. Methodological quality was assessed using the Cochrane Risk of Bias Tool v2. Where available, the extracted data were entered into a meta-analysis to determine weighted effect size estimates for the outcomes of interest.RESULTSSix studies (191 participants), out of 142 identified, met inclusion criteria. Meta-analyses indicated a statistically significant small effect on stress (SMD = -0.49 [95% CI of -0.89 - -0.08]), in favour of ACT. There were no statistically significant effects of ACT on anxiety (SMD = -0.41 [95% CI of -0.93 - 0.11]), depression (SMD = -0.92 [95% CI of -1.91 - 0.06]), or ACT-targeted processes (SMD = -0.18 [95% CI of -0.62 - 0.25]). There was a small, nonsignificant effect on QoL, in favour of control conditions (SMD=0.39 [95% CI of -0.08 - 0.85]). Methodological quality of the studies was variable; all but one study had at least one high risk of bias.CONCLUSIONSFindings suggest a small effect of ACT on reducing stress for people with MS, but not reducing anxiety or depression, or improving quality of life. Due to small sample sizes and few studies within this area, generalisability of findings is limited. Future trials should be pay more attention to methodological rigour.
  • Decentralised clinical trials in multiple sclerosis research

    das Nair, Roshan (2022)
    Randomised controlled trials (RCTs) play an important role in multiple sclerosis (MS) research, ensuring that new interventions are safe and efficacious before their introduction into clinical practice. Trials have been evolving to improve the robustness of their designs and the efficiency of their conduct. Advances in digital and mobile technologies in recent years have facilitated this process and the first RCTs with decentralised elements became possible. Decentralised clinical trials (DCTs) are conducted remotely, enabling participation of a more heterogeneous population who can participate in research activities from different locations and at their convenience. DCTs also rely on digital and mobile technologies which allows for more flexible and frequent assessments. While hospitals quickly adapted to e-health and telehealth assessments during the COVID-19 pandemic, the conduct of conventional RCTs was profoundly disrupted. In this paper, we review the existing evidence and gaps in knowledge in the design and conduct of DCTs in MS.
  • How do stroke survivors and their caregivers manage post-stroke fatigue? A qualitative study

    das Nair, Roshan (2022)
    OBJECTIVESThe primary objective was to gain insight into the lived experiences of using day-to-day strategies to manage post-stroke fatigue.DESIGNQualitative, descriptive study.SETTINGCommunity telephone interviews.PARTICIPANTSA purposive sample of 20 stroke survivors with current, or previous, post-stroke fatigue, and 8 caregivers, who provided informal care or support, were recruited.MAIN MEASURESSemi-structured telephone interviews were undertaken. Data were analysed using a framework approach.RESULTSMost participants had found their own ways of coping and their personal strategies included acceptance of having fatigue; 'pacing' (spreading activities out and interspersing with rest periods); keeping a diary in order to plan activities and to identify 'trigger' activities which induced fatigue; talking to (and educating) others about having fatigue; using relaxation; and accessing professional advice and support. The burden placed on caregivers was considerable and they often had to oversee the post-stroke fatigue management strategies used.CONCLUSIONSPost-stroke fatigue is managed in different ways and there was not one particular strategy that seemed effective for everyone. Most people in our study had had to devise their own ways of coping practically. Given the scale of this problem, which profoundly impacts the lives of both stroke survivors and caregivers, the management of post-stroke fatigue merits more attention and evaluation. However, this must be directly informed by those with lived experience.
  • Neuropsychological evaluation and rehabilitation in multiple sclerosis (NEuRoMS): protocol for a mixed-methods, multicentre feasibility randomised controlled trial

    das Nair, Roshan (2022)
    Background: Cognitive problems affect up to 70% of people with multiple sclerosis (MS), which can negatively impact mood, ability to work, and quality of life. Addressing cognitive problems is a top 10 research priority for people with MS. Our ongoing research has systematically developed a cognitive screening and management pathway (NEuRoMS) tailored for people with MS, involving a brief cognitive evaluation and rehabilitation intervention. The present study aims to assess the feasibility of delivering the pathway and will inform the design of a definitive randomised controlled trial (RCT) to investigate the clinical and cost-effectiveness of the intervention and eventually guide its clinical implementation. Methods: The feasibility study is in three parts. Part 1 involves an observational study of those who receive screening and support for cognitive problems, using routinely collected clinical data. Part 2 is a two-arm, parallel group, multicentre, feasibility RCT with a nested fidelity evaluation. This part will evaluate the feasibility of undertaking a definitive trial comparing the NEuRoMS intervention plus usual care to usual care only, amongst people with MS with mild cognitive problems (n = 60). In part 3, semi-structured interviews will be undertaken with participants from part 2 (n = 25), clinicians (n = 9), and intervention providers (n = 3) involved in delivering the NEuRoMS cognitive screening and management pathway. MS participants will be recruited from outpatient clinics at three UK National Health Service hospitals. Discussion: Timely screening and effective management of cognitive problems in MS are urgently needed due to the detrimental consequences of cognitive problems on people with MS, the healthcare system, and wider society. The NEuRoMS intervention is based on previous and extant literature and has been co-constructed with relevant stakeholders. If effective, the NEuRoMS pathway will facilitate timely identification and management of cognitive problems in people with MS.
  • UK clinical approaches to address post-stroke fatigue: findings from The Nottingham Fatigue after Stroke study

    das Nair, Roshan (2022)
    Background/aims Although post-stroke is common and debilitating, there is little published research on how it is managed by clinicians. The aim of this study was to document UK management of post-stroke fatigue and ascertain whether there are any differences in its management compared to fatigue arising from other conditions. Methods A cross-sectional survey was used with allied health professionals, psychologists, doctors and nurses working clinically in hospitals, the community or both, who routinely provided information, management or treatment to patients with fatigue. Questionnaires were designed and underwent pilot testing. Recruitment was conducted using healthcare professional networks, professional and condition special interest groups and social media, snowballing and personal emails targeting key professional experts. Results A total of 305 questionnaires were analysed; the majority of responses were from occupational therapists (56%, n=171). Although there were different opinions about whether post-stroke fatigue was the same as fatigue resulting from other conditions, the strategies suggested for both were similar. Post-stroke management included pacing (67%, n=204), which is spreading activities out during the day or week, keeping a fatigue diary (39%, n=119) and education (38%, n=117). There were variations in how support was offered, and marked variations in length of follow up; some services were flexible and could retain patients for up to 18 months, while others offered one session and no follow up. conclusions People with post-stroke fatigue and fatigue arising from other conditions experience different levels of support to manage their fatigue, but the main strategies used in management are similar.
  • Experiences of people with multiple sclerosis at work: Towards the understanding of the needs for a job retention vocational rehabilitation intervention

    das Nair, Roshan (2022)
    BACKGROUNDSupporting people with multiple sclerosis (MS) at work can be challenging due to the unpredictable nature and myriad of disease-related symptoms, and issues related to the work environment.OBJECTIVETo explore, amongst people with MS in employment, their experiences of and need for vocational rehabilitation (VR), and perceived barriers and facilitators to implementing VR.METHODSWe conducted 20 semi-structured interviews with people with MS, employers, and healthcare professionals. Interviews were audio-recorded, transcribed, and analysed using the framework method.RESULTSWe identified nine themes reflecting the main MS symptoms (e.g. cognition, fatigue), and environmental factors such as support provided at work (e.g. change of working hours) and workplace characteristics. Providing support tailored to the individual's needs and early intervention were seen as important attributes for the intervention. The barriers identified referred to lack of resources and confidentiality issues; however, having flexibility in the content and delivery of the intervention were seen as facilitators.CONCLUSIONThe impact of environmental factors (e.g. attitudes towards disability) on employment difficulties is equal to or greater than disease-related factors. Environmental changes in the attitudes of co-workers and workplace flexibility can enable people with MS to remain in work for longer.
  • Spatial binding impairments in visual working memory following temporal lobectomy

    Katshu, Mohammad Z. (2022)
    Disorders of the medial temporal lobe (MTL) adversely affect visual working memory (vWM) performance, including feature binding. It is unclear whether these impairments generalise across visual dimensions or are specifically spatial. To address this issue, we compared performance in two tasks of thirteen epilepsy patients, who had undergone a temporal lobectomy, and fifteen healthy controls. In the vWM task, participants recalled the color of one of two polygons, previously displayed side by side. At recall, a location or shape probe identified the target. In the perceptual task, participants estimated the centroid of three visible disks. Patients recalled the target color less accurately than healthy controls because they frequently swapped the non-target with the target color. Moreover, healthy controls and right temporal lobectomy patients made more swap errors following shape than space probes. Left temporal lobectomy patients, showed the opposite pattern of errors instead. Patients and controls performed similarly in the perceptual task. We conclude that left MTL damage impairs spatial binding in vWM, and that this impairment does not reflect a perceptual or attentional deficit.Significance StatementThis study examined color recall in temporal lobectomy patients and healthy controls, to determine whether patients show differential impairments binding color and shape vs color and location of memorised objects. Left temporal lobectomy patients were less accurate recalling color, especially when the target object was identified by the location, rather than the shape it had in the initial display. We found no group difference in a task, which required estimating the centroid of three circles, indicating that the memory impairment was not accounted by perceptual or attentional difficulties. Our findings indicate that lateralised medial temporal circuits are crucial for binding visual features to the location where they had appeared, thus ensuring the primacy of space in organising declarative memories.
  • The oscillatory effects of rhythmic median nerve stimulation

    Jackson, Stephen R. (2022)
    Entrainment of brain oscillations can be achieved using rhythmic non-invasive brain stimulation, and stimulation of the motor cortex at a frequency associated with sensorimotor inhibition can impair motor responses. Despite the potential for therapeutic application, these techniques do not lend themselves to use outside of a clinical setting. Here, the aim was to investigate whether rhythmic median nerve stimulation (MNS) could be used to entrain oscillations related to sensorimotor inhibition. MEG data were recorded from 20 participants during 400 trials, where for each trial 10 pulses of MNS were delivered either rhythmically or arrhythmically at 12 or 20 Hz. Our results demonstrate a frequency specific increase in relative amplitude in the contralateral somatosensory cortex during rhythmic but not arrhythmic stimulation. This was coupled with an increase in inter-trial phase coherence at the same frequency, suggesting that the oscillations synchronised with the pulses of MNS. The results show that 12 and 20 Hz rhythmic peripheral nerve stimulation can produce entrainment. Rhythmic MNS resulted in synchronous firing of neuronal populations within the contralateral somatosensory cortex meaning these neurons were engaged in processing of the afferent input. Therefore, MNS could prove therapeutically useful in disorders associated with hyperexcitability within the sensorimotor cortices. © 2022
  • Experiences of receiving a diagnosis of multiple sclerosis: a meta-synthesis of qualitative studies

    das Nair, Roshan (2022)
    Purpose: This meta-synthesis aimed to synthesise qualitative evidence on experiences of people with Multiple Sclerosis (MS) in receiving a diagnosis, to derive a conceptual understanding of adjustment to MS diagnosis. Methods Five electronic databases were systematically searched to identify qualitative studies that explored views and experiences around MS diagnosis. Papers were quality-appraised using a standardised checklist. Data synthesis was guided by principles of meta-ethnography, a well-established interpretive method for synthesising qualitative evidence. Results Thirty-seven papers were selected (with 874 people with MS). Synthesis demonstrated that around the point of MS diagnosis people experienced considerable emotional upheaval (e.g., shock, denial, anger, fear) and difficulties (e.g., lengthy diagnosis process) that limited their ability to make sense of their diagnosis, leading to adjustment difficulties. However, support resources (e.g., support from clinicians) and adaptive coping strategies (e.g., acceptance) facilitated the adjustment process. Additionally, several unmet emotional and informational support needs (e.g., need for personalised information and tailored emotional support) were identified that, if addressed, could improve adjustment to diagnosis. Conclusions Our synthesis highlights the need for providing person-centred support and advice at the time of diagnosis and presents a conceptual map of adjustment for designing interventions to improve adjustment following MS diagnosis. Implications for Rehabilitation The period surrounding Multiple Sclerosis diagnosis can be stressful and psychologically demanding. Challenges and disruptions at diagnosis can threaten sense of self, resulting in negative emotions. Adaptive coping skills and support resources could contribute to better adjustment following diagnosis. Support interventions should be tailored to the needs of newly diagnosed people.
  • How do people with acquired brain injury interpret the Valued Living Questionnaire? A cognitive interviewing study

    das Nair, Roshan (2022)
    Background: The accurate evaluation of valued living in people with acquired brain injury (ABI) is important for measuring the outcome of interventions targeting valued living. The Valued Living Questionnaire (VLQ) is one of the most widely used measures, however its validity in an ABI cohort may be affected by the cognitive demands associated with evaluating the value-consistency of actions in the past week. Objectives: We aimed to systematically identify common difficulties or errors associated with the comprehension and completion of the VLQ in people with ABI in order to guide a potential adaptation of the measure. Methods: Adults with an ABI (traumatic brain injury, stroke, tumour), experiencing cognitive difficulties and/or emotional distress impacting participation in valued activities, were invited to participate in a cognitive interview which probed their understanding of the VLQ. Concurrent verbal probing was used, whereby scripted verbal probes were asked alongside each questionnaire item as it was being rated by participants. Interviews were transcribed and analysed by combining data pertaining to each item and aggregating these across interviews to highlight common comprehension errors or difficulties. Results: There were 11 participants (mean age = 59.55 years, SD = 12.84; mean education = 14.73 years, SD = 2.87) with a range of ABI aetiologies (7 stroke, 2 TBI, 2 tumour). Common difficulties with the VLQ included confusion caused by question phrasing and structure of the measure, errors due to the cognitive demands associated with rating the importance of abstract values and value-consistency of actions in the last week, and problems with the rating scale. Conclusions: Key problems with the validity of the VLQ within an ABI sample were identified due to comprehension errors relating to its structure and content. Findings will inform an adapted version, suited to the needs of individuals with ABI-associated cognitive difficulties. © 2022
  • Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

    Lee, Claire (2021)
    In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge.Objectives To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus.Setting Virtual nominal group technique (vNGT) across the UK.Participants Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience.Methods Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique’s five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements.Results A combined total of 421 statements achieved positive consensus (&gt;75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required.Conclusion The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.Data are available on reasonable request.
  • Efficacy of hydrogels for repair of traumatic spinal cord injuries: A systematic review and meta-analysis

    Shokraneh, Farhad (2021)
    Hydrogels have been used as promising biomaterials for regeneration and control of pathophysiological events after traumatic spinal cord injuries (TSCI). However, no systematic comparison was conducted to show the effect of hydrogels on pathophysiological events. This study was designed to address this issue and evaluate the regenerative potential of hydrogels after TSCI. From 2857 records found in MEDLINE and EMBASE databases (April 23, 2021), 49 articles were included based on our inclusion/exclusion criteria. All studies discussing the effect of hydrogels on at least one of the main pathophysiological events after TSCI, including inflammation, axon growth, remyelination, glial scar formation, cavity size, and locomotor functional recovery were included. For statistical analysis, we used mean difference with 95% confidence intervals for locomotor functional recovery. The results showed that both natural and synthetic hydrogels could reduce the inflammatory response, hinder glial scar formation, and promote axon growth and vascularization. Also, the meta-analysis of the BBB score showed that using the hydrogels can lead to locomotor functional recovery. It was found that hydrogels are more efficient when used in transection and hemisection injuries (SMD: 1.89; 95% CI: 1.26, 2.52; P < .00001) compared to other injury models. The pre-formed implanted hydrogels (SMD: 1.79; 95% CI: 1.24, 2.34; P < .00001) found to be more effective compared to injection (SMD: 1.58; 95% CI: 0.64, 2.52; P = 0.0009). In conclusion, based on the available evidence, it was concluded that hydrogel composition as well as implantation method are dominant factors affecting tissue regeneration after TSCI and should be chosen according to the injury model in animal studies.
  • Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

    Lee, Claire (2021)
    In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge.Objectives To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus.Setting Virtual nominal group technique (vNGT) across the UK.Participants Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience.Methods Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique’s five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements.Results A combined total of 421 statements achieved positive consensus (&gt;75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required.Conclusion The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.Data are available on reasonable request.
  • A comparison of simultaneous and sequential visuo-spatial memory in children born very preterm

    Groom, Madeleine J. (2021)
    Research suggests that children born very preterm (≤32 weeks' gestation) are at greater risk of impairments in information processing (particularly when information is presented simultaneously rather than sequentially) and visuo-spatial short-term and working memory relative to children born at term. This study compared the performance of children born very preterm with their term-born peers to elucidate the nature of group differences in these areas. 113 children (65 very preterm; 48 term-born) aged 8-to-11 years completed four visuo-spatial recall tasks. Tasks varied by presentation type (simultaneous or sequential) and memory type (short-term or working memory). Both groups recalled more locations in simultaneous than sequential tasks, and in short-term than working memory tasks. In short-term memory tasks, children born at term recalled more locations than children born very preterm for the sequential task, but groups did not differ on the simultaneous task. The opposite pattern was observed in the working memory tasks, with no group differences on the sequential task, but better performance on the simultaneous task for children born at term. Our findings indicate that simultaneous processing may not be impaired in children born very preterm per se, with poorer performance observed only under high cognitive demand. This interaction suggests very preterm birth may affect the level of cognitive resources available during feature integration, the consequences of which become apparent when resources are already stretched. The impact of interactions with cognitive demand in this population should be an important consideration for educational support strategies, and for assessment in research and clinic.
  • The impact of data from remote measurement technology on the clinical practice of healthcare professionals in depression, epilepsy and multiple sclerosis: survey

    Andrews, Jacob A.; Craven, Michael P.; Morriss, Richard K.; Hollis, Chris P. (2021)
    BACKGROUNDA variety of smartphone apps and wearables are available both to help patients monitor their health and to support health care professionals (HCPs) in providing clinical care. As part of the RADAR-CNS consortium, we have conducted research into the application of wearables and smartphone apps in the care of people with multiple sclerosis, epilepsy, or depression.METHODSWe conducted a large online survey study to explore the experiences of HCPs working with patients who have one or more of these conditions. The survey covered smartphone apps and wearables used by clinicians and their patients, and how data from these technologies impacted on the respondents' clinical practice. The survey was conducted between February 2019 and March 2020 via a web-based platform. Detailed statistical analysis was performed on the answers.RESULTSOf 1009 survey responses from HCPs, 1006 were included in the analysis after data cleaning. Smartphone apps are used by more than half of responding HCPs and more than three quarters of their patients use smartphone apps or wearable devices for health-related purposes. HCPs widely believe the data that patients collect using these devices impacts their clinical practice. Subgroup analyses show that views on the impact of this data on different aspects of clinical work varies according to whether respondents use apps themselves, and, to a lesser extent, according to their clinical setting and job role.CONCLUSIONSUse of smartphone apps is widespread among HCPs participating in this large European survey and caring for people with epilepsy, multiple sclerosis and depression. The majority of respondents indicate that they treat patients who use wearables and other devices for health-related purposes and that data from these devices has an impact on clinical practice.
  • Improving smoking cessation support for people with multiple sclerosis: A qualitative analysis of clinicians' views and current practice

    das Nair, Roshan (2021)
    Introduction Smoking is a key modifiable risk factor in multiple sclerosis (MS). MS healthcare providers have a central role informing people of the deleterious effects of smoking on MS progression and promote smoking cessation, yet there is limited information about smoking cessation and support provided by these providers. This study aimed to gain an understanding of MS healthcare providers current practices, barriers and facilitators related to providing smoking cessation support for people with MS. Methods A total of 13 MS nurses and 6 neurologists working in public and private MS clinics across Australia were recruited through professional networks and MS organisations. Telephone interviews were conducted, transcribed and evaluated using framework analysis. Results MS nurses and neurologists reported that they routinely assess smoking status of people with MS at initial appointments and less regularly also at follow-up appointments. Clinicians considered it important to provide information about smoking impact on MS health outcomes and advise to cease smoking, but the content and delivery varies. Beyond this, some clinicians offer referral for smoking cessation support, while others stated this was not their responsibility, especially in light of competing priorities. Many were unsure about referral pathways and options, requiring more information, training and resources. Conclusion Results of this research indicate that there is potential to improve support for MS clinicians to promote smoking cessation among people with MS. Smoking cessation support may include tailored patient resources, clinician training and stronger collaboration with smoking cessation service providers.

View more