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Helen Rodgers

Publications and source records attributed to Helen Rodgers.

12 recordsLinked to original sources
PubMed2006

Randomized controlled trial to evaluate the effect of surface neuromuscular electrical stimulation to the shoulder after acute stroke.

BACKGROUND AND PURPOSE: Surface neuromuscular electrical stimulation (sNMES) after stroke aims to improve upper limb function and reduce shoulder pain, but current evidence of effectiveness is inconclusive. We have undertaken a randomized controlled trial to evaluate sNMES to the shoulder after acute stroke. METHODS: One hundred seventy-six patients, within 10 days of stroke onset, were randomized to receive sNMES or placebo in addition to stroke unit care. The primary outcome measure was upper limb function measured by the Action Research Arm Test (ARAT) 3 months after stroke. Secondary outcome measures included other measures of upper limb function, upper limb impairment, pain, disability, and global health status. Outcome assessments were blinded. RESULTS: There was no difference in arm function between groups in terms of the primary outcome measure. The median ARAT at 3 months was 50 in the intervention group and 55.5 in the control group (P=0.068). Significant differences were seen at 3 months in favor of the control group for other measures of arm function and impairment: grasp and gross movement subsections of the ARAT, Frenchay Arm Test, and the arm subsection of the Motricity Index. Secondary analysis suggested that these differences were most marked in subjects with severe initial upper limb weakness. CONCLUSIONS: A 4-week program of sNMES to the shoulder after acute stroke does not improve functional outcome and may worsen arm function in severely impaired stroke patients. "Routine" use of sNMES to the proximal affected upper limb after acute stroke cannot be recommended.

Acute Disease↗
PubMed2006

Screening for hemochromatosis in asymptomatic subjects with or without a family history.

BACKGROUND: Hemochromatosis in white subjects is mostly due to homozygosity for the common C282Y substitution in HFE. Although clinical symptoms are preventable by early detection of the genetic predisposition and prophylactic treatment, population screening is not currently advocated because of the discrepancy between the common mutation prevalence and apparently lower frequency of clinical disease. This study compared screening for hemochromatosis in subjects with or without a family history. METHODS: We assessed disease expression by clinical evaluation and liver biopsy in 672 essentially asymptomatic C282Y homozygous subjects identified by either family screening or health checks. We also observed a subgroup of untreated homozygotes with normal serum ferritin levels for up to 24 years. RESULTS: Prevalence of hepatic iron overload and fibrosis were comparable between the 2 groups. Disease-related conditions were more common in male subjects identified by health checks, but they were older. Hepatic iron overload (grades 2-4) was present in 56% and 34.5% of male and female subjects, respectively; hepatic fibrosis (stages 2-4) in 18.4% and 5.4%; and cirrhosis in 5.6% and 1.9%. Hepatic fibrosis and cirrhosis correlated significantly with the hepatic iron concentration, and except in cases of cirrhosis, there was a 7.5-fold reduction in the mean fibrosis score after phlebotomy. All subjects with cirrhosis were asymptomatic. CONCLUSIONS: Screening for hemochromatosis in apparently healthy subjects homozygous for the C282Y mutation with or without a family history reveals comparable levels of hepatic iron overload and disease. Significant hepatic fibrosis is frequently found in asymptomatic subjects with hemochromatosis and, except when cirrhosis is present, is reversed by iron removal.

Adolescent↗
PubMed2005

Caring for carers of people with stroke: developing a complex intervention following the Medical Research Council framework.

OBJECTIVE: To develop an intervention, using the first three phases of the Medical Research Council (MRC) framework for complex interventions, to facilitate coping skills in new carers of stroke patients. METHODS: In the preclinical (theoretical) phase, a theoretically based framework for a small group course for carers of people with stroke was developed. The intervention was grounded in a cognitive behavioural model and included carers' needs identified from a literature review. Phase I (modelling phase) comprised a qualitative study involving one-to-one semi-structured interviews with a purposive sample of informal carers of people with stroke. Following this, the intervention was modified. In phase II (exploratory phase), the modified intervention was delivered by a clinical psychologist and stroke nurse practitioner to five carers. Following postcourse interviews the course was further refined and delivered to seven new carers who subsequently completed a satisfaction questionnaire. RESULTS: Carers' needs identified from the literature included information provision; managing emotions; social support; health maintenance; and practical problem solving. Consultation with existing carers confirmed these as important issues with a strong emphasis on finding niches of control in life, becoming an expert carer, and dealing with emotional upheaval. Participants reported feeling more optimistic and empowered subsequent to the course. CONCLUSIONS: The MRC framework provided a useful methodology for the development of a complex intervention. The course aimed to assist carers to regain control over aspects of their lives and manage their emotions. It was feasible to run and acceptable to carers; however a randomized controlled trial (RCT) is required to evaluate its effectiveness.

Adaptation, Psychological↗
PubMed2003

Risk factors for first-ever stroke in older people in the north East of England: a population-based study.

BACKGROUND AND PURPOSE: Although older people potentially have most to gain from prevention, they have been excluded from or underrepresented in many stroke incidence studies. We sought to determine the risk factors for stroke in older people. METHODS: A 5-year follow-up study of a population-based cohort of 4440 subjects aged >65 years in northern England. Subjects were recruited from 27 general practices between 1995 and 1997. RESULTS: A total of 329 out of 4351 subjects with follow-up data suffered a first-ever stroke. On multivariate analysis, risk factors for stroke in older people included atrial fibrillation (hazard ratio [HR], 2.03 [95%CI, 1.31 to 3.16]); previous transient ischemic attack (1.87 [95% CI, 1.27 to 2.76]); smoking (1.72 [95% CI,1.28 to 2.32]); and cardiovascular disease (1.55 [95% CI, 1.19 to 2.03]). The HR per 10-mm Hg increase in systolic blood pressure was 1.15 (95% CI, 1.06 to 1.24). Age was associated with a HR of 1.74 (95% CI, 1.42 to 2.12) per 10-year increase. CONCLUSIONS: "Classic risk factors" increase the risk of stroke in older people. Stroke is not an inevitable consequence of aging, so by identifying and modifying risk factors in older people there are opportunities to reduce the incidence and mortality of this devastating condition.

Age Factors↗
PubMed2003

British Association of Stroke Physicians: benchmarking survey of stroke services.

BACKGROUND: the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. OBJECTIVE: to describe the organisation and staffing of specialist hospital-based stroke services in the UK. DESIGN: a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. RESULTS: the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. CONCLUSIONS: significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

Aged↗
PubMed2003

Does an early increased-intensity interdisciplinary upper limb therapy programme following acute stroke improve outcome?

OBJECTIVE: To determine whether an early increased-intensity upper limb therapy programme following acute stroke improves outcome. DESIGN: A randomized controlled trial. SETTING: A stroke unit which provides acute care and rehabilitation for all stroke admissions. SUBJECTS: One hundred and twenty-three patients who had had a stroke causing upper limb impairment within the previous 10 days. INTERVENTION: The intervention group received stroke unit care plus enhanced upper limb rehabilitation provided jointly by a physiotherapist and occupational therapist, commencing within 10 days of stroke, and available up to 30 minutes/day, five days/week for six weeks. The control group received stroke unit care. MAIN OUTCOME MEASURES: The primary outcome measure was the Action Research Arm Test (ARAT) three months after stroke. SECONDARY OUTCOME MEASURES: Motricity Index; Frenchay Arm Test; upper limb pain; Barthel ADL Index; Nottingham E-ADL Scale; and costs to health and social services at three and six months after stroke. RESULTS: There were no differences in outcomes between the intervention and control groups three and six months after stroke. During the intervention period the intervention group received a median of 29 minutes of enhanced upper limb therapy per working day as inpatients. The total amount of inpatient physiotherapy and occupational therapy received by the intervention group was a median of 52 minutes per working day during the intervention period and 38 minutes per working day for the control group (p = 0.001). There were no differences in service costs. CONCLUSIONS: An early increased-intensity interdisciplinary upper limb therapy programme jointly provided by a physiotherapist and occupational therapist did not improve outcome after stroke. The actual difference in the amount of therapy received by intervention and control groups was less than planned due to a competitive therapy bias.

Activities of Daily Living↗
PubMed2002

Cognitive decline in a prospectively studied group of stroke survivors, with a particular emphasis on the >75's.

BACKGROUND: Although cognitive decline is frequent after stroke, there has been very little work focussing upon older age groups, in whom the majority of strokes occur. OBJECTIVE: To determine whether cognitive decline is more common in older (>75) compared to younger (<75) stroke survivors. METHOD: A cohort of 360 stroke survivors of all ages from a stroke register in Newcastle, UK, were assessed prospectively at 3 time points over 1 year with a standardized battery. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. RESULTS: The overall one year prevalence of dementia was 23%, but rose from 7% in the under 65's to 53% in over 85's. People over 75 were significantly more likely to have dementia (Odds Ratio 8.9, 95% Confidence Intervals 4.1-19.1). CONCLUSION: The striking age related increase in the prevalence of dementia has important implications for service planning and clinical management.

Aged↗
PubMedDate not supplied

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

BACKGROUND: Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. METHODS: We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. FINDINGS: Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. INTERPRETATION: Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

Activities of Daily Living↗