Supplemental material, Supplemental_Material for A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries by Jade Kettlewell, Roshan das Nair and Kate Radford in Clinical... more
Supplemental material, Supplemental_Material for A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries by Jade Kettlewell, Roshan das Nair and Kate Radford in Clinical Rehabilitation
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... more
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....
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Introduction Following traumatic injury, occupational therapists (OTs) are pivotal in supporting people to return-to-work (RTW) and regain independence. Aim: to identify priorities for RTW after traumatic injury and highlight barriers... more
Introduction Following traumatic injury, occupational therapists (OTs) are pivotal in supporting people to return-to-work (RTW) and regain independence. Aim: to identify priorities for RTW after traumatic injury and highlight barriers hindering the process. Method We recruited 17 participants with direct (i.e. trauma survivor [ n = 11]; OT trauma survivor [ n = 2]) or indirect (i.e. OT [ n = 4]) experience of returning to work following traumatic injury. Online consultations, lasting 60 min, were guided by a semi-structured script ensuring relevant topics were covered. An inductive approach was used for coding themes using thematic analysis. Findings Sense of purpose, identity and social interaction were greater priorities for RTW, than financial stability. Major barriers were: pain and fatigue; adapting to physical changes; impacts on mental health; and lack of support (healthcare and the workplace). Participants (public and healthcare professionals) reported a lack of vocational r...
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<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g002" target="_blank">Fig. 2A</a>. A segment of the daily PKG record from a person with ICB, showing... more
<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g002" target="_blank">Fig. 2A</a>. A segment of the daily PKG record from a person with ICB, showing expected responses (tan diamonds) and unexpected responses (red diamonds). Note that in this example, the 2 minute dyskinesia scores are mostly high. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g002" target="_blank">Fig. 2B</a>. A segment of the daily PKG record from a person without ICB, showing expected responses (tan diamonds) and unexpected responses (red diamonds). Note that in this example, the 2 minute dyskinesia scores are below the median for controls. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g002" target="_blank">Fig. 2C</a>. Histograms of the median dyskinesia score in the 30 minutes either side of expected (tan bars) and unexpected (red bars) response in the High RR group, the False Negative Group and in low RR Group. The histogram bars represent the median and 75<sup>th</sup> percentile values for the subjects in each group. The median dyskinesia score in control (i.e. non PD) subjects is shown as a dotted line. Note that median dyskinesia scores of both expected and unexpected responses in the False Negative Group and the low RR subjects were below the median of controls. On the other hand, while the dyskinesia scores associated with expected responses in the correlated group were high, they were significantly higher still in the period surrounding unexpected responses. The P values associated with expected and unexpected response is shown.</p
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<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g001" target="_blank">Fig. 1A</a>. Example of the output from one day of PKG recording from a patient who... more
<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g001" target="_blank">Fig. 1A</a>. Example of the output from one day of PKG recording from a patient who was prescribed 6 doses of levodopa/day. The green and blue dots represent the dyskinesia and bradykinesia (respectively) score, which was calculated every 2 minutes, with greater severity represented by increasing distance from the middle of the graph. The horizontal lines are the medians, 75<sup>th</sup> percentile and 90<sup>th</sup> percentiles of controls. The red vertical lines are when medications were prescribed and the diamonds are when the taking of medication was acknowledged. This subject provided a second acknowledgment to the 6:00 am dose shortly after the first acknowledgement (circle), thus providing 7 acknowledgments for 6 doses. The response ratio (RR) for this patient was 116% (7/6). <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g001" target="_blank">Fig. 1B</a>. This subject was prescribed 7 doses/day but provided 35 acknowledgements. Note that this subject had many more dyskinesia scores at higher levels with many at the upper levels of the graph (e.g. 10:00 am to 11:00 am). The response ratio (RR) for this patient was 500% (35/7). <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0089319#pone-0089319-g001" target="_blank">Fig. 1C</a>: A plot of the QUIP score (y axis) plotted against the RR (X axis). Two groups are apparent: False Negatives (blue dots: n = 6), and a Correlated Group (Red dots: n = 19). The grey shaded area represents people whose RR was less than 137% and whose ICB score was 7.</p
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Background: There is currently a scarcity of research addressing the long-term impact of TIA and minor stroke, despite evidence that people experience physical, emotional and social difficulties that affect their quality of life [ref:1],... more
Background: There is currently a scarcity of research addressing the long-term impact of TIA and minor stroke, despite evidence that people experience physical, emotional and social difficulties that affect their quality of life [ref:1], [ref:2]. Currently management of TIA focusses[for full text, please go to the a.m. URL]
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Over one million people live with the long-term consequences of acquired brain injury (ABI). Individuals with ABI may find it difficult to self-manage the effects of injury and it is important to provide them with the skills to live... more
Over one million people live with the long-term consequences of acquired brain injury (ABI). Individuals with ABI may find it difficult to self-manage the effects of injury and it is important to provide them with the skills to live independently. Many smart technologies exist to aid rehabilitation, but there is limited technology available to support self-management. Brain-in-Hand (BiH) is a smartphone application that was specifically engineered to support the management of persistent emotional and behavioural problems, which are commonly seen following ABI. However, it has not been systematically evaluated in this population. The aim of this thesis was to understand the perspectives and experiences of people with ABI and healthcare professionals after using BiH. A systematic review was conducted to highlight the level of evidence available for smart technologies in the ABI population, and determine the effectiveness of technologies compared to usual care/other technologies on ind...
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Excessive daytime sleepiness (EDS) is common in Parkinson's Disease (PD). Actigraphy uses periods of immobility as surrogate markers of nighttime sleep but there are no examples of its use in assessing EDS of PD. A commercial wrist... more
Excessive daytime sleepiness (EDS) is common in Parkinson's Disease (PD). Actigraphy uses periods of immobility as surrogate markers of nighttime sleep but there are no examples of its use in assessing EDS of PD. A commercial wrist worn system for measuring bradykinesia and dyskinesia also detects 2 min periods of immobility, which have a 85.2% concordance with the detection of sleep by ambulatory daytime polysomnography, (p < 0.0001 Chi Squared). High Epworth Sleepiness Scores (ESS) were associated with a proportion of time immobile (PTI) (p = 0.01 Mann-Whitney U). The median PTI between 0900 and 1800 h w in 30 age matched control subjects was 2%, representing 10 min and PTI at or above the 75th percentile (5% or 27 min) was taken as a high level. PD patients had higher PTI (median 4.8%) than controls (p < 0.0001, Mann-Whitney U). PD subjects with a high PTI had more bradykinesia, less dyskinesia and higher PDQ39 scores than those with low PTI. There was no relationship b...
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Objective Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to... more
Objective Injuries can have a long-lasting effect on ability to return to work, but there is little research on which outcomes are most important to patients. This study aims to identify and prioritise return-to-work outcomes important to patients for evaluating vocational rehabilitation interventions. Methods Nominal group technique focus group with trauma patients. Results Focus group participants ( n = 6) included mostly traumatic brain injuries, a range of occupation types, ages and both genders. Participants identified and prioritised their eight most important outcomes which were: sense of purpose and life satisfaction, understanding the impact of injury, assessment of readiness to return to work, using SMART (specific, measurable, achievable, relevant and time-bound) goals, facilitated reintegration to work, assessing capacity to return to work, collaboration between key stakeholders and improved employer and employee knowledge. Many of these were measures of the process of, ...
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Supplemental material, Supplemental_Material for A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries by Jade Kettlewell, Roshan das Nair and Kate Radford in Clinical... more
Supplemental material, Supplemental_Material for A systematic review of personal smart technologies used to improve outcomes in adults with acquired brain injuries by Jade Kettlewell, Roshan das Nair and Kate Radford in Clinical Rehabilitation
Background: Cognitive, emotional and behavioural problems resulting from acquired brain injury (ABI) limit independence, restrict participation and pose a challenge for rehabilitation. Smart technologies to support independence are... more
Background: Cognitive, emotional and behavioural problems resulting from acquired brain injury (ABI) limit independence, restrict participation and pose a challenge for rehabilitation. Smart technologies to support independence are limited [ref:1]. Brain-in-Hand (BiH) is a smartphone app designed[for full text, please go to the a.m. URL]
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Background: Over one million people live with the long-term consequences of acquired brain injury (ABI). Many smart technologies exist to aid rehabilitation, but technology to support self-management is limited. Brain-in-Hand (BiH) is a... more
Background: Over one million people live with the long-term consequences of acquired brain injury (ABI). Many smart technologies exist to aid rehabilitation, but technology to support self-management is limited. Brain-in-Hand (BiH) is a smartphone app designed to support psychological problems and encourage[for full text, please go to the a.m. URL]
Engagement activity questionnaire for ABI survivors and carers. (DOCX 88Â kb)
Engagement activity questionnaire for professionals. (DOCX 62Â kb)
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Objective: To identify where and how trauma survivors’ rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. Design: Qualitative study (interviews,... more
Objective: To identify where and how trauma survivors’ rehabilitation needs are met after trauma, to map rehabilitation across five UK major trauma networks, and to compare with recommended pathways. Design: Qualitative study (interviews, focus groups, workshops) using soft-systems methodology to map usual care across trauma networks and explore service gaps. Publicly available documents were consulted. CATWOE (Customers, Actors, Transformation, Worldview, Owners, Environment) was used as an analytic framework to explore the relationship between stakeholders in the pathway. Setting: Five major trauma networks across the UK. Subjects: 106 key rehabilitation stakeholders (service providers, trauma survivors) were recruited to interviews ( n = 46), focus groups ( n = 4 groups, 17 participants) and workshops ( n = 5 workshops, 43 participants). Interventions: None. Results: Mapping of rehabilitation pathways identified several issues: (1) lack of vocational/psychological support particu...
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Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists... more
Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); be...
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Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work... more
Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 ...
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Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work... more
Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 ...
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Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to... more
Returning to work after traumatic injury can have a range of benefits, but there is currently little research that incorporates patient perspectives to identify outcomes of vocational rehabilitation interventions that are important to survivors. Trauma survivors (n = 17) participated in in-depth semi-structured interviews or focus groups exploring outcomes that were important to them for recovery and return to work. Data were analysed using thematic analysis. Participants identified a range of outcomes that they considered important and necessary to facilitate a successful and sustainable return to work: physical and psychological recovery, purposeful life engagement, managing expectations of recovery, managing expectations about return to work, and employers’ expectations. Our participants advocated for a multifaceted and biopsychosocial understanding of recovery and outcomes that need to be captured for vocational rehabilitation interventions. Implications for practice and researc...
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Objective: This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury. Data sources: A systematic literature search was conducted on 30 May 2019. Twelve electronic... more
Objective: This review aimed to determine the effectiveness of personal smart technologies on outcomes in adults with acquired brain injury. Data sources: A systematic literature search was conducted on 30 May 2019. Twelve electronic databases, grey literature databases, PROSPERO, reference list and author citations were searched. Methods: Randomised controlled trials were included if personal smart technology was used to improve independence, goal attainment/function, fatigue or quality of life in adults with acquired brain injury. Data were extracted using a bespoke form and the TIDieR checklist. Studies were graded using the PEDro scale to assess quality of reporting. Meta-analysis was conducted across four studies. Results: Six studies met the inclusion criteria, generating a total of 244 participants. All studies were of high quality (PEDro ⩾ 6). Interventions included personal digital assistant, smartphone app, mobile phone messaging, Neuropage and an iPad. Reporting of interv...
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Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to... more
Brain in Hand is a smartphone application (app) that allows users to create structured diaries with problems and solutions, attach reminders, record task completion and has a symptom monitoring system. Brain in Hand was designed to support people with psychological problems, and encourage behaviour monitoring and change. The aim of this paper is to describe the process of exploring the barriers and enablers for the uptake and use of Brain in Hand in clinical practice, identify potential adaptations of the app for use with people with acquired brain injury (ABI), and determine whether the behaviour change wheel can be used as a model for engagement. We identified stakeholders: ABI survivors and carers, National Health Service and private healthcare professionals, and engaged with them via focus groups, conference presentations, small group discussions, and through questionnaires. The results were evaluated using the behaviour change wheel and descriptive statistics of questionnaire r...