Papers by Alex Todhunter-Brown
International Journal of Stroke, 2019
Citation for published version (Harvard): Brady, M, Stott, D, Weir, CJ, Chalmers, C, Sweeney, P, ... more Citation for published version (Harvard): Brady, M, Stott, D, Weir, CJ, Chalmers, C, Sweeney, P, Barr, J, Barr, M, Pollock, A, Gray, H, Bain, B, Colins, M, Keerie, C & Langhorne, P 2019, 'A pragmatic, multi-centred, stepped wedge, cluster randomised controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral health Care intervention pLan compared to usual oral health care in stroke wards (SOCLE II)', International Journal of Stroke.
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Systematic Reviews
Background Stakeholder engagement has become widely accepted as a necessary component of guidelin... more Background Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. Methods This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engage...
Clinical Rehabilitation
Objective: We sought to (1) identify the outcome measures currently used across stroke arm rehabi... more Objective: We sought to (1) identify the outcome measures currently used across stroke arm rehabilitation randomized trials, (2) identify and compare outcomes important to stroke survivors, carers and clinicians and (3) describe where existing research outcome measures capture outcomes that matter the most to stroke survivors, carers and clinicians and where there may be discrepancies. Methods: First, we systematically identified and extracted data on outcome measures used in trials within a Cochrane overview of arm rehabilitation interventions. Second, we conducted 16 focus groups with stroke survivors, carers and clinicians using nominal group technique, supplemented with eight semi-structured interviews, to identify these stakeholders’ most important outcomes following post-stroke arm impairment. Finally, we described the constructs of each outcome measure and indicated where stakeholders’ important outcomes were captured by each measure. Results: We extracted 144 outcome measure...
F1000Research
International government guidance recommends patient and public involvement (PPI) to improve the ... more International government guidance recommends patient and public involvement (PPI) to improve the relevance and quality of research. PPI is defined as research being carried out ‘with’ or ‘by’ patients and members of the public rather than ‘to’, ‘about’ or ‘for’ them (http://www.invo.org.uk/). Patient involvement is different from collecting data from patients as participants. Ethical considerations also differ. PPI is about patients actively contributing through discussion to decisions about research design, acceptability, relevance, conduct and governance from study conception to dissemination. Occasionally patients lead or do research. The research methods of PPI range from informal discussions to partnership research approaches such as action research, co-production and co-learning. This article discusses how researchers can involve patients when they are applying for research funding and considers some opportunities and pitfalls. It reviews research funder requirements, dr...
Journal of advanced nursing, 2017
The aim of this study was to systematically review evidence relating to clinical supervision for ... more The aim of this study was to systematically review evidence relating to clinical supervision for nurses, midwives and allied health professionals. Since 1902 statutory supervision has been a requirement for UK midwives, but this is due to change. Evidence relating to clinical supervision for nurses and allied health professions could inform a new model of clinical supervision for midwives. A systematic review with a contingent design, comprising a broad map of research relating to clinical supervision and two focussed syntheses answering specific review questions. Electronic databases were searched from 2005 - September 2015, limited to English-language peer-reviewed publications. Systematic reviews evaluating the effectiveness of clinical supervision were included in Synthesis 1. Primary research studies including a description of a clinical supervision intervention were included in Synthesis 2. Quality of reviews were judged using a risk of bias tool and review results summarized ...
Systematic Reviews, 2015
, A. (2015). User involvement in a Cochrane systematic review: using structured methods to enhanc... more , A. (2015). User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update.
Neurorehabilitation and Neural Repair, 2013
Introduction. Limited evidence suggests that visual impairments may influence outcome after strok... more Introduction. Limited evidence suggests that visual impairments may influence outcome after stroke. The degree of recovery from these impairments is poorly characterized. Objectives. To describe recovery and to determine whether visual impairments influence functional outcome and quality of life. Methods. We extracted demographic and outcome data from the Virtual International Stroke Trials Archive (VISTA). We examined horizontal eye movement disorders and hemianopia using the Best Gaze and Visual domains of the National Institutes of Health Stroke Scale (NIHSS) and described recovery at 30 and 90 days. Proportional odds modelling was used to examine the association between impairments at baseline, modified Rankin Scale (mRS), and European Quality of Life Score (EQ-5D) at 90 days. Results. Visual impairments were reported in 7,204/11,900 (60.5%) patients at baseline. Complete recovery occurred in 1,398/3,285 (42.6%) and 3,243/7,204 (45.0%) patients by 30 and 90 days respectively. Th...
Neurorehabilitation and Neural Repair. February 2013 vol. 27 no. 2 133-141
Limited evidence suggests that visual impairments may influence outcome after stroke. The degree ... more Limited evidence suggests that visual impairments may influence outcome after stroke. The degree of recovery from these impairments is poorly characterized. To describe recovery and to determine whether visual impairments influence functional outcome and quality of life. We extracted demographic and outcome data from the Virtual International Stroke Trials Archive (VISTA). We examined horizontal eye movement disorders and hemianopia using the Best Gaze and Visual domains of the National Institutes of Health Stroke Scale (NIHSS) and described recovery at 30 and 90 days. Proportional odds modelling was used to examine the association between impairments at baseline, modified Rankin Scale (mRS), and European Quality of Life Score (EQ-5D) at 90 days. Visual impairments were reported in 7,204/11,900 (60.5%) patients at baseline. Complete recovery occurred in 1,398/3,285 (42.6%) and 3,243/7,204 (45.0%) patients by 30 and 90 days respectively. The burden of persistent visual impairment in survivors was 1,135/4,028 (28.2%) at 30 days and 1,915/9,338 (20.5%) at 90 days. Partial gaze palsy (P < .0001; OR = 0.81; 95% CI = 0.74-0.87), forced deviation (P < .0001; OR = 0.48; 95% CI = 0.43-0.53), and complete homonymous hemianopia (P < .0001; OR = 0.67; 95% CI = 0.62-0.73) at baseline were associated with poor mRS at 90 days. The rate of recovery was greater in the first month after stroke, suggesting a potential time frame for interventions. The associations between visual impairments and poor mRS suggest that these impairments should be considered in multidisciplinary assessments and interventions.
Journal of Clinical Epidemiology, 2015
Objectives: One recommended use of the Grading of Recommendations Assessment, Development and Eva... more Objectives: One recommended use of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is supporting quality assessment of evidence of comparisons included within a Cochrane overview of reviews. Within our overview, reviewers found that current GRADE guidance was insufficient to make reliable and consistent judgments. To support our ratings, we developed an algorithm to grade quality of evidence using concrete rules. Methods: Using a pragmatic, exploratory approach, we explored the challenges of applying GRADE levels of evidence and developed an algorithm to applying GRADE levels of evidence in a consistent and transparent approach. Our methods involved application of algorithms and formulas to samples of reviews, expert panel discussion, and iterative refinement and revision. Results: The developed algorithm incorporated four key criteria: number of participants, risk of bias of trials, heterogeneity, and methodological quality of the review. A formula for applying GRADE level of evidence from the number of downgrades assigned by the algorithm was agreed. Conclusion: Our algorithm which assigns GRADE levels of evidence using a set of concrete rules was successfully applied within our Cochrane overview. We propose that this methodological approach has implications for assessment of quality of evidence within future evidence syntheses.
Introduction Upper limb impairment is associated with disability in activities of daily living. T... more Introduction Upper limb impairment is associated with disability in activities of daily living. The use of commercially available gaming consoles (such as Nintendo Wii) are now being introduced to rehabilitation services to address upper limb impairment yet little evidence is available to justify this choice of intervention. Method Mixed methods systematic review of any research evidence relating to the use of commercial gaming. The aim of the review was to investigate the effectiveness of this intervention together with participant and therapist/researcher experiences. Cochrane registers, electronic databases and internet sources were searched supplemented by contacting experts in the field. All adults with upper limb impairment following stroke were included. Results 12 studies were identified including 2 randomised control trials, 1 case control study, 6 cohort studies and 3 case reports. The evidence has demonstrated that the use of commercially available gaming is a feasible, s...
Stroke
C ochrane Overviews aim to provide a succinct overview of reviews relevant to a specific clinical... more C ochrane Overviews aim to provide a succinct overview of reviews relevant to a specific clinical question. We completed the first stroke-related Cochrane Overview synthesizing systematic reviews of interventions to improve upper limb (UL) function after stroke. 1
European Journal of Physical and Rehabilitation Medicine
British Journal of Occupational Therapy
Introduction Visual field loss affects around 20% of stroke survivors, reducing quality of life. ... more Introduction Visual field loss affects around 20% of stroke survivors, reducing quality of life. Eye movement training is a promising rehabilitation method, and several different interventions are used by occupational therapists. This study aimed to explore the feasibility and effects of four eye movement training interventions for stroke survivors with visual field loss. Method A mixed methods study – quantitative n-of-1 with qualitative interviews. The participants were 11 home-dwelling stroke survivors with visual field loss. The interventions used were MyHappyNeuron, NVT, Rainbow Readers and VISIOcoach, delivered in a randomised order. Visual search, reading speed, activities of daily living and quality of life were assessed three times before intervention use, then immediately after each intervention; these were analysed visually. A final semi-structured interview was then analysed using framework methods. Results Evidence of effect was divergent. Quantitatively there was no me...
European Journal of Physical and Rehabilitation Medicine
European Journal of Physical and Rehabilitation Medicine
Altmetric. The overview within our worked example had four key impact goals, each with different ... more Altmetric. The overview within our worked example had four key impact goals, each with different beneficiaries and required actions; this example led to a generic map of potential pathways to impact for other overviews. Conclusions Cochrane overviews have the potential to play a key role in knowledge translation and therefore to be useful in supporting evidence-based rehabilitation practice. However, current overviews relating to rehabilitation differ in methods, approaches and intended impact, and sometimes fall short of promoting easy access to key information for beneficiaries. Future Cochrane overviews should address topics of importance to key beneficiaries and clearly outline potential pathways to impact in order to have a potential beneficial impact on evidence-based rehabilitation and to improve rehabilitation outcomes.
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Papers by Alex Todhunter-Brown