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International Journal of Stroke ; 18(1 Supplement):57, 2023.
Article in English | EMBASE | ID: covidwho-2271208


Introduction: The Queen Square Upper Limb (QSUL) Programme is a clinical service offering high dosage and intense rehabilitation to individuals with upper limb impairment following neurological injury. In response to COVID-19 pandemic, the QSUL Programme was adapted to a predominantly virtual service. The virtual programme consists of 1:1 Physiotherapy, Occupational Therapy and Rehabilitation Assistant sessions, groups, and independent practice. Patients engaged in an average of 83 hours of rehabilitation over four weeks including two face-to-face appointments for assessment. Here, we explore the perspectives of stroke survivors, carers and staff involved in the virtual QSUL programme. Method(s): Descriptive qualitative design using a conventional thematic content approach to analyse the data. Stroke survivors and caregivers who participated in the virtual upper limb programme and staff involved in service delivery were purposively sampled. Six focus groups were conducted with semi-structured interviews: four with stroke survivors (n=16) and carers(n=2) and two with staff (n=12). Result(s): Themes from stroke survivors and carers include (i) intensity and structured nature of the programme, (ii) value of goal directed and meaningful rehabilitation, (iii) camaraderie and shared experience gained from group interactions, (iv) importance of knowledgeable and empowering staff who could effectively deliver virtual therapy and (v) virtual rehabilitation was a 'good compromise' for face-to-face therapy. Conclusion(s): Stroke survivors and carers found the virtual upper limb programme to be intensive, individualised, and motivational. All groups identified positive and negative factors to virtual rehabilitation. Ongoing thematic analysis continues for staff focus groups.

Journal of Sleep Research Conference: 26th Conference of the European Sleep Research Society Athens Greece ; 31(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2114244


Introduction: High non-adherence rates to CPAP remain a major obstacle to good outcomes in OSA. In trials, 29%-83% of patients do not adhere to CPAP. CPAP adherence in clinical practice, and the effect of clinical pathways and interventions, remain unknown because of incomplete datasets and use of non-clinically relevant criteria for adherence in previous studies. Patients are reported to become adherent or non-adherent to CPAP from treatment onset, forming the basis of current clinical practice, but the studies have been small. We addressed these evidence gaps using a large, UK multicentre clinical dataset, using changes to sleep centres' treatment pathways during the COVID-19 pandemic as a natural experiment. Method(s): Five sleep centres that telemonitored patient data in 2019 and 2020 were recruited. Using a 18% difference in CPAP adherence between years (Philips Respironics data), 80% power, alpha < 0.05, n = 92 was required. Objective CPAP-usage data over the first three months of treatment was collected from 100 patients who started CPAP prepandemic (April 2019) and 100 patients post-start of pandemic (September 2020), per centre. CPAP adherence criteria: Mean CPAP use >=4 h/night for >=70% of nights (for Night 1-3 period, median CPAP use used, as data non-normally distributed). Growth mixture modelling (GMM) and logistic regression were performed using all centres' data (1000 patients). Result(s): Three months after treatment started, only 34% of patients were treatment-adherent in 2019 and 42% in 2020 (p = 0.24). GMM identified six distinct, CPAP-usage behaviours over the first month, each with a different likelihood of CPAP non-adherence at three months. Four behaviours consisted of changing (increasing or decreasing) CPAP use (54% of patients), two behaviours consisted of consistent good or no use (remaining 46%). Treatment pathway determined prevalence of behaviours and CPAP adherence at three months;OSA severity was a weaker determinant of CPAP adherence at three months. Conclusion(s): CPAP use at treatment onset does not predict long-term adherence in most patients. This can explain why current practice is ineffective, and may even be detrimental, as the changing users are inappropriately managed as consistent users . Our data supports precision medicine tailored to specific behaviour from Week 2 of treatment.

Journal of Cystic Fibrosis ; 21:S47, 2022.
Article in English | EMBASE | ID: covidwho-1996758


Objectives: COVID-19 has limited in-person networking opportunities worldwide. To address this, we formed a collaboration of representatives from Australia’s Inc, the UK’s Association of Chartered Physiotherapists in Cystic Fibrosis (CF) and US specialist CF physical therapists (PT) with the objective of creating a virtual international discussion forum. To ensure wider interest, views were gathered from international CF colleagues via a self-designed online survey. Here we present survey results and planned outcomes. Methods: Survey topics included respondent demographics;professional development and research priorities;and future forum interest. The online survey circulated between Oct-Dec 2021 via social media channels, established networks and targeted emails to international physio and PT groups. Results: Eighty-four people responded - 94% physio/PTs;74% hospitalbased;equal split between paediatrics and adults;30% currently researchactive. 100% of respondents were interested in attending virtual discussion forums, with 73% keen to plan sessions. The top 3 professional development and research priorities are described in the table. (Table Presented) Conclusions: Results indicate international CF PT/physio interest in a virtual discussion forum. In response to this interest, we developed our vision "To create a virtual space for clinicians and researchers across the globe, working in CF, to learn and to collaborate and deliver on innovative and robust research into the future." Quarterly virtual discussion forums start in Spring 2022, hosted and promoted by (a global exercise and education platform for people with CF and their clinicians). Sessions address the top professional development priorities identified from survey results and aim to facilitate discussions between colleagues to enhance clinical practice and forge future research collaborations.

British Journal of Surgery ; 108:1, 2021.
Article in English | Web of Science | ID: covidwho-1535588