Clinimetric properties of the Timed Up and Go Test for patients with stroke: a systematic review.

OBJECTIVE: To systematically review and summarize the clinimetric properties, including reliability, validity, and responsiveness, the procedures used, and the meanings of the scores in the Timed Up and Go Test (TUG). The TUG is a performance test that identifies problems with functional mobility in patients with stroke. METHODS: MEDLINE and the Cochrane Central Register of Controlled Trials were searched from 1991 to January 2013. Studies were included if (1) the participants were adults with stroke; (2) the research design was cross-sectional, descriptive, or longitudinal and examined the clinimetric properties, including reliability, validity, and sensitivity to change, and procedural differences in the TUG; and (3) the study was published in English from 1991 to January 2013. RESULTS: Thirteen studies met the inclusion criteria. Of these, 4 showed the TUG to have good convergent validity, as it had significant correlations with various instruments. Three studies that investigated the test-retest reliability showed the TUG to have excellent intrarater and interrater reliability (intraclass correlation coefficient [ICC] ≯ 0.95). The 3 studies that investigated whether the TUG could predict falls after stroke showed inconclusive results. Three studies showed the TUG to be sensitive to change, and 1 study showed the TUG to be responsive in moderate- and fast-walking patients with stroke. However, there were wide variations in the procedures and instructions used. CONCLUSION: The TUG can be recommended for measuring basic mobility skills after stroke in patients who are able to walk. However, the procedures and instructions should be described more clearly.

Feasibility of a nursing rehabilitation guideline for patients with stroke: evaluating the use by nurses.

PURPOSE: To determine the feasibility of the Clinical Nursing Rehabilitation Stroke-guideline (CNRS-guideline) in the care of stroke patients in terms of the experiences, views and attitudes of nurses towards the guideline and their adoption of the guideline and how often the recommendations were used. METHOD: A four phase cross sectional design was used. Demographic data were collected from nurses (n=30) and patients (n=105). After each test phase the nurses received questionnaires about their experiences of the guideline including questions about their attitude towards the guideline and adoption of the guideline. Also, how often the recommendations were used was registered. RESULTS: The nurses' general impression of the recommendations scored a median of 6.0. A majority of the nurses indicated that the aims of the guideline were clear, that it provided new insights into stroke care. Among the challenges experienced were lack of knowledge and skills and organizational difficulties. Half of the nurses adopted the guideline and the nurses' attitude towards the guideline scored a median of 6.0. CONCLUSION: The guideline provides nurses with an important means for evidence based care for patients with stroke. The guideline was feasible for nurses to use but various challenges need ongoing attention when planning implementation. IMPLICATIONS FOR REHABILITATION: • The CNRGS-guideline was found to be feasible for nurses to use in the daily care of patients with stroke, but various challenges, need an ongoing attention. • The CNRGS-guideline is an important step in the stimulation of quality improvement and efficiency and may result in better outcome and satisfaction of patients with stroke. • The CNRGS-guideline provides nurses with an important means to provide evidence based care for patients with stroke.

Task-oriented training in rehabilitation after stroke: systematic review.

AIM: This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice. BACKGROUND: Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world. The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes. Nurses are therefore exploring other forms of rehabilitation intervention, including task-oriented rehabilitation. Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily nursing practice are lacking. DATA SOURCES: A range of databases was searched to identify papers addressing task-oriented training in stroke rehabilitation, including Medline, CINAHL, Embase and the Cochrane Library of systematic reviews. Papers published in English between January 1996 and September 2007 were included. There were 42 papers in the final dataset, including nine systematic reviews. REVIEW METHODS: The selected randomized controlled trials and systematic reviews were assessed for quality. Important characteristics and outcomes were extracted and summarized. RESULTS: Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life. CONCLUSION: Generally, task-oriented rehabilitation proved to be more effective. Many interventions are feasible for nurses and can be performed in a ward or at home. Nurses can and should play an important role in creating opportunities to practise meaningful functional tasks outside of regular therapy sessions.