Papers by Esme Worthington
Clinical Rehabilitation, Jan 13, 2015
Review methods: We included: randomised controlled trials, non-randomised controlled trials and c... more Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed 're-ablement' or 'restorative homecare' (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. Conclusion: There is limited evidence that interventions targeted at personal ADL can reduce homecare service users' dependency with activities, the content of evaluated interventions varies greatly.
BMC Medical Education
Training to enhance healthcare practitioners’ capabilities in engaging people in sensitive and en... more Training to enhance healthcare practitioners’ capabilities in engaging people in sensitive and end-of life-related conversations is in demand. However, evaluations have either not measured, or found very limited impact on actual practice and patient experience. Training effectiveness is improved when it is based on in-depth evidence, reflects the complexity of real-life interactions, and instils principles adaptable to everyday practice. A relatively new source of in-depth evidence and practice-relevant insights on healthcare interactions is conversation analytic research, a form of observational analysis of real-life interactions. However, conversation analytic research findings have largely been disseminated by and for scientists, rather than clinicians and trainers. We used conversation analytic evidence to develop resources for use by healthcare trainers. The aim was to increase training’s evidence-base and authenticity. We further aimed to develop resources applicable to workin...
The Cochrane database of systematic reviews, 2016
BACKGROUND Memory problems are a common cognitive complaint following stroke and can potentially ... more BACKGROUND Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007. OBJECTIVES To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered the immediate and long-term outcomes of memo...
BACKGROUNDCommunication skills training for professionals caring for people with life-limiting co... more BACKGROUNDCommunication skills training for professionals caring for people with life-limiting conditions is in demand. Evidence shows that transfer of skills into practice is limited. Training can be improved by building on in-depth evidence and reflecting the complexity of actual interactions. Scientific advances from direct observational ‘conversation analytic’ studies of conversations in healthcare and beyond provide this evidence, but the linguistic complexities are often inaccessible to clinical trainers. We address this dilemma via a novel training initiative, ‘RealTalk’, designed to support trainers by increasing the authenticity and evidence base of end-of-life communication training for health and social care staff and trainees.METHODSWe conducted a development study to create a communication intervention for testing. In collaboration with stakeholders, we identified the rationale for the content and mode of delivery, converted research findings into an applied interventio...
Background/Aims: Post-stroke fatigue is common and impacts on patient outcomes. Our aim was to in... more Background/Aims: Post-stroke fatigue is common and impacts on patient outcomes. Our aim was to investigate day-to-day experiences of fatigue six months after stroke. Methods: Participants were identified from a cohort study of fatigue (NotFAST) which excluded those with depression and aphasia. Participants who reported high fatigue scores at six months post-stroke were interviewed individually. Data were analysed thematically. Findings: Twenty-two participants were interviewed. Fatigue was reported to impact on instrumental activities of daily living, leisure activities, social relationships and work life. Variations in fatigue were reported throughout the day and over the longer term. Triggers included physical and mental exertion, and periods of inactivity. Self-devised management strategies included daytime rest or sleep, pacing activities, making compromises, accepting help from others, and keeping active. It was sometimes unclear whether fatigue was a specific result of stroke ...
Background: Musculoskeletal conditions are a common cause of sickness absence and work disability... more Background: Musculoskeletal conditions are a common cause of sickness absence and work disability. Occupational therapists regularly treat patients with these conditions but little is known about the work-related advice and support they provide to patients and their employers. Method: A postal questionnaire survey was conducted of UK occupational therapists who treat employed patients with musculoskeletal conditions in community/outpatient settings. Questions included the provision of work-related advice and support, the interventions used and communication with employers. Questionnaires were posted to 960 hospitals/units identified through NHS websites to reach as many respondents as possible; the survey was available on-line. Results/findings: Two hundred and seventy-nine questionnaires were analysed and 257 respondents reported on their provision of work-related advice and support. Over 30% reported that this involved a moderate amount of their time. One hundred and fifty-four re...
Objective. To identify factors associated with post-stroke fatigue in a sample of stroke survivor... more Objective. To identify factors associated with post-stroke fatigue in a sample of stroke survivors without depression. Design. Cross-sectional cohort study. Setting. Recruitment was from four stroke units in the UK. Subjects. Participants were assessed within four weeks of first stroke; those with high levels of depressive symptoms (score ≥7 Brief Assessment Schedule Depression Cards) were excluded. Main measures. Participants were assessed four to six weeks after stroke on the Fatigue Severity Subscale of the Fatigue Assessment Inventory, the Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Beck Anxiety Index, Sleep Hygiene Index, 6m walk test, and measures of cognitive ability. Results. Of the 371 participants recruited, 103 were excluded and 268 were assessed. Of the latter, the mean age was 67.7 years (SD 13.5) and 168 (63%) were men. The National Institutes of Health Stroke Scale mean score was 4.96 (SD 4.12). Post-stroke fatigue was reported by 115 (43%) of participants, with 71 (62%) reporting this to be a new symptom since their stroke. Multivariate analysis using the Fatigue Severity Scale as the outcome variable found prestroke fatigue, having a spouse/partner, lower Rivermead Mobility Index score, NotFAST final paper 3 and higher scores on both the Brief Assessment Schedule Depression Cards and Beck Anxiety Index were independently associated with post-stroke fatigue, accounting for approximately 47% of the variance in Fatigue Severity Scale scores. Conclusions. Pre-stroke fatigue, lower mood, and poorer mobility were associated with post-stroke fatigue.
British Journal of Occupational Therapy, Jan 9, 2018
Introduction: Virtual reality has the potential to assist occupational therapists in preparing pa... more Introduction: Virtual reality has the potential to assist occupational therapists in preparing patients for discharge by facilitating discussions and providing education about relevant practical issues and safety concerns. This study aimed to explore the feasibility of using a virtual reality intervention to support patient discharge after stroke and pilot its use. Method: Practical aspects of delivering a virtual reality intervention prior to discharge were explored by means of a non-randomised feasibility study and a subsequent pilot randomised controlled trial. Factors considered included eligibility, recruitment, intervention delivery, attrition, and suitability of outcome measures. Outcome measures included standardised assessments of stroke severity, mobility, health-related quality of life, functional ability, satisfaction with services, and concerns about falling. Results: Thirty-three participants were recruited in total: 17 to the feasibility study and 16 to the pilot trial. At one-month follow-up, 14 participants (82%) were reassessed in the feasibility and 12 (75%) in the pilot. The main difficulties encountered related to recruitment, particularly regarding post-stroke cognitive impairments, the presence of mild deficits, or illness. Conclusion: It was feasible to recruit and retain participants, deliver the intervention and collect outcome measures, despite slow recruitment rates. These findings could inform the design of a definitive trial.
International Journal of Therapy and Rehabilitation, 2015
Objectives: To identify interventions that aim to reduce dependency in activities of daily living... more Objectives: To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed ‘re-ablement’ or ‘restorative homecare’ (n=5/13); and those involving separate components which were...
International Journal of Therapy and Rehabilitation
British Journal of Occupational Therapy
Introduction: The level of assessment and intervention received by patients prior to discharge va... more Introduction: The level of assessment and intervention received by patients prior to discharge varies widely across stroke services in the United Kingdom. This study aimed to explore the potential value of virtual reality in preparing patients for discharge following stroke. Method: Semi-structured interviews were carried out with 13 occupational therapists, eight patients with a stroke and four community stroke survivors. Views were sought of the perceived acceptability, potential utility and limitations of a 'virtual home' environment for use in pre-discharge education and assessment. Data were analysed thematically. Findings: Interviewees found the virtual home to be an acceptable and visual means of facilitating discussions about discharge. It was perceived as valuable in assessing patient insight into safety risks and exploring the implications of installing assistive equipment at home. Limitations were identified relating to specific software issues and the use of virtual reality with patients with cognitive or perceptual impairments. Conclusion: The results demonstrate the potential utility of the virtual home within stroke rehabilitation. Patients and therapists engaged with the virtual home and, moreover, made practical suggestions for future development. Feasibility and pilot testing in a clinical setting is required to compare the use of the virtual home with traditional approaches of pre-discharge assessment.
Clinical Rehabilitation
Objective: To identify factors associated with post-stroke fatigue in a sample of stroke survivor... more Objective: To identify factors associated with post-stroke fatigue in a sample of stroke survivors without depression. Design: Cross-sectional cohort study. Setting: Recruitment was from four stroke units in the UK. Subjects: Participants were assessed within four to six weeks of first stroke; those with high levels of depressive symptoms (score ⩾7 Brief Assessment Schedule Depression Cards) were excluded. Main measures: Participants were assessed after stroke on the Fatigue Severity Scale of the Fatigue Assessment Inventory, the Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Beck Anxiety Index, Sleep Hygiene Index, 6m walk test, and measures of cognitive ability. Results: Of the 371 participants recruited, 103 were excluded and 268 were assessed. Of the latter, the mean age was 67.7 years (SD 13.5) and 168 (63%) were men. The National Institutes of Health Stroke Scale mean score was 4.96 (SD 4.12). Post-stroke fatigue was reported by 115 (43%) of pa...
Topics in Stroke Rehabilitation
Background: Post-stroke fatigue is common and disabling. Objectives: The aim of NotFAST was to ex... more Background: Post-stroke fatigue is common and disabling. Objectives: The aim of NotFAST was to examine factors associated with fatigue in stroke survivors without depression, six months after stroke. Methods: Participants were recruited from four UK stroke units. Those with high levels of depressive symptoms (score ≥7 on Brief Assessment Schedule Depression Cards) or aphasia were excluded. Follow-up assessment was conducted at six months after stroke. They were assessed on the Fatigue Severity Scale, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Barthel Index, Beck Anxiety Index, Brief Assessment Schedule Depression Cards, Impact of Event Scale-Revised, and Sleep Hygiene Index. Results: Of the 371 participants recruited, 263 (71%) were contacted at six months after stroke and 213 (57%) returned questionnaires. Approximately half (n=109, 51%) reported fatigue at six months. Of those reporting fatigue initially (n=88), 61 (69%) continued to report fatigue. De novo fatigue was reported by 48 (38%) of those not fatigued initially. Lower Nottingham Extended Activities of Daily Living scores and higher Beck Anxiety Index scores were independently associated with fatigue at six months. Conclusions: Half the stroke survivors reported fatigue at six months post-stroke. Reduced independence in activities of daily living and higher anxiety levels were associated with the level of fatigue. Persistent and delayed onset fatigue may affect independence and participation in rehabilitation, and these findings should be used to inform the development of appropriate interventions.
Reviews, 2016
Memory problems are a common cognitive complaint following stroke and can potentially affect abil... more Memory problems are a common cognitive complaint following stroke and can potentially affect ability to complete functional activities. Cognitive rehabilitation programmes either attempt to retrain lost or poor memory functions, or teach patients strategies to cope with them.Some studies have reported positive results of cognitive rehabilitation for memory problems, but the results obtained from previous systematic reviews have been less positive and they have reported inconclusive evidence. This is an update of a Cochrane review first published in 2000 and most recently updated in 2007. To determine whether participants who have received cognitive rehabilitation for memory problems following a stroke have better outcomes than those given no treatment or a placebo control.The outcomes of interest were subjective and objective assessments of memory function, functional ability, mood, and quality of life. We considered the immediate and long-term outcomes of memory rehabilitation. We used a comprehensive electronic search strategy to identify controlled studies indexed in the Cochrane Stroke Group Trials Register (last searched 19 May 2016) and in the Cochrane Central Register of Controlled Trials (CENTRAL2016, Issue 5), MEDLINE (2005 to 7 March 2016), EMBASE 2005 to 7 March 2016), CINAHL (2005 to 5 February 2016), AMED (2005 to 7 March 2016), PsycINFO (2005 to 7 March 2016), and nine other databases and registries. Start dates for the electronic databases coincided with the last search for the previous review. We handsearched reference lists of primary studies meeting the inclusion criteria and review articles to identify further eligible studies. We selected randomised controlled trials in which cognitive rehabilitation for memory problems was compared to a control condition. We included studies where more than 75% of the participants had experienced a stroke, or if separate data were available from those with stroke in mixed aetiology studies. Two review authors independently selected trials for inclusion, which was then confirmed through group discussion. We assessed study risk of bias and extracted data. We contacted the investigators of primary studies for further information where required. We conducted data analysis and synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We performed a 'best evidence' synthesis based on the risk of bias of the primary studies included. Where there were sufficient numbers of similar outcomes, we calculated and reported standardised mean differences (SMD) using meta-analysis. We included 13 trials involving 514 participants. There was a significant effect of treatment on subjective reports of memory in the short term (standard mean difference (SMD) 0.36, 95% confidence interval (CI) 0.08 to 0.64, P = 0.01, moderate quality of evidence), but not the long term (SMD 0.31, 95% CI -0.02 to 0.64, P = 0.06, low quality of evidence). The SMD for the subjective reports of memory had small to moderate effect sizes.The results do not show any significant effect of memory rehabilitation on performance in objective memory tests, mood, functional abilities, or quality of life.No information was available on adverse events. Participants who received cognitive rehabilitation for memory problems following a stroke reported benefits from the intervention on subjective measures of memory in the short term (i.e. the first assessment point after the intervention, which was a minimum of four weeks). This effect was not, however, observed in the longer term (i.e. the second assessment point after the intervention, which was a minimum of three months). There was, therefore, limited evidence to support or refute the effectiveness of memory rehabilitation. The evidence was limited due to the poor quality of reporting in many studies, lack of consistency in the choice of outcome measures, and small sample sizes. There is a need for more robust, well-designed, adequately powered, and better-reported trials of memory rehabilitation using common standardised outcome measures.
Family Practice, 2015
Background. GPs can use the fit note to advise that a patient 'may be fit' or is 'not fit' for wo... more Background. GPs can use the fit note to advise that a patient 'may be fit' or is 'not fit' for work. Previous employer-based research on the fit note is largely qualitative and based on general perceptions and past experience. Knowledge of the return-to-work outcomes and usefulness of actual fit notes is needed to strengthen the evidence-base and inform practice. Objective. To investigate the return-to-work outcomes of fit notes issued to employed patients, and their employers' opinions as to the usefulness of each note. Methods. Participating organizations collecting fit notes were asked to rate the outcome and usefulness of each fit note via postal questionnaires. Quantitative data were analysed descriptively; qualitative data were analysed using thematic content analysis. Results. Five hundred and sixteen questionnaires were posted, with a 97% return rate (n = 498). More than 80% of employees (n = 44) returned to work after the expiry date of a 'may be fit' note compared with 43% (n = 167) of those issued with a 'not fit' note. Fit notes were considered more useful if they provided information on the condition and its effect on the employee's ability to work, if they stated whether or not the employee needed reassessment and if clear advice regarding return-to-work had been provided. Conclusions. 'May be fit' notes are useful in helping employees return to work. However, this option is infrequently used, and the completion and content of many fit notes does not meet employers' needs. These factors need to be urgently addressed if the fit note is to reach its full potential.
British Journal of Neuroscience Nursing, 2007
Journal of Transport & Health, 2015
Clinical Psychology Forum
The management of mood problems after stroke was audited for 140 patients across 10 services. Mos... more The management of mood problems after stroke was audited for 140 patients across 10 services. Most patients were screened using clinical interviews. The most common outcomes of assessment were monitoring and advice. Only 42% received psychological treatment.
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Papers by Esme Worthington