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WORK PACKAGE 2
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  1. WORK PACKAGE 2 Sybil Farmer VenugopalDurairaj AnandPandyan September 2010

  2. Where are the Gaps? A framework for development and evaluation of RCTs for complex interventions to improve health MRC 2000

  3. WP2 Activity Completion of van Tulder Scoring Meeting re Data Extraction

  4. Data Extraction Form • Ref Works ID • Form number • Treatment Regime • Duration = of course of tx—number FT and unit drop down • Session duration • Session frequency • Joint (listed)—yes /no • Technology --select from drop down list • TX Comparisons • AT/AT, • Routine TX/AT, • NoTx/AT, • Sham/AT, other • Time from end of Tx to last assessment • Time after Stroke • Under 1 month • 1-6 months ( inclusive of month 6) • Over 6 months • Other • Odds ratio data • Effect size data • Study design

  5. Effect Size 'Effect size' is simply a way of quantifying the size of the difference between two groups. Odds Ratio Compares the proportion of those who benefitted from treatment with the proportion of those in the control group who improved

  6. WP2 Activity • Completion of van Tulder Scoring • Meeting re Data Extraction • Webform designed • Level 4 & 3 papers allocated • Data Extracted • Meeting re Extracted Data

  7. Study Designs

  8. Selecting Papers Gold Standard Van Tulder Questions • Randomisation • Similar Prognosis • Assessor Blinded

  9. High Quality Papers

  10. Papers with Extractable Data

  11. Joints Treated and ATs

  12. Outcome Measures • Fugl Myer • ARAT • WMFT • FIM • BPI • Ashworth • Bartel • 9 Hole Peg Test • MAL • Stroke Impact Score • Jebson Taylor Hand Function • Force • Distance • ROM • Active • Passive • Movement Time • Repetition • Drawing • Tracking

  13. Outcome Measure, Maximum Effect Size and ATs

  14. Where are the Gaps? A framework for development and evaluation of RCTs for complex interventions to improve health MRC 2000

  15. Timing of Intervention Over 6 months ----- mean range 15 -98 months

  16. WP2 Activity • Completion of van Tulder Scoring • Meeting re Data Extraction • Webform designed • Level 4 & 3 papers allocated • Data Extracted • Meeting re Extracted Data • Papers Cross-checked with Cochrane Reviews

  17. Cochrane Reviews Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke Electrostimulation for promoting recovery of movement or functional ability after stroke Electrical stimulation for preventing and treating post-stroke shoulder pain Supportive devices for preventing and treating subluxation of the shoulder after stroke Constraint-induced movement therapy for upper extremities in stroke patients EMG biofeedback for the recovery of motor function after stroke Interventions for sensory impairment in the upper limb after stroke Orthotic devices after stroke and other non-progressive brain lesions -Withdrawn

  18. Cochrane Reviews

  19. Cochrane Protocols Virtual reality for stroke rehabilitation Botulinum toxin for adult spasticity after stroke or non-progressive brain lesion Home-based therapy programmes for upper limb functional recovery following stroke Hands-on therapy interventions for upper limb motor dysfunction following stroke Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke Mirror therapy for improving motor function after stroke Interventions for maintaining soft tissue length in the stroke –affected shoulder

  20. WP2 Activity • Completion of van Tulder Scoring • Meeting re Data Extraction • Webform designed • Level 4 & 3 papers allocated • Data Extracted • Meeting re Extracted Data • Papers Cross-checked with Cochrane Reviews • Contact with NIHR re development of website

  21. Next Stage • Write up • Systematic Review Method • Refine and Test • Quality Assessment Method • Update • All searches • Contact Cochrane Stroke Team • Further data exploration and Analysis

  22. Further Questions? • Improvement maintained at Follow-up? • How long after 6 Months? More data exploration For Discussion