A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness

Journal article


French, Beverley, Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Thomas, Lois H., Forster, A., Langhorne, Peter J., Price, Christopher I.M., Walker, Annette and Watkins, Caroline. (2008). A systematic review of repetitive functional task practice with modelling of resource use, costs and effectiveness. Health Technology Assessment. 12(30), pp. 1 - 140. https://doi.org/10.3310/hta12300
AuthorsFrench, Beverley, Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Thomas, Lois H., Forster, A., Langhorne, Peter J., Price, Christopher I.M., Walker, Annette and Watkins, Caroline
Abstract

Objectives: To determine whether repetitive functional task practice (RFTP) after stroke improves limb-specific or global function or activities of daily living and whether treatment effects are dependent on the amount of practice, or the type or timing of the intervention. Also to provide estimates of the cost-effectiveness of RFTP. Data sources: The main electronic databases were searched from inception to week 4, September 2006. Searches were also carried out on non-English-language databases and for unpublished trials up to May 2006. Review methods: Standard quantitative methods were used to conduct the systematic review. The measures of efficacy of RFTP from the data synthesis were used to inform an economic model. The model used a pre-existing data set and tested the potential impact of RFTP on cost. An incremental cost per quality-adjusted life-year (QALY) gained for RFTP was estimated from the model. Sensitivity analyses around the assumptions made for the model were used to test the robustness of the estimates. Results: Thirty-one trials with 34 intervention-control pairs and 1078 participants were included. Overall, it was found that some forms of RFTP resulted in improvement in global function, and in both arm and lower limb function. Overall standardised mean difference in data suitable for pooling was 0.38 [95% confidence interval (CI) 0.09 to 0.68] for global motor function, 0.24 (95% CI 0.06 to 0.42) for arm function and 0.28 (95% CI 0.05 to 0.51) for functional ambulation. Results suggest that training may be sufficient to have an impact on activities of daily living. Retention effects of training persist for up to 6 months, but whether they persist beyond this is unclear. There was little or no evidence that treatment effects overall were modified by time since stroke or dosage of task practice, but results for upper limb function were modified by type of intervention. The economic modelling suggested that RFTP was cost-effective. Given a threshold for cost-effectiveness of 20,000 pounds per QALY gained, RFTP is cost-effective so long as the net cost per patient is less than 1963 pounds. This result showed some sensitivity to the assumptions made for the model. The cost-effectiveness of RFTP tends to stem from the relatively modest cost associated with this intervention. Conclusions: The evidence suggests that some form of RFTP can be effective in improving lower limb function at any time after stroke, but that the duration of intervention effect is unclear. There is as yet insufficient good-quality evidence to make any firm recommendations for upper limb interventions. If task-specific training is used, adverse effects should be monitored. While the effectiveness of RFTP is relatively modest, this sort of intervention appears to be cost-effective. Owing to the large number of ongoing trials, this review should be updated within 2 years and any future review should include a comparison against alternative treatments. Further research should evaluate RFTP upper limb interventions and in particular constraint-induced movement therapy, address practical ways of delivering RFTP interventions, be directed towards the evaluation of suitable methods to maintain functional gain, and be powered to detect whether RFTP interventions are cost-effective.

Year2008
JournalHealth Technology Assessment
Journal citation12 (30), pp. 1 - 140
PublisherNational Coordinating Centre for Health Technology Assessment
ISSN1366-5278
Digital Object Identifier (DOI)https://doi.org/10.3310/hta12300
Page range1 - 140
Place of publicationUnited Kingdom
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Study protocol :iCONS: identifying continence options after stroke: A randomised trial
Thomas, Lois, Watkins, Caroline, French, B, Sutton, C, Forshaw, D, Cheater, F, Roe, B, Leathley, M, Burton, C, McColl, E and Booth, J. (2011). Study protocol :iCONS: identifying continence options after stroke: A randomised trial. Trials. 12, pp. 1 - 10. https://doi.org/10.1186/1745-6215-12-131
The 12-month effects of early motivational interviewing after acute stroke :A randomized controlled trial
Watkins, Caroline, Wathan, J, Leathley, M, Auton, M, Deans, Carol, Dickinson, H, Jack, Cathy, Sutton, C, Van Den Broek, M and Lightbody, C. (2011). The 12-month effects of early motivational interviewing after acute stroke :A randomized controlled trial. Stroke: a journal of cerebral circulation. 42(7), pp. 1956 - 1961. https://doi.org/10.1161/STROKEAHA.110.602227
Combined conservative interventions for urge, stress or mixed incontinence in adults (protocol)
French, Beverley, Thomas, Lois H., Sutton, Christopher J., Booth, J., Brittain, Katie, Burton, Christopher R., Cheater, Francine, Roe, Brenda, Hay-Smith, E. Jean C., McAdam, J. J. and Watkins, Caroline. (2010). Combined conservative interventions for urge, stress or mixed incontinence in adults (protocol). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD008910
Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England
Sutton, C, Marsden, J, Watkins, Caroline, Leathley, M and Dey, P. (2010). Changing stroke mortality trends in middle-aged people : An age-period-cohort analysis of routine mortality data in persons aged 40 to 69 in England. Journal of Epidemiology and Community Health. 64(6), pp. 523 - 529. https://doi.org/10.1136/jech.2008.086785
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial
Langhorne, P, Stott, D, Knight, A, Bernhardt, Julie, Barer, D and Watkins, Caroline. (2010). Very early rehabilitation or intensive telemetry after stroke : A pilot randomised trial. Cerebrovascular Diseases. 29(4), pp. 352 - 360. https://doi.org/10.1159/000278931
Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis
French, Beverley, Thomas, Lois, Leathley, Michael, Sutton, Christopher, McAdam, Joanna, Forster, Anne, Langhorne, Peter, Price, Chris, Walker, Annette and Watkins, Caroline. (2010). Does repetitive task training improve functional activity after stroke? : A Cochrane systematic review and meta-analysis. Journal of Rehabilitation Medicine. 42(1), pp. 9 - 15. https://doi.org/10.2340/16501977-0473
Stroke knowledge and awareness : An integrative review of the evidence
Jones, Susanne, Jenkinson, A, Leathley, M and Watkins, Caroline. (2010). Stroke knowledge and awareness : An integrative review of the evidence. Age and Ageing. 39(1), pp. 11 - 22. https://doi.org/10.1093/ageing/afp196;10.1093/ageing/afp196
Nursing patients with neurological problems
Watkins, Caroline Leigh. (2009). Nursing patients with neurological problems. In In G. Castledine and A. Close (Ed.). Oxford handbook of adult nursing pp. 435 - 484 Oxford University Press. https://doi.org/10.1093/med/9780199231355.003.0013
Repetitive task training for improving functional ability after stroke
French, Beverley, Thomas, Lois H., Leathley, Michael John, Sutton, Christopher J., McAdam, Joanna J., Forster, Anne, Langhorne, Peter J., Price, Christopher I.M., Walker, Andrew and Watkins, Caroline L.. (2009). Repetitive task training for improving functional ability after stroke. Stroke: a journal of cerebral circulation. 40(4), pp. 98 - 99. https://doi.org/10.1161/STROKEAHA.108.519553
Psychological intervention poststroke: ready for action?
Watkins, Caroline and French, Beverley. (2009). Psychological intervention poststroke: ready for action? Stroke. 40(9), pp. 2951 - 2952. https://doi.org/10.1161/STROKEAHA.109.562348
Treatment of stroke: Acting on the symptoms
Jones, Stephanie, Leathley, Michael J. and Watkins, Caroline Leigh. (2008). Treatment of stroke: Acting on the symptoms. Asian Hospital and Healthcare Management.
Treatment of urinary incontinence after stroke in adults (review)
Thomas, Lois H., Cross, S., French, B., Leathley, M. J., Sutton, C. J. and Watkins, Caroline Leigh. (2008). Treatment of urinary incontinence after stroke in adults (review). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004462.pub3
Engaging service users in the development of stroke services: An action research study
Jones, Stephanie P., Auton, Malcolm F., Burton, Christopher R. and Watkins, Caroline L.. (2008). Engaging service users in the development of stroke services: An action research study. Journal of Clinical Nursing. 17(10), pp. 1270 - 1279. https://doi.org/10.1111/j.1365-2702.2007.02259.x
Acute stroke management: An online course
Jones, Stephanie, McLoughlin, A. and Watkins, Caroline. (2008). Acute stroke management: An online course. Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 3(6), pp. 322 - 326.
Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence
Marsden, Jenny, Gibson, Lorna Mary, Lightbody, Catherine Elizabeth, Sharma, Anil Kumar, Siddiqi, Mashood and Watkins, Caroline. (2008). Can early onset bone loss be effectively managed in post-stroke patients? An integrative review of the evidence. Age and Ageing. 37(2), pp. 142 - 150. https://doi.org/10.1093/ageing/afm198