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Exploratory Study of Breast Cancer Survivors’ Experience: Activity Engagement During and After Breast Cancer Treatment
e16 Research Poster 3050 Portable Myoelectric Brace Use Improves Self-Reported Function but not Reaching Kinematics in Patients >1 Year Post-Stroke Nienke Willemien Willigenburg (The Ohio State University, Sports Health and Performance Institute), Michael McNally, Timothy Hewett, Stephen Page Objective(s): To examine the efficacy of an 8-week regimen combining repetitive task-specific practice with a myoelectric brace (RTP + Myomo) on paretic upper extremity (UE) use in valued activities, perceived recovery, and reaching kinematics. Design: Randomized controlled trial. Setting: Outpatient rehabilitation hospital. Participants: Twelve chronic stroke patients (4 males; mean age 53.5 years; mean time post stroke 61.7 months). Interventions: Seven subjects were administered RTP + Myomo therapy, and 5 were administered RTP only. Both groups participated in individualized, 45-minute therapy sessions occurring 3 days/week over an 8-week period. Main Outcome Measure(s): The arm, hand ability, activities of daily living, and perceptions of recovery scales of the Stroke impact Scale (SIS), as well as UE kinematics, assessed before and after the intervention. Results: Subjects in the RTP + Myomo group showed significantly greater improvements on most SIS subscales, but this did not coincide with increased elbow extension during the reaching tasks. Conclusions: RTP integrating myoelectric bracing appears more beneficial than RTP only in increasing UE movement and ability to perform valued activities and perceptions of overall recovery, but does not convey superior benefits in terms of UE kinematics. When taken in combination with other study findings, results suggest that clinicians may be able to significantly reduce the debilitating impact of moderate UE impairment in a large number of stroke survivors using the RTP + Myomo approach. Key Words: Stroke, Upper extremity, Orthotic devices Disclosure(s): None disclosed. Research Poster 3068 Can Change Agents Improve Best Practice Uptake in a Rehabilitation Setting? The Clinician’s Perspective Dahlia Kairy (Universite´ de Montre´al, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal - Institut de re´adaptation Gingras-Lindsay de Montre´al), Diana Zidarov, Andre´ E. Bussie`res, Aliki Thomas, Lise Poissant Objective(s): To identify factors influencing uptake of best practice among clinicians when working with Specialists in the Application and Generalization of Expertise (SAGEs) as change agents. Design: A qualitative single case study with embedded units of analysis was conducted. In each of the four programs in which SAGEs were present, focus groups were held 6 months after implementing the intended clinical practice change. Setting: Rehabilitation hospital in Montreal. Participants: Twenty-three clinicians from four clinical teams, including professionals from eight health disciplines and clinical coordinators, participated in four focus groups (4-7 participants per focus group). Interventions: SAGEs were introduced in four clinical programs to support clinicians when introducing an interdisciplinary practice change. Main Outcome Measure(s): The focus group guide was developed based upon the Consolidated Framework for Implementation Research (CFIR). Focus groups were audio recorded, transcribed verbatim, and analyzed using a deductive content analysis with comparisons between programs. Results: Implementation was likely if a new practice was perceived as addressing both patient and clinical needs, as being superior to current practice, and if the new practice fit into their current clinical workflow. A common barrier to uptake was the presence of individuals within teams who resisted the proposed change. Greater clinician knowledge of, and
Research Posters attitudes and self-efficacy about the new practice appeared to enhance uptake. Further, SAGEs’ personal attributes, leadership and communication skills, and promotion of a learning climate were perceived as positively impacting uptake. Conclusions: SAGEs as change agents appear to be a promising strategy to support the implementation of new interdisciplinary practices. Implementing new practices is influenced by multiple factors, and their positive or negative influence remains context-dependent. Nonetheless, SAGEs can act on most factors to promote uptake of new practices. Key Words: Organizational change, Interdisciplinary communication, Evidence-based practice, Organizational innovation, Professional practice Disclosure(s): None Disclosed. Research Poster 3084 Exploratory Study of Breast Cancer Survivors’ Experience: Activity Engagement During and After Breast Cancer Treatment Anne Fleischer (Wake Forest Baptist Health), Max Ito, Doris Brown Objective(s): Describe breast cancer survivors’ experiences participating in important activities during and after breast cancer treatment. Design: Concurrent mixed method design using interpretative phenomenological analysis for qualitative and descriptive statistics for quantitative. Setting: Cancer Center. Participants: Ten survivors diagnosed with Stage I, II, or III breast cancer, consecutively received surgery, chemotherapy, and radiation therapy, 40 and 65 years of age. Interventions: N/A. Main Outcome Measure(s): Activity Card Sort modified (ACSm) and emergent themes from each interview. Results: The proportion of activity participation incrementally increased from the end of radiation therapy to 6-months post-treatment (63%, 61%, 81%, and 84%). Seventy-five percent of important activities were either instrumental or social activities, and remaining 25% were low- or high-demand leisure activities at each time point. Fatigue, fear of infection and side effects, and personal and treatment stresses seemed to reduce activity participation during radiation therapy; and strategies to reduce stress and treatment side effects, looking toward future, and making personal changes seemed to encourage it. At 6months post-treatment, appreciation for life, family and work, and desire to make lifestyle changes seemed to encourage activity participation. Current cancer status appeared to either encourage or discourage participation in important activities. Conclusions: Results from this study cannot be generalized to all breast cancer survivors. Some observations require further investigation because of its possible application to oncology rehabilitation, including teaching adaptive strategies, fatigue education, stress management and life style support. Additional research is needed on interventions to improve social and high-demand leisure activities, particularly for single mothers. Key Words: Breast Neoplasm, Occupations, Intrinsic factors Disclosure(s): None Disclosed. Research Poster 3087 Upper Limb Robotic Therapy in the Home after Stroke: A Pilot Study Grace J. Kim (NewYork Presbyterian Hospital-Weill Cornell Medical Center), Lisa Rivera, Joel Stein Objective(s): To investigate the feasibility and gather pilot data on integrating a robotic elbow brace into a 6-week home exercise program. Design: Non-randomized pre/post interventional study. Setting: Outpatient clinic and participants’ homes Participants: Individuals at least 6 months after stroke with minimal AROM for elbow flexion/extension, full PROM at elbow, and MAS 3 for the bicep, triceps, and pronators were enrolled from the community (NZ11, mean age, 51.7; mean time since stroke, 7.6 years; mean FMA score 22/66; 5 women, 6 men).
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Research Posters attitudes and self-efficacy about the new practice appeared to enhance uptake. Further, SAGEs’ personal attributes, leadership and communication skills, and promotion of a learning climate were perceived as positively impacting uptake. Conclusions: SAGEs as change agents appear to be a promising strategy to support the implementation of new interdisciplinary practices. Implementing new practices is influenced by multiple factors, and their positive or negative influence remains context-dependent. Nonetheless, SAGEs can act on most factors to promote uptake of new practices. Key Words: Organizational change, Interdisciplinary communication, Evidence-based practice, Organizational innovation, Professional practice Disclosure(s): None Disclosed. Research Poster 3084 Exploratory Study of Breast Cancer Survivors’ Experience: Activity Engagement During and After Breast Cancer Treatment Anne Fleischer (Wake Forest Baptist Health), Max Ito, Doris Brown Objective(s): Describe breast cancer survivors’ experiences participating in important activities during and after breast cancer treatment. Design: Concurrent mixed method design using interpretative phenomenological analysis for qualitative and descriptive statistics for quantitative. Setting: Cancer Center. Participants: Ten survivors diagnosed with Stage I, II, or III breast cancer, consecutively received surgery, chemotherapy, and radiation therapy, 40 and 65 years of age. Interventions: N/A. Main Outcome Measure(s): Activity Card Sort modified (ACSm) and emergent themes from each interview. Results: The proportion of activity participation incrementally increased from the end of radiation therapy to 6-months post-treatment (63%, 61%, 81%, and 84%). Seventy-five percent of important activities were either instrumental or social activities, and remaining 25% were low- or high-demand leisure activities at each time point. Fatigue, fear of infection and side effects, and personal and treatment stresses seemed to reduce activity participation during radiation therapy; and strategies to reduce stress and treatment side effects, looking toward future, and making personal changes seemed to encourage it. At 6months post-treatment, appreciation for life, family and work, and desire to make lifestyle changes seemed to encourage activity participation. Current cancer status appeared to either encourage or discourage participation in important activities. Conclusions: Results from this study cannot be generalized to all breast cancer survivors. Some observations require further investigation because of its possible application to oncology rehabilitation, including teaching adaptive strategies, fatigue education, stress management and life style support. Additional research is needed on interventions to improve social and high-demand leisure activities, particularly for single mothers. Key Words: Breast Neoplasm, Occupations, Intrinsic factors Disclosure(s): None Disclosed. Research Poster 3087 Upper Limb Robotic Therapy in the Home after Stroke: A Pilot Study Grace J. Kim (NewYork Presbyterian Hospital-Weill Cornell Medical Center), Lisa Rivera, Joel Stein Objective(s): To investigate the feasibility and gather pilot data on integrating a robotic elbow brace into a 6-week home exercise program. Design: Non-randomized pre/post interventional study. Setting: Outpatient clinic and participants’ homes Participants: Individuals at least 6 months after stroke with minimal AROM for elbow flexion/extension, full PROM at elbow, and MAS 3 for the bicep, triceps, and pronators were enrolled from the community (NZ11, mean age, 51.7; mean time since stroke, 7.6 years; mean FMA score 22/66; 5 women, 6 men).
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