Development, evaluation and measurement of a complex intervention : a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation

Development, evaluation and measurement of a complex intervention; a preliminary investigation of shoulder strapping used as an adjunct therapy to conventional stroke rehabilitation Some therapeutic treatments show promise for improving upper limb motor recovery after stroke, especially those with a focus on high-intensity task-specific practice. However, application of such treatments poses a problem in those patients with insufficient joint stability and weakness of the shoulder complex. Intensive exercise might be possible if the shoulder complex were supported during exercise by, for example, shoulder strapping. Whilst studies indicate an interest in shoulder strapping for stroke patients, evidence for its use is not strong. To establish an evidence base for shoulder strapping, clarification is needed on: underlying mechanisms of any action; strapping methods used; which patients benefit; what effect is achieved; what outcome measures should be used; and patient and staff experience. To develop, evaluate and measure shoulder strapping as a complex intervention within the updated MRC framework, four preliminary studies were completed. A systematic review of shoulder movement impairments suggested that in the early aftermath of stroke, shoulder weakness was severe. Another systematic review indicated that few studies have investigated shoulder strapping and focused on treatment of paralysis. The feasibility of a strapping protocol was, therefore, examined in participants with paresis. This indicated that strapping has potential beneficial effects on upper limb function with minimal adverse skin reactions. Strapping was accepted by staff and stroke participants as feasible. Findings of these studies directed the development and preliminary testing of a new tool for measuring shoulder movement in participants with paresis. Results indicated reliable assessment of video footage by neurophysiotherapists and informed further development of the tool. Findings of these four studies will inform development of a future randomised controlled trial to test the efficacy of shoulder strapping on motor recovery after stroke.EThOS - Electronic Theses Online ServiceGBUnited Kingdo