Fletcher-Smith, Joanna C.
(2011)
Recovery of dressing ability after stroke.
MPhil thesis, University of Nottingham.
Abstract
The research programme was designed to coincide with a separate phase II randomised controlled trial (RCT) of a Neuropsychological approach to dressing rehabilitation after stroke entitled ‘Dressing Rehabilitation Evaluation Stroke Study’ (DRESS). This research programme incorporated the cohort of participants from the DRESS study. It was an original piece of work that involved three separate but related research studies.
The first project involved an inter-rater reliability study of the Nottingham Stroke Dressing Assessment (NSDA) and accompanying error analysis form which is the primary outcome measure used in the DRESS RCT. The inter-rater reliability study measured agreement between three raters’ dressing assessments on twenty patients. Of the 44 items on the NSDA that could be tested, there was excellent agreement (k >0.75) on 29 items, good agreement (k >0.6) on 8 items, fair agreement (k >0.4) on 5 items, and poor agreement (k <0.4) on 2 items. The intra-class correlation coefficient between the three raters’ final percentage score was 0.988, representing excellent agreement between raters. For the error analysis form there was excellent agreement (k >0.75) on 2 items, good agreement (k >0.6) on 4 items, and fair agreement (k >0.4) on 1 items.
The aim of the second study was to explore to what extent upper limb hemiparesis affects dressing performance in the presence of cognitive impairment. Using a cohort of 70 participants from the ‘DRESS study’, this study explored the dressing performance of cognitively impaired stroke survivors who had bilateral hand function as compared with unilateral hand function. A Chi-square test for independence indicated a strong association between dressing method and dressing success, χ2 (1, n=70) = 12.79, p<0.001, phi=0.47. Of those who were unsuccessful at dressing at baseline, a Mann-Whitney U test revealed a significant difference in NSDA scores between the bi-manual group (median=78) and the uni-manual group (median=29). U=118, Z=-4.045, p<0.001, r=0.6. The results indicated that the ability to use both hands in the presence of cognitive impairment had a positive effect on dressing performance.
The final study was an acceptability study which was carried out to survey the participants on the DRESS study. An acceptability questionnaire was devised and used to conduct structured interviews with the DRESS study participants during their final outcome assessment. The aim was to explore patients’ experiences of being a participant on the DRESS study phase II randomised controlled trial and to ascertain their opinion on the importance of independent dressing, the usefulness and efficacy of the different dressing treatments, the frequency and duration of dressing treatment sessions, and their perceptions of the success of the DRESS study treatment approaches. The majority of participants felt that it was “very important” (n=34) or “quite important” (n=10) to be able to dress on their own without help. Similarly, the majority of participants (n=44) felt that dressing was an important part of their recovery from stroke. All aspects of the DRESS study were considered to be acceptable and there was no significant difference in participants’ responses between the two treatment groups.
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