Saudi Cultural Missions Theses & Dissertations
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Item Restricted THE CURRENT PRACTICE OF OCCUPATIONAL THERAPISTS ON UPPER LIMB SPLINTING FOR STROKE PATIENTS IN SAUDI ARABIA: CROSS-SECTIONAL SURVEY(Saudi Digital Library, 2025-03-02) Almutairi, Laila; Purcell, CatherineBackground: Stroke is a major global cause of disability, with upper limb impairments significantly affecting daily function and quality of life. Occupational therapists play a crucial role in stroke rehabilitation, with splinting being a commonly used intervention. However, there is limited research on the splinting practices of occupational therapists in Saudi Arabia, leading to a gap in understanding how splinting is implemented in clinical settings. Aim: this study aimed to investigate the current practices of occupational therapists in Saudi Arabia regarding upper limb splinting for stroke rehabilitation. The objectives were to explore therapists’ knowledge and patterns of splinting practice, identify preferred splint types and regimes, identify occupational therapists’ clinical rationale for splinting and how occupational therapists view the effectiveness of splints, and examine factors influencing splinting decisions. Methodology: a cross-sectional survey was conducted among occupational therapists working with stroke patients in Saudi Arabia. A total of 82 participants completed an online questionnaire assessing their knowledge, splinting patterns, clinical rationale, and perceptions of effectiveness. Descriptive and inferential statistical analyses were performed using Statistical Package for Social Sciences v26 to identify trends and relationships between demographic variables and effectiveness and competence. Results: the findings revealed that most therapists had moderate competence in splinting, with university education and on-the-job training being the primary knowledge sources. Custom-made static splints were the most frequently preferred, while dynamic splints were rarely used. The primary clinical rationale for splinting was to reduce spasticity and prevent contractures. However, challenges such as limited resources, patient non-compliance, and financial constraints were reported as barriers to effective splinting. Despite these challenges, most therapists perceived splinting as a beneficial intervention for stroke rehabilitation. No significant differences in competence or perceived effectiveness were found based on education level or specialisation, though years of experience were positively correlated with higher competence. Conclusion: this study provides valuable insights into the splinting practices of occupational therapists in Saudi Arabia, highlighting areas for improvement in standardisation, training, and resource accessibility. The findings highlight the need for updated guidelines and professional development programmes to enhance splinting effectiveness. Future research should explore patient perspectives, adherence to splinting protocols, and long-term outcomes to further inform evidence-based practice in stroke rehabilitation.9 0Item Restricted Advances in the assessment and rehabilitation of ambulatory chronic stroke survivors.(King's College London, 2024-11-13) Ajaj, Kawthar; Pavlou, Marousa; Harridge, Stephen; Sorinola, IsaacWalking at a functional level is a requirement for walking safely in the community. Walking at a functional level requires good balance control and the ability to perform functional tasks while walking in challenging situations such as walking across a busy road. This thesis attempts to answer a number of questions regarding assessment of walking at a functional level in older people at risk of falls and in stroke survivors. The first part of the work involves a systematic review. The aim of the systematic review is to identify the available clinical OM used in clinical physiotherapy to assess walking at a functional level for stroke rehabilitation and to evaluate their psychometric properties. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) tool was used to assess the risk of bias in the quality of the methodological design and statistical methods in reliability, validity, and responsiveness in the included studies. Fifty-four studies were included in the review, six OM were identified for dynamic balance, twenty-one OM for functional gait, and three studies including five tests each for motor and cognitive tests to assess dual task while walking. The most tested psychometric properties were reliability and construct validity. Studies on responsiveness were limited. The aim of the first experimental study (Chapter 5) is to identify the associations between walking at a functional level and subjective visual verticality (SVV), cognitive function, psychosocial aspects, and physical activity (PA) levels. Twenty chronic stroke survivors capable of independently walking at least 6 metres and twenty healthy controls were recruited in this study. Assessment of functional-level walking included the Mini-Balance Evaluation Test (Mini-BESTest), and the Functional Gait Assessment (FGA). The Rod and Disc test was used to assess the SVV, the Cambridge Neuropsychological Test Automated Battery (CANTAB) tests for the cognitive functions, a set of questionnaires were used to assess psychosocial aspects and the AX3 monitor to determine the PA levels. The difference was significant between the groups in the Mini-BESTest and the FGA (p<0.001), lower (i.e., worse) Mini-BESTest and FGA scores were observed for ambulatory chronic stroke survivors. Balance confidence emerged as a key factor associated with both the Mini-BESTest and the FGA in ambulatory chronic stroke survivors. The Spearman’s rank-order correlations between the balance confidence scale and the Mini-Best, and the FGA were (rs = 0.72 and 0.75) respectively in ambulatory chronic stroke survivors. The results suggest that there is a need for rehabilitation for walking at a functional level for ambulatory stroke survivors and balance confidence should be considered in their assessment and treatment. Difficulties in balance control and limited walking functions are also common in older adults and increase their risk of falls. Both populations (older adults at risk of falls and stroke survivors) need balance training rehabilitation based on a multifactorial approach, which current rehabilitation programmes do not incorporate. Current rehabilitation programmes are limited to simple physical exercises. In addition, previous studies have shown that adherence rates to exercise rehabilitation programmes are low. Using telerehabilitation can enhance adherence rates and adds enjoyment to the exercise rehabilitation programmes. The aim of the next experimental work presented in this thesis was to assess the feasibility and acceptability of a novel telerehabilitation system in older adults at risk of falls and ambulatory chronic stroke survivors: the HOLOBalance system. This is a platform that uses a hologram to deliver the exercise instructions for balance training and uses wearable sensors to detect simultaneous body movements. The training addresses all components relevant to balance using multisensory rehabilitation exercises, exergames, and cognitive training. In addition to assessment of feasibility and acceptability, trends of improvement in balance and functional gait were also investigated. This was undertaken in both older adults at risk of falls and stroke survivors. For older adults at risk of falls (n=54) the participants were randomised to HOLOBalance intervention home-based (HOLOBalance), clinic based (HOLOBox) or control groups. In a second study, the HOLOBalance system (clinic based HOLOBox) was assessed for feasibility and acceptability in stroke survivors (n=8). The main finding from both feasibility studies was that the HOLOBalance system was feasible and acceptable for older adults at risk of falls and ambulatory stroke survivors, as assessed by drop-out, adherence rates, exit interviews, and usability scales. The preliminary data showed that there were trends of improvement in balance and functional gait measures in the intervention groups (HOLOBalance and HOLOBox) in the older adults, and in the stroke survivors who had received the clinic based HOLOBox intervention.49 0Item Restricted Epidemiological evaluation of oral anticoagulants prescribing and clinical outcomes in atrial fibrillation patients with and without cancer: analysis of primary care data in England(University of Manchester, 2024-05-01) Ajabnoor, Alyaa Mohammedali; Kontopantelis, EvangelosAtrial fibrillation (AF) is a prevalent cardiac arrhythmia imposing a substantial global burden. Given its five-fold increase in stroke risk, prescribing oral anticoagulants (OAC) to intermediate to high-risk AF patients is crucial. However, OAC prescribing rates vary, influenced by factors beyond stroke risk, particularly evident in patients with cancer who face complex clinical conditions affecting stroke and bleeding risks. Yet, the efficacy of risk assessment tools in this population remains unexplored, complicating anticoagulation therapy initiation, often tailored to individual patients. Nevertheless, evidence regarding this matter remains limited. Using the Clinical Practice Research Datalink (CPRD), this thesis presents unique research on Nonvalvular Atrial Fibrillation (NVAF) epidemiology in England. It addresses five key questions: 1) NVAF incidence and OAC prescribing, 2) factors influencing OAC prescription, 3) MB incidence and OAC resumption in NVAF patients, 4) stroke and bleeding risk comparison in NVAF patients with and without cancer, and 5) CHA2-DS2-VASc and HAS-BLED score performance in predicting stroke and bleeding in NVAF patients with and without cancer history. Key findings reveal a temporal increase in NVAF incidence in England until 2015, subsequently plateauing. Disparities in OAC prescription correlate with comorbidities, ethnicity, and socioeconomic status, emphasizing the need for interventions to address inequities in NVAF patient care. Between 2009 and 2019 the incidence of MB in NVAF patients surged tenfold with many experiencing MB despite lacking OAC prescription at the time of bleeding. The decision to resume OAC post-MB appears contingent upon the initial anticoagulant used and does not significantly associate with recurrent MB risk. Examining NVAF patients with different cancer types revealed varying stroke and bleeding risks, with certain cancers exhibiting higher bleeding risks than stroke risks. Notably, certain cancer types, such as haematological and lung cancer, were less likely to receive OAC, highlighting disparities in care. Finally, it was found that CHA2-DS2-VASc score performed similarly in predicting ischemic stroke in NVAF patients, irrespective of cancer history. In contrast, the HAS-BLED score, while well- calibrated, lacked discrimination in predicting major bleeding events in the NVAF population overall and in specific cancer cohorts. Overall, this thesis contributes to the evidence around the pharmacoepidemiology of OACs in the NVAF population in England and highlights socioeconomic disparities in NVAF care. It addresses challenges in managing NVAF cohorts with major bleeding or specific cancers, where current risk assessment scores may inadequately predict clinical outcomes. Further research is necessary to explore health inequalities in OAC prescribing for AF patients in England and understand why certain cancers predispose individuals to bleeding or stroke events.16 0