We are looking for a master student human movement sciences, health sciences, biomedical sciences, physical therapy sciences or similar, who has affinity with clinical practice of (neuro)rehabilitation, delivers thorough and detailed work, speaks Dutch and has good sense of honor and social skills. Experience with qualitative data analysis is desired.
After a stroke (cerebrovascular accident, CVA), many patients experience problems in arm and hand function; in 30-66% of patients arm function is hardly recovered after 6 months, while only 5-20% of patients the arm reached a functional level. An intensive rehabilitation programme is required in the early phase after a stroke to stimulate recovery of arm/hand function as much as possible. Within current clinical practice, a large number of treatment options is available, such as individual occupational therapy, hand function groups or electrical stimulation. Ideally, the chosen treatment is based as much as possible on individual abilities and needs of the patient. For this, it is highly relevant to have insight in the current status and progression of the patient, which is usually acquired through standardized clinical tests administered by therapists.
The scores of those clinical tests (and specific cut-off points) and the choice for a certain treatment option are in many cases not directly related to each other. Also, scientific literature does provide starting points, but they mostly don’t match specific treatment options as used in the rehab centre. In practice, this means that the choice for the contents of a treatment programme for a certain patient is probably influenced by the preferences and/or experience of a therapist. To optimize the choice of treatment options and its eventual effect, and as such streamline the treatment as much as possible, a flow diagram of decision criteria for those treatment options based on objective and structured criteria is desired.
Objective of the assignment
The assignment is part of the so-called ‘armb(h)and’ working group within Roessingh Centre for Rehabilitation (RCR), consisting of a rehab physician, physical therapist, occupational therapist and two researchers from Roessingh Research and Development (RRD). The goal of this working group is to define a guideline for treatment covering every treatment module available and streamlining the choice for the various treatment options for the arm and hand within physical and occupational therapy of the adult neurology rehab department.
In earlier work a first global set-up of such a flow chart was created and prepared as a website/app, based on an inventory of the current approach regarding decision criteria in clinical practice. The current assignment is a continuation of the earlier master assignment, focused on fine-tuning of the current flow chart, through adding details and specifications of more specific treatment options and corresponding decision criteria, based on as objective criteria as possible. The objective of the current assignment is therefore:
Identifying objective decision criteria for choice of treatment options for arm/hand function for people with a stroke, to be applied within a (digital) flow chart as decision support tool for therapists when selecting the most appropriate treatment option for an individual patient.
Contents of the assignment
The assignment will require largely observational research at the rehab centre, involving amongst others a comparative study among treatment choices of physical and occupational therapists in their current approach versus choices as indicated after use of the existing flow chart, which will serve as a starting point for identifying additional or more specific decision criteria. This can be elaborated by qualitative research by means of interviews/questionnaires among physical and occupational therapists, to further refine the current decision support flow chart. The following activities will be involved during the assignment:
- Collecting background information through desk research, involving treatment guidelines for stroke and through accompanying therapists during their treatment (work shadowing)
- Inventorying treatment choices among therapists regarding arm and hand function with and without help from the existing decision support flow chart
- Designing and administering interviews/questionnaires among therapists about contents and experience with the decision support flow chart
- Analysing and interpreting qualitative and quantitative information regarding treatment choices
- Defining recommendations for adaptations of the (digital) flow chart as decision support tool
- Reporting the work done and the resulting recommendations
For this master assignment with a duration of approximately 6-9 months, we are looking for a student human movement sciences, health sciences, biomedical sciences, physical therapy sciences or similar, who has affinity with clinical practice of (neuro)rehabilitation, delivers thorough and detailed work, speaks Dutch and has good sense of honor and social skills. Experience with qualitative data analysis is desired.
The assignment will be done at Roessingh Centre for Rehabilitation (RCR) and Roessingh Research and Development (RRD), under supervision of a rehabilitation physician and a researcher and with collaboration from therapists (from the department of neurology). The specific duration and period during which the assignment will be done can be discussed, but our preference goes to starting the assignment in January 2018.
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