Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose
Advancing Stroke Recovery Through Improved Articulation of Nonpharmacological Intervention Dose
复制标题
DOI：
10.1161/strokeaha.120.032496
复制
发表时间：
2021-02-01
期刊：
影响因子：
8.3
通讯作者：
Bernhardt, Julie
中科院分区：
文献类型：
--
作者：
Hayward, Kathryn S.;Churilov, Leonid;Bernhardt, Julie
剂量表达是干预开发和测试的一个普遍问题。在中风恢复中，非药物干预的剂量似乎会影响结果，但往往报道很少。非药物性中风恢复研究中阐明剂量的挑战包括：（1）缺乏国际商定的具体剂量报告指南； (2) 剂量概念化不充分，是多维的； (3) 包含多个剂量维度的术语不明确且不一致。为了应对这些挑战，我们需要一种概念完善且一致的剂量表达方法，该方法可以应用于中风恢复领域，以激发在干预开发过程中对剂量的批判性思维，并促进计划干预剂量与实际交付剂量的报告。我们遵循设计研究范式开发了一个框架，指导如何阐明剂量，概念化剂量维度之间的多维性质和系统联系，并为该领域提供参考术语。我们的框架认识到剂量是多维的，由一段持续时间组成，其中包含单独的会话和片段，可以是活跃的（任务时间）或不活跃的（任务休息时间），并且每个单独的片段可以由有关长度、强度和难度的信息组成。通过假设应用于中风恢复的临床前和临床领域，证明了该框架的临床实用性。该框架适用于解决剂量阐明挑战，这一点得到了国际专家咨询小组的确认。这一新颖的框架为更好地阐明非药物剂量提供了一条途径，从而在中风恢复研究中实现透明和准确的描述、实施、监测和报告。
Dose articulation is a universal issue of intervention development and testing. In stroke recovery, dose of a nonpharmaceutical intervention appears to influence outcome but is often poorly reported. The challenges of articulating dose in nonpharmacological stroke recovery research include: (1) the absence of specific internationally agreed dose reporting guidelines; (2) inadequate conceptualization of dose, which is multidimensional; and (3) unclear and inconsistent terminology that incorporates the multiple dose dimensions. To address these challenges, we need a well-conceptualized and consistent approach to dose articulation that can be applied across stroke recovery domains to stimulate critical thinking about dose during intervention development, as well as promote reporting of planned intervention dose versus actually delivered dose. We followed the Design Research Paradigm to develop a framework that guides how to articulate dose, conceptualizes the multidimensional nature and systemic linkages between dose dimensions, and provides reference terminology for the field. Our framework recognizes that dose is multidimensional and comprised of a duration of days that contain individual sessions and episodes that can be active (time on task) or inactive (time off task), and each individual episode can be made up of information about length, intensity, and difficulty. Clinical utility of this framework was demonstrated via hypothetical application to preclinical and clinical domains of stroke recovery. The suitability of the framework to address dose articulation challenges was confirmed with an international expert advisory group. This novel framework provides a pathway for better articulation of nonpharmacological dose that will enable transparent and accurate description, implementation, monitoring, and reporting, in stroke recovery research.