PhD Study : An exploration of the effectiveness of carer-delivered mirror box therapy for upper limb rehabilitation with stroke within the home setting

Summary

Approximately 10,000 people in Ireland (IHF 2010b) and 4,000 in Northern Ireland (Stroke Association 2017) suffer a stroke each year. As a result, stroke services incur huge costs to health services, approximately 422 million euro per year in ROI (IHF 2010b) and £260m in Northern Ireland (Stroke Association 2017). Individuals who have sustained a stroke are often left with residual deficits of the upper limb that can restrict functional use of the limb in everyday activities and can result in dependency upon others to engage in some tasks. Regaining independence through functional use of the arm and hand is the aim of rehabilitation.  Mirror box therapy (MBT) is a relatively new innovation thought to improve upper limb function through both movement and mental stimulation (Stevens and Stoykov 2003, Uswatte et al 2005).

The pilot study conducted by this research team has demonstrated that caregivers play a key role in delivering mirror box intervention outside restricted therapy time. Further, the fully powered randomised controlled trial funded through the Cross-border Healthcare Intervention Trials in Ireland Network (CHITIN INTERREG VA SEUPB) and commencing in January 2019, will see caregivers play an even greater role in co-delivering the intervention as many of the 180 participants in this trial will be living in very rural cross-border areas, with limited access to therapists for regular rehabilitation sessions.

This study provides plentiful opportunities for a PhD student to explore how caregivers can support the rehabilitation process and co-engage in the delivery of mirror box therapy for patient benefit.

PhD Aim:  To investigate the effectiveness of carer-delivered mirror box therapy for upper limb rehabilitation with stroke within the home setting.

The objectives of the study will be to:

1.Develop a range of service-user and carer friendly information and training resources on the use of mirror box therapy for upper limb rehabilitation post stroke;

2.Pilot the use of the training resources through a series of training events for caregivers of individuals with stroke;

3.Operationalise a small clinical trial (nestled within the main study) to investigate the effectiveness of carer-delivered mirror box  therapy to individuals with stroke within the home setting.

4.Maximise the opportunities for patient and public involvement within the fully –powered Randomised Controlled Trial, of which the PhD student will be a member.

Strategic Importance

This study could not be more relevant to HSC/HSE priorities at present, due to (1) the 2016 National Stroke Audit (IHF) and (2) the Reshaping of Stroke Services in Northern Ireland consultation (Health and Social Care Board 2017). Considerable inequity exists in specialist stroke services across Ireland (IHF National Stroke Audit 2016), with geographical location and proximity to a major hospital determining whether or not stroke survivors receive adequate rehabilitation (IHF 2010b, IHF2016). This lack of availability in some regions results in many people living with avoidable disability (IHF 2010a). A recent expert report by the Health Minister emphasised that all stroke patients should have access to appropriate levels of rehabilitation irrespective of their age or geographical location’ (Department of Health and Children 2010).

AccessNI clearance required

Please note, the successful candidate will be required to obtain AccessNI clearance prior to registration due to the nature of the project.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• Relevant professional qualification and/or a Degree in a Health or Health related area

Funding and eligibility

The University offers the following levels of support:

Vice Chancellors Research Studentship (VCRS)

The following scholarship options are available to applicants worldwide:

• Full Award: (full-time tuition fees + £19,000 (tbc))
• Part Award: (full-time tuition fees + £9,500)
• Fees Only Award: (full-time tuition fees)

These scholarships will cover full-time PhD tuition fees for three years (subject to satisfactory academic performance) and will provide a £900 per annum research training support grant (RTSG) to help support the PhD researcher.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Please note: you will automatically be entered into the competition for the Full Award, unless you state otherwise in your application.

Department for the Economy (DFE)

The scholarship will cover tuition fees at the Home rate and a maintenance allowance of £19,000 (tbc) per annum for three years (subject to satisfactory academic performance).

This scholarship also comes with £900 per annum for three years as a research training support grant (RTSG) allocation to help support the PhD researcher.

• Candidates with pre-settled or settled status under the EU Settlement Scheme, who also satisfy a three year residency requirement in the UK prior to the start of the course for which a Studentship is held MAY receive a Studentship covering fees and maintenance.
• Republic of Ireland (ROI) nationals who satisfy three years’ residency in the UK prior to the start of the course MAY receive a Studentship covering fees and maintenance (ROI nationals don’t need to have pre-settled or settled status under the EU Settlement Scheme to qualify).
• Other non-ROI EU applicants are ‘International’ are not eligible for this source of funding.
• Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year (or part-time equivalent) are NOT eligible to apply for an award.

Due consideration should be given to financing your studies. Further information on cost of living