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A considerable number of patients present with an upper limb impairment after stroke, which has a significant impact on daily life activities and quality of life. Currently, based on a Cochrane review, there is no high-quality evidence for any of the upper limb interventions used in routine practice. Therefore, the Jessa Hospital developed an additional arm-hand boost programme (AHA-BOOST), a novel, stratified intervention that integrates neurophysiological knowledge with an early start to optimise poststroke upper limb recovery.
This multicentre randomised controlled trial with parallel design compares AHA-BOOST with a dose-matched programme for the lower limbs. Both interventions are in addition to usual care and consist of a combination of group sessions (1 hour per day, 5 times per week) and individualised therapy (two 30 min sessions per week) provided over 4 weeks. In total, 80 subacute stroke patients will be recruited from five rehabilitation centres in Belgium and randomised to one of both interventions. Patients will be followed up until 12 months post stroke to support a cost-utility analysis and assess long-term clinical effects of the programme. Various outcomes are collected at different time points: preintervention, immediately post intervention, 3 months post intervention, 6 months post stroke and 12 months post stroke. The Action Research Arm Test is the clinical primary outcome. The secondary outcomes are: Fugl-Meyer assessment—upper extremity, Stroke Upper Limb Capacity Scale, Barthel Index, modified Rankin Scale, Stroke Impact Scale and EuroQoL 5D-5L (EQ-5D-5L). The clinical analysis includes a multivariate analysis of variance (MANOVA) analysis for comparing clinical changes between both groups and a subgroup analysis to explore the effects in different types of stroke survivors. Additionally, a process evaluation, guided by the Medical Research Council Framework, will assess key aspects of the implementation, including delivery (structures and resources), dose, reach, fidelity, adaptations, quality, mechanisms of change and the context. Both quantitative and qualitative data will be collected using the following tools during the intervention: therapy diaries for each session; video recordings of AHA-BOOST group sessions and after the intervention using: interviews with patients, therapists and management. The qualitative data will be assessed using content and thematic analysis and the quantitative data with descriptive statistics. Ultimately, in addition to the EQ-5D-5L, direct and indirect healthcare costs are collected for the health economic evaluation. A cost-utility analysis will be performed with a time horizon of 12 months post stroke comparing both therapies, and a Markov model will assess the cost-effectiveness of AHA-BOOST on a lifetime horizon. To test the robustness of the results, sensitivity and scenario analysis will be performed.
Ethical approval has been obtained by different ethical committees (UZ/KU Leuven (central committee), UZ Gent, Gasthuiszusters Antwerpen and Maria Middelares). The study will be performed in accordance with the protocol, current International Council for Harmonisation (ICH) and Good Clinical Practice (ICH-GCP) guidelines, and applicable regulatory requirements. The current approved protocol is version 5, dated 7 May 2025. Protocol amendments will be submitted to all involved ethical committees. The study results will be disseminated through peer-reviewed publications, conference presentations and stakeholder reports.
Despite the increasing number of doctorally prepared midwives in Europe, particularly after the Bologna Declaration 1999, little is known about the context and experiences of their doctoral education.
To explore European initially qualified midwives' experiences with doctoral education; and the context of their education through their professional associations.
An exploratory descriptive observational survey.
An ethically approved web-based survey was used to collect data from midwifery associations and midwives in 33 European countries between October and December 2024. Descriptive statistics and inductive thematic analysis were used to analyse the responses.
Twenty-two midwifery associations from 19 European countries and 207 midwives from 23 European countries participated. Over the last two decades, there has been an increase in the number of doctorally prepared midwives. Common reasons to gain doctoral qualifications included an interest in research, career progression, in particular in education, and improving healthcare. Midwives reported growing availability of European-wide opportunities for doctoral programmes, alongside an increase in the number of doctoral midwifery programmes and supervisors with midwifery expertise. Although many barriers were reported, effectively combining study with their personal life and support from family, friends and colleagues was highlighted as crucial factors in completing their doctoral studies.
This is the first study exploring the experiences of European midwives pursuing a doctoral degree. The findings highlight a need for universities to improve the collaboration with midwives' supportive networks as well as for the profession to reduce intraprofessional hostilities to enhance doctoral midwifery students' well-being.
Implications for the profession: Acknowledging challenges faced by these midwives is necessary to improve professional and institutional support in academia and midwifery.
Findings of this study inform strategies to improve doctoral education for midwives and, in this way, strengthen the contributions of midwives to maternal evidenced-based care development and healthcare innovations.
The Consensus-Based Checklist for Reporting of Survey Studies (CROSS) was used to guide reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
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