Background: Dysphagia is common after stroke, so feeding through a naso-gastric (NG) tube may be necessary. NG tubes are frequently dislodged, potentially causing feed or fluids to enter the lungs. Interventions to prevent this include taping NG tubes to the face, hand mittens and nasal bridles. Overall Aim The aim of this study was to explore the opinions of staff, patients and relatives about the maintenance of NG tube feeding for stroke patients while investigating current clinical practice. Research Design and Methods: A three-phased mixed method design was used. Phase 1 involved focus groups with multidisciplinary stroke unit staff (n=17); one-to-one interviews, with stroke patients (n=4) and relatives (n=6). Phase 2 incorporated a postal survey sent to a convenience sample (n=528) registered nurses working in the field of stroke across the UK. Phase 3 involved interviews with nurses (n=5) outside the speciality of stroke. Findings: Phase 1 highlighted many categories, including: lack of protocols; ethical and legal concerns; training to insert NG tubes; patient dignity; patient autonomy and potential harms and benefits of interventions used. There were variations in the opinions of staff, patients and relatives concerning the effectiveness and acceptability of methods for securing NG tubes. Phase 2 achieved a response rate of 59% (n=314/528); 22% (n=68/312) of nurses used hand mittens, only 11% (n=34/312) used a protocol; 56% (n=176/314) of nurses had received formal training to insert an NG feeding tube, more senior nurses had been formally trained than junior nurses (p<0.005). Acceptability and effectiveness ratings for tube securing interventions varied: 50% (n=158/312) considered hand mittens to be unacceptable. However, from a total of n=92 responses about their effectiveness, 66% (n=61/92) felt they were effective. Phase 3 produced more detailed results about fear associated with NG feeding; inconsistent approaches to training and ethical and legal issues of patient restraint. Conclusions: Overall this study demonstrates differences in opinion about what constitutes acceptable, effective and legal practice when maintaining NG feeding for stroke patients. It also suggests that the lack of consistent nurse training affects the standards of care patients receive. Furthermore, there is a need for more robust evidence to inform clinical practice. This study culminates in a model of nursing related to the insertion and maintenance of NG feeding for stroke patients.

Chronic neck pain can occur in a proportion of individuals who have suffered a whiplash injury and also in individuals that have not experienced a trauma to the neck. The mechanisms that cause chronic pain are unclear, and whether they differ in traumatic or non-traumatic onset is unknown. A review of the background literature identified differences in muscle activation for individuals with chronic neck pain, following a whiplash injury and from a non traumatic onset, compared to healthy controls. However, differences in the combined action or synergy of superficial neck muscles in these chronic neck pain groups, during non-forced activities, had not been widely reported. A new methodology was developed to address this area of research. A pilot study was undertaken to establish the reliability of the method and to identify areas for refinement. The main study employed the refined methodology to determine possible differences in activation and synergies of the upper trapezius and sternocleidomastoid muscles, alongside correlations of subjective pain and fatigue with surface electromyographic measures, using linear array electrodes. Some differences in muscles activation and synergy were observed between the groups. Individuals showed different strengths of relationships between subjective and objective measures and different proportions of significant correlations were shown between groups.