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There is a gap in research on how best to support exercise in moderate to severe MS. The objective of this study is to share perspectives of people living with MS and physiotherapists on their experiences in a randomized clinical trial of online physiotherapy vs. an active comparator. Semi-structured exit interviews were conducted with volunteer participants from the online and comparator arms of the trial, and focus groups were held with study physiotherapists. Transcripts were analyzed using reflexive thematic analysis. Perspectives from participants with MS yielded three themes: usability of their program, utility of their program, and motivation to participate. Visual and dexterity impairments limited the usability of the online program. Having an opportunity "to be pushed" was valued by participants in both trial arms. Motivation to exercise was variable, and participants desired periodic face-to-face contact with their physiotherapists. Perspectives from trial physiotherapists yielded similar and complementary findings concerning usability and utility. Participants with MS and physiotherapists found the online physiotherapy platform useful for supporting exercise, yet they identified some limitations. As the appeal of online platforms has increased since the pandemic, it will be important to consider the needs of people with moderate to severe MS. NCT03039400. People with moderate-to-severe MS and physiotherapists involved in a clinical trial found online physiotherapy useful for supporting exercise. Physiotherapists and participants using the online program desired improved platform accommodations for people living with MS with visual and dexterity impairments. Physiotherapists and people living with MS from both the online exercise program and comparator groups perceived a need for more face-to-face contact and opportunities to build therapeutic alliance. Perspectives from prescribing physiotherapists and people living with MS about supporting exercise online may have practice implications during and post-pandemic. [ABSTRACT FROM AUTHOR]

Purpose: To discuss the representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health, using spinal cord injury as a case in point for disability. Methods: The scientific literature was reviewed, discussion rounds conducted, and qualitative secondary analyses of data carried out using an iterative inductive–deductive approach. Results: Conceptual considerations are explicated that distinguish the personal factors perspective from other components of the International Classification of Functioning, Disability and Health. A representation structure is developed that organizes health-related concepts describing the internal context of functioning. Concepts are organized as individual facts, subjective experiences, and recurrent patterns of experience and behavior specifying 7 areas and 211 concept groups. Conclusions: The article calls for further scientific debate on the perspective of personal factors in the light of the International Classification of Functioning, Disability and Health. A structure that organizes concepts in relation to a personal factors perspective can enhance the comprehensiveness, transparency and standardization of health information, and contribute to the empowerment of persons with disabilities. The present study collected data from scientific literature reviews, discussion rounds and qualitative secondary analyses in order to develop a representation and organization of information describing persons' lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health. The following representation structure for health-related information from a personal factors perspective was developed: (i) Individuals facts (i.e., socio-demographical factors, position in the immediate social and physical context, personal history and biography), (ii) subjective experience (i.e., feelings, thoughts and beliefs, motives), and (iii) recurrent patterns of experience (i.e., feelings, thoughts and beliefs) and behavior. With this study, we aim to stimulate further scientific discussion about the personal factors component in the International Classification of Functioning, Disability and Health, including its application and subsequent validation for potential implementation into clinical practice. [ABSTRACT FROM AUTHOR]

Experiencing spinal cord injury (SCI) can be life-changing for individuals and their families. Previous reviews have focused on coping and psychological adjustment, sexual function and sexuality, or factors facilitating or impeding interpersonal relationships after SCI. However, there is a very little synthesis of research focusing on changes to adult attachment and emotional intimacy post-SCI. This review aims to examine the mechanisms of change in adult attachment and intimacy in romantic relationships following SCI. Four online databases (Psycinfo, Medline, CINAHL, and Scopus) were searched for qualitative papers concerning romantic relationships, attachments, and intimacy post-SCI. Sixteen of the 692 papers met the inclusion criteria. These were quality assessed and analysed using meta-ethnography. Three main themes emerged from the analysis: (a) strengthening and maintaining adult attachment; (b) changes in roles; and (c) changing views of intimacy. Many couples face significant changes to adult attachment and intimacy following SCI. Systematic ethnographic analysis of their negotiations enabled the identification of underlying relational processes and adaptation strategies associated with changes to inter-dependence, communication, role revision, and re-definition of intimacy. The findings indicate that healthcare providers should assess and respond to challenges faced by couples post-SCI using evidence consistent with adult attachment theory. Professionals should support both partners to develop strategies to try to cope with spinal cord injury (SCI) and its associated stressors following injury. Information and support regarding both the physical and emotional impact of the injury on coupledom and romantic relationships should be provided after SCI. Support should be tailored to reflect an individual with SCI and their partner's cultural and societal background and needs. [ABSTRACT FROM AUTHOR]

While innovation is known to catalyse solutions to global sustainable development challenges, lack of engagement from stakeholders during conceptualisation and development may influence the degree of success of implementation. This paper presents a complete and novel engagement methodology, developed from value led business modelling approaches, for working with multi-sector stakeholders. The methodology can be used to determine barriers and facilitators to clinical practice innovations or translational research, within a country-specific context. The approach has then been applied in the Cambodian prosthetics and orthotics sector to provide a practice-based exemplar application of the framework. This approach seeks to ensure the suitability and sustainability of clinical practice and research programmes being implemented within a complex ecosystem. A theoretical basis, drawn from academic and business innovation sectors, has been consolidated and adapted for practical application to design, direct, and inform initiatives in low resource settings. The methods presented provide a way to both develop and articulate the mission, vision, and goals of any proposed change, and to effectively communicate these with stakeholders in a way that engages the personal and professional values that exist in their ecosystem. It provides a structured process through which meaningful conversations can happen, and a basis for relationship management with key stakeholders; intrinsic to enable a sustained legacy from research and development. The engagement from stakeholders during conceptualisation and throughout development can determine the success, or not, of any implementation and scale of innovation. This paper presents a conceptual stakeholder-led engagement methodology, developed from value led business modelling approaches, for determining barriers and facilitators to translational global healthcare research in a country-specific context, in this case the Cambodian prosthetics and orthotics sector. Subsequent research and development work in this area needs to carefully manage and negotiate influencing factors identified through the application of the described methodology, to ensure initiatives (whether research or wider national development work) are sustainable and successful. [ABSTRACT FROM AUTHOR]

Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. The objective of the present study was to explore the use of numeric pain assessment in individuals with hEDS, from a patient-centered perspective. Our analysis is based on in-depth qualitative interviews. The interviews were conducted over the phone. Our participants were patients living with hEDS (N = 35). Interviews were recorded, transcribed, and analyzed to identify factors related to their use of these pain assessment instruments. Three primary themes emerged from these data, namely, (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. These results demonstrate the need for caution in relying exclusively on numeric pain assessment instruments. We conclude with a brief proposal for a clinical communication strategy that may help to address the limitations of numeric pain assessment that were identified in our interviews. Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. Clinicians should be aware that patients have difficulties with the Numeric Rating Scale (NRS) for at least three reasons: (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. Clinicians should use caution in relying exclusively on NRS instruments. Clinicians may benefit from using clinical communication strategies outlined in our paper, which may help to address the limitations of the NRS that were identified in our interviews. [ABSTRACT FROM AUTHOR]

The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada. Tracking the details of activity-based therapy (ABT) sessions and programs across the continuum of care and injury trajectory may provide important information to support the development of ABT practice guidelines and implementation strategies. Tracking objective and subjective parameters are needed to provide a comprehensive description of an ABT session and program. Clinicians and individuals with spinal cord injury or disease (SCI/D) should both be able to track ABT to accommodate all settings and types of data. Digital tracking tools, such as an app, may provide an accessible, versatile and efficient way of tracking ABT. [ABSTRACT FROM AUTHOR]

This paper authentically represents the voices of non-verbal children with cerebral palsy using a case study design. Policy suggests that children should have the right to play and leisure opportunities, however non-verbal children with cerebral palsy have fewer choices. Additionally, children with communication, learning and mobility limitations are usually excluded from research. The aim of this research was to capture the voices of non-verbal children by exploring their well-being impact in terms of their experiences and choices about their level of participation in recreational activities. A qualitative case series study included interviews, observations, photographs and diaries. Where possible, the diaries were completed by both caregivers and children. Data were analysed thematically, and the lens of positioning theory applied. Seven children aged nine to sixteen years participated. The findings showed how equipment, people and environments enabled or hindered the children's participation. The children also advocated as champions for their own well-being. Positioning theory was applied across the data and was adapted offering a way to better understand the children's well-being responses. The findings demonstrate how these children were able to self-advocate, demonstrating their well-being by their intentional behaviours from their level of participation in a recreational activity. The voices of non-ambulant and non-verbal children are underrepresented in the literature. This study offers an innovative approach to highlight their voices using visual data. The images project the narrative about their choices for participation in recreational activities. The proposed kaleidoscope of well-being offers a way to demonstrate the fluctuations in their emotional responses from their participation. Choices for participation in recreational activities remains limited for non-ambulant and non-verbal children with cerebral palsy. Designers and policy makers should consider how equipment and environments can be adapted or created to increase the choices for non-ambulant and non-verbal children with cerebral palsy. Practitioners in health and social care should consider how to listen to the voices of non-verbal and non-ambulant children with cerebral palsy and their parents/guardians and work towards jointly setting participation goals to affirm their strengths. [ABSTRACT FROM AUTHOR]

To review the feasibility, acceptability, and effects of physiotherapy when delivered remotely. CINAHL, MEDLINE, EBM Reviews, and Cochrane Library databases (January 2015–February 2022) were searched and screened for papers (of any design) investigating remote physiotherapy. Data were extracted by two independent raters. Methodological quality of the identified papers was not assessed. Thematic content analysis drew out the key issues. Forty-one papers (including nine systemic reviews and six with meta-analyses) were selected involving musculoskeletal, stroke and neurological, pulmonary, and cardiac conditions. The most commonly delivered intervention was remote exercise provision, usually following assessment which was completed in-person. All studies, which assessed it, found that remote physiotherapy was comparably effective to in-person delivery at lower cost. Patient satisfaction was high, they found remote physiotherapy to be more accessible and convenient. It boosted confidence and motivation by reminding patients when and how to exercise but adherence was mixed. No adverse events were reported. Barriers related to access to the technology; technical problems and concerns about therapists' workload. Remote physiotherapy is safe, feasible, and acceptable to patients. Its effects are comparable with traditional care at lower cost. Remote physiotherapy is safe, feasible, and acceptable to patients with comparable effects to in-person care. Remote delivery increases access to physiotherapy especially for those who cannot travel to a treatment facility whether due to distance or disability. Remote physiotherapy may increase adherence to exercise by reminding patients when and how to exercise. Remote physiotherapy does not suit everyone, thus a hybrid system with both in-person and remote delivery may be most effective. [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to verify the development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), investigating methodology and how many core sets have been created. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Six bibliographic databases were searched: MEDLINE, SCOPUS, Web of Sciences, CINHAL, PEDro, and OT Seeker. Papers included in the study have the following characteristics: (a) pediatric population with different health conditions, (b) assessment of ICF domains, (c) development of ICF-CY core set in different health conditions, and (d) recommendation for clinical uses. Search strategies allowed to identify 270 research papers. After the elimination of duplicates, 154 articles were analyzed. Finally, 28 records were included for qualitative synthesis. Twelve different ICF-CY Core Sets were identified. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and cerebral palsy were the main health conditions studied at international level. Most of the studies involved international experts using Cieza' methodology to inform ICF-CY Core Set. After 15 years since the adoption of ICF-CY, it still finds some barriers to use. Concrete actions should be taken to develop further core sets following a rigorous methodology and to contribute implementing the ICF framework. In 15 years since the implementation of International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), only 12 core sets have been developed. To develop ICF-CY Core Set, health professionals should follow methodology described by Cieza et al. Strong collaboration between low- and middle-income countries and high-income countries are recommended. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective. [ABSTRACT FROM AUTHOR]

Purpose: Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods: The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results: Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions: The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. [ABSTRACT FROM AUTHOR]

This meta-synthesis aimed to synthesise qualitative evidence on experiences of people with Multiple Sclerosis (MS) in receiving a diagnosis, to derive a conceptual understanding of adjustment to MS diagnosis. Five electronic databases were systematically searched to identify qualitative studies that explored views and experiences around MS diagnosis. Papers were quality-appraised using a standardised checklist. Data synthesis was guided by principles of meta-ethnography, a well-established interpretive method for synthesising qualitative evidence. Thirty-seven papers were selected (with 874 people with MS). Synthesis demonstrated that around the point of MS diagnosis people experienced considerable emotional upheaval (e.g., shock, denial, anger, fear) and difficulties (e.g., lengthy diagnosis process) that limited their ability to make sense of their diagnosis, leading to adjustment difficulties. However, support resources (e.g., support from clinicians) and adaptive coping strategies (e.g., acceptance) facilitated the adjustment process. Additionally, several unmet emotional and informational support needs (e.g., need for personalised information and tailored emotional support) were identified that, if addressed, could improve adjustment to diagnosis. Our synthesis highlights the need for providing person-centred support and advice at the time of diagnosis and presents a conceptual map of adjustment for designing interventions to improve adjustment following MS diagnosis. The period surrounding Multiple Sclerosis diagnosis can be stressful and psychologically demanding. Challenges and disruptions at diagnosis can threaten sense of self, resulting in negative emotions. Adaptive coping skills and support resources could contribute to better adjustment following diagnosis. Support interventions should be tailored to the needs of newly diagnosed people. [ABSTRACT FROM AUTHOR]

To evaluate the reliability, internal consistency, and construct validity of the Swedish versions of PROMIS-29 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) instruments in patients with systemic sclerosis (SSc). In a cross-sectional study, consecutive SSc patients completed a paper-based survey. Internal consistency was assessed using Cronbach's alpha. Test–retest reliability was tested employing weighted Kappa (Kw) and intra-class correlation coefficient (ICC). Construct validity was evaluated by hypotheses testing using RAND-36, MRC Dyspnea score, Scleroderma Health Assessment Questionnaire (SHAQ) and clinical measurements. Forty-nine patients (86% female; 73% limited cutaneous SSc) completed the survey. The mean disease duration was 11 years and mean SHAQ was 0.5. Internal consistency and test–retest reliability were good with the exception of PROMIS-29 anxiety. PROMIS-29, FACIT-Dyspnea, and Functional limitation showed strong correlations to corresponding RAND-36 domains (|rs|=0.67 to −0.85). Relevant PROMIS-29 domains, FACIT-Dyspnea and Functional limitation correlated strongly to SHAQ and VAS overall disease severity (|rs|=0.60 to −0.75). Ceiling effects (>15%) were found in six PROMIS-29 domains and in both FACIT-Dyspnea and Functional limitations. Four (4/5) hypotheses were confirmed. PROMIS-29 and FACIT-Dyspnea meet the requirements for reliability and have adequate construct validity in Swedish patients with SSc. PROMIS-29v2 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) Index are patient outcome measures that gain increasing interest for the evaluation of patient with rheumatologic diseases. PROMIS-29v2 and FACIT-Dyspnea Index meet the requirements for reliability and have adequate construct validity compared to legacy measures in Swedish patients with systemic sclerosis. Translation and validation of PROMs is important for studies of rare diseases in multi-center collaborations. [ABSTRACT FROM AUTHOR]

The Traumatic Injuries Distress Scale is a patient-reported measure capturing experiences of distress following non-catastrophic musculoskeletal injuries. The original English version has shown adequate accuracy for predicting recovery trajectories up to 12 months later. Herein we describe the translation of the English TIDS into the TIDS-Spanish. The prototype version was developed through a two-step forwards-back translation involving four independent bilingual speakers. 73 participants (51% female, mean age 47 years, 32% acute) with musculoskeletal pain responded to the prototype through an online platform or in paper format through a single administration. A series of hypotheses including correlation with an external standard and factor structure were tested for both concurrent and factorial validity compared to those of the English version. Despite an overall higher mean TIDS score in the Spanish-speaking participants compared to the original English development cohort, all hypotheses for concurrent associations with external pain criteria were satisfied and the three-factor structure of the original was replicated in the new TIDS-Spanish (CFI = 0.97, TLI = 0.96, RMSEA = 0.05). While prospective data collection is needed to explore the equivalence in prognostic validity, all other analyses indicated psychometric equivalence of the new TIDS-Spanish with the original English version. The Traumatic Injuries Distress Scale has previously shown prognostic validity for stratifying people with acute musculoskeletal injury into risk-recovery trajectories. A Spanish-translated version of the TIDS was developed and evaluated for psychometric equivalence with the original English version. Results indicate that we were successful in creating a conceptually and empirically equivalent version of the TIDS for use in Spanish-speaking populations. [ABSTRACT FROM AUTHOR]

Health care providers have highlighted the need for tools and resources that support promotion of exercise behavior within comprehensive multiple sclerosis (MS) care. This study involved a final quality improvement evaluation of exercise promotion models and materials for inclusion within this setting. Our research team distributed a paper-based survey containing Likert scales, open answer questions, and copies of the models for editing. We distributed this survey among health care providers across the United States. We conducted a novel mixed-methods analysis evaluating quantitative, qualitative, and creative data. We received completed surveys from 13 health care providers who strongly rated the clarity and applicability of the models and materials, and reported that no major improvements were necessary. The minor improvements were specific per comprehensive MS care center. The feedback indicated that the "Exercise in Medicine" models and materials are guides such that the processes should be integrated into real world practice by amending roles and responsibilities with the team members and structure per comprehensive MS care center. This paper presents finalized models and materials for exercise promotion within comprehensive MS care that are ready to be tested for feasibility and efficacy in a clinical trial. Health care providers require support to promote exercise within the context of comprehensive MS care. The practice models in this article provide guides regarding how to promote exercise in this context. Implementing these exercise promotion guides can reduce the burden of neurologists, and ensure patients receive exercise support from appropriate providers. These guides should be implemented within the context of each individual care center, and not as an explicit step by step guide as each care center is unique. [ABSTRACT FROM AUTHOR]

There is unprecedented opportunity to evaluate children's participation in diverse cultural contexts, to enhance cross-cultural research, advance the delivery of culturally responsive pediatric rehabilitation, and translate new knowledge on a global scale. The participation concept is complex and heavily influenced by a child's context. Therefore, effectively capturing the participation concept requires valid, reliable, and culturally sensitive participation-focused measures. This perspective paper proposes a structured process for culturally adapting measures of participation for children and youth with disabilities. Elements of the Applied Cultural Equivalence Framework and Beaton and colleagues' six-step process were used to create a guiding process for culturally adapting a Participation and Environment Measure (PEM) while drawing on two distinct cultural contexts. This process included forward and back language translations, and semi-structured cognitive interviews, to develop adapted versions of the PEM that are ready for psychometric validation. Common challenges to culturally adapting PEM content and administration are identified and methodological strategies to mitigate these challenges are proposed. The proposed process can guide rehabilitation specialists and researchers in adapting participation measures that are suitable for their culture. Such a process can facilitate scalable implementation of evidence-based tools to support participation-based practice in the rehabilitation field. The use of a systematic process can harmonize efforts by rehabilitation researchers and service providers to effectively culturally adapt pediatric participation measures to optimize its impact for culturally sensitive research and practice targeting participation. Two distinct, yet complementary, illustrative exemplars showcase the range of considerations and strategies, such as by conducting consecutive rounds of cognitive interviews, when teams use this systematic process to cultural adapt a pediatric participation measure. The systematic process outlined in this paper promotes rigor in achieving all elements of cultural equivalency, when feasible, to best ensure that the participation measure is suitable for use in the target cultural context. [ABSTRACT FROM AUTHOR]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

Communication between patients and clinicians influences the development of therapeutic relationships. Communication is disrupted when the patient has communication impairments after stroke. However, how these communication disruptions influence therapeutic relationships is not well-understood. This qualitative metasynthesis explores the perspectives of people with communication impairment to understand how interpersonal communication influences therapeutic relationships. Four databases were searched for qualitative studies which discussed how communication influenced therapeutic relationships from the perspectives of people with aphasia, dysarthria or apraxia of speech. Additional papers were identified through citation searching and subject experts. Nineteen eligible papers were included and analysed using thematic analysis. Four themes were constructed from the analysis: (1) Relationships provide the foundation for rehabilitation; (2) Different relational possibilities arise from "reading" the clinician; (3) Creating therapeutic relationships through validating interactions and connections; and (4) Creating therapeutic disconnections through invalidating, exclusionary interactions. A therapeutic relationship develops, at least in part, in response to the clinician's communication and how this is received and experienced by the patient. Understanding the characteristics of relationship-fostering communication and knowing how communication influences relationships can help clinicians critically reflect on their communication and better develop therapeutic relationships with people with communication impairment. Practitioner-patient communication can facilitate therapeutic relationships or create therapeutic disconnections. Communication patterns that are commonly evident when a patient has communication impairments can impede therapeutic relationships. Clinicians need to attend to how their communication is received and how it influences people's sense of self. Communication partner training should address the existential and relational needs of people with communication impairment after stroke. [ABSTRACT FROM AUTHOR]

Article 12 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) emphasises full and equal legal capacity of all citizens to participate in decisions. This paper examines whether the principles of Article 12, also reflected in other reform documents, were evident within 12 guardianship hearings conducted in Victoria, Australia from 2001 to 2016 involving adults with cognitive disability. The issues this study raises resonate loudly across the globe as multiple signatory nations to the CRPD grapple with the complexities of implementing Article 12. Reports of VCAT decisions with written reasons of Guardianship List hearings from 2001 to 2016 were selected from the Australasian Legal Information Institute site and analysed thematically. Thematic analysis of proceedings revealed three consistent trends. Firstly, a presumption of incapacity based on disability excluded Proposed Represented Persons (PRP) from involvement in decision-making. Secondly, external perceptions of PRPs best interest were dominated by safeguarding concerns and conflict between supporters. Finally, in multiple cases, although a PRP's preference had been established, it was considered immaterial to the final decision. The paper concludes with a promising discussion of the new Guardianship and Administration Act 2019 (Vic), which came into force on 1 March 2020, and recommendations for guardianship practice both locally and internationally. Legal capacity should be recognised as inherent in all people, and therefore decision making incapacity should not be assumed based on a person's cognitive and/or communication disability; The supported decision making mechanisms, born from Article 12 of the CRPD, that facilitate acknowledgment, interpretation and acting upon a person's expression of will and preference need to be recognised and promoted within the context of Guardianship proceedings and by health professionals when assessing decision making capacity of people with cognitive disability; Significant knowledge and attitudinal changes are required within the Tribunal and incorporated into the practice of health professionals informing the Tribunal, in order to counter many conceptual underpinnings embedded within current guardianship legislation across the globe; Ascertaining the will and preference of the proposed represented person should be prioritised by Guardianship tribunal members' rather than the management of conflict between interested parties. [ABSTRACT FROM AUTHOR]

To identify the definitions of a fall, faller classifications and outcomes used in prospectively-recorded falls research among people with Multiple Sclerosis (MS). A systematic review of peer-reviewed journal articles was conducted using electronic databases. Relevant data were extracted by one reviewer and verified by a second independent reviewer. Twenty-six papers met the inclusion criteria. A relative degree of heterogeneity existed amongst studies for the outcomes of interest to this review. Thirteen different fall definitions were identified. Fourteen different falls outcomes were used across the included studies, with six of these reported by only one study each. Data regarding injurious falls were presented by only eight papers. The majority (n = 17) of papers classified individuals as a faller if they fell at least once. This review highlights the large variation in fall definitions, faller classifications and outcomes used in this research field. This hinders cross-comparison and pooling of data, thereby preventing researchers and clinicians from drawing conclusive findings from existing literature. The creation of an international standard for the definition of a fall, faller classification and falls outcomes would allow for transparent and coordinated falls research for people with MS, facilitating progression in this research field. Falls are a common occurrence among people with Multiple Sclerosis (MS) resulting in numerous negative consequences. There is large heterogeneity in the definitions, methods and outcomes used in falls research for people with MS. This lack of standardisation prevents the accurate cross-comparison and pooling of data, impeding the identification of falls risk factors and effective falls prevention interventions for people with MS. Consequently, clinicians should interpret the outcomes of falls research for people with MS with caution, particularly when comparing studies regarding falls risk assessments and falls prevention interventions for use in clinical practice. [ABSTRACT FROM AUTHOR]

A randomised controlled trial (RCT) of a mindfulness-based yoga program, MiYoga, for cerebral palsy (CP) demonstrated improved attention in children and decreased mindfulness in parents post-intervention. This paper evaluates the retention of treatment effects at 6-months follow-up. 42 children with CP and their parents participated in a RCT with two groups MiYoga (n = 21) and Waitlist control group (n = 21). Waitlist control participants were offered MiYoga following the post-intervention assessment. 23 out of 42 child-parent dyads from both groups completed follow-up assessment 6-months after completing MiYoga. This paper evaluates and reports data from both groups collapsed (n = 23; MiYoga n = 11; and waitlist control n = 12; 47.8% male; mean age = 9:10 ± 2.4 years) to assess retention from post-MiYoga to follow-up and pre-MiYoga to follow-up. The primary outcome was attention, measured by Conner's Continuous Performance Test II (CCPT). Secondary outcomes included child executive function, physical function, behaviour, quality of life, child and parent mindfulness, personal wellbeing, psychological wellbeing and parent-child relationship. Paired t-tests showed no significant changes between post-MiYoga to follow-up and pre-MiYoga to follow-up for variables that showed an intervention effect immediately after MiYoga, namely, children's attention variables and parent's mindfulness. Paired t-tests showed that children's executive function and physical function and parent's wellbeing improved significantly from pre-MiYoga to 6-months follow-up which may potentially reflect sleeper or delayed effects of MiYoga. This study identified possible delayed or sleeper effects in children's executive function and physical function and parent's well-being. 6-month follow-up evidence for retention of effects of MiYoga on children's attention was inconsistent; therefore, booster sessions or continued practice of MiYoga as a lifestyle option are needed to maintain an effect on attention. Because MiYoga can be practised during daily activities, it may provide additional support for children with CP, complementing standard rehabilitation options. By embedding mindfulness in children and parents' daily activities, MiYoga, could provide families with accessible and time-efficient means of learning and practicing mindfulness. [ABSTRACT FROM AUTHOR]

To identify and appraise the existing clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of adult and paediatric focal spasticity to generate a single synthesized guideline. Systematic review of 12 electronic databases. Clinical practice guidelines, consensus statements and Cochrane systematic reviews for focal spasticity in adults and children. Included studies were appraised according to the AGREE II criteria. A total of 25 papers were included in this review, comprising 12 clinical practice guidelines, nine consensus statements and four Cochrane systematic reviews. The areas most strongly endorsed were: (1) management to be provided by a multi-disciplinary team, (2) therapy should be goal-directed, (3) goals to be developed in conjunction with the patient and family, and (4) importance of follow-up evaluations. There was a greater focus on activity outcomes and classification in the paediatric papers. The guidelines varied considerably in their quality, with AGREE II scores ranging from 52.8 to 97.1%. This systematic review has synthesized the key elements regarding principles of focal spasticity management, outcome measures, physical interventions and educational recommendations into a single, readily applied guideline available for clinical use. Despite considerable variability in the quality of the guidelines, several strong themes emerged. Focal spasticity management should be multi-disciplinary, patient-centred and goal-directed. Routine measurement of impairment and activity are strongly endorsed. Botulinum toxin A injection should only be provided as part of an integrated approach to focal spasticity management. [ABSTRACT FROM AUTHOR]

Co-creation is identified as a concept with potential to address many challenges in modern healthcare systems. Its application within stroke rehabilitation is yet to be reviewed. The purpose of this paper is to identify when and how co-creation has been used in the literature to develop services and approaches to stroke survivor care and rehabilitation. A scoping review was conducted guided by the framework outlined by Arksey and O'Malley. Articles were included if they involved co-creation with stroke survivors and identified co-creation as their methodology to develop post-stroke services. Quality appraisal of included articles was completed. The search strategy identified 565 articles. Fourteen articles met inclusion criteria. The results demonstrate that co-creation as a methodology to develop stroke rehabilitation services is a contemporary field, producing both technology and non-technology-based interventions, predominately in the community context. Co-creation application was inconsistent, with a plethora of methodologies used, and terminology to describe co-creation varying between the studies. Co-creation in stroke rehabilitation is currently in an expanding and rudimentary phase. This review identified the variability of its application, with future work needed to establish clarity and consistency in terminology and methodologies utilised to operationalise co-creation in stroke rehabilitation. Co-creation is a contemporary and evolving service improvement approach in stroke rehabilitation, utilised most commonly in the community context. Inconsistent terminology and diverse methodologies are utilised to enact co-creation in stroke rehabilitation. Opportunities exist to advance co-creation in the stroke rehabilitation space through developing consistency in its application, and further investigation into its use with the stroke survivor population. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to share insights from an ongoing project that seeks to promote physical activity to disabled people. Narrative commentary. An overlooked yet important group of messengers for promoting physical activity is first highlighted. These are social workers. Second, the process of developing guidelines for these messengers is described and the guide signposted. Third, an infographic to communicate physical activity is highlighted and insights offered on some of the messages co-produced in it. These messages include a focus on pleasure, amounts of physical activity, strength, sedentariness, visual images, language, and different impairments. The paper contributes to knowledge by offering new insights into how to promote physical activity to disabled people. A new group of messengers – social workers – for promoting physical activity to people with disabilities is highlighted. A guide for social workers to promote physical activity is described and offered. Insights for health promotion is offered on the co-production of physical activity messages. [ABSTRACT FROM AUTHOR]

This paper outlines the first steps toward developing the ICF-based assessment schedule for manual medicine with a focus on low back pain (LBP). It reports on the results of a consensus process to develop the default and optional versions of the set of ICF categories (ManMed Set) the assessment schedule should cover, and gives insight in expert input toward building a toolbox of instruments for assessing the ManMed Set categories. A scoping review and qualitative study were conducted, each resulting in a list of ICF categories. These categories, along with the categories of the ICF Generic-30 Set, Comprehensive ICF Core Set for LBP, and from an existing Delphi study, served as the starting point for an established consensus process to decide on the ManMed Set. After alternating plenary and working group sessions, an iterative ranking process and cut-off calculation, the multi-professional and international group of 20 experts in manual medicine included 23 categories in the default ManMed version (16 + the ICF Generic-7 Set categories) and 25 in the optional version. Their development is a major step toward developing an assessment schedule that can be employed in standardizing the assessment and reporting of functioning in manual medicine, initially of LBP patients. The ICF assessment schedule for manual medicine has potential use in supporting rehabilitation practice, such as for planning interventions, defining rehabilitation goals, and measuring and documenting functioning outcomes. It can be used to promote interdisciplinary coordination of care and facilitate communication between members of a multidisciplinary rehabilitation team within manual medicine and beyond. The ICF assessment schedule for manual medicine can facilitate rehabilitation and manual medicine research by providing evidence for optimizing rehabilitation practice. [ABSTRACT FROM AUTHOR]

Little research has explored the process of disclosure decision-making from antecedents to outcomes. This paper presents a model of decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace shortly after starting a new job. A qualitative descriptive design was employed to explore participants' experiences of the disclosure decision-making process, the disclosure event itself (if applicable), and their perceptions of the impact of the decision on personal, interpersonal, and organizational outcomes. The transcripts were coded and analyzed using directed content analysis. Twenty-eight participants were purposively selected to represent different disclosure decisions, sex, diagnoses, and maintenance of employment. Analysis identified goals and conditions/context were important antecedents for the disclosure decision. All participants discussed concerns about prejudice and discrimination if they disclosed, and, for those who chose to disclose, high stress and anxiety were described during the disclosure event; however, supervisor reactions were generally described as positive. Regardless of the disclosure strategy adopted, participants reported that their disclosure decision helped to support their self-acceptance and recovery. For those who disclosed, most perceived a positive response by their supervisor. However, the pervasive concerns of prejudice indicate there is still much work to be done. Decision-making about disclosure of a mental health condition to the immediate supervisor in the workplace is a complex process. Disclosure goals, the relationship with the supervisor and the workplace context are important antecedents to the disclosure decision. Careful consideration should be given to the planning of disclosure, particularly related to what information will be shared, how it will be shared, and an appropriate level of emotional content to enhance the likelihood of a positive response from the supervisor. Disclosure planning should take the supervisor's style and organizational norms into account. [ABSTRACT FROM AUTHOR]

In the field of pediatric concussion, little to no scholarship has examined how clinical practice is shaped by patterned ways of thinking, talking about, and coming to understand concussion and young people (or "discourses of concussion in young people"). In this paper, we examine the ways in which one such discourse, the Pediatric Concussion Discourse (PCD), shapes how young people with concussion, their parents, and clinicians can think about, act in relation to, and experience concussion. This critical rehabilitation research is informed by the post-structuralist theory of Michel Foucault (1926-1984), and the key concepts of power/knowledge, discourse, and the subject. Circulating through clinical guidelines for the management of pediatric concussion, the PCD re/produces the expectation that young people with concussion and their parents will behave as "responsible" subjects who follow the recommendations of so-called experts without question. If recommendations are not implemented, the PCD has the potential to constitute these same groups as "nonadherent", re/producing problematic discourses of medical compliance. By examining the effects of the PCD, it becomes possible to imagine how clinical practice and research might evolve in new ways that respect the knowledges and experiences of young people with concussion and their parents. Engaging in critical examination of clinical rehabilitative practice creates opportunity to imagine how we might approach commonly adopted clinical approaches, including the delivery of health education, differently. Implications for clinical rehabilitation practice include delivering health education in the context of supportive therapeutic relationships that respect the knowledges and experience of young people with concussion and their parents. Implications for rehabilitation research include engaging with critical scholarship within and beyond field and disciplinary boundaries, engaging in formal educational opportunities, and connecting with less formal but invaluable communities of practice. [ABSTRACT FROM AUTHOR]

This paper provides recommendations for neurorehabilitative research informed by insights from critical disability studies (CDS) and a research study that tested an augmented neurorehabilitative technology prototype. The methodology combines critical reflection, feminist science studies and CDS to analyze how neurorehabilitation and disability studies conceptualize notions of disability and cure. It offers recommendations for reconciling the conflicting ideologies of cure that operate within neurorehabilitative research. The prototype acted as a kind of virtual reality hope machine that tapped into different emotions and language games regarding disability and cure. The result is five recommendations about the ways that a CDS perspective might inform neurorehabilitation research: (I) ensure clarity in recruitment materials to account for dominant social views on disability and the possibility of cure; (II) build "strong objectivity" into research methods through attention to social context and multiple meanings of terms; (III) engage in critical reflection about research processes and findings; (IV) incorporate principles of crip technoscience; and (V) include CDS perspectives in neurorehabilitation education. Bridging a conversation between neurorehabilitative research and CDS can address the discrepancies between ideologies of cure, and situate rehabilitation within the wider concerns of social determinants of health and disability justice. Bridging connections between rehabilitation studies and critical disability studies can generate productive insights that open up conversations with disabled people and a commitment to disability justice. Disability and cure are social constructs and may have different meanings for patients and rehabilitation professionals. Clinicians should be mindful of the conflicting ideological constructs and socio-political dimensions of disability and cure that are operating below the surface in the rehabilitation profession and in interactions between clinicians and patients. As technology continues to transform clinical rehabilitation care through virtual reality and other innovative paradigms, rehabilitation clinicians should recognize the potential for these technologies to become "hope machines," generating patient expectations that are idealized constructions of hoped-for outcomes of returning to a previous state or level of functionality rather than predictive expectations of likely results. [ABSTRACT FROM AUTHOR]

Purpose: The "Joint Resources – Sedentary Behavior Study" (JR-SB) revealed significant behavioral and cardio-metabolic effects of reducing daily sedentary behavior replaced by light-intensity physical activity in patients with rheumatoid arthritis. This study explores the participant perception and experiences of the intervention and impact on the participants' health, family and physical activity behavior. Materials and Methods: A mixed-methods study design, including quantitative and qualitative data, was applied. Quantitative data were collected post-intervention using a questionnaire (n = 69) evaluating experiences of participation in the intervention. By maximum variation sampling, 18 participants were recruited to three focus group interviews with discussions of intervention elements. Data from the two sub-studies were collected and analyzed separately, although integrated at the interpretation and reporting level. Results: Based on four overarching themes, results indicated participant satisfaction with the individually tailored, behavioral approach and the focus on light-intensity physical activity rather than higher intensities. Study participation had an additional positive impact on the behaviors of family and social relations. Conversely, the family motivated the participants to achieve their physical activity goals. Conclusions: The study results support the use of individually tailored and behavioral approaches to reduce sedentary behavior, increase light-intensity physical activity and improve physical abilities in patients with rheumatoid arthritis. This paper presents positive participant perception and motivation for an individually tailored, behavioural intervention that aimed to reduce sedentary behaviour replaced by light-intensity physical activity in patients with rheumatoid arthritis. The results indicate that especially the focus on light-intensity physical activity, a consistent focus on the individual's everyday life and continuous support from health professionals motivated the participants to reduce their daily sedentary behaviour – also in the long term. Involvement of participants' family members seems to have influence on their own physical activity behavior as well as on the participants' motivation for changing physical activity behavior. Together with earlier evidence, the results underpin the use of behavioural strategies to support patients with rheumatoid arthritis in achieving their physical activity goals and in improving the abilities needed to manage their everyday lives. [ABSTRACT FROM AUTHOR]

The Cumberland Ankle Instability Tool is a common patient reported outcome used to assess those with Chronic Ankle Instability. However, paper versions of the Cumberland Ankle Instability Tool have only been assessed for reliability purposes. The purpose of this study was to assess the agreement and reliability of a digital version of the Cumberland Ankle Instability Tool-Digital. Sixty-eight participants with a history of ankle sprain(s) were recruited to participate in this study. Participants completed a paper version of the Cumberland Ankle Instability Tool and a digital version then returned one week later and completed them again. Intraclass correlation coefficients (ICC) and Kappa coefficients were used to determine the agreement between the paper and digital versions as well as test-retest reliability between the two time periods. The digital version showed excellent reliability (ICC = 0.93, 95% CI: 0.89–0.96) with the paper version. The test-retest reliability between testing sessions was considered good (ICC = 0.86, 95% CI: 0.77–0.92). A majority of individual items on the digital version demonstrated substantial agreement (κ = 0.60–0.81) with the paper version. A digital version of the Cumberland Ankle Instability Tool demonstrated good to excellent psychometric properties. Clinicians who utilize a digital version as part of an electronic medical record system can utilize them confidently to accurately assess patients with Chronic Ankle Instability. Future studies may want to consider assessing a digital version with expanded clinical and research populations. The digital version of the Cumberland Ankle Instability Tool demonstrated adequate psychometric properties. The digital version of the Cumberland Ankle Instability Tool can be considered a reliable instrument for the assessment of Chronic Ankle Instability. A digital version of the Cumberland Ankle Instability Tool can provide automated scoring and quick administration for clinicians in a rehabilitation setting. [ABSTRACT FROM AUTHOR]

Joubert Syndrome (JS) is a rare inherited neurodevelopmental disorder defined by a characteristic cerebellar and brainstem malformation (i.e. the molar tooth sign) and variable organ involvement. The aim of the present study was to describe functional limitations and disabilities in a large sample of adult patients with a diagnosis of JS. We administered the International Classification of Functioning (ICF) checklist to thirty-six adult Italian patients with JS or their caregivers through telephone calls. None-to-mild impairment was documented for basic cognitive and mental functions, whereas severe deficit emerged for higher-order skills and language. A mismatch between individuals' capacity for daily activity and social participation and the actual performance in these fields emerged, suggesting that adults with JS may greatly benefit from external support from the caring environment. Indeed, specific facilitators were highlighted, including communication technologies as well as family members, healthcare professionals and peers support. Mild-to-severe barriers have been identified by adult patients with JS in the domains of services, systems and policies. These findings highlight challenges and barriers for adults with JS in areas of daily functioning that may be improved by investing in rehabilitation care models that embed social support programs and policies into clinical interventions. Children with Joubert Syndrome, a child-onset rare inherited neurodevelopmental condition, are growing up and becoming adults; a life course approach in rehabilitation is needed; There is a substantial lack of information on the long-term adaptive daily functioning of children with a diagnosis of Joubert Syndrome; In this paper, the International Classification of Functioning (ICF) was applied to assess the daily functioning in people with JS; Severe deficits emerged for high-order skills and language, whereas the use of communication technologies and the engagement of family members were highlighted as key facilitators; These findings highlight the need for a change of paradigm in the care model of subjects with JS, with the embedding of social support in rehabilitation programs. [ABSTRACT FROM AUTHOR]

To summarise the range and nature of decision-making aids that guide upper limb (UL) neurorehabilitation. Our scoping review followed Arksey and O'Malley's 6-step framework. Electronic databases were systematically searched; grey literature was hand-searched. Included papers were: (1) published in English; (2) related to UL rehabilitation for people with upper motor neuron conditions; and (3) provided a description of, or research on, a decision-making aid that guides therapists when choosing between two or more intervention approaches, techniques, or applications of a technique. Levels of evidence were rated. An expert panel of occupational therapists working in UL neurorehabilitation was consulted. The 24 included articles described 15 decision-making aids with varying breadth and depth of the assessment process and suggested interventions. Six aids had published research, but lacked high quality evidence. The expert panel identified four key decision-making aids as being clinically useful. Preferred aids either included client-centred goal-setting within a holistic assessment or matched specific intervention options to distinct UL assessment results. Prompts to re-evaluate client performance are desirable. Few decision-making aids guide therapists to holistically assess and make specific intervention decisions across all domains of UL neurorehabilitation. Their usefulness depends on the purpose, setting, and therapist experience. Considering the complexity and heterogeneity of upper limb (UL) neurorehabilitation, a selection of evidence-based and purpose-designed decision-making aids may assist therapists across different experience levels and practice settings to choose individualised interventions. Decision-making aids for UL interventions in neurorehabilitation may be more clinically useful if they include a holistic and client-centred information gathering process that focuses on daily life goals. Decision-making aids should illustrate a clear clinical picture based on UL assessment results, with corresponding UL intervention recommendations provided. Inclusion of a cyclic process to re-evaluate client performance and function could also enhance the usefulness of a decision-making aid. [ABSTRACT FROM AUTHOR]

Individualized funding of disability support services has implications for people's choices about when to share their home. This paper examines how people with disabilities made choices about who to live with and the factors influencing these choices. This paper discusses data from interviews with 30 people with mostly intellectual disabilities using individualized support services, 21 interviews with family members, four interviews with service managers, and a focus group with five support workers. The data come from a large evaluation of individualized housing support programs in New South Wales, Australia. Only some people had the opportunity to choose whether to share and with whom. Their choices were constrained by the range of housing options and their limited experience of them, even when they had support to make choices about shared housing or living alone. In some cases, the choices reflected a conceptualization of people with disabilities as different to other citizens in their rights and expectations about their social arrangements. The results have implications for information sharing, housing stock, and the need to challenge the positioning of people with disabilities relative to other people regarding choices about where and with whom to live. Many people preferred not to live alone, so as to improve their economic and social circumstances, and their choice and control. The choices about shared housing that many people and their supporters made were constrained by their limited experience of housing options or their familiarity with the range of choices made by other people with disabilities. Being able to draw on the material, social, and information resources of family made a big difference to their housing choices. It raises questions for policy implementation about whether individualized support may lock some people into shared housing arrangements by failing to include housing costs in the individual package. [ABSTRACT FROM AUTHOR]

To examine the effects of an Arabic smartphone application on adherence to home exercise programs (HEPs) and the effectiveness of mobile-based HEPs on pain, physical function, and lower-limb muscle strength among older women with knee osteoarthritis (OA). This randomised control trial (ClinicalTrials.gov: (NCT04159883) enrolled 40 women aged ≥50 years with knee OA who were randomised into the app group (experimental; n = 20) receiving HEPs using an Arabic smartphone application called "My Dear Knee", whereas the paper group (control; n = 20) receiving HEPs as hand-outs. Both groups had the same exercise program. Outcome measures were self-reported adherence, changes in the Arabic Numeric Pain Rating Scale, the Arabic version of the reduced Western Ontario, McMaster Universities Osteoarthritis Index-Physical Function subscale, and Five-Times Sit-To-Stand Test scores. All participants were assessed at baseline, at week 3 and week 6. Using completer-only analyses, the repeated measures ANOVA was used to compare the means of the outcome measures between the two groups. At the end of week 6, the app group reported greater adherence to HEPs (p =.002) and significant reduction in pain (p =.015). A smartphone application with motivational and attractive features could enhance adherence to HEPs in this patient cohort. Older adults with knee OA may face many obstacles that prevent or limit their adherence to the prescribed HEP. Smart device apps supported with attractive and motivational features could be an effective strategy to enhance adherence to HEPs among older adults with knee OA. Using such remote technology appears to overcome the barriers that may limit the ability of older women to receive supervised physical therapy in a clinical setting. [ABSTRACT FROM AUTHOR]

The Complex Audio Visual Emotion Assessment Task (CAVEAT) is a measure of emotion recognition using dynamic, naturalistic videos to assess recognition of 22 different emotional states (11 positive, 11 negative). It has established construct validity and demonstrated sensitivity to emotion perception impairments in those with moderate-severe traumatic brain injury (TBI). Despite this, its lengthy administration has limited its use in clinical practice and rehabilitation. The current paper aimed to develop shortened versions of the CAVEAT and examine their psychometric properties. The CAVEAT-S A and CAVEAT-S B (22 items each) and the CAVEAT-S AB (44 items) were developed using the original data. Comparability, reliability, construct and predictive validity were examined in the original sample (Study 1: 32 people with TBI and 32 demographically matched control participants) and a replication sample (Study 2: 18 adults with TBI and 21 demographically matched controls). All short forms produced comparable accuracy ratings to the full measure, as well as discriminating between people with or without a TBI. Shortened forms all correlated with other measures of emotion perception and social cognition and also predicted psychosocial outcomes in terms of self-reported interpersonal relationships. Internal reliability of the short forms was low relative to the longer forms, especially for the two very short measures. The new shortened forms of the CAVEAT are promising tools that are sensitive and valid for assessing emotion perception in people with TBI for clinical purposes. Their application in other clinical disorders is yet to be examined. Emotion perception deficits are present in many clinical populations and an important target for rehabilitation. CAVEAT Short provides ecologically valid emotional stimuli. Such stimuli are important for assessing real world function and to set rehabilitation targets. By having parallel versions of CAVEAT, there is the opportunity to test pre and post intervention while minimising practice effects. Alternatively, one version of CAVEAT-S can be used for assessment, while the other is used for training purposes during remediation. [ABSTRACT FROM AUTHOR]

To evaluate the usability and acceptability of the Mental Capacity Assessment Support Toolkit (MCAST) in healthcare settings and whether its use was associated with increased legal compliance and assessor confidence. A mixed methods convergence triangulation model was used. Multidisciplinary professionals used the MCAST during mental capacity assessments for UK hospital patients with diagnoses of stroke or acute or chronic cognitive impairment. Changes in legal compliance were investigated by comparing scores on case note audits before and after implementation of the MCAST. Changes in assessor confidence and professionals' perceptions of the MCAST's usability and acceptability were explored using surveys. Patients' and family members' views on acceptability were determined using semi-structured interviews. Data were integrated using triangulation. Twenty-one professionals, 17 patients and two family members participated. Use of the MCAST was associated with significant increases in legal compliance and assessor confidence. Most professionals found the MCAST easy to use and beneficial to their practice and patients. Patients and family members found the MCAST materials acceptable. The MCAST is the first toolkit to support the needs of individuals with communication disabilities during mental capacity assessments. It enables assessors to deliver high quality, legally compliant and confident practice. Mental capacity assessment practice needs to be improved to maximise patient autonomy, safety and well-being. The MCAST is a paper-based toolkit designed to facilitate and improve mental capacity practice in England and Wales. This study suggests the MCAST would be easy and acceptable to use in healthcare settings and could lead to improvements in assessment quality and assessor confidence. [ABSTRACT FROM AUTHOR]

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care's core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question. Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of "diffractive" analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members' diverse experiences, traditions, and epistemological commitments, we engaged with data from nine "care events" generated in previous research to interrogate the multiple forces that co-produce care practices. Results: We map our analyses under three categories: scripts mediate practice, securing compliance through "benevolent manipulations", and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one's expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care. Determinations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics. Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters. Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or person-centered care cannot be determined in advance. "Tinkering" is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care. [ABSTRACT FROM AUTHOR]

Purpose: There is a growing movement in pediatric rehabilitation to understand how approaches addressing aspects beyond body function contribute to enhanced psychosocial well-being. Among such approaches is the use of creative arts. A scoping review was undertaken to synthesize the current literature on performance and visual arts-based programs and outcomes for children with disabilities. Methods: Data sources included CINAHL, MEDLINE, and PsycINFO. Eligible articles described programs involving performing or visual art activities in community and ambulatory care settings, delivered to children between 6 and 18 years with physical or developmental disabilities, and reported on at least one psychosocial outcome. Domains of interest included emotional, social, behavioral, physical, cognitive, and/or communicative functioning, which are known to impact well-being and participation. No limits were applied to study design. Results: Twelve articles using primarily case study and quasi-experimental designs were identified, encompassing an 11-year period. Most programs focused on theater as the central modality. A majority of papers addressed changes in physical, cognitive, and communicative function (n = 8), followed by social function (n = 6), emotional function (n = 5), and finally, behavioral function (n = 3). Across individual papers, diverse study designs, measures, and outcomes were examined with positive qualitative and/or quantitative findings noted across all domains. Conclusions: Within an emerging evidence base, arts-based programs show potential to positively impact psychosocial well-being and warrant further investigation with broader populations of children with physical and developmental disabilities. A greater emphasis on programmatic approaches and enhanced methodological rigor to establishing benefits is needed to advance understanding. Pediatric therapists may wish to consider recommending arts-based programs for children with ASD, TBI, and other developmental disabilities given their potential in achieving psychosocial outcomes Arts-based programs in rehabilitation provide creative ideas (e.g., drawing, painting) and techniques (e.g., modeling, role-play), which may be incorporated into individualized or group-based therapy to promote psychosocial well-being Program evaluators and researchers are encouraged to adopt a programmatic approach to further explore how art activities facilitate psychosocial outcomes [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this scoping review were to summarize, understand, and disseminate findings from a broad body of literature on rehabilitation interventions used with survivors of head and neck cancer. Method: Searches were conducted in six databases. Inclusion criteria were studies of adult head and neck cancer survivors with a predefined primary rehabilitation outcome as a result of an intervention. Excluded were studies not written in English, opinion papers, or studies where the intervention was not carried out by a rehabilitation healthcare service. A second level, full-text review of the studies was conducted. A thematic analysis was used to examine and combine study findings. Results: A total of 3804 results were retrieved from all sources resulting in 39 papers that were analyzed. The thematic analysis of the included papers represented interventions focusing on swallowing and nutrition, speech, physical therapy, assistive devices, complementary and alternative modalities, comprehensive interdisciplinary programs, and preventive rehabilitation programs. Conclusion: This review has provided an overview of the scope of rehabilitation interventions available for survivors of head and neck cancer and preliminary information about their efficacy. This is foundational information for the development and refinement of rehabilitation interventions and programs for head and neck cancer survivors. The existing evidence suggests that survivors of head and neck cancer can benefit from early screening of potential rehabilitation needs and being involved in preventive rehabilitation programs pre-surgery when possible. Rehabilitation programs should consider swallowing interventions for patients as evidence reports improved swallowing function, decreased pain and discomfort, and reduced duration of feeding tube use. Rehabilitation programs should consider nutritional interventions after radiotherapy: Patients benefited from stabilized weights, improved nutritional status, and an improved quality of life. Physical exercise interventions demonstrated improvements in physical function, muscular endurance, range of motion, overall quality of life, and showed reductions in pain, and fatigue. [ABSTRACT FROM AUTHOR]

Among people with physical disabilities, one of the most frequently-cited barriers to physical activity participation is a lack of basic information on what to do. Likewise, rehabilitation professionals often cite a lack of knowledge about what to recommend or prescribe, as their primary reason for not promoting physical activity to clients with disabilities. The development and implementation of disability-specific physical activity guidelines are important steps toward addressing informational barriers. This paper describes the reasoning behind disability-specific physical activity guidelines, the gold-standard process used to develop disability-specific guidelines for people with spinal cord injury and multiple sclerosis, and the "who, what, and how" of behavioural interventions and messaging to support people with disabilities in achieving physical activity guidelines. Not Applicable. Not Applicable. The needs, values and preferences of people with disabilities must be taken into consideration when undertaking a disability-specific guideline development process. Guidelines can play an important role in physical activity promotion, but behavioural and other interventions are required to address the myriad physical activity barriers faced by people with disabilities. People with and without disabilities can achieve significant fitness and health benefits from activity well below the WHO's 150 minutes/week guideline. Disability-specific physical activity guidelines can alleviate informational barriers for people who want to get active and rehabilitation professionals who want to promote physical activity. Behavioural and other interventions are needed to support people's efforts to achieve physical activity guidelines. A physiotherapist-delivered intervention has shown promise for increasing physical activity in adults with a physical disability. [ABSTRACT FROM AUTHOR]

This two-year (2016–2018) study aimed to identify what a good life is for Aboriginal people with disability in remote Central Australia and how service providers can support them to achieve a good life. This paper presents the findings that relate to barriers to delivering services for Aboriginal people with disability. In-depth interviews and focus groups were held with Aboriginal people with disability and their carers aged at least 18 years from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Lands and community organisations providing services there. The data were analysed using thematic analysis. There were 109 participants, of whom 47 were workers in service provider organisations and 62 were Aboriginal people. From the data, barriers to delivering services to support Aboriginal people to live a good life and solutions to overcome the barriers, were identified and described under the headings of environmental barriers and systemic issues. We discuss the policy implications of these findings with regard to addressing Indigenous disadvantage and how governments, service providers, communities, and Aboriginal people with disability and their families can work in partnership to address these barriers. Indigenous people with disability living in remote and very remote communities experience significant access and equity barriers to culturally responsive services that enable them to live a socially and culturally engaged life. Localised government and service provider disability policy approaches in Indigenous communities need to focus on both environmental and systemic issues. Greater investment in local remote communities is required to build the capacity of Indigenous families to support Aboriginal people with a disability to live a culturally and socially included life. [ABSTRACT FROM AUTHOR]

Despite the importance of the stigma construct for the rehabilitation of people with severe mental illness, there are still no scales that offer a measurement for public stigma in Spanish with good psychometric properties. The aim of this paper is to refine and improve an existing scale to measure public stigma towards people with severe mental illness among the Spanish population. We also intended to decrease the number of items in order to facilitate its applicability. 402 college students (73% women) responded to the attributional questionnaire (AQ27) in two subsamples. Exploratory and confirmatory factorial analysis with high cutoffs were conducted. The convergent validity with the resource allocation questionnaire was also tested. We have obtained a parsimonious tool, with 14 items and four factors, and some reliable psychometric indexes and convergent validity. The factors obtained were dangerousness-fear, lack of solidarity, coercion and avoidance. These results improve the findings from other studies that try to validate the AQ27 in other languages. We discuss the different factors that should be considered in the estimation of public stigma and the necessity to implement programmes to reduce it to enable recovery. Since the public stigma of mental illness is an obstacle to recovery and rehabilitation, reliable instruments are needed to assess it. A parsimonious instrument in Spanish with good psychometric characteristics for measuring public stigma is obtained. Using exploratory and confirmatory factor analysis, a questionnaire of 14 items is obtained. Four factors constitute the instrument: "dangerousness-fear", "coercion", "lack of solidarity", and "avoidance". [ABSTRACT FROM AUTHOR]

Between 13 and 32% of children in developed nations are at-risk for developmental delays. In order to identify concerns, there is a need to understand the mechanisms that facilitate becoming aware of it. A scoping review was conducted to understand this process of "noticing", through existing literature on parent experiences. Records from major academic databases and grey literature sources were searched using key terms. Thematic analysis was then conducted to synthesise findings. Twenty papers meeting inclusion were identified. Noticing a delay was found to be an interplay between who notices – parents or other – and how they do so. How concerns are noticed was through two mechanisms: knowledge of child development, and comparison with other children. This review highlights the nuanced complexity of noticing concerns with a child's development. Understanding how this process occurs and the key ingredients that enable it is vital to supporting early detection of developmental delays. Noticing developmental delays is a complex process that evolves over time, derived of 'who' notices and 'how' this occurs. When asking parents about child development, professionals need to listen for both bolder "aha moments" as well as more subtle "niggling" comments as indicators of parental concerns. Building baseline parental knowledge of developmental milestones may facilitate noticing of atypical development. Encouraging parents to engage in social opportunities with other children promotes both positive child development and enables developmental monitoring through use of comparison. [ABSTRACT FROM AUTHOR]

Previous studies have shown that aerobic exercise with cycle ergometer improves motor control. The objective of this systematic review and meta-analysis are to evaluate evidence about the effects of aerobic exercise with cycle ergometer on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS), and functional capacity, evaluated by the maximal oxygen intake and six-minute walk test (6MWT). The research was conducted on MEDLINE, LILACS, Cochrane Library, EMBASE, Physiotherapy Evidence Database, and Google Scholar until March 2018 (CRD42015020146). Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was balance assessed by the Berg scale and the secondary outcome was functional capacity of the maximal oxygen intake and the 6MWT. Meta-analysis was conducted using a random-effects method, and mean pre-post intervention difference with a 95% confidence interval (95%CI). The review included 5 papers and a total of 258 patients. It was observed that the cycle ergometer did not improve balance in this population (0.03 [−0.57 to 0.64] p = 0.91) or functional capacity in maximal oxygen intake (2.40 [−0.24 to 5.04] p = 0.07) and 6MWT (−40.49 [−131.70 to 50.72] p = 0.38). The cycle ergometer aerobic exercise did not seem to improve balance or functional capacity in post-stroke patients. Aerobic exercise with cycle ergometer does not improve balance in patients after chronic stroke, but the results for functional capacity are more promising. Beneficial changes in functional capacity can be seen after 12–4 weeks of training, and are dependent on the initial level of physical fitness of each individual. The use of the cycle-ergometer to improve balance and functional capacity was not superior when compared to conventional physiotherapy; therefore, a combination of therapeutic modalities would be ideal for rehabilitation and post-stroke patients. [ABSTRACT FROM AUTHOR]

In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework. The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components. The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people. We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home. Falls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community. Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety. This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best. [ABSTRACT FROM AUTHOR]

An ageing population presents a challenge for municipal eldercare in Sweden due to difficulties recruiting staff and there being a strained economy. A strategy involving welfare technology is presented as one such solution. An important group to carry out this strategy involves those who work with welfare technology in municipal eldercare. In this paper we describe their perception of welfare technology, and the challenges and opportunities they perceive in utilizing it. A self-administered online questionnaire was distributed to all Swedish municipalities and answered by 393 respondents. Analyses show that the respondents were representative of the different professions who work with welfare technology within municipal eldercare. Welfare technology was perceived as being more reliable and safer than humans with regards to supervisions and reminders. The respondents acknowledged factors that slowed down the implementation of welfare technology in municipal eldercare organizations, such as resistance to change, lack of finances, lack of supporting evidence, lack of infrastructure, high staff turnover, difficulties with procurement and uncertainties about responsibility and laws. We found that the people who work with and make decisions about welfare technology in municipal eldercare organizations were generally very positive about the deployment and use of such technology, but there appear to be problems within municipal eldercare organizations to realize this vision. The lack of structured implementation processes and coherent evaluation models indicates inequality of the access to welfare technology and, as a result, even though Swedish eldercare is publicly funded, the availability of welfare technologies and their usage differ between municipalities. The research findings show that implementing welfare technologies in municipal eldercare must include transformed working processes and long-term strategies or they may lead to conflicts of priorities or unstructured implementation processes. Structured implementation processes and coherent evaluation models are needed for equality of access and availability of welfare technologies in municipal eldercare. High staff turnover negatively affects the deployment of welfare technology and the root cause of high staff turnover needs to be addressed. [ABSTRACT FROM AUTHOR]

Objectives: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, “What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?” Materials and methods: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Results: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Discussion and conclusion: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation: International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery. [ABSTRACT FROM AUTHOR]

Purpose: Many children with cerebral palsy (CP) are known to experience tactile impairments. Research evaluating specific interventions to manage this is, however, minimal. This paper seeks to consolidate current literature and provide a framework to help clinicians and researchers think strategically about tactile treatment selection and future research planning. Method: The framework is described via a novel analogy - “The Apartment Block Theory”. The theory describes the relative effectiveness of three intervention strategies aimed at overcoming a poorly responsive tactile system: (1) Pressing the buzzer - providing repeated passive tactile stimulation at the periphery; (2) Sneaking in the door - providing active tactile-enhanced motor training that capitalises on the opportunity to provide high-dose tactile input during motor interventions; and (3) Connecting another way - providing visually enhanced touch strategies with the aim of enhancing tactile function, which can be compared to phoning the apartment as an alternative to using the buzzer. Results: Using this theory, the paper describes which sub-groups of children with CP may benefit from each intervention strategy when considering their capabilities in visual, motor, and attention domains. Conclusions: This theory can assist clinicians to provide effective interventions and researchers to make informed future research decisions to optimise tactile function for children with CP. Implications for Rehabilitation: Although tactile impairments are reported to be common in children with cerebral palsy, very few successful interventions are reported in the literature. Visually enhanced touch is a successful strategy for treating tactile impairments in children with cerebral palsy who have sufficient vision and attention. Combining intentional tactile input with upper limb movement training may improve tactile function in children with cerebral palsy who have sufficient movement and attention. In children who have complex co-morbidities, including both visual and movement impairments, it may be necessary to consider providing passive tactile stimulation in tactile intervention. [ABSTRACT FROM AUTHOR]

Purpose: An evidence-practice gap exists between the amount of active practice recommended and the amount completed by stroke inpatients. The aim of this paper is to describe steps in the design of a participatory, theoretically tailored staff behaviour change intervention to help staff use strategies to increase active practice by stroke inpatients. Methods: A staff behaviour change intervention was developed in one rehabilitation unit in Queensland, Australia using a six-step process guided by the Behaviour Change Wheel framework. Mixed methods were used including direct observation (behavioural mapping), and focus groups to identify barriers and facilitators to implementation. Barriers and facilitators were mapped to the behaviour change techniques, and a behaviour change intervention developed in participation with rehabilitation staff. Results: Staff chose to implement ward-based practice books. Barriers included patient factors (including low motivation and severity of stroke), environmental segregation and limited skills for motivating patients. Staff belief in increasing active practice was a facilitator to implementation. The staff intervention included a training programme about motivation, environmental restructuring, audit, and feedback. Conclusions: This example of collaborative implementation research can be used and adapted by clinicians and researchers in other rehabilitation services. Rehabilitation staff can be actively involved in designing behaviour change interventions. Behaviour change interventions should target local barriers to increase activity levels and practice completed by stroke inpatients. The process of co-designing behaviour change interventions has the potential to improve the uptake of a strategy such as ward-based practice books, by more precisely identifying local barriers and possible solutions. [ABSTRACT FROM AUTHOR]