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Background: An increasing number of older people are living with chronic kidney disease (CKD). Many have complex healthcare needs and are at risk of deteriorating health and functional status, which can adversely affect their quality of life. Comprehensive geriatric assessment (CGA) is an effective intervention to improve survival and independence of older people, but its clinical utility and cost-effectiveness in frail older people living with CKD is unknown. Methods: The GOAL Trial is a pragmatic, multi-centre, open-label, superiority, cluster randomised controlled trial developed by consumers, clinicians, and researchers. It has a two-arm design, CGA compared with standard care, with 1:1 allocation of a total of 16 clusters. Within each cluster, study participants ≥ 65 years of age (or ≥ 55 years if Aboriginal or Torres Strait Islander (First Nations Australians)) with CKD stage 3–5/5D who are frail, measured by a Frailty Index (FI) of > 0.25, are recruited. Participants in intervention clusters receive a CGA by a geriatrician to identify medical, social, and functional needs, optimise medication prescribing, and arrange multidisciplinary referral if required. Those in standard care clusters receive usual care. The primary outcome is attainment of self-identified goals assessed by standardised Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index – Short Form), transfer to residential aged care facilities, cost-effectiveness, and safety (cause-specific hospitalisations, mortality). A process evaluation will be conducted in parallel with the trial including whether the intervention was delivered as intended, any issue or local barriers to intervention delivery, and perceptions of the intervention by participants. The trial has 90% power to detect a clinically meaningful mean difference in GAS of 10 units. Discussion: This trial addresses patient-prioritised outcomes. It will be conducted, disseminated and implemented by clinicians and researchers in partnership with consumers. If CGA is found to have clinical and cost-effectiveness for frail older people with CKD, the intervention framework could be embedded into routine clinical practice. The implementation of the trial's findings will be supported by presentations at conferences and forums with clinicians and consumers at specifically convened workshops, to enable rapid adoption into practice and policy for both nephrology and geriatric disciplines. It has potential to materially advance patient-centred care and improve clinical and patient-reported outcomes (including quality of life) for frail older people living with CKD. Trial registration: ClinicalTrials.gov NCT04538157. Registered on 3 September 2020. [ABSTRACT FROM AUTHOR]

Aim: Our objective was to describe the goals identified by patients upon entering a specialized programme for treatment of first-episode psychosis (FEP) in Chennai, India. Methods: 68 patients with FEP completed the Goal Attainment section of the Wisconsin Quality of Life - Client Questionnaire upon entry into treatment. Patients were asked to identify a maximum of three treatment goals and rate each identified goal on its importance and the extent of its achievement. Results: In the order of frequency of endorsement, the primary goalsidentified pertained to work, family/interpersonal relationships, education, symptom relief and psychological recovery, living condition, religion, finances, and household responsibilities. All patients identified at least one goal, 41 patients identified two goals, and 11 patients identified three goals. Conclusion: Individuals with FEP in India present with a range of realistic and reasonable goals. Findings have implications for improving early intervention services in India by targeting patient-identified goals. [ABSTRACT FROM AUTHOR]

Goal-oriented care is an approach to care delivery that uses patient-identified goals to drive care planning. Implementing goal-oriented care requires team members to cognitively shift the focus from "what is the matter" to "what matters to patients," and align their mental models of what it means to care for patients. Yet, no empirical studies of goal-oriented care apply evidence from the cognitive sciences, such as Shared Mental Model (SMM) theory. We conducted a qualitative case study of an interprofessional team that adopted goal-oriented care in Vermont, US (n = 18). Guided by SMM theory, we distinguished between task-related and team-related mental models. We used framework analysis and qualitative content analysis to determine mental model content and similarity. The most shared content areas were operationalizing goal-oriented care, engaging in formal and informal communication, taking a "whole-person" approach, taking a team approach, and building trusting relationships with patients and with other team members. Trust was the only construct that spanned both task and team mental model categories, highlighting the importance of both intra-team trust and provider-patient trust to the implementation of goal-oriented care. Team members developed SMMs through training, regular meetings, and interactions during care delivery. This study provides insight into the cognitive mechanisms that underlie team-based goal-oriented care delivery, which can be used to inform implementation, training content, and future research. [ABSTRACT FROM AUTHOR]

Improving care for older people with end-stage kidney disease (ESKD) requires the adaptation of standards to meet their needs. This may be complex due to their heterogeneity in terms of multimorbidity, frailty, cognitive decline and healthcare priorities. As benefits and risks are uncertain for these persons, choosing an appropriate treatment is a daily challenge for nephrologists. In this narrative review, we aimed to describe the issues associated with healthcare for older people, with a specific focus on decision-making processes; apply these concepts to the context of ESKD; identify components and modalities of shared decision-making and suggest means to improve care pathways. To this end, we propose a geronto-nephrology dynamic, described here as the necessary collaboration between these specialties. Underscoring gaps in the current evidence in this field led us to suggest priority research orientations. [ABSTRACT FROM AUTHOR]

I Recommendations i : Define the ideal model of perioperative care, and identify relevant performance criteria with evidence-based, best practice protocols, pathways and models of care for the entire patient journey. Surgery is an essential aspect of health care, required for approximately one-third of the global disease burden, and is projected to increase substantially over the coming decades.1-3 Disturbingly, it is not without risk; approximately one in five patients suffers major post-operative complications,4 and death within 30 days of surgery is the third leading cause of death worldwide (a hidden pandemic).5 Risks to patients, and healthcare budgets, are estimated to increase three-fold out to 2047 because of an ageing population and increasing burden of co-morbid disease.6 To address this "hidden pandemic", we need proactive strategies to generate higher value care, improve patient outcomes and reduce healthcare expenditure. Funding models to enable: Integrated care, appropriate SDM which incorporates risk discussions (with multidisciplinary teams for some risk groups), patient-identified goals and appropriate value-based advance care plans and intervention ceilings. [Extracted from the article]

INTRODUCTION: People enrolled in Medicaid managed care who struggle with diabetes control often have complex medical, behavioral, and social needs. Here the authors report the results of a program designed to partner with primary care teams to address those needs. METHODS: A nonprofit organization partnered with a Medicaid managed care plan and a Federally Qualified Health Center in California to enroll people with A1cs >9% in a 12-month program. The program team included a community health worker, certified diabetes care and education specialist/registered dietitian, behavioral health counselor, and registered nurse. They developed patient-led action plans, connected patients to community resources, and supported behavior changes to improve diabetes control. Baseline assessments of behavioral health conditions and social needs were collected. Monthly A1c values were tracked for participants and a comparison group. RESULTS: Of the 51 people enrolled, 83% had at least 1 behavioral health condition. More than 90% reported at least 1 unmet social need. The average monthly A1c among program participants was 0.699 lower than the comparison group post-enrollment (P = .0008), and the disparity in A1c between Hispanic and non-Hispanic White participants at enrollment declined. DISCUSSION: Participants had high levels of unmet medical, behavioral, and social needs. Addressing these needs resulted in a rapid and sustained improvement in A1c control compared to non-enrollees and a reduction in disparity of control among Hispanic participants. CONCLUSION: By partnering with a primary care team, a program external to Federally Qualified Health Center primary care can improve clinical outcomes for people with complex needs living with diabetes. [ABSTRACT FROM AUTHOR]

Background: Goals generated by Goal Attainment Scaling (GAS) can be used as an outcome measure to promote person-centred research and care. There are no training packages which support its use outside of the rehabilitation discipline. This paper describes the development and evaluation of a training package to support the implementation of GAS as an outcome measure in healthcare research. The training package consisted of classroom teaching, a training manual for self-directed learning, one-on-one simulation and hot reviews. It was developed for the GOAL Trial, a randomised controlled trial assessing a Comprehensive Geriatric Assessment's effectiveness in enabling frail older people living with chronic kidney disease to attain their goals. Training participants were invited to complete pre- and post-training online evaluation surveys. Results: Forty-two healthcare professionals attended an initial online classroom teaching, with 27 proceeding to administer GAS to GOAL Trial patients. Response rates for the online pre- and post-training surveys were 95% and 72%, respectively. Prior to training, only 15% of participants reported being able to appropriately scale and troubleshoot GAS goals. Post-training this was 92%. There was 100% participant satisfaction for the training manual, one-on-one simulation, and hot reviews. Conclusions: This training package helps ensure healthcare professionals administering GAS have adequate knowledge and skills. It has the potential for adoption as a guide to support the implementation of GAS by other researchers seeking to embrace persont-centred principles in their work. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to determine the feasibility of low-load resistance training with blood flow restriction (BFR) for people with advanced disability due to multiple sclerosis (MS). Methods In this prospective cohort study, 14 participants with MS (Expanded Disability Status Scale [EDSS] score = 6.0 to 7.0; mean age = 55.4 [SD = 6.2] years; 71% women) were asked to perform 3 lower extremity resistance exercises (leg press, calf press, and hip abduction) bilaterally twice weekly for 8 weeks using BFR. Feasibility criteria were as follows: enrollment of 20 participants, ≥80% retention and adherence, ≥90% satisfaction, and no serious adverse events related to the intervention. Other outcomes included knee extensor, ankle plantar flexor, and hip abductor muscle strength, 30-Second Sit-to-Stand Test, Berg Balance Scale, Timed 25-Foot Walk Test, 12-Item MS Walking Scale, Modified Fatigue Impact Scale, Patient-Specific Functional Scale, and daily step count. Results Sixteen participants consented, and 14 completed the intervention, with 93% adherence overall. All participants were satisfied with the intervention. A minor hip muscle strain was the only intervention-related adverse event. There were muscle strength improvements on the more-involved (16%–28%) and less-involved (12%–19%) sides. There were also changes in the 30-Second Sit-to-Stand Test (1.9 repetitions; 95% CI = 1.0 to 2.8), Berg Balance Scale (5.3 points; 95% CI = 3.2 to 7.4), Timed 25-Foot Walk Test (−3.3 seconds; 95% CI = −7.9 to 1.3), Modified Fatigue Impact Scale (−8.8 points; 95% CI = −16.5 to −1.1), 12-Item MS Walking Scale (−3.6 points; 95% CI = −11.5 to 4.4), Patient-Specific Functional Scale (2.9 points; 95% CI = 1.9 to 3.8), and daily step count (333 steps; 95% CI = −191 to 857). Conclusion Low-load resistance training using BFR in people with MS and EDSS scores of 6.0 to 7.0 appears feasible, and subsequent investigation into its efficacy is warranted. Impact Although efficacy data are needed, combining BFR with low-load resistance training may be a viable alternative for people who have MS and who do not tolerate conventional moderate- to high-intensity training because of more severe symptoms, such as fatigue and weakness. Lay Summary Low-load strength training with BFR was feasible in people who have advanced disability due to MS. Using BFR may provide an alternative for people with MS who do not tolerate higher intensity training due to more severe symptoms, such as fatigue and weakness. [ABSTRACT FROM AUTHOR]

Purpose:We investigated stroke rehabilitation clinician’s perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement. Methods:Semi-structured interviews, subject to general inductive analysis with 20 Clinicians’ working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams). Results:There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke’s impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians’). Conclusions:Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians’ identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation.Implications for rehabilitationGoal setting is often promoted as a relatively simple, straightforward way to structure interactions with patientsPatient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitationClinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics [ABSTRACT FROM PUBLISHER]

The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity. [ABSTRACT FROM AUTHOR]

Background: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).Patients and Methods: Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group.Conclusion: ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group.Trial Registration: The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.Plain Language Summary: Older people need support when they are discharged from the Emergency Department (ED) to their home as a visit to the ED is linked to negative outcomes. This study reports on a trial to reduce negative outcomes in older people discharged from the ED by an assessment in the ED and treatment in the home. Twenty-nine patients attending the ED of University Hospital Limerick were randomly assigned to three groups as follows: One group got the normal care and treatment; Group two received a comprehensive assessment by a dedicated geriatric doctor in the ED and were referred to other health professionals as needed; a third group, called ED PLUS, also received a comprehensive assessment by a dedicated geriatric doctor in the ED and an additional six-week treatment program led by a physiotherapist. The physiotherapist visited the older adult in their own home within twenty-four hours of discharge to start treatment based on what the older adult needed to do to live safely in their own home and again at week four and week six. The same geriatric doctor who saw the older adult in the ED telephoned the older adult in week two to check medications and discussed the case with the physiotherapist. A dietitian and occupational therapist telephoned the older adults to check nutritional intake and if any aids were needed in the home. All older adults in the ED PLUS group had improved quality of their life, improved mobility and did not need to go back to the hospital or ED at six weeks and six months unlike the two other groups. The COVID-19 pandemic affected recruitment, but all ED PLUS patients were extremely satisfied. [ABSTRACT FROM AUTHOR]

Objective Disparities exist in health care access, diagnosis, and treatment of chronic pain in Latino populations and other minority populations. Cognitive behavioral–based physical therapy (CBPT) interventions have been shown to be effective in predominantly non-Hispanic white populations with chronic spine pain. However, there is a need for culturally adapted CBPT interventions that focus on the conservative management of chronic spine pain. The primary purpose of the study described in this protocol is to test the efficacy of an adapted cognitive behavioral–based hybrid telerehabilitation intervention for Latino patients with chronic spine pain. Methods A single-blind, 2-arm parallel group, superiority randomized clinical trial is planned to compare an adapted CBPT intervention to Usual Care physical therapy. Goal Oriented Activity for Latinos with chronic Spine pain (GOALS/Metas) is an 8-week hybrid telerehabilitation intervention that integrates guideline-based physical therapy and pain management interventions using cognitive behavioral approaches and has been adapted for Latino patients with chronic spine pain. Usual Care physical therapy will be administered based on institutional standards at the referring health center. Outcome measures will be evaluated preintervention and at 1-week, 3-months, and 6-months postintervention. The primary outcome is pain-related disability 1-week postintervention using the Brief Pain Inventory Pain Interference subscale. Secondary outcome measures include behavioral measures of functional activity, social participation, physical activity, and sleep. Determinants of treatment effect, including pain-related psychological measures, posture and movement, self-efficacy, treatment expectancy, and therapeutic alliance, will be included in the secondary moderation and mediation analyses. Impact This clinical trial will provide information on the extent to which an adapted CBPT hybrid telerehabilitation intervention is effective in reducing pain-related disability for Latino patients with chronic spine pain. This information will be useful for clinicians to integrate in their practice, given the growing population of Latino patients who experience disparities in health care management of chronic pain. [ABSTRACT FROM AUTHOR]

Aim: Individual Placement and Support (IPS), an evidence‐based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. Methods: We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. Results: Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. Conclusion: Future research should examine how IPS programmes could best provide services to young adults. [ABSTRACT FROM AUTHOR]

Background: Discontinuation of antipsychotic medication may be linked to high risk of relapse, hospitalization and mortality. This study investigated the use and discontinuation of antipsychotics in individuals with first-episode schizophrenia in relation to cohabitation, living with children, employment, hospital admission and death. Methods: Danish registers were used to establish a nationwide cohort of individuals ⩾18 years with schizophrenia included at the time of diagnosis in1995–2013. Exposure was antipsychotic medication calculated using defined daily dose and redeemed prescriptions year 2–5. Outcomes year 5–6 were analysed using binary logistic, negative binomial and Cox proportional hazard regression. Results: Among 21 351, 9.3% took antipsychotics continuously year 2–5, 38.6% took no antipsychotics, 3.4% sustained discontinuation and 48.7% discontinued and resumed treatment. At follow-up year 6, living with children or employment was significantly higher in individuals with sustained discontinuation (OR 1.98, 95% CI 1.53–2.56 and OR 2.60, 95% CI 1.91–3.54), non-sustained discontinuation (OR 1.25, 95% CI 1.05–1.48 and 2.04, 95% CI 1.64–2.53) and no antipsychotics (OR 2.00, 95% CI 1.69–2.38 and 5.64, 95% CI 4.56–6.97) compared to continuous users. Individuals with non-sustained discontinuation had more psychiatric hospital admissions (IRR 1.27, 95% CI 1.10–1.47) and longer admissions (IRR 1.68, 95% CI 1.30–2.16) year 5–6 compared to continuous users. Mortality during year 5–6 did not differ between groups. Conclusion: Most individuals with first-episode schizophrenia discontinued or took no antipsychotics the first years after diagnosis and had better functional outcomes. Non-sustained discontinuers had more, and longer admissions compared to continuous users. However, associations found could be either cause or effect. [ABSTRACT FROM AUTHOR]

Background: An expanding base of evidence indicates that chronic gastrointestinal disorders not only impact physical wellbeing, but also affect many psychosocial aspects of life. However, less is known about gastrointestinal motility disorders. The present study aimed to explore how individuals experience gastrointestinal motility disorders and their impact on daily living. Methods: Eleven people with a gastrointestinal motility disorder participated in semi‐structured interviews face‐to‐face or via telephone. The interviews explored how participants came to be diagnosed, their experiences with health professionals, as well as the impact of dysmotility on enjoyment of food, socialising, eating out and quality of life (QoL). Interviews were tape‐recorded, transcribed and analysed using an inductive thematic analysis approach. Results: Analysis revealed an overarching theme of frustration that stemmed from three subthemes: (1) feeling misunderstood, judged and dismissed by health professionals leading to delayed diagnosis, misdiagnosis and multiple diagnoses; (2) severity and unpredictability of undesirable gastrointestinal symptoms; and (3) reduced QoL because of physical and social limitations, impairing their ability to have normal life experiences, including education, work and social activities. Conclusions: Dysmotility is a complex illness that impacts almost all aspects of a person's life. In addition to managing reported physical symptoms, the social and psychological burden associated with dysmotility needs to be addressed to improve outcomes and QoL. Key points: This research indicates that current healthcare systems are inadequate for supporting people suffering from severe dysmotility.Delayed diagnosis and misdiagnosis lead to feelings of mistrust in the healthcare system, poorly managed symptom control and reduced quality of life for this patient group.A comprehensive multidisciplinary model of care for the management of dysmotility is needed to ensure that people suffering dysmotility are provided with the best‐practice care. [ABSTRACT FROM AUTHOR]

Objective This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals. Methods A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated. Results Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69–0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3 months after discharge. The minimal important change was estimated to be 1.58 points. Conclusion This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation. Impact This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach. [ABSTRACT FROM AUTHOR]

While ≧10,000 Americans turn 65 years old every day, only 10% of American homes are "aging ready." Unsafe homes can exacerbate disability, lead to falls, and increase the likelihood of hospitalization. With increased investments in home and community-based services, public health stakeholders are considering home modifications to promote successful aging. While several home modification models exist, there is significant heterogeneity between models and no consensus on critical features. PubMed, EMBASE, and Web of Science were reviewed and twelve randomized controlled trials of home modifications for older adults were identified and evaluated for model structure, reported outcomes, and risk of bias. Overall, occupational therapist-driven home modifications supplemented with clinical, physical activity, and/or behavioral components saw the greatest success. This systematic review discusses the components of these models, highlights particularly effective and frequently used features, and the practice and research needed to create effective next-generation home modification models which promote healthy longevity. [ABSTRACT FROM AUTHOR]

Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations. [ABSTRACT FROM AUTHOR]

To describe, in a naturalistic setting, the impact of the early use of LAI-AP on functional outcomes of early psychosis patients as compared to oral antipsychotics (OAP). Longitudinal prospective 3-year naturalistic study of all consecutive admissions (n = 416) to two Early intervention services (EIS) for psychosis comparing baseline characteristics and the evolution of global functioning, occupation (work and studies), and living arrangements autonomy according to the route of administration of the antipsychotic medication. The cohort was divided into four groups: LAI-AP first (started on LAI-AP and later received OAP), OAP first, LAI-AP only, and OAP only. Global assessment of functioning (GAF) improved in all groups, but our mixed-effect model did not show any significant association between the route of administration and the GAF outcome. The LAI-AP only group was significantly less likely to have extreme residential instability at 3 years than the other groups despite its highest proportion of homeless youth and their poor prognostic factors at baseline. Our naturalistic study suggests a significant protective effect of LAI-AP on extreme residential instability for the most vulnerable patients, but no impact of the first AP administration route on other functional outcomes was observed at 3 years of follow-up. Long-acting injectable antipsychotics seem promising to avoid extreme residential instability in early psychosis. Global assessment of functioning (GAF) improved in all groups. There was no significant association between the first route of administration and global functionning. [ABSTRACT FROM AUTHOR]

It is suggested that goals are hierarchically organised, with goals at the highest level representing fundamental values and motivations. These abstract goals are said to have a series of sub-goals which represent a means of reaching higher-level goals. While a number of studies have explored goals in the context of psychosis, little is known about idiographic goal generation processes in those experiencing psychosis. Using a Behaviour Sequence Analysis approach, the aim of the current study was to assess the feasibility of the goal task for use with individuals experiencing psychosis. A total of 73 adults receiving care from UK rehabilitation services completed a goal task designed to elicit higher-level goals. Results indicated that the goal task may be a feasible tool to support those experiencing psychosis to generate lower- and higher-level goals. The goal task utilised in the current study may therefore be a valuable goal generation tool for use by clinicians. [ABSTRACT FROM AUTHOR]

Individualized and interdisciplinary rehabilitation programs are recommended following a mild traumatic brain injury (mTBI), but often have long waitlists. Accordingly, innovative evidence-based programs are needed. The first objective of this study was to determine the number and types of rehabilitation goals chosen by individuals completing an interdisciplinary outpatient rehabilitation intervention (BrainEx90) for persisting symptoms following an mTBI. The second objective was to investigate whether completing BrainEx90 or choosing specific types of goals influenced performance and satisfaction ratings of these goals. 217 individuals (44.4 ± 13.5 years old) with persisting symptoms following an mTBI completed BrainEx90, a 16-session interdisciplinary group outpatient rehabilitation intervention at Parkwood Institute between November 2013 and September 2019. Performance and satisfaction ratings of self-identified goals before and after BrainEx90 were assessed using the Canadian Occupational Performance Measure, and changes in ratings were analyzed using a linear mixed effects model. 1008 goals were identified and categorized as: productivity (45%); leisure (37%); and self-care (18%). Satisfaction ratings were significantly higher for all goal types following BrainEx90. Satisfaction with self-care goals improved significantly more than leisure [t(151) = 3.24, p <.01] and productivity [t(144) = 2.97, p <.01] goals. Performance ratings were also significantly greater following BrainEx90 [2.4, 95% CI [2.27, 2.53], p <.01)]. Performance and satisfaction of self-identified rehabilitation goals significantly improved following BrainEx90. Satisfaction with self-care goals demonstrated the greatest improvements, yet the most identified goal type was productivity. [ABSTRACT FROM AUTHOR]

The role of the Individual Placement and Support (IPS) employment specialist is a new type of occupation within mental healthcare. High turnover among employment specialists necessitates improvement in their recruitment and retention. One element that impacts retention is job satisfaction. We assessed the personality of 38 employment specialists (Big 5 Inventory‐2) and measured job satisfaction over three time periods. Compared to norm data, employment specialists were significantly higher on Extraversion (ΔT = 8.0, CI: 5.59–10.42), Agreeableness (ΔT = 7.8, CI: 5.56–10.12), Conscientiousness (ΔT = 3.3, CI: 0.8–5.84), Open‐mindedness (ΔT = 3.5, CI: 0.97–6.07), while lower on Negative emotionality (ΔT = −3.5, CI: −6.5 to −0.42). Extraversion had a substantial longitudinal positive effect on job satisfaction (β at T1 = 0.39; CI: 0.10–0.73) (β at T2 = 0.40; CI: 0.03–0.80), while Negative emotionality – a substantial negative effect (β at T1 = −0.60; CI: −0.90 to −0.30) (β at T2 = −0.50; CI: −0.90 to −0.12). Male gender was significantly associated with higher job satisfaction at the time point 1 (β = −0.46; CI: −0.80 to −0.14). Age, length of employment in the role, Agreeableness, Conscientiousness and Open‐mindedness were not found to have substantial significant effects on job satisfaction of employment specialists. Recruiting employment specialists who score high on Extraversion and low on Negative emotionality may be a good fit for the role and job satisfaction. [ABSTRACT FROM AUTHOR]

Aim: Community participation in occupational, social, recreational, and other domains is critically important during young adulthood. Coordinated Specialty Care (CSC) programs provide developmentally tailored care to young adults experiencing early psychosis within the United States, but little is known about the breadth of efforts to promote community participation. This study aimed to develop and evaluate indicators of these efforts based on the perspectives of a national multi‐stakeholder group. Methods: Seventeen stakeholders (i.e., young adults with early psychosis, family members, experts by profession) participated in a modified e‐Delphi study, conducted in two rounds. The purpose of round one was to generate a comprehensive list of community participation‐promoting indicators. During round two, stakeholders rated the importance and feasibility of the implementation of each indicator. Descriptive statistics and percentage of agreement regarding round two ratings were assessed. Results: During round one, 186 indicators of activities and/or practices designed to promote community participation were identified; this list was reduced to 44 by eliminating redundancies or indicators not related to community participation. In round two, we found broad agreement regarding the importance, but significant variation in perceived feasibility of indicators. The highest‐rated indicators in both categories pertained to staff knowledge (regarding barriers and supports to participation and the importance of participation to health) and strategies for addressing participation barriers. Conclusions: This study is expected to facilitate the identification and development of promising CSC activities and practices designed to promote community participation among young adults while potentially also enhancing engagement in services and improving clinical outcomes. [ABSTRACT FROM AUTHOR]

B Lisa Whop SP 1,3 sp b I SP 1 sp Menzies School of Health Research, Brisbane, QLD, Australia i I SP 2 sp The University of Queensland, Brisbane, Queensland, Australia i I SP 3 sp Australian National University, Canberra, ACT, Australia i Cancer prevention, population screening and early detection programs along with universal health care have largely contributed to the high survival rates in Australia. Oral targeted therapies in non-small cell cancer - managing toxicities B Marliese Alexander SP 1,2 sp b I SP 1 sp Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia i I SP 2 sp The University of Melbourne, Parkville, Victoria, Australia i Advances in targeted therapies for the treatment of non-small cell lung cancer (NSCLC) has delivered expanded treatment options against targetable alterations including EGFR, ALK, ROS1, KRAS, MET, BRAF, RET, NTRK and HER2. - update on renal dosing anticancer drugs in frail patients B Geeta Sandhu SP 1,2 sp b I SP 1 sp St Vincent's Hospital, Sydney, NSW, Australia i I SP 2 sp University of Sydney, Camperdown, NSW, Australia i Organ dysfunction, especially kidney dysfunction creates complexities in dosing anticancer drugs in older, frailer patients. Development and acceptability testing of a patient decision-aid for cancer patients with anxi... B Joanne Shaw SP 1 sp , Rebecca Raynor SP 2 sp , Caroline Hunt SP 2 sp b I SP 1 sp Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia i I SP 2 sp School of Psychology, The University of Sydney, NSW, Australia i B Aim b : One-third of cancer patients experience anxiety and depression. [Extracted from the article]

In addition, all participants improved their BMI category (1 severe obesity to normal weight, 10 severe obesity to overweight, and 1 obesity to normal weight) by end of the follow up. B Conclusions: b Immersive residential obesity treatment can be highly effective in adolescent girls with severe obesity. Patients who had a diagnosis of OW/OB, or were diagnosed with obesity-associated morbidities, or were treated with anti-obesity medications or bariatric surgery prior to the BMI measurement were excluded. "eatNplay" A Family-Based Telehealth Intervention for Childhood Obesity: A Mixed-Methods RCT... Britney Arce, MSN, MBA, RN Bloomington IN, Mary Lynn Davis-Ajami, PhD, MBA, MS, FNP-C, RN, B... B Background: b Childhood obesity is increasing. B Results: b In total, 1850 participants completed the survey; 56.3% had BMI 30-<35 kg/m SP 2 sp (obesity class I), 26.8% had BMI 35-<40 kg/m SP 2 sp (obesity class II), and 16.9% had BMI 40-<70 kg/m SP 2 sp (obesity class III). Body mass index (BMI) category was defined using BMI percentile range: underweight (<5 SP th sp ), normal weight (5 SP th sp -<85 SP th sp ), overweight (85 SP th sp -<95 SP th sp ), obesity (95 SP th sp -<1.2x 95 SP th sp ), and severe obesity (>=1.2x 95 SP th sp ). [Extracted from the article]

Introduction and hypothesis: The Self-Assessment Goal Achievement (SAGA) questionnaire is a patient-completed instrument designed to assess goal attainment in the behavioral or pharmacologic treatment of lower urinary tract symptoms (LUTS), including overactive bladder (OAB). The SAGA questionnaire allows patients to identify and rank the importance of treatment goals before treatment is initiated; the follow-up SAGA questionnaire quantifies the achievement of these patient-identified goals. The objective of this qualitative research was to confirm the content validity of the German, Spanish, Swedish, and English (UK) language versions of the SAGA questionnaire in patients with OAB with or without other LUTS. Methods: The SAGA questionnaire was translated to each language in accordance with a well-established forward and backward harmonization method. Patient interviews were then conducted according to a cognitive debriefing methodology. Qualitative analysis of patients' input allowed assessment of content validity of each linguistically adapted SAGA questionnaire. Results: All patients ( n = 29; six to eight per targeted country) found the SAGA questionnaire easy to understand and to complete. Most patients completed the nine prespecified (fixed) treatment goals and were able to add up to five personal goals in the open-ended portion and rate each goal by importance. Differences were identified in how the various languages communicated some of the concepts assessed with the SAGA questionnaire. Rewording of the translated versions of the questionnaire was necessary in some cases. Conclusions: This linguistic content validation study in four European languages indicates that SAGA is a comprehensive, easy-to-understand, and relevant questionnaire for patient-completed evaluation of LUTS/OAB symptoms and treatment goal attainment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care–coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p =.02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p =.04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes. [ABSTRACT FROM AUTHOR]

There is evidence that peer support can be helpful for people suffering from psychosis, but there is a lack of research describing peer support in the context of Early Intervention in Psychosis (EIP). We aim to investigate the key elements of peer support in EIP and how peer support workers might best be recruited and supported in their work. We used purposive sampling to recruit seven participants for semi-structured interviews. Thematic analysis was used to analyse the data. Destigmatisation of psychotic experiences is a central concept that runs through all themes. Participants perceived peer support as a meaningful source of support that could provide benefits to peers (service users) and peer support workers. Themes included a "symbol of hope," "practical support," "mutuality and reciprocity," "bridge between service and peers," "ideal requirements of peer support workers," "delivering peer support," and "team-working and role clarification." Peer support makes a strong contribution to destigmatising psychosis. Findings potentially contribute to developing peer support workers' roles in EIP. Future research is recommended to investigate the perspectives of ethnic minorities on this topic and practical applications of these findings. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapists have an integral role in the treatment of people with functional neurological disorder, yet there is evidence of variable implementation of occupational therapy in community settings. This study explored the barriers and enablers to delivering community-based occupational therapy to people with functional neurological disorder in the United Kingdom. Methods: Community-based neurological occupational therapists (n = 10) with experience in functional neurological disorder were invited to complete semi-structured qualitative interviews. The interview schedule and analysis were based on the Theoretical Domains Framework, a behavioural science tool for investigating barriers and enablers to clinical practice. Data were analysed using a combined content and framework analysis approach. Findings: Important barriers to treatment included limited published information to guide practice, lack of professional role clarity and restricted multidisciplinary team working. Enablers included occupational therapists' dual training in physical and mental health and focus on activity engagement. Service provision, quality and access varied across geographical locations. Conclusion: Occupational therapists are uniquely placed to help people with functional neurological disorder; however, findings suggest that existing community service structures in many regions in the United Kingdom are inadequate and limit the quality of treatment that can be provided. Additional resources are required to support occupational therapy service provision in community settings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design: Feasibility randomised controlled trial. Setting: Outpatient rehabilitation facility. Subjects: Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions: The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures: Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results: Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions: The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance. [ABSTRACT FROM AUTHOR]

New efforts have begun to transform healthcare to focus on patient‐centered care. Such efforts will be facilitated by eliciting, operationalizing, and measuring the attainment of patient‐identified goals of healthcare. This article describes a practical approach to goal setting and measurement that can be used in efforts to implement patient‐centered care. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes. Methods: Open-label randomized controlled trial with 1:1 assignment that took place in a single institution resident-run outpatient medicine clinic. Patients 18–75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were randomized to standard of care (SOC) (continued with routine follow up with their primary provider) or to the SOC + pharmacist-managed diabetes clinic PMDC group (had an additional 6 visits with the pharmacist within 6 months from enrollment). Patients were followed for 12 months after enrollment. Data collected included HbA1c, lipid panel, statin use, blood pressure control, immunization status, and evidence of diabetic complications (retinopathy, nephropathy, neuropathy). Intention-to-treat and per-protocol analysis were performed. Results: Forty-four patients were enrolled in the SOC + PMDC group and 42 patients in the SOC group. Average decrease in HbA1c for the intervention compared to the control group at 6 months was − 2.85% vs. -1.32%, (p = 0.0051). Additionally, the odds of achieving a goal HbA1c of ≤8% at 6 months was 3.15 (95% CI = 1.18, 8.42, p = 0.0222) in the intervention versus control group. There was no statistically significant difference in the remaining secondary outcomes measured. Conclusions: Addition of pharmacist managed care for patients with type 2 diabetes mellitus is associated with significant improvements in HbA1c compared with standard of care alone. Missing data during follow up limited the power of secondary outcomes analyses. Trial registration: ClinicalTrials.gov, ID:NCT03377127; first posted on 19/12/2017. [ABSTRACT FROM AUTHOR]

Objective: Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making, which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians.Methods: Tool development occurred in 3 phases: (1) clinician feedback on the initial prototype during a communication training session; (2) semistructured interviews with RA patients; and (3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool.Results: Clinicians (n = 15) and patients (n = 10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool deemphasizing goals outside of their perceived treatment domain or available resources; they highlighted the benefits of the tool to facilitate conversation but raised concerns regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and preparing for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve.Conclusion: A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher-quality care in RA. [ABSTRACT FROM AUTHOR]

Background: Care coordination is central in models of integrated care. Goal-oriented care is one approach that supports care coordination for multimorbid and complex patients by tailoring shared care plans to patient-identified goals rather than disease-specific targets. However, providers struggle with the adoption of goal-oriented care. Personal values have been found to influence provider behaviour in care delivery. It is possible that personal values may be a mechanism to drive the adoption of goal-oriented care. This work aims to understand the personal values of providers in the adoption of goal-oriented care. Methods: This is a sub-study of an international comparative case study of three primary healthcare sites that have implemented goal-oriented care in Ghent (Belgium), Ottawa, (Canada), and Vermont, (United States). A secondary analysis of 17 semi-structured interviews from the Vermont case site was conducted using inductive thematic analysis. The Vermont case study is situated within an integrated care setting. At this site, providers come from various disciplines and work in collaboration across organizations. Findings: Preliminary findings demonstrated that providers delivering goal-oriented care valued 'putting the patient at the centre', providing care in a holistic manner to understand the 'whole person', which could best be supported through team-based care. These values were often linked to beliefs around the importance of addressing the social determinants of health to improve health outcomes of patients. While most providers shared these values, they told different stories regarding how they came to these beliefs, which related to their education and training experiences. Community-based providers including social workers and mental health providers were introduced to the concepts of social determinants early in their professional training and reported personcentredness to be a core value of their profession. Alternatively, physicians and providers trained in medical models reported a shift in their values from problem-oriented towards personcentredness. Specific team-based training supported the adoption of core values like personcentredness. Discussion: Despite differences in disciplines and organizations, participants demonstrated similar values. These perceived difference in values appear to trace back to the model of training in postsecondary education that providers were trained under. However, with additional training on goal oriented care, shifts in values appear to be possible as participants were aligned in the values they held that support goal-oriented care. Another value that supported the adoption was a belief in team-based care for their patients. In practice, this was reinforced by working with interdisciplinary teams and an increasing presence of integration in their work environment. Conclusion: Across different disciplines and organizations, participants strongly valued personcenteredness, understanding the whole person, and team-based care. There is an opportunity to utilize structured training in goal-oriented care for providers to have aligned values to support its adoption. Lessons learned: Common values among interdisciplinary teams seem to support the adoption of goal-oriented care. Structured training in goal-oriented care appears to lead to providers having common values. Future research: The analysis will expand to other case study sites to compare and contrast the provider values working in other primary healthcare settings in different contexts. [ABSTRACT FROM AUTHOR]

For individuals with tetraplegia, regaining upper limb function forms the highest priority for improving quality of life. Use of nerve transfers to reconstruct upper limb function is increasing, however little is known about individual's decision to have and experience of the surgery and associated rehabilitation outcomes. This qualitative study aimed to understand the experience of surgery on the lives of individuals with tetraplegia 18 months post-surgery. In-depth, semi-structured interviews were conducted with five purposively selected individuals who have undergone upper limb nerve transfers at a metropolitan health service, Melbourne, Australia, specializing in spinal cord injury rehabilitation. Collaizi's phenomenological framework guided data analysis, resulting in an essence statement describing the individuals' experience. An essence statement comprising three themes; Deciding on Surgery, Facing Challenges: Surgery to Recovery and Evaluating Surgical Outcomes, was developed. The study suggests that for individuals with tetraplegia, hope to regain lost upper limb function forms a core consideration in the decision to have surgery. For clinicians supporting patient's decision, balancing hope with the realities of surgery is important. Even small changes in upper limb function had an important influence on participant's confidence in social situations through enhanced participation in a range of everyday activities. In making a decision to have surgery, individuals with tetraplegia benefit from two way discussions with the healthcare team and others who have already undergone surgery. Healthcare teams need to help prepare individuals for the challenges of surgery including: expectations of pain, hospital stay, initial loss of independence and the time it may take to see re-innervation of target muscles and subsequent functional changes. Surgery should be routinely considered as individuals' report that even small changes in upper limb function positively increases participation in everyday tasks and confidence in social situations. When evaluating changes in upper limb function, patient-centered measures should be used. [ABSTRACT FROM AUTHOR]

Aim: People diagnosed with mental disorders experience higher rates of unemployment than those without. Career adaptability, defined as the ability to respond flexibly and make informed career decisions in work and throughout career transitions, is becoming increasingly important as the nature of work changes rapidly. Early vocational intervention may ameliorate poor education and employment outcomes experienced by young people with mental ill‐health and promote transferable skills and adaptability. Online‐based career support allows for ongoing access throughout different career stages. The current study combines mental health‐informed digital career and peer motivation, to create a Youth Online Training and Employment System (YOTES) that supports young people with mental ill‐health obtain and remain in education or employment. Methods: This study is an unblinded randomized controlled trial for young people with mental ill‐health, aged 16–25, who are seeking vocational support. Participants will be randomized to receive either YOTES, a moderated, online intervention with vocational, social, and peer motivation, or a control intervention, the headspace Digital Work and Study Service. Both groups will have access to in‐person career support if seeking employment. The primary outcome will be career adaptability compared between the YOTES and control groups at 6‐months post baseline. Secondary outcomes include number of hours worked in the past 7 days, hope, career confidence, psychological distress and health economic outcomes at 6‐ and 12‐months post baseline. Conclusion: Results will demonstrate whether an online career intervention moderated by career practitioners with peer motivation can result in improved career adaptability in young people with mental ill‐health. [ABSTRACT FROM AUTHOR]