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Purpose: To explore student and tutor perspectives on the learning efficacy of virtual, compared to in-person, problem-based tutorial (PBT) in occupational therapy, physiotherapy, and speech-language pathology health professional programs. Materials and Methods: This was a quality improvement study using a cross sectional survey at a single institution. Separate student and tutor surveys were disseminated online. Students received the survey at two timepoints, tutors received the survey at one timepoint. Descriptive statistics summarized quantitative survey questions. Chi-squared or Fischer's Exact analyses explored differences between in-person and virtual PBT. Exploratory analyses determined if associations amongst programs and/or between cohorts existed on variables of interest. Open-ended survey questions were analyzed using content analysis. Results: A total of 241 students and 85 tutors completed the survey. Results demonstrate most students and tutors were satisfied with the use of virtual tutorials (77%; 89% respectively) and felt that they were effective in exploring content within the PBT course. However, students in the most recent cohort rated virtual tutorials more highly (p = 0.01). Conclusions: Virtual modes of PBT were successful in achieving course objectives and led to high satisfaction in users. Health professional programs can use this information when designing virtual problem-based tutorial courses in the post-pandemic era. IMPLICATIONS FOR REHABILITATION: Problem-based learning (PBL) involves the active engagement of students in self-directed learning where learning gaps are identified, and information is retrieved and critically appraised to apply clinical reasoning to healthcare decisions. Traditionally, the PBL process has been implemented in-person through the use of small group tutorial with six to eight students and a tutor, however, the COVID-19 pandemic led to a quick transition to virtual tutorials. This study found that virtual modes of conducting PBL tutorial were successful in achieving course objectives and both students and tutors were satisfied with using virtual means to achieve course objectives in three professional rehabilitation programs (Occupational Therapy, Physiotherapy, Speech Language Pathology). Health professional programs in rehabilitation can use this information when designing courses using PBL processes in the future, and clinicians can use this information when considering the use of virtual means for care and for collaboration between professionals in various healthcare settings. [ABSTRACT FROM AUTHOR]

Perspectives of individuals with acquired brain injury (ABI) regarding inpatient rehabilitation experiences can inform patient-centered care; however, these voices are under-represented in the literature. To explore the experiences, needs, and preferences of patients from an ABI inpatient rehabilitation program in Ontario. Using an interpretive description approach, we interviewed 12 participants and analyzed the transcripts inductively to generate themes. We identified three major themes: (1) Life Rerouted – participants felt their lives diverted due to ABI, with rehabilitation seen as a way to return to pre-injury life, (2) Autonomy within Rehab highlighted the perceived importance of personal autonomy in decision-making within rehabilitation, and (3) Life (and Recovery) Go On reflected an ongoing recovery process after discharge – leading to mixed emotions. An overall message, "re-establishing personal identity is important to the recovery process," reflected theories of biographical disruption and relational autonomy. Our findings provide a patient perspective for clinicians and administrators to consider. We found that ABI was significantly disruptive to personal identity – resulting in tensions in autonomy while attempting to reclaim a sense of identity. We suggest counseling services and strategies supporting post-injury adjustment, along with ways for rehabilitation professionals to enhance patient autonomy where possible. Sustaining an ABI can significantly disrupt personal identity and sense of autonomy – especially as persons occupy the role of "patient" while in inpatient rehabilitation. Psychological support is recommended to address the impacts of ABI on patients' sense of identity, as well as on family members. Strategies of support might include, providing formal psychotherapy, as well as creating opportunities for patients and family members to discuss the changes they are experiencing, and to establish their personal narratives (e.g., through writing or art) or peer mentorship programs between discharged and current patients. Clinicians can enhance patient autonomy by increasing opportunities for communication with patients about choice; educating patients and family members on the rehabilitation team's decision-making process, and other methods that increase communication and provide consistent up-to-date information to patients and their family members. [ABSTRACT FROM AUTHOR]

In-bed cycling is a novel modality that permits the early initiation of rehabilitation in the intensive care unit. We explored clinicians' experiences and perceptions of in-bed cycling with critically ill cardiac surgery patients. We used an interpretive description methodology. All critical care clinicians who had been present for at least 2 cycling sessions were eligible. Data were collected using semi-structured, audio-recorded, face-to-face interviews transcribed verbatim. Content analysis was used to identify themes. Nine clinicians were interviewed. Our sample was predominantly female (77.8%) with a median [IQR] age of 40 [21.5] years. Critical care experience ranged from <5 years to ≥30 years. Acceptability was influenced by previous cycling experiences, identifying the "ideal" patient, and the timing of cycling within a patient's recovery. Facilitators included striving towards a common goal and feeling confident in the method. Barriers included inadequate staffing, bike size, and the time to deliver cycling. Clinicians supported the use of in-bed cycling. Concerns included appropriate patient selection and timing of the intervention. Teamwork was integral to successful cycling. Strategies to overcome the identified barriers may assist with successful cycling implementation in other critical care environments. In-bed cycling is a relatively novel rehabilitation modality that can help initiate physical rehabilitation earlier in a patient's recovery and reduce the iatrogenic effects of prolonged admissions to an intensive care unit. Clinicians found in-bed cycling to be an acceptable intervention with a population of critically ill cardiac surgery patients. Teamwork and interprofessional communication are important considerations for successful uptake of a relatively new rehabilitation modality. Identified barriers to in-bed cycling can assist with developing strategies to encourage cycling uptake in similar critical care environments. [ABSTRACT FROM AUTHOR]

Patient participation is recognized as an important element of rehabilitation. However, few studies have used a qualitative lens to specifically examine factors influencing patient participation in stroke rehabilitation. The purpose of this study was to investigate patient perspectives of barriers and facilitators to participating in hospital-based stroke rehabilitation. Semi-structured interviews were conducted with 11 patients, with confirmed diagnoses of stroke, recruited from three separate rehabilitation settings. Analysis of the interviews was guided by a process of interpretive description to identify key barriers and facilitators to participation in stroke rehabilitation. Four main themes and corresponding sub-themes were constructed concerning participation in rehabilitation: (i) Environmental Factors, (ii) Components of Therapy, (iii) Physical and Emotional Well-Being, and (iv) Personal Motivators. An exploratory model of personalized rehabilitation emerged, integrating the themes emerging from the data. Personalized rehabilitation can be considered in comparison to person-centred care principles. The barriers and enablers experienced by patients in this study contribute to the existing knowledge of the patient experience of stroke rehabilitation and may be used to inform clinical practices and future research. The surrounding environments can facilitate participation in rehabilitation using strategies to reduce noise and disruption and also by encouraging social interactions among patients. Increasing the frequency and consistency of communication with patients about rehabilitation goals and progress could enhance participation. Designing interventions to include activities that are meaningful and focused on the resumption of valued life roles is key to participation. Therapy intensity, time spent sedentary, and the emotional impact of stroke are aspects of rehabilitation patient's feel are neglected. [ABSTRACT FROM AUTHOR]

Objective. The purpose was to determine if upper extremity impairment and function in individuals with chronic stroke is dependent upon whether the dominant or nondominant hand is affected. Methods. Ninety-three [...]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. Methods This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. Results Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. Conclusion This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.

Background: In-bed cycling is a novel modality for the initiation of early mobilization in the intensive care unit. No study has investigated its use in the critically ill, off-track post cardiac surgery population. Before conducting an effectiveness trial, feasibility data are needed. The aim of this study was to determine the feasibility of in-bed cycling in a population of off-track cardiac surgery patients. Methods: We conducted a prospective feasibility study in a 16-bed adult cardiac surgery intensive care unit in Ontario, Canada. Previously ambulatory adults (≥ 18 years) who were mechanically ventilated for ≥ 72 h were enrolled within 3 to 7 days post cardiac surgery. Twenty minutes of in-bed cycling was delivered by ICU physiotherapists 5 days/week. The primary outcome, feasibility, was the percent of patient-cycling sessions that occurred when cycling was appropriate. The secondary outcome was cycling safety, measured as cycling discontinuation due to predetermined adverse events. Results: We screened 2074 patients, 29 met eligibility criteria, and 23 (92%) consented. Patients were male (78.26%) with a median [IQR] age of 76 [11] years, underwent isolated coronary bypass (39.1%), and had a median EuroScore II of 5.4 [7.8]. The mean (SD) time post-surgery to start of cycling was 5.9 (1.4) days. Patients were cycled on 80.5% (136/169) of eligible days, with limited physiotherapy staffing accounting for 48.5% of the missed patient-cycling sessions. During 136 sessions of cycling, 3 adverse events occurred in 3 individual patients. The incidence of an adverse event was 2.2 per 100 patient-cycling sessions (95% CI 0.50, 6.4). Conclusions: In-bed cycling with critically ill cardiac surgery patients is feasible with adequate physiotherapy staffing and appears to be safe. Future studies are needed to determine the effectiveness of this intervention in a larger sample. Trial registration: This trial was registered with Clinicaltrials.gov (NCT02976415). Registered November 29, 2016. [ABSTRACT FROM AUTHOR]

Abstract Background Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.

Low motivation is a common problem after acquired brain injury (ABI) and can persist for years after injury. Little is known, however, about perspectives of motivation with respect to engaging in the community, many years after ABI. To explore the client with ABI perspective of motivation and engagement in individuals based in community ABI programs. Interpretive description methods were utilized. Semi-structured interviews were conducted with 21 individuals with an ABI. Participants felt that both internal factors, such as feelings of hope, and external factors, such as social support, influence levels of motivation to engage. When positive internal and external motivators were enhanced, and negative internal and external motivators reduced, this gave rise to a sense of choice and control, which led to increased engagement. Fostering positive aspects of rehabilitation and increasing choice and control may promote engagement. External motivators, such as reducing repetitiveness and promoting peer support, are motivators that community and clinical settings can implement relatively easily, whilst internal motivators such as attitudes toward therapy may need to be addressed continuously to enhance motivation and engagement. [ABSTRACT FROM AUTHOR]

Using the International Classification of Functioning, Disability, and Health, this scoping review mapped environmental barriers and facilitators that can influence driving with arthritis. A search of research databases located 2445 studies from which 19 were included. The predominant diagnosis researched was rheumatoid arthritis. The most common facilitators were vehicle adaptations (e.g., supplemental mirrors, seat cushions). Barriers included a lack of knowledge among clinicians to address behind-the-wheel concerns and nonuse/abandonment of such adaptions. Results highlight key clinical and research opportunities to support drivers with arthritis. [ABSTRACT FROM AUTHOR]

Purpose: To develop a Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to estimate the construct validity and inter-rater reliability. Materials and methods: The Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure was used to systematically adapt the CAHAI. We recruited 56 adults admitted to an inpatient stroke facility to evaluate the psychometric properties of the Singapore version of the CAHAI. The Singapore version of the CAHAI, Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and the Action Research Arm Test (ARAT) were administered to all participants. We used Spearman's rank correlation coefficients to estimate convergent and discriminative validity, and reliability was estimated using the intra-class correlation coefficient and standard error of measurement. Results: Implementation of the Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure resulted in the modification to two test items. The Singapore version of the CAHAI demonstrated convergent validity with the FMA-UE (rs= 0.87; 95% CI: 0.76, 0.92) and ARAT (rs = 0.80; 95% CI: 0.63, 0.9). Discriminative validity between the Singapore version of the CAHAI and FMA-UE pain subscale was rs= 0.42 (95% CI: 0.22, 0.59). Reliability of the Singapore version of the CAHAI was 0.97 (95% CI: 0.94, 0.99) and standard error of measurement of 4.80 points (95% CI: 4.23, 5.55). Conclusion: The Singapore version of the CAHAI demonstrated good validity and reliability, similar to the properties of the original CAHAI. The Singapore version of the Chedoke Arm and Hand Activity Inventory demonstrates evidence of construct validity and inter-rater reliability. The Singapore version of the Chedoke Arm and Hand Activity Inventory can be used by clinicians and researchers to evaluate function in the affected upper extremity for persons with stroke in Singapore. [ABSTRACT FROM AUTHOR]

Background: In acquired brain injury (ABI) populations, low motivation to engage in rehabilitation is associated with poor rehabilitation outcomes. Motivation in ABI is thought to be influenced by internal and external factors. This is consistent with Self-determination Theory, which posits that motivation is intrinsic and extrinsic. This paper discusses the benefit of using Self-determination Theory to guide measurement of motivation in ABI. Methods: Using a narrative review of the Self-determination Theory literature and clinical rehabilitation research, this paper discusses the unique role intrinsic and extrinsic motivation has in healthcare settings and the importance of understanding both when providing rehabilitation in ABI. Results: Based on the extant literature, it is possible that two independently developed measures of motivation for ABI populations, the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self and the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, may assess intrinsic and extrinsic motivation, respectively. Conclusion: Intrinsic and extrinsic motivation in ABI may be two equally important but independent factors that could provide a comprehensive understanding of motivation in individuals with ABI. This increased understanding could help facilitate behavioural approaches in rehabilitation. Conceptualization of motivation in ABI would benefit from drawing upon Self-determination Theory. External factors of motivation such as the therapeutic environment or social support should be carefully considered in rehabilitation in order to increase engagement. Assessing motivation as a dual rather than a global construct may provide more precise information about the extent to which a patient is motivated. [ABSTRACT FROM AUTHOR]

Objective: To characterize environmental barriers to leisure participation among individuals living with stroke; examine relationships between environmental barriers and leisure interest and satisfaction; and investigate participant factors associated with the perception of environmental barriers. Design: Survey. Setting: Community. Participants: Convenience sample of 51 community-dwelling adults less than six months post stroke. Interventions: Not applicable. Main outcome measure(s): Craig Hospital Inventory of Environmental Factors-Short Form. Results: Physical and structural environmental barriers were reported as the most frequent and large barrier to leisure participation (n = 26 (51%) rated as "monthly or more," n = 12 (24%) rated as "big problem"). While attitude and support and policy barriers were not as commonly encountered, participants labeled these as "big problem(s)" (attitude and support n = 6 (12%), policy n = 7 (14%)). The presence of depressive symptoms was associated with the frequency in which attitudinal and support (rho = 0.50, P < 0.001), physical and structural (rho = 0.46, P < 0.001), and service and assistance (rho = 0.28, P = 0.04) barriers were reported, as well as magnitude of attitude and support barriers (rho = 0.48, P < 0.001). In multivariable regression analysis, depressive symptoms and walking capacity explained 21% of the variance of the frequency of attitude and support barriers (P = 0.004), where depressive symptoms was an independent correlate (P = 0.004). No other factors were associated with environmental barriers to leisure participation. Conclusion: Individuals with stroke report frequent and large physical and structural environmental barriers to leisure participation, which may be associated with the presence of depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether there was a difference in the sensitivity to change of the subscales of the Functional Independence Measure and the Assessment of Motor and Process Skills within three different post-acute inpatient rehabilitation populations. Material and methods: We conducted retrospective chart review of patients consecutively admitted to inpatient rehabilitation units, with both admission and discharge Functional Independence Measure and Assessment of Motor and Process Skills scores. A total of 276 participants were included and categorized into diagnostic groups (orthopedic, oncology, and geriatric). Within group, sensitivity to change was evaluated for the subscales of each measure by calculating the difference in standardized response means (SRM) and 95% confidence intervals (CI). Results: The Functional Independence Measure motor subscale was more sensitive to change than the Assessment of Motor and Process Skills in the orthopedic and geriatric groups (SRMdifference = 1.53 [95% CI 0.93, 2.3] and 0.65 [95% CI 0.3, 1.02], respectively) but not in the oncology group (SRMdifference = 0.42 [95% CI −0.2, 1.04]). For the cognitive subscales, the Assessment of Motor and Process Skills was more sensitive to change than the Functional Independence Measure in all three groups (SRMdifference = 0.38 [95% CI 004, 0.74], 0.65 [95% CI 0.45, 0.90], and 1.15 [95% CI 0.77, 1.69] for orthopedic, geriatric, and oncology, respectively). Conclusions: The Functional Independence Measure is a mandated measure for all rehabilitation units in Canada. As the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change than the Functional Independence Measure, we recommend also administering the Assessment of Motor and Process Skills to better detect changes in the cognitive aspect of function. Implications for rehabilitation: When deciding between the Functional Independence Measure or the Assessment of Motor and Process Skills, it is important to consider whether patients’ functional status is expected to change similarly or differently. The difference in sensitivity to change between the subscales of the two outcome measures varies with the characteristics of change (similar or different) in patients’ functional status. We recommend using the Assessment of Motor and Process Skills, along with the Functional Independence Measure, for patients who are expected to make similar amounts of change in functional status, as the cognitive subscale of the Assessment of Motor and Process Skills is more sensitive to change and can better detect changes in the cognitive aspect of functioning. For patients whose functional status are expected to change differently (diverse diagnoses), the Functional Independence Measure may be more useful as the motor subscale was more sensitive to change when comparing between rehabilitation populations. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article looks at the eight steps from the Translation and Cross-Cultural Adaptation for Objectively-Assessed Outcome (TCCA-OAO) procedure that guides the process by describing aims and recommends resources for reach step. Topics covered include advantages of translating and adapting an outcome measure over developing a new instrument, how conceptual equivalence is achieved, and the limitations of the TCCA-OAO.

Purpose: Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. Method: A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists’ confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists’ perspectives on MLS use during VR-based therapy provision. Results: The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists’ clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. Conclusion: The KT intervention improved therapists’ confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy. [ABSTRACT FROM AUTHOR]

Purpose:There has been an increase in research on the effect that virtual reality (VR) can have on physical rehabilitation following stroke. However, research exploring participant perceptions of VR for post-stroke rehabilitation has been limited. Method:Semi-structured interviews were conducted with 10 chronic stroke participants (10 males, mean age = 72.1, mean time since injury = 38.6 mos.) who had recently completed an upper extremity VR stroke rehabilitation programme. Results:Four main themes emerged: ‘the VR experience,’ ‘functional outcomes,’ ‘instruction,’ and the ‘future of VR in stroke rehabilitation,’ along with nine sub-themes. Participants illustrated the positive impact that VR training had on their functional abilities as well as their confidence towards completing activities of daily living (ADL). Participants also expressed the need for increased rehabilitation opportunities within the community. Conclusion:Overall, participants were optimistic about their experience with VR training and all reported that they had perceived functional gain. VR is an enjoyable rehabilitation tool that can increase a stroke survivor’s confidence towards completing ADL.Implications for RehabilitationAlthough there is an increase in rehabilitation programmes geared towards those with chronic stroke, we must also consider the participants’ perception of those programmes.Incorporating participant feedback may increase enjoyment and adherence to the rehabilitation programmes.The VR experience, as well as provision of feedback and instruction, are important aspects to consider when developing a VR programme for stroke survivors.VR for rehabilitation may be a feasible tool for increasing the survivors’ confidence in completing ADL post-stroke. [ABSTRACT FROM AUTHOR]

Background: Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods: A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results: Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions: Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. [ABSTRACT FROM AUTHOR]

Background The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom. Methods Semi-structured interviews were conducted with therapists who were involved in implementing GRASP at their work site, or who had experience of using GRASP. Normalisation Process Theory (NPT), a sociological theory used to explore the processes of embedding innovations in practice, was used to develop an interview guide. Intervention components outlined within the GRASP Guideline Manual were used to develop prompts to explore how therapists use GRASP in practice. Interview transcripts were analysed using a coding frame based on implementation theory. Results Twenty interviews were conducted across eight sites in British Columbia Canada. Therapists identified informal networks and the free online availability of GRASP as key factors in finding out about the intervention. All therapists reported positive opinions about the value of GRASP. At all sites, therapists identified individuals who advocated for the use of GRASP, and in six of the eight sites this was the practice leader or senior therapist. Rehabilitation assistants were identified as instrumental in delivering GRASP in almost all sites as they were responsible for organising the GRASP equipment and assisting patients using GRASP. Almost all intervention components were found to be adapted to some degree when used in clinical practice; coverage was wider, the content adapted, and the dose, when monitored, was less. Conclusions Although GRASP has translated into clinical practice, it is not always used in the way in which it was shown to be effective. This formative evaluation has informed the development of a novel intervention which aims to bridge this evidence-practice gap in upper limb rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

The article presents a study which aims at analyzing the effect of an aerobic exercise intervention on symptoms of depression in patients suffering from traumatic brain injury. An aerobic exercise program of 12 week was conducted on patients having physical impairment. According to the results of the study, aerobic exercise was effective for patients as it resulted in an improved mood, cardiovascular fitness and self-esteem.

Purpose: To disseminate findings from an international workshop regarding priority issues for girls' and women's health and quality-of-life after sustaining a traumatic brain injury (TBI). Methods: A workshop was held prior to the American Congress of Rehabilitation Medicine Conference 2010. The purpose of the workshop was to highlight the unique health issues experienced by women after a TBI, to identify research, education and policy gaps and to develop strategies to promote women's health. Presentations by researchers and consumers as well as large group discussions formed the basis of the recommendations. Results: Twenty researchers, clinicians, consumers and community agency personnel attended from five countries. Significant gaps in service provision in the community were identified as were unique issues for the short- and long-term effects on maturation and ageing, reproductive and sexual health, mental health and life satisfaction. The workshop led to the development of an international task force and recommendations for future directions. Conclusion: Women and girls experience unique outcomes after a TBI. The workshop identified research, policy, education and service priorities for the promotion of health and quality-of-life within this population. [ABSTRACT FROM AUTHOR]

Background: The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. Methods: This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. Results: Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. Conclusion: This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury. [ABSTRACT FROM AUTHOR]

Background: Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/ function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods: This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results: Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion: The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify goal priorities in a sample of individuals with chronic stroke. Method: In this descriptive study involving 19 community-dwelling individuals with stroke, participants were interviewed on the Canadian Occupational Performance Measure (COPM) to ascertain problem areas experienced after hospital discharge. Once problems were identified, they were classified under the three dimensions of the COPM: self-care, productivity, and leisure. Results: The mean time since stroke was 6.8 (± 2.9) years. Eighty-four problems were identified within the three dimensions of the COPM. The most frequently cited problems in each dimension were bathing (self-care) by 42% of participants, household maintenance (productivity) by 32% of participants, and walking outdoors (leisure) by 32% of participants. Overall, participants rated their performance of identified problems and satisfaction with their abilities as low and rated each dimension as equally important for problem priority. Conclusion: Long after hospital discharge, individuals with chronic stroke were able to identify issues of concern that could benefit from involvement of rehabilitation professionals. Clinicians should be aware that issues of bathing, walking, household maintenance, and recreational activities are of particular importance to people with chronic stroke living in the community. A client-centred approach to problem generation (ie, use of the COPM) may assist in enhancing client involvement and motivation towards rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: This study investigated psychometric properties of the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q), the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self (BMQ-S), the Rehabilitation Therapy Engagement Scale--Revised (RTES-R), and the BMQ-Relative (BMQ-R) in individuals with an acquired brain injury (ABI). Design: Thirty-nine patients with an ABI completed the MOT-Q, BMQ-S, measures of apathy (Apathy Evaluation Scale-Self), insight (Patient Competency Rating Scale-Self), depression, and anxiety (HADS). Twenty clinicians provided 39 ratings using the RTES-R, BMQ-R, measures of patient apathy (Apathy Evaluation Scale-Clinician) and insight (Patient Competency Rating Scale-Clinician). Internal consistency, test-retest reliability, interrater reliability, and convergent validity were estimated. Results: The MOT-Q (a = .93) and BMQ-S (a = .91) had excellent internal consistency and test-retest reliability (intraclass correlation coefficient [ICC] = 0.80 and 0.85). The MOT-Q and BMQ-S did not correlate with each other. The MOT-Q correlated with insight (r = -0.37, p < 0.05). The BMQ-S correlated with insight (r = -0.44, p < 0.01), apathy (r = .50, p < 0.01), depression (r = .55, p < 0.01), and anxiety (r = .49, p < 0.01). The RTES-R (a = .96) and BMQ-R (a = .95) had excellent internal consistency and good interrater reliability (ICC = 0.67 and 0.68). The RTES-R and BMQ-R correlated with each other (r = -0.88, p < 0.01), with apathy (r = -0.82 and r = .88, p < 0.01), and insight (r = -0.61 and r = .63, p < 0.01). Conclusions: The MOT-Q, RTES-R, BMQ-S, and BMQ-R have good reliability and validity. Using the MOT-Q and BMQ-S together may provide additional insight. [ABSTRACT FROM AUTHOR]