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Background: Post-stroke sequelae frequently lead to a more isolated and inactive life. The introduction of a novel selfmanagementintervention in combination with traditional physical and occupational therapy, may enhance self-efficacy of selfmanagementafter stroke. This may thereby also increase quality of life and lessen the burden on relatives.Purpose: To investigate the effect of a novel self-management intervention to support elderly people after stroke.Methods and content: Randomized controlled trial. Sixty-nine individuals with stroke aged > 65 years have been randomizedeither to a group receiving conventional neurorehabilitation (control) or to an additional novel self-management intervention. Inthe intervention group, patients with stroke were offered eight self-management sessions of 45–60 min duration by aphysiotherapist or an occupational therapist during a period of nine months after discharge.Study outcome measurements: Stroke Self-efficacy Questionnaire, a short version of Stroke Specific Quality of Life Scale,Impact of Participation and Autonomy Questionnaire, and Caregiver Burden Scale. Furthermore, physical activity will beassessed using accelerometers. All outcomes except “impact on participation” and “autonomy” will be assessed at baseline,three months, and nine months after discharge. Impact of participation and autonomy will be assessed at three and ninemonths after discharge.Patient, informal caregiver, and therapist satisfaction were examined by way of questionnaires and interviews.The inclusion is complete. The final results will be available in summer 2021 and will be presented and discussed at thecongress.Perspectives: Self-management interventions are promising strategies for rehabilitation, potentially increasing self-efficacy,quality of life, as well as participation and autonomy. The current trial “Stroke - 65 Plus. Continued Active Life,” will providefurther evidence of self-management strategies to clinicians, patients, and health economists.

Brain Computer Interfaces (BCI) use brain activity to elicit visual and / or motor feedback. They may provide sorely needed training alternatives for patients with severely impaired upper limb after stroke, where treatment choices are limited and unsatisfactory. In this study, we wanted to explore a) the feasibility of BCI training early after stroke and b) therapists’ experiences and satisfaction with BCI training. MethodsThis a qualitative sub-study of an ongoing pilot RCT to assess effectiveness and feasibility of BCI training in subacute stroke at a specialized neurorehabilitation hospital in Denmark. In this study, patients with severe upper limb paresis are included while admitted to subacute rehabilitation after stroke. The BCI system (RecoveriX, gtec, Austria) uses brain activity to control a functional electrical stimulation system for the upper limb and to provide visual feedback. To explore feasibility and user perspectives, semi-structured interviews were conducted with therapists who work with BCI training. Furthermore, feasibility was assessed by the number of patients recruited and retained, and the number of intervention sessions provided as intended. Systematic text condensation for thematic cross-case analysis was used for data analysis.ResultsFive physiotherapists, experienced in neurorehabilitation, participated in individual interviews. In general, they experienced BCI training in the subacute phase after stroke as feasible and motivating for patients. They valued the ability of the BCI systems to provide intensive upper limb training and thereby new training opportunities for patients with severe paresis and paralysis. They also expressed that patients were focused and concentrated. Positive experiences were compromised by some initial technical challenges. Therapists emphasized the need to familiarize themselves with the system. All patients included so far reached the minimum number of 8 sessions with BCI training.ConclusionBCI training provides new treatment opportunities and is feasible early after stroke even for patients with multiple challenges. Therapists appreciate the motivating and intense training, which would not be possible otherwise.

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BACKGROUND:Development of clinical practice at a Danish neurorehabilitation center was delegated to a group of health professional developers. Their job function lacked conceptual foundation, and it was unclear how their job tasks contributed to evidence-based practice.OBJECTIVE:Conceptual clarification of the job function and pattern analysis of activity distributions for health professional developers.METHODS:Side 2 af 30Health professional developers kept time geographical diaries for two weeks continuously. Meaningful categories from reported activities were subtracted through content analysis. Patterns within activity distributions were analysed with regards to evidence-based practice.RESULTS:A total of 213 diaries were collected from 21 health professional developers of three professions (seven physiotherapists, six occupational therapists and eight nurses). Each informant reported from 6-13 days (median 10 days). Eleven main categories of work tasks emerged with 42 subcategories. Overall, 7% of total time reported was allocated to adding external knowledge with a minimum of variation between professions and contractual time allocation.CONCLUSION:Conceptual clarification of work tasks of health professional developers was established. Their work activity distributions primarily contributed to maintenance of an existing level of professional knowledge and clinical expertise rather than adding external knowledge, which did not fulfil the intended development of evidence-based practice. BACKGROUND:Development of clinical practice at a Danish neurorehabilitation centre was delegated to a group of health professional developers. Their job function lacked conceptual foundation, and it was unclear how their working tasks contributed to evidence-based practice.OBJECTIVE:Conceptual clarification of the job function and pattern analysis of activity distributions for health professional developers.METHODS:Health professional developers kept continuous time geographical diaries for two weeks. Meaningful categories were subtracted through content analysis. Patterns were analysed within activity distributions with regards to evidence-based practice.RESULTS:A total of 213 diaries were collected from 21 health professional developers of three professions (physiotherapists, occupational therapists and nurses). Each participant reported 6–13 workdays (median 10 days). Eleven main categories of work tasks emerged with 42 subcategories. Overall, 7% of total time reported was spent on external knowledge, with minimal variation between professions and contractual time allocation.CONCLUSION:Conceptual clarification of work tasks was established for health professional developers. Their work activity distributions contributed mainly to maintenance of existing level of professional knowledge rather than to implementation of new knowledge, which did not fulfil the intended responsibility for development of evidence-based practice. Educational competence boost and data-driven change of organisation structure was recommended.

Purpose: This paper aims at examining who is perceived as relatives in rehabilitation of severe brain injured young adults since engaging relatives is crucial for social participation/the social life situation of the injuredMethods:A longitudinal qualitative study explored the perceptions and engagement of relatives throughout a rehabilitation trajectory of eight young adults with a severe acquired brain injury from three different perspectives: those of the professionals, the closest relatives and the injured. We apply a sociological theoretical framework concerning friendship . A social network analysis (SNA) methodology is used to capture, visualise and analyse the young adults’ perceptions of their social relations. Results: The ties engaged during the rehabilitation process are not only based on the young adults’ perceptions of their close network ties but rather is determined by professionals and parents. In some cases, this leads a reduction of the larger social network with the risk of the young adult’s social isolation. Conclusion:Institutions and professionals play a decisive role in maintenance of young adults’ social network also after rehabilitation. The authors therefore suggest an expansion of the term “relative” as well as considering these ties as dynamic.

Background: Post-stroke sequelae frequently lead to a more isolated and inactive life. The introduction of a novel selfmanagementintervention in combination with traditional physical and occupational therapy, may enhance self-efficacy of selfmanagementafter stroke. This may thereby also increase quality of life and lessen the burden on relatives.Purpose: To investigate the effect of a novel self-management intervention to support elderly people after stroke.Methods and content: Randomized controlled trial. Sixty-nine individuals with stroke aged > 65 years have been randomizedeither to a group receiving conventional neurorehabilitation (control) or to an additional novel self-management intervention. Inthe intervention group, patients with stroke were offered eight self-management sessions of 45–60 min duration by aphysiotherapist or an occupational therapist during a period of nine months after discharge.Study outcome measurements: Stroke Self-efficacy Questionnaire, a short version of Stroke Specific Quality of Life Scale,Impact of Participation and Autonomy Questionnaire, and Caregiver Burden Scale. Furthermore, physical activity will beassessed using accelerometers. All outcomes except “impact on participation” and “autonomy” will be assessed at baseline,three months, and nine months after discharge. Impact of participation and autonomy will be assessed at three and ninemonths after discharge.Patient, informal caregiver, and therapist satisfaction were examined by way of questionnaires and interviews.The inclusion is complete. The final results will be available in summer 2021 and will be presented and discussed at thecongress.Perspectives: Self-management interventions are promising strategies for rehabilitation, potentially increasing self-efficacy,quality of life, as well as participation and autonomy. The current trial “Stroke - 65 Plus. Continued Active Life,” will providefurther evidence of self-management strategies to clinicians, patients, and health economists.

1) Please declare any conflicts of interest below The authors have no conflicts of interest to declare. No funding was obtained. 2) Ethics Approval:All participating clinical staff received written and verbal information about the study and gave their verbal and written consent to participate. The quality development study was conducted in accordance with Danish legislation on research ethics. 3) Context: The project took place at a sub-acute rehabilitation ward at Hammel Neurorehabilitation Center and University Research Clinic.Management, researchers and health professionals responsible for clinical development collaborated.Patients are admitted shortly after injury for in-hospital rehabilitation following severe acquired brain injury. Disturbances in consciousness and cognition are frequent in these patients. 4) Problem: In early rehabilitation, a large proportion of patients with severe brain injury show only weak signs of contact. The results of a previous research project conducted at the previously mentioned rehabilitation ward showed that promoting active participation of patients with reduced consciousness in therapeutic interventions and everyday activities is difficult, but also possible. Staff at the same ward contributed to further research clarifying that specific staff competencies were of significant importance when promoting early participation for patients with severe acquired brain injury. However, there was no systematic education and implementation plan to ensure that these competencies were present in each individual within the staff.5) Assessment of problem and analysis of its causes: Individual competence levels did not warrant a systematic approach to promote early participation in patients with severe acquired brain injury. A systematic education and implementation plan was needed. 6) Intervention: Management, researchers and health professionals responsible for clinical development collaborated closely to strategically develop and implement a plan to promote the growth of relevant competencies among all employees during 2019 outlined in the 5 steps below:1) Individual competencies from clinical staff was observed by researchers (empirical data)• High quality clinical practice• Individual competencies• Observations of early participation 2) Empirical studies• Research projects• Clinical setting described• Interdisciplinary strategies observed and systematized 3) Systematic results• New approach developed• Strategies to promote early participation 4) Implementation• Systematic approach• Educational training• Peer feedback• Using a theoretical model as a framework to promote early participation5) Evaluation• Effect and experience• Evaluation on two levels; organisational and patient related• Qualitative and quantitative outcome meassures7) Strategy for change: The strategy for change was a feedback loop between researchers, managers, and clinical staff ensuring a systematic approach based on the individual competencies in the clinical staff. Step 1,2 and 3 took place in 2015-2017Step 4 took place in 2019. Step 5 – evaluation – will take place in 2020Management and interdisciplinary health professionals were facilitators of the new systematic approach.All staff were involved in educational training and peer feedback on the strategies implemented.8) Measurement of improvement: Preliminary results: Staff responded by questionnaires after each teaching course. Further, focus group interviews have been conducted after educational training 2. Early Functional Ability scores from patients have been registered. All findings will be presented as descriptive data.9) Effects of changes:Staff will report their experience of the systematic approach in focus group interviews. It will also be interesting to see if ● staff report changed level of perceived competencies● average early functional ability of the patients have changed post implementation 10) Lessons learnt:Facilitation of patient participation among patients with severe disturbances in consciousness and cognition involves several professional and often tacit competencies. A ward with a highly skilled multidisciplinary staff and 24 hour rehabilitation service requires that development and implementation of capacity building programs are based on values, customized to the specific staff, systematic and closely monitored. 11) Messages for others: Final analysis of implementation evaluation will be ready in March 2020.12) Please describe how you have involved patients, carers or family members in the project:The whole implementation project has derived from empirical data gathered from observational studies in the clinic. This means that knowledge and actions from the clinical staff were systematized and given back to the clinical staff as a systematic approach. Part of the evaluation of the implementation was based on questionnaire and focus group assessments of clinical staff regarding their learning experience and perceived level of competence.

Source at https://doi.org/10.1155/2018/1972190 . Aim: To explore and compare the content of rehabilitation practices in, respectively, a Danish and a Norwegian region, focusing on how the citizens’ rehabilitation needs are met during rehabilitation in the municipalities. Method: Six Danish and five Norwegian cases were followed 12 months after the onset of stroke. Field work and focus group interviews with multidisciplinary teams in the municipalities were conducted. The conceptual frame of the International Classification of Functioning was used to outline general patterns and local variation in the rehabilitation services. Findings: Each of the settings faces different challenges and opportunities in the provision of everyday life-supportive rehabilitation services. Rehabilitation after stroke in both settings basically follows the same guidelines, but the organization of rehabilitation programmes is more specialized in Denmark than in Norway. Team organization, multidisciplinarity, and collaboration to assess and target the patients’ needs characterized the Danish rehabilitation services. Decentralized coordination and monodisciplinary contributions with scarce or unsystematic collaboration were common in the Norwegian cases. Seamless holistic rehabilitation was challenged in both countries, but more notably in Norway. The municipal services emphasized physical functioning, which could conflict with the patients’ needs. Cognitive disturbances to and aspects of activity or participation were systematically addressed by the interdisciplinary teams in Denmark, while practitioners in Norway found that these disturbances were scarcely addressed. Discussion: The study showed major differences in municipal stroke rehabilitation services in the Northern Norway and Central Denmark Regions—in their ability to conduct everyday life—supportive rehabilitation services. Despite the fact that biopsychosocial conceptions of disease and illness, as recommended in the ICF, have been generally accepted, they seemed scarcely implemented in the political and health managerial arenas, especially in Norway. These national diversities can partly be explained by the size of the municipalities and the available health profiles in delivering patient and family-centred rehabilitation services.

Interview guide - mentor: Translation of Danish interview guide (DOCX 19 kb)

Appendix. Operationalization of the six social psychological mechanisms - the mentorsâ focus areas â in the self-management intervention (DOCX 16 kb)

AimTo explore and compare the content of rehabilitation practices in, respectively, a Danish and a Norwegian region, focusing on how the citizens’ rehabilitation needs are met during rehabilitation in the municipalities.MethodSix Danish and five Norwegian cases were followed 12 months after the onset of stroke. Field work and focus group interviews with multidisciplinary teams in the municipalities were conducted. The conceptual frame of the International Classification of Functioning was used to outline general patterns and local variation in the rehabilitation services.FindingsEach of the settings faces different challenges and opportunities in the provision of everyday life-supportive rehabilitation services. Rehabilitation after stroke in both settings basically follows the same guidelines, but the organization of rehabilitation programmes is more specialized in Denmark than in Norway. Team organization, multidisciplinarity and collaboration to assess and target the patients’ needs characterized the Danish rehabilitation services. Decentralized coordination, mono-disciplinary contributions with scarce or unsystematic collaboration was common in the Norwegian cases. Seamless holistic rehabilitation was challenged in both countries, but more notably in Norway. The municipal services emphasized physical functioning, which could conflict with the patients’ needs. Cognitive disturbances to and aspects of activity or participation were systematically addressed by the interdisciplinary teams in Denmark, while practitioners in Norway found that these disturbances were scarcely addressed.DiscussionThe study showed major differences in municipal stroke rehabilitation services in the Northern Norway and Central Denmark Regions – in their ability to conduct everyday life-supportive rehabilitation services. Despite the fact that bio-psycho-social conceptions of disease and illness, as recommended in the ICF, have been generally accepted, they seemed scarcely implemented in the political and health managerial arenas, especially in Norway. These national diversities can partly be explained by the size of the municipalities and the available health profiles in delivering patient and family-centred rehabilitation services.

BackgroundHammel Neurorehabilitation Centre and University Research Clinic (HNURC) is a hospital with a public reputation of good practice and up-to-date practice development. A group of expert clinicians are responsible for practice development. The experts have multiple functions and tasks and manage the practice development in a variety of ways on each of the clinics at the Centre. Given that there are several ways to manage the specialist role, there is an on-going dialogue between management and experts on how to best fulfil it. The time geographical analysis will contribute with an outlay of the factual time-/task distribution for the individual expert and for the expert group in total.AimTo investigate patterns in the time-/task distribution for experts responsible for clinical development at HRNUC through• conceptual clarification and categorisation on how experts name their work tasks• description and visualisation of experts’ individual and group based time-/task distributions MethodsAll experts responsible for practice development at HRNUC were included. Time geographical diaries were filled out by the experts at every work day in a continuous period of two weeks. Diary data consisted of the date and time for activities performed, and the places and people present during the activities. Participants were to name their activities individually. Phenomenological analysis was performed to subtract meaningful categories from reported activities within data. Validity was ensured with member checks from experienced clinicians. Visualised results were presented to the experts and the management at HRNUC.ResultsA total of 213 diaries were collected from 21 experts responsible for practice development from 3 professions at HRNUC (7 physiotherapists, 6 occupational therapists and 8 nurses) from January 19th to June 3rd 2018. Each participant reported from 6-13 days (median 10 days). Eleven main categories of work tasks emerged with 42 subcategories. Work time was summed to 100% per participant and time-/task distributions for individuals and groups were generated for visual presentation. PerspectiveVisualised time-/task distributions can facilitate a fact-based and meaningful dialogue between clinical experts and management. Further, data-informed management can lead to strategic decisions based on facts in combination with individual narratives on work tasks, preferences, wishes and competencies in yearly appraisals.ConclusionConceptual clarification and categorisation of the work tasks of the experts responsible for practice development is now established. The visualisation of experts’ individual and group based time-/task distribution was valuable for both participants and management.

This article unravels the genesis and history of neurorehabilitation (NR) in Denmark in order to understand the transformation that this subfield has undergone since the 1970s and how this is reflected in the present structure. Seen through the lens of Bourdieu’s concept of field and based on a document review strategy of historical sources and political documents the article constructs three analytic periods: 1. the genesis of NR until the first half of the 1980s, 2. the institutionalization of NR from 1985-2006 and 3. the political restructuring of NR after the local government reform in 2007. Our analysis shows that NR is a multi- and interdisciplinary practice characterized by heterogeneity, although with growing homogeneity in clinical practice due to an increased number of NR institutions, and later political guidelines. We conclude that despite an increased power to psycho-social and comprehensive approaches, biomedical knowledge is still dominant and reflected in doxa

This article unravels the genesis and history of neurorehabilitation (NR) in Denmark in order to understand the transformation that this subfield has undergone since the 1970s and how this is reflected in the present structure. Seen through the lens of Bourdieu’s concept of field and based on a document review strategy of historical sources and political documents the article constructs three analytic periods: 1. the genesis of NR until the first half of the 1980s, 2. the institutionalization of NR from 1985-2006 and 3. the political restructuring of NR after the local government reform in 2007. Our analysis shows that NR is a multi-and interdisci-plinary practice characterized by heterogeneity, although with growing homogeneity in clin-ical practice due to an increased number of NR institutions, and later political guidelines. We conclude that despite an increased power to psycho-social and comprehensive approaches, biomedical knowledge is still dominant and reflected in doxa. This article unravels the genesis and history of neurorehabilitation (NR) in Denmark in order to understand the transformation that this subfield has undergone since the 1970s and how this is reflected in the present structure. Seen through the lens of Bourdieu’s concept of field and based on a document review strategy of historical sources and political documents the article constructs three analytic periods: 1. the genesis of NR until the first half of the 1980s, 2. the institutionalization of NR from 1985-2006 and 3. the political restructuring of NR after the local government reform in 2007. Our analysis shows that NR is a multi- and interdisciplinary practice characterized by heterogeneity, although with growing homogeneity in clinical practice due to an increased number of NR institutions, and later political guidelines. We conclude that despite an increased power to psycho-social and comprehensive approaches, biomedical knowledge is still dominant and reflected in doxa.