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BackgroundThe number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation.ObjectiveTo investigate whether ACTIV improved physical function compared with usual care.MethodsThis 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants' homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control.ResultsA total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up.ConclusionsACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.

A desire to have every student attending our University be aware of, and reflect on, disability in their studies and future careers, initiated our project to explore how to enhance disability awareness within all our University's papers. In this project we systematically reviewed pertinent literature and ran an action research workshop for staff. Strategies to enhance disability awareness identified in the literature and workshop were presented and verified at an interactive conference presentation. Embedding disability awareness into curricula is challenging; staff considered themselves powerless to bring about change in their departments, but thought that one way to do so would be by modelling inclusive behaviour and by introducing subtle inclusive practices into papers taught. The identified strategies may be of use to others contemplating similar curricular modifications.

This study aimed to understand the experience of older adults with dementia towards, and the practicality of, the Balance Wise exercise programme. A qualitative study guided by the General Inductive Approach was employed. Ten people with dementia aged 71–87 years who completed the exercise programme and four care partners aged 69–76 years old (three of whom also participated in Balance Wise) were interviewed in dyads. The programme (individually or group delivered) was held once a week for 30 min for 10 weeks and included balance and strength exercises, cognitive training, and other enjoyable physical activities. Interviews were thematically analysed. Three overarching themes were identified (i) decision making, (ii) comprehension, and (iii) perceived benefits. Participants acknowledged their decision to participate was influenced by 'awareness' about their declining memory and their 'health belief' about the potential benefits of exercise. 'Perceived benefits' were influenced by the 'support system' and improvement in postural stability. 'Comprehension' was, however, an important cognitive ability to understand the purpose of the activities in the programme and facilitated motivation. This study highlighted an important message that such programmes should be developed from the end-user perspective, and this included that the programme be flexible and safely delivered, as well as be fun and pleasurable, thus promoting socialisation. [ABSTRACT FROM AUTHOR]

Abstract Background In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent. Methods/design This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study. Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home. Trial registration ACTRN12612000464864