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This study examined the statistical relationship between offender rehabilitation and leisure functioning of Oregon prisoners ( N = 281) soon to reenter society. The strong positive correlation between leisure functioning and rehabilitation is an important finding of the study. Perception of freedom and intrinsic motivation in leisure, as independent variables, were significantly related to rehabilitation even when controlling for the influence of demographic and important forensic variables. This study provides initial empirical evidence for the importance of leisure in offender rehabilitation and successful offender reentry. The role of leisure education programming as a supportive offender rehabilitation strategy is also discussed.

Purpose: The Australian National Disability Insurance Scheme (NDIS) will provide people with individual funding with which to purchase services such as therapy from private providers. This study developed a framework to support rural private therapists to meet the anticipated increase in demand., Method: The study consisted of three stages utilizing focus groups, interviews and an online expert panel. Participants included private therapists delivering services in rural New South Wales (n = 28), disability service users (n = 9) and key representatives from a range of relevant consumer and service organizations (n = 16). We conducted a thematic analysis of focus groups and interview data and developed a draft framework which was subsequently refined based on feedback from stakeholders., Results: The framework highlights the need for a 'rural-proofed' policy context in which service users, therapists and communities engage collaboratively in a therapy pathway. This collaborative engagement is supported by enablers, including networks, resources and processes which are influenced by the drivers of time, cost, opportunity and motivation., Conclusions: The framework identifies factors that will facilitate delivery of high-quality, sustainable, individualized private therapy services for people with a disability in rural Australia under the NDIS and emphasizes the need to reconceptualize the nature of private therapy service delivery. Implications for Rehabilitation Rural private therapists need upskilling to work with individuals with disability who have individual funding such as that provided by the Australian National Disability Insurance Scheme. Therapists working in rural communities need to consider alternative ways of delivering therapy to individuals with disability beyond the traditional one-on-one therapy models. Rural private therapists need support to work collaboratively with individuals with disability and the local community. Rural private therapists should harness locally available and broader networks, resources and processes to meet the needs and goals of individuals with disability.

Purpose: The manual, user-operated Arise Standing Wheelchair (SWC) is the end result of multiple design iterations based on findings and feedback from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customisability. This paper describes a long-term community integration study of the Arise SWC. Methods: All participants (N = 8; 7 Male, 1 Female) were persons with spinal cord injuries. During the study period (six months), the participants integrated the Arise SWC into their daily routines. To assess the impact of the Arise SWC on various outcome measures, participants' responses were captured using a Likert-scale questionnaire at the beginning of the study, after 30 days, and after 180 days of Arise SWC usage. Results: The long-term usage of the Arise SWC positively impacted the users' standing performance (ability to stand regularly, stand at different locations, and stand in community settings), productive ability (accessibility to environmental controls and ability to perform overhead reaches), and pathophysiology (spasticity and ability to get proper sleep). Furthermore, all the users were able to independently move using the Arise SWC over even and uneven terrain (some needed minimal assistance over uneven terrain). Conclusions: Overall, we believe that Arise SWC will benefit eligible users and improve their ability and performance in daily activities. IMPLICATIONS FOR REHABILITATION: Arise Standing Wheelchair (SWC) positively impacted users' standing performance, mobility over uneven terrain, ability to transfer between surfaces, and overhead reaches. Arise SWC positively impacted users' overall physical well-being. The study shows that Arise SWC improved the users' overall daily living activities. Arise SWC, an affordable solution, is anticipated to have a global impact, especially on low-income nations. [ABSTRACT FROM AUTHOR]

To translate and cross-culturally adapt The Community Integration Measure into Turkish (CIM-T) and to assess its reliability and validity in patients with chronic stroke. Fifty participants completed the CIM-T, Community Integration Questionnaire (CIQ) and the London Handicap Scale (LHS). All participants completed the CIM-T questionnaire twice in 7 days. The internal consistency of the CIM-T was assessed using Cronbach's alpha, while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of CIM-T was determined with CIQ and LHS by using Pearson's and Spearman's correlation coefficient analysis. The CIM-T demonstrated high internal consistency (Cronbach's α = 0.955) and test-retest reliability (ICC= 0.992). The CIM-T showed a good correlation with CIQ (R = 0.727, p < 0.001) and LHS (R = 0.694, p < 0.001). The Turkish version of CIM is a valid and reliable instrument for assessing chronic stroke patients. It is a preferable scale for the clinical evaluation of Turkish-speaking patients with chronic stroke. The Community Integration Measure was successfully translated into Turkish and validated in a population with chronic stroke according to established guidelines. The Turkish version of the Community Integration Measure has very good internal consistency and test–retest reliability. The Turkish version of the Community Integration Measure is valid and reliable. [ABSTRACT FROM AUTHOR]

The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke. To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke. This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score. After controlling for age, the CIM score significantly correlated with the scores for FAS (r=-0.48, p < 0.001), 6MWT distance (r = 0.24, p = 0.039), and SAFE (r=-0.39, p = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, p < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores. This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling. [ABSTRACT FROM AUTHOR]

This study investigated the impact of recovery capital (RC) on community integration (CI) among a sample of adults formerly incarcerated. A sample of 78 participants who identified as being in recovery from substance use disorder and having been previously incarcerated completed a survey asking about their RC and CI. Results of a hierarchical regression model investigating the relationship between RC and CI revealed a significant model, accounting for 27% of the variance in CI. Results provide support for considering aspects of RC, particularly social support, when facilitating reentry and reintegration for individuals who have experienced incarceration. Results also reveal that people who identified as multiracial reported significantly lower levels of CI. [ABSTRACT FROM AUTHOR]

The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness. [ABSTRACT FROM AUTHOR]

Background: The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods: A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results: Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion: The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI. This descriptive qualitative study explores the perceived changes within a community-based organisation following the implementation of a strength-based approach for people living with the sequela of a traumatic brain injury. Positive changes resulting from the implementation process were revealed through semi-structured interviews with community support workers of the organisation. [ABSTRACT FROM AUTHOR]

This study presents an analysis of the experiences of 15 men convicted of sexual offences, from England and Wales, who have completed the Horizon treatment programme in the community, facilitated by The Probation Service. We found that whilst men felt initially coerced into the programme, finishing the programme was experienced as a significant loss of support. Beyond the programme, the men described the constraints on their citizenship, difficulty accessing support, and rejection in society due to their offence. We conclude by discussing the limitations of personal rehabilitation, the need for social rehabilitation, including tailored support beyond the programme, the importance of user voice and a 'community integration paradox'. [ABSTRACT FROM AUTHOR]

This study identified individual sociodemographic and clinical characteristics and service use patterns associated with quality of life (QoL) among 308 individuals living in permanent supportive housing (PSH) in Québec (Canada). Data were collected between 2020 and 2022, and linear multivariate analyses produced. Results demonstrated that better individual psychosocial conditions were positively associated with higher QoL. As well, living in PSH located in good neighborhoods for at least 5 years, higher self-esteem and community integration were positively associated with greater QoL. Met needs, satisfaction with housing support services, and no use of acute care were also linked with positive QoL. Comprehensive efforts to improve treatment for mental health disabilities responsive to the needs of PSH residents, and sustained long-term housing may reinforce QoL. Encouraging active participation in community-based activities, incorporating biophilic design into the neighborhoods around PSH, and promoting satisfaction with care may also enhance QoL. [ABSTRACT FROM AUTHOR]

Background: Participation in leisure activities is significantly impacted following acquired brain injury (ABI). Despite this being a common community rehabilitation goal, re-engagement with leisure activities following ABI is poorly addressed within Australian community rehabilitation services, which often cater to a mixed-diagnostic group of both ABI and non-ABI clients. Objectives: To evaluate the feasibility and effect of a leisure reintegration group programme within a community rehabilitation service. Method: A single-site, pre- and post-test feasibility study was conducted. Three cohorts of a semi-structured leisure group programme were offered, each conducted over eight sessions within 4 weeks. The Nottingham Leisure Questionnaire (NLQ) and Leisure Satisfaction Measure (LSM) were used as primary outcome measures. Measures of acceptability, including adherence, and a post-intervention participant survey were also completed. Results: Of the 14 consenting participants, 9 completed all outcome measures. Mean change score for the NLQ was −3.63 (p = 0.11) and the LSM 4.25 (p = 0.46). The programme was well attended (79%), acceptable for ABI and non-ABI participants and able to be implemented within an existing community rehabilitation service. Conclusion: Providing a leisure reintegration group programme met an identified need, developed client and carer capacity and could be delivered within a community rehabilitation service for clients with mixed diagnoses including ABI. A larger trial is warranted to examine the effectiveness and cost-effectiveness of this intervention for people with ABI. [ABSTRACT FROM AUTHOR]

This research is an integrative review of the literature on social factors in TBI outcomes. It examines how such factors have been framed in TBI models, the social experience of people post-injury, and the evidence for effective social interventions. Evidence suggests that even when physical functioning has improved after injury, there is a lingering social distress that leaves individuals isolated and functionally impaired. A novel hypothesis is proposed to explain why these difficulties persist. This hypothesis draws from existing biopsychosocial models of TBI recovery, including those prominent in neuropsychology. It is argued that the social component of several TBI outcome models is too narrowly defined. This potentially has the effect of focusing efforts on the individual and their social skills or abilities as opposed to the seeking improvements at the level of the community. Evidence for and against this hypothesis is considered. This evaluation supports the idea that TBI outcomes are subject to a wider range of post injury social factors than is typically recognized, and that these factors are dynamic rather than static. Inspired by this hypothesis, this review proposes that social interventions for TBI should be adjusted to suit the stage of recovery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up. Design: A multicenter, longitudinal, and observational study. Subjects: Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China. Methods: In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions. Results: The participants’ scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p

Introduction: Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas. Methods: A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion. Results: Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level. Conclusion: The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.

Background: Various factors affect the community integration (CI) of persons experiencing traumatic brain injury (TBI). To ensure positive outcomes in terms of life at home, social activities, and productive work among persons suffering TBI, it is necessary to understand the factors that facilitate or impede CI. Purpose: To compare CI by looking at demographic and clinical characteristics and determine significant predictors of CI among TBI Nepalese persons. Methods: 120 participants were selected using a stratified random sampling technique. A questionnaire was used to identify the participants' demographic and clinical characteristics, and the Community Integration Questionnaire was used to measure CI. Univariate and multivariate analyses were performed for demographic and clinical factors associated with community integration. Results: Using univariate analysis, male, employed, living with family, and independence in performing activities of daily living had significantly higher CI scores than female (t = −4.18, p<.000), unemployed (t = −10.52, p<.000), living with friends (t = −3.30, p<.001), and those with moderate to slight dependence (t = −2.83, p<.005). The multivariate analysis revealed that employment status, living with family, and length of hospital stay were significant predictors of CI among TBI Nepalese persons. Conclusion: Employment status, living with family, and length of hospital stay were significant predictors of CI. These findings suggest that rehabilitation efforts should focus on minimizing hospital stay and promoting both productive and social activities among people surviving TBI. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to identify factors that may predict community participation among adults with lower limb amputation. Design: This study is a secondary analysis of a cross-sectional data set, including 126 community-dwelling adults, ≥1 yr after unilateral transfemoral- (n = 44; mean age = 59 ± 14 yrs) or transtibial-level amputation (n = 82; mean age = 59 ± 14 yrs) seen in an outpatient limb loss clinic. Participation was assessed with the Community Integration Questionnaire. Factors, that is, demographics, comorbidities, prosthesis use per the Houghton Scale, Socket Comfort Score, assistive device use, falls history, and activity level per General Practice Physical Activity Questionnaire were evaluated. Moreover, balance confidence per the Activities-Specific Balance Confidence Scale, mobility per the Locomotor Capabilities Index, fast and self-selected gait speed per 10-meter walk tests, and functionalmobility via Timed Up and Go were also included. Results: Community participation was correlated with several factors (P ≤ 0.050). Stepwise regression of correlated factors found absence of peripheral neuropathy and greater self-reported physical activity, balance confidence, and prosthesis use, as the strongest correlates, collectively explaining 50.1% of the variance in community participation post-lower limb amputation. Conclusions: Findings identify key modifiable factors for consideration in future prospective research seeking to enhance community reintegration and participation among adults living with a unilateral transfemoral- or transtibial-level amputation. [ABSTRACT FROM AUTHOR]

Individuals who have experienced incarceration are an underserved population in need of career development to reduce barriers to employment. Given the high rates of disability and health concerns for individuals who have been previously incarcerated, this study explored the relationships between individual health functioning, vocational identity, core self‐evaluations, and community integration. Using structural equation modeling structural regression, results showed that functional difficulties negatively impact vocational identity and core self‐evaluations. Conversely, core self‐evaluations significantly improve community integration and mediate a positive relationship between vocational identity and community integration. Career development activities aimed at core self‐evaluations and increasing meaning in employment may reduce some of the barriers experienced by individuals post incarceration. [ABSTRACT FROM AUTHOR]

William (Bill) A. Anthony was a pioneer in the field of psychosocial/psychiatric rehabilitation and recovery. He established the Center for Psychiatric Rehabilitation at Boston University and served as the editor/coeditor of the Psychosocial Rehabilitation Journal (later Psychiatric Rehabilitation Journal). He helped to clarify ideas, principles, policies, and practices that promoted the right and ability of people living with psychiatric disabilities and mental health challenges to aspire to and achieve their own vision of a meaningful life. This introductory article briefly overviews Bill's contributions to psychiatric rehabilitation and recovery of people with mental health challenges and his influence on recent work in this field, a sample of which is presented in the current special section dedicated to him. To conclude, the article overviews this special section, which reports on studies in the United States and elsewhere, addressing supported education, recovery colleges, photovoice to promote community integration, and policy developments in Israel. Impact and Implications: This article summarizes the seminal impact of Bill Anthony's body of work on the field of psychiatric rehabilitation and recovery. Additionally, it traces the broad implications of his vision and contributions to the field, to the four articles presented in the special section, as examples of current work that will lead to future developments built upon his legacy. [ABSTRACT FROM AUTHOR]

To examine the effect of the COVID-19 pandemic on societal participation in people with moderate-to-severe traumatic brain injury (TBI). Cross-sectional retrospective cohort. National TBI Model Systems centers, United States. TBI Model Systems enrollees (N=7003), ages 16 and older and 1-30 years postinjury, interviewed either prepandemic (PP) or during the pandemic (DP). The sample was primarily male (72.4%) and White (69.5%), with motor vehicle collisions as the most common cause of injury (55.1%). Not applicable. The 3 subscales of the Participation Assessment with Recombined Tools-Objective: Out and About (community involvement), Productivity, and Social Relations. Out and About, but not Productivity or Social Relations, scores were appreciably lower among DP participants compared to PP participants (medium effect). Demographic and clinical characteristics showed similar patterns of association with participation domains across PP and DP. When their unique contributions were examined in regression models, age, self-identified race, education level, employment status, marital status, income level, disability severity, and life satisfaction were variably predictive of participation domains, though most effects were small or medium in size. Depression and anxiety symptom severities each showed small zero-order correlations with participation domains across PP and DP but had negligible effects in regression analyses. Consistent with the effect of COVID-19 on participation levels in the general population, people with TBI reported less community involvement during the pandemic, potentially compounding existing postinjury challenges to societal integration. The pandemic does not appear to have altered patterns of association between demographic/clinical characteristics and participation. Assessing and addressing barriers to community involvement should be a priority for TBI treatment providers. Longitudinal studies of TBI that consider pandemic-related effects on participation and other societally linked outcomes will help to elucidate the potential longer-term effect the pandemic has on behavioral health in this population. [ABSTRACT FROM AUTHOR]

Objectives The United States has seen increasing shifts toward home- and community-based services (HCBS) in place of institutional care for long-term services and supports. However, research has neglected to assess whether these shifts have improved access to HCBS for persons with dementia. This paper identifies HCBS access barriers and facilitators, and discusses how barriers contribute to disparities for persons with dementia living in rural areas and exacerbate disparities for minoritized populations. Methods We analyzed qualitative data from 35 in-depth interviews. Interviews were held with stakeholders in the HCBS ecosystem, including Medicaid administrators, advocates for persons with dementia and caregivers, and HCBS providers. Results Barriers to HCBS access for persons with dementia range from community and infrastructure barriers (e.g. clinicians and cultural differences), to interpersonal and individual-level barriers (e.g. caregivers, awareness, and attitudes). These barriers affect the health and quality of life for persons with dementia and may affect whether individuals can remain in their home or community. Facilitators included a range of more comprehensive and dementia-attuned practices and services in health care, technology, recognition and support for family caregivers, and culturally competent and linguistically accessible education and services. Discussion System refinements, such as incentivizing cognitive screening, can improve detection and increase access to HCBS. Disparities in HCBS access experienced by minoritized persons with dementia may be addressed through culturally competent awareness campaigns and policies that recognize the necessity of familial caregivers in supporting persons with dementia. These findings can inform efforts to ensure more equitable access to HCBS, improve dementia competence, and reduce disparities. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of baseline injury characteristics and one-year functional level on the 10-year community integration outcomes for working-age patients with moderate-to-severe traumatic brain injury (TBI). Patients aged 16–55 and diagnosed with moderate-to-severe TBI within 24 h of injury were eligible for the study. Multivariable hierarchical linear regression was utilized to assess the impact of baseline characteristics and one-year functional measures on the mean Community Integration Questionnaire (CIQ) scores 10 years after injury. Of 133 original study participants, 97 survived 10 years, and 75 were available for this study. The mean total CIQ score changed positively from one to 10 years post-injury, from 18.7 (±5.5) to 19.8 (±4.8) (p = 0.04). The results suggested that age (β = −0.260, p = 0.013), FIM-Cognitive subscale (β = 0.608, p = 0.002), and the bodily pain subscale (BP) (β = 0.277, p = 0.017) of the SF-36 were significantly associated with the mean CIQ scores. In conclusion, this study demonstrated improved community integration from one to 10 years in a sample of working-age patients with moderate-to-severe TBI. The findings also showed that age, cognitive function, and bodily pain were significant predictors of long-term community integration, suggesting post-acute rehabilitation should focus on factors related to long-term risk and protective factors to improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This scoping review explores the many benefits of Brazilian Jiu-Jitsu (BJJ) on veterans and first responders, focusing on physical health improvements, psychological benefits, and social integration. The purpose is to synthesize existing literature to identify research gaps and suggest directions for future studies. By examining both qualitative and quantitative research, this review seeks to show the utility of BJJ as a therapeutic modality option and propose it as a comprehensive intervention for enhancing the overall well-being of veterans and first responders. Methods: PubMed and Google Scholar searches were conducted to capture a broad range of studies involving BJJ with veterans or first responders. This review adheres to the PRISMA-ScR guidelines, focusing on studies discussing physical, mental, and social outcomes. Results: The initial search yielded numerous qualitative and quantitative studies. This review categorizes the findings into themes of physical health improvements, psychological benefits, and social integration, highlighting the variability and scope of the existing literature. Conclusions: The review highlights the need for well-structured research to substantiate BJJ's therapeutic benefits. It recommends areas for in-depth exploration in future systematic reviews or primary studies, especially longitudinal studies on BJJ's effects and specific therapeutic contributions. Application in Sport: For coaches and trainers, integrating BJJ into programs for veterans and first responders enhances physical fitness and mental health. BJJ improves cardiovascular health, strength, and endurance and reduces PTSD, depression, and anxiety symptoms. BJJ supports mental resilience and provides a supportive community, helping in social integration and reducing isolation. Incorporating BJJ can holistically enhance the recovery and effectiveness of veterans and first responders. [ABSTRACT FROM AUTHOR]

Objective: To explore older persons’ perceptions of the impact of COVID-19 restrictions on participating in community activities after discharge from inpatient rehabilitation. Methods: Mixed-methods study design. Participants were older adults who were discharged home following inpatient rehabilitation. Interviews were conducted with 70 participants, with a variety of diagnoses, 8 weeks after discharge from inpatient rehabilitation. Frequency of participation in domestic, leisure/work and outdoor activities was measured using the Frenchay Activities Index (FAI). Qualitative analysis was completed using qualitative content analysis and triangulated with FAI scores. Results: In all, 70 older adults (mean age: 73.0 years, SD: 9.9; 59% female) participated in the study. The overarching theme was that participants felt socially isolated following discharge from rehabilitation, with COVID-19 restrictions increasing perceptions of social isolation and complicating their return to participating in community activities. The four categories informing the overarching theme were as follows: physical health was the primary limitation to participation in community activities; COVID-19 restrictions limited participation in social activities and centre-based physical rehabilitation; low uptake of videoconferencing to facilitate socialisation and rehabilitation; and reduced incidental physical activity. Mean FAI score was 21.2 (SD 7.8), indicating that participants were moderately active. Participants most commonly performed domestic activities (mean: 10.0, SD: 4.1), followed by outdoor activities (mean: 6.6, SD: 3.5) and leisure/work activities (mean: 4.5, SD: 2.5). Conclusions: COVID-19 restrictions exacerbated perceptions of social isolation and the limitations already imposed by poor physical health after discharge from rehabilitation. The findings highlight the need for rehabilitation that addresses the psychological and social dimensions of community reintegration. [ABSTRACT FROM AUTHOR]

To further understand social and leisure (SL) participation after stroke and how it can be supported in a long-term perspective, this study aims to deepen the understanding of strategies used by long-term stroke survivors in relation to SL activities. The study has a qualitative design, using a grounded theory approach, and is based on in-depth interviews with 10 persons who had a stroke 15 years ago and four of their family members. The findings comprise nine different strategies used by the participants. These had two overarching purposes; to protect and re-construct the post-stroke self and to enable participation in valued SL activities despite challenges. The findings are summarized in one overarching theme: "Employing different strategies to balance costs and rewards of engagement in social and leisure activities". Strategies for SL participation involves balancing different priorities in life and can change over time as they are continuously influenced by various personal and environmental conditions. These findings contribute to an improved understanding of why and how people hold on to activities, give up activities and find new activities after a stroke. It also highlights the need for a long-term perspective on stroke rehabilitation and support. Re-engagement in social and leisure activities after stroke is a long-term process and various types of support may be needed during different stages of recovery and adaptation. Successful rehabilitation interventions build on an understanding of each individual's priorities, goals and strategies and how these may change or manifest over time. Special attention should be given to the individual's perception of costs and benefits in relation to engagement in activities, and the role that it has for the person's identity. By providing knowledge and supporting the use of adequate coping strategies, rehabilitation professionals can help patients find a new and accepted post-stroke identity. [ABSTRACT FROM AUTHOR]

To examine return to school outcomes 1 year after traumatic brain injury (TBI) rehabilitation discharge. Longitudinal observational study using Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) data at 1-year post-TBI. Inpatient rehabilitation centers using follow-up telephone calls. Individuals (n = 237) enrolled in the TBIMS-NDB since 2001 between the ages of 18 and 59 years who were engaged in postsecondary education (full or part-time) before recorded TBI. Return to school, categorized as in a postsecondary setting at first follow-up (reported hours in school greater than zero at one-year follow-up). Using an alpha level of 0.05 binary logistic regression analysis identified four predictive variables. Significant predictors of return to school include being of lower age, possessing a higher level of functioning at discharge, reporting lower ratings of disability at discharge, and being able to use a vehicle independently for transportation. Pursuit of higher education is a viable means of community reintegration after TBI. Some individuals with TBI face a myriad of barriers and challenges when returning to school. Study findings may facilitate understanding of how TBI affects return to school and community reintegration outcomes. [ABSTRACT FROM AUTHOR]

Stroke is an acute condition that requires immediate care and long-term community-based chronic care supports. Communities vary in their ability to support the complex needs of this population. To bring stroke recovery stakeholders together to discuss the needs of community-based stroke recovery and develop possible solutions across one province in Canada. The participatory research approach of the World Café was used to explore topics related to community-based stroke recovery. Three World Cafés were held in three communities, including rural, urban-multicultural, and indigenous communities. Sixty-one stakeholders participated in this study. The data was analyzed following an inductive approach for all three Word Cafés. Four main themes were revealed from the data. First, Individual Needs, but Holistic Care encompassed the idea that stroke survivors' needs are complex and changing. Second, Whole of the Community indicated that all the people in stroke survivors' communities should be considered when designing solutions. Third, Transition in Care focused on the needs and solutions during the transition from hospital to community. Lastly, participants emphasized that better Connection, Collaboration, and Communication are needed among all stakeholders. While some similarities in needs and solutions were identified for stroke survivors across three diverse communities, differences between them were also reported. Approaches to enhance better communication among all stakeholders and facilitate a continuous transition from hospital to community are needed. Co-creating solutions with each local community should be considered as individual needs, and challenges are specific to each community. [ABSTRACT FROM AUTHOR]

Objective: To understand and explore the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities post‐injury, and if geographical location plays a role in those outcomes. Design: Cross‐sectional mail‐out survey of TBI patients, using standardised, quantitative measures. Setting: Data were drawn from three Accessibility Remoteness Index of Australia (ARIA) areas in Queensland to model the contribution of these areas and other factors to TBI outcomes. Participants: Using hospital records, 662 people with mild to severe TBI were identified. These people were sent a survey, postdischarge. Usable surveys were returned by 91 individuals, 6‐ to 18‐months post‐injury. Location was coded using the ARIA (urban n = 22, rural n = 43, remote n = 26). Main Outcome Measures: TBI‐related symptoms, quality of life, service obstacles, unmet needs, mental health and community integration. Results: No group differences in TBI outcomes due to location were found. While the participant's gender, age, and injury severity were significant independent predictors of five of the six outcomes, location did not play a role. Conclusion: Consistent with previous findings, geographical remoteness did not affect self‐reported TBI outcomes. Older people, women and those with severe TBI had worse outcomes and required additional supports, and men require community integration assistance. An Australia‐wide study with regular follow‐ups is strongly recommended to support direct regional comparisons and improve service planning. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate functional outcomes and community reintegration of disaster survivors in Pakistan. Methods: This was a cross-sectional descriptive study of community-based participants at the Armed Forces Institute of Rehabilitation Medicine, Pakistan. The medical records were screened for eligibility of adults with disaster-related disability. Participants were interviewed in ambulatory clinics using validated measures: Neurological-Trauma Impairment Scale (NIS-Trauma), International Classification of Functioning, Disability, and Health-Generic Set, Community Integration Measure (CIM), Community Integration Questionnaire (CIQ), and EuroQol 5-Dimension 5-Level. Results: Participants were (n = 117, mean age = 35 years) with postdisaster injury up to 17 years; the majority had spinal cord injury (n = 62; 53%) and amputations (n = 44; 38%). At assessment, 80% were independent with mobility (with aids) and 29% with everyday living activities. They reported ongoing fatigue (54.7%), altered sensations (51.28%), and pain (50.43%), but fewer problems with mood and emotions. The impairment severity negatively impacted community activities (NIS-Trauma vs. CIQ: P < 0.001). As impairments improved with time (NIS-Trauma vs. time since injury: P = 0.003), so did community reintegration (time since injury vs. CIQ; P < 0.001) and perceived health status (time since injury vs. EuroQol; P = 0.001). Conclusion: Many participants reported various ongoing disability-related issues; however, majority were dependent with everyday living activities and well adapted in the community. Further robust studies are needed for evaluation of longer-term impact of the disability in disaster victims for the comprehensive healthcare in the community.

The focus of this scoping review was to identify the extent, range, and nature of studies that have been published regarding community integration programs and interventions that support people during the transition home from hospital following spinal cord injury. Four electronic databases and one search engine were searched for articles published between 2010 and 2020. Grey literature and manual searches were also done. Of the 16 articles included, 8 were published in peer-reviewed journals. Two of these did not include an evaluation. Study designs included but were not limited to pilot studies (n = 2); mixed methods evaluations (n = 2); single-site randomized controlled trials (n = 3); and, non-randomized single-arm study design (n = 1). The articles were from the United States (n = 12), Canada (n = 2), Australia (n = 1), and the United Kingdom (n = 1). The majority of interventions focused on addressing health-related educational needs, followed by community mobility. Goal setting and promoting self-efficacy were identified as important components, and the importance of involvement of people with lived experience was also highlighted. There was a lack of focus on management of relationships, including addressing sexuality needs. This review highlights the need for further empirical evaluation of implemented programs and interventions in this area, particularly in countries other than the USA, to inform service development. Successful community integration is an important outcome of spinal cord injuries rehabilitation. The majority of published programs focus on health-related educational needs, followed by community mobility. It is recommended that goal setting and promoting self-efficacy are included in programs. It is recommended that people with lived experience of spinal cord injuries are involved in interventions. It is recommended that programs include a focus on management of relationships, including addressing sexuality needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Telerehabilitation is an effective health delivery method for patients with a variety of health conditions. There is insufficient knowledge about use of telerehabilitation to support patients with disabilities and chronic illness in obtaining or sustaining competitive employment. Employment rates of Veterans are lower than civilian rates, and the employment gap is higher for Veterans living in rural areas. OBJECTIVE: To investigate factors that enabled and constrained routine use of video tele-technologies in delivering individualized community-based vocational rehabilitation (referred to as Tele-VR) services and to identify impacts and promising practices in implementation. METHODS: Semi-structured interviews with providers from two Veterans Health Administration Medical Sites that use telerehabilitation to supplement their existing face-to-face individualized community-based VR services. Interviews were analyzed using thematic analysis. RESULTS: Five themes in the implementation of Tele-VR were identified (1) Enhancing Workflow for Providers, (2) Improving Quality of Therapeutic Care, (3) Practicalities in Implementing Tele-VR, (4) Embedding Vocational Rehabilitation into Interdisciplinary Care as a Facilitator to Implementation, and (5) Impact of Tele-VR. CONCLUSIONS: The telerehabilitation delivery of employment service to Veterans with disabilities is a viable means for remotely providing or enhancing face-to-face individualized and community-based VR services that support Veterans' competitive employment and job stability within their communities. [ABSTRACT FROM AUTHOR]

Introduction: Residential-based rehabilitation programmes were introduced by the Western Cape Department of Health in 2008 to relieve the burden of long-term hospitalization in South Africa. In South Africa, more men than women of working age require long-term support from public mental health services. Most of these healthcare users live in communities characterised by poverty and unemployment. There is limited research on male mental health service users' perspectives on the impact that residential-based rehabilitation programmes have on their community integration. The aim of the study was to inform the continuum of care for people with serious mental disorders to better align residential-based rehabilitation and primary care public mental health services with the recovery needs of mental health service users. Method: An instrumental case study design was applied, and five male participants were identified through purposive sampling. Observations, semi-structured interviews, community maps and document analysis were used to collect data. Thematic cross-case analysis of qualitative data was done. Findings: The theme, It's a catch-22 situation, describes the participants' ambivalence towards the residential-based rehabilitation programme's contribution to their community reintegration after discharge. Three categories, namely 'It's not just what you call it', 'There's no one size for all', and 'It's tricky choosing between places to go and things to do', capture how the perceived inflexibility of the programme curtailed their adjustment to community living. Conclusion: Participants proposed co-constructing their recovery plan with mental health professionals so that it is more personalised in supporting them as they adapt to emergent occupational challenges. It is recommended that a seamless continuum of support between different levels of care should be implemented. [ABSTRACT FROM AUTHOR]

Self-generated strategy use has substantial potential for improving community living outcomes in adults with impaired executive function after stroke. However, little is known about how self-generated strategies support task performance in people with post-stroke executive function impairments living in the community. We explored strategy use among home-dwelling persons with stroke and neurologically-healthy control participants during the Multiple Errands Test-Home Version (MET-Home), a context-specific assessment with evidence of ecological validity designed to examine how post-stroke executive dysfunction manifests during task performance in the home environment. For persons with stroke, significant associations were identified between planning and tasks accurately completed on the MET-Home. Significant associations were also identified among the control participants for self-monitoring, multitasking, and "using the environment" strategies. These associations are related to enhanced MET-Home performance on sub-scores for levels of accuracy, passes, and total time. Rehabilitation interventions that focus on reinforcing self-generated strategy use may support community living outcomes in persons with post-stroke executive function impairments, but this area needs additional investigation. [ABSTRACT FROM AUTHOR]

Purpose: To explore participants' experiences in a group-based yoga with psychoeducation intervention designed to facilitate community integration for people with traumatic brain injury and their caregivers. Materials and methods: We conducted semi-structured interviews with 13 people with traumatic brain injury and three caregivers who had completed LoveYourBrain Yoga, a 6-session, manualized, group-based yoga intervention that incorporates breathing exercises, yoga, meditation, and psychoeducation. Interviews were analyzed using content analysis. Results: We identified seven themes: ease of participation, belonging, sustaining community connection, physical health, self-regulation, self-efficacy, and resilience. All participants valued the community-based yoga studio environment and multifaceted structure of the program. Participants reported improvements in strength, balance, flexibility, and attention control, and a greater sense of belonging, community connection, and ability to move forward with their lives. Participants reported ongoing use of tools (e.g., breathing exercises) to cope with negative emotions and stress. About half of participants sustained relationships built during LoveYourBrain Yoga and felt more capable of accessing other activities in their community. Conclusions: LoveYourBrain Yoga successfully promoted community integration for people with traumatic brain injury. It also facilitated diverse and meaningful physical, psychological, and social health benefits, which suggest that it may be an effective mode of community-based rehabilitation. Traumatic brain injury survivors often struggle to participate in their community, the ultimate goal of rehabilitation Yoga is a holistic therapy with many benefits, yet is not accessible to the traumatic brain injury population at the community level Participants in a community-based yoga with psychoeducation intervention in six states experienced diverse and meaningful physical, psychological, and social health benefits Group-based yoga with psychoeducation may be an effective mode of community integration and community-based rehabilitation for traumatic brain injury survivors [ABSTRACT FROM AUTHOR]

Veterans with traumatic brain injury (TBI) may experience long-term challenges that compromise community reintegration (CR) outcomes. Resource facilitation (RF) is an evidence-based model of service delivery that bridges community support services following acute care or rehabilitation. Coalition building is an implementation strategy used to cultivate relationships to promote access and referral to CR services. This one-year, mixed-method community-based pilot study included a Veteran leadership planning team and thirteen coalition members. Wilder Collaboration Factors Inventory (WCFI) results show a decrease in overall coalition function concerns and an increase in coalition function strengths. Themes emerged in the areas of facilitators of coalition functioning, and barriers to coalition functioning. Coalition building can be used to cultivate relationships and build partnerships to promote Veteran access and referral to CR services. [ABSTRACT FROM AUTHOR]

Objectives: There is limited research on the use of telerehabilitation platforms in service delivery for people with acquired brain injury (ABI), especially technologies that support delivery of services into the home. This qualitative study aimed to explore the perspectives of rehabilitation coordinators, individuals with ABI, and family caregivers on the usability and acceptability of videoconferencing (VC) in community-based rehabilitation. Participants' experiences and perceptions of telerehabilitation and their impressions of a particular VC system were investigated. Methods: Guided by a theory on technology acceptance, semi-structured interviews were conducted with 30 participants from a community-based ABI service, including 13 multidisciplinary rehabilitation coordinators, 9 individuals with ABI, and 8 family caregivers. During the interview, they were shown a paper prototype of a telehealth portal for VC that was available for use. Interview transcripts were coded by two researchers and analysed thematically. Results: The VC was used on average for 2% of client consultations. Four major themes depicted factors influencing the uptake of VC platforms; namely, the context or impetus for use, perceived benefits, potential problems and parameters around use, and balancing the service and user needs. Participants identified beneficial uses of VC in service delivery and strategies for promoting a positive user experience. Conclusions: Perceptions of the usability of VC to provide services in the home were largely positive; however, consideration of use on a case-by-case basis and a trial implementation was recommended to enhance successful uptake into service delivery. [ABSTRACT FROM AUTHOR]

To examine differences in long-term social reintegration outcomes for burn survivors with and without peer support attendance. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area (TBSA) or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Burn support group attendance was reported by 330 (55%) of 596 respondents who responded to this item. Attendees had larger burn size (43.4%±23.6% vs 36.8%±23.4% TBSA burned, P <.01) and were more likely to be >10 years from injury (50% vs 42.5%, P <.01). Survivors who attended at least 1 support group scored significantly higher on 3 of the scales: Social Interactions (P =.01), Social Activities (P =.04), and Work and Employment (P =.05). In adjusted analyses, peer support attendance was associated with increased scores on the Social Interactions scale, increasing scores by 17% of an SD (95% confidence interval, 1%–33%; P =.04). Burn survivors who reported peer support attendance had better social interaction scores than those who did not. This is the first reported association between peer support group attendance and improvements in community reintegration in burn survivors. This cross-sectional study prompts further exploration into the potential benefits of peer support groups on burn recovery with future intervention studies. [ABSTRACT FROM AUTHOR]

To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. Cross-sectional survey. Community-dwelling burn survivors. Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). Not applicable. The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. Older participants, those who were married, and men were more likely to be burned at work (P <.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P =.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P <.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work. Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes. [ABSTRACT FROM AUTHOR]

To classify patients with stroke into subgroups based on their characteristics at the moment of discharge from inpatient rehabilitation in order to predict community ambulation outcome 6 months later. Prospective cohort study with a baseline measurement at discharge from inpatient care and final outcome determined after 6 months. Community. A cohort of patients (N=243) with stroke, referred for outpatient physical therapy, after completing inpatient rehabilitation in The Netherlands. Not applicable. A classification model was developed using Classification And Regression Tree (CART) analysis. Final outcome was determined using the community ambulation questionnaire. Potential baseline predictors included patient demographics, stroke characteristics, use of assistive devices, comfortable gait speed, balance, strength, motivation, falls efficacy, anxiety, and depression. The CART model accurately predicted independent community ambulation in 181 of 193 patients with stroke, based on a comfortable gait speed at discharge of 0.5 meters per second or faster. In contrast, 27 of 50 patients with gait speeds below 0.5 meters per second were correctly predicted to become noncommunity walkers. We show that comfortable gait speed is a key factor in the prognosis of community ambulation outcome. The CART model may support clinicians in organizing community services at the moment of discharge from inpatient care. [ABSTRACT FROM AUTHOR]

• Childhood adversity was positively related to depressive symptoms and suicide attempts. • Depressive symptoms mediated the relationship between childhood adversity and suicide attempts. • Community integration moderated the mediating effect of depressive symptoms on the association between childhood adversity and suicide attempts. The aim of this study was to verify the moderated mediating effect of community integration on the influence of childhood adversity on suicide attempts in adolescent who have dropped out of school and examine the mediating effect of depressive symptoms. This study used the data of the first year from a Longitudinal Survey and Support Plan for Dropouts in 2013. Among 776 respondents, 685 (mean age = 18.04, SD = 0.78) participants were included in the final analysis. The results of this study showed that both childhood adversity and depressive symptoms were positively associated with suicide attempts. Depressive symptoms mediate the relationship between childhood adversity and suicide attempts. In particular, the mediating effect of depression on the influence of childhood adversity on suicide attempts was moderated by community integration. The results of this study suggest that help from counselors and social workers at a national level is needed to strengthen social ties between out-of-school youth and community members to prevent suicide among youth who have dropped out of school. [ABSTRACT FROM AUTHOR]

Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate whether emotional intelligence (EI) skills measured via the Perceiving, Understanding, and Managing Emotions branches of the Mayer-Salovey-Caruso Emotional Intelligence Test V2.0 are associated with community integration (CI) and return to work (RTW) after moderate-to-severe acquired brain injury (ABI), after accounting for other established predictors. Design Retrospective cohort study. Setting Outpatient follow-up services within 2 specialist ABI rehabilitation centers in Melbourne, Australia. Participants Individuals (N=82) with moderate-to-severe ABI discharged from inpatient rehabilitation and living in the community (2mo to 7y postinjury). Intervention Not applicable. Main Outcome Measures Community Integration Questionnaire scores for the total sample (N=82; age range 18-80) and RTW status (employed vs not employed) for the subset of participants employed prior to ABI (n=71; age range 19-66). Results Hierarchical logistic and multiple regression analyses were used to examine the unique contribution of Perceiving, Understanding, and Managing Emotions scores to RTW and CI, after controlling for demographic, injury-related, psychological, and cognitive predictors. As a set, the 3 EI variables did not explain incremental variance in outcomes. However, individually, Understanding Emotions predicted RTW (adjusted odds ratio=3.10, P =.03), χ2 (12)=35.52, P <.001, and Managing Emotions predicted CI (β=0.23, P =.036), F 12,69 =5.14, P <.001. Conclusion Although the EI constructs in combination did not improve prediction beyond the effects of established variables, individual components of strategic EI may be important for specific participation outcomes after ABI. [ABSTRACT FROM AUTHOR]

Purpose: Participation is widely recognized as an important outcome for rehabilitation. However, it lacks a universally accepted definition. The purpose of this review is to synthesize the literature about participation in rehabilitation in order to clarify the term and increase its usefulness for rehabilitation providers and researchers. Methods: We undertook an interpretive synthesis of the literature, drawing from a broad and varied selection of the vast number of publications on the subject of participation. The search and analysis was iterative and continued until saturation of themes was achieved. Results and Conclusions: Seventy-six articles were included in our analysis. We argue that three essential dimensions - performance, subjective experience, and interpersonal connection - constitute participation. We further divide participation into community-based and interventional contexts. Interventional participation is circumscribed by the treatment setting, whereas community-based encompasses all other areas. Participation in either interventional or community-based contexts is largely determined by the available opportunities from which a person can choose, with such opportunities affected by conditions that are either internal or external to the individual. As defined in this framework, participation is not inherently good or bad; rather, its effect is determined by a person’s unique life circumstances and the impact may not always be apparent. We posit this model as a resource for future research as well as clinical reasoning. Implications for Rehabilitation: The often tacit assumption that increasing participation is a desirable outcome needs to be challenged and considered in each patient’s life situation. Treatment settings constitute a unique context in which patients participate. Intervention goals should be clearly connected with patients’ personal goals for community-based participation. [ABSTRACT FROM AUTHOR]

Abstract Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work. [ABSTRACT FROM AUTHOR]