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Background: The Cardiovascular Disease Outcomes Strategy (department of health (DoH), 2013) recommends the use of existing cardiac rehabilitation (CR) programmes for people after transient ischaemic attack (TIA) and mild disability stroke. However, there is no research exploring the attitudes of CR or stroke staff who might feasibly be delivering this service. Method: Using a qualitative interpretive approach with five researchers, seven focus groups with CR and stroke teams were conducted prior to stroke patients taking part in CR and four focus groups after CR. Group discussions were audiotaped and transcribed verbatim. Themes were identified to explain attitudes. Results/Findings: Main themes were as follows: Confidence - CR team lack of confidence to deliver the service and the stroke team having lack of confidence in the CR team, change in confidence in CR team post CR. Lack of Knowledge - CR team -stroke knowledge, Stroke team - CR knowledge, cardiovascular (CV) training, and healthy lifestyles, Stroke and Exercise - barriers - stroke team more aware of personal barriers, both teams aware of environmental barriers, social barriers, and cultural barriers, both teams - identified most patients motivated early after stroke. CR adaptations needed - education programme to include stroke information and class structure. Discussion: Importance of communication, education, and support between stroke and CR teams to provide effective CR for people with stroke. Conclusion: Stroke and CR teams feel that small numbers of people with mild stroke can be included in existing CR programmes where CR staff have increased stroke knowledge and confidence and the programme is adapted and supported by specialist stroke staff. [ABSTRACT FROM AUTHOR]

Objective: To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery., Design: Qualitative focus group-based study., Setting: Acute and community national health service trusts., Participants: Stroke and cardiac rehabilitation team members., Intervention: Adapted cardiac rehabilitation., Main Measures: Focus groups. Thematic analysis was applied to the transcribed data., Results: Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles., Conclusions: Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed., Registration: ISRCTN65957980., Competing Interests: Declaration of Conflicting InterestsThe authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Professor Robinson is an NIHR Senior Investigator. Professor Singh is an NIHR Senior Investigator.

Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for why long COVID should not be considered as a functional neurologic disorder. It will begin by discussing the parallel historical development of pathobiological and psychosomatic/sociogenic diagnostic constructs arising from a common root in neurasthenia, which has resulted in the collective understandings of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and functional neurologic disorder (FND), respectively. We will also review the case definition criteria for FND and the distinguishing clinical and neuroimaging findings in FND vs. long COVID. We conclude that considering long COVID as FND is inappropriate based on differentiating pathophysiologic mechanisms and distinguishing clinical findings.

Background: Myalgic encephalomyelitis (ME) is a complex, multi-system neurological condition. The defining feature of ME is post-exertional malaise (PEM) with over 30 symptoms triggered by physical, cognitive, emotional and social activity. The cause of PEM is unclear but one area of research using cardio-pulmonary exercise tests show a reduced ventilatory anaerobic threshold (VAT) with repeated tests leading to PEM. Pacing with heart rate monitoring (HRM) provides feedback to maintain activity intensity below the VAT. There is only one piece of research investigating the use of HRM although a number of guidelines recommend it., Objective: To identify the experiences and attitudes of people with ME towards HRM., Methods: A 40 question online survey was devised and released on ME websites, Twitter and Facebook pages. People with ME read the information sheet and followed an online link to the survey. The survey was open for three weeks and all answers were anonymous., Results: 488 people with ME completed the survey. Most participants were female, 35-50 years and with a reported illness of greater than 5 years. Over 100 types of HR monitor used. Over 30 benefits and over 30 negatives identified. HRM reduced severity of ME and severity and duration of PEM., Conclusion: Although there are limitations, HRM has many benefits including helping PwME to understand and manage their PEM and support them to increase their activities, including work. There is a need for more research and education of healthcare professionals in the safe use of HRM.

Objective: To determine the construct validity and test re-test reliability of the Six-minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT) in the sub-acute recovery phase following mild-to-moderate severity stroke., Participants: 40 stroke patients (mean age: 68.27 years, SD: 13.48) of median National Institutes of Health Stroke Scale (NIHSS) score 1.2 (range: 0 to 8) within six months of stroke., Method: Each participant completed one Incremental Cycle Test (ICT) followed by two ISWT and two 6MWT in a randomised order. Pearson's Correlation Coefficients were used to determine the validity and Bland Altman plots were used to determine the test re-test reliability., Results: The Incremental Cycle Test (ICT) was positively correlated with the ISWT (r=0.59, 95% confidence intervals 0.35 to 0.76, P=0.001) and the 6MWT (0.55, 0.35 to 0.71, P<0.001). The correlation of the ICT with the ISWT and 6MWT was higher for the 17 patients with no residual (ISWT: r=0.79, P<0.001; 6MWT: 0.826, P<0.001) compared to mild-to-moderate neurological impairment (ISWT: r=0.45, P=0.03; 6MWT: r=0.38, P=0.08). Test-retest reliability for both the ISWT and the 6MWT showed that there was some variability between the first and second tests with a better performance on the second test., Conclusion: The ISWT and 6MWT have a significant, modest correlation with the ICT for stroke patients in the sub-acute recovery phase. The ISWT and 6MWT are not strongly correlated with ICT (VO 2 peak) in a stroke population that is disabled. The test-retest reliability of the ISWT and 6MWT indicated that two tests may be needed to accurately assess an individual's capabilities., (Copyright © 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Integrated services which utilise the expertise of team members along care pathways are evolving. Changes in service structure and subsequent team working arrangements can be a challenge for practitioners expected to redefine how they work with one another. These services are particularly important for the care of frail older people. This exploratory study of one newly forming team presents the views of staff involved in establishing an interprofessional healthcare advisory team for older people within an acute hospital admissions unit. Staff experiences of forming a new service are aligned to a model of team development. The findings are presented as themes relating to the stages of team development and identify the challenges of setting up an integrated service alongside existing services. In particular, team process issues relating to the clarity of goals, role clarification, leadership, team culture and identity. Managers must allow time to ensure new services evolve before setting up evaluation studies for efficiency and effectiveness which might prove against the potential for interprofessional teamworking.