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Background Functional loss, the inability to perform necessary or desired tasks, is a common consequence of life-limiting illnesses and associated symptoms (pain, fatigue, breathlessness, etc.) and causes suffering for patients and families. Rehabilitation, a set of interventions designed to address functional loss, is recognised as essential within palliative care, as it can improve quality of life and reduce care costs. However, not everyone has equal access to rehabilitation. Despite limited life expectancy or uncertain ability to benefit from interventions, palliative rehabilitation services are often absent. This is partly due to a lack of high-quality research around optimal models of rehabilitation. Research in this area is methodologically challenging and requires multidisciplinary and cross-speciality collaboration. Aim and objectives We aimed to establish and grow a United Kingdom research partnership across diverse areas, commencing with partners from Edinburgh, East Anglia, Lancashire, Leeds, London and Nottingham, around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The objectives were to (1) develop a multidisciplinary, cross-speciality research partnership, (2) generate high-priority unanswered research questions with stakeholders, (3) co-design and submit high-quality competitive research proposals, including (4) sharing topic and methodological expertise, and (5) to build capacity and capability to deliver nationally generalisable studies. Activities The partnership was established with professionals from across England and Scotland with complementary areas of expertise including complex palliative and geriatric research, physiotherapy, nursing, palliative medicine and psychology. Research questions were generated through a modified version of the Child Health and Nutrition Research Initiative, which allowed for the collation and refinement of research questions relating to functional loss and rehabilitatio

Purpose: To evaluate the dissemination and implementation impacts of a rehabilitation intervention. Methods: Systematic evaluation of data sources including academic publishing metrics, publications, and surveys was used to describe the dissemination and implementation impact of the graded repetitive arm supplementary program (GRASP). Three categories in the Payback Framework were evaluated: knowledge production and dissemination, benefits to future research and research use, and real-world uptake and implementation. Results: In the Knowledge production and dissemination category, seven publications, authored by the GRASP research team, were associated with the GRASP, and there were approximately 17,000 download counts of GRASP manuals from the website from 120 countries. In the Benefits to future research and research use category, 15 studies and 8 registered clinical trials, authored by researchers outside of the GRASP team, have used GRASP as an intervention. In the real-world uptake and implementation category, GRASP has informed recommendations in 2 clinical guidelines and 20 review papers, and had high implementation uptake (e.g., 35% [53/154] of UK therapists surveyed had used GRASP; 95% [649/681] who downloaded GRASP had used it). More than 75% of those who had used GRASP identified that GRASP provides more intensity in upper extremity rehabilitation, is evidence-based and easy to implement, and the equipment and manual are easy to obtain. Conclusion: The Payback Framework is useful to evaluate the dissemination and implementation impacts of a rehabilitation intervention. GRASP has been implemented extensively in clinical practice and community in a relatively short time since it has been developed.

Background Existing evidence suggests that clinician and organisation engagement in research can improve healthcare performance. However, current evidence has considered the relationship across all healthcare professions collectively. With the increase in allied health professional (AHP) clinical academic and research activity, it is imperative for healthcare organisations, leaders and managers to understand research engagement within these specific clinical fields. This systematic review aims to examine the value of research engagement by allied health professionals and organisations on healthcare performance. Methods This systematic review had a two-stage search strategy. Firstly, the papers from a previous systematic review examining the effect of research engagement in healthcare were screened to identify relevant papers published pre-2012. Secondly, a multi-database search was used to update the previous review but with a specific focus on allied health to identify publications from 2012 to date. Studies which explored the value of allied health research engagement on healthcare performance were included. All stages of the review were conducted by two reviewers independently, plus documented discussions with the wider research team when discrepancies occurred. Each study was assessed using the appropriate critical appraisal tool developed by the Joanna Briggs Institute. Results Twenty-two studies were included, of which six were ranked as high importance. This sample comprised mixed research designs. Overall, the findings indicated positive improvements in processes of care. The review also identified the most common mechanisms which may link research engagement with improvements to processes of care. Conclusion This landmark review is the first benchmark of evidence that explicitly shows improved processes of care and outcomes from AHP research engagement. The lack of transparent reporting of AHP research engagement highlights the need for clear recommendation

Leg ulcers pose a significant challenge to healthcare services, requiring effective wound cleansing strategies to promote healing and prevent complications. Large amounts of nursing time is spent managing patients with venous leg ulcers (VLU), with an average appointment time of approximately 30 minutes. Yet, there is a lack of clear guidance for the treatment of VLU’s with nurses adopting a wide range of cleansing practices. This commentary provides an overview of existing evidence on wound cleansing and care in treating leg ulcers, for the benefit of healthcare professionals working within clinical practice.

Introduction: Delivering the intensity of exercise required to promote upper limb recovery after stroke is challenging within resource limited health systems. Self-directed exercise may be a way of increasing rehabilitation intensity. Developing an understanding of the hows, whys, and in what contexts self-directed upper limb therapy is successfully prescribed and performed is key to developing implementable interventions, and potentially supporting those that already exist. Method: We are undertaking a realist review to identify and test, (1) What supports and constrains people doing self-directed upper limb exercise after stroke, (2) How, why and in what context and for whom it improves outcomes. A realist review differs from a traditional systematic review in that it focuses on an explanation of an intervention’s causal mechanisms and how they work in different contexts, as well as its outcomes. Consisting of two phases, Phase 1 involves identifying stakeholder theories about self-directed upper limb exercise from the literature. We have searched Embase, CINAHL, PEDro, PsycINFO, Epistemonikos, TRIP database, trade journals (e.g., Frontline, OTnews) and Google. In Phase 2, we will test these theories, allowing them to be refined, refuted or confirmed, using empirical evidence from databases and websites appropriate to the theory being tested. As an iterative process, areas of focus will develop dependent upon the theories found and based on stakeholder consultation. Results: N/A Conclusion: The resulting programme theory and logic model for self-directed exercise after stroke will be further refined through fieldwork, providing the basis for co-design of a toolkit to support self-directed exercise.

Background There is a need to evaluate if and how telerehabilitation approaches might co-exist within healthcare in the long-term. Our aim was to implement and evaluate a multidisciplinary group-based telerehabilitation approach for people engaging in neurological rehabilitation. Methods NeuroRehabilitation OnLine (NROL) was adapted and implemented within an existing healthcare system as a programme of repeating six-week blocks. A robust evaluation was undertaken simultaneously using a convergent parallel design underpinned by implementation frameworks. This included service data, and patient and staff interviews. Implementation success was conceptualised using the outcomes of appropriateness, acceptability and sustainability. Results Eight NROL blocks delivered 265 sessions with 1347 patient contacts, and NROL continues as part of standard practice. The approach was appropriate for varied demographics and had positive patient opinions and outcomes for many. Staff perceived NROL provided a compatible means to increase therapy and help meet targets, despite needing to mitigate some challenges when fitting the approach within the existing system. NROL was considered acceptable due to good attendance (68%), low drop-out (12%), and a good safety record (one non-injury fall). It was accepted as a new way of working across rehabilitation disciplines as an ‘extra layer of therapy’. NROL had perceived advantages in terms of patient and staff resource (e.g. saving time, energy and travel). NROL provided staffing efficiencies (ratio 0.6) compared to one-to-one delivery. Technology difficulties and reluctance were surmountable with dedicated technology assistance. Leadership commitment was considered key to enable the efforts needed for implementation and sustained use. Conclusion Pragmatic implementation of group-based telerehabilitation was possible as an adjunct to neurological rehabilitation within an existing healthcare system. The compelling advantages reported of having

Background: Existing evidence suggests that clinician and organization engagement in research can improve healthcare processes of care and outcomes. However, current evidence has considered the relationship across all healthcare professions collectively. With the increase in allied health clinical academic and research activity, it is imperative for healthcare organizations, leaders and managers to understand engagement in research within these specific clinical fields. This systematic review aims to identify the effect of engagement in research by allied health professionals (AHPs) and organizations on healthcare performance. Methods: This systematic review has a two‐stage search strategy. The first stage will be to screen a previous systematic review examining the effectiveness of engagement in research in health and social care to identify relevant papers published pre‐2012. The search strategy used in the previous review will then be rerun, but with a specific focus on allied health. This multi‐database search will identify publications from 2012 to date. Only studies that assessed the effectiveness of allied health engagement in research will be included. All stages of the review will be conducted by two reviewers independently, plus documented discussions with the wider research team when discrepancies occur. This systematic review protocol follows the EQUATOR reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Protocols (PRISMA‐P). Discussion: The findings of this review will make a significant contribution to the evidence base around the effect of allied health engagement in research on healthcare performance. It will provide insights for clinicians and managers looking to understand the consequences of developing AHP research capability and capacity. The findings of this review will also aim to make recommendations for future evaluation approaches for engagement in research interventions. Trial registration: Th

Recovery following an upper arm break can be prolonged and cause loss of independence. Appropriate information provision to empower and enable active participation in rehabilitation is vital to achieve the best clinical outcomes. To identify and analyse, through the lens of health literacy, publicly available information leaflets produced for patients following upper arm breaks in the United Kingdom National Health Service (NHS) to understand their fitness for purpose. An electronic search of online search engines was undertaken using search terms to identify information leaflets for upper arm breaks. Relevant leaflets were retrieved and a thematic analysis was undertaken from a health literacy perspective. To complement this, each information leaflet was also formally assessed for readability. Thirty-five information leaflets were analysed. Two main themes were generated: 'Empowerment' and 'Language Use', with subthemes of promoting recovery, readability and risk of misinterpretation. The information presented in these leaflets was often complicated and sometimes contradictory. Less than half (46%) of the information leaflets were presented at a level that would be understood by the general population. Current information leaflets made available for patients following upper arm breaks are not fit for purpose and are written in a way that the general population would not readily understand. There is an urgent need to understand the information needs of patients and present such information in an accessible way to optimise clinical outcomes following upper arm breaks. [Abstract copyright: Crown Copyright © 2022. Published by Elsevier Ltd. All rights reserved.]

It is often cited it takes 17 years for evidence to get into everyday practice, though the pandemic demonstrated how this varies dramatically. In stroke and neurorehabilitation, the evidence suggests that for optimal motor recovery to occur, rehabilitation should include intensive, and repetitive task specific practice for a prolonged period. However, the reality is that dose of rehabilitation is low and often of limited intensity. Implementation science, the scientific study of methods to promote the uptake of research findings into routine healthcare practice, emerged to improve evidence use. The evidence regarding implementation of research into the real clinical world will be discussed, identifying what we know about how to implement evidence to improve neurorehabilitation practice. This will include examples from our work in stroke rehabilitation and highlight the importance of connections. Conclusions will be made about how to apply an implementation lens to increase the use of evidence in practice and discuss ways forward to improve clinical practice.

Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n=75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality of life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where we enable the entire unit to use the protocol as part of standard of care. What is the effect of introducing structured, progressive exercise (termed the Walk 'n Watch protocol) to standard of care on the primary outcome of walking in adult participants with stroke over the hospital inpatient rehabilitation period? Secondary outcomes will be evaluated and include quality of life.Methods and sample size estimates: This national, multisite clinical trial will randomize 12 sites using a stepped-wedge design where each site will be randomized to deliver Usual Care initially for 4, 8, 12 or 16-months (three sites for each duration). Then, each site will switch to the Walk 'n Watch phase for the remaining duration of a total 20-month enrolment period. Each participant will be exposed to only one of Usual Care or Walk 'n Watch. The trial will enrol a total of 195 participants with stroke to achieve a power of 80% with a Type I error rate of 5%, allowing for 20% dropout. Participants will be medically stable adults post-stroke and able to take 5 steps with a maximum physical assistance from one therapist. The Walk 'n Watch protocol focuses on completing a minimum of 30-minutes of weight-bearing, walking-related activities (at the physical therapists' discretion) that progressively increases in intensity info

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Purpose: Musculoskeletal (MSK) disorders are one of the highest causes of disability and financial cost in the UK, and physiotherapists are well placed to manage patients with MSK problems. MSK physiotherapy often includes self-management, requiring patients to undertake some form of behaviour change, including carrying out exercise programmes. Adherence is required in order to benefit from self-management programmes however, adherence rates are suboptimal. Little is known about the provision and content of self-management physiotherapy programmes (SMPP) in NHS MSK outpatient physiotherapy practice, and how these are experienced by patients. It is proposed that the behavioural change wheel, and its underpinning COM-B (capability, opportunity, and motivation-behaviour) model and theoretical domains framework (TDF) can be used in practice to explore patient adherence behaviours.

Introduction: The use of motor imagery (MI) has been shown to offer significant improvements in movement performance in sports, and is now receiving a lot of attention as a relatively new therapeutic approach which can be applied in rehabilitation. However, the effects of MI on the quality of movement is still unclear. This study explored the immediate effect of MI on reaching tasks in healthy subjects. Methods: 17 healthy individuals (33 ± 8.2 years) participated in the study. Surface electromyography (sEMG) and inertial measurement units (IMU) were used to identify muscle activity and angular velocity in both upper limbs. Participants performed a reach task using their dominant and non-dominant arms at their most comfortable speed, they were then asked to imagine themselves performing the same reaching task, and finally they were asked to repeat the reaching task. Results: Significant decreases were seen in the muscle activity between pre and post MI for Biceps Brachii, Anterior Deltoid and Triceps Brachii. In addition, a significant increase was seen in extension angular velocity post MI. Discussion: The results indicate that the use of MI just after physical practice appears to have an immediate effect on the muscle activity and kinematics during a reaching task, which may suggest an improved quality of movement. Conclusion: This proof of concept study shows the potential for MI to improve the quality of performing reaching task and offers a possible therapeutic option for Stroke survivors and other neuromuscular disorders.

Background Predicting motor recovery after stroke is a key factor when planning and providing rehabilitation for individual patients. The PREP2 algorithm has been developed to help clinicians predict upper limb functional outcome. Translating evidence-based interventions into clinical practice can be challenging and slow. However, shortly after its external local validation, PREP2 was successfully implemented into clinical practice at the same site in New Zealand. In parallel to further model validation, useful lessons can be learned from this experience to aid future implementation. Objective To explore how PREP2 was implemented in clinical practice within the Auckland District Health Board (ADHB) in New Zealand. Design A case study design using semi-structured interviews. Methods Nineteen interviews were conducted with clinicians involved in stroke care at ADHB. To explore factors influencing implementation, interview content was coded and analysed using the Consolidated Framework for Implementation Research. Strategies identified by the Expert Recommendations for Implementing Change (ERIC) project were used to describe how implementation was undertaken. Results Implementation of PREP2 was initiated and driven by therapists. Key factors driving implementation were the support given to staff from the implementation team; the knowledge, beliefs and self-efficacy of staff, and the perceived benefits of having PREP2 prediction information. Twenty-six ERIC strategies were identified relating to three areas: the implementation team, the clinical/academic partnerships and the training. Limitations Limitations included potential self-selection bias, reliance on clinicians’ ability to recall events, and potential social desirability bias affecting interview content. Conclusions The PREP2 prediction tool was successfully implemented in clinical practice at ADHB. Barriers and facilitators to implementation success have been identified, and implementation strategies described

Purpose To identify health professionals awareness of stroke rehabilitation guidelines, and factors perceived to influence guideline use internationally. Methods Online survey study. Open-ended responses were thematically analysed, guided by the Consolidated Framework for Implementation Research. Results Data from 833 respondents from 30 countries were included. Locally developed guidelines were available in 22 countries represented in the sample. Respondents from high-income countries were more aware of local guidelines compared with respondents from low- and middle-income countries. Local contextual factors such as management support and a culture of valuing evidence-based practice were reported to positively influence guideline use, whereas inadequate time and shortages of skilled staff inhibited the delivery of guideline-recommended care. Processes reported to improve guideline use included education, training, formation of workgroups, and audit-feedback cycles. Broader contextual factors included accountability (or lack thereof) of health professionals to deliver rehabilitation consistent with guideline recommendations. Conclusion While many health professionals were aware of clinical guidelines, they identified multiple barriers to their implementation. Efforts should be made to raise awareness of local guidelines in low- and middle-income countries. More attention should be paid to addressing local contextual factors to improve guideline use internationally, going beyond traditional strategies focused on individual health professionals.

Background: Repetitive sensory stimulation (RSS) is a therapeutic approach which involves repeated electrical stimulation of the skin’s surface to improve function. This rapid systematic review aimed to describe the current evidence for repetitive sensory stimulation (RSS) in rehabilitation of the upper-limb for people who have had a stroke. Main text: Methods: Relevant studies were identified in a systematic search of electronic databases and hand-searching in February 2020. The findings of included studies were synthesized to describe: the safety of RSS, in whom and when after stroke it has been used, the doses used and its effectiveness. Results: Eight studies were included. No serious adverse events were reported. The majority of studies used RSS in participants with mild or moderate impairments and in the chronic stage after stroke. Four studies used RSS in a single treatment session, reporting significant improvements in strength and hand function. Findings from longitudinal studies showed few significant differences between control and experimental groups. Meta-analysis was not possible due to the heterogeneity of included studies. Conclusions: This review suggests that there is insufficient evidence to support the use of RSS for the upper-limb after stroke in clinical practice. However, this review highlights several clear research priorities including establishing the mechanism and in whom RSS may work, its safety and optimal treatment parameters to improve function of the upper-limb after stroke.

This research is adapted from Exploring the factors influencing the use of electrically assisted bikes (e-bikes) by stroke survivors: a mixed methods multiple case study published by Taylor & Francis in Disability and Rehabilitation

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be a

Objective Effectiveness depends on adherence, so did patients use the intervention to the recommended level? If not, what reasons did they give? The purpose of this study was to investigate these and related questions. Design A prospective cohort study, plus qualitative analysis of interviews, was conducted. Methods Seventeen patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for 8 weeks and were advised to use it 3 times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. Results Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak positive correlation between duration and baseline reported activities of daily living. Participants reported lack of familiarity with technology and competing commitments as barriers to use, although they appreciated the flexibility of the intervention and found it motivating. Limitations The small sample size limits the conclusions that can be drawn. Conclusions Level of use is variable and can fall far short of recommendations. Competing commitments were a barrier to use of the equipment, but participants reported that the intervention was flexible and motivating. It will not suit everyone, but some participants recorded high levels of use. Implications for practice are discussed.

Background Granulocyte-colony stimulating factor (G-CSF) mobilises endogenous haematopoietic stem cells and enhances recovery in experimental stroke. Recovery may also be dependent on an enriched environment and physical activity. G-CSF may have the potential to enhance recovery when used in combination with physiotherapy, in patients with disability late after stroke. Methods A pilot 2 x 2 factorial randomised (1:1) placebo-controlled trial of G-CSF (double-blind), and/ or a 6 week course of physiotherapy, in 60 participants with disability (mRS >1), at least 3 months after stroke. Primary outcome was feasibility, acceptability and tolerability. Secondary outcomes included death, dependency, motor function and quality of life measured 90 and 365 days after enrolment. Results Recruitment to the trial was feasible and acceptable; of 118 screened patients, 92 were eligible and 32 declined to participate. 60 patients were recruited between November 2011 and July 2013. All participants received some allocated treatment. Although 29 out of 30 participants received all 5 G-CSF/placebo injections, only 7 of 30 participants received all 18 therapy sessions. G-CSF was well tolerated but associated with a tendency to more adverse events than placebo (16 vs 10 patients, p = 0.12) and serious adverse events (SAE) (9 vs 3, p = 0.10). On average, patients received 14 (out of 18 planned) therapy sessions, interquartile range [12, 17]. Only a minority (23%) of participants completed all physiotherapy sessions, a large proportion of sessions (114 of 540, 21%) were cancelled due to patient (94, 17%) and therapist factors (20, 4%). No significant differences in functional outcomes were detected in either the G-CSF or physiotherapy group at day 90 or 365. Conclusions Delivery of G-CSF is feasible in chronic stroke. However, the study failed to demonstrate feasibility for delivering additional physiotherapy sessions late after stroke therefore a definitive study using this trial design

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be a

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be a

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be a

Sensory impairment is common after stroke though problems with the assessment of sensation have hindered research into sensation and its recovery. The revised Nottingham Sensory Assessment [NSA] (Lincoln et al, 1998) is a standardised assessment but there have been difficulties interpreting results, as it is not possible to calculate total scores. Therefore the purpose of this study was: - To investigate the extent of sensory impairment and recovery in stroke patients - To investigate if a total score for the NSA can be obtained - To explore the factors that are related to sensory impairment and outcome Method Patients with a first stroke were recruited on admission to two rehabilitation units in Nottingham. The NSA, which measures tactile sensations, proprioception and stereognostic ability, was administered on admission and at two, four and six months after stroke. Rasch analysis was used to examine if total scores of the NSA could be calculated. Results Seventy patients were recruited during a fifteen-month period. Mean age was 71 years (SD 10.00) and 36 were men. Sensory impairment was common in stroke patients and was significantly related to stroke severity. Stereognosis was the most frequently and severely impaired sensation. Rasch analysis enabled total scores of the NSA to be calculated. These totals showed significant recovery at six months post-stroke for upper limb tactile sensations, stereognosis and proprioception. Lower limb tactile sensations did not show significant recovery. The severity of the stroke, initial sensory impairment and activities of daily living ability were significantly related to sensory recovery, however they only accounted for 46-71% of the variance. Conclusion Sensation is a complex ability and a problem in its own right. Sensory impairment was a reflection of stroke severity but low variance indicates other factors were involved. Therefore there is a need to assess sensory impairment after stroke. Sensory outcome could not be a