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The present study investigates how counsellors working with children and young people (CYP) perceive their professional identity, and how the ‘Practitioner Manual’ and BACP Competence Frameworks, commissioned by the British Association for Counselling & Psychotherapy (BACP; 2014/2019a), can contribute to the strengthening of CYP counsellor professional identity. Participants were qualified counsellors working with CYP clients in England and Scotland. Interpretative Phenomenological Analysis (IPA) was used to analyse data. Findings were organised under three master themes: individual perception of professional identity; others’ perceptions of professional identity; role of resources on formation and development of professional identity. Sub-themes included: discomfort with the concept of professionalism; misunderstandings and misconceptions; a desire for a recognised professional identity. Findings indicate that the provision of counselling for CYP clients could be enhanced by establishing a recognised professional identity underpinned by required minimum training standards and leading to registration with a recognised professional body.

Health inequalities are unfair differences in health between different groups in society. We conducted a commissioned rapid review of the research literature of health inequalities and stroke as a first step to finding out what research exists on health inequalities across the stroke pathway, and we collated these studies. We systematically searched five electronic databases for peer reviewed journal articles in September 2022, restricted to studies from 2009 onwards. We included any studies that were about stroke survivors, their carers, or stroke clinicians that reported data on any aspect of health inequalities. We screened studies based on the country the research was from and agreed with Stroke Association to prioritise studies from the UK, expanding to Anglosphere countries, Western Europe and Japan (as a G7 country) where UK data were sparse on the topic area. USA studies were excluded due to major differences to UK healthcare. We categorised studies by four non-mutually exclusive focal lenses of health inequalities: 1. socioeconomic status (SES)/deprivation, 2. protected characteristics, 3. vulnerable groups (inclusion health groups such as migrants, asylum seekers, Gypsy, Roma and traveller communities, rough sleepers and unhoused people, sex workers, people in prison) and 4. geography (urban/rural/coastal communities), and by study topic e.g. thrombectomy, access to services, carers and by stages of the UK stroke care pathway. We conducted parallel Patient Carer and Public Involvement and Engagement (PCPIE) work including visiting six stroke groups across Greater Manchester (November and December 2022) to introduce the topic of health inequalities, discuss stroke survivor and carer priorities and build relationships. A panel of nine stroke survivors and carers met with us at the University/online (January 2023) to consider the findings from our review and contribute to the key messages and recommendations for the next steps for research. We identified 6179

Objective: Investigate feasibility and acceptability of prism adaptation training for people with inattention (spatial neglect), early after stroke, during usual care. Design: Phase II feasibility randomised controlled trial with 3:1 stratified allocation to standard occupational therapy with or without intervention, and nested process evaluation. Setting: Ten hospital sites providing in-patient stroke services. Participants: Screened positive for inattention more than one-week post-stroke; informal carers. Occupational therapists participated in qualitative interviews. Intervention: Adjunctive prism adaptation training at the start of standard occupational therapy sessions for three weeks. Main measures: Feasibility measures included recruitment and retention rates, intervention fidelity and attrition. Outcomes collected at baseline, 3 weeks and 12 weeks tested measures including Nottingham Extended Activities of Daily Living Scale. Acceptability was explored through qualitative interviews and structured questions. Results: Eighty (31%) patients were eligible, 57 (71%) consented, 54 randomised (40:13, +1 exclusion) and 39 (74%) completed 12-week outcomes. Treatment fidelity was good: participants received median eight intervention sessions (IQR: 5, 12) lasting 4.7 min (IQR: 4.1, 5.0). All six serious adverse events were unrelated. There was no signal that patients allocated to intervention did better than controls. Twenty five of 35 recruited carers provided outcomes with excellent data completeness. Therapists, patients and carers found prism adaptation training acceptable. Conclusions: It is feasible and acceptable to conduct a high-quality definitive trial of prism adaptation training within occupational therapy early after stroke in usual care setting, but difficult to justify given no sign of benefit over standard occupational therapy. Clinical trial registration: https://www.isrctn.com/ Ref ISRCTN88395268.

Background People with spatial neglect after stroke or other brain injury have difficulty attending to one side of space. Various rehabilitation interventions have been used, but evidence of their benefit is unclear. Objectives The main objective was to determine the effects of non‐pharmacological interventions for people with spatial neglect after stroke and other adult‐acquired non‐progressive brain injury. Search methods We searched the Cochrane Stroke Group Trials Register (last searched October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; last searched October 2020), MEDLINE (1966 to October 2020), Embase (1980 to October 2020), the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1983 to October 2020), and PsycINFO (1974 to October 2020). We also searched ongoing trials registers and screened reference lists. Selection criteria We included randomised controlled trials (RCTs) of any non‐pharmacological intervention specifically aimed at spatial neglect. We excluded studies of general rehabilitation and studies with mixed participant groups, unless separate neglect data were available. Data collection and analysis We used standard Cochrane methods. Review authors categorised the interventions into eight broad types deemed to be applicable to clinical practice through iterative discussion: visual interventions, prism adaptation, body awareness interventions, mental function interventions, movement interventions, non‐invasive brain stimulation, electrical stimulation, and acupuncture. We assessed the quality of evidence for each outcome using the GRADE approach. Main results We included 65 RCTs with 1951 participants, all of which included people with spatial neglect following stroke. Most studies measured outcomes using standardised neglect assessments. Fifty‐one studies measured effects on ADL immediately after completion of the intervention period; only 16 reported persisting effects on ADL (our primary outcome). One stud

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without. Design: Prospective observational cohort. Setting: Four UK inpatient stroke rehabilitation units. Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without. Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay. Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without. Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.

Objectives To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation.Methods Data sources (MEDLINE, CINAHL, AMED and Psychinfo) were searched systematically from database inception date to August 2018. Full text English language studies of data from stroke clinicians were included. Studies of patients were excluded. Included studies were any design focussed on clinical decision-making for referral or admission into stroke rehabilitation. Summary factors were compiled from each included study. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.Results After removing duplicates 1915 papers were identified, of which thirteen met the inclusion criteria. Eight included studies were qualitative, one used mixed methods. A total of 292 clinicians were included in the studies. Quality of included studies was mixed. Patient-level and organisational factors, as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients’ pre- and post-stroke function (n=6 studies), presence of dementia (n=6), patients’ social/family support (n=6), organisational service pressures (n=7) and the decision-making clinician’s own knowledge (n=5) and emotions (n=5).Conclusion The results highlight a lack of clinical guidance to aid decision-making, and reveal a subjective approach to rehabilitation decision-making influenced by patient-level and organisational factors alongside clinicians’ characteristics occurs across services and countries.

Objectives To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation.Methods Data sources (MEDLINE, CINAHL, AMED and Psychinfo) were searched systematically from database inception date to August 2018. Full text English language studies of data from stroke clinicians were included. Studies of patients were excluded. Included studies were any design focussed on clinical decision-making for referral or admission into stroke rehabilitation. Summary factors were compiled from each included study. The quality of included studies was assessed using the Mixed Methods Appraisal Tool.Results After removing duplicates 1915 papers were identified, of which thirteen met the inclusion criteria. Eight included studies were qualitative, one used mixed methods. A total of 292 clinicians were included in the studies. Quality of included studies was mixed. Patient-level and organisational factors, as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients’ pre- and post-stroke function (n=6 studies), presence of dementia (n=6), patients’ social/family support (n=6), organisational service pressures (n=7) and the decision-making clinician’s own knowledge (n=5) and emotions (n=5).Conclusion The results highlight a lack of clinical guidance to aid decision-making, and reveal a subjective approach to rehabilitation decision-making influenced by patient-level and organisational factors alongside clinicians’ characteristics occurs across services and countries.

Objective: To examine whether stroke survivors in inpatient rehabilitation with pre-existing cognitive impairment receive less therapy than those without. Design: Prospective observational cohort. Setting: Four UK inpatient stroke rehabilitation units. Participants: A total of 139 stroke patients receiving rehabilitation, able to give informed consent/had an individual available to act as personal consultee. In total, 33 participants were categorized with pre-existing cognitive impairment based on routine documentation by clinicians and 106 without. Measures: Number of inpatient therapy sessions received during the first eight weeks post-stroke, referral to early supported discharge, and length of stay. Results: On average, participants with pre-existing cognitive impairment received 40 total physiotherapy and occupational therapy sessions compared to 56 for those without (mean difference = 16.0, 95% confidence interval (CI) = 2.9, 29.2), which was not fully explained by adjusting for potential confounders (age, sex, National Institutes of Health Stroke Scale (NIHSS), and pre-stroke modified Rankin Scale (mRS)). While those with pre-existing cognitive impairment received nine fewer single-discipline physiotherapy sessions (95% CI = 3.7, 14.8), they received similar amounts of single-discipline occupational therapy, psychology, and speech and language therapy; two more non-patient-facing occupational therapy sessions (95% CI = –4.3, –0.6); and nine fewer patient-facing occupational therapy sessions (95% CI = 3.5, 14.9). There was no evidence to suggest they were discharged earlier, but of the 85 participants discharged within eight weeks, 8 (42%) with pre-existing cognitive impairment were referred to early supported discharge compared to 47 (75%) without. Conclusion: People in stroke rehabilitation with pre-existing cognitive impairments receive less therapy than those without, but it remains unknown whether this affects outcomes.

OBJECTIVE: To identify factors influencing clinicians decision-making about ongoing stroke rehabilitation for people with pre-existing dementia/cognitive impairment and the impact on clinical practice. DESIGN: Qualitative semi-structured interviews with stroke specialist healthcare professionals analysed using thematic analysis. SETTING: Acute stroke unit, inpatient stroke rehabilitation units, and community stroke services. PARTICIPANTS: Twenty three professionals from six multidisciplinary stroke teams involved in decision-making about stroke patients' rehabilitation potential and clinical pathways. RESULTS: Factors influencing decision-making about ongoing rehabilitation were (1) gaining understanding of the individual patient, (2) clinician's knowledge of dementia/cognitive impairment, (3) predicting rehabilitation potential, (4) organizational constraints, and (5) clinician's perceptions of their role within the team. Decision-making led to two outcomes, either accommodating the pre-existing dementia/cognitive impairment within delivery of rehabilitation or ending rehabilitation for that patient to allocate limited resources where they were perceived more likely to be effective. Participants felt that patients with pre-existing dementia/cognitive impairment had difficulty demonstrating the required rehabilitation potential within the short timescales available in the current model of service delivery. Participants identified a need for training to improve their knowledge and confidence for decision-making and delivery of rehabilitation for this growing population. CONCLUSION: Clinicians' decision-making about ongoing rehabilitation for patients with prestroke dementia/cognitive impairments is influenced by gaps in their knowledge and by service constraints. Increased training and more flexible, patient-centred services would enable clinicians to better accommodate these patients in rehabilitation.

OBJECTIVE: To identify factors influencing clinicians decision-making about ongoing stroke rehabilitation for people with pre-existing dementia/cognitive impairment and the impact on clinical practice. DESIGN: Qualitative semi-structured interviews with stroke specialist healthcare professionals analysed using thematic analysis. SETTING: Acute stroke unit, inpatient stroke rehabilitation units, and community stroke services. PARTICIPANTS: Twenty three professionals from six multidisciplinary stroke teams involved in decision-making about stroke patients' rehabilitation potential and clinical pathways. RESULTS: Factors influencing decision-making about ongoing rehabilitation were (1) gaining understanding of the individual patient, (2) clinician's knowledge of dementia/cognitive impairment, (3) predicting rehabilitation potential, (4) organizational constraints, and (5) clinician's perceptions of their role within the team. Decision-making led to two outcomes, either accommodating the pre-existing dementia/cognitive impairment within delivery of rehabilitation or ending rehabilitation for that patient to allocate limited resources where they were perceived more likely to be effective. Participants felt that patients with pre-existing dementia/cognitive impairment had difficulty demonstrating the required rehabilitation potential within the short timescales available in the current model of service delivery. Participants identified a need for training to improve their knowledge and confidence for decision-making and delivery of rehabilitation for this growing population. CONCLUSION: Clinicians' decision-making about ongoing rehabilitation for patients with prestroke dementia/cognitive impairments is influenced by gaps in their knowledge and by service constraints. Increased training and more flexible, patient-centred services would enable clinicians to better accommodate these patients in rehabilitation.