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Adherence to prescribed exercise poses significant challenges for older adults despite proven benefits. The aim of this exploratory descriptive qualitative study was to explore the perceived barriers to and facilitators of prescribed home exercise adherence in community-dwelling adults 65 years and older. Three focus groups with 17 older adults (Mage ± SD = 77 ± 5.12) living in Singapore were conducted. Inductive thematic analysis revealed that "the level of motivation" of individuals constantly influenced their exercise adherence (core theme). The level of motivation appeared to be a fluid concept and changed due to interactions with two subthemes: (a) individual factors (exercise needs to be tailored to the individual) and (b) environmental factors (i.e., support is essential). Hence, these factors must be considered when designing strategies to enhance exercise adherence in this vulnerable population. Strategies must be informed by the culturally unique context, in this case, a developed country with a multiethnic urban Asian population. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7–36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1–38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments. Optimising patient activity throughout the day in inpatient rehabilitation is important to support recovery. Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood. Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment is common post-stroke. There is a need to understand patterns of early cognitive recovery post-stroke to guide both clinical and research practice. The aim of the study was to map the trajectory of cognitive recovery during the first week to 90-days post-stroke using serial computerised assessment. Method: An observational cohort study recruited consecutive stroke patients admitted to a stroke unit within 48 hours of onset. Cognitive function was assessed using the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB) daily for seven days, then 14, 30 and 90 days post-stroke. The CANTAB measured visual episodic memory and learning, information processing speed, visuo-spatial working memory, complex sustained attention and mental flexibility. Repeated measures MANOVA/ANOVA with Least Squares Difference post-hoc analyses were performed to ascertain significant change over time. Result: Forty-eight participants, mean age 73, primarily mild, ischaemic stroke, completed all assessment timepoints. There was a trajectory of early, global cognitive improvement, indicative of a post-stroke delirium, that largely stabilised between 6 and 14-days post-stroke. Change over time was examined within each cognitive test, with one measure stabilising by day 6 (Reaction Time) and others detecting improving performances up to 14 days post-stroke. Conclusions: Serial, computerised cognitive assessment can effectively map post-stroke cognitive recovery and revealed an early phase of global improvement over 14 days that is evidence for an acute post-stroke delirium. Resolution of post-stroke delirium in the second week following mild stroke indicates more extensive neuropsychological testing may be undertaken earlier than previously thought. [ABSTRACT FROM AUTHOR]

To seek physiotherapists' perspectives on patient adherence to exercise prescription for falls prevention/risk reduction in the Singapore setting. Three focus groups with physiotherapists (n = 16) were conducted. An inductive thematic analysis was performed to identify main themes by four independent researchers. Three main themes emerged: "it's about the patient," "delivery of the programme," and "carer/family support and facilitation." Physiotherapists believed that adherence was all about the patients' mindset and motivation, and they had to tailor interventions to optimise adherence to cater for patients as distinct characters, with different health/cultural beliefs and ability to prioritise time. Furthermore, physiotherapists reported better patient adherence when therapy goals referred to maintaining function rather than reducing falls. Families/carers can act as facilitators while providing practical and/emotional support further enhanced exercise adherence. Awareness of the perspectives of physiotherapists in identifying and addressing patients' adherence to exercise may better equip researchers and healthcare providers in developing culturally relevant interventions that promote exercise adherence in Singapore. Certainly, adherence varies widely among patients receiving the same treatment. Analysis of predictive factors of non-adherence will assist to tailor intervention. Physiotherapists believe the use of individualised approaches that adapt to patients and their health beliefs are critical for exercise adherence in older people in Singapore to prevent falls and falls risk. Adherence to exercise is multi-factorial: physiotherapists need to include attention to education, building rapport and facilitating practical and emotional family/carer support. Non-adherence is not merely a patient problem but is influenced by both clinicians and the healthcare system in Singapore/Southeast Asia. [ABSTRACT FROM AUTHOR]

To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke. Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed. Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes. Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients. Referral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs. Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making. Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). Design: This is a substudy of a controlled before–after observational study. Setting: The study was conducted in an Australian acute stroke unit. Participants: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. Intervention: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants' bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. Main measures: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. Results: Higher activity levels in the enriched group (n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity (P < 0.001), weekday non-scheduled activity (P = 0.007) and weekends (P = 0.018) when compared to the control group (n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. (P = 0.324). The enriched group spent more time on upper limb (P < 0.001), communal socializing (P < 0.001), listening (P = 0.007) and iPad activities (P = 0.002). No difference in total staff assistance during activities was observed (P = 0.055). Conclusion: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment is common post-stroke. There is a need to understand patterns of early cognitive recovery post-stroke to guide both clinical and research practice. The aim of the study was to map the trajectory of cognitive recovery during the first week to 90-days post-stroke using serial computerised assessment., Method: An observational cohort study recruited consecutive stroke patients admitted to a stroke unit within 48 hours of onset. Cognitive function was assessed using the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB) daily for seven days, then 14, 30 and 90 days post-stroke. The CANTAB measured visual episodic memory and learning, information processing speed, visuo-spatial working memory, complex sustained attention and mental flexibility. Repeated measures MANOVA/ANOVA with Least Squares Difference post-hoc analyses were performed to ascertain significant change over time., Result: Forty-eight participants, mean age 73, primarily mild, ischaemic stroke, completed all assessment timepoints. There was a trajectory of early, global cognitive improvement, indicative of a post-stroke delirium, that largely stabilised between 6 and 14-days post-stroke. Change over time was examined within each cognitive test, with one measure stabilising by day 6 (Reaction Time) and others detecting improving performances up to 14 days post-stroke., Conclusions: Serial, computerised cognitive assessment can effectively map post-stroke cognitive recovery and revealed an early phase of global improvement over 14 days that is evidence for an acute post-stroke delirium. Resolution of post-stroke delirium in the second week following mild stroke indicates more extensive neuropsychological testing may be undertaken earlier than previously thought.