Rehabilitation Current Awareness Bulletin December 2019

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Title: The ESCAPS study: a feasibility randomized controlled trial of early electrical stimulation to the wrist extensors and flexors to prevent post-stroke complications of pain and contractures in the paretic arm.

Citation: Clinical Rehabilitation; Dec 2019; vol. 33 (no. 12); p. 1919-1930

Author(s): Fletcher-Smith, Joanna C; Walker, Dawn-Marie; Allatt, Kate; Sprigg, Nikola; James, Marilyn; Ratib, Sonia; Boadu, Janet; Richardson, Carla; Pandyan, Anand D

Objective: To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain.

Design: Feasibility randomized controlled trial with economic evaluation.

Setting: A specialist stroke unit in Nottinghamshire.

Subjects: A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis.

Interventions: Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments.

Measures: Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization.

Results: A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death (n = 2), end-of-life care (n = 2), and unable to contact (n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected. Conclusion: Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.

Title: Dance-based exergaming for upper extremity rehabilitation and reducing fall-risk in community-dwelling individuals with chronic stroke. A preliminary study.

Citation: Topics in Stroke Rehabilitation; Dec 2019; vol. 26 (no. 8); p. 565-575

Author(s): Subramaniam, Savitha; Bhatt, Tanvi

Background: Post-stroke, individuals demonstrate persistent upper extremity (UE) motor impairments that impact functional movements and change-in-support strategies essential for recovery from postural instability.

Objectives: This study primarily aims to quantify the effect of dance-based exergaming (DBExG) intervention on improving paretic UE movement control. The secondary aim is to assess if these improvements in UE movement control if observed, could partially account for improved fall-risk.

Methods: Thirteen adults with chronic stroke received DBExG training using the commercially available Kinect dance gaming "Just Dance 3". Surface electromyography of shoulder muscle activity during the stand-reaching task and UE shoulder kinematics for a

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dance trial were recorded. Changes in balance control were determined using the Activities-specific Balance Confidence scale [ABC] and Timed-Up-and-Go test [TUG].

Results: Post-training, participants demonstrated improvements in shoulder muscle activity in the form of performance (reaction time, burst duration, and movement time) and production outcomes (peak acceleration) (p <.05). There was also a post-training increase in shoulder joint excursion (Ex) and peak joint angles (∠) during dance trials (p <.05). Participants exhibited positive post-intervention correlations between ABC and shoulder joint Ex [R2 of 0.43 (p <.05)] and between TUG and peak joint ∠ [R2 of 0.51 (p <.05)].

Conclusion: Findings demonstrated the beneficial effect of DBExG for improving UE movement and the training-induced gains were also positively correlated with improvements in fall-risk measures in people with chronic stroke. Thus, DBEx training could be used as a meaningful clinical application for this population group.

Title: Motor imagery as a complementary technique for functional recovery after stroke: a systematic review.

Citation: Topics in Stroke Rehabilitation; Dec 2019; vol. 26 (no. 8); p. 576-587

Author(s): López, Noelia Díaz; Monge Pereira, Esther; Centeno, Estefanía Jodra; Miangolarra Page, Juan Carlos

Background: Stroke is the leading cause of disability in adults, producing a major personal and economic impact on those affected. The scientific evidence regarding the use of Motor Imagery (MI) as a preparatory process for motor control reinforces the need to explore this method as a complement to physical therapy.

Objectives: The objectives of this systematic review were to determine the effectiveness of MI for functional recovery after stroke and to identify a possible intervention protocol, according to the level of existing scientific evidence.

Methods: A comprehensive literature search was performed using Medline, Cochrane Library and PEDro databases. Studies were limited to those published between 2007 and 2017, and restricted to English and/or Spanish language publications.

Results: Thirteen randomized clinical trials that met the inclusion criteria were included. The methodological quality of studies was determined using the Critical Review Form for Quantitative Studies, obtaining scores of 9–13 points out of 15. The level of evidence and strength of recommendations were assessed using the U.S. Preventive Services Task Force (USPSTF) assessment, obtaining levels IA and II-B1. Significant improvements were found in outcome measures evaluating upper limb functionality, balance and kinematic gait parameters.

Conclusions: The use of MI combined with conventional rehabilitation is an effective method for the recovery of functionality after stroke. Due to the great heterogeneity in the scientific literature available, new lines of research are necessary, in order to include well-designed studies of good methodological quality and to establish a consensus regarding the most appropriate protocols.

Title: Improving balance with wobble board exercises in stroke patients: single-blind, randomized clinical trial.

Citation: Topics in Stroke Rehabilitation; Dec 2019; vol. 26 (no. 8); p. 595-601

Author(s): Madhuranga, Padukka Vidanalage Hasitha; Mathangasinghe, Yasith; Anthony, Dimonge Joseph

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Background: A primary objective in stroke rehabilitation is to restore functional balance, in order to reduce falls. Objectives: To identify the efficacy and safety of wobble board exercises when combined with conventional physiotherapy, in improving balance in hemiplegic patients following ischemic strokes.

Methods: A block-randomized, controlled, observer blinded, superiority trial was conducted on ambulatory hemiplegic patients following ischemic strokes of middle cerebral artery territory. Subjects in the control group received a conventional physiotherapy regime. Subjects in the intervention group received training on a wobble board combined with conventional physiotherapy. Main Outcome measures were the improvement of Four-Square Step Test (FSST) and the Berg Balance Scale (BBS), both of which assess functional balance at the end of 6 weeks.

Results: Thirty patients were randomly assigned for intervention (n = 15) and control (n = 15) groups. One patient dropped out from the study, leaving 29 eligible for the analysis. Intervention and control groups were comparable in sociodemographic characteristics and pre-test scores of balance. A repeated-measures MANOVA showed a significant difference in improvement of balance between the two study groups after 6 weeks [F(1,28) = 32.6,p =.000; Wilk's lambda =.46]. The improvement of mean score of balance in interventional group was greater than in the control group [BBS:9.5 (intervention group),5.5 (control group); FSST:3.9 (intervention group),1.7 (control group)]. There were no injuries in both groups.

Conclusions: Wobble board exercises, when combined with the conventional physiotherapy, are safe and effective in restoring functional balance in patients with hemiplegia following ischemic strokes.

Title: Effects of Training for Finger Perception on Functional Recovery of Hemiplegic Upper Limbs in Acute Stroke Patients.

Citation: Occupational Therapy International; Nov 2019 ; p. 1-5

Author(s): Umeki, Naho; Murata, Jun; Higashijima, Misako

Background: Stroke causes severe disability, including motor and sensory impairments. We hypothesized that upper limb functional recovery after stroke may be augmented by combining treatments for motor and sensory functions. In order to examine this hypothesis, we conducted a controlled trial on rehabilitation for sensory function to the plegic hand.

Methods: The sensory training program consisted of several types of discrimination tasks performed under blind conditions. The sensory training program was performed for 20 min per day, 5 days a week. An experimental group of 31 patients followed this sensory program, while a control group of 25 patients underwent standard rehabilitation. The efficacy of the intervention was evaluated by the tactile-pressure threshold, handgrip strength, and the completion time of manipulating objects. A two-way repeated measures analysis of variance was used to assess interactions between group and time. Moreover, to provide a meaningful analysis for comparisons, effect sizes were calculated using Cohen's d.

Results: The mean change in the tactile pressure threshold was significantly larger in the experimental group than in the control group (p<0.05, d=0.59). Moreover, the completion times to manipulate a middle-sized ball (d=0.53) and small ball (d=0.80) and a small metal disc (d=0.81) in the experimental group were significantly different from those in the control group (p<0.05).

Conclusion: The present results suggest that the sensory training program to enhance finger discrimination ability contributes to improvements in not only sensory function but also manual function in stroke patients. The trial is registered with the UMIN Clinical Trials Registry (UMIN000032025).

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Title: Lived experiences of return to paid work following a brain injury.

Citation: British Journal of Occupational Therapy; Nov 2019; vol. 82 (no. 11); p. 658-665

Author(s): Beaulieu, Karen

Introduction: Due to resulting psychosocial, cognitive, psychological, communication and/or physical difficulties following a brain injury, it is often difficult to return to paid work. Being in paid work is generally good for individuals' health; however, currently only one third of the brain injury population manage to achieve this return.

Method: A descriptive phenomenological approach was used to collect and analyse data from 10 male and six female individuals who had sustained either a moderate or severe traumatic or acquired brain injury. Unstructured interviews explored their experiences of return to paid work. Data analysis resulted in synthesised descriptions of their return to paid work lived experiences following a brain injury.

Findings: Sixty-one meaning units were established from the data, and six themes emerged: coping with ongoing difficulties; expectation and timing of return to work; workplace colleague reactions; things that help; change and return to work options; and feelings of success.

Conclusion: Findings can be used to develop a more consistent approach to return to paid work, and will inform future occupational therapy practice and return to paid work rehabilitation. Occupational therapists need to support these individuals to cope with the ongoing difficulties facing them, especially in relation to fatigue, memory and transportation difficulties.

Title: Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice.

Citation: International Journal of Language & Communication Disorders; Nov 2019; vol. 54 (no. 6); p. 914-926

Author(s): Volkmer, Anna; Spector, Aimee; Warren, Jason D.; Beeke, Suzanne

Background: Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. Aims: To survey the practices of SLTs in the areas of assessment and intervention for people with PPA.

Methods & Procedures: A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis.

Outcomes & Results: A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment

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focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service.

Conclusions & Implications: This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services.

Title: Occupational Therapy for Multiple Sclerosis: Exploring Health Promoting Intervention Across Practice Settings.

Citation: OT Practice; Nov 2019; vol. 24 (no. 11); p. 12-14

Author(s): Athmann, Ashley; Molitor, Whitney Lucas

Title: Music in mechanically ventilated stroke patients.

Citation: British Journal of Neuroscience Nursing; Oct 2019; vol. 15

Author(s): Olson, DaiWai M; Perera, Anjali; Atem, Folefac; Wagner, Audra S; Zanders, Michael; Venkatachalam, Aardhra M; Stutzman, Sonja E

Background: Music as a therapeutic intervention for critically ill stroke patients has not been adequately researched. This may be related to a limited number of tools being available to measure the hypnotic response when patients cannot respond verbally. This pilot study examines the feasibility of bispectral index (BIS) monitoring to study music as a stress-reduction intervention in the neurocritical care setting.

Methods: This prospective, randomised, crossover, pilot study enrolled 30 patients. On each of two consecutive days, patients were randomised to either 1 hour of silence followed by a crossover to 1 hour of music, or the reverse (music then silence). BIS values were recorded to evaluate stress and agitation before, during and after the 2-hour study period.

Results: There were no reported adverse events, supporting feasibility of this pilot intervention. BIS values were sampled once every 6 seconds during the 2-hour study period. There was a statistically significant difference in BIS scores between the music and no music group (p<0.0001).

Conclusion: The use of neurofunction monitors to assess response to music is feasible during the critical care phase for patients with stroke. Additional studies should focus on genre, timing and route of delivery for music as an intervention.

Title: The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits.

Citation: International Journal of Therapy & Rehabilitation; Oct 2019; vol. 26 (no. 10); p. 1-12

Author(s): Pumprasart, Thanchanok; Pramodhyakul, Noppol; Piriyaprasarth, Pagamas

Background/Aims: The Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly

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demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits.

Methods: A pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test.

Results: Almost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved.

Conclusions: The 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

Title: Toward Improving Poststroke Aphasia: A Pilot Study on the Growing Use of Telerehabilitation for the Continuity of Care.

Citation: Journal of Stroke & Cerebrovascular Diseases; Oct 2019; vol. 28 (no. 10)

Author(s): Maresca, Giuseppa; Maggio, Maria Grazia; Latella, Desiree; Cannavò, Antonino; De Cola, Maria Cristina; Portaro, Simona; Stagnitti, Maria Chiara; Silvestri, Giuseppe; Torrisi, Michele; Bramanti, Alessia; De Luca, Rosaria; Calabrò, Rocco Salvatore

Background: Aphasia is a quite common and very disabling symptom following stroke, negatively affecting patient's quality of life. Aim of the study is to evaluate the effectiveness of a rehabilitation training for aphasia that employ a touch-screen tablet using a virtual reality rehabilitation system (VRRS-Tablet).

Material and Methods: Thirty patients with aphasia due to ischemic or hemorrhagic stroke were randomized into either the control or the experimental group and assessed by means of a specific neuropsychological evaluation. The study lasted 6 months and included 2 phases. During the former, the experimental group underwent an experimental linguistic treatment performed using the VRRS-Tablet, while the control group was trained with a traditional linguistic treatment. In the latter, the control groups were delivered to territorial services, while the experimental group was provided with the VRRS-Tablet.

Results: The experimental group improves in all the investigated areas, except for writing, while the control group only improves in comprehension, depression, and quality of life.

Conclusions: Our study has demonstrated the effectiveness of a home-based telerehabilitation program specific for poststroke aphasia. The use of telerehabilitation by means of VRRS-Tablet could be one of the best solutions to treat aphasic patients after their discharge, promoting continuity of care by monitoring functional outcomes, maintaining preserved abilities, reducing depression, and improving linguistic functions, besides the psychological well-being.

Title: Occupational Therapy in the ICU: A Scoping Review of 221 Documents.

Citation: Critical care medicine; Dec 2019; vol. 47 (no. 12); p. e1014

Author(s): Costigan, F Aileen; Duffett, Mark; Harris, Jocelyn E; Baptiste, Susan; Kho, Michelle E

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Objectives: Occupational therapists have specialized expertise to enable people to perform meaningful "occupations" that support health, well-being, and participation in life roles. Given the physical, cognitive, and psychologic disability experienced by ICU survivors, occupational therapists could play an important role in their recovery. We conducted a scoping review to determine the state of knowledge of interventions delivered by occupational therapists in adult ICU patients.

Data Sources: Eight electronic databases from inception to 05/2018.

Study Selection: We included reports of adult patients receiving direct patient care from an occupational therapist in the ICU, all study designs, and quantitative and qualitative traditions.

Data Extraction: Independently in duplicate, interprofessional team members screened titles, abstracts, and full texts and extracted report and intervention characteristics. From original research articles, we also extracted study design, number of patients, and primary outcomes. We resolved disagreements by consensus.

Data Synthesis: Of 50,700 citations, 221 reports met inclusion criteria, 74 (79%) published after 2010, and 125 (56%) appeared in critical care journals. The three most commonly reported types of interventions were mobility (81%), physical rehabilitation (61%), and activities of daily living (31%). We identified 46 unique original research studies of occupational therapy interventions; the most common study research design was before-after studies (33%).

Conclusions: The role of occupational therapists in ICU rehabilitation is not currently well established. Current interventions in the ICU are dominated by physical rehabilitation with a growing role in communication and delirium prevention and care. Given the diverse needs of ICU patients and the scope of occupational therapy, there could be an opportunities for occupational therapists to expand their role and spearhead original research investigating an enriched breadth of ICU interventions.

Title: Occupational therapy for people with dementia and their family carers provided at home: a systematic review and meta-analysis.

Citation: BMJ open; Nov 2019; vol. 9 (no. 11); p. e026308

Author(s): Bennett, Sally; Laver, Kate; Voigt-Radloff, Sebastian; Letts, Lori; Clemson, Lindy; Graff, Maud; Wiseman, Jodie; Gitlin, Laura

Objective: To determine the effect of occupational therapy provided at home on activities of daily living, behavioural and psychological symptoms of dementia (BPSD) and quality of life (QOL) for people with dementia, and the effect on family carer burden, depression and QOL.

Design: Systematic review and meta-analysis.

Methods: Eight databases were searched to February 2018. Randomised controlled trials of occupational therapy delivered at home for people with dementia and their family carers that measured ADL, and/or BPSD were included. Two independent reviewers determined eligibility, risk of bias and extracted data.

Results: Fifteen trials were included (n=2063). Occupational therapy comprised multiple components (median=8 sessions). Compared with usual care or attention control occupational therapy resulted in improvements in the following outcomes for people with dementia: overall ADL after intervention (standardised means difference (SMD) 0.61, 95% CI 0.16 to 1.05); instrumental ADL alone (SMD 0.22, 95% CI 0.07 to 0.37; moderate quality); number of behavioural and psychological symptoms (SMD -0.32, 95% CI -0.57 to -0.08; moderate quality); and QOL (SMD 0.76, 95% CI 0.28 to 1.24) after the intervention and at follow-up (SMD 1.07, 95% CI 0.58 to 1.55). Carers reported less hours assisting the person

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with dementia (SMD -0.33, 95% CI -0.58 to -0.07); had less distress with behaviours (SMD -0.23, 95% CI -0.42 to -0.05; moderate quality) and improved QOL (SMD 0.99, 95% CI 0.66 to 1.33; moderate quality). Two studies compared occupational therapy with a comparison intervention and found no statistically significant results. GRADE ratings indicated evidence was very low to moderate quality.

Conclusions: Findings suggest that occupational therapy provided at home may improve a range of important outcomes for people with dementia and their family carers. Health professionals could consider referring them for occupational therapy.

Prospero Registration Number: CRD42011001166.

Title: Occupational therapy and decision-making capacity assessment: A survey of practice in Ireland.

Citation: Australian occupational therapy journal; Nov 2019

Author(s): Usher, Ruth; Stapleton, Tadhg

Introduction: The aim of the study was to explore occupational therapy practices regarding decision-making capacity assessment and to examine factors that impact on engagement in this area.

Methods: Occupational therapists in Ireland were invited to participate in a cross-sectional online questionnaire.

Results: One hundred and seventy-two occupational therapists responded. 65.77% (n = 98) reported that occupational therapy plays an important role in capacity assessment in their workplace. Occupational therapists most frequently contributed to decision-making capacity assessment for independent living (79.19%, n = 118), driving (45.89%, n = 67) and financial management (44.44%, n = 64). Many participants reported that this is more difficult than other aspects of practice and that they are not satisfied with decision-making capacity assessment procedures in their workplace. A large majority (91.86%, n = 113) reported occupational therapists would benefit from additional training and practice guidelines in the area of decision-making capacity assessment.

Conclusion: The study confirms that occupational therapists have a role to play in the multi-disciplinary assessment of decision-making capacity. The results of the survey suggest that decision-making capacity assessment is complex and challenging. Factors such as confidence, education and training impact on engagement with this area of practice. There is a need to develop education resources and guidelines for occupational therapists.

Title: Effectiveness of occupational therapy intervention for people with Parkinson's disease: Systematic review.

Citation: Australian occupational therapy journal; Oct 2019

Author(s): Welsby, Ellana; Berrigan, Sonja; Laver, Kate

Introduction: Occupational therapists commonly provide intervention that promotes quality of life in people with Parkinson's disease. Existing research supports the effects of multidisciplinary and motor intervention for people with Parkinson's disease. However, few studies have identified the effectiveness of occupational therapy intervention alone. The aim of this review was to examine the efficacy of interventions provided by occupational therapists for people with Parkinson's disease.

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Methods: A comprehensive database search of the literature was performed using Medline, EMBASE, PsycInfo and CINAHL between 2003 and January 2018. There were no restrictions on study design and studies with or without a control group were selected for review. Studies were included if intervention consisted of at least 50% of occupational therapy intervention for Parkinson's disease. Two independent reviewers extracted and synthesised data from relevant articles.

Results: In all, 10 studies representing data from 1,343 people with Parkinson's disease and 180 caregivers were included in this review. Occupational therapy interventions focussing on meaningful activities were shown to improve perceived occupational performance. Upper limb therapy programmes were shown to improve upper limb function in the short term though longer-term effects are unclear.

Conclusion: Current research supports interventions which are intermittent, short term and intensive and involve tailored therapy plans working towards an individual's goals. Occupational therapists should implement goal-oriented intervention programmes in conjunction with following the guidance of existing best practice guidelines.

Title: Feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent tasks and exercises: 'My Therapy'.

Citation: Australian occupational therapy journal; Oct 2019

Author(s): Brusco, Natasha K; Tilley, Louise; Walpole, Brianna; Kugler, Helen; Li, Ran; Kennedy, Emma; Morris, Meg E

Introduction: The dosage of occupational therapy and physiotherapy positively correlates with rehabilitation patient and health service outcomes. Nevertheless, increasing the dosage during inpatient rehabilitation without additional resources can be challenging. This study aimed to determine feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation with independent tasks and exercises outside of supervised sessions, the 'My Therapy' programme. Methods: A two-group, quasi-experimental, pre-post-design examined feasibility of delivering My Therapy in addition to usual care, compared to usual care alone, for hospitalised musculoskeletal and frail older rehabilitation patients. My Therapy was prescribed by the occupational therapist and physiotherapist. A booklet was provided with an individually tailored set of tasks and exercises that were a sub-set of routine therapy, to be practised safely, effectively and independently outside of supervised sessions. The primary outcome was feasibility of My Therapy implementation to achieve at least 70% adherence. Secondary outcomes were self-reported daily My Therapy participation (minutes), total daily rehabilitation participation (minutes), adverse events, length of stay, 10-metre walk speed, FIM scores and discharge destination. Results: Participation in My Therapy was achieved by 72% (83/116) of the My Therapy group, who averaged 14 min (SD 14) of daily practice outside of supervised sessions. Total daily rehabilitation participation was 177 min (SD 47) for My Therapy participants (n = 116) and 148 min (SD 88) for usual care participants (n = 89); mean difference 30 min (p = .00). A minimal clinically important difference in FIM was achieved for a significantly higher portion of the My Therapy group (22%, n = 26) compared to usual care (10%, n = 9; p = .02). There were no adverse events, safety concerns or group differences for other secondary outcomes. Conclusion: My Therapy was a feasible and safe way to increase the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent practice. Clinical Trial Registry: ACTRN12616000691448

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Title: Perceptions about trust: a phenomenographic study of clinical supervisors in occupational therapy.

Citation: BMC medical education; Nov 2019; vol. 19 (no. 1); p. 404

Author(s): Lundh, Pernilla; Palmgren, Per J; Stenfors, Terese

Background: Finding the best way to facilitate student learning in clinical practice can be challenging for clinical supervisors. While high levels of trust might jeopardize patient safety, low trust might hinder student learning; however, carrying out professional activities is necessary for students to develop professional competence. There is a dearth of scholarly literature regarding the concept of trust among clinical supervisors in occupational therapy education. A better understanding of how trust is created between the supervisor and student may thus aid in facilitating student learning. The aim of this study, therefore, was to explore occupational therapy clinical supervisors' perception of trust and how it is formed.

Methods: A qualitative method deploying a phenomenographic approach was chosen. Twelve clinical supervisors were interviewed, and the data were analyzed according to the seven-step phenomenographic approach.

Results: Three qualitatively different ways of thinking about trust were found: (1) that trust is about the student and is rather static; (2) trust as a dynamic process based on student performance; and (3) trust as something mutual and interrelated. The findings indicate that trust can be understood in various ways, such as being something inherent in the student or, alternatively, about the student, the supervisor, the relationship between them, and the surrounding context, including the tasks performed. Furthermore, the study shows that trust can be seen either as something static or as a dynamic process.

Conclusions: This study contributes to a deeper understanding of the variation of ways in which the concept of trust is understood among clinical supervisors in occupational therapy. The study corroborates the prior research finding that trust can be understood as a multifaceted construct. It contributes novel insights about the role of the supervisor as an influential factor in the trust-building process. A deep understanding of the possible differences in the ways of conceptualizing something can help supervisors support learning by building on this understanding. The results from this study contribute to our knowledge of the drivers behind entrusted decisions in clinical education in various professional contexts. We suggest that the results be used in the continuing professional development of clinical supervisors.

Title: Occupational therapy in primary care: exploring the role of occupational therapy from a primary care perspective.

Citation: The British journal of general practice : the journal of the Royal College of General Practitioners; Nov 2019; vol. 69 (no. 688); p. 575-576

Author(s): Chamberlain, Emily; Truman, Juliette; Scallan, Samantha; Pike, Amanda; Lyon-Maris, Johnny

Title: Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults.

Citation: Journal of the American Geriatrics Society; Nov 2019

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Author(s): Pavon, Juliessa M; Sloane, Richard J; Pieper, Carl F; Colón-Emeric, Cathleen S; Cohen, Harvey J; Gallagher, David; Hall, Katherine S; Morey, Miriam C; McCarty, Midori; Hastings, Susan N

Background: Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital.

Objective: To examine whether wearable hospital activity trackers can be used to predict HAD.

Design: A prospective observational study between January 2016 and March 2017.

Setting: An academic medical center.

Participants: Community-dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46).

Main Measures: Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated.

Results: Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0-6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD.

Conclusions: Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs.

Title: The effectiveness of group exercise for improving activity and participation in adult stroke survivors: a systematic review.

Citation: Physiotherapy; Dec 2019; vol. 105 (no. 4); p. 399-411

Author(s): Church, Gavin; Parker, Jack; Powell, Lauren; Mawson, Susan

Abstract: Following post stroke rehabilitation, group exercise interventions can be used to continue improving cardiovascular fitness, activity levels, balance, gait, movement efficiency, and strengthening. However, little is known of the effectiveness of group exercise for improving activity and participation in stroke survivors. This review aims to assess the effectiveness of group exercise for improving activity and participation in adult stroke survivors. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. Randomised controlled trials (RCTs) of group exercise using validated outcome measures of activity and participation for post stroke rehabilitation. Two independent reviewers assessed all abstracts, extracted data, conducted a narrative synthesis and assessed the quality of all included articles. The Cochrane Risk of Bias Tool assessed methodological quality and included outcome measure quality was assessed. 14 RCTs were included (n = 624 chronic stroke survivors collectively). Studies ranged between 12 and 243 stroke participants with an average of left:right hemisphere lesions of 32:39 and average age was 66.7 years. Although intervention and control groups improved, no

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significant difference between group differences were evident. and implications of key findings: The review found improvements are short-term and less evident at long-term follow up with little improvements in participation after 6 months. However, this review was limited to the standard of intervention reporting. Further research should consider consistency in measuring underpinning mechanisms of group exercise interventions, which may explain the lack of activity changes in long-term follow-up. CRD42017078917.

Title: Moving Stroke Rehabilitation Research Evidence into Clinical Practice: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable.

Citation: Neurorehabilitation & Neural Repair; Nov 2019; vol. 33 (no. 11); p. 935-942

Author(s): Eng, Janice J.; Bird, Marie-Louise; Godecke, Erin; Hoffmann, Tammy C.; Laurin, Carole; Olaoye, Olumide A.; Solomon, John; Teasell, Robert; Watkins, Caroline L.; Walker, Marion F.

Abstract: Moving research evidence to practice can take years, if not decades, which denies stroke patients and families from receiving the best care. We present the results of an international consensus process prioritizing what research evidence to implement into stroke rehabilitation practice to have maximal impact. An international 10-member Knowledge Translation Working Group collaborated over a six-month period via videoconferences and a two-day face-to-face meeting. The process was informed from surveys received from 112 consumers/family members and 502 health care providers in over 28 countries, as well as from an international advisory of 20 representatives from 13 countries. From this consensus process, five of the nine identified priorities relate to service delivery (interdisciplinary care, screening and assessment, clinical practice guidelines, intensity, family support) and are generally feasible to implement or improve upon today. Readily available website resources are identified to help health care providers harness the necessary means to implement existing knowledge and solutions to improve service delivery. The remaining four priorities relate to system issues (access to services, transitions in care) and resources (equipment/technology, staffing) and are acknowledged to be more difficult to implement. We recommend that health care providers, managers, and organizations determine whether the priorities we identified are gaps in their local practice, and if so, consider implementation solutions to address them to improve the quality of lives of people living with stroke.

Title: Exercise Interventions for Individuals With Neurological Disorders: A Systematic Review of Systematic Reviews.

Citation: American Journal of Physical Medicine & Rehabilitation; Oct 2019; vol. 98 (no. 10); p. 921-930

Author(s): Lai, Chien-Hung MD, PhD; Chen, Hung-Chou MD; Liou, Tsan-Hon MD, PhD; Li, Wei MD; Chen, Shih-Ching MD, PhD

Abstract: Fall prevention requires a multifaceted approach that should include individual risk assessment and intervention strategies. Exercise interventions may mitigate most risk factors for falls (eg, balance impairment, gait impairment, and muscle weakness). Numerous systematic reviews or meta-analyses have assessed the effectiveness of exercise interventions among people with various types of neurological disorders; however, the evidence obtained has not been synthesized into an overview. Therefore, the present

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systematic review assessed systematic reviews of exercise intervention for fall prevention among people with neurological disorders. The research sources were the Cochrane Database of Systematic Reviews, PubMed, and Embase. Eligible studies were selected, and data were extracted independently by two reviewers. A total of 15 studies (six systematic reviews and nine meta-analyses) were included. These systematic reviews examined in this study have demonstrated that exercise interventions reduced the number, frequency, and rate of falls among people with neurological disorders, including cognitive impairment, dementia, and Parkinson disease. Furthermore, the current study presented insufficient evidence regarding the effectiveness of exercise interventions for fall prevention among people with stroke, multiple sclerosis, and diabetes mellitus with polyneuropathy. Therefore, additional investigations are necessary to evaluate the effectiveness of exercise for fall prevention among people with multiple sclerosis, stroke, and diabetes mellitus with polyneuropathy.

Title: Factors Influencing the Delivery of Intensive Rehabilitation in Stroke: Patient Perceptions Versus Rehabilitation Therapist Perceptions.

Citation: Physical therapy; Nov 2019

Author(s): Janssen, Jessie; Klassen, Tara D; Connell, Louise A; Eng, Janice J

Background: Despite increasing evidence on intensive task-specific practice and aerobic exercise in stroke rehabilitation, implementation remains difficult. The factors influencing implementation have been explored from therapists' perspectives; however, despite an increased emphasis on patient involvement in research, patients' perceptions have not yet been investigated.

Objective: The study aimed to investigate factors influencing implementation of higher intensity activity in people with stroke and to compare this with therapists' perspectives.

Design: The design was a cross-sectional qualitative study.

Methods: The study used semi-structured interviews with people with stroke who were part of a randomized clinical trial, the Determining Optimal post-Stroke Exercise (DOSE) study, which delivered a higher intensity intervention. An interview guide was developed and data analyzed using implementation frameworks. Factors emerging from people with stroke were compared and contrasted to factors perceived by rehabilitation therapists.

Results: Ten people with stroke were interviewed before data saturation was reached. Participants had a positive attitude regarding working hard, and were satisfied with the graded exercise test, high intensity intervention, and the feedback monitoring devices. Therapists and patients had contrasting perceptions about their beliefs of intensive exercise and the content of the intervention, with therapists more focused on the methods and patients more focused on the personal interactions stemming from the therapeutic relationship.

Conclusions: People with stroke perceived no barriers regarding the implementation of higher intensity rehabilitation in practice and were positive towards working at more intense levels. Contrastingly, from the therapists' perspective, therapists' beliefs about quality of movement and issues around staffing and resources were perceived to be barriers. In addition, therapists and people with stroke perceived the contents of the intervention differently, highlighting the importance of involving patients and clinicians in the development and evaluation of rehabilitation interventions.

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Title: Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness.

Citation: Journal of clinical medicine; Nov 2019; vol. 8 (no. 11)

Author(s): Bevilacqua, Roberta; Maranesi, Elvira; Riccardi, Giovanni Renato; Donna, Valentina Di; Pelliccioni, Paolo; Luzi, Riccardo; Lattanzio, Fabrizia; Pelliccioni, Giuseppe

Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest "cibersikness" symptomatology.

Data Sources: a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years.

Study Selection: we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity.

Data Extraction: quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine.

Data Synthesis: VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy.

Conclusions: as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.

Sources Used: The following databases are used in the creation of this bulletin: Amed, Cinahl & Medline. Disclaimer: The results of your literature search are based on the request that you made, and consist of a list of references, some with abstracts. Royal United Hospital Bath Healthcare Library will endeavour to use the best, most appropriate and most recent sources available to it, but accepts no liability for the information retrieved, which is subject to the content and accuracy of databases, and the limitations of the search process. The library assumes no liability for the interpretation or application of these results, which are not intended to provide advice or recommendations on patient care.