PURPOSE:To translate and culturally adapt the Protection, Amount, Frequency, Adjustment, and Body Image (PRAFAB) questionnaire into Turkish and assess its validity and reliability. MATERIALS AND METHODS:Content validity was assessed using the item-level content validity index (I-CVI) and the scale-level content validity index based on the average method (S-CVI/Ave). Validity analyses included exploratory factor analysis (EFA), convergent validity, known-groups validity, and floor and ceiling effects. Reliability included internal consistency, corrected item-total correlations, and test-retest reliability using a two-way mixed-effects intraclass correlation coefficient (ICC). RESULTS:The study included 63 women with urinary incontinence (UI) and 51 healthy women (mean age: 52.54 ± 13.33 years). After revision, all I-CVIs and S-CVI/Ave were 1.00. EFA suggested a unidimensional structure in this sample, explaining 52% of variance, with loadings ≥0.598. PRAFAB-Turkish correlated strongly with UI scales (p < 0.001) and discriminated between groups (p < 0.001). Corrected item-total correlations exceeded 0.542. Internal consistency (Cronbach's α = 0.824) and test-retest reliability (ICC = 0.990) were good and excellent, respectively. Standard error of measurement (SEM), SEM%, minimum detectable change (MDC), and MDC% values were 0.372, 2.97%, 1.031, and 8.22%, respectively. CONCLUSION:Findings support the validity and reliability of PRAFAB-Turkish for assessing UI-related quality of life.Trial registration: ClinicalTrials.gov, NCT07339657.
PURPOSE:We aim to summarize the literature on family caregiver experiences and support needs following stroke and highlight person- and family-centred care (PFCC) as a potential approach to addressing gaps in caregiver support and mental health. MATERIALS AND METHODS:Literature was reviewed to examine caregiver mental health outcomes, caregiver-focused interventions, challenges integrating caregiver support into patient-centred models of care, and the potential role of PFCC. RESULTS:Caregivers are at increased risk of adverse mental health outcomes, including stress, burden, and psychological distress. Although interventions have been developed to improve caregiver health and well‑being, effectiveness has been mixed, with persistent challenges integrating caregiver‑focused programs into patient‑centred models of care. CONCLUSION:PFCC offers a promising approach by recognizing and engaging family caregivers as partners in care planning and implementation, with potential to enhance caregiver support and mental health and wellbeing.
PURPOSE:This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Slovenian translation of The Eating Assessment Tool (SI-EAT-10) as a patient-reported measure of swallowing-related symptoms in adults with dysphagia. MATERIALS AND METHODS:The SI-EAT-10 was translated according to established guidelines and administered to 203 patients and 104 healthy controls. Content and criterion validity, internal consistency, and test-retest reliability was assessed. Criterion validity was evaluated through correlations with the Functional Oral Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS). RESULTS:Patients had higher SI-EAT-10 scores than heathy controls (median 7 vs. 0). The threshold of ≥ 3 points showed 100% sensitivity and 93% specificity (AUC = 0.96). Strong correlations were found with FOIS (ρ = -0.84) and PAS (ρ = -0.89). Test-retest reliability was excellent (ICC = 0.97). Internal consistency was very high in patients (λ2 =0.90) and moderate in healthy controls (λ2 = 0.69). Content validity was rated as adequate. CONCLUSIONS:The SI-EAT-10 is a reliable and valid self-assessment instrument with strong psychometric characteristics. It is a useful patient-reported outcome measure for clinical and research use in Slovenian-speaking populations, with relevance for evaluating swallowing-related symptoms, supporting further diagnostic procedures, and rehabilitation planning.
PURPOSE:Pain is commonly experienced after stroke. It may impact the survivor's ability to sleep and is associated with an increase in disability, reduced physical function, and poor rehabilitation outcomes. Multiple factors have been reported to affect post-stroke pain. However, factors specifically associated with the perception (or experience) of pain in stroke survivors have not been systematically identified and characterised. The aim of this review was to identify and summarise the factors affecting pain and pain perception in stroke survivors. METHODS:A scoping review of included articles searched in Cochrane, PubMed, CINAHL, Web of Science, MEDLINE, AMED databases and Scopus (till 21 April 2026) was conducted. RESULTS:Sixty-seven studies were identified with a total of 31,075 participants included. This review found several main factors associated with pain outcomes in stroke survivors, including sensorimotor functions, functional dependency, specific somatosensory impairments, depression and fatigue, shoulder subluxation, movement restrictions, spasticity, and stroke severity. Factors that may reduce pain in stroke survivors, including peace, warmth, rest, quiet, posture adjustments, rubbing the arm, and early rehabilitation, were also identified. CONCLUSIONS:There is currently limited literature related to the pain experience of the stroke survivor and factors that may impact it. A systematic investigation of pain perception post-stroke and factors impacting it, is required.
PURPOSE:Robot-assisted lower limb rehabilitation (RALLR) may be an effective adjunct to conventional therapy for those with neurological conditions. Robot-assisted rehabilitation is emerging in Western Australia (WA) and local perspectives on this technology have not been explored. This study aimed to explore perspectives of WA clinicians on RALLR, to inform further implementation. METHODS:This was a cross-sectional survey of neurorehabilitation clinicians across metropolitan WA. A subset of respondents completed semi-structured interviews. Transcripts were analysed thematically. RESULTS:Fifty-six clinicians (across four professions) completed the survey. Eleven participated in an interview. The majority of clinicians expressed interest in upskilling in rehabilitation robotics (87.5%, n = 49) and incorporating robotics into their clinical practice (78.6%, n = 44). Access to devices, device practicality and clinician confidence using technology were identified as barriers to RALLR implementation. Comprehensive experiential learning, ongoing technical support and knowledge sharing were identified as key implementation facilitators. Suggestions for an optimised RALLR service in WA were discussed. CONCLUSION:Most clinicians supported broader implementation of RALLR in WA. Successful integration will require coordinated clinician, organisational and health-system wide collaboration. Sustainable funding models, comprehensive workforce training, accessible technical support and consultation with clinicians and people with neurological conditions are priorities for RALLR optimisation.
INTRODUCTION:Extrinsic feedback (EF) provides external signals during motor practice to enhance knowledge of performance or results. While EF can improve outcomes after stroke, its relative effects on motor learning versus functional recovery remain unclear. OBJECTIVE:To directly compare EF effects on motor learning and functional recovery after stroke. METHODS:We conducted a secondary analysis of controlled trials from a previous systematic review, updated through November 2025. Trials reporting both motor learning and functional recovery were included. Standardized mean differences (SMDs) were calculated using random-effects meta-analysis. Multivariate meta-analysis accounted for within-study dependence, with analyses varying assumed correlations (ρ = 0.3, 0.5, 0.7). Risk of bias was assessed using ROB2, and certainty of the evidence with GRADE. RESULTS:Five trials (149 participants) were included. EF significantly improved motor learning (SMD 1.19; 95% CI 0.16-2.22; low-certainty). Effects on functional recovery were not significant (SMD 1.00; 95% CI -0.42-2.42; very low-certainty). Multivariate meta-analysis detected no statistical difference between outcomes (ΔSMD 0.19-0.23; p > 0.43). CONCLUSIONS:No significant difference between outcomes, though uncertainty is substantial due to small sample size and imprecision. Motor learning gains may not generalize to functional recovery, supporting the value of assessing both outcomes in stroke rehabilitation trials.
PURPOSE:Stroke-related visual impairment (SRVI) is common but often under-recognised and inconsistently supported. While clinical features and acute rehabilitation are documented, less is known about how people live with SRVI over time or whether services meet changing needs. This study examined: (1) the daily impact of SRVI; (2) self-management strategies used; and (3) unmet support needs. MATERIALS AND METHODS:Sixteen community-dwelling adults in Scotland participated in semi‑structured interviews (7 women; mean age 58.8 years; mean time post‑stroke 29.5 months). Purposive sampling captured variation in SRVI type and recovery stage. Data were analysed using the Framework Method. Participants then ranked 18 unmet needs generated from the dataset. Patient and public involvement supported design and interpretation. RESULTS:Three themes emerged: (1) Multidimensional impact: SRVI resulted in practical, emotional, and social consequences. (2) Self‑developed management strategies included compensatory, environmental, technological, and psychological strategies. (3) Unmet needs included delayed assessment, limited tailored information, and short‑term rehabilitation misaligned with long‑term recovery. Ranking prioritised early assessment, realistic expectations, and clear information. CONCLUSIONS:Participants demonstrated considerable resilience but reported substantial unmet needs, emphasising the need for integrated pathways offering timely assessment, accessible information, practical strategies, and sustained follow-up.
PURPOSE:Stroke rehabilitation often involves long-term challenges across physical, psychological, cognitive, and social domains, and existing services do not always meet these multidimensional needs. A small number of studies have examined the use of animal-assisted therapy (AAT) in this context. This systematic review aimed to synthesise the available evidence on AAT in adults undergoing stroke rehabilitation, focusing on its reported effects across key domains of recovery. MATERIALS AND METHODS:A systematic review was conducted following PRISMA guidelines. Eligible studies reported original findings on the use of AAT with adults post-stroke. Data were extracted, appraised using the Mixed Methods Appraisal Tool, and synthesised narratively. RESULTS:Twelve studies were included, using varied designs and intervention approaches. AAT was typically delivered alongside standard rehabilitation and was associated with study-reported improvements in gait, balance, mood, motivation, and perceived recovery, although findings varied across studies. CONCLUSIONS:AAT may offer supportive value in stroke rehabilitation, particularly in domains aligned with holistic recovery. Further research is needed to evaluate feasibility, long-term outcomes, and the ethical implications of implementation.
PURPOSE:To develop a Japanese version of the Client-Centredness of Goal Setting (C-COGS) scale and examine its measurement properties. METHODS:A convenience sample of 111 clients in four Japanese subacute rehabilitation wards participated in this cross-sectional psychometric study. Internal consistency (Cronbach's α and McDonald's ω), test-retest reliability (intraclass correlation coefficient; ICC), convergent validity (correlation with the 9-item Shared Decision-Making Questionnaire; SDM-Q-9), and structural validity (confirmatory factor analysis) were assessed. RESULTS:Internal consistency was high for the 10 scored items (α = 0.91), with ω = 0.86 (Participation) and 0.92 (Goals), and test-retest reliability was moderate (ICC = 0.73). Convergent validity was moderate (r = 0.53 with SDM-Q-9, p < .001). Most fit indices supported the two-factor model (robust CFI = 0.971, TLI = 0.961, SRMR = 0.058), although RMSEA (0.070) exceeded the cutoff; a WLSMV sensitivity analysis supported the same structure with poorer fit (RMSEA = 0.099). Ceiling effects exceeded the 15% criterion for all items, subscales, and the total score (30.6-74.8%); floor effects were not indicated. CONCLUSION:The Japanese C-COGS showed preliminary evidence for the properties examined. Content validity, responsiveness, known-groups validity, and measurement invariance remain to be established, and ceiling effects warrant caution in interpreting absolute scores.
PURPOSE:To explore how collaborative challenges are experienced and navigated among vocational rehabilitation professionals, including case workers (CWs) and general practitioners (GPs), and citizens on long-term sick leave due to common mental disorders. METHODS:A qualitative case study in two Danish municipalities, including semi-structured interviews with seven citizens and seven GPs, and six focus group interviews with 31 CWs. Data were analysed inductively using systematic text condensation followed by abductive interpretation informed by relational coordination theory. RESULTS:Collaborative challenges among citizens, CWs, and GPs stemmed from weak relational ties and were reinforced by counterproductive communication. Lack of shared goals turned collaboration into a competition over the agenda, perpetuated by campaigning communication aimed at persuading others of one's perspectives. Lack of shared knowledge made collaboration feel laborious, exacerbated by clarifying communication aimed at reducing ambiguity. Lack of mutual trust and respect contributed to perceiving collaborators as adversaries, sustained by self-protective communication strategies aimed at shielding oneself from criticism. CONCLUSION:Collaborative challenges in vocational rehabilitation can be understood as self-reinforcing cycles of weak relational ties, negative collaborative experiences, and counterproductive communication. Strengthening relational coordination may improve collaboration for people on long-term sick leave due to common mental disorders.
PURPOSE:Complex pressure injuries (PIs) in people with spinal cord injury/disorder (SCI/D) often require flap surgery, with high complication rates, extended immobility and prolonged hospitalisation. This study explored the experiences of both people with lived experience of post-flap complications and the multidisciplinary clinicians involved in their care. MATERIALS AND METHODS:A descriptive phenomenological qualitative study was undertaken at a specialist Spinal Injuries Unit in Queensland, Australia. Purposive sampling recruited eight participants with lived experience of flap-related complications and ten multidisciplinary clinicians. Data were collected via focus groups and interviews using semi-structured questions, and data were analysed thematically. RESULTS:Three themes emerged: Living in the present, waiting for the future; Negotiating multiple obstacles; and Harnessing purposeful strategies. Participants described prolonged and uncertain recovery characterised by physical, psychological, social, and healthcare challenges, alongside strategies that fostered resilience through specialised multidisciplinary support, self-efficacy, comprehensive preparation and meaningful engagement during recovery. Participants also identified staffing and infrastructure limitations as barriers to optimal care. CONCLUSION:Recovery after flap repair is complex and multifaceted, requiring specialised SCI/D multidisciplinary care and sustained engagement from individuals. Strengthening preadmission assessment, supporting resilience and wellbeing, and improving models of care may help reduce complications and improve recovery trajectories.
PURPOSE:To establish the feasibility, content, and construct validity of the Patient Specific Functional Scale (PSFS) for chronic stroke survivors using the COSMIN standards. To identify functional predictors of PSFS completion and evaluate their predictive accuracy. METHODS:Sixty-six stroke survivors (81 years old, 76 months from onset; median) were participated. Feasibility was assessed via completion rate and ceiling/floor effects. Predictive ability was analyzed using receiver operating characteristic (ROC) curves. Content validity was established through linking activities to the International Classification of Functioning, Disability and Health (ICF). Construct validity was confirmed with hypothesis testing for correlations between the PSFS and standardized functional measurements. RESULTS:Fifty-six participants (85%) were PSFS completers; non-completers reported no perceived difficulties. No ceiling/floor effects were observed. Hemiparesis was a significant independent predictor of PSFS completion, with adequate predictive accuracy (AUC= 0.864). Content validity was supported by 90.5% of activities linking to the ICF "Activity and Participation" component. Adequate construct validity was demonstrated by significant relationships with functional measurements, with 85.7% of hypotheses were confirmed. CONCLUSION:The PSFS is a feasible, valid instrument to capture the patient-identified difficulties in stroke survivors. Notably, it shows better applicability for those with hemiparesis.
PURPOSE:To co-design a physical activity (PA) maintenance programme for stroke survivors who have completed a community-based rehabilitation programme. MATERIALS AND METHODS:A mixed methods approach, following the DECIPHer framework, incorporated stakeholder consultation (five focus groups) and intervention co-production (three workshops) involving stroke survivors, carers, physiotherapists, and exercise professionals. The final phase, intervention prototyping, remains ongoing and will be reported separately. RESULTS:Thirty-eight participants participated in the stakeholder consultation, with 11 participants participating in the co-production workshops. Focus groups results through inductive thematic analysis identified two themes: shifting realities of PA post stroke and motivation through community. Subthemes included barriers to PA, building confidence through PA, peer support and structuring a supportive post stroke PA pathway. Co-production workshops focused on identifying key characteristics of the intervention resulting in the development of a group-based exercise programme in a gym setting, led by exercise professionals and supported by a physiotherapist. CONCLUSIONS:Co-design with key stakeholders informed the development of a prototype PA maintenance programme that reflects the priorities of those who will use and deliver it. Social connection and appropriate stroke-specific training for providers may improve long-term engagement in PA and inform future implementation and evaluation.
PURPOSE:Routine assessment of caregiver burden in low-resource settings is constrained by limited culturally relevant measures. This study developed and initially evaluated the Zimbabwe Caregiver Challenges Scale (ZCCS) among caregivers of children with cerebral palsy (CP). MATERIALS AND METHODS:We developed the ZCCS through a systematic review, caregiver interviews, and two rounds of expert content validation, then field-tested it with 461 caregivers of children with CP. We analysed data using content-validity indices, Rasch analysis, and exploratory factor analysis in SPSS and RUMM2030 (α = 0.005). RESULTS:The ZCCS yielded four factors: physical and economic burden, concerns for the child, family relations and community participation. Internal consistency was high across subscales (Cronbach's α = 0.765-0.841) and the total scale (α = 0.925). The four-week test-retest intraclass correlation coefficient for the total score was 0.880 (95% confidence interval, 0.793-0.930). Higher ZCCS scores were associated with greater psychiatric morbidity and poorer health-related quality of life. CONCLUSIONS:The ZCCS demonstrated acceptable initial psychometric properties and may support research and structured assessment of caregiving challenges. Further validation is needed before adopting clinical cut-offs or broader applications.
PURPOSE:To examine the construct validity of scores from the Godin Leisure-Time Exercise Questionnaire Health Contribution Score (GLTEQ HCS) as a measure of moderate-to-vigorous physical activity (MVPA) in adults with Crohn's disease (CD) and healthy controls. MATERIALS AND METHODS:Thirty-eight adults with CD (78.9% female; 41.3 ± 12.0 years) and 41 controls (73.2% female; 39.3 ± 12.0 years) completed the GLTEQ and wore an ActiGraph GT3X-BT accelerometer for 7 days. Mean differences in accelerometer outcomes across HCS categories were examined (known-groups test of construct validity). Correlations between GLTEQ HCS and accelerometer-derived MVPA (convergent validity), and light PA (LPA) and sedentary behavior (divergent validity), were examined separately by group. RESULTS:Significant differences in accelerometer-derived MVPA across the three HCS categories were observed in controls [F(2,40)=3.90, p=.03, η2=.17], but not CD. When dichotomized (active ≥24 units versus insufficiently active <24 units), medium-to-large differences in MVPA emerged for both CD (d=.62) and controls (d=.87), though this difference did not reach statistical significance in CD. GLTEQ HCS correlated with MVPA in controls (rs=.40, p=.01) but not in CD (rs=.28, p=.09), and was not associated with LPA or sedentary behavior. CONCLUSION:GLTEQ HCS demonstrated modest, context-dependent construct validity for MVPA assessment, with stronger evidence using dichotomized classification and in controls than in adults with CD.
BACKGROUND:The Fitness and Mobility Exercise (FAME) program is an evidence‑based, community program designed to support stroke recovery. The extent of real‑world implementation of FAME is unknown. OBJECTIVE:To evaluate the dissemination and implementation of FAME. METHODS:This mixed‑methods, multi-data source study used the RE-AIM Framework to synthesize bibliometric analysis, FAME manual downloaders data, and an online survey of manual downloaders. Quantitative data were summarized descriptively. Qualitative responses underwent inductive content analysis. Findings were converged and triangulated using the RE‑AIM Framework. RESULTS:Thirty‑five publications were identified, demonstrating evidence through randomized trials (49%) and international research uptake (43% outside Canada). Between 2015-2024, 4279 individuals downloaded the manual; 188 completed the online survey. The Reach of FAME has primarily been stroke survivors, but also reached non-stroke neurological and non-neurological populations. Effectiveness has been tested beyond physical outcomes, including cognition. Manual downloads data indicated that Adoption has been primarily by physiotherapists (49%) within healthcare settings (42%). Survey data indicated Implementation facilitators as primarily the ease of finding equipment (51%) and meeting user priorities and goals (48%). Maintenance barriers were primarily staffing‑related (48%). CONCLUSION:FAME has achieved global implementation beyond the stroke population. The findings highlight the need to further support community-based adoption.
PURPOSE:This study aims to explore perspectives of stroke survivors, caregivers, and physiotherapists on goal-setting in stroke rehabilitation. MATERIALS AND METHODS:A qualitative study included in-depth interviews with 15 stroke survivors and seven caregivers and four focus groups with 16 physiotherapists. Data were analyzed using reflexive thematic analysis. RESULTS:An overarching theme "Readiness to patient-centered goal-setting in physiotherapy" emerged, reflecting goal-setting as a clinician-led process with limited involvement of stroke survivors and caregivers. Four themes were identified: a) Attitudes and perceived roles regarding goal-setting throughout rehabilitation, (b) Uncertainty as a barrier to goal-setting, (c) Strategies and challenges in communicating goals, and (d) Health system and policies challenges to person-centered goal-setting. While physiotherapists recognized the importance of patient involvement, goal-setting was often implicit, informal, and constrained by individual, organizational, and systemic factors. CONCLUSION:The findings suggest a systemic lack of preparedness for implementing person-centered goal-setting in post-stroke physiotherapy. Addressing this gap may require structured approaches that combine training, communication strategies, and organizational support to promote collaborative goal-setting and enhance stroke survivors' and caregivers' engagement in rehabilitation planning. Further research should focus on testing and refining theory-informed behavior change and implementation strategies to support the uptake of person-centered goal-setting practices.
PURPOSE:To translate and culturally adapt the LEFS into European Portuguese and evaluate its measurement properties in adults with lower limb musculoskeletal disorders. METHODS:The LEFS was translated and adapted following international guidelines. A total of 105 participants completed the LEFS, SF-36 and baseline form; 80 repeated the LEFS after 48-72 h. Structural validity was assessed by confirmatory factor analysis. Internal consistency, test-retest reliability, measurement error, floor/ceiling effects and construct validity through a priori hypothesis testing were evaluated. RESULTS:Cross-cultural adaptation supported conceptual, semantic and operational equivalence. Structural validity was mixed: one-factor and correlated two-factor models met the SRMR criterion, whereas other fit indices were suboptimal. Internal consistency was adequate (α = .984), and test-retest reliability was good (ICC = .970; weighted kappa = .769-.956). SEM was 4.17 and SDC was 11.56. Floor and ceiling effects were minimal (2.9% and 0%). Construct validity hypotheses were confirmed, with strongest correlations between LEFS and SF-36 Physical Functioning (ρ = .916 total; .555 acute; .812 chronic). CONCLUSION:The European Portuguese LEFS showed adequate internal consistency, good test-retest reliability, acceptable measurement error and evidence supporting construct validity; structural validity should be interpreted cautiously.
PURPOSE:To measure the implementability of the Clinical Frailty Scale (CFS), de Morton Mobility Index (DEMMI) and modified Iowa Level of Assistance Scale (mILOA) for internal medicine patients requiring physiotherapy. MATERIALS AND METHODS:Implementation study (March 2023-December 2024). Behavior change strategies were delivered. Evaluation included fidelity and sustainability (80% outcome measure completion), acceptability (acceptability survey, score range 0-40), and feasibility via limited efficacy of clinical utility (association between frailty and length of stay, mobility and discharge destination via Spearman's rho). RESULTS:Of 3,375 eligible patients, 23% had all outcome measures completed and 63% (n = 2,122) had CFS scores (80% fidelity was not achieved). Mobility measure completion were higher at admission than discharge (DEMMI admission 53%, discharge 28%; mILOA admission 55%, discharge 32%). Acceptability surveys (n = 22) indicated that the CFS (mean = 30.1, SD 3.2), mILOA (mean = 28.5, SD 3.5) and DEMMI (mean = 27.8, SD 3.2) were all acceptable; the CFS was significantly more acceptable than the DEMMI (p = 0.003), but not the mILOA (p = 0.097). Weak correlations were found between frailty and hospital outcomes. CONCLUSION:After implementation strategies (including education and goalsetting) outcome measure completion improved. While physiotherapists found the measures were acceptable, weak associations were found between frailty hospital outcomes, indicating questionable utility.
