ObjectivesThis study evaluates the responsiveness of the Timed 'Up and Go' test in people with Parkinson's disease to determine its sensitivity in detecting changes in functional mobility.DesignRetrospective cohort study.SettingInpatient rehabilitation.ParticipantsOne hundred ninety-six people with Parkinson's disease.Main measuresData on the Timed 'Up and Go' test, the 10 m walk test, and the 6 min walk test, collected before and after an assigned multidisciplinary inpatient rehabilitation stay, were retrieved from an existing clinical database and analysed retrospectively, for the period from January 2020 to 2025.ResultsAfter a median (first quartile, third quartile) inpatient rehabilitation stay of 20 days (19, 27), significant (p < 0.001) median (first quartile; third quartile) changes and corresponding effect sizes were observed for the Timed 'Up and Go' test (-2 (-1; -4), effect size = -0.83), the 10 m walk test (-1 (0; -2), effect size = -0.61), and the 6 min walk test (44 (13; 86), effect size = 0.76). Analyses showed moderate correlations between changes in the Timed 'Up and Go' test and the 10 m walk test (Spearman's rank correlation coefficient = 0.35, p < 0.001) and between the Timed 'Up and Go' test and the 6 min walk test (Spearman's rank correlation coefficient = -0.32, p < 0.001).ConclusionThe Timed 'Up and Go' test demonstrated strong responsiveness to changes in functional mobility in people with Parkinson's disease. The consistent pattern of large effect sizes across all gait-related measures following multidisciplinary inpatient rehabilitation suggests that these assessments capture a shared underlying construct, gait performance, essential for maintaining independent community living.
ObjectiveTo summarise evidence on the intervention design, safety, feasibility, acceptability, and effectiveness of a cardiac rehabilitation-based intervention for people who have had a stroke or transient ischaemic attack (TIA).Data sourcesMedline, PsycINFO, Embase, and CINAHL were searched between inception and 2026 for experimental or observational English-language studies that evaluated a cardiac rehabilitation-based intervention delivered to people with a history of stroke or TIA.Review methodsData were synthesised descriptively.ResultsNineteen studies were included (1951 participants), nine included people who had had a TIA, one exclusively. Most studies specified that participants had to have minimal or no stroke-associated disability. Reported time since stroke or TIA ranged from four weeks to more than one year. The interventions varied considerably in dose and components, though all included aerobic exercise training. Adverse event reporting was inconsistent; no study concluded that their interventions were unsafe, and one study stopped exercise testing. All 14 studies that measured feasibility reported that their study or intervention was feasible, though one concluded that it may not be feasible to enrol people with moderate stroke severity into existing cardiac rehabilitation programmes. Eight studies examined acceptability, all concluding that the interventions were acceptable and positively received. One powered randomised controlled trial found improvements were not sustained at 1-year follow-up.ConclusionsThe evidence suggests that cardiac rehabilitation after stroke and TIA is safe, feasible and acceptable. There are limited data relating to the inclusion of people with moderate or severe disability after stroke, or from trials regarding effectiveness.
ObjectivePrognostication may help guide mobility rehabilitation planning and goal setting post-stroke. This systematic review aimed to examine the prognostic capacity of early neuroimaging and neurophysiological biomarkers of mobility outcomes up to 24 months post-stroke.Data sourcesMEDLINE/EMBASE was searched from inception to May 2026. Cohort studies that reported neuroimaging or neurophysiological biomarkers measured <14 days post-stroke and mobility outcome(s) assessed >14 days but ≤24 months post-stroke were included.Review methodsBiomarker analyses were classified by statistical analysis approach (association, discrimination/classification, validation). Magnitude of relevant statistical measures was the primary indicator of prognostic capacity. Risk of bias was assessed using the Quality in Prognostic Studies tool.ResultsTwenty-six reports from 23 independent study samples (n = 2678 participants) were included. Biomarkers were measured a median of 9.3 days post-stroke, and outcomes were assessed between 1 and 24 months. One hundred and nine biomarker analyses were identified (84 neuroimaging, 25 neurophysiological). Most analyses were association (88%), and few were discrimination/classification (10%) and validation (2%). Structural and functional corticospinal tract integrity metrics were frequently investigated, but findings were mostly small or non-significant. Lesion location and size findings were also commonly examined, but findings were inconsistent. Common methodological limitations included small sample sizes, moderate to high risk of bias, poor magnitude reporting and heterogeneous outcomes and follow-up timepoints.ConclusionCurrent evidence is insufficient to support the use of early neuroimaging and neurophysiological biomarkers for post-stroke mobility prognostication. International collaboration using harmonised methodologies, standardised statistical reporting and consistent outcome measures and timepoints is needed to generate meaningful prognostic information to guide rehabilitation.RegistrationCRD42022350771.
ObjectiveTo determine the effect of non-pharmacological interventions on physical and mental health-related quality of life among adults with early diagnosed multiple sclerosis.Data sourcesPubMed, EMBASE, Cochrane CENTRAL, ClinicalTrials.gov and APA PsycINFO were searched from database inception to 8 July 2026.Review methodsWe conducted a systematic review and meta-analysis of randomised controlled trials comparing non-pharmacological interventions with control conditions in adults with early-stage multiple sclerosis and minimal disability. Outcomes were physical and mental health-related quality of life after treatment and at follow-up. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Effects were pooled using standardised mean differences.ResultsEleven randomised controlled trials including 696 participants were included. The updated search identified no additional eligible trials. Interventions included exercise, physiotherapy, balance training, cognitive rehabilitation and behavioural therapies. After treatment, interventions produced a small improvement in physical health-related quality of life, with a standardised mean difference of 0.28 and a 95% confidence interval from 0.11 to 0.46. The effect on mental health-related quality of life was smaller and uncertain, with a standardised mean difference of 0.16 and a 95% confidence interval from -0.04 to 0.35. Follow-up effects were not clearly sustained.ConclusionNon-pharmacological interventions may provide modest short-term physical health-related quality-of-life benefits. Effects on mental health-related quality of life and digitally delivered rehabilitation remain uncertain.
ObjectiveTo investigate the prevalence and longitudinal course of post-stroke fatigue and identify subgroups with distinct fatigue trajectories up to 5 years post-stroke.DesignA prospective, longitudinal, multi-centre cohort study.SettingHospital stroke units in the Central-Norway health region.ParticipantsIncident ischaemic stroke patients were recruited during acute hospitalisation between June 2015 and November 2017. Data were collected during the hospital stay and at 3 months, 1 year, 3 years, and 5 years.Main measuresFatigue was assessed using the 7-item Fatigue Severity Scale with >5 as cut-off to define clinical fatigue.ResultsA total of 693 participants were included. The prevalence of clinical fatigue was 24% (3 months), 28% (1 year), 30% (3 years), and 28% (5 years). A Sankey diagram illustrated substantial variability in fatigue status across time points. Using group-based trajectory modelling, four latent subgroups with distinct fatigue trajectories were identified: (1) low fatigue, (2) emerging fatigue, (3) improving fatigue, and (4) high fatigue.ConclusionOne quarter to one third of the study population consistently exhibited fatigue up to 5 years post-stroke. High variability in fatigue status over time was evident, indicating individual-level heterogeneity in the longitudinal course. This was further confirmed by the identification of four latent subgroups with distinct post-stroke fatigue trajectories. Early detection of individuals at risk of an adverse fatigue trajectory and differentiated follow-up may improve outcomes for stroke survivors.
ObjectiveThis study aimed to identify subgroups of stroke survivors based on multiple-adverse health conditions and determine the potential mediation effects of mental health in their relationship with health-related quality of life.DesignA cross-sectional study.SettingThree tertiary hospitals in Tianjin, China.ParticipantsA total of 558 stroke survivors were recruited between March and June 2023.Main measuresMultiple-adverse health conditions (multimorbidity, frailty and disability) were assessed using the age-corrected Charlson Comorbidity Index, FRAIL Scale, and Barthel Index. Mental health was measured with Patient Health Questionnaire-4, and health-related quality of life was evaluated using the EuroQol 5-dimension 5-level scale. Latent profile analysis identified subgroups, and mediation analysis explored mental health's role.ResultsThree subgroups were identified: Mild (65.4%, n = 365), Moderate (17.4%, n = 97), and Severe (17.2%, n = 96). Mediation analysis showed that, compared with the Mild subgroup, survivors in the Moderate subgroup (β = 0.138, 95% CI: 0.055 to 0.232) and the Severe subgroup (β = 0.217, 95% CI: 0.113 to 0.316) exhibited worse mental health, and poorer mental health was associated with lower health-related quality of life (β = -0.119, 95% CI: -0.170 to -0.075).ConclusionsThis study suggests heterogeneity in multiple-adverse health conditions and indicates that mental health may partially account for the association between these conditions and health-related quality of life in stroke survivors. The findings highlight the need for further research into subgroup-specific interventions-with particular attention to mental health-to determine whether such approaches could improve health-related quality of life.
ObjectiveTo examine the feasibility and acceptability of a co-designed breakfast group intervention, BISTRo, delivered within an acute stroke rehabilitation service.DesignMultisite mixed-methods feasibility study.SettingThree National Health Service stroke rehabilitation wards in the United Kingdom.ParticipantsSixteen stroke survivors and 53 multidisciplinary staff from occupational therapy, physiotherapy, speech and language therapy, dietetics, nursing, and psychology.InterventionA structured breakfast group, delivered on five mornings a week over two weeks, integrating social dining, peer support, multidisciplinary rehabilitation, and functional eating and drinking practice.MethodsAttendance, attrition, and therapy dose were recorded. Patient-reported outcomes included a self-confidence Likert scale and subscales of the Confidence after Stroke Measure. Semi-structured interviews with stroke survivors and staff focus groups explored acceptability. Qualitative data were analysed thematically using feasibility and acceptability frameworks.ResultsSixteen stroke survivors participated across all wards, with high attendance (mean 8.9 sessions/standard deviation 1.45 out of 10), no intervention-related withdrawals, and complete data collection. Fifteen participants improved on the self-confidence measure. Positive attitude scores improved in eight participants, remained stable in five, and declined in three. In interviews with stroke survivors (n = 12) and focus groups with staff (n = 21), BISTRo was described as meaningful, confidence-building, and socially supportive. Staff also reported improved interdisciplinary working and manageable resource demands.ConclusionsDelivery of the BISTRo breakfast group was feasible and acceptable and warrants further evaluation. Conducting this feasibility study has enabled identification of potential changes to the trial design.
ObjectiveTo review the extent of the available evidence, and to identify and describe the approaches that have been used to facilitate leisure participation following stroke.Data sourcesEmbase, Medline, PsycINFO, CINAHL, AMED and Cochrane Library were searched between 1989 and June 2026 for studies (quantitative, qualitative and mixed methods) reporting an intervention that addressed leisure and measured the impact on post-stroke leisure participation.Review methodsEstablished scoping review methods guided data extraction with a piloted data charting tool, appraisal utilising Quality Assessment for Diverse Studies (QuADS), and meta-narrative (quantitative findings) and meta-aggregation (qualitative findings) synthesised using a Convergent Segregated Approach.ResultsWe included 28 studies (2588 participants). Most interventions to address leisure participation were face-to-face (93%) and delivered in the community (82%). Interventions were diverse and heterogeneous; however, 8/28 incorporated leisure education/counselling. Quantitative studies reported 12 distinct measures of leisure participation. A positive impact on leisure participation was reported in 13/22 studies reporting quantitative findings and 8/8 studies reporting qualitative findings. Studies were limited by poor reporting of delivery, 'dose' and methodological quality.ConclusionFuture research needs to explore the role of leisure education/counselling, recognise the importance of motivation, social connectedness and hope, and address barriers to leisure participation. Leisure interventions should be co-created with people that have lived experience of stroke. Programme theory, core components of the intervention and delivery methods must be clearly articulated to enable replication. Future studies should capture psychosocial outcomes alongside leisure participation and satisfaction, and assess long-term impact of interventions.
ObjectiveTo identify key factors influencing motor learning in children with motor difficulties and to examine the level of agreement and disagreement among paediatric physiotherapists regarding these factors within contemporary and conventional paradigms.DesignA three-round modified Delphi study using online questionnaires.ParticipantsThe study included 16 experienced paediatric physiotherapists in the first round, of whom 14 (87.5%) completed all three rounds.Main MeasuresIn Round 1, experts identified factors via open-ended questions. In Rounds 2 and 3, participants rated their agreement on a 5-point Likert scale. Consensus was defined using mean scores (mean ≥ 4.0), coefficient of variation (≤ 30%) and percentage agreement (≥ 70%). Kendall's coefficient of concordance (W) was used to assess inter-rater agreement on prioritisation.ResultsFrom an initial 646 items, 251 factors reached consensus by Round 3. High levels of agreement were observed for factors aligned with contemporary motor learning paradigms (e.g. child motivation, goal-directed activity, family involvement). However, experts simultaneously reached consensus on conventional, impairment-based strategies (e.g. normalisation of tone, restriction of atypical movement). Despite high agreement on item importance, Kendall's W (0.244) indicated weak agreement on the relative prioritisation of these factors.ConclusionsThe participating experts endorsed a dual-consensus, valuing both active motor learning principles and traditional impairment-based normalisation. This coexistence highlights an apparent translational gap between current theoretical evidence and clinical practice. The identified framework has the potential to inform curriculum development to bridge conventional approaches and contemporary evidence-based paediatric rehabilitation.
ObjectiveTo evaluate the effects of gliding and resistance exercises on median nerve and third flexor digitorum superficialis tendon shear wave velocity in patients with carpal tunnel syndrome.DesignProspective, randomised, three-arm, parallel-group trial.SettingAt the Institute of Clinical Neurophysiology.ParticipantsA total of 102 patients with electrodiagnostically confirmed mild to moderate carpal tunnel syndrome aged 20-80 years (51.5 ± 12.9 years; 85.3% female).InterventionParticipants were randomised to the Gliding Exercise group, the Resistance Exercise group or the Control group. Participants in the exercise groups performed daily home-based gliding or low-load resistance exercises for 3 weeks, whereas controls received no intervention. At baseline and follow-up, shear wave velocity of the median nerve and the third flexor digitorum superficialis tendon was measured longitudinally at the carpal tunnel inlet, and the cross-sectional area of the median nerve was measured at the carpal tunnel inlet and 10 cm proximally to the distal wrist crease.Main measuresThe primary outcome was the change in median nerve shear wave velocity at the carpal tunnel inlet. Secondary outcomes were changes in the third flexor digitorum superficialis tendon shear wave velocity and median nerve cross-sectional area at the same level.ResultsNinety-one participants completed the post-intervention assessment. No significant changes were observed in primary or secondary outcome measures despite improvements in self-reported symptoms in the gliding exercise group compared to controls.ConclusionShort-term exercise-based interventions do not modify median nerve or tendon elasticity in mild to moderate carpal tunnel syndrome. Symptom improvement may occur through mechanisms other than changes in tissue stiffness.
DesignOnline Delphi method with five survey rounds and one virtual meeting to achieve international multidisciplinary recommendations for the screening and assessment of spatial neglect in clinical practice.Participants175 experts with ≥5 publications in spatial neglect were invited.Main MeasuresSurveys were developed from a published review. Working definitions were provided for clarity: screening (as applicable for all stroke survivors) and assessment (conducted if positive screen). Participants rated the importance of screening and assessment of each spatial neglect subtype, and preferences for measurement tools. Consensus was pre-defined as ≥75% agreement. Participants could also provide explanatory free text responses. After each round, participants received summarised results to inform subsequent rounds. A final meeting focused on assessment items without consensus.Results66 experts participated in Round 1, representing 15 countries and six disciplines; with 29 in the final 5th Round and nine attended the meeting. There was consensus that: all survivors should be screened for spatial neglect within 2 weeks post stroke; and those screening positive should have a comprehensive assessment of all subtypes of spatial neglect. Several tools reached consensus with shortlists for some subtypes.ConclusionThis work presents international, multidisciplinary recommendations on screening and assessment, developed by experts from 15 countries and six disciplines; however, attrition across rounds and a small consensus meeting (n = 9) may limit the representativeness of some tool-specific decisions. Implementing these findings may improve the detection of spatial neglect in clinical practice. Further research exploring psychometrics (validity, reliability, sensitivity, specificity) of shortlisted tools will support a full clinical protocol.
ObjectiveTo investigate health-related quality of life, pain, socket comfort and residual limb conditions in children with lower limb absence.DesignThis is a cross-sectional study with patient-reported outcomes measures collected from children with congenital and acquired lower limb absence. Outcomes included health-related quality of life, body pain mapping, socket comfort score and clinical evaluation of the residual limb. Effects of age, prosthetic technology, school attendance and pain on health-related quality of life and socket comfort were investigated.SettingData from 31 children were collected in prosthetic centres in the UK (N = 15) and Cambodia (N = 16).ResultsThis cohort had a clinically important reduction in health-related quality of life compared to normative data (Δ = 13.21). Psychosocial health declined with age (ρ = -0.394, p = 0.014). Low intensity pain in the residual limb, back and intact joints was frequent and negatively correlated with health-related quality of life (ρ = -0.327, p = 0.036). Socket comfort was positively correlated with physical well-being (ρ = 0.398, p = 0.013). Unplanned emergency amputations resulted in worse residual limb outcomes than planned surgeries (p = 0.02).ConclusionThis cohort experience significant, under-addressed challenges in physical and mental well-being. Declining mental well-being underscores the urgent need for age-appropriate psychological support that addresses the evolving social and emotional demands of growing up with a disability. The prevalence of widespread pain highlights the need for targeted gait training and improved prosthetic fit and design. Poorer residual limb health outcomes following emergency amputations reinforce the importance of paediatric-specific surgical and post-operative protocols. Holistic, child-centred care integrating physical, psychological and social support is essential.
ObjectiveTo investigate if post-discharge oral nutritional supplementation improves physical functional performance and other outcomes in older hip fracture patients at nutritional risk.SettingDepartment of Orthopaedic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.ParticipantsHip fracture patients aged ≥65 years and identified as being at nutritional risk. Of 768 individuals screened, 123 were randomised and 109 (89%) completed the 12-week follow-up.InterventionParticipants were randomised to receive either two cans of high energy, high protein oral nutritional supplementation enriched with vitamin D and omega 3 fatty acids daily for 12 weeks after discharge or standard care.Main measuresThe primary outcome was physical functional performance assessed by the 30-s chair-stand test. Secondary outcomes included muscle mass, hand grip strength, activities of daily living, hydration status, inflammation, appetite, quality of life, energy and protein intake, and omega-3 fatty acid status.ResultsPhysical functional performance improved in both groups, with no significant between-group difference in the number of repetitions performed in the intention-to-treat analysis. Protein intake increased in the intervention group (p = 0.003), while no between-group differences were observed for other outcomes. In the per-protocol analysis, the intervention group showed greater improvement in physical functional performance compared with the control group (p = 0.040). Energy and protein intake were also higher in the intervention group (p = 0.003, p = <.001),ConclusionsPost-discharge oral nutritional supplementation increased protein intake but did not improve physical functional performance. Per-protocol findings suggest that high adherence may be necessary to achieve functional benefits.
ObjectiveFalls are a serious complication of Parkinson's disease, leading to functional decline, psychological distress, and substantial economic burden. Although multiple interventions have been proposed, structured quantitative guidance on prioritising fall-prevention strategies for clinical implementation in Parkinson's disease remains limited.DesignA multi-method study integrating a structured narrative review, expert consensus via a two-round Delphi process with 15 multidisciplinary Parkinson's disease experts, and multi-criteria decision-making using the Best-Worst Method to identify and quantitatively prioritise fall-prevention strategies for people with Parkinson's disease.SettingExpert-based consensus and decision-analysis study.ParticipantsFifteen multidisciplinary experts with clinical and research expertise in Parkinson's disease and neurorehabilitation.InterventionFall-prevention interventions identified through a structured narrative review and refined through a two-round Delphi process, followed by prioritisation using the Best-Worst Method.Main measuresRelative priority weights of intervention categories and sub-criteria derived using the Best-Worst Method based on expert judgements.ResultsThe Delphi process yielded three main criteria (exercise, dance-based interventions, and neuroscience-based interventions) and 14 sub-criteria. Best-Worst Method weighting showed that exercise had the highest priority (weight=0.49), followed by dance-based interventions (weight=0.32) and neuroscience-based interventions (weight=0.19). Within exercise, balance training and resistance strength training received the greatest weights, whereas Tai Chi and transcranial direct current stimulation received the highest expert-derived priority weights within the dance-based and neuroscience-based categories, respectively.ConclusionThis integrative framework provides an evidence-informed hierarchy of expert-derived priorities for fall-prevention interventions and may support clinical decision-making and programme design, while highlighting the need for further effectiveness and implementation research.
ObjectiveTo examine physical activity and its spatial context after geriatric rehabilitation and to identify determinants of out-of-home activity in older adults with cognitive impairment.DesignCross-sectional observational study.SettingCommunity, following discharge from geriatric rehabilitation.Participants113 geriatric patients (mean age 82.1 ± 6.0 years; 76.1% female) with cognitive impairment following geriatric rehabilitation.Main MeasuresPhysical activity was assessed over 48 h using a body-worn accelerometer (PamSys®) and location-based tracking derived from the Global Positioning System (Qstarz BT-Q1000XT). Group differences between participants with and without out-of-home activity were analysed. Multivariable logistic regression identified predictors across physical, psycho-social, cognitive, environmental, financial, and personal domains.ResultsOnly 36 (31.9%) of the 113 participants (82.1 ± 6.0 years; 76.1% female) left their homes. Those with out-of-home activity accumulated significantly more daily steps, walking episodes, active time, and less sedentary time than those staying in-home (all p < .01). Receiver operating characteristic analyses identified thresholds of 2140 steps/day (area under the curve 0.81) and 29.6 s mean walking episode duration (area under the curve 0.73) for discriminating between participants with and without out-of-home activity. Physical capacity (OR: 1.30, 95% CI: 1.02-1.65) and cognitive function (OR: 1.29, 95% CI: 1.02-1.62) were independent predictors of out-of-home activity.ConclusionOut-of-home activity is infrequent after rehabilitation in older adults with cognitive impairment and closely reflects overall physical activity. It may serve as a practical marker of mobility and highlights the need for targeted interventions to support community mobility during this vulnerable phase.
ObjectiveThis study aimed to implement and evaluate a structured, team-based approach to integrating sexual health into stroke rehabilitation using the Permission-Limited Information-Specific Suggestions-Intensive Therapy model, operationalized through the Stroke Sexual Health Practice Profile.DesignQuality Improvement Initiative.SettingOntario, Canada.ParticipantsPatients attending inpatient or outpatient stroke rehabilitation.InterventionThe Stroke Sexual Health Practice Profile was developed collaboratively by an interprofessional team and implemented within a stroke rehabilitation program. It outlined standardized practices across the Permission-Limited Information-Specific Suggestions-Intensive Therapy framework, including scripts, educational materials, and documentation protocols.Main measuresOutcomes included staff knowledge, comfort, and approaches to addressing sexual health, participation in educational activities, patient awareness and comfort discussing sexual health, and documentation of sexual health practices in clinical charts.ResultsPreimplementation surveys identified gaps in patients' awareness of poststroke sexual health and providers' confidence in addressing it. Among eligible staff, 86.3% completed online modules and 62.1% attended workshops, which were associated with significant improvements in knowledge and comfort. These gains were partially sustained at 6 months. Postimplementation patient surveys demonstrated improved awareness and comfort discussing sexual health. Chart audits showed increased documentation of sexual health discussions over time.ConclusionsThe Stroke Sexual Health Practice Profile supported integration of sexual health into stroke rehabilitation by improving clinician knowledge and confidence and increasing documentation of care. Sustained improvements may require ongoing reinforcement and system-level supports.
There are few studies involving the mechanism of the emotions that consumers experience before a service failure on their willingness to forgive. This research intends to explore the effect of two different types of compassion on the willingness to forgive under uncontrollable and controllable service failure, examine the mediating role of empathy and the moderating role of the type of service failure. This research designed two experiments. Experiment 1 involved 450 voluntary participants and adopted a between-group design (spontaneous compassion vs. neutral emotions) × (controllable service failure vs. uncontrollable service failure). Experiment 2 involved 431 voluntary participants and used a between-subject experimental design (merchant-induced compassion vs. neutral emotions) × (controllable service failure vs. uncontrollable service failure). Results demonstrated that consumers with spontaneous compassion still "treat others as themselves" and showed a higher willingness to forgive. However, the compassion induced by merchants is a "double-edged sword", which will have positive and negative effects on consumers' willingness to forgive under uncontrollable and controllable service failure situations. This research deepens the research on the impact of compassion as a self-transcendent emotion on consumer forgiveness and provides empirical support for the transformation of service recovery from "after-the-fact recovery" to "pre-intervention".
ObjectiveTo analyse physical fitness trajectories in paediatric burn survivors from discharge to 2 years post-injury, compare them with an age- and gender-matched control group, and identify baseline demographic and clinical determinants.DesignProspective and longitudinal cohort study.ParticipantsThe study included participants with burn injuries (burn group, n = 45), aged 10-17 years, with burns involving ≥25% of total body surface area, and an age- and gender-matched group of healthy children (control group, n = 45).Main measuresParticipants underwent standardised fitness assessments at discharge and 24 months later. Health-related physical fitness was quantitatively assessed using the validated EUROFIT physical fitness test battery.ResultsLongitudinal analysis revealed significant improvements in seven of nine fitness domains for participants with burn injuries over two years (pFDR < 0.001). Despite these gains, these participants exhibited persistent fitness deficits compared to healthy controls across all domains at follow-up (all p < 0.001). Among those with burn injuries, greater total body surface area (β = -0.007, p = 0.03) and third-degree burn percentage (β = -0.57, p < 0.001) predicted lower overall fitness, while longer rehabilitation predicted higher fitness (β = 0.50, p < 0.001). No baseline clinical factors significantly predicted the rate of fitness change over time (all interaction p > 0.05).ConclusionPaediatric burn survivors demonstrated significant improvements in physical fitness over 2 years but failed to close the performance gap with their healthy peers. Injury severity and rehabilitation duration were strong determinants of fitness level, but they did not predict the rate of improvement.
ObjectiveTo examine the association between increased energy and protein intake through oral nutritional supplements and mortality and hospital admissions in older hip fracture patients at nutritional risk, using a preplanned secondary analysis of a randomised controlled trial.SettingDepartment of Orthopaedic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.ParticipantsHip fracture patients aged ≥65 at nutritional risk.InterventionParticipants were randomised to receive two cans daily of high-energy, high-protein oral nutritional supplements enriched with vitamin D and omega-3 fatty acids for 12 weeks after discharge or standard care.Main MeasuresAll-cause mortality and hospital admissions during a pre-planned 38-week follow-up after discharge, including time to first admission and length of hospital stay.ResultsAll-cause mortality was low, with no difference between intervention and control groups 2 (3%) versus 3 (5%). During follow-up, 31% (n = 19) of intervention participants was admitted to hospital compared with 47% (n = 29) in the control group. The difference approached significance in the intention-to-treat analysis (Risk ratio 0.72, 95% CI 0.51-1.03, p = 0.075) and was statistically significant in the per-protocol analysis (18% vs. 44%; Risk ratio 0.69, 95% CI 0.52-0.92, p = 0.019). No significant differences were observed in admissions frequency, length of hospital stay, or time to first admission.ConclusionPost-discharge oral nutritional supplementation was associated with a trend towards fewer hospital admission, with the strongest effect among adherent participants. No significant effects were observed in mortality, admission frequency, length of hospital stay or time to admission.ClinicalTrials.gov: NCT05556876. Date of registration: 2022-09-23.URL: https://clinicaltrials.gov/study/NCT05556876.
ObjectiveParticipation plays a pivotal role in rehabilitation for people with multiple sclerosis. In clinical practice, the International Classification of Functioning, Disability and Health serves as a basis for characterizing participation. However, this framework lacks the subjective perception of participation. This study examines the perceived participation of people with multiple sclerosis and gait impairment through a sense of connection, efficacy, and meaning.DesignQualitative research design with focus group and individual interviews.SettingParticipants were interviewed using an online conference tool.ParticipantsTranscripts from four online focus group interviews with people with multiple sclerosis and gait impairment (4-6 participants each, totaling N = 19, aged 33 to 76, with 12 females) and from 12 individual interviews with participants from these focus groups were analyzed.InterventionNone.Main measuresTwo researchers coded transcripts using qualitative content analysis by Kuckartz.ResultsA sense of connection was about common activities, a sense of inclusion, sameness, familiarity, and contributing to a social system. Experiences of exclusion, otherness, and foreignness were reported. A sense of efficacy ranged from a sense of competence, influence, and independence to a sense of dependence, a lack of spontaneity, and helplessness, leading to refraining from activities. Meaningful activities, sensual experience, a sense of purpose, identity, and equality were related to a sense of meaning.ConclusionsPerceived participation goes beyond the ability of being involved in life situations. Clinicians following a patient-centered approach can incorporate the presented perspective of people with multiple sclerosis and gait impairment on participation into their clinical action.
