Background: Approximately 70% of survivors of stroke have problems with arm function. Physiotherapists assess arm functional range of motion (ROM) using either a goniometer or functional questionnaires, which lack objective accuracy and require a skilled physiotherapist. We developed the Track-UL algorithm based on a markerless motion capture system to measure arm ROM. Objective: This study aimed to measure the agreement between our novel Track-UL algorithm and Kinovea software in assessing arm ROM during functional tasks in the laboratory and home settings. Methods: Videos were recorded while 27 survivors of chronic stroke performed 4 functional tasks (forward reaching, arm abduction, moving the hand toward the mouth, and moving the hand toward the head) in the laboratory and at home. The videos were analyzed by 2 independent raters using the Track-UL algorithm and Kinovea software. The limits of agreement and intraclass correlation coefficients were calculated. Results: We found no clinically significant systematic bias in shoulder and elbow angle, with good agreement between the Track-UL algorithm and Kinovea software (assessed via Bland-Altman plots). The 95% limits of agreement were -3.18 to 6.41 degrees for the shoulder joint and -5.35 to 8.78 degrees for the elbow joint in the laboratory setting, and -6.21 to 3.62 degrees for the shoulder joint and -4.06 to 2.53 degrees for the elbow joint in the home setting. There was excellent absolute agreement between the measurement tools across all tasks and joints; intraclass correlation coefficient values ranged from 0.97 (95% CI 0.97-0.99) to 0.99 (95% CI 0.99-0.99; P<.001 for both laboratory and home measurements). Conclusions: The novel Track-UL algorithm is an accurate, valid, and easy tool that can be used to assess upper-limb ROM in survivors of stroke at clinics and potentially at home. This will support physiotherapists in remotely monitoring and adapting rehabilitation programs.

ObjectiveThis study adopted a novel approach to exploring the content validity, safety, usability, and user experiences of different games for telerehabilitation purposes from the perspective of physiotherapists and stroke survivors.DesignA cross-sectional content validity and usability study.SettingLab and online.Participants23 participants were recruited; 11 neuro-physiotherapists and 12 chronic stroke survivors.OutcomesContent validity and safety were assessed using a bespoke state evaluation questionnaire. The usability was evaluated using the system usability scale (SUS) and user experience questionnaire (UEQ). House of Quality analysis was conducted to identify the priority aspects for improvement.ResultsPhysiotherapists perceived the usability of the games as good to excellent for three games, median SUS = 80%, and poor for two games SUS < 68%. Three games had a mean average content validity index (CVI) > 0.8, and all games were safe to be administrated at home; mean CVI-safety item = 0.90. Stroke survivors with Fugl-Meyer Assessment of Upper Extremity function mean (SD) = 41(19.4), and mild to moderate spasticity perceived usability as very good to excellent for four games (median SUS = 85%). UEQ scale showed good to excellent acceptance among most of the games. House of Quality analysis revealed that clear instructions, avatar quality, motivational exercise scenarios, and clinical assessment tools are important criteria that should be considered throughout the development.ConclusionThis study demonstrated the value of exploring patient and physiotherapist perspectives for better telerehabilitation interventions co-development. Clinical trials should be conducted after further refinement of the games to investigate their feasibility and potential efficacy as a telerehabilitation tool for arm and balance training.

The Cavendish Review (2013) highlighted the array of constraints, issues, barriers and obstacles that healthcare assistants (HCAs) face in the workplace. Approximately 10 years after the initial report was published, Griffin et al (2024) conducted a follow-up study to examine whether the situation had changed or developed. This article briefly explores their wider findings and discusses the implications for the HCA workforce.

Objective What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers? Design A three-round modified e-Delphi study. Participants Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field. Methods A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus. Results Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 52 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n=36; 2) Assessment, n=39; 3) Management, interventions and prevention n=40; 4) Communication, therapeutic relationship and person-centred care, n=17; and 5) Physiotherapists self-management and improvement, n=5. Conclusions This e-Delphi outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians. Contribution of the paper •This e-Delphi study has developed, through expert consensus, the first comprehensive physiotherapy specific core capability framework for providing high-quality care to people with dementia and their families/caregivers.•The core capability framework can be used by physiotherapists to identify knowledge and/or skill gaps, and by physiotherapy educators to assist with entry-level and post-graduate curriculum development and student/workforce training.As physiotherapists play a vital role in working with people with dementia and their caregivers/families, and competencies lie at the heart of effective quality care and service delivery, the newly developed core capability framework serves as basis for broader consultation and input.

Background:Advanced practitioner (AP) roles are becoming increasingly common in primary care and community settings for supporting older people and those living with frailty. Aims:The aim of this study was to explore health and social work AP roles in primary care and community settings in the UK, and understand how they support older people and factors that may impact on APs use of technology in practice. Methods:A cross-sectional, web-based survey was adopted to explore the views and perspectives of APs. Results:The survey received 111 responses. There were different views as to whether technology was suitable for older people. Although digital exclusion was a concern, it was perceived that this would change in the future as generations become more digitally literate. Respondents suggested that using technology brought about efficiencies and the ability to respond sooner to symptom changes, with some concerns mentioned regarding the accuracy of technology that may miss signs and symptoms. Conclusion:This is the first national survey to explore advanced practice roles with older people in non-hospital settings. While APs have wide-ranging skills, few currently use technology in their practice. Findings will inform a future study on digitally enhanced comprehensive geriatric assessments.

To date there has been little focus on the concept of joy amongst older people in the literature. The objective of this scoping review was to understand the extent and type of evidence about joy and older people. Searches were run in ten databases in January 2022 (re-run January 2023). Eligible studies included people aged 65 and over living in their usual place of residence and described the experience or evaluation of joy. Screening was conducted independently by two reviewers and data were extracted by one reviewer and checked by a second. We included 11 papers reporting both qualitative (n = 5) and quantitative (n = 6) studies involving 1,487 participants with a mean age of 81.6 years. Seven of the studies were based in care or nursing homes with four in community settings. Five studies reported the experience of joy, three reported on the assessment of joy, and three examined the association between joy and other factors. Social connections and participation in activities that are meaningful to the individual are important sources of joy. Joy amongst older people has received little attention in the literature despite it being highlighted as being important to older people themselves in relation to their health and wellbeing.

Background The Risk Assessment for moving Individuals SafEly (RAISE) program is a hospital-based manual handling nursing training program. RAISE involves upskilling on continual risk assessment during patient-assisted movements. RAISE aims to optimise staff and patient safety while providing the patient with movement and rehabilitation opportunities. Implementation of RAISE in the hospital setting has been established. The aim of this study was to explore the feasibility of implementing RAISE in the long-term care setting. Methods We examined three feasibility domains: acceptability, practicality, and limited efficacy (observed nursing behaviour change which has the potential to reduce nursing injuries), using a prospective pilot pre-post design in the long-term care setting. Staff completed a 4-hour training session on RAISE delivered by two physiotherapists, followed by 8 h of supported behaviour change in the workplace. Staff acceptability and practicality of incorporating risk assessment strategies into manual handling approaches were explored through pre- and post-training staff surveys and a semi-structured interview. Resident acceptability of manual handling practices was explored via survey data collected after the RAISE training. Pre to post-training changes in staff knowledge and behaviour were examined through the pre- and post-training staff survey, and observation of staff assisting resident movement. Results Two enrolled nurses and five residents participated. Staff reported the RAISE program was acceptable and practical to implement in the long-term care setting. There were no adverse events or safety concerns. Staff reported the RAISE program provided guidance and enhanced staff empowerment to make decisions during assisted resident movement. There were 26 observed resident-staff manual handling interactions recorded, with 13 pre-training and 13 post-training. Post-training, RAISE skills had improved and were completed 100% of the time, except for completing a physical risk assessment which improved from 46 to 85%, demonstrating limited efficacy. Residents reported it’s important for staff to be trained on how to assist them to mobilise and they found the concept of the RAISE program acceptable. Conclusions This pilot study supports the feasibility of long-term care facilities participating in future studies testing the effectiveness and cost-effectiveness of the Risk Assessment for moving Individuals SafEly (RAISE) patient and resident manual handling program.

Objective: To present the extent of evidence concerning the effectiveness of extended reality telerehabilitation and patients' experiences of using different types of virtual reality exercises at home. Methods: We included studies on virtual reality and augmented reality telerehabilitation published in English. Systematic searches were undertaken in PubMed, Web of Sciences, Medline, Embase, CINAHL, and PEDro, with no date limitations. We included only RCTs and qualitative studies exploring patients' experiences. Methodological quality was assessed using the Cochrane Risk of Bias assessment tool for quantitative papers and the CASP scale for qualitative studies. All results are presented narratively. Results: Thirteen studies, nine quantitative and four qualitative, were included, with one qualitative and seven quantitative having a high risk of bias. All studies reported that extended reality-based telerehabilitation may be effective compared to conventional exercises or other extended reality exercises. Seven quantitative studies focused on upper limb function. Qualitative papers suggested that VR exercises were perceived as feasible by patients. Conclusions: The literature suggests VR home exercises are feasible and potentially effective for patients after a stroke in the upper limb. Further high-quality studies are needed to examine the effectiveness of XR exercises early adoption on different qualitative and quantitative outcomes. Registration number: (CRD42022384356).

The diversity of patient experiences of orphan drug development has until recently been overlooked, with the existing literature reporting the experience of some patients and not others. The current evidence base (the best available current research) is dominated by quantitative surveys and patient reported outcome measures defined by researchers. Where research that uses qualitative methods of data collection and analysis has been conducted, patient experiences have been studied using content analysis and automatic textual analysis, rather than in-depth qualitative analytical methods. Systematic reviews of patient engagement in orphan drug development have also excluded qualitative studies. The aim of this paper is to review qualitative literature about how patients and other members of the public engage with orphan drug development. We conducted a systematic search of qualitative papers describing a range of patient engagement practices and experiences were identified and screened. Included papers were appraised using a validated tool (CASP), supplemented by reporting guidance (COREQ), by two independent researchers. 262 papers were identified. Thirteen papers reported a range of methods of qualitative data collection. Many conflated patient and public involvement and engagement (PPIE) with qualitative research. Patients were typically recruited via their physician or patient organisations. We identified an absence of overarching philosophical or methodological frameworks, limited details of informed consent processes, and an absence of recognisable methods of data analysis. Our narrative synthesis suggests that patients and caregivers need to be involved in all aspects of trial design, including the selection of clinical endpoints that capture a wider range of outcomes, the identification of means to widen access to trial participation, the development of patient facing materials to optimise their decision making, and patients included in the dissemination of trial results. This narrative qualitative synthesis identified the explicit need for methodological rigour in research with patients with rare diseases (e.g. appropriate and innovative use of qualitative methods or PPIE, rather than their conflation); strenuous efforts to capture the perspectives of under-served, under-researched or seldom listened to communities with experience of rare diseases (e.g. creative recruitment and wider adoption of post-colonial practices); and a re-alignment of the research agenda (e.g. the use of co-design to enable patients to set the agenda, rather than respond to what they are being offered).

Abstract Background Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. Objective This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. Methods Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14–0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05–0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11–0.60) were independently associated with increased physical activity. Conclusions Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.

Objectives To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19. Methods The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools. Results Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence. Conclusions Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19. Registration: Open Science Framework https://osf.io/prc2y ? 2021 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Abstract Background The majority of older people (> 65 years) in hospital have frailty and are at increased risk of readmission or death following discharge home. In the UK, following acute hospitalisation, around one third of older people with frailty are referred on for rehabilitation, termed ‘intermediate care’ services. Although this rehabilitation can reduce early readmission to hospital (< 30 days), recipients often do not feel ready to leave the service on discharge, suggesting possible incomplete recovery. Limited evidence suggests extended rehabilitation is of benefit in several conditions and there is preliminary evidence that progressive physical exercise can improve mobility and function for older people with frailty, and slow progression to disability. Our aim is to evaluate the effectiveness of the Home-based Older People’s Exercise (HOPE) programme as extended rehabilitation for older people with frailty discharged home from hospital or intermediate care services after acute illness or injury. Methods A multi-centre individually randomised controlled trial, to evaluate the clinical and cost-effectiveness of the HOPE programme. This individualised, graded and progressive 24-week exercise programme is delivered by NHS physiotherapy teams to people aged 65 and older with frailty, identified using the Clinical Frailty Scale, following discharge from acute hospitalisation and linked intermediate care rehabilitation pathways. The primary outcome is physical health-related quality of life, measured using the physical component summary score of the modified Short Form 36- item health questionnaire (SF36) at 12 months. Secondary outcomes include self-reported physical and mental health, functional independence, death, hospitalisations, care home admissions. Plans include health economic analyses and an embedded process evaluation. Discussion This trial seeks to determine if extended rehabilitation, via the HOPE programme, can improve physical health-related quality of life for older people with frailty following acute hospitalisation. Results will improve awareness of the rehabilitation needs of older people with frailty, and provide evidence on the clinical and cost-effectiveness of the targeted exercise intervention. There is potential for considerable benefit for health and social care services through widespread implementation of trial findings if clinical and cost-effectiveness is demonstrated. Trial registration ISRCTN 13927531 . Registered on April 19, 2017.

Research investigating the effect of lighting and viewpoint changes on unfamiliar and newly learnt faces has revealed that such recognition is highly image dependent and that changes in either of these leads to poor recognition accuracy. Three experiments are reported to extend these findings by examining the effect of apparent age on the recognition of newly learnt faces. Experiment 1 investigated the ability to generalize to novel ages of a face after learning a single image. It was found that recognition was best for the learnt image with performance falling the greater the dissimilarity between the study and test images. Experiments 2 and 3 examined whether learning two images aids subsequent recognition of a novel image. The results indicated that interpolation between two studied images (Experiment 2) provided some additional benefit over learning a single view, but that this did not extend to extrapolation (Experiment 3). The results from all studies suggest that recognition was driven primarily by pictorial codes and that the recognition of faces learnt from a limited number of sources operates on stored images of faces as opposed to more abstract, structural, representations.

Background Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents’ enjoyment of meals, and resulting health and wellbeing. Methods Semi-structured interviews were conducted with eleven residents from four care homes in the South West UK. Thematic analysis was used to derive content and meaning from transcribed interviews. Interviews were supplemented by researcher observations of mealtimes. Results The dining experience was a focal point for participants’ broader experiences of residing in a care home. Three themes pertaining to residents’ experiences were identified: (1) Emotional and psychological connections with other residents; (2) managing competing interests with limited resources; and (3) familiarity and routine. Conclusion Mealtimes are a mainstay of life in a care home through which residents’ experiences are characterised, exemplified and magnified. Understanding how residents interact with one another, accommodating their preferences and encouraging autonomy may enhance their mealtime experiences. It may also help to ease the transition from independent-living to life in care, which can be particularly stressful for some residents, and improve health and wellbeing over the long-term.