OBJECTIVE:To evaluate the effectiveness of an individualized multidisciplinary rehabilitation program for treating individuals with persistent post-concussive symptoms (PPCS), and identify initial symptoms which predict overall symptom burden after rehabilitation. DESIGN:This retrospective cohort study employed routine assessment data from the Epworth HealthCare Rehabilitation Concussion Clinic. Patients with PPCS (n=528) participated in an individualized outpatient rehabilitation program, and self-reported symptoms and activity levels (using the Oregon Post-Concussion Symptom Checklist) on clinic admission and discharge. Summed checklist scores produced four subscale scores (physical, thinking, emotional and sleep) and a total score. RESULTS:On Clinic admission, patients self-reported a mean of 10.9 symptoms (SD: 6.0). Fatigue, cognitive impairments and headache were common. There was a statistically significant mean decrease in checklist scores (symptom burden) after rehabilitation (P=<0.001). Patients' mean daily activity levels also significantly increased between clinic admission (43.1%) and discharge (73.9%) (mean difference: 30.8%, 95% CI: 28.2-33.5, P=<.001). A subset of somatic and vestibular-ocular symptoms cumulatively predicted 31.1% of the total variance in symptom burden on clinic discharge. CONCLUSION:This study suggested that a multidisciplinary rehabilitation model was effective for treating PPCS. A focus should be on early, tailored intervention to moderate the initial symptom burden and improve patient prognosis.

BACKGROUND:Mild traumatic brain injury (mTBI) and concussion are important healthcare issues, with ongoing and persisting symptoms significantly affecting a person's quality of life. Management is often challenging. OBJECTIVE:Using a case study example, this article outlines key updates and practical guidance for assessment and management of mTBI/concussion, informed by the newly developed Australian and Aotearoa New Zealand (ANZ) mTBI and concussion clinical practice guideline. DISCUSSION:The 'Australian and Aotearoa New Zealand Clinical Practice Guideline for the management of mild traumatic brain injury/concussion and persisting post-concussion symptoms in adults and children' is the first guideline to address the full scope of mTBI/concussion management across diverse ANZ populations. It provides general practitioners and other clinicians with practical, evidence-based recommendations for assessing and managing mTBI and persisting symptoms across all ages. Developed through multidisciplinary and consumer collaboration, it aims to promote consistent, high-quality care and reduce practice variation across healthcare settings.

Stroke patients are rarely asked about their responses to specific design attributes. Virtual reality (VR) offers a promising tool to explore how hospital environments are experienced after stroke.PurposeTo gather perspectives and emotional responses regarding physical design attributes of hospital patient rooms after stroke.Material and MethodsWe developed a 'VR experience' for adult stroke patients in both single and multi-patient room designs, with four additional physical design attributes: spaciousness, greenery outlook, night-time noise, and design attributes for social connectivity e.g. furnishings. A qualitative study approach involved semi-structured interviewing, that followed immersion in the VR patient room designs. Qualitative descriptive and thematic analysis was done. (Australian New Zealand Clinical Trials Registry, Trial Id: ACTRN12620000375954).ResultsThirty-five stroke patients participated (April 2019-March 2020). Interviews yielded three themes and ten sub-themes. Themes were: (1) action and care supported by design and layout, such as ease of movement; (2) connection to people, nature, and place, emphasising social interaction and greenery; and (3) control of the environment, involving attributes like space.ConclusionsFindings showed how physical design attributes enhance movement accessibility, promote social interaction, or provide sensory comfort. Using VR allowed rich, detailed feedback from patients, offering valuable insights for designing hospital environments.

Botulinum neurotoxin-A (BoNT-A) injections are effective in reducing focal limb spasticity; however, their impact on strength and active function needs to be established. This review was a secondary analysis aimed at evaluating changes to active function in the context of muscle strength changes following BoNT-A intramuscular injection for adult upper and lower limb spasticity. The original review searched eight databases (CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Google Scholar, MEDLINE, PEDro, PubMed, Web of Science) and was conducted with methodology that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as described in section 6.2 of Gill et al. For this secondary analysis, no databases were searched; only further data were extracted. The current and preceding review were registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Twenty studies were screened for inclusion, and three studies were excluded because active function was not assessed in all participants. Seventeen studies (677 participants) met the inclusion criteria for analysis. Quality was examined using the PEDro scale and modified Downs and Black checklist and rated as fair to good. Pre- and post-BoNT-A injection strength (agonist, antagonist, and global), active function (activity), participation, and quality-of-life outcomes at short-, mid-, and long-term time points were extracted and analysed. Significant heterogeneity and limited responsiveness in strength and active function outcome measures limited the ability to determine whether changes in strength mediate an effect on active function. Further, variability in BoNT-A type and dose, adjunctive therapies provided, and variability in reporting limited analyses. Overall, no clear relationship existed between the change in muscle strength and active function following BoNT-A injections to the upper and lower limbs for focal spasticity in adult-onset neurological conditions.

ObjectiveTo evaluate the perceptions, knowledge, and attitudes of multidisciplinary clinicians within a healthcare organisation completing a stroke-integrated cardiac rehabilitation research programme in addition to usual care neurorehabilitation.DesignA qualitative study based on a phenomenological approach.SettingOne-on-one, semi-structured, qualitative interview completed either face-to-face or over the telephone.ParticipantsFourteen multidisciplinary clinicians (e.g., physical therapists, occupational therapists, psychologists, speech therapists, cardiac nurses and a physician) working in usual care neuro- and cardiac-rehabilitation.Main measuresTwo independent researchers completed line-by-line coding and thematic analysis and derived relevant themes and sub-themes addressing the research question. To enhance trustworthiness and transparency of findings, a third researcher reviewed final themes.ResultsThree main themes emerged with 3-4 relevant sub-themes. The first theme was clinicians' knowledge. Participants were aware of exercise recommendations within the clinical stroke guidelines, but their knowledge of the content of the recommendations, and the stroke-integrated cardiac rehabilitation programme, varied. The second theme was clinicians' attitudes and beliefs towards the stroke-integrated cardiac rehabilitation programme. All participants described exercise as being important and believed the stroke-integrated cardiac rehabilitation programme was a good idea. However, clinicians highlighted numerous barriers and suggested programme adaptations (third theme) to the stroke-integrated cardiac rehabilitation programme. Increased awareness of the stroke-integrated cardiac rehabilitation programme, and a more flexible and adaptable programme, may enhance future implementation.ConclusionClinicians believed the stroke-integrated cardiac rehabilitation programme was important and had clinical utility. Increased awareness of evidence-based recommendations, and a more flexible and adaptable programme may aid uptake and future implementation.

Background: Sensory changes are commonly observed in individuals with moderate-severe traumatic brain injury (msTBI) but remain under-researched. Objectives: This study examined the prevalence of sensory changes after msTBI and relationships with emotional distress, functional disability, and life satisfaction. Methods: A cross-sectional survey was conducted including 387 participants with msTBI (M=12.8 years post-injury; range=0.4–35.0) and 60 controls, not matched on age and sex but recruited in the same time period. Self-reported sensory symptoms were assessed using a custom checklist and the Somatic Symptom Scale–8. Emotional distress, functional disability, and life satisfaction were measured through the Hospital Anxiety and Depression Scale, 12-Item World Health Organization Disability Assessment Schedule 2.0, and Satisfaction With Life Scale. We compared the frequency of sensory symptoms between groups, and associations with demographics, injury factors, and clinical outcomes were examined within the msTBI sample. Results: 70% with msTBI reported experiencing ≥1 sensory changes due to their brain injury, and 35% reported experiencing dizziness in the previous week, averaging 2.2 symptoms in total—significantly higher than controls after adjusting for age and sex. Sensory changes were more common in younger participants (light hypersensitivity), females (light and noise hypersensitivity), those with more severe TBI (overall sensory changes, affected vision, reduced smell), and those fewer years post-injury (overall sensory changes, noise hypersensitivity, reduced smell, altered taste, dizziness), though many of these associations did not survive multiple comparison correction. Sensory changes were clearly and consistently associated with worse clinical outcomes, with medium-large effect sizes for emotional distress and functional disability and smaller effects for life satisfaction. Conclusions: Although causality cannot be established, these findings suggest that sensory changes are a clinically significant issue after msTBI, even among individuals more than a decade post-injury on average. This underscores the need for routine assessment and further research on underlying mechanisms and interventions.

BACKGROUND:Returning to work (RTW) is an important goal for individuals sustaining traumatic injury (Multi-Trauma Orthopaedic [MTO], traumatic brain injury [TBI], and spinal cord injury [SCI]). Vocational rehabilitation is often unavailable or delayed, and controlled evaluation limited. OBJECTIVES:This study evaluated the impact of providing an Early Intervention Vocational Rehabilitation Service (EIVRS) following traumatic injury on employment outcomes, mental health and quality of life 1- and 2-years post-injury. METHODS:A randomised parallel 2-group design was used to compare the EIVRS group with a control group receiving usual rehabilitation. Outcomes included hours worked and time to return to first job (primary outcomes), anxiety, depression and quality of life 1- and 2-years post-injury. Participants were adults aged 16-70, employed pre-injury. Eighty-eight EIVRS treatment and 82 controls were recruited; mean 47 days post-injury, 75% male, mean age 38 years. Dedicated EIVRS therapists provided activities associated with fostering hope for RTW, thinking about and preparing for returning to work, building RTW goals into rehabilitation, identifying an employer liaison, and peer support. RESULTS:There were no significant group differences in employment outcomes at 1-year follow-up, but EIVRS participants reported lower anxiety. Median quartile regressions revealed that at 2-year follow-up, the EIVRS group worked more hours (38, 24; 40) and took significantly less time from injury to RTW (166, 87; 280) than controls (29, 23; 36 and 238, 144; 325). Quartile regressions by diagnosis showed a significant main effect of group (P = 0.02) but no interaction between group and diagnosis (P = 0.60). Trends for shorter time to RTW were strongest in the MTO and TBI groups at 2 years. At 2 years there were no group differences in anxiety, depression or quality of life. CONCLUSIONS:Offering EIVRS may reduce time to RTW and increase hours worked 2 years after traumatic injury. TRIAL REGISTRATION:#ACTRN12619000521123.

BACKGROUND:Following multiple trauma, individuals experience significant disability and poor functioning across several health domains. Rehabilitation is a component of trauma care management, however, there is limited evidence on patient outcomes after multiple trauma and the effectiveness of rehabilitation. This study was based on a Value-Based HealthCare (VBHC) framework and aimed to evaluate the impact of multiple trauma on patients' function and quality of life, and the relationship between these outcomes and the cost of inpatient rehabilitation. It also aimed to obtain the patient perspective regarding health areas to address for future trauma research. METHODS:This prospective, cohort study recruited 62 adult participants from a specialist inpatient rehabilitation unit following multiple trauma orthopaedic injuries. Patients health-related quality of life was measured using the 12-Item Short Form Health Survey (Version 2) (SF-12v2). The SF-12v2 was completed during inpatient rehabilitation (to capture patient recalled pre-injury quality of life) and via a telephone interview at two weeks after rehabilitation discharge. Patients also self-reported their satisfaction with the SF-12v2 and identified important health areas to address after multiple trauma. Routine inpatient rehabilitation data was collected including: the Functional Independence Measure (FIM) (assesses patients' functional independence on rehabilitation admission and discharge) and demographics. RESULTS:The sample's mean age was 51.6 years (standard deviation: 17.8) and the majority were male (69.4 %). Between rehabilitation admission to discharge, patients' demonstrated a statistically significant increase in function (FIM scores). However, quality of life (SF-12v2 scores) significantly decreased between pre-injury to after hospital discharge. At both timepoints, an increased proportion of patients had quality of life scores that were below the population norms. Increased rehabilitation costs (i.e., longer inpatient stays) were positively and significantly associated with increased functional independence, albeit, not quality of life scores. Patients identified important health areas that related to individual outcomes (e.g., mental health, limitations, goals) and familial impacts. CONCLUSIONS:This study reported that an individually tailored rehabilitation program was cost effective and led to significant improvements in patient function. Patients experienced significant impacts to quality of life after multiple trauma, which suggests the need for a long-term and integrated care plan including psychological medical input.

IMPORTANCE:The role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS) following mild traumatic brain injury is an emerging practice area. Research that contributes to growing knowledge and understanding of the profession's role may increase the recognition and visibility of occupational therapy in concussion rehabilitation programs. OBJECTIVE:To identify and categorize (using World Health Organization International Classification of Functioning, Disability and Health [WHO ICF] One-Level Classification domains) existing literature that describes occupational therapy practice (including assessments and interventions) in the rehabilitation of adults with PPCS. DATA SOURCES:Five scientific databases (MEDLINE, Embase, Emcare, PsycINFO, and CINAHL Complete) and gray literature were searched. STUDY SELECTION AND DATA COLLECTION:Eligibility criteria included publications between 2013 and 2023, written in English, and within the peer-reviewed literature or on specified web domains (.gov, .edu, or .org). FINDINGS:Nineteen publications from 16 sources met eligibility criteria, consisting of quantitative studies (n = 6); case studies, series, or reports (n = 3); qualitative studies (n = 2); systematic or scoping literature reviews (n = 2); and gray literature sources (n = 3). The United States was the origin for many sources (n = 10). Assessments and interventions reported were heterogenous, mapping across 27 of the 30 WHO ICF One-Level Classifications. CONCLUSIONS AND RELEVANCE:Evidence to inform occupational therapy practice in adult PPCS rehabilitation is limited; however, some useful information about the assessments and interventions used by occupational therapists was found. At a time when considerable advancements in concussion rehabilitation are occurring, further research on evidence-informed occupational therapy practice is required. Plain-Language Summary: This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS). It identifies and methodically documents a range of occupational therapy assessments and interventions described in the literature that may be used by occupational therapists within concussion rehabilitation programs or research. The study also categorizes these by using an internationally recognized taxonomy, the World Health Organization's International Classification of Functioning, Disability and Health. The review offers a novel synthesis of published evidence to guide occupational therapy practice and inform resource allocation in concussion rehabilitation. It also highlights the need for further research about the role of occupational therapy-including both high-quality evidence of current approaches and identification of future practice opportunities-in the rehabilitation of adults experiencing PPCS following brain injury.

Objective : To determine the incidence of exercise-induced symptom exacerbation and adverse events from cardiorespiratory fitness (CRF) and high-level mobility (HLM) exertional testing in the early subacute phase (≤3 months post-injury) following moderate-to-severe traumatic brain injury (TBI). Setting : Inpatient TBI subacute rehabilitation unit. Participants : One hundred fifty adults and adolescents ≥15 years with moderate-to-severe TBI completed a total of 205 exertional tests (83 participants completed CRF only, 12 HLM only, and 55 both CRF and HLM). Design : Prospective observational cohort study. Consecutive admissions were screened for recruitment between August 2017 and August 2021. Symptom ratings were recorded pre- and post-CRF and HLM exertional testing on the Sports Concussion Assessment Tool symptom scale. A summed symptom severity score (SCAT-SS) was calculated with a ≥10-point increase classified as symptom exacerbation and a ≥10-point reduction classified as symptom improvement. Main measures : SCAT symptom scale. Results : One participant experienced a ≥10-point increase in SCAT-SS (ie, symptom exacerbation) post-CRF testing (1/138 = 0.7%, 95% confidence interval [CI] = 0.01%-4.0%) and 1 post-HLM testing (1/67 = 1.5%, 95% CI = 0.04%-8.0%). Sixteen of 138 (11.6%, 95% CI = 6.8%-18.1%) CRF tests resulted in a ≥10-point decrease in SCAT-SS (ie, symptom improvement). Nine of 67 (13.4%, 95% CI = 6.3%-24.0%) HLM tests resulted in a ≥10-point decrease in SCAT-SS. Participants were more likely to experience symptom improvement than symptom exacerbation for both CRF and HLM exertion ( P ≤ .05). One adverse event, a fall, occurred during an HLM testing session. Conclusions : CRF and HLM exertional testing in the early subacute phase of recovery following moderate-to-severe TBI appears to be safe, with low rates of symptom exacerbation and adverse events identified.

ABSTRACTAimThe study aim was to develop an age‐appropriate definition of sport and exercise in children and adolescents for use in concussion research and management.MethodsA modified Delphi methodology, with three rounds and consensus defined a priori as ≥ 80% agreement.ResultsThirty‐one participants (13 male, 18 female) from 13 countries, including clinical psychologists, epidemiologists, implementation scientists, neurologists, neuropsychologists, neurosurgeons, paediatric emergency physicians, paediatricians, physiotherapists, rehabilitation physicians, speech‐language pathologists, and sports medicine physicians came to a consensus that sport‐related paediatric concussion extends beyond the sporting arena, and includes the school yard, playground, park, street, recreational site, and home; excludes non‐accidental violence, assault, and passenger vehicle road trauma; may include falls; and age‐group terminology includes Toddlers and Young Children (1–4 years), Children (5–12 years), and Adolescents (13 to < 18 years). Sport and exercise categories and individual examples are provided.ConclusionsThis consensus definition of sport and exercise in paediatrics for concussion research and management will enable researchers and guideline development groups to expand paediatric concussion research and management guidelines to encompass the broad range of activities commonly associated with sport‐ and exercise‐related concussion in children and adolescents and thus limit exclusion of relevant studies from systematic reviews and guideline development.

PURPOSE:To investigate the agreement between a graded exercise test (GXT) and a 45-second sit-to-stand test and prediction equation to predict cardiorespiratory fitness (CRF) in people with stroke. METHODS:People with ischaemic stroke admitted to subacute outpatient rehabilitation at Epworth HealthCare were screened for eligibility and invited to participate. Participants completed two tests of CRF: 1) a 45-second sit-to-stand test, and 2) a GXT with measurement of gas exchange. Both tests were completed within seven days of each other, with the order of test administration randomised. Heart rate response during and after the sit-to-stand test was input into a prediction equation to obtain predicted maximal volume of oxygen consumption (VO2max). Concurrent validity was determined by calculating Lin's concordance correlation coefficients (CCC). RESULTS:A total of 30 people with stroke (males n = 23, mean ± standard deviation age 67.1 ± 9.9 years) were recruited. Predicted mean VO2max based on the sit-to-stand test was 36.2 ml.kg-1.min-1, while the GXT mean VO2max was 28.0 ml.kg-1.min-1. There was poor agreement between the two fitness tests (CCC 0.11, 95% CI -0.07 to 0.28). CONCLUSION:Predicted VO2max based on a 45-second sit-to-stand test does not appear to be a valid test of CRF in people with stroke.

ObjectiveModerate to severe persistent pain can affect up to 25% of people after a knee replacement for osteoarthritis. The aim of the trial was to test the feasibility of implementing Kneed, a novel digital pain rehabilitation self-management programme.DesignProspective, two group parallel randomised pilot study.SettingOnline in Australia.ParticipantsAdults with persistent pain rated as ≥4/10 in the operated knee more than 3 months post-knee replacement for osteoarthritis.InterventionThe Kneed group were provided with 8 weeks of access to a digital pain rehabilitation self-management programme and compared to usual care.Main measuresRecruitment, acceptability, usability and limited efficacy with descriptive statistics.ResultsSixty participants, mean age 68.7 years, 75% female, 66.7% retired and 43% living outside metropolitan areas, were recruited between 15 October and 19 December, 2024 via social media advertising with 418 online eligibility surveys performed. There were 190 (45.5%) deemed potentially eligible; 82 (19.6%) left contact details and 60 (14.4%) consented. At 8 weeks, there were 48 (80%) participants remaining in the trial (20 Kneed (64.5%), 28 usual care (96.6%)). A majority of the Kneed group found the Kneed programme acceptable, would use it again and found that it helped them effectively manage pain and function.ConclusionIt is feasible to recruit and retain older Australians with moderate to severe knee pain post-knee replacement for a trial testing a digital pain rehabilitation self-management programme. A larger trial is indicated to further test the clinical effectiveness of Kneed to reduce pain and improve function.

Background: Sensory changes are commonly observed in individuals with moderate-severe traumatic brain injury (msTBI) but remain under-researched. Objectives: This study examined the prevalence of sensory changes after msTBI and their relationships with emotional distress, functional disability, and life satisfaction. Methods: In a cross-sectional survey of 387 participants with msTBI (M=12.76 years post-injury; range=0.40–35.02) and 60 controls, we examined self-reported sensory symptoms across visual, auditory, gustatory, olfactory, and vestibular modalities, using a purpose-designed checklist and the Somatic Symptom Scale – 8. Emotional distress, functional disability, and life satisfaction were measured through the Hospital Anxiety and Depression Scale, 12-Item World Health Organization Disability Assessment Schedule 2.0, and Satisfaction With Life Scale, respectively. We compared the frequency of sensory symptoms between the TBI group and control group and examined associations with demographics, injury factors, and clinical outcomes within the msTBI sample. Results: 75% of participants with msTBI reported experiencing at least one sensory change due to their brain injury, averaging 2.21 symptoms (SD=2.01)—significantly higher than the 43% of controls reporting sensory symptoms. Within the msTBI sample, sensory changes were more common in younger participants (light hypersensitivity), females (light and noise hypersensitivity), those with more severe TBI (overall sensory changes, affected vision, reduced smell), and individuals who were fewer years post-injury (overall sensory changes, noise hypersensitivity, reduced smell, altered taste, dizziness). Sensory changes were consistently associated with worse clinical outcomes, with medium-large effect sizes for emotional distress and functional disability and smaller effects for life satisfaction. Outcomes worsened with the number of reported sensory changes. Conclusions: Sensory changes are a clinically significant yet often overlooked issue after msTBI, even among individuals more than a decade post-injury on average, underscoring the need for routine assessment. Further research is needed to understand the mechanisms behind these sensory changes and develop effective interventions.

Objective: Given the high variability in traumatic brain injury (TBI) outcomes and relative lack of examination of the influence of noninjury factors on outcome, this study aimed to examine factors associated with functional outcome at 1 and 2 years after moderate to severe TBI, including both preinjury and injury-related factors. Design: Observational cohort study. Setting: Inpatient hospital recruitment with outpatient follow-up at 1 and 2 years post injury. Participants: Individuals with moderate to severe TBI were recruited prospectively into a Longitudinal Head Injury Outcome Study. Of the eligible 3253 individuals who were eligible, 1899 participants consented to the study (N=1899). Main Outcome Measure: Functional outcome was measured using the Glasgow Outcome Scale-Extended (GOS-E). Results: 1476 participants (73.6% males) and 1365 participants (73% males) completed the GOS-E at 1 and 2 years post injury. They had a mean age at injury of 40 years and mean duration of post-traumatic amnesia (PTA) of 26 days. Good recovery, representing return to previous activities on the GOS-E (score 7-8), was present in 31% of participants at 1 year post injury and 33.5% at 2 years post injury. When predictor variables were entered into regression together, good outcome was significantly associated with not being from a culturally and linguistically diverse background and not having preinjury mental health or alcohol treatment, shorter PTA duration, and absence of limb injuries at both 1 and 2 years; higher education was also a significant predictor at 1 year post injury. Conclusions: Alongside consideration of injury severity, understanding and addressing preinjury factors is important to maximize outcomes.

Botulinum neurotoxin-A (BoNT-A) injections are effective for focal spasticity. However, the impact on muscle strength is not established. This study aimed to investigate the effect of BoNT-A injections on muscle strength in adult neurological conditions. Studies were included if they were Randomised Controlled Trials (RCTs), non-RCTs, or cohort studies (n ≥ 10) involving participants ≥18 years old receiving BoNT-A injection for spasticity in their upper and/or lower limbs. Eight databases (CINAHL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Pubmed, Web of Science) were searched in March 2024. The methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Quality was assessed using the modified Downs and Black checklist and the PEDro scale. Pre-/post-injection agonist, antagonist, and global strength outcomes at short-, medium-, and long-term time points were extracted for analysis. Following duplicate removal, 8536 studies were identified; 54 met the inclusion criteria (3176 participants) and were rated as fair-quality. Twenty studies were analysed as they reported muscle strength specific to the muscle injected. No change in agonist strength after BoNT-A injection was reported in 74% of the results. Most studies’ outcomes were within six weeks post-injection, with few long-term results (i.e., >three months). Overall, the impact of BoNT-A on muscle strength remains inconclusive.

OBJECTIVES:To examine the safety of cardiorespiratory fitness (CRF) assessment and training in the early sub-acute phase of recovery (≤3 months) following moderate-to-extremely severe traumatic brain injury (TBI). METHODS:A systematic review was completed in accordance with the PRISMA guidelines. Studies investigating adults and adolescents ≥15 years with moderate-to-extremely severe TBI were considered for inclusion. The methodological quality of the included studies was evaluated according to the McMaster Guidelines for Critical Review Form - Quantitative Studies. RESULTS:Eleven studies with a total of 380 participants were included in the review. Adverse events (AEs) and symptom monitoring were poorly reported. Only four studies reported on the occurrence of AEs, with a total of eight AEs reported. Three of the reported AEs were concussion-like symptoms with no further exercise-induced symptom exacerbation reported. No serious AEs were reported. CONCLUSION:There is no evidence to suggest that CRF assessment and training is unsafe in the early sub-acute phase of recovery following moderate-to-extremely severe TBI. However, despite the low AE and symptom exacerbation rates identified, a timeframe for safe commencement was unable to be established due to poor reporting and/or monitoring of exercise-induced symptoms and AEs in the current literature.

Although sexuality has been shown to be negatively impacted in up to half of individuals who sustain traumatic brain injury (TBI), few studies have sought to evaluate the efficacy of targeted interventions. Gaining insight into the participant experience of undergoing treatment for post-TBI sexuality changes is a crucial aspect of intervention evaluation. This study aimed to investigate participants with TBI experience of undergoing eight sessions of a novel CBT intervention designed to help both couples and singles improve sexual wellbeing after TBI. Eight participants (50% male) with moderate-severe TBI, and a mean age of 46.38-years (SD = 13.54), completed a qualitative interview. A six-phase reflexive thematic analysis approach was used. Despite variability in participant characteristics, the findings suggested that participants with TBI experience reflected that of a positive treatment journey characterized by high levels of enjoyment and satisfaction. Key themes identified included contextual factors that preceded treatment, factors that facilitated treatment engagement, outcomes derived from the treatment experience, and feedback provided on reflection. The results not only provide an enriched understanding of the client experience of the intervention but provide corroborating preliminary evidence of efficacy for this novel CBT intervention in addressing complex and persistent sexuality problems after TBI.

OBJECTIVE:To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program.METHODS:People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction.RESULTS:There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke.CONCLUSION:Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.