Access to group-based multidisciplinary pain management programmes is limited in Aotearoa New Zealand. To address this, a 12-week online pain management programme - iSelf-help, was co-designed with people living with persistent pain including cultural considerations for Māori - the Indigenous population of Aotearoa New Zealand. A non-inferiority randomised controlled trial demonstrated clinical and cost-effectiveness of iSelf-help compared to the in-person programme. The Behaviour Change Technique (BCT) Taxonomy (v1) contains 93 distinct BCTs in 16 clusters and is one way of describing the active components of iSelf-help. Using mixed-methods, this study aimed to: (1) map content of 13 iSelf-help modules using the BCT Taxonomy, and (2) identify and code participant experiences, mapping these to the taxonomy. Three reviewers independently mapped 130 resources across the modules to distinct BCTs, calculating frequencies by consensus. Of the 36 participants randomised to the iSelf-help arm of the non-inferiority trial, 15 took part in process evaluation interviews. A qualitative deductive analysis identified participant quotes corresponding to the distinct BCTs. Findings from the content analysis and qualitative mapping were then integrated using a mixed methods approach. 46 BCTs were identified in iSelf-help content. From seven BCT clusters, (#5) Natural consequences and (#8) Repetition and substitution were most frequent. Alignment between content and qualitative mapping was found in (#1) Goals and planning, (#4) Shaping knowledge, (#8) Repetition and substitution, (#9) Comparison of outcomes, and (#13) Identity. As group-based pain management programmes improve long-term outcomes, the identified BCT clusters could be key targets for future online group-based pain management programmes. PERSPECTIVE: iSelf-help is a co-designed, online group pain management programme with cultural considerations for Māori - the Indigenous population of New Zealand. The mapping of iSelf-help contents and iSelf-help participants using Behaviour Change Technique (BCT) Taxonomy (v1) has identified key behaviour change techniques. The identified BCTs could be candidates to include in online group pain management programmes.

Biomechanical differences between the paretic knee (PK) and non-paretic knee (NPK) post-stroke are well documented. Due to limited knowledge of the potential impacts of altered biomechanics on knee morphology, this study aimed to (1) assess and compare gross morphological characteristics of the distal femoral cartilage and patellar tendon in the PK and NPK; (2) compare knee biomechanics; (3) investigate associations between biomechanical and morphological data. This exploratory case-control observational study included seven people with stroke (6 male; M (SD) age, 75.7 (4.5) years). Magnetic resonance imaging was used to assess the femoral articular cartilage (thickness and integrity) and patellar tendon (physical characteristics), alongside optic-based gait analyses. Descriptive and correlational (ρ and τ) analyses were applied. The PK and NPK were morphologically similar. Maximum flexion was reduced at the PK (49.3°; 95%CI [41.9, 56.7]) compared to the NPK (62.7°; 95%CI [57.3, 68.2]). Correlations were observed between maximal PK extension moments and medial condyle chondral thickness (ρ = –0.87, 95%CI [–0.98, –0.32]); maximum PK extension and patellar tendon length (ρ = 0.86, 95%CI [0.27, 0.98]); maximum NPK extension and patellar tendon width (ρ=0.93, 95%CI [0.56, 0.99]); maximum PK valgus and patellar tendon width (ρ = 0.86, 95%CI [0.27, 0.98]); maximum PK flexion moments and patellar tendon length (ρ = 0.93, 95%CI [0.56,0.99]); and NPK maximum extension moments and patellar tendon thickness (ρ = –0.84, 95%CI [0.98, 0.20]). These findings suggest a relationship between biomechanics and knee morphology post-stroke. This study offers insight for physiotherapists working in gait rehabilitation, and for future research.

BackgroundIncreasingly, people are living with multimorbidity and long-term conditions or permanent impairments, which contribute substantially to health loss and additional health inequity. Critical to managing this health crisis is the appropriate support provided by health and social services. International research has informed the implementation of supported self-management knowledge into Aotearoa New Zealand. Meagre attention has been given to how New Zealand health care organizations can appropriately support people to self-manage their lifelong conditions within their own life contexts and cultures. Currently in New Zealand, those experiencing the greatest health inequities are Māori and Pacific peoples—Tāngata Whaikaha Māori (Māori living with disability) and people with learning (intellectual) disability who live with long-term health conditions or permanent impairments. This research aims to challenge and reframe supported self-management in New Zealand to enable our underserved populations and their whānau (families) to receive appropriate support to live well. ObjectiveWe aim to reconceptualize supported self-management in New Zealand as a holistic approach to the provision of support and care within the complexities of the lived human and whānau experience. In total, three objectives will be considered across 3 key populations of people with long-term conditions or permanent impairments (Māori, Pacific Peoples, and those with learning disability) to (1) understand our community partners’ and their communities’ aspirations for living well and how best to support these desires, (2) develop innovative models of support by working alongside communities to enable supported self-management within their own context, and (3) implement models and evaluate outcomes. MethodsEmbracing social construction of reality, this participatory case study program uses mixed methods and implementation evaluation design and is underpinned by Whānau Tuatahi (Māori) and Fonua (Tongan) research models and the Transformative Paradigm. Moreover, 3 case studies, 1 for each population group, will apply the same program objectives. Objectives 1 and 2 will be addressed with qualitative methodologies underpinned by relevant participatory designs. Objective 3 will use appropriate implementation frameworks. ResultsFunded in October 2023, we have completed 2 years of this 5-year program grant. These first 2 years were focused on relationship building, ethical applications, research capability, and capacity building. Substantial, progressive consultation with the respective communities of each case study was undertaken. ConclusionsNew knowledge generated across our program has the potential to inform New Zealand policy and practice about service delivery acceptable to the people to whom it matters (particularly Māori, Pacific Peoples, and people with a learning disability) and places emphasis on well-being promotion. This approach focuses on the inherent strengths and abilities of people, rather than the deficits or problems, acknowledging the wealth of expertise and experience people living with long-term conditions or permanent impairments bring, and builds relationships and partnerships between people and health care partners. International Registered Report Identifier (IRRID)PRR1-10.2196/89658

PURPOSE:The growing prevalence of long-term health conditions has intensified focus on self-management to ease burdens on individuals and health systems. Yet, its meaning remains ambiguous, encompassing individual responsibility, resource provision, and professional support. Physiotherapists are well positioned to support self-management, but how this occurs in practice is unclear. This study examined New Zealand physiotherapy scholars' philosophies, interpretations, and delivery of supported self-management. METHOD:Using the qualitative methodology of Interpretive Description, 14 semi-structured interviews were conducted and thematically analysed. FINDINGS:Three themes were constructed: (1) Role of physiotherapy in supported self-management, considered important and integral to patient wellbeing but not fully embraced. (2) Components of supported self-management, viewed as central to person-centred care, included strategies of skill-building, enabling environments, and psychologically-informed tools strengthening patient self-efficacy. (3) Complexities of implementation spoke to how systemic barriers, particularly financial and time constraints, limits implementation. Targeted training and practical tools were identified as essential for improving implementation. CONCLUSIONS:Physiotherapist scholars appeared to endorse and/or engage with supporting self-management; however, there was a continuum of what this meant and how such support was delivered. Given that support requirements fluctuate, we suggest physiotherapists maintain a critically reflective stance and demonstrate flexibility to accommodate these inherent uncertainties.

Parkinson's is one of the fastest growing neurological disorders worldwide, yet little is known about this disorder in Pacific Peoples in Aotearoa New Zealand. This study aimed to explore the experiences and impact of Parkinson's on Pacific Peoples living with Parkinson's and their 'āiga/kāinga/kāiga/vuvale [family] in Aotearoa New Zealand. Underpinned by Talanoa research methodology [a Pacific phenomenological methodology founded on oral traditions of producing, sharing and transferring knowledge through conversation], eight consenting Pacific adults (>18 years) living in Aotearoa and diagnosed with Parkinson's, irrespective of type, were invited to participate in talanoa [face-to-face conversations that understand the cultural relationality and connectedness of those involved]. Data were transcribed and analysed using Reflexive Thematic Analysis. Pacific researchers lead the research, data collection and analysis, and facilitated subsequent talanoa with participants and their wider communities to discuss how findings could be used to benefit these communities. The key finding was an overarching theme portraying a metaphor of a journey that participants had and were navigating from the time of their Parkinson's diagnosis. This journey was described as travelling in unpredictable and turbulent seas in a va'a/vaka (a traditional Polynesian outrigger canoe). This overarching metaphor comprised four themes (1) An unexpected journey, (2) Who's on the va'a/vaka with me? (3) Navigating your va'a/vaka - looking up to the stars, and (4) Steering your va'a/vaka - finding your way. For our participants, Parkinson's was seen as a "new" health condition for Pacific Peoples. Strengthening knowledge and understanding of this disorder in ways that are acceptable and accessible to families and their communities is essential to harness the community spirit that defines Pacific culture. Healthcare services also need to improve how they offer accessible care and support Pacific communities in culturally appropriate and safe ways that considers the permanent and progressive nature of Parkinson's.

INTRODUCTION:Physical activity engagement can improve wellbeing and social participation for individuals living with long-term neurological conditions. Student-led services enable healthcare access for those clinically underserved and increase student clinical opportunities. Furthermore, attendees become important facilitators of student learning. UMove is a free undergraduate physiotherapy student-led physical activity program aimed at improving wellbeing for people living with long-term neurological conditions. Its ongoing nature is unique for a physical activity program, with some attendees coming for over 12 years. Student experiences within physiotherapy student-led programs are well-documented, however, those of attendees, particularly those with long-term neurological conditions, remain underexplored. OBJECTIVE:The primary objective was to explore the experiences of long-term UMove attendees. Secondary objectives included identifying perceived benefits and barriers to participation, and evaluating whether and how UMove affected attendees' wellbeing. METHOD:Participants were 11 adults with a long-term neurological condition attending UMove for over one year. Employing Interpretive Description qualitative methodology, individualized interviews were semi-structured, audio-recorded, transcribed verbatim, and analyzed. Questions included experiences, reasons for joining, and perceived barriers and motivators to attendance. RESULTS:The key theme, "Valuing UMove," epitomized the value participants placed not only on this accessible program but their work with students. The flexible, tailored program met diverse and evolving needs of attendees ("Person-Centered Care"). Opportunities for social interaction with other attendees and students facilitated meaningful social connection and a sense of community, driving adherence and engagement ("Connection Conundrum" and Wise Participation). "Challenges and Improvements" highlighted improvements that could be made. CONCLUSION:Participants had positive experiences and valued the opportunities UMove provided them which went beyond physical activity to include socialization and supporting student learning.

Physical activity and exercise decreases falls by improving gait, balance, and strength. All types of exercise, particularly balance and functional exercises reduce the rate of falls by approximately 24%, although walking practice alone does not reduce falls rate. New Zealand has developed three effective, empowering and sustainable falls-prevention exercise classes for older adults. The world-renowned, home-based Otago Exercise Programme, the peer-led community-based Steady As You Go© and Aligned to Go, and Taurite Tū indigenous exercise program. The majority of the exercises are conducted while standing and progress to where the participant stands with feet close together, on one leg, minimises hands assisting with balance, and practice controlled movements of the body’s centre of mass and body awareness. Peer-led classes such as Steady As You Go©, Aligned to Go and Taurite Tū have demonstrated their ability to attract participants to engage long term through strong social connections and culturally appropriate exercises that enable older adults to maintain their balance, strength and reduce their falls risk.

Disabled children often experience limited access to Family-Centred Care and social participation, while their families face significant caregiving responsibilities. Healthcare providers have a vital role in providing paediatric rehabilitation and support, yet access to and quality of services remain a key concern. To improve quality healthcare delivery, it is essential to understand stakeholder experiences of Family-Centred Care. Using an interpretive paradigm, semi-structured qualitative interviews and focus groups were conducted with paediatric healthcare service providers and service users, followed by reflexive thematic analysis. A key theme of ‘relationships enhance knowingness’ was identified. This theme highlights relationships as critical in meaningful service delivery and emphasises that mutual understanding, or knowingness, between service providers and service users is essential for success. Both service providers and service users identified subthemes related to ‘individual characteristics’ and ‘perceptions of families’, shaped by their differing positions within the care relationship. A distinct subtheme concerning ‘experiences of therapy’ was described by service users but was absent from service provider accounts. Fluctuating family capacity was identified as an influential factor affecting service engagement. A new service delivery model is presented to guide providers in delivering tailored, Family-Centred responsive Care.

A group-based, online-delivered version (iSelf-help) of an existing group-based in-person pain management programme was developed. Development included Māori (New Zealand's Indigenous population) cultural considerations of content. This study determined whether offering iSelf-help was non-inferior to the in-person pain management programme in reducing pain-related disability at six months. The study used a non-inferiority randomised, two-arm, parallel, open-label trial with blinding of assessors, including health economic and process evaluations. Participants were adults (age≥18 years) with persistent non-cancer pain referred to a hospital-based regional pain service who were deemed eligible for a pain management programme. iSelf-help groups participated in two 60-minute video-conferencing sessions (first, peer support facilitated; second, clinician facilitated) weekly for 12 weeks with access to resources via smartphone app and website. In-person groups received 12-week in-person pain management programme. The primary outcome was the Modified Roland Morris Disability Questionnaire. Secondary outcomes included anxiety, depression, stress, pain severity and interference, health related quality of life, self-efficacy, acceptance, and satisfaction. Recruited were 113 participants (56 iSelf-help, 57 in-person), mean(SD) age 38.2(13.7) years, 75% female, 16% Māori. Using modified intention-to-treat analysis on the primary outcome at six months (n=73), iSelf-help was non-inferior to in-person pain management programme with a point estimate (95% one-sided CI) of -0.4 (∞, 1.5). It was also non-inferior for secondary outcomes of anxiety, depression, stress, activity interference, health related quality of life, and self-efficacy. iSelf-help was cheaper, had similar overall satisfaction, but higher accessibility, scores. iSelf-help showed non-inferior clinical outcomes for improving pain-related disability in people with persistent non-cancer pain. PERSPECTIVE: This article evaluates a novel online-delivered pain management programme (iSelf-help) co-created with people with persistent pain, with committed and ongoing collaboration with Māori whānau (Indigenous population of New Zealand). iSelf-help may improve access to the regional pain service used in this study for more people living with persistent pain.

PURPOSE:Investigate the reliability of balance and walking assessments undertaken remotely via telehealth in people with PD. MATERIAL AND METHODS:Thirty people with mild-to-moderate PD and 15 older adults performed 14 tests of balance and walking twice between 7 and 14 days: (i) in-person and (ii) remotely via videoconference. The tests included items from the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Timed-Up-And-Go (TUG) test simple and dual-task. We compared in-person and videoconference performances to assess intra-rater reliability and between two assessors' ratings to evaluate inter-rater reliability. Prospective fall data were collected and compared with balance and gait assessments to assess the criterion validity. RESULTS:Specific items of BBS (items 5, 11 and 14), DGI (item 1), and TUG simple and dual-task appeared reliable and feasible for use remotely by people with mild to moderate PD. Further, specific assessment items such as 360° turning, stepping performance, pivot turning, and TUG dual-task appeared valid for assessing fall risk remotely. CONCLUSIONS:These findings provide clinicians with a means of remotely assessing balance and walking in people with mild-to-moderate PD who may have difficulty accessing healthcare due to physical limitations, lack of transportation, or residing in remote and rural areas.

Self-management is an important strategy to improve quality of life, appropriately manage long-term health conditions, and reduce the economic burden of long-term health conditions. However, equitable healthcare access remains an issue, and the focus on ‘self’ in self-management is problematic. Our review aims to explore the conceptualisation and evolution of supported self-management in an African context and its relevance to physiotherapy. A state-of-the-art review of the literature was undertaken by the authors. The authors knowledge of the subject area and a database search retrieved recent articles exploring patients’ and healthcare providers’ understanding of supported self-management in Africa. Relevant articles were read, and data summaries of included studies were extracted and tabulated. Findings were organised deductively. Sixteen studies, 11 primary research, and 5 reviews (2016–2023) undertaken in a variety of sub-Saharan countries with healthcare workers (~n = 177) and people (~n = 16 115) living with a mix of non-communicable and communicable conditions were considered in this state-of-the-art review. Self-management perceptions were drawn from Western authors spanning development research and understanding of the concepts in Western thinking. We conclude that imported concepts, such as supported self-management for long-term conditions, should be considered within local health delivery solutions. These should be embedded in an understanding of traditional African health systems. Clinical implications: There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.

Supported self-management (SSM) assists development of the skills people living with long-term conditions require to manage their health and live well. Physiotherapy students should learn how to deliver SSM but how to facilitate optimal student learning of SSM is currently not known. This mixed methods study aimed to determine, from a student perspective, how to best teach undergraduate physiotherapists to optimise their learning of the knowledge and skills in delivering SSM. Final year physiotherapy students were invited to participate in a nominal group session (n = 17) and then three rounds of an e-Delphi survey. Round one (n = 33) elicited ideas and themes for subsequent rounds, while rounds two (n = 25) and three (n = 13) measured consensus on ideas for improving the current SSM curriculum. Consensus was reached that learning SSM should be frequent, interesting, explicit, and incorporated into all years of training. Practical opportunities were favoured over theoretical learning via lectures. Learning SSM was seen as an ongoing process, important in providing person-centred care and improving health outcomes. Increasing learning opportunities that provide students with clear knowledge of SSM and a chance to practise using these skills in a real-life setting should be incorporated into entry-level physiotherapy education.

INTRODUCTION:Uncertainty about safe engagement in activity during early recovery after cardiac events is common. Websites are a potential source of health information, especially for those unable to access follow-up support from health professionals. The variability in online health information quality is concerning as poor web-based information can negatively impact patient health outcomes and the ability to self-manage. OBJECTIVE:To evaluate the quality and self-management-related content of websites providing information about physical activity following an MI or cardiac surgery. METHODS:Patient-facing websites were searched using three search engines (Google, Bing, and Yahoo). Information about activities of daily living (ADLs), exercise (aerobic and resistance), and safety considerations were explored. Self-management strategies for physical activity were evaluated using a customized 9-item checklist. Website quality was assessed using the 4-item JAMA framework criteria. RESULTS:31 websites were included. Aerobic exercise, ADLs, and safety considerations were the most comprehensively covered topics. Resistance exercise was less frequently and comprehensively covered. The median self-management checklist score was 3/9 (with nine being the highest possible score). Partnering with healthcare professionals, decision-making, action planning, and verbal persuasion were the most common self-management skills addressed by the websites. In contrast, ten or fewer websites modelled mastery experiences, vicarious experiences, reflection, problem-solving, and resource utilization. The median JAMA score for website quality was 2/4 (with four being the highest possible score). CONCLUSIONS:The findings highlight quality improvement opportunities for web providers and provide insight for patients and clinicians regarding the highest quality websites that best meet the information and self-management needs following an MI or cardiac surgery.

This paper describes the integration of environmental physiotherapy education into the physiotherapy curriculum in a New Zealand university in response to the environmental physiotherapy agenda and the University of Otago Sustainability Framework. We describe and discuss three learning activities, the associated challenges and lessons learnt, and the current position. Given the encompassing nature of environmental and health interactions, we aimed for multilayer immersive experiences using a range of pedagogical approaches. The first learning activity example exemplifies embracing and threading Aotearoa New Zealand’s indigenous knowledge and practices throughout our BPhty curriculum. The second example demonstrates how environmental physiotherapy can be made explicit within a delineated learning activity. In the third example, we describe a clinical placement learning activity that occurred in our student-led private practice. Recent full accreditation of the curriculum by the New Zealand Registration Board and positive student evaluations and feedback demonstrate that this integrated holistic curriculum is both acceptable and enjoyable. Frequent and rapid curriculum modifications in response to the COVID19 Global pandemic’s impact on teaching and learning have however prevented full formal curriculum evaluation at this stage. We envisage that this educational approach be an ongoing process of review and restructure. Aligned with global trends toward sustainability in healthcare, our goal is to prepare students to address the growing environmental influences on public health. By integrating environmental physiotherapy philosophy into the undergraduate physiotherapy curriculum, we aim to develop holistic healthcare perspectives in students that will strengthen future physiotherapy practice in New Zealand and internationally.

BACKGROUND:Physical activities performed under free-living conditions that are unsupervised in the home or community have the potential to modulate non-motor symptoms in people with Parkinson's disease. OBJECTIVE:This systematic review investigates the relationships between physical activities performed in free-living conditions and non-motor symptoms in people with Parkinson's disease: cognition, anxiety, apathy, depression, sleep disturbances, fatigue, and pain. DATA SOURCES:A database search was performed on Scopus, Web of Science, Ovid (PsycINFO), CINAHL, PubMed, and ProQuest (Health and Medicine). REVIEW METHODS:Observational studies published from 2000 to 2024 that examined the relationships between physical activity and non-motor symptoms were included. The methodological quality of reports was evaluated using critical appraisal checklists appropriate to the study design. Where appropriate, a meta-analysis was conducted to combine data from the included articles. RESULTS:A total of 14 articles met the criteria and used various tools to evaluate non-motor symptoms and physical activity. Meta-analyses showed that people with Parkinson's who are more physically active have better global cognition [β ranged from 0.12 to 0.28; p = 0.00-0.02] and less affective disorders [β -0.20, p = 0.00]. Increased physical activity levels were also associated with better sleep quality (n = 1) and less chronic pain (n = 1). The overall methodological quality of the included articles was considered high. CONCLUSION:Engagement in increased levels of physical activities performed under free-living conditions is associated with better cognition and less anxiety, apathy, and depression in people with Parkinson's disease.

Parkinson’s is the fastest-growing neurological disorder worldwide, exhibiting motor and non-motor symptoms. The condition impacts individuals at multiple levels with both motor and non-motor symptoms (NMS). This study qualitatively explored perceptions of people with Parkinson’s (PwP), NMS, and functional ability. Ten PwP took part in semi-structured phone or Zoom interviews. Data were analysed using the General Inductive Approach. Four major themes were identified: (a) diagnosis as a turning point; (b) nonmotor symptoms and functional ability; (c) self-management; and (d) significant others. The themes were further classified into 13 subthemes and 10 categories. Interaction between the four themes also emerged from the data. A complex nuanced impact was found on the relationships between the individual and their significant others. People with Parkinson’s experienced either a “vicious cycle” or a “virtuous cycle” of symptoms, which were dependent on a multitude of factors, for example, whether it is a “good” or “bad” day and the corresponding actions taken on these days. The findings provide key insights into tailoring advice and support into self-management of Parkinson’s, particularly of actions that can be taken for better outcomes.

Purpose: Following coronary artery bypass graft (CABG) surgery, people are required to navigate the majority of their physical recovery, including progressive engagement in physical activity, after they leave hospital. However, there are many physical and psychological challenges to physical activity during the early recovery period. The aim of this study was to identify facilitating factors that help overcome such challenges to physical activity following CABG surgery. Methods: A qualitative descriptive study using semistructured interviews (n = 22) was undertaken. Data analysis was informed by the COM-B model and Theoretical Domains Framework (TDF) and performed using the Framework Method. Interview data were first inductively coded to identify factors that facilitated physical activity followed by a deductive analysis to group these facilitators under the relevant COM-B and TDF headings. Results: Facilitators relevant to all 6 COM-B elements and 13 of 14 TDF domains were identified. Although having physical capability and physical opportunity were important, the most prevalent facilitators identified by participants as being helpful related to psychological capability (for example, knowledge, having a plan, identifying barriers and coming up with solutions, and listening to their body), reflective motivation (for example, goals, experiencing positive benefits from activity, and being optimistic and determined), and social opportunity (for example, support from family, health professionals, and peers). Conclusions: Psychosocial facilitators play a large role in overcoming barriers to physical activity following CABG surgery. The findings provide insight for clinicians regarding potential factors to address when preparing and supporting people to engage in physical activity.

This study aimed to understand the experience of older adults with dementia towards, and the practicality of, the Balance Wise exercise programme. A qualitative study guided by the General Inductive Approach was employed. Ten people with dementia aged 71–87 years who completed the exercise programme and four care partners aged 69–76 years old (three of whom also participated in Balance Wise) were interviewed in dyads. The programme (individually or group delivered) was held once a week for 30 min for 10 weeks and included balance and strength exercises, cognitive training, and other enjoyable physical activities. Interviews were thematically analysed. Three overarching themes were identified (i) decision making, (ii) comprehension, and (iii) perceived benefits. Participants acknowledged their decision to participate was influenced by ‘awareness’ about their declining memory and their ‘health belief’ about the potential benefits of exercise. ‘Perceived benefits’ were influenced by the ‘support system’ and improvement in postural stability. ‘Comprehension’ was, however, an important cognitive ability to understand the purpose of the activities in the programme and facilitated motivation. This study highlighted an important message that such programmes should be developed from the end-user perspective, and this included that the programme be flexible and safely delivered, as well as be fun and pleasurable, thus promoting socialisation.

The impact of stroke is lifelong; affecting independence and quality of life. Stroke survivors need support to manage their recovery. The Bridges stroke self-management approach (Bridges) empowers stroke survivors and facilitates self-management within usual rehabilitation. We implemented Bridges into a New Zealand stroke service, aiming to identify context-specific delivery factors and long-term sustainability strategies. Using a case study design, data were collected from multiple sources, including meeting and training notes, researcher observations, workshop evaluations, and in-depth semi-structured interviews (n = 7). Data were compared for congruency or disparity, and integrated to develop a comprehensive case description. Overall, 69 health professionals were trained. Collectively, the data found Bridges to be conceptually acceptable and contextually appropriate, raising awareness of self-management support across the service. Identified key factors that would assist with the implementation of this new intervention, including the need for time and sustained support for staff; an initial small, contained inter-professional team; ongoing communication to staff by managers about their expectations and endorsement of the intervention; and staff “champions”, requiring training, resources, and managerial support. Whilst staff may value Bridges, they needed time and the opportunity to develop knowledge, skills, and self-efficacy to support patient self-management.

Older adults with cognitive impairment are at high risk of experiencing falls. Although no specific fall prevention guidelines presently exist for this population, exercise programmes to prevent falls are recommended. Limited literature exploring what older adults with mild to moderate cognitive impairment think about or how they make sense of the need for such programmes exists. This study explored the perspectives of older adults with mild to moderate cognitive impairment and their caregivers about exercise and physical activity in the context of fall prevention. Underpinned by Interpretive Phenomenological Analysis, qualitative semi-structured interviews were undertaken with nine community-dwelling adults (>65 years) with mild to moderate cognitive impairment and their caregivers (N = 6). Three themes of acceptance, denial, and accommodation were identified. The fluctuating concept of ‘self’ appeared to influence individual decisions to exercise or be physically active and what sort of physical activity to undertake more than any practical barriers. We suggest that healthcare professionals emphasise the concept of personhood, listening to and reinforcing biographic narratives of older adults living with cognitive impairment to foster a sense of autonomy, and shared decision-making while emphasising fall prevention activities that older adults with cognitive impairment might like to engage with.