Objectives Traumatic brain injury commonly causes dizziness and balance problems. Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of inner-ear related post-traumatic vestibular dysfunction. However, optimal assessment and treatment practices are poorly evidenced. Using a mixed methods approach, we aimed to explore the feasibility of managing post-traumatic BPPV.Design A mixed-methods randomised feasibility study. In this paper, quantitative and qualitative data relating to key feasibility targets around recruitment, randomisation and assessment and treatment were selected and integrated to provide an in-depth understanding of BPPV management.Setting Three UK major trauma centresParticipants Hospitalised adults with post-traumatic BPPV.Interventions Patients were randomised to one of three interventions (repositioning manoeuvres, Brandt-Daroff exercises and advice).Results Screening and recruitment varied between sites due to individual and site-specific factors. Randomisation to advice was experienced differently by healthcare professionals and patients, suggesting that changes to the study design of a future effectiveness trial may be required. Assessment and treatment were acceptable to participants, supporting advancement to an effectiveness trial.Conclusions Integration of qualitative and quantitative data revealed new findings relating to the primary outcomes of the feasibility study, while strengths and weaknesses of the trial design were also elucidated. Taken together, such data will influence and enhance the design of a future trial.Trial registration number ISRCTN91943864.

BACKGROUND:This study aimed to understand the experiences and views of children with cerebral palsy, their parents and physiotherapists participating in the ACCEPT feasibility randomised controlled trial, which explored a 10-week physiotherapy intervention using an interactive gaming training device. DESIGN:Qualitative methods included semi-structured interviews, e-diary and photographs. Nine parent-child dyads and three physiotherapists participated. Children were aged between 7 and 16 years; four had co-existing additional needs. Interviews were transcribed. Reflexive thematic analysis was used. RESULTS:Five themes covered the breadth of participants' experiences: (1) Fitting in therapy; (2) Motivation; (3) New opportunities; (4) Physiotherapists out of their comfort zone; and (5) Altruism and challenges. Parents spoke of the challenge of finding time to engage their children in therapeutic exercise. Several children talked about trial-related procedures (e.g. removal of adhesive markers) that they disliked. Physiotherapists, children and parents supported the gaming aspect of the device to improve motivation to exercise. CONCLUSIONS:Overall, the intervention and measures were acceptable to children and parents. Parents were willing to accommodate the device for 10 weeks and children found the gaming aspect both motivating and enjoyable. Physiotherapists required more support to solve technical problems with the device. A full trial evaluating the device requires additional technical support from the supplier and experienced 'champion' users. Exercise trainers that encompass gaming may increase motivation and adherence to therapeutic programmes. PATIENT OR PUBLIC CONTRIBUTION:Children, families and care givers were included in the study design. They helped to produce participant facing documents including the e-diary and interview topic guides. The study steering committee included several parents and one teenager, and provided governance and oversight of the project.

Introduction:The primary objective of this review was to evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of inner ear decompression sickness (IEDCS). Secondary objectives were to summarise the diver characteristics, HBOT parameters and outcome measures. Methods:All descriptive observational study designs including case series and individual case reports involving divers suffering IEDCS treated with HBOT were included. PubMed, Scopus, CINAHL and EMBASE were used to search for texts reporting the outcome for divers treated with HBOT. Eligible studies were appraised by two independent reviewers and any disagreements resolved via the third reviewer. Data were extracted using standardised tools and narrative synthesis was undertaken. Results:3,683 records were identified with 24 included in the final review representing 539 cases of IEDCS. Mean age was 44, average (in-water) dive depth 29 metres of seawater and dive duration 38 minutes. Mean onset of symptoms was 32 minutes and 74% had a right sided lesion. Only 37% had residual symptoms on discharge despite 68% showing dysfunction on laboratory testing. Follow-up duration and assessment methods were variable. Vestibular rehabilitation was underutilised and only 46% of divers went on to have patent foramen ovale (PFO) screening despite the well-established link to IEDCS. Conclusions:A standardised method of examination and assessment of symptoms should be considered along with vestibular rehabilitation (or referral to this service). All divers should be counselled on PFO screening. A standard 3-month follow-up is recommended to allow for assessment of residual dysfunction / symptoms and discussion regarding returning to diving. Further research should focus on assessment of vestibular deficit / symptoms over time to assess efficacy of HBOT including the effects of delay to recompression and number of treatments. Laboratory testing should be utilised to determine the mechanism of injury and recovery.

Background Anxiety is a common non-motor symptom of Parkinson’s disease (PD). There is no specific pharmacological intervention for people with PD who experience anxiety. Current non-pharmacological treatments have mixed or inconclusive results and there does not appear to be a non-pharmacological intervention for people with PD disease and anxiety that focuses on activity and participation.Objective To co-produce an occupation-focused complex intervention to help people with PD live well with anxiety that community-based occupational therapists can deliver.Design Six-stage complex intervention development was conducted using online logic modelling and a participatory approach to organise the new intervention’s key inputs, processes and outcomes important to people with PD living with anxiety.Setting Data were collected via online logic modelling sessions involving people with Parkinson’s, care partners and occupational therapists across the UK from April 2022 to June 2022.Participants 34 participants were recruited (people with PD n=14, care partners n=9, occupational therapists n=11) for the online logic modelling sessions.Results Resources to support the new intervention (‘inputs’) include adequate resourcing, education for professionals and people with PD, flexibility of delivery methods and goal setting. The intervention’s actions to produce outcomes (‘processes’) should include 1:1 support, lifestyle management, providing meaningful information, collaborative goal setting, therapeutic use of everyday activities, and involvement of friends and families. The intended results (‘outcomes’) should include a reduction in anxiety symptoms, people with PD enjoying more meaningful activities, increased understanding of anxiety and PD, improvement in clinical outcomes and improvement of service-level outcomes. These key aspects were incorporated into an intervention manual, educational material and training video.Conclusions We have systematically coproduced a new occupation-focused complex intervention to help people with PD to live well with anxiety. This provides the basis for the next project in which this intervention will be tested for feasibility.Trial registration number ISRCTN62762494.

The brain's high metabolic demands make it highly sensitive to oxygen level changes, with both hypoxia and hyperoxia affecting cognitive and neural function. However, the underlying neural mechanisms remain unclear. This study aimed to characterise the effects of acute normobaric hypoxia and hyperoxia on neural function and perceptual thresholds using EEG, visual evoked potentials (VEPs), and critical flicker fusion (CFF) thresholds. In a single-blind, randomised, crossover design, thirty participants inhaled 10.5%, 21%, or 100% oxygen while resting-state EEG, VEPs, and CFF thresholds were recorded. Hypoxia reduced CFF thresholds in an exposure-dependent manner, while hyperoxia produced a smaller, transient reduction. Resting-state EEG revealed significantly increased power across delta, theta, and beta bands in response to hypoxia. Whereas hyperoxia induced smaller increases in theta and alpha and decreases in gamma power and a reduction in beta power over the sensorimotor area. Hypoxia increased spectral entropy, indicating impaired network synchronisation, while hyperoxia increased fuzzy entropy, particularly in eyes-closed states, potentially reflecting enhanced neural complexity. In VEPs, hypoxia reduced P1 amplitude and increased N2 deflections, reflecting disrupted early and late sensory processing, with sustained effects across blocks. Hyperoxia transiently increased P1 amplitude and showed minor effects on other components. These findings demonstrate the impact of altered cerebral oxygen on fundamental neural processing and the associated state- and time-dependent effects on brain function. This provides insight into the mechanisms underlying oxygen-induced neuromodulation and highlights the value of EEG and CFF as biomarkers for tracking neural responses to oxygen variability.

Aim A novel interactive exergaming device enables children with cerebral palsy (CP) to exercise whilst standing. A small study showed gains in ankle motion after training with the device. This study explores the feasibility of a community-based randomised controlled trial (RCT) using this device to improve mobility in children with CP (Registered ISRCTN80878394). Method Fifteen children with CP Gross Motor Function Classification System (GMFCS) levels I-III were randomised 1:1 to either 10-weeks training with the device or usual care. Two potential primary outcome measures were assessed at 10-weeks with 20-week follow up: motion of the centre-of-mass estimate while stepping (Next Step) and Pediatric Balance Scale (PBS). Results Twenty-one children were assessed for eligibility, three declined to participate, two withdrew and one did not receive the intervention but remained in follow-up. Two serious adverse events occurred (n=2). Participant recruitment was 1.2 per month, limited by device availability. Completion of PBS and Next Step was 100% and 87% at baseline, dropping to 75% and 65% respectively at 10-weeks. The intervention group showed clinically meaningful changes in median (interquartile range) PBS at 10-weeks 2.7 (1) compared to the control 1.7 (0.67). Conclusion This study found multiple feasibility issues and further work is needed prior to implementing a RCT. There were signs of efficacy of the intervention, but findings are limited by small sample size.

PURPOSE:Stroke imposes significant burden on informal caregivers (ICs) in the Philippines, yet factors associated with caregiver strain remain unclear. This study examined sociodemographic and caregiving factors associated with burden among stroke ICs. MATERIALS AND METHODS:A cross-sectional survey of 462 Filipino ICs collected sociodemographic characteristics, caregiver responsibilities and strain using the Modified Caregiver Strain Index-Filipino (MCSI-F). Data were analyzed using chi-square tests and ordinal logistic regression. RESULTS:Caregivers were predominantly female (75.3%), spouses/partners (47.8%), and economically disadvantaged (66.9%). Median MCSI-F score was 22 (IQR = 8), indicating no burden, while 11.9% reported severe strain. In the multivariable ordinal logistic regression model, work interference showed the strongest adjusted association with higher burden severity (aOR = 5.38, p < 0.001), followed by spousal relationship (aOR = 2.10, p = 0.028); male sex was protective (aOR = 0.34, p < 0.001), and providing <1 h/day of care (vs. >6 h/day) was associated with lower burden (aOR = 0.17, p = 0.004). Age, income, employment status, education, religion, and urban-rural residence were not significant after adjustment. Parallel lines held (p = 0.765), and Nagelkerke's R2 was 0.231. CONCLUSIONS:Filipino stroke ICs experience substantial strain primarily driven by work interference and intensive caregiving hours, with spouses and female caregivers disproportionately affected. Interventions should prioritize employment support for female spouses providing prolonged daily care.Implications for rehabilitationInformal caregivers of stroke survivors in the Philippines experience substantial burden, particularly when caregiving interferes with employment and requires intensive daily commitment.Female spouses providing prolonged daily care represent a particularly vulnerable group requiring targeted support from rehabilitation services.Rehabilitation teams should routinely assess caregiver work disruption and daily care hours as part of comprehensive stroke care planning.Employment-focused interventions, such as flexible appointment scheduling and liaison with employers, should be integrated into community-based rehabilitation programs to reduce work-care conflict.Rehabilitation professionals should prioritize training family caregivers in strategies that promote survivor independence and reduce intensive care demands over time.

BACKGROUND:Gait and balance impairment can profoundly impact people with multiple sclerosis (PwMS). OBJECTIVES:To evaluate the analytical and clinical validity of the U-Turn Test (UTT), a smartphone-based assessment of dynamic balance in PwMS. METHODS:The GaitLab study (ISRCTN15993728) enrolled adult PwMS (EDSS 0.0 - 6.5). PwMS performed the UTT in a gait laboratory (supervised) using six smartphones at different wear locations and daily during a two-week remote period (unsupervised) using one smartphone (belt front). Median turn speed was computed per UTT. In the supervised setting, turn detection accuracy of smartphones was compared to motion capture (mocap) via F1 scores. Agreement between smartphone- and mocap-derived turn speed was assessed by Bland-Altman and ICC(3,1). In the unsupervised setting, test-retest reliability (ICC[2,1]) and correlations with Timed 25-Foot Walk (T25FW), EDSS, Ambulation score, 12-item Multiple Sclerosis Walking Scale (MSWS-12), and Activities-specific Balance Confidence scale (ABC) were evaluated. RESULTS:Ninety-six PwMS were included. Turn speed was comparable across supervised (1.44 rad/s) and unsupervised settings (1.47 rad/s). In the supervised setting, turn detection was highly accurate (F1 > 95% across wear locations). Turn speed agreement with mocap was high (ICC[3,1]: 0.87 - 0.92), with minimal bias (-0.04 to 0.11 rad/s). Unsupervised test-retest reliability (ICC[2,1]) was > 0.90 when aggregating ≥ 2 tests. Turn speed correlated with T25FW (rho = -0.79), EDSS (rho = -0.75), Ambulation score (rho = -0.73), MSWS-12 (rho = -0.65), and ABC (rho = -0.61). CONCLUSION:The UTT accurately and reproducibly measures turn speed across wear locations and settings, providing complementary dynamic balance insights to clinical measures and showing potential for use in multiple sclerosis trials.

ABSTRACT Background and Aims Home‐based high‐intensity interval training (HIIT) could be feasible and useful for people with Parkinson's (PwP). However, no home‐based HIIT program for PwP has been undertaken. This trial was designed to obtain preliminary data regarding the feasibility, acceptability and safety of HIIT‐Home4Parkinson's (HH4P), a previously co‐created home‐based HIIT program for PwP, explore outcomes that may be sensitive to change, and inform the implementation of a potential full trial. Methods A randomized, controlled feasibility trial was undertaken. Thirteen independently mobile PwP of Hoehn and Yahr stages 1–3 were randomized to the 12‐week, three times weekly HH4P HIIT program (n = 7), or usual care (n = 6). Feasibility and safety outcomes included aspects such as program completion, adherence, exercise intensity and adverse effects and events. Potential primary outcomes for a full trial were serum brain‐derived neurotrophic factor, maximal oxygen uptake and the Unified Parkinson's Disease Rating Scale part III. Process evaluation with a qualitative aspect explored implementation fidelity and participant thoughts and feelings. Results Six HIIT participants completed the program, with one withdrawing due to an unrelated back injury. Mean exercise adherence was 78.4%, while the mean exercise intensity was 77.2% HRmax per session, with three participants not achieving mean 75% HRmax. HIIT related adverse effects were minor and temporary, and the majority of exercise program and delivery procedures were deemed feasible and acceptable by participants. When compared to controls, the HIIT group did not experience benefits in any of the potential primary outcomes. Conclusion Preliminary data suggests that home‐based HIIT could be feasible, safe and acceptable for some PwP, although the capacity to stimulate the required exercise intensity, along with the potential benefits remain uncertain. Progression to a full HH4P trial cannot be recommended until further evaluation of aspects such as exercise type and model of support is undertaken. Trial Registration ClinicalTrials.gov NCT05485428.

Introduction:The mechanism of injury and recovery of divers with inner ear decompression sickness (IEDCS) is not well understood and there is no consensus regarding management following recompression treatment. Given the rare occurrence, divers are not routinely offered the standard therapies that patients with other acute vestibular disorders may be offered such as vestibular rehabilitation. Methods:This is an observational case series of 13 divers presenting acutely with IEDCS to DDRC Healthcare in Plymouth, UK between July 2021 and January 2024. Vestibular and balance tests were undertaken to aid the treating dive physician in the diagnosis and management of the divers with both hyperbaric oxygen therapy and customised vestibular rehabilitation. Results:Average values for vertical perception, posturography, dynamic gait index and patient-reported outcomes measures improved by discharge and at the three month follow up despite 67% showing an ongoing positive head impulse test or nystagmus in the dark on videonystagmography at follow up. Conclusions:Divers should be warned that despite symptom resolution or minimal residual symptoms post-IEDCS there is a high rate of deficit evident on vestibular testing, and this, alongside investigation for a right to left cardiac shunt, should be a major consideration when considering returning to diving. For the clinician, a stopwatch timed Sharpened Romberg's test appears to be a reasonable method for monitoring progress of balance stabilisation during the treatment period. Early initiation of vestibular rehabilitation exercises should be considered for all divers with IEDCS.

BACKGROUND:Vestibular dysfunction (resulting in dizziness and imbalance) is common in acute traumatic brain injury (aTBI). The most frequently diagnosed cause of peripheral vestibular dysfunction in aTBI is benign paroxysmal positional vertigo (BPPV). However, post-traumatic BPPV is often undiagnosed and left untreated in these patients. OBJECTIVES:To investigate clinical risk factors for BPPV in patients experiencing aTBI. METHODS:Patients were recruited from three Major Trauma Centres in London. Logistic regression was used to derive the adjusted odds ratio (aOR) of diagnosed BPPV for sex, categorised age, severity of traumatic brain injury (TBI), and site of skull fracture. RESULTS:166 patients with aTBI were included. Approximately a third (n = 55; 33.1 %) tested positive for BPPV. Compared to patients aged less than or equal to 40 years, those aged 41 to 64 years were more likely to experience BPPV (aOR=3.86; 95 % CI: 1.47 to 10.16; p = 0.006), as were those aged 65 years and above (4.41; 1.52 to 12.81; p = 0.006). Patients that experienced both facial and cranial skull fracture were more likely to experience BPPV than those that didn't have a skull fracture (23.64; 6.36 to 87.89; p < 0.001). CONCLUSION:The risk of post-traumatic BPPV increased with increasing age, plus in those with combined skull and facial fractures when compared to those without a skull fracture. We advocate routine BPPV screening of those with aTBI, especially in older adults and those with combined facial and skull fractures.

There is increasing evidence to suggest that physical activity can slow Parkinson’s progression. There is also increasing interest in non-pharmacological interventions to alleviate Parkinson’s symptoms. This scoping review aimed to map and describe the evidence for interventions that promote physical activity in people with newly diagnosed Parkinson’s. Studies conducted since 2011, on adults with Parkinson’s (≥ 18 years), investigating the effects of non-pharmacological interventions to promote physical activity and/or exercise were considered. Interventions needed to be conducted in healthcare or healthcare-related settings for people within 5 years of Parkinson’s diagnosis. Published or unpublished full-text articles since 2011 were searched in November 2023, using online focused, broad, and grey literature databases. JBI scoping review methodology was used and results presented in table format accompanied by a narrative review. A total of 22 articles with a variety of research designs were included with 14 randomized trials, one single-site, prospective, single-arm study, two retrospective cohort studies, one case series, two case reports, and two qualitative reports. Many studies (n = 7) were conducted in outpatient clinics with the majority of interventions (n = 17) involving physiotherapists. Interventions varied widely, including aerobic exercise, balance exercise, dance, and yoga. The duration of intervention varied from 4 weeks to 8 years. Dosage of interventions varied widely from 30 to 90 min, and from twice weekly to seven times weekly. Several different outcome measures related to physical activity levels and/or physical fitness were used. The most frequent clinician/researcher reported outcome measure was the 6-min walk test (in nine studies) and the most frequently used participant/patient reported outcome measure was the 39-item Parkinson’s Disease Questionnaire (PDQ-39) (also in nine studies). The review showed limited research in identifiable cohorts with newly diagnosed Parkinson’s. Sample sizes were predominantly small. In all but one study, authors interpreted their results as favoring interventions to promote physical activity for people with newly diagnosed Parkinson’s. All authors recommended further studies. There is a need for more research with larger sample sizes and standardized reporting to inform the evidence base for interventions that promote physical activity in people with newly diagnosed Parkinson’s. https://pearl.plymouth.ac.uk/ ( http://hdl.handle.net/10026.1/20098 )

PURPOSE:To evaluate feasibility and impact of an individualised rebound therapy programme on chest health in children with complex neurodisability. METHODS AND MATERIALS:A single-case ABA design was conducted over 18 weeks with five children aged 5-15 years with complex neurodisability. Intervention involved twice weekly rebound therapy for six consecutive weeks in school. Summary outcomes included parent/carer-reported chest health, quality-of-life and clinician-observed motor ability. Serial weekly outcomes included chest health observations, usual care changes, adherence and adverse events. Parents completed a semi-structured interview after follow-up. Quantitative data were analysed descriptively and qualitative data were analysed using thematic analysis. RESULTS:Within-case and across-case findings indicated improvement in motor ability following rebound therapy intervention. Additional trends of improvement were noted in parent/carer-reported chest health and quality-of-life, but these changes were not specific to the intervention phase. Improvements in motor ability, chest health and quality-of-life indicators were verified through qualitative interview data. CONCLUSION:Co-design successfully informed an inclusive, feasible intervention study for children with complex neurodisability. However, overall improvement in parent/carer-reported chest health, quality-of-life and observed motor ability were not limited to the intervention phase. Measurement tools lacked published thresholds to determine if changes were clinically significant.

Background:Functional motor disorder often causes persistent disabling symptoms that are associated with high healthcare costs. In recent years, specialist physiotherapy, informed by an understanding of functional motor disorder, has emerged as a promising treatment, but there is an absence of evidence of its effectiveness from large randomised controlled trials. Methods:We conducted a pragmatic, multicentre, randomised controlled trial, comparing specialist physiotherapy for functional motor disorder to treatment as usual, which was defined as community neurological physiotherapy. The primary outcome was the Short Form questionnaire-36 items Physical Functioning domain at 12 months (scale range 0-100, with 100 indicating optimum health). The trial was powered to detect a 9-point difference in the primary outcome with 90% power at the 5% level of significance. Secondary domains of measurement included a patient perception of improvement, health-related quality of life, mobility, anxiety, depression and illness perception. We also completed a health economic analysis with the primary aim of calculating the mean incremental cost per quality-adjusted life-year over 12 months. In prespecified analysis plans, we excluded participants from the primary analysis if they were unable to receive their trial-allocated treatment due to COVID-19 lockdown restrictions. Sensitivity analysis explored the impact of this decision. Results:Between 19 October 2018 and 31 January 2022, 355 adults with functional motor disorder were randomised (1 : 1) to specialist physiotherapy (n = 179) and treatment as usual (n = 176). Eighty-nine participants were excluded due to COVID-19 disruptions. Retention for the primary analysis was 90% for both groups, leaving 241 participants in the primary analysis. At 12 months, there was no between-group difference in the primary outcome (adjusted mean difference 3.5, 95% confidence interval -2.3 to 9.3). However, several secondary outcomes favoured specialist physiotherapy, including the participant perception of improvement, Short Form questionnaire-36 items Mental Health domain, confidence in the diagnosis and two subscales (Personal Control and Illness Coherence) of the Revised Illness Perception Questionnaire. There were no differences in the remaining outcomes. At 6 months, the following outcome measures were significantly different, in favour of specialist physiotherapy: participant perception of improvement, the Short Form questionnaire-36 items Physical Role Limitations, Short Form questionnaire-36 items Social Functioning, Short Form questionnaire-36 items Mental Health, EuroQol-5 Dimensions five-level version utility score, confidence in the diagnosis and three subscales (Timeline Cyclical, Personal Control and Treatment Control) of the Revised Illness Perception Questionnaire. No outcomes significantly favoured treatment as usual. In the health economic analysis, the incremental cost per quality-adjusted life-year gained from a health and social care cost perspective was £4133 with an 86% probability that specialist physiotherapy is cost-effective compared to treatment as usual at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained. There were no adverse events related to physiotherapy. Conclusion:Specialist physiotherapy was not superior to treatment as usual for the primary outcome, the Short Form questionnaire-36 items Physical Functioning domain at 12 months. However, a number of secondary outcome measures favoured specialist physiotherapy at 6 and 12 months. There is a high probability that specialist physiotherapy is cost-effective. Limitations:Participants in treatment as usual waited longer to start physiotherapy, which resulted in a shorter time between concluding treatment and completing the primary outcome. Most outcome measures, including the primary outcome, were participant reported, which may have been biased by perceptions of the randomised treatment allocation. Future work:Future work should identify or develop more suitable outcome measures for functional motor disorder research, explore who is most likely to benefit from specialist physiotherapy and identify alternative interventions for those unlikely to benefit from this treatment. Additional work is needed to adapt treatment to meet the needs of minority groups and young people. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 16/31/63.

BACKGROUND:Vestibular dysfunction occurs in 30% to 70% of cases with multiple sclerosis (MS). OBJECTIVE:To compare the clinical and cost-effectiveness of a customized vestibular rehabilitation (VR) program with a generic booklet-based VR intervention in people with MS with clinical signs of vestibulopathy. METHODS:People with MS and symptoms of vertigo and/or imbalance were screened for vestibulopathy (n = 73). Seventy recruited participants were randomly allocated to a 12-week generic booklet-based home program with telephone support (n = 35) or a 12-week customized VR program (n = 35, 12 face-to-face sessions and a home exercise program). The primary clinical outcome was the Dizziness Handicap Inventory (DHI) at 26 weeks post-randomization. The primary economic endpoint was quality-adjusted life-years (QALYs). Secondary outcomes included vertigo severity, balance, gait, and perceived impact of physical symptoms in MS. RESULTS:There was no significant between-group difference in the DHI: mean reduction -1.76 (95% confidence interval -10.02, 6.50) at week 26 in favor of the customized group (P = .670). There were significant differences in favor of the customized group for vertigo symptom score, balance confidence, walking, and perceived impact of MS. Primary cost-effectiveness analysis showed customized VR to be less costly and more effective. However, removal of 2 cost outliers in sensitivity analysis resulted in a mean cost-per-QALY of £30 147. Customized VR was also cost-effective from a societal perspective. DISCUSSION:Impairment level improvements did not translate into functional improvements as measured by the DHI perhaps reflecting that vestibular dysfunction is one of several impairments in MS. The findings indicate the potential cost-effectiveness of the customized program. CLINICAL TRIAL REGISTRATION:ISRCTN27374299.

Background: Many attempts to validate gait pipelines that process sensor data to detect gait events have focused on the detection of initial contacts only in supervised settings using a single sensor. Objective: To evaluate the performance of a gait pipeline in detecting initial/final contacts using a step detection algorithm adaptive to different test settings, smartphone wear locations, and gait impairment levels. Methods: In GaitLab (ISRCTN15993728), healthy controls (HC) and people with multiple sclerosis (PwMS; Expanded Disability Status Scale 0.0-6.5) performed supervised Two-Minute Walk Test [2MWT] (structured in-lab overground and treadmill 2MWT) during two on-site visits carrying six smartphones and unsupervised walking activities (structured and unstructured real-world walking) daily for 10-14 days using a single smartphone. Reference gait data were collected with a motion capture system or Gait Up sensors. The pipeline's performance in detecting initial/final contacts was evaluated through F1 scores and absolute temporal error with respect to reference measurement systems. Results: We studied 35 HC and 93 PwMS. Initial/final contacts were accurately detected across all smartphone wear locations. Median F1 scores for initial/final contacts on in-lab 2MWT were >=98.2

OBJECTIVES:This study aimed to illustrate the state of stroke care and rehabilitation in the Philippines through the perspectives of local government officials, policymakers, and organisational leaders. It sought to identify challenges, opportunities, and recommendations for improving stroke policies and services across different administrative levels. METHODS:Mixed-methods approach involving a structured survey of 131 local government officials and in-depth interviews with eight key stakeholders. Survey participants included Department of Health (DoH) officials, local chief executives, policymakers, Local Government Unit (LGU) employees, and representatives from non-government agencies. Interviewees comprised leads and managers from the DoH and representatives from organisations including the Philippine Academy of Rehabilitation Medicine (PARM), Physicians for Peace Philippines, and the Philippine Council for Health Research and Development (PCHRD). Quantitative survey data were analysed using descriptive statistics and qualitative interview data were thematically analysed, then the two types of data were triangulated and organised by theme. RESULTS:Findings revealed significant gaps in funding, healthcare infrastructure, and policy implementation. Challenges included inadequate facilities, lack of qualified staff, financial barriers, and regional disparities in service provision. Survey and interview participants emphasised the need for increased government support, comprehensive policies, and community-based rehabilitation (CBR) programmes. Improving stroke survivors' quality of life was ranked as the most critical aspect of rehabilitation programmes. CONCLUSIONS:The study highlights the critical need for more equitable and accessible stroke care and rehabilitation in the Philippines. This can be facilitated by sustained government support, inter-agency collaboration, community engagement, and the implementation of holistic, evidence-based, and cost-effective CBR initiatives.