Background: Running, while challenging, offers benefits for individuals with multiple sclerosis (MS). Health care professionals (HCPs) can support this activity but may need further training to do so. Understanding the barriers and facilitators to running can help HCPs provide better support. This study aims to explore the running experience of individuals with MS and provide guidance to HCPs to support their patients who run. Methods: A qualitative descriptive study was conducted using semistructured focus groups and individual interviews. Transcribed data were coded with NVivo software, and inductive thematic analysis was used to identify emergent themes. Demographic and basic running activity data were collected via survey and analyzed using descriptive statistics. Participants included individuals with MS living in Australia who ran regularly. Results: Eighteen participants (3 male, 15 female) with a median age of 44 years (IQR, 12.8; range, 31-57) were included in the study. Most participants met or exceeded the general MS aerobic exercise guidelines, running 3 days per week (IQR, 2.0; range, 1-4) for a median duration of 42 minutes per run (IQR, 25; range, 15-243). Five focus groups and 1 individual interview were conducted. Six themes were generated: running ability and adaptation, navigating temperature, ensuring environmental safety, managing health and MS, developing strategies to support running, and the need to run. Conclusions: HCPs have opportunities to support and sustain running participation for individuals with MS by considering safe training adaptations, environmental safety, and appropriate referrals to other HCPs.

CONTEXT:Exercise benefits people with multiple sclerosis (MS); however, most research focuses on gym or home-based aerobic and strength training. Little is known about how individuals with MS participate in dynamic sports like running. We aimed to quantify running participation over a 4-week period in individuals with MS and investigate whether running volume and training characteristics were associated with fatigue, disability, cognition, and quality of life. DESIGN:A prospective observational cohort study. METHODS:We included 29 participants from Australia who were regular runners with MS. Participants recorded their running frequency, intensity, duration, distance, and mode (indoor/outdoor/treadmill) over 4 weeks. Associations between participants' running activities, and measures of fatigue (Modified Fatigue Impact Scale), disability (Patient Determined Disease Steps), cognition (Psytoolkit online cognitive assessment), and physical and mental health (Multiple Sclerosis Quality of Life-54) were assessed using Spearman or Kendall τ b correlation coefficients. RESULTS:Participants with low to moderate disability demonstrated a broad range of running ability (range: average distance 2-13 km and 16-95 min per run). Most ran outdoors on combination surfaces (concrete, grass, and trail). Negative correlations were observed between fatigue and running distance (r = -.382, P = .041) and running duration (r = -.365, P = .052). Positive correlations were observed between running distance and quality of life, physical health (r = .380, P = .042), and mental health (r = .375, P = .045). Correlations were not significant after applying the corrected significance value of P < .0025. CONCLUSION:Regular running is feasible for individuals with MS with low to moderate disability. Participants demonstrated the ability to run despite differing levels of fatigue, cognitive function, and disability. Participants could engage in outdoor running under conditions considered challenging for those with MS. A relationship between running distance, duration, fatigue, and quality of life was identified; however, the findings were not statistically significant after correction for multiple comparisons.

Objectives: To evaluate the effects of functional electrical stimulation (FES) cycling on muscle spasticity in individuals with spinal cord injury (SCI) and provide recommendations for optimal FES cycling parameters to treat muscle spasticity. Method: In this systematic review, database searches of CINAHL, MEDLINE (Ovid), PEDro, PubMed, and Scopus were conducted to identify relevant studies published up to June 2023. Studies were screened for eligibility. Those that included an FES cycling intervention, an outcome measure of spasticity, and were available in full-text English were included. Two independent reviewers extracted the data and appraised the literature via the Crowe Critical Appraisal Tool (CCAT). Results: Of the 1782 studies identified, 16 satisfied the criteria for this review. Two-hundred and three participants were included, aged 7 to 80 years old. Ten studies identified a reduction in spasticity following FES cycling via objective or subjective outcome measures. Methodological quality was variable, with CCAT scores ranging from 19/40 (48%) to 35/40 (88%). National Health and Medical Research Council hierarchy levels ranged from II to IV. Conclusion: Evidence for the effectiveness of FES cycling to reduce muscle spasticity remains inconclusive. Long-term effects on spasticity were evident in moderate- to high-quality studies where FES cycling was conducted for 60 minutes, three times per week for 16 weeks. Additional research with larger sample sizes is warranted to confirm these findings. Further clarification of the optimal parameters of FES frequency, amplitude, and pulse width to reduce spasticity is required.

Introduction:One in six stroke survivors continue to experience arm and language disability at 3 months post-stroke. This study aims to identify which model(s) of integrated UPper limb and Language Impairment and Functional Training (UPLIFT) show promise for people 3 months to 24 months post-stroke. We hypothesise that at least one promising UPLIFT model of rehabilitation will be identified. Methods and analysis:This is an adaptive Phase IIa master protocol umbrella design that includes four simultaneous Bayesian Optimal Phase II studies to evaluate individual UPLIFT interventions against prespecified objective performance criteria. The intervention is upper limb and language training at 2 or 4 hours/day, 5 days/week for 4 weeks, delivered either in person (severe stratum) or via telerehabilitation (mild-moderate stratum). Up to 160 adult participants will be recruited across six metropolitan/regional university or healthcare hubs spanning five Australian states. Baseline and post-intervention assessments are blinded. A promising response is defined as a composite binary outcome combining indicators of promise of efficacy, safety and feasibility. For each UPLIFT intervention, the proportion of participants with a promising response will be monitored at three equally spaced, predefined interim stopping points and one final analysis point (n=40 participants/study). An intervention will be stopped if too few promising responses are observed. Ethics and dissemination:Ethical approval was obtained from The Royal Melbourne Human Research Ethics Committee. All participating sites obtained local governance approval. All recruited participants will provide informed consent. Trial results will be disseminated through peer-reviewed publications and presented at major stroke and rehabilitation conferences. Trial registration number:ACTRN12622000373774.

Objective To quantitatively describe therapists’ use of coaching with stroke survivors, in a hospital-based rehabilitation setting, to promote perseverance with longer-term practice. Design Prospective observational behavioural mapping study. Setting Rehabilitation unit of a regional public hospital in Queensland, Australia. Main measures A custom-designed behavioural mapping tool was used to collect rehabilitation session contextual data and therapists' use of coaching. Data were captured in 3-minute epochs for a maximum of 30 minutes. Data were analysed using descriptive statistics. Results Thirty-six rehabilitation sessions, including 34 participants (therapists n = 22, stroke survivors n = 12) were observed. Rehabilitation sessions were mostly inpatient ( n = 33, 91.7%), one-on-one ( n = 30, 83.3%), and conducted in the physiotherapy ( n = 160, 45.5%) or occupational therapy ( n = 155, 44.0%) gym. Strategies to promote perseverance were used in 76.7% ( n = 267) of observed epochs. The most frequently used strategy was monitoring the quality of practice and the least frequently used strategy was utilising a support person to facilitate practice. Conclusion Coaching that may promote perseverance with practice was regularly used by therapists during hospital-based rehabilitation sessions. Coaching that may enable longer-term perseverance beyond a therapist-dependent rehabilitation model was less commonly observed.

Background: Although interprofessional student led health clinics have been implemented worldwide, the impact of this model await confirmation. Objectives: To conduct a critical analysis of the literature on interprofessional student led clinics, and the views of stakeholders on feasibility and the barriers and facilitators to implementation. Design: A scoping review, evidence synthesis and quality appraisal were conducted using PRISMA Scr. Eight databases were searched from 2003 to 2023: Medline (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, Scopus, ERIC, Web of Science and Informit Health Collection. A qualitative descriptive approach was used to analyse data from patients, students and educators and inductive thematic analysis identified emergent themes. Results: Forty-six studies were included from a yield of 3140 publications. A key theme to emerge was that patients perceived improvements in their health and wellbeing and valued gaining health information from student led clinics. Student experiences were mostly positive although some found it challenging to work in interprofessional teams and roles were not always clear. The clinics enabled students to improve communication skills and autonomy. Clinical educators reported that students benefited from experiential learning within an interprofessional context. The clinics were feasible, provided that sufficient funding, infrastructure, staff and resources were available. Barriers to implementation included lack of funding, excessive waiting times and non-aligned student timetables. Pre-clinic orientation and support from on-site clinical educators facilitated implementation. Conclusions: Despite some challenges with implementing interprofessional student led clinics, they can have a positive impact on student learning and patient experiences.

PURPOSE The aim of this study was to explore factors that influence stroke survivors' ability to persevere with home-based upper limb practice. METHODS A qualitative descriptive study embedded within a theoretical framework was conducted. Data were collected through semi-structured focus group, dyadic, and individual interviews. The Theoretical Domains Framework and Capability, Opportunity, Motivation - Behaviour (COM-B) model guided data collection and directed content analysis. FINDINGS Participants were 31 adult stroke survivors with upper limb impairment, with 13 significant other/s, who were living at home in Queensland, Australia. Three central tenants aligned with the COM-B and six themes were identified. Stroke survivors' capability to persevere was influenced by being physically able to practice and being able to understand, monitor and modify practice, their opportunity to persevere was influenced by accessing therapy and equipment required for practice and fitting practice into everyday life, and their motivation to persevere was influenced by having goals and experiencing meaningful outcomes and having support and being accountable. CONCLUSION Persevering with practice is multifaceted for stroke survivors. All facets need to be addressed in the design of strategies to enhance stroke survivors' ability to persevere and in turn, enhance their potential for continued upper limb recovery.IMPLICATIONS FOR REHABILITATIONMany stroke survivors do not persevere with long-term home-based upper limb practice despite the belief that high dose practice will promote continued recovery.Therapists need to support stroke survivors to setup individualised goal-based home programs that they can complete independently, or with support, within their everyday life.Stroke survivors need coaching to monitor and modify their practice and map their progress, so that they can recognise and experience meaningful recovery.To optimise upper limb recovery after stroke, strategies to enhance stroke survivors' capability, opportunity, and motivation to persevere across the continuum of recovery, need to be co-designed by stroke survivors, therapists and researchers.

Background and purpose: Individuals with multiple sclerosis (MS) want health advice regarding participation in their choice of exercise. To address this need, a flexible exercise participation programme (FEPP) was developed, underpinned by the MS aerobic exercise guidelines and supported by a physiotherapist using behaviour change techniques. The aim of this study was to investigate the feasibility of the FEPP for individuals with minimal disability from MS. Methods: A feasibility study utilising a single group pre/post-intervention design was conducted. The 12-week FEPP was completed by 10 individuals with MS (EDSS 0-3.5). Exercise progression in duration, intensity or frequency of exercise (in line with MS exercise guidelines) was guided by a self-perceived weekly energy level score, and weekly telephone coaching sessions using behavioural change techniques. Trial feasibility was assessed via measures of process (recruitment and retention), resources/management (communication time; data entry) and scientific feasibility (safety; compliance). Secondary FEPP feasibility outcomes included the Goal Attainment Scale (GAS) T-score, exercise participation (weekly exercise diary), high-level mobility (HiMAT), vitality (Subjective Vitality Scale), biomarkers for inflammation (cytokines levels [IL2, IL4, IL6, IL10, TNF and IFN gamma]), and acceptability (participant survey). Results: Process: In total, 11 (85%) of 13 eligible participants enroled at baseline with 10 (91%) completing the study. Resources/management: Coaching sessions included a baseline interview-mean 39 min (SD: 6.6) and telephone coaching-mean 10 min (SD: 3.8) per week. Outcome measure data collection time-mean 44 min (SD: 2.1). Scientific feasibility: Two participants experienced a fall during their exercise participation. Self-reported compliance was high (99%). GAS T-scores increased significantly, indicating achievement of exercise participation goals. Secondary outcomes showed trends towards improvement. Discussion: The FEPP was feasible, safe and highly acceptable for use with individuals with MS and warrants a larger trial to explore effectiveness.

Spinal cord infarction is rare, often with a sudden onset of symptoms including bladder and bowel dysfunction, paralysis and sensory disturbances. This case reports the efficacy of a therapeutic exercise program as a non-invasive functional treatment for urinary incontinence and reports its results. It describes a 67-year-old woman who experienced a T10‑L1 anterior spinal cord infarction living with residual urinary incontinence and lower limb sensory and strength deficits. This paper explains the overflow effect of high volume exercise prescribed to address urinary incontinence symptoms resulting from spinal cord infarction. It highlights the potential use of co‑contraction techniques in the conservative management of neurogenic lower urinary tract symptoms.

OBJECTIVE The objective of this study is to measure the activity levels of patients admitted to adult general inpatient rehabilitation units in regional areas. These included physical, social, cognitive and self-care activities. A secondary aim was to explore differences in activity levels across different diagnostic groups. DESIGN An observational study using behavioural mapping. Patient activity was mapped every 15 minutes, over a 12-hour period (07:00-19:00), on two, non-consecutive days. SETTING 2 inpatient rehabilitation units, inner regional NSW. PARTICIPANTS All patients were admitted for rehabilitation in an adult general rehabilitation unit. Patients presented with diverse diagnoses (eg neurological, musculoskeletal, orthopaedic, pulmonary and cardiovascular diseases). The sample had a mean age of 74.4 years with a range of 33-96 years. MAIN OUTCOME MEASURES The percentage of the day spent in physical, cognitive or social activities was recorded. In addition, the patients' location and interacting personnel were recorded. RESULTS Fifty-six participants across 8 diagnosis groups were observed. A total of 2285 observations were made. Patients were observed being active physically for 10% of their day, socially active for 23%, and cognitively for 6%. Patients engaged in other activities such as watching TV or eating 21% of their time, and completing self-care activities 7% of their time. Patients were inactive for 27% of their day. There was no statistically significant difference between the diagnostic groups and activity categories. CONCLUSION Patients spent a large proportion of their time inactive and alone in rehabilitation. In order to maximise outcome, rehabilitation units can look at new opportunities to maximise activity and promote engagement.

Physical activity is recommended after stroke. However, the rehabilitation day is largely spent sedentary. Understanding patterns of physical activity across the rehabilitation week may help identify opportunities to improve participation. We aimed to examine: (1) differences between weekday and weekend sedentary time and physical activity, (2) the pattern of 24-h rehabilitation activity. Participants with stroke (n = 29) wore an activity monitor continuously during the final 7-days of inpatient rehabilitation. Linear mixed models (adjusted for waking hours) were performed with activity (sedentary, steps per day, walking time) as the dependent variable, and day type (weekday or weekend) as the independent variable. Patterns of upright time during the 24-h period were determined by averaging daily activity in 60-min intervals and generating a heat map of activity levels as a function of time. Participant mean age was 69 (SD 13) years (52% male) and mean National Institutes of Health Stroke Scale score was 7.0 (SD, 5.5). There was no significant difference in sedentary time between weekdays and weekends. At the weekend, participants spent 8.4 min less time walking (95% CI, -12.1 to -4.6) taking 624 fewer steps/day (95% CI, -951 to -296) than during the week. Activity patterns showed greatest upright time in the morning during the week. Afternoon and evening activities were low on all days. Sedentary time did not change across the 7-day rehabilitation week, but less walking activity occurred on the weekend. There are opportunities for stroke survivors to increase physical activity during afternoons and evenings and on weekend mornings during rehabilitation.

Background and Purpose: The flexible exercise participation program (FEPP) is a novel intervention developed to enable individuals with multiple sclerosis (MS) participate and progress in an exercise or sport of their choice. The FEPP is underpinned by guidelines on aerobic exercise for individuals with MS and is supported by a physiotherapist using behaviour change techniques. As part of a FEPP feasibility trial, the aim of this nested study was to explore the experience of participation in the FEPP from the perspective of individuals with MS. The objectives were to (i) determine the acceptability of the FEPP and (ii) identify recommendations for improvement. Methods: A mixed methods study using a sequential explanatory design was conducted. Part I consisted of a quantitative participant survey. Survey data were analysed descriptively using SPSS and informed the protocol for part II - qualitative interviews. Interview data were analysed thematically using NVivo. Part III consisted of integration of quantitative and qualitative data to allow greater explanation of survey responses. Individuals with MS who had participated in the FEPP feasibility trial were invited to take part in the study. Results: The FEPP was highly acceptability to the 10 participants. Five themes emerged to describe the experience of participating in the FEPP: (i) exploring exercise boundaries, (ii) measuring energy, (iii) acknowledging accountability, (iv) adjusting to exercising in a pandemic and (v) sustaining participation. Recommendations for improving the FEPP included changes to energy level monitoring and incorporation of peer support mechanisms. Discussion: Participants found the FEPP highly acceptable and valued the flexibility to choose their own activity and the health professional support. Based on participant recommendations, future versions of the FEPP will include daily rather than weekly monitoring of exercise and peer support to further enable individuals with MS to find the right balance with exercise and sport.

IntroductionIndividuals with minimal disability from multiple sclerosis (MS) requested advice on finding the right balance, between too much and too little exercise, when participating in their choice of sport or exercise. To optimise exercise participation during the early stages of the disease, a flexible exercise participation programme (FEPP) has been developed. The FEPP is novel because it provides guidance and support for individuals with MS to participate and progress in their preferred sport or exercise. The primary objective was to assess the feasibility of the FEPP. The secondary objective was to assess the feasibility of a larger trial to demonstrate the efficacy of the FEPP.Methods and analysisA stage I feasibility study of the FEPP, using a single group preintervention/post-intervention design, will be conducted with 16 participants with minimal disability from MS (Expanded Disability Status Scale level of 0–3.5). The 12-week FEPP will guide participants to independently participate in their preferred sport or exercise at a location of their choice. Exercise progression will be guided by individual energy levels and a weekly telephone coaching session with a physiotherapist. Participation in exercise or sport will be recorded in parallel with assessment of disease biomarkers (plasma cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, interferon (IFN)-γ and tumour necrosis factor (TNF)), subjective vitality and high-level mobility. Acceptability of the FEPP will be assessed using a sequential explanatory mixed methods design where the findings of a participant survey will inform the interview guide for a series of focus groups.Feasibility of a larger trial will be assessed via process, resources, management and scientific metrics. Progression to a larger trial will depend on the achievement of specified minimum success criteria.Ethics and disseminationEthical approval has been obtained for this study from the James Cook University Human Research Ethics Committee (H7956). Dissemination of findings is planned via peer-reviewed journals, conference presentations and media releases. The protocol date was 21 December 2019, V.1.Trial registration numberThe trial is registered with Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000076976.

Objective To investigate the effect of exercise on high-level mobility (i.e. mobility more advanced than independent level walking) in individuals with neurodegenerative disease. Data sources A systematic literature search was conducted in Medline, CINAHL, Scopus, SportDiscus and PEDro. Study selection Randomised controlled trials of exercise interventions for individuals with neurodegenerative disease, with an outcome measure that contained high-level mobility items were included. High-level mobility items included running, jumping, bounding, stair climbing and backward walking. Outcome measures with high-level mobility items include the High Level Mobility Assessment Tool (HiMAT); Dynamic Gait Index; Rivermead Mobility Index (RMI) or modified RMI; Functional Gait Assessment and the Functional Ambulation Category. Study appraisal Quality was evaluated with the Cochrane Risk of Bias Tool. Results Twenty-four studies with predominantly moderate to low risk of bias met the review criteria. High-level mobility items were included within primary outcome measures for only two studies and secondary outcome measures for 22 studies. Eight types of exercise interventions were investigated within which high-level mobility tasks were not commonly included. In the absence of outcome measures or interventions focused on high-level mobility, findings suggest some benefit from treadmill training for individuals with multiple sclerosis or Parkinson’s disease. Progressive resistance training for individuals with multiple sclerosis may also be beneficial. With few studies on other neurodegenerative diseases, further inferences cannot be made. Conclusion Future studies need to specifically target high-level mobility in the early stages of neurodegenerative disease and determine the impact of high-level mobility interventions on community participation and maintenance of an active lifestyle.Systematic review registration number PROSPERO register for systematic reviews (registration number: CRD42016050362).

Restricted accessAbstractFirst published online August 5, 2019Abstracts Presented at the SMART STROKES 2019 Conference, 8–9 August 2019, Hunter Valley, NSWVolume 14, Issue 1_supplhttps://doi.org/10.1177/1747493019858233

Aim: To measure the physical, cognitive and social activity levels of patients admitted to rehabilitation units in regional areas. A secondary aim was to explore differences in activity levels across different diagnostic groups. Design: An observational study using behavioural mapping was conducted in two inpatient general rehabilitation wards, at regional hospitals in NSW. Patient activity was mapped every 15 minutes, over a 12-hour period, on two, nonconsecutive days. The percentage of the day spent in physical, cognitive or social activities was recorded. In addition, the patients' location and interacting personnel were recorded. Results: Fifty-six participants across the following diagnostic groups were observed: stroke, brain injury, neurological, spinal cord injury, orthopaedic, reconditioning, pain and other. A total of 2285 observations were made. Patients were observed being active physically for 12.5% of their day, socially for 23.6%, and cognitively for 7.6% of their day. Patients were observed engaged in no-activity 29.3% of their day. There was no statistically significant difference between the diagnostic groups and activity categories. The majority of time patients were in their bedroom (74.9%) and alone (51.6%). Conclusion: Patients can spend a large proportion of their time inactive and alone in rehabilitation. In order to maximise outcome, rehabilitation units can look at new opportunities to maximise activity and promote engagement. Enriching rehabilitation environments is an area for future study. Key Practice Points: • Opportunities exist to increase the amount of time patients in rehabilitation are engaged in physical, social and cognitive activity.

Objectives Machado-Joseph disease (MJD) is the most common spinocerebellar ataxia worldwide. Prevalence is highest in affected remote Aboriginal communities of the Top End of Australia. Aboriginal families with MJD from Groote Eylandt believe ‘staying strong on the inside and outside’ works best to keep them walking and moving around, in accordance with six key domains that form the ‘Staying Strong’ Framework. The aim of this current study was to review the literature to: (1) map the range of interventions/strategies that have been explored to promote walking and moving around (functional mobility) for individuals with MJD and; (2) align these interventions to the ‘Staying Strong’ Framework described by Aboriginal families with MJD. Design Scoping review. Data sources Searches were conducted in July 2018 in MEDLINE, EMBASE, CINAHL, PsychINFO and Cochrane Databases. Eligibility criteria for selecting studies Peer-reviewed studies that (1) included adolescents/adults with MJD, (2) explored the effects of any intervention on mobility and (3) included a measure of mobility, function and/or ataxia were included in the review. Results Thirty studies were included. Few studies involved participants with MJD alone (12/30). Most studies explored interventions that aligned with two ‘Staying Strong’ Framework domains, ‘exercising your body’ (n=13) and ‘searching for good medicine’ (n=17). Few studies aligned with the domains having ‘something important to do’ (n=2) or ‘keeping yourself happy’ (n=2). No studies aligned with the domains ‘going country’ or ‘families helping each other’. Conclusions Evidence for interventions to promote mobility that align with the ‘Staying Strong’ Framework were focused on staying strong on the outside (physically) with little reflection on staying strong on the inside (emotionally, mentally and spiritually). Findings suggest future research is required to investigate the benefits of lifestyle activity programmes that address both physical and psychosocial well-being for families with MJD.

Abstract Background Erectile dysfunction (ED) and premature ejaculation (PE) often have underlying musculoskeletal abnormalities. Despite this, traditional management has focused on pharmaceutical prescription. Objective To investigate the efficacy of pelvic floor muscle training in treating ED and PE. Data sources A computerized literature search of CINAHL ® , Cochrane, InFormit, Ovid Medline, Pedro, and Scopus (from inception until January 2018) was conducted of type of dysfunction and intervention. Secondary search strategies included Medical Subject Headings expansion, hand searching of conference abstracts, key authors, reference lists and forward citation searching via Web of Science. Study selection All studies where participants were males greater than 18 years with ED or PE, with no history of neurological injury or previous major urological surgery were included. Study appraisal Two independent reviewers assessed methodological quality using the Crowe Critical Appraisal Tool. Disagreements between reviewers were resolved by consensus. Results Ten trials were included for review. Among the measures of ED, all trials showed comparative improvement and cure rates in response to treatment. Within PE outcomes, the majority of trials showed comparative improvement rates, with a greater range in overall cure rates in response to treatment. Training protocols varied significantly in overall therapist contact, concurrent interventions, intervention length, training frequency and intensity. Limitations The included studies were of low to moderate methodological quality with discrepancies in reporting. Study heterogeneity was not conducive to data pooling. Conclusion Pelvic floor muscle training appears effective in treating ED and PE; however, no optimal training protocol has been identified. Systematic Review Registration Number PROSPERO CRD42016047261.