Explore the vast range of titles available.

The needs of people with stroke and caregivers' change as they transition across the stroke care continuum from initial symptom onset to community living. Continuity of care interventions may support these changing needs. Continuity of care refers to care provided to individuals that is coherent, connected, and consistent across settings. Interventions have been developed to enhance continuity of care, but to date, no reviews have identified the core components of these interventions specific to various care transitions. To examine the literature on continuity of care interventions that address the needs of people with stroke and/or their caregivers specific to stroke care transitions. The study is guided by the Joanna Briggs Institute methodological framework for scoping reviews. The search will be conducted on Ovid MEDLINE, CINAHL Plus with Full Text, PsycINFO, and EMBASE, restricting to articles in English. Core concepts of stroke (e.g., ischemic or hemorrhagic stroke) and continuity of care (e.g., early supported discharge) and their synonyms will be used as search terms. Two reviewers will assess articles for inclusion. Data will be extracted and synthesised using quantitative descriptive analysis and deductive content analysis. A steering committee, consisting of people with lived experiences, researchers, and healthcare professionals, will discuss the charted data, and identify any gaps in the literature. This research will identify the components of continuity of care interventions, the specific transitions that they address, and any variability in components across different transitions. This research will identify gaps in the continuity of care literature such as where transition interventions are needed.

Rehabilitation is important for regaining mobility poststroke. Clinical practice guidelines suggest a high number of repetitive stepping activities to optimize subacute recovery especially when undertaken at intensities that challenge cardiovascular fitness. However, adherence to these guidelines is unclear. The objective of this study was to quantify aerobic minutes and step number in usual care inpatient stroke rehabilitation unit physical therapy sessions across Canada and identify characteristics of participants who met guideline aerobic intensity minutes at a session midpoint in their rehabilitation. To gain insight into usual care, we analyzed cross-sectional data from the usual care arm of the Walk 'n Watch implementation trial; trial sites included Canadian rehabilitation units that were not typically involved in research studies. To be included, medically stable patients were admitted for inpatient stroke rehabilitation, and able to take > 5 steps with a maximum of one person assisting. We assessed a midpoint physical therapy session with a wrist-based heart monitor (aerobic minutes) and ankle-based step counter (step number). Means, histograms, and correlations between aerobic minutes (> 40% heart rate reserve) and steps were calculated. There were 166 participants (69 females, age 69 standard deviation (SD)12 years) with stroke (138 Ischemic/ 27 Hemorrhagic) included. Participants had a mean of 10(SD11) aerobic minutes and 985(SD579) steps. The relationship between step number and aerobic minutes was negligible (R2 = 0.003). More participants with ≥20 aerobic minutes in a session were male, with lower 6 Minute Walk Test distance, and have a subcortical stroke location. The number of steps has increased, but aerobic minutes has not changed and remains extremely low compared to published reports in the past several years. Given that increasing activity levels are critical for stroke recovery, further investigation into the potential barriers to achieving targets set by guidelines is recommended. ClinicalTrials.gov NCT04238260.

Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke. In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18–85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912. The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 43·7 s [IQR 26·1–68·0] to 29·7 s [21·4–45·2], 32·0% reduction for VRWii vs 38·0 s [IQR 28·0–64·1] to 27·1 s [21·2–45·5], 28·7% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=0·70) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=0·60). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 4·1 s, 95% CI −14·4 to 22·6). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups. In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies. Heart and Stroke Foundation of Canada and Ontario Ministry of Health.

The objective of this study was to compare the outcomes of two tongue resistance training protocols. One protocol (“tongue-pressure profile training”) emphasized the pressure-timing patterns that are typically seen in healthy swallows by focusing on gradual pressure release and saliva swallowing tasks. The second protocol (“tongue-pressure strength and accuracy training”) emphasized strength and accuracy in tongue-palate pressure generation and did not include swallowing tasks. A prospective, randomized, parallel allocation trial was conducted. Of 26 participants who were screened for eligibility, 14 received up to 24 sessions of treatment. Outcome measures of posterior tongue strength, oral bolus control, penetration–aspiration and vallecular residue were made based on videofluoroscopy analysis by blinded raters. Complete data were available for 11 participants. Significant improvements were seen in tongue strength and post-swallow vallecular residue with thin liquids, regardless of treatment condition. Stage transition duration (a measure of the duration of the bolus presence in the pharynx prior to swallow initiation, which had been chosen to capture impairments in oral bolus control) showed no significant differences. Similarly, significant improvements were not seen in median scores on the penetration–aspiration scale. This trial suggests that tongue strength can be improved with resistance training for individuals with tongue weakness following stroke. We conclude that improved penetration–aspiration does not necessarily accompany improvements in tongue strength; however, tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.

Investigators evaluated the caregivers of patients who had received mechanical ventilation for at least 7 days in an ICU. Although there was a large burden of depressive symptoms soon after discharge, the burden diminished in magnitude, in most caregivers, during the subsequent year. Unpaid caregivers (typically family or close friends) are essential to the sustainability of North American health care systems, because their unpaid labor annually accounts for $27 billion in Canada and $642 billion in the United States. 1 , 2 More than half the patients who have received prolonged mechanical ventilation during a stay in the intensive care unit (ICU) and have survived to discharge continue to require assistance from a caregiver 1 year after ICU discharge. 3 Although caregiver assistance can be beneficial for patients, such care may have negative consequences for caregivers, including poor health-related quality of life, 4 emotional distress, 4 – 8 a . . .

Background Despite the proliferation of clinical research that can be used to inform Clinical Practice Guidelines there remain many areas where the number and quality of research studies vary widely. Using the Canadian Clinical Practice Guideline for Moderate-to-Severe Traumatic Brain Injury (MOD-SEV TBI) as an example, there is a lack of robust research evidence, derived from randomized controlled trials, meta-analyses, and systematic reviews to inform the recommendations. Randomized controlled trials in this field often have limitations, such as smaller sample sizes and gender and racial disparities in enrollment, that reduce the level of evidence they can provide. Notably, evidence is often lacking in the priority areas identified by people with lived experience (PWLE) and guideline end-users. Methods The Canadian Clinical Practice Guideline for MOD-SEV TBI rehabilitation is a Living Guideline that implemented a robust and replicable process to mitigate these issues. This process includes: 1. Identification of Priorities by PWLE of MOD-SEV TBI and Guideline End-Users; 2. Involvement of Diverse Multidisciplinary Expert Panels, Including PWLE; 3. Compilation, Review and Evaluation of Published MOD-SEV TBI Evidence; 4. Identification of Gaps in the Published Literature; 5. Formulation of Recommendations, Rigorous Grading of Available Evidence and Formal Voting; 6. Creation of Knowledge Translation and Mobilization Tools and 7. Publication of the Updated Living Guideline. Results Since 2014–15, the Canadian TBI Living Guideline has implemented and refined this process to produce high-quality expert consensus-based recommendations and knowledge translation and mobilization tools across 21 comprehensive domains of TBI rehabilitation. There are 351 recommendations in the current version of the Canadian TBI Living Guideline; 68% of these are primarily consensus-based recommendations. Developing a comprehensive guideline in areas where research may not be present or strong ensures that the Guideline is comprehensive and addresses the priority needs of clinicians and PWLE. Conclusions The use of robust, transparent, and replicable evidence reviews and expert consensus building process produces clinical guidelines that are relevant and applicable even when empirical data are lacking or absent. This process of developing consensus-based recommendations can be used to develop guidelines in other content areas and populations facing similar challenges.

Background Neurological disorders may negatively impact community integration and/or quality of life. Peer support has emerged as a potential strategy to enhance patients’ efficacy in managing their own health. This review examines the key characteristics and impact of peer support interventions for adults with acquired brain injury, cerebral palsy, and spina bifida on community integration and quality of life. Methods Eligible studies reported on peer support interventions for adults (16 years of age or older) with acquired brain injury, cerebral palsy, or spina bifida. Only randomized controlled trials published in English in the last 10 years were included. MEDLINE, EMBASE, PsycINFO, and CINAHL were used to conduct the literature search. Two reviewers independently screened studies, abstracted data, and evaluated the risk of bias (for individual study elements and overall) using the Cochrane Risk of Bias Tool. Results The systematic review included 6 trials reporting on acquired brain injury only. Of these studies, 4 reported on stroke and 2 reported on traumatic brain injury. Two studies found significant improvements in quality of life following peer support. No studies reported significant results on community integration. Considerable heterogeneity existed in the key characteristics of interventions. Conclusions There are a limited number of studies on the impact of peer support interventions for adults with acquired brain injury, cerebral palsy, or spina bifida on community integration and quality of life. Standardization of key intervention characteristics may aid the global adoption of peer support as a formalized, evidence-based practice.

This scoping review aimed to map existing research on adverse events encountered during telerehabilitation delivery, across rehabilitation populations. This includes identifying characteristics of adverse events (frequency/physical/non-physical, relatedness, severity) and examining adverse events by different modes of telerehabilitation delivery and disease states. Telerehabilitation, a subset of telemedicine, has gained traction during the COVID-19 pandemic for remote service delivery. However, no prior scoping review, systematic review, or meta-analysis has identified and summarized the current primary research on adverse events in telerehabilitation. Understanding adverse events, such as falls during physiotherapy or aspiration pneumonia during speech therapy, is crucial for identifying limitations and optimizing delivery through risk mitigation and quality indicators. This understanding could also help to improve the uptake of telerehabilitation among clinicians and patients. This review addresses this gap by summarizing published literature on adverse events during telerehabilitation. The review followed the Joanna Briggs Institute framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The review protocol was registered and published on Open Science Framework. A comprehensive search across multiple databases (MEDLINE ALL/EMBASE/APA PsycINFO/CENTRAL/CINAHL) was conducted. Screening, extraction, and synthesis were performed in duplicate and independently. Data extraction followed the Template for Intervention Description and Replication framework and also involved extraction on authors, publication year (pre- or post-COVID), population, sample size, and modes of telerehabilitation delivery (asynchronous, synchronous, hybrid). For synthesis, data were summarized quantitatively using numerical counts and qualitatively via content analysis. The data were grouped by intervention type and by type of adverse event. This scoping review included qualitative and quantitative studies published between 2013-2023, written in English, and conducted in any geographic area. All modes of telerehabilitation delivery were included. Systematic reviews, meta-analyses, commentaries, protocols, opinion pieces, conference abstracts, and case series with fewer than five participants were excluded. The search identified 11,863 references, and 81 studies were included in this review with a total of 3,057 participants (mean age:59.3 years; females:44.6%). Modes of telerehabilitation delivery (whether asynchronous, synchronous or hybrid) used in the studies included videoconferencing (52), phone calls (25), text messaging (4), email (6), mobile apps (10), and internet-based virtual reality systems (3). A total of 295 adverse events occurred during 84,534 sessions (0.3%), with the majority being physical (e.g., falls or musculoskeletal pain), non-serious/non-severe/mild, and unrelated to (i.e., not caused by) to the telerehabilitation provided. From the 81 included studies, telerehabilitation was delivered with related adverse events being rare, and mostly characterized as mild/non-severe. A comparable occurrence of adverse events (~30%) was found between asynchronous and synchronous telerehabilitation studies. When categorized by disease type, cardiac telerehabilitation studies had the most frequent adverse events. Detailed reporting of telerehabilitation interventions and adverse event characteristics is recommended for future studies (i.e., use of TIDieR reporting guidelines). Telerehabilitation has the potential to make rehabilitation services more accessible to patients; however, more evidence on the safety of telerehabilitation is needed.

People who sustain a concussion and live in remote areas can experience challenges in accessing specialized assessments. In these cases, virtual approaches to assessment are of value. There is limited information on important psychometric properties of physical assessment measures used to evaluate people postconcussion virtually. The aims of this method-comparison psychometric study were to determine (1) inter- and intrarater reliability of a battery of concussion physical tests administered virtually in people with brain injury and (2) sensitivity and specificity of the virtual battery when compared to the in-person assessment. A total of 60 people living with acquired brain injuries attended an in-person and virtual assessment at the Ottawa Hospital Rehabilitation Centre. The order of the assessments, in-person and virtual, was randomized. The following physical measures were administered in-person and virtually: finger-to-nose test, vestibular ocular motor screening (VOMS), static balance testing (double leg, single leg, and tandem), saccades, cervical spine range of motion, and evaluation of effort. The virtual assessment was recorded, and a second clinician viewed and independently documented findings from the recordings twice at 1-month intervals. The mean age of the participants was 45.65 (SD 16.50) years. The sensitivity metrics ranged from moderate (60%, 95% CI 30-86) to excellent (100%, 95% CI 71-100) for saccades and cervical spine right lateral flexion, respectively. Specificity ranged from 75%, 95% CI 35-95 to 100%, 95% CI 91-100 for left single leg stance eyes closed and left finger-to-nose testing, respectively. The interrater reliability ranged from poor for cervical spine extension (Cohen κ=0.20, 95% CI -0.07 to 0.47) to excellent for VOMS change in symptoms (Cohen κ=0.93, 95% CI 0.83-1). The intrarater reliability ranged from poor for cervical spine extension (Cohen κ=0.31, 95% CI 0.04-0.58) to excellent for the finger-to-nose testing on the right (Cohen κ=0.90, 95% CI 0.71-1). The wide CIs highlight variability in precision and suggest that further research with larger samples is needed before clinical use can be fully standardized. This study provides information on the psychometric properties associated with virtual administration of concussion measures. The VOMS change in symptoms measure appears to have the most promising properties when administered virtually when in-person visits are not possible. This is particularly relevant for patients in rural areas, for those facing access barriers, and in contexts where timely follow-up is challenging. However, caution should be maintained when administering certain concussion measures virtually. The wide CIs for some measures caution against over-reliance on single test findings, and clinicians should consider both the strengths and limitations of virtual delivery. Clinicians are encouraged to make informed decisions about which measures can be effectively used remotely, and which may still require in-person administration to maintain accuracy.

Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants' experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. RR2-10.2196/40446.