The moderating effect of altruism on the relationship between occupational stress and turnover intentions: a cross-sectional study of community rehabilitation workers in China.

BACKGROUND: In China, community rehabilitation workers are facing a growing challenge related to heavy occupational stress, which is having an impact on employment turnover. Previous studies have explored the effect of the public service motivation of workers in "helping" jobs on occupational stress or turnover intention, but there is a lack of clarification of the impact of altruism on turnover intention in the case of complex pathways involving various factors. METHODS: A stratified sampling method was used, and a total of 82 community rehabilitation workers who assist disabled people from 34 community health centres in Jiangmen city were included in the study from August to October 2022. The turnover intention, occupational stress, burnout, quality of life, altruism, and certain sociodemographic information of community rehabilitation workers were measured using a structured questionnaire. The partial least squares method was employed to construct and test the structural equation model. RESULTS: Although altruism had no direct impact on occupational stress or turnover intention, altruism moderated the effect of occupational stress on burnout (ßMod = -0.208) and quality of life (ßMod = 0.230) and weakened the mediation of burnout and quality of life between occupational stress and turnover intention. CONCLUSIONS: This study proposes to address the dilemma of "strong function" and "weak specialty" in community rehabilitation services and to conduct positive psychological interventions for community rehabilitation workers through the guidance of altruistic values.

To be visible yet remain unseen: An interpretative phenomenological analysis of embodied drug use and recovery of Filipinas.

The experience of drug use is a gendered and culturally embodied phenomenon. This qualitative study aims to unpack the lived experiences of 16 urban, poor, Filipina mothers who used drugs. In-depth interviews were conducted. Data was analyzed using interpretative phenomenological analysis (IPA). Their experiences were divided into drug initiation and recovery. Key findings show embodied experiences of initiation through starting use, losing control, and navigating through public and private spaces of drug use. Their experiences of drug recovery revolved around decoupling relations, avoiding drug use spaces, and healing their strained home. Theoretically, this study contributes to enriching the analytical underpinnings of IPA through a gendered and embodied perspective. In terms of practical implications, findings point to the need for a gender-conscious approach in intervention design and implementation in the community setting considering the life space of Filipinas who use drugs.

Real-world environmental enrichment rehabilitation paradigm in people with severe traumatic brain injury: a pilot feasibility study.

BACKGROUND: The use of Environmental Enrichment (EE) has been widely studied in animal models. However, the application of the same in humans is limited to rehabilitation settings. OBJECTIVE: To investigate the feasibility of a community-based EE paradigm in adults with brain injury. METHODS: Six individuals diagnosed with traumatic brain injury enrolled in the study. The Go Baby Go Café instrumented with a body weight harness system, provided physical and social enrichment as participants performed functional tasks for 2 hours, three times a week, for 2 months. Feasibility and safety outcomes were recorded throughout sessions. Clinical measures including 10-meter walk, timed up and go, jebsen hand function, 6-minute walk, and trail making tests were obtained pre and post intervention. RESULTS: All participants completed the study. The attendance was 100% and adherence was 87%. Positive changes in clinical measures were statistically significant for the timed up and go (p = 0.0175), TUG-cognitive (p = 0.0064), 10-meter walk (p = 0.0428), six-minute walk (p = 0.0196), TMT-A (p = 0.034). Changes in JHFT were not significant (p = 0.0506), with one subject recording values counter to the trend. CONCLUSION: The Café was a comprehensive EE-based intervention that was feasible, safe, and has the potential to enhance motor and cognitive function in individuals with brain injury.

Cost modelling rehabilitation in the home for reconditioning in the Australian context.

BACKGROUND: Inpatient rehabilitation services are challenged by increasing demand. Where appropriate, a shift in service models towards more community-oriented approaches may improve efficiency. We aimed to estimate the hypothetical cost of delivering a consensus-based rehabilitation in the home (RITH) model as hospital substitution for patients requiring reconditioning following medical illness, surgery or treatment for cancer, compared to the cost of inpatient rehabilitation. METHODS: Data were drawn from the following sources: the results of a Delphi survey with health professionals working in the field of rehabilitation in Australia; publicly available data and reports; and the expert opinion of the project team. Delphi survey data were analysed descriptively. The costing model was developed using assumptions based on the sources described above and was restricted to the Australian National Subacute and Non-Acute Patient Classification (AN-SNAP) classes 4AR1 to 4AR4, which comprise around 73% of all reconditioning episodes in Australia. RITH cost modelling estimates were compared to the known cost of inpatient rehabilitation. Where weighted averages are provided, these were determined based on the modelled number of inpatient reconditioning episodes per annum that might be substitutable by RITH. RESULTS: The cost modelling estimated the weighted average cost of a RITH reconditioning episode (which mirrors an inpatient reconditioning episode in intensity and duration) for AN-SNAP classes 4AR1 to 4AR4, to be A$11,371, which is 28.1% less than the equivalent weighted average public inpatient cost (of A$15,820). This represents hypothetical savings of A$4,449 per RITH reconditioning substituted episode of care. CONCLUSIONS: The hypothetical cost of a model of RITH which would provide patients with as comprehensive a rehabilitation service as received in inpatient rehabilitation, has been determined. Findings suggest potential cost savings to the public hospital sector. Future research should focus on trials which compare actual clinical and cost outcomes of RITH for patients in the reconditioning impairment category, to inpatient rehabilitation.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions.

BACKGROUND: Chronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory. METHODS: Realist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory. RESULTS: Four contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client's home, skilled occupational therapists, and clients feeling ready for making changes. CONCLUSIONS: The ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings. TRIAL REGISTRATION: The trial was prospectively registered on www. CLINICALTRIALS: gov (registration date: 05/03/2020; identifier: NCT04295837 ) prior to data collection that occurred between August 2020 and October 2021.

Conceptualizing a Rehabilitation 'Model of Care' for Improving the Quality of Life of People with Parkinson's in India.

Given the rise in the elderly population and predicted increase in age-related diseases like Parkinson's disease, as well as the treatment gaps in Low-and-Middle-Income Countries (LMICs), there is an urgent need to develop a culturally and socioeconomically viable Parkinson's model of care that would be multidisciplinary, replicable, affordable, and accessible to those who need it the most. We present here an outline of a rehabilitation model of care, which incorporates a standardized group therapy format, community-based Parkinson's Support Centers, collaboration with local stakeholders to ensure sustainability, and active engagement of People with Parkinson's (PwPs) and caregivers (CGs) in rehabilitation programs. This model of care incorporates a unique 16-session multi-disciplinary community rehabilitation module for PwPs and CGs which is evidence-based, easily deliverable by non-medical facilitators, relevant to PwPs and CGs, adaptable to different groups, practical and beneficial, and effective in a group - format. This rehabilitation model of care, encompassing the multidisciplinary rehabilitation module, holds promise for implementation in LMICs due to its dynamic nature, cost-effectiveness, community-based approach and easy adaptability to telehealth platforms. We share our experience of developing the model and outline implications for practice and insights about community rehabilitation work in LMICs.

Patient reported experiences of community rehabilitation and/or support services for people with long term neurological conditions: a narrative review of quantitative studies.

Objectives: 1. To identify validated quantitative Patient Reported Experience Measures (PREM's) being used in Community Rehabilitation and/or Support services for people with long term neurological conditions (PwLTNC). 2. To explore how data from quantitative PREM's adds to research on patient experiences of Community Rehabilitation and Support for PwLTNC.Method: Eight data bases were searched for peer reviewed studies (2005-2021) which met inclusion criteria. Data extraction and quality assessment for sixteen studies was performed by two reviewers. Narrative synthesis was conducted.Results: Eleven validated PREM's were identified which captured data for 15,831 PwLTNC. PREM scores indicated positive and negative experiences for people with Multiple Sclerosis (n = 13,123), Parkinson's Disease (n = 2215) and Acquired Brain Injury (n = 493). Negative experiences related to Picker Institute Principles: 1 (accessibility); 3 (coordination/continuity); 4 (involvement/support for family and carers); 5 (information provision), 6 (Involvement in decision making) and 7 (empathy and emotional support).Conclusion: Quantitative PREM's provide evidence of process quality and person-centred care within community rehabilitation and support services across large data sets of heterogeneous neurological conditions and geographical locations. Quality improvement initiatives for people with MS, PD and ABI should target processes relating to Picker Institute Principles 1,3,4,5,6, and 7.Implications for RehabilitationQuantitative validated Patient Reported Experience Measures can be used to evaluate process quality and person- centred care within community rehabilitation and support services for people with long term neurological conditions.Experiences of people with Multiple Sclerosis, Parkinson's Disease and Acquired Brain Injury indicate the need for quality improvement in community rehabilitation.Training in communication skills and person-centred care may enhance information provision and support for self-management for people with long term neurological conditions.

Outcomes from a collaborative project developing and evaluating a community rehabilitation worker program for Northwestern Ontario First Nations.

INTRODUCTION: Major inequities exist in levels of health and wellbeing, availability, and access to healthcare services between seniors of Indigenous and non-Indigenous background in Ontario. First Nations elders are 45-55% more frail than the average senior in Ontario. Additionally, needed rehabilitation services are not easily accessible or available in the first language of most First Nations elders within their home communities. A literature review demonstrated community-based rehabilitation assistant models had been successfully developed and implemented in regions facing similar equity and access challenges. Building on these findings, a needs assessment was conducted to capture unique needs and requirements in Northwestern Ontario relating to rehabilitation among First Nations elders. METHODS: The needs assessment resulted in four First Nations, three Indigenous health organizations, three rehabilitation health organizations, and two academic institutions iteratively developing and evaluating curriculum for a Community Rehabilitation Worker (CRW) program in treaty territories 5, 9, and Robinson-Superior. The goal of the program is to train local CRWs, familiar with local languages and cultures, to provide rehabilitative services that support ageing in place, health, wellbeing, and quality of life for First Nations elders. The study employed a community participatory action research approach aligning with the OCAP® (Ownership, Control, Access, and Possession) framework for working with Indigenous populations. Seventeen community partners were active participants in the program development, evaluation, and adaptation of the CRW curriculum. Feedback was received through advisory committee meetings, surveys, and individual and group interviews. RESULTS: All 101 participants agreed, across all curriculum modules, that (1) the time allotment was realistic; (2) instructional materials, activities, and resources were appropriate and easy to understand; (3) evaluation activities accurately measured learning; and (4) participants identifying as Indigenous felt that Indigenous culture was adequately reflected. The qualitative findings highlighted the importance of incorporating culture, spirituality, traditions, local language use, and reintegration of First Nations elders into traditional activities and community activities for both the CRW curriculum and rehabilitation efforts. The need for locally available First Nations, elder-focused mental health support, transportation options, and gathering spaces such as those commonly seen in urban areas was also highlighted. CONCLUSION: The process of iteratively developing and evaluating a CRW program resulted in a Northwestern Ontario college welcoming the first cohort of students to the CRW program in March 2022. The program is co-facilitated with a First Nations Elder and includes components of local culture, language, and the reintegration of First Nations elders into community as part of the rehabilitation efforts. In addition, to appropriately support the quality of life, health, and wellbeing of First Nations elders, the project team called upon provincial and federal governments to work with First Nations to make available dedicated funding to address inequities in resources available to First Nations elders in Northwestern Ontario urban and First Nations remote communities. This included elder-focused transportation options, mental health services, and gathering places. The program implementation will be evaluated with the first cohort of CRWs for further adaptations considering potential scale and spread. As such, the project and findings may also represent a resource for others wishing to pursue similar development using participatory approaches in rural and remote communities both nationally and internationally.

Parental Perceptions on the Importance of Nutrients for Children with Autism Spectrum Disorder (ASD) and the Coping Strategies: A Qualitative Study.

Autism Spectrum Disorder (ASD) is a developmental disorder that comes with co-occurring eating behavior such as limited food varieties, selective food intake, and repetitive eating patterns, contributing to significant challenges for their parents. Many parents find mealtimes difficult and develop anxiety or stress about their child's nutrition, health, and overall well-being. Hence, parents must equip themselves with the correct awareness and nutrition knowledge. An online open-ended semi-structured interview was conducted among fifteen parents from the community-rehabilitation program center to explore their understanding of nutrition's importance and the possible coping strategies when facing challenges. The interview sessions were recorded, followed by three researchers' coding processes. Data were then subjected to thematic analysis. The interview sessions suggested that the parents were aware of the autism trait eating behavior and had a general knowledge about nutrition. However, it was quite challenging when it came to preparation. Nevertheless, the parents are able to manage the challenges with unique kinds of coping strategies. In addition, a complete educational dietary intervention program including psychosocial aspects for parents is recommended for better effectiveness.

Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia.

BACKGROUND: Reconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning. METHODS: A multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses. RESULTS: One-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each. CONCLUSIONS: Strong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost-benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.

Applying the ICF codes, flag model and C-OAR-SE in the development of return-to-work assessment scale for stroke survivors.

BACKGROUND: The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return-to-work among post-stroke survivors. OBJECTIVE: The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS. METHOD: The development of the RAS consisted of three phases: (i) Initial item generation (ii) Face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: 'C' [construct definition], 'OAR' [object representation, attribute classification, and rater entity identification], and 'SE' [selection of item type and answer scale, as well as, enumeration]. RESULTS: A triangulated approach drawn on three separate theories and models. Phase one was developed by using the flag model which provided the semi-structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return-to-work. CONCLUSION: An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.

"It gave her that soft landing": Consumer perspectives on a transitional rehabilitation service for adults with acquired brain injury.

Transitional rehabilitation service models for people with acquired brain injury (ABI) may address sub-optimal support for individuals returning home after hospitalization for ABI. This study investigated perspectives of people with ABI and close others who received transitional rehabilitation. A qualitative study involving semi-structured interviews with 10 individuals with ABI and 12 associated close others was conducted as part of a mixed-method evaluation of an Australian transitional rehabilitation service (TRS) pilot project. Thematic analysis based on the Framework method was conducted independently by two researchers. Three broad themes illustrated participants' experience of the TRS: (1) structure after hospital discharge; (2) a "soft landing"; and (3) equipped for community living. Findings suggest that home-based, interdisciplinary transitional rehabilitation after hospital discharge was perceived as an important stage of rehabilitation by participants. Valued features relate to post-hospital rehabilitation structure: a single point of contact to facilitate organization and information exchange, a known discharge destination, and consistent communication; support and therapy within a familiar home environment; and being equipped with relevant knowledge and strategies to manage ongoing challenges. Further research exploring the experiences of individuals with ABI without close family or social support, and research capturing longitudinal outcomes from transitional rehabilitation is recommended.

Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings.

BACKGROUND: The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings. OBJECTIVE: To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke. METHODS: Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety. RESULTS: ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively. CONCLUSION: CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion. PROTOCOL REGISTRATION NUMBER: PACTR202001714888482.

Mental Health Recovery Using the Individual Recovery Outcomes Counter (I.ROC) in a Community Rehabilitation Team: A Service Evaluation.

There are many definitions of recovery in mental health. Community Rehabilitation Teams (CRTs) aim to support the mental health recovery of people. The Individual Recovery Outcomes Counter (I.ROC) is a way to measure recovery. To determine if being supported by a CRT helps mental health recovery for people transitioning from an inpatient service to the community. Individual reliable and clinically meaningful change indices were calculated for a total of 31 people. Two I.ROC questionnaires were completed by 31 people. Of these 31 people, 14 people had three completed I.ROC questionnaires. Of the 31 people, 17 showed a positive reliable change and three people made a clinically meaningful change. Of the 14 people, one had a positive reliable change, two had a negative reliable change, and no-one had a clinically meaningful change. The I.ROC shows the CRT to successfully support recovery in people with mental health difficulties.

A Study Protocol for Persons With Neurological Diseases: Linking Rehabilitation Goals to the International Classification of Functioning, Disability and Health With a Focus on Assistive Technology for Cognition and Its Effects.

Persons with neurological diseases often have some degree of cognitive impairment. They are in need of assistive technology for cognition (ATC) to compensate for cognitive impairments that affect their daily functioning. Goal setting in relation to cognitive deficits using ATC are common in clinical practice, and therapists often set several rehabilitation goals together with a patient. However, these rehabilitation goals are usually phrased differently, which limit the comparison of ATC and rehabilitation goals. It is thus valuable to link the goals to some standardized terminologies, such as the International Classification of Functioning, Disability and Health (ICF). Furthermore, goal achievement is seldom used to evaluate long-term effects of ATC in persons with neurological diseases and limited attention has been paid to the factors that predict goal achievement in using the ATC as cognitive support in persons with neurological diseases. The aim of the project is 3-fold. Firstly, we will use the ICF to link rehabilitation goals regarding the use of ATC in adults with neurological diseases. Secondly, we will evaluate effects of the ATC using goal achievement over a 5-year period. Thirdly, we will explore the variables that predict goal achievement in relation to the effects of ATC.

Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background.

Introduction: Spinal cord injury (SCI) causes significant and permanent disability affecting motor, sensory and autonomic functions. We conducted a survey on the priorities of functional recovery and preferences for community rehabilitation services in a cohort of Chinese individuals with SCI as well as the primary caregivers. The study also investigated their views on advanced technology and research. Methods: An online platform with a self-administered questionnaire was used to collect the opinions of clients that received services from an SCI follow-up clinic, a self-help association, or a non-government organization from 1 September-31 December 2021. Results: Eighty-seven subjects (74 individuals with SCI-48 tetraplegic, 26 paraplegic, and 13 caregivers) responded to the survey. Recovery of arm/hand function was given the highest priority among tetraplegics, followed by upper trunk/body strength and balance, and bladder/bowel function. Sexual function had a significant lower ranking than all priority areas except normal sensation (p < 0.05). Paraplegics viewed bladder/bowel function as the most important area of functional recovery, followed by walking movement, upper trunk/body strength and balance, elimination of chronic pain, and regaining normal sensation. There was no statistically significant difference among the top priority areas (p > 0.05). In contrast to previous studies done in Western populations, the study revealed that sexual function was ranked as the lowest by all 3 groups of respondents (tetraplegics, paraplegics, and caregivers). The majority of participants thought community rehabilitation services were inadequate. Most of the respondents were interested to try advanced technology which would facilitate their daily life and rehabilitation. About half of the individuals with SCI thought advance in technology and research could bring significant improvement in their quality of life in the coming 10 years. Conclusion: This survey is the first study specifically looking into the recovery and rehabilitation priorities of a Chinese population of individuals with SCI. This is also the first study to investigate the priorities of the primary caregivers of SCI individuals. The findings are useful as a reference for planning of future research and provision of rehabilitation services for the SCI community locally and in other parts of China.

The Chaeli Campaign Journal Club: Strengthening evidence-based practice and contributing to practice-based evidence in under-resourced South African communities.

Background: The Chaeli Campaign is a Cape Town based non-profit organisation offering programmes largely for children and youth with disabilities in diverse under-resourced communities in South Africa. Their therapy team established a Health Professions Council of South Africa accredited interdisciplinary journal club in January 2012, with the aim to improve the team's service to the community. Objectives: Our first objective was to make our practice more evidence-based through reading systematically and critically in our field. Our second objective was to write up and share some of our practices to contribute to the generation of practice-based evidence. Method: First-person action research was applied. The core group of participants over time comprised two occupational therapists, one physiotherapist, two speech therapists, two teachers and four community development workers. Nine iterative cycles of planning, action, review and revised planning have been implemented on an annual basis in this non-formal, long-term action research project. Results: For over nine and a half years we have pre-read, discussed and completed evaluation questionnaires on 54 peer-reviewed journal articles, conducted 12 conference presentations and published three articles in accredited journals. Participants reported a broadened understanding of issues around disability, more reflective, contextually and culturally appropriate practice and improved interdisciplinary teamwork. Conclusion: The Chaeli Campaign journal club has built the capacity of therapists, teachers and community development workers to find, read, evaluate and use research evidence to improve their practice. It has also given participants the opportunity to ethically research, present and write up their grass roots interventions, thus contributing to locally applicable practise-based evidence. It is hoped that the sharing of our experience will assist and encourage other teams to start interdisciplinary journal clubs as a step towards facilitating two-way knowledge translation from evidence to practice and from practice to evidence.

Factors associated with willingness to receive a novel community care service for older people in Foshan, China: a cross-sectional study.

BACKGROUND: In China, the majority of community care for older people is planned and offered in a few large cities. The provision of community care to the rural population is a new concept. This study aimed to assess the prevalence of willingness to receive a novel community care service that incorporates community rehabilitation among older people, and identify the possible factors influencing utilization willingness in Foshan, China. METHODS: A cross-sectional study was conducted involving 413 older people in Lishui county, China from January to March 2021. Trained staff interviewed older people using structured questionnaires. Multivariate logistic regression analysis was used to determine factors that were significantly associated with the willingness to receive this novel community care. RESULTS: The prevalence of willingness to receive community care for older people was 61.9% (n = 245) in Foshan, China. Older people who were living alone or living with spouses were about two times significantly more likely to receive community care compared to those living with children/others (OR = 2.19, 95%CI:2.44 ~ 3.19, OR = 2.015, 95%CI: 1.39 ~ 2.23, respectively). Older people who lived closer to the community care center were about two times significantly more likely to receive community care compared to those who lived far away (OR = 2.10, 95%CI: 1.61 ~ 2.41). Older people with activity of daily living disability were about three times significantly more likely to receive community care compared to those without a disability (OR = 3.13, 95%CI: 2.38 ~ 3.29). CONCLUSIONS: A majority of rural older people were willing to receive this novel community care service that includes community rehabilitation. The findings suggest the need for policies and programs to not only improve the provision of this novel community care service but also promote its uptake among older people in the study setting.

Physiotherapists perceived role in managing anxiety in patients with relapsing-remitting multiple sclerosis: a mixed-methods study.

BACKGROUND: Anxiety is common for people with Multiple Sclerosis (PwMS) and is higher in those with relapsing-remitting MS (RRMS) and in community-based samples. Anxiety can impact self-efficacy, pain, fatigue, engagement in physical activity and treatment adherence, all of which influence the rehabilitation process. Little is known about how physiotherapists manage anxiety in PwMS and the challenges associated with anxiety throughout the rehabilitation process, in community and outpatient settings. METHODS: A mixed-methods design, combining a cross-sectional survey and semi-structured interviews with UK-physiotherapists, was used to answer the research question. To inform the qualitative study, a cross-sectional survey collected data from physiotherapists working in neurology to understand the impact and management of anxiety in people with MS (PwMS) during rehabilitation. Analysis used descriptive statistics and the findings formed the interview guide. Semi-structured interviews with specialist physiotherapists explored barriers and facilitators to managing anxiety in PwMS in community and outpatient settings, identified perceived physiotherapy training needs and offered suggestions to develop physiotherapy research and practice. Themes were derived inductively. RESULTS: The survey suggested how PwMS present with anxiety, its impact during rehabilitation, physiotherapy management practices, and physiotherapist skills and training needs. Five semi-structured interviews with specialist physiotherapists expanded on the survey findings and identified five main themes: Understanding the MS journey, modifying assessment and treatment, anxiety management toolbox, lagging behind Musculoskeletal Physiotherapy, and gaining knowledge and skills. CONCLUSION: Physiotherapists encounter anxiety in PwMS in community and outpatient rehabilitation and perceive they have a role in managing it as it presents. Facilitators included communication, listening skills and opportunities to develop strong therapeutic relationships. Poor training and support, lack of clinical guidelines and limited research evidence were considered barriers. Clinically relevant learning opportunities, interprofessional working, and greater support through clinical supervision is recommended to better develop physiotherapy practice.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators.

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.