Low Genetic Impact of the Roman Occupation of Britain in Rural Communities.

The Roman period saw the empire expand across Europe and the Mediterranean, including much of what is today Great Britain. While there is written evidence of high mobility into and out of Britain for administrators, traders, and the military, the impact of imperialism on local, rural population structure, kinship, and mobility is invisible in the textual record. The extent of genetic change that occurred in Britain during the Roman military occupation remains underexplored. Here, using genome-wide data from 52 ancient individuals from eight sites in Cambridgeshire covering the period of Roman occupation, we show low levels of genetic ancestry differentiation between Romano-British sites and indications of larger populations than in the Bronze Age and Neolithic. We find no evidence of long-distance migration from elsewhere in the Empire, though we do find one case of possible temporary mobility within a family unit during the Late Romano-British period. We also show that the present-day patterns of genetic ancestry composition in Britain emerged after the Roman period.

Evaluation of a non-diagnostic 'Psychology of Emotions' group intervention within a UK youth IAPT service: a mixed-methods approach.

BACKGROUND: A novel CBT-based intervention, tailored for young people, was developed in response to concerns about traditional diagnostically based approaches. Psychology of Emotions workshops use a normative approach to emotional difficulty instead of a diagnostic framework. AIMS: To evaluate the acceptability and efficacy of Psychology of Emotions workshops within an IAPT service for young people aged 16-25 years. METHOD: This was a mixed-methods study, evaluating routinely collected self-report measures of depression and anxiety, and qualitative feedback forms. The main outcomes were rates of attendance, change in symptom severity, and participant views of the intervention. RESULTS: From January to September 2016, 595 young people were invited to attend the Psychology of Emotions workshops, of whom 350 (58.8%) attended at least one session. Young people who attended all six sessions (8.1%) experienced significant reductions in self-reported anxiety (d = .72) and depression (d = .58) and 35.5% were classified as recovered at completion. Those who attended at least two sessions (41.3%) reported smaller but significant improvements in anxiety (d = .42) and depression (d = .45); 22.0% were classified as recovered at the last session attended. Participants provided largely positive feedback about the intervention. CONCLUSION: Psychology of Emotions is a promising treatment option, delivered outside of a diagnostic framework, for young people with mild to moderate mental health difficulties seen within IAPT services. Better understanding reasons for non-attendance might enable the intervention to be made accessible to more young people.

Shared decision-making within goal-setting in rehabilitation: a mixed-methods study.

OBJECTIVES:: To assess the extent of shared decision-making within goal-setting meetings and explore patient-reported factors that influenced their participation to shared decision-making about their goals. DESIGN:: A two-phase explanatory sequential mixed-methods study, using questionnaires and interviews. SETTING:: A rehabilitation centre and patients' homes. SUBJECTS:: Frail elderly patients. MAIN MEASURES:: Quantitative data were collected after every patient's goal-setting meeting using the Multifocal Approach to Sharing in Shared Decision Making (MAPPIN'SDM) questionnaire that assesses competencies relevant to shared decision-making. Shared decision-making was rated by an observer, patients and staff and compared. Qualitative data were collected through semi-structured interviews. RESULTS:: A total of 24 rehabilitation team members and 40 patients (mean age: 83 years) participated. All study participants felt that competency 7a (the language used by staff made sense to the patient) was observed in all meetings. Patients reported that for 22 of the meetings competency 4a, the advantages and disadvantages of rehabilitation, was not discussed. Games-Howell tests for direction of differences between groups showed significant difference ( P = 0.001) between patients and staff in whether patients' problems were discussed. Nine patients' interviews suggested that motivation, self-confidence, family support, preparing themselves, getting information about goal-setting and rehabilitation options could enable them to participate in shared decision-making. They suggested that staff should communicate clearly and demonstrate that they are listening to patients but without a paternalistic approach. CONCLUSION:: Staff exhibited most shared decision-making competencies at a good level. However, patients highlighted problems with information sharing and felt staff might not be listening to them. Research and practice should explore tools to address these shortfalls.

East Anglian early Neolithic monument burial linked to contemporary Megaliths.

In the fourth millennium BCE a cultural phenomenon of monumental burial structures spread along the Atlantic façade. Megalithic burials have been targeted for aDNA analyses, but a gap remains in East Anglia, where Neolithic structures were generally earthen or timber. An early Neolithic (3762-3648 cal. BCE) burial monument at the site of Trumpington Meadows, Cambridgeshire, UK, contained the partially articulated remains of at least three individuals. To determine whether this monument fits a pattern present in megalithic burials regarding sex bias, kinship, diet and relationship to modern populations, teeth and ribs were analysed for DNA and carbon and nitrogen isotopic values, respectively. Whole ancient genomes were sequenced from two individuals to a mean genomic coverage of 1.6 and 1.2X and genotypes imputed. Results show that they were brothers from a small population genetically and isotopically similar to previously published British Neolithic individuals, with a level of genome-wide homozygosity consistent with a small island population sourced from continental Europe, but bearing no signs of recent inbreeding. The first Neolithic whole genomes from a monumental burial in East Anglia confirm that this region was connected with the larger pattern of Neolithic megaliths in the British Isles and the Atlantic façade.

Health inequality in medieval Cambridge, 1200-1500 CE.

Health inequality is not only a major problem today; it left its mark upon past societies too. For much of the past, health inequality has been poorly studied, mostly because bioarchaeologists have concentrated upon single sites rather than a broader social landscape. This article compares 476 adults in multiple locations of medieval Cambridge (UK). Samples include ordinary townspeople (All Saints), people living in a charitable institution (the Hospital of St. John), and members of a religious order (the Augustinian Friary). These groups shared many conditions of life, such as a similar range of diseases, risk of injury, and vertebral disk degeneration. However, people living on charity had more indicators of poor childhood health and diet, lower adult stature, and a younger age at death, reflecting the health effects of poverty. In contrast, the Augustinian friars were members of a prosperous, well-endowed religious house. Compared with other groups, they were taller (perhaps a result of a richer diet during their adolescent growth period); their adult carbon and nitrogen isotope values are higher, suggesting a diet higher in terrestrial and/or marine animal protein; and they had the highest prevalence of foot problems related to fashionable late medieval footwear. As this illustrates, health inequality will take particular forms depending upon the specificities of a social landscape; except in unusual circumstances where a site and its skeletal samples represent a real cross-section of society, inequality is best investigated by comparison across sites.

Ethics and applications of isotope analysis in archaeology.

This synthesis explores specific ethical questions that commonly arise in isotopic analysis. For more than four decades, isotope analysis has been employed in archeological studies to explore past human and animal dietary habits, mobility patterns, and the environment in which a human or animal inhabited during life. These analyses require consideration of ethical issues. While theoretical concepts are discussed, we focus on practical aspects: working with descendant communities and other rights holders, choosing methods, creating and sharing data, and working mindfully within academia. These layers of respect and care should surround our science. This paper is relevant for specialists in isotope analysis as well as those incorporating these methods into larger projects. By covering the whole of the research process, from design to output management, we appeal broadly to archaeology and provide actionable solutions that build on the discussions in the general field.

Genetic history of Cambridgeshire before and after the Black Death.

The extent of the devastation of the Black Death pandemic (1346-1353) on European populations is known from documentary sources and its bacterial source illuminated by studies of ancient pathogen DNA. What has remained less understood is the effect of the pandemic on human mobility and genetic diversity at the local scale. Here, we report 275 ancient genomes, including 109 with coverage >0.1×, from later medieval and postmedieval Cambridgeshire of individuals buried before and after the Black Death. Consistent with the function of the institutions, we found a lack of close relatives among the friars and the inmates of the hospital in contrast to their abundance in general urban and rural parish communities. While we detect long-term shifts in local genetic ancestry in Cambridgeshire, we find no evidence of major changes in genetic ancestry nor higher differentiation of immune loci between cohorts living before and after the Black Death.

Cognitive-behavioral prevention of postconcussion syndrome in at-risk patients: a pilot randomized controlled trial.

OBJECTIVE: To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS). SETTING: Tertiary rehabilitation center. PARTICIPANTS: Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury. DESIGN: Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist. MAIN MEASURES: Rivermead Postconcussion Symptoms Questionnaire. RESULTS: Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05). CONCLUSION: Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted.

The management of cognitive labour in same-gender couples.

OBJECTIVE: This study explored how cognitive labour as a form of unpaid, household labour is performed by people in same-gender couples. BACKGROUND: Excessive performance of unpaid labour has been associated with several health impacts. Cognitive labour (anticipating needs, identifying options for meeting needs, making decisions and monitoring progress) is an underexamined dimension of unpaid labour which has centered on the experiences of heterosexual couples. METHOD: Dyadic and individual interviews were carried out to explore how cognitive labour was performed in same-gender couples between March and October 2021 using an inductive methodology. Adults who were in a same-gender couple, had lived with their partner for at least six months, were not living with children were recruited largely via social media. RESULTS: Examining cognitive labour performance amongst same-gender couples revealed four key themes: 1) habitually fostered patterns of trust; 2) agency in redefining family; 3) barriers to cognitive harmony; and 4) facilitators to cognitive harmony. Findings regarding the relationships between themes are presented in a narrative model. Dyadic interviews allowed for deep, narratives relating to cognitive labour performance. CONCLUSIONS: The narrative model provides new conceptual understanding of how cognitive labour is performed outside of the heteronormative sphere. Couple's adoption of a strengths-based frame to cognitive labour performance removed the opposition inherent in gender dichotomies. These findings support calls for research to incorporate social change to build and refine theory, including how queer and feminist movements have challenged gendered and heteronormative family and household roles.

Changing the Underlying Conditions Relevant to Workplace Bullying through Organisational Redesign.

In view of the discrepancy between anti-bullying strategies used in organisations and knowledge of bullying that is grounded in the international scholarly literature, the aim of this study is to implement and evaluate an intervention program specifically targeting the root causes of workplace bullying by identifying, assessing, and changing the contexts of people management in which bullying arises. The present research describes the development, procedures, and co-design principles underpinning a primary intervention that is focused on improving organisational risk conditions linked to workplace bullying. Our study evaluates the effectiveness of this intervention using deductive and abductive approaches and multi-source data. Specifically, our quantitative analysis examines changes in job demands and resources as a central mechanism underlying how the intervention takes effect and provides support for job demands as a mediator. Our qualitative analysis expands the inquiry by identifying additional mechanisms that form the foundations of effective change and those that drive change execution. The results of the intervention study highlight the opportunity to prevent workplace bullying through organisational-level interventions and reveal success factors, underlying mechanisms, and key principles.

In Their Own Words: Sexual Assault Resistance Strategies Among Kenyan Adolescent Girls Following Participation in an Empowerment Self-Defense Program.

The purpose of this study was to examine, via testimonial data, resistance strategies used to thwart a sexual assault among slum-dwelling Kenyan adolescent girls (N = 678) following their participation in an empowerment self-defense program (IMpower). The majority (58.2%) of perpetrators were strangers; there were no differences in resistance strategies used between strangers versus known perpetrators (83.8% used verbal strategies, 33.2% used resistance strategies, 16.7% ran away, and 7.9% used distraction). Associations between resistance strategies and perpetrator tactics, number of assailants, location of the assault, and the presence of a bystander were also examined.

Ancient herpes simplex 1 genomes reveal recent viral structure in Eurasia.

Human herpes simplex virus 1 (HSV-1), a life-long infection spread by oral contact, infects a majority of adults globally. Phylogeographic clustering of sampled diversity into European, pan-Eurasian, and African groups has suggested the virus codiverged with human migrations out of Africa, although a much younger origin has also been proposed. We present three full ancient European HSV-1 genomes and one partial genome, dating from the 3rd to 17th century CE, sequenced to up to 9.5× with paired human genomes up to 10.16×. Considering a dataset of modern and ancient genomes, we apply phylogenetic methods to estimate the age of sampled modern Eurasian HSV-1 diversity to 4.68 (3.87 to 5.65) ka. Extrapolation of estimated rates to a global dataset points to the age of extant sampled HSV-1 as 5.29 (4.60 to 6.12) ka, suggesting HSV-1 lineage replacement coinciding with the late Neolithic period and following Bronze Age migrations.

Depression strongly influences postconcussion symptom reporting following mild traumatic brain injury.

OBJECTIVE: To examine the influence of depression on postconcussion symptom reporting in patients following mild traumatic brain injury (MTBI). PARTICIPANTS: Sixty patients referred to a specialty clinic following MTBI, 58 outpatients with Structured Clinical Interview for DSM-diagnosed depression, and 72 healthy community control participants. PROCEDURE: Participants with MTBI were divided into 2 subgroups on the basis of self-reported symptoms of depression (23 MTBI-depressed, 37 MTBI-not depressed). All participants completed a postconcussion symptom questionnaire. MAIN OUTCOME MEASURE: British Columbia Post-concussion Symptom Inventory. RESULTS: There were significant differences in total reported postconcussion symptoms among all 4 groups (all P < .002; Cohen's d = 0.68-3.24, large to very large effect sizes; MTBI-depressed > depressed outpatients > MTBI-no depression > healthy controls). There were significant differences in the number of symptoms endorsed (P < .05), with the highest number of symptoms endorsed by the MTBI-depressed group, followed by depressed outpatients, MTBI-no depression, and healthy controls. CONCLUSIONS: Patients who experience MTBIs and who have a postinjury recovery course complicated by significant depression report more postconcussion symptoms, and more severe symptoms, than (a) outpatients with depression, and (b) patients with MTBIs who do not have significant symptoms of depression.

Multi-tissue and multi-isotope (δ13 C, δ15 N, δ18 O and 87/86 Sr) data for early medieval human and animal palaeoecology.

Human isotopic ecology at its core aims to study humans as a part of their environments, as animals within an ecosystem. We are complex animals with complicated foodways and mobility patterns that are hard to address without large multifaceted data sets. As biomolecular data from archaeological remains proliferates scientists are now at the stage where we are able to collate large bodies of data and undertake complex meta-analyses and address the complexities of human ecology and past socioenvironmental dynamics. Here we present a data set of 862 entries of new primary isotopic data (37 faunal bone, 235 human enamel carbonate with a subset of 18 for 87/86 Sr, 347 human bone, 243 human bulk dentine) within a larger data set compiled from available legacy data. It contains a total of 8,910 isotopic entries from ancient humans and animals relating to diet and mobility from the late Roman period into the Middle Ages (c. 400-1200 AD). It includes carbon, nitrogen, oxygen, and strontium isotope ratios from human bone, human dentine, faunal bone, and human bioapatite from thousands of individuals, and hundreds of sites found across 26 modern countries in western Europe. Studies have previously focused on only one of these aspects, compiling data sets for one tissue, or common isotopic pairing, or focusing on a particular site or region at a smaller scale for multi-isotope multitissue studies. This is the largest and first multitissue, multi-isotope, multiproxy data set of its kind from premodern populations. In publishing this data set, we hope to inspire more synthetic and meta-analytical work on human isotopic ecology. Insights from these data should lead to greater understanding of diet, agriculture, climate change, human-animal interactions, mobility/migration, and much more in the past. It is hoped that these insights into past socioenvironmental dynamics will help inform current discourse on human-environmental interactions. There are no copyright or proprietary restrictions on the data; these data papers should be cited when these data are used in publications. Additionally, we would like to hear from other researchers who use these data sets in teaching or for their own research.

Ten-Year Results of the Triathlon Knee Replacement: A Cohort Study.

Introduction Studies evaluating the outcomes of different brands of knee prostheses are important to monitor patient outcomes and generate evidence to aid decisions around the choice of implant. The Triathlon® prosthesis (Stryker, Limerick, Ireland), one of the most commonly used total condylar knee prosthesis, is designed to provide greater knee motion and the potential for longer implant survivorship. The aim of this cohort study was to evaluate outcomes and survivorship of the Triathlon total knee replacement (TKR) up to 10 years post-operative. Methods Two-hundred sixty-six (266) patients listed for a Triathlon TKR in one orthopaedic hospital were recruited. Assessments were conducted preoperatively and then at three months and one, two, three, five, seven, and 10 years after surgery. Outcomes assessed included pain, function, knee-related quality of life (QoL), satisfaction, kneeling ability, activity levels, American Knee Society Score, complications, and survivorship. Results Large improvements in patient-reported outcomes were observed in the first three months after surgery, followed by small improvement up to one year post-operative, and then outcomes plateaued up to 10 years post-operative. Satisfaction with overall outcome ranged from 79%-94% over the duration of follow-up. Activity levels and kneeling ability were similar before and after surgery. There was a large improvement in the median American Knee Society score in the first three months post-operative, followed by a small but gradual improvement to 10 years post-operative. Survivorship was 95.4% (95% confidence interval 91.8-97.5%) at 10 years post-operative. Conclusions This study found that the Triathlon TKR results in excellent outcomes and survivorship to 10 years post-operative.

Health effects of climate change: an overview of systematic reviews.

OBJECTIVES: We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies' characteristics, climate impacts, health outcomes and key findings. DESIGN: We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available. DATA SOURCES: On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science. ELIGIBILITY CRITERIA: We included systematic reviews that explored at least one health impact of climate change. DATA EXTRACTION AND SYNTHESIS: We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors' affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies. RESULTS: We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research. CONCLUSIONS: Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.

Variability in long-term pain and function trajectories after total knee replacement: A cohort study.

INTRODUCTION: Previous research suggests that patient-reported outcomes plateau by one year after total knee replacement (TKR). Analysis of trajectories to date has predominately been based on changes in median/mean scores over the first post-operative year, rather than variability in trajectory patterns over the longer-term. The aim was to evaluate variability in long-term pain and function trajectories after TKR. HYPOTHESIS: There will be variability in long-term pain and function trajectories after TKR. PATIENTS AND METHODS: In all, 266 patients undergoing a Triathlon® TKR because of osteoarthritis were recruited from one orthopaedic centre. Participants completed the WOMAC Pain and Function scales preoperatively and then at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operative. Longitudinal analyses evaluated patterns of clinically meaningful change. RESULTS: Most patients had an improvement in pain and function during the first year post-operative; improvement was greatest in the first 3 months. By 1-year post-operative, 8% of patients had no change or a worsening of pain and 21% for function. Thereafter, approximately 15% of patients improved and 15% worsened between each assessment time. For those patients who had no change in symptoms from pre-operative to 1-year post-operative, one third had further improvement between 1 and 2 years post-operative. DISCUSSION: This study identified clinically meaningful variability in long-term outcomes after TKR, which could be discussed with patients to ensure they have realistic expectations of their outcome. Further research is needed to evaluate determinants of this variability and whether patients who will do poorly can be identified early in their recovery pathway. LEVEL OF EVIDENCE: IV, prospective cohort study.

Osteobiography: The History of the Body as Real Bottom-Line History.

What is osteobiography good for? The last generation of archaeologists fought to overcome the traditional assumption that archaeology is merely ancillary to history, a substitute to be used when written sources are defective; it is now widely acknowledged that material histories and textual histories tell equally valid and complementary stories about the past. Yet the traditional assumption hangs on implicitly in biography: osteobiography is used to fill the gaps in the textual record rather than as a primary source in its own right. In this article we compare the textual biographies and material biographies of two thirteenth-century townsfolk from medieval England-Robert Curteis, attested in legal records, and "Feature 958," excavated archaeologically and studied osteobiographically. As the former shows, textual biographies of ordinary people mostly reveal a few traces of financial or legal transactions. Interpreting these traces, in fact, implicitly presumes a history of the body. Osteobiography reveals a different kind of history, the history of the body as a locus of appearance and social identity, work, health and experience. For all but a few textually rich individuals, osteobiography provides a fuller and more human biography. Moreover, textual visibility is deeply biased by class and gender; osteobiography offers particular promise for Marxist and feminist understandings of the past.

Anterior or posterior walkers for children with cerebral palsy? A systematic review.

OBJECTIVE: To review the literature comparing use of anterior and posterior walkers (PW's) by children with cerebral palsy (CP) to determine which walker type is preferable. METHODS: Electronic databases were searched using pre-defined terms by two independent reviewers. Reference lists of included studies were hand searched. Studies published between 1985 and 2016 comparing use of anterior and PW's by children with CP were included. All study designs and outcomes were accepted. Risk of bias was assessed using the "Quality assessment standard for a cross-over study". Quality of evidence was evaluated using GRADE. RESULTS: Six studies were analysed. All studies had small sample sizes. A total of 4/6 studies were randomized. A total of 4/6 had high risk of bias. Outcomes included velocity, pelvic tilt, hip flexion, knee flexion, step length, stride length, cadence, double stance time, oxygen cost and participant/parental preference. Velocity, trunk flexion/pelvic tilt, and stability may be improved by using a PW, however, GRADE quality was very low for all outcomes and there was heterogeneity between studies. The majority of participants and parents preferred the PW. CONCLUSIONS: Heterogeneity and low quality of existing evidence prevented recommendation of one walker type. Well-designed studies with adequate power are needed to inform clinical recommendations. Implications for rehabilitation Clinical recommendations cannot be made for whether anterior or posterior walkers are preferable for children with cerebral palsy based on the existing evidence. Velocity, trunk flexion/pelvic tilt, and stability may be improved by using a posterior walker. The majority of walking aid users and their parents preferred posterior walkers. Adequately powered studies designed to minimize bias are needed.

Shared decision making within goal setting in rehabilitation settings: A systematic review.

OBJECTIVE: To map out and synthesise literature that considers the extent of shared decision-making (SDM) within goal-setting in rehabilitation settings and explore participants' views of this approach within goal-setting. METHODS: Four databases were systematically searched between January 2005-September 2015. All articles addressing SDM within goal-setting involving adult rehabilitation patients were included. The literature was critically appraised followed by a thematic synthesis. RESULTS: The search output identified 3129 studies and 15 articles met the inclusion criteria. Themes that emerged related to methods of SDM within goal-setting, participants' views on SDM, perceived benefits of SDM, barriers and facilitators to using SDM and suggestions to improve involvement of patients resulting in a better process of goal-setting. CONCLUSIONS: The literature showed various levels of patient involvement existing within goal-setting however few teams adopted an entirely patient-centred approach. However, since the review has identified clear value to consider SDM within goal-setting for rehabilitation, further research is required and practice should consider educating both clinicians and patients about this approach. PRACTICE IMPLICATIONS: To enhance the use of SDM within goal-setting in rehabilitation it is likely clinicians and patients will require further education on this approach. For clinicians this could commence during their training at undergraduate level.