Early Daily Activity: Development and description of an occupation-based intervention for surgically repaired distal radius Fractures.

OBJECTIVE: To describe the theoretical development and structure of an occupation-based intervention for people with a surgically repaired distal radius fracture. INTERVENTION DEVELOPMENT AND RATIONALE: The Early Daily Activity (EDA) intervention uses the performance of strategically selected daily activities as the primary rehabilitative strategy. Occupation-based interventions are recommended for hand injury rehabilitation but are often poorly described and lack explicit theoretical underpinnings. The EDA-intervention was developed from exploratory research that informed the theory and structure. The theoretical principles are that daily activity performance is (i) safe within defined parameters (ii) appropriately self-determined (iii) produces high ranges and amounts of therapeutic movement, and (iv) builds psychosocial competencies. INTERVENTION DESCRIPTION: The EDA-intervention is designed to be commenced within 2 weeks of surgery. There are three key components. The first is activity-specific education to emphasise the safety, benefits, and therapeutic actions of activity performance. A set of parameters for defining safe activities is described to support education. The second component is patient-therapist collaboration to select a range of daily activities that provide a 'just-right' challenge. Collaboration occurs at regular intervals throughout the rehabilitation period to incrementally increase the challenge of activities. The third component is performance of activities at-home targeted at improving range of movement and function. NEXT STEPS: The EDA-intervention can be used by hand therapists, but it has not yet undergone effectiveness evaluation. A planned study will explore clinician readiness to adopt the EDA-intervention, inform iterative changes to the protocol and the design of feasibility and effectiveness studies.

A six-month telerehabilitation programme delivered via readily accessible technology is acceptable to people following stroke: a qualitative study.

OBJECTIVE: To explore the experiences of participants during a six-month, post-stroke telerehabilitation programme. DESIGN: A qualitative descriptive study to investigate participant experiences of ACTIV (Augmented Community Telerehabilitation Intervention), a six-month tailored exercise programme delivered by physiotherapists primarily using readily accessible telecommunication technology. Semi-structured, in-depth interviews were used to collect data, which were analysed using thematic analysis. SETTING: Interviews conducted in participants' homes or a community facility. PARTICIPANTS: Participants were eligible if they had a stroke in the previous 18 months and had participated in ACTIV. RESULTS: Twenty-one participants were interviewed. Four key themes were constructed from the data: 1. 'ACTIV was not what I call physio' (it differed from participants' expectations of physiotherapy, but they reported many positive aspects to the programme). 2. 'There's somebody there' (ongoing support from the physiotherapists helped participants find strategies to continue improving). 3. 'Making progress' (in the face of barriers, small improvements were valued). 4. 'What I really want' (participant goals were frequently more general than therapy goals and involved progress towards getting back to 'normal'). CONCLUSIONS: Although ACTIV was not what participants expected from physiotherapy, the majority found contact from a physiotherapist reduced the feeling of being left to struggle alone. Most participants found a programme with minimal face-to-face contact augmented by phone calls and encouraging text messages to be helpful and acceptable. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registration Number: ACTRN12612000464864 CONTRIBUTION OF THE PAPER.

Randomised pragmatic waitlist trial with process evaluation investigating the effectiveness of peer support after brain injury: protocol.

INTRODUCTION: Traumatic brain injury (TBI) is an important global health problem. Formal service provision fails to address the ongoing needs of people with TBI and their family in the context of a social and relational process of learning to live with and adapt to life after TBI. Our feasibility study reported peer support after TBI is acceptable to both mentors and mentees with reported benefits indicating a high potential for effectiveness and likelihood of improving outcomes for both mentees and their mentors. OBJECTIVES: To (a) test the effectiveness of a peer support intervention for improving participation, health and well-being outcomes after TBI and (b) determine key process variables relating to intervention, context and implementation to underpin an evidence-based framework for ongoing service provision. METHODS AND ANALYSIS: A randomised pragmatic waitlist trial with process evaluation. Mentee participants (n=46) will be included if they have moderate or severe TBI and are no more than 18 months post-injury. Mentor participants (n=18) will be people with TBI up to 6 years after injury, who were discharged from inpatient rehabilitation at least 1 year prior. The primary outcome will be mentee participation, measured using the Impact on Participation and Autonomy questionnaire after 22 weeks. Primary analysis of the continuous variables will be analysis of covariance with baseline measurement as a covariate and randomised treatment as the main explanatory predictor variable at 22 weeks. Process evaluation will include analysis of intervention-related data and qualitative data collected from mentors and service coordinators. Data synthesis will inform the development of a service framework for future implementation. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the New Zealand Health and Disability Ethics Committee (19/NTB/82) and Auckland University of Technology Ethics Committee (19/345). Dissemination of findings will be via traditional academic routes including publication in internationally recognised peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12619001002178.

Reflecting on challenges and opportunities for the practice of person-centred rehabilitation.

OBJECTIVES: To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. CHALLENGES: Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. OPPORTUNITIES: Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. CONCLUSION: Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.

Inpatient trial of a tablet app for communicating brain injury rehabilitation goals.

PURPOSE: We examine the use of a custom iPad application, the Rehab Portal, to provide clients in an inpatient brain injury rehabilitation service with access to short videos where clinicians-or the clients themselves-discuss their current rehabilitation goals. MATERIALS AND METHODS: We developed an initial version of the Rehab Portal app based on our previous co-design with service users, their families, and clinicians. This was examined in a field trial with a series of six clients over the course of their stays in inpatient rehabilitation, collecting quantitative data on clinician and client engagement with the Rehab Portal, alongside a thematic analysis of qualitative interviews with clients and clinicians at the point of discharge. RESULTS: Engagement with the platform was high for two clients while it was limited with four more. In our thematic analysis we discuss how introduction of the Rehab Portal disrupted practice, changing how things are done, causing deviation from usual routines, adding burden, and threatening professional integrity. At the same time, where it worked well it led to a repositioning of goal planning away from being clinician directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Finally, in some cases we identified a reverting to the status quo, with client demotivation having an unexpected impact on clinician behaviour leading to the process being abandoned. CONCLUSIONS: The current findings do not provide wholesale support for this approach, yet we continue to feel that approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation.IMPLICATIONS FOR REHABILITATIONThe use of a novel technique to communicate rehabilitation goals via video disrupted practice, changed how things are done, caused deviation from usual routines, added burden, and threatened professional integrity for clinicians.Where it worked well it led to a repositioning of goal planning away from being clinician-directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families.Approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation.

Perceptions of a self-guided web-based exercise programme for shoulder pain after spinal cord injury: A qualitative study.

STUDY DESIGN: Qualitative study. OBJECTIVES: The benefits of exercise to reduce shoulder pain in people with spinal cord injury (SCI) are well documented. Digital health interventions offer a potential solution to overcome barriers to access rehabilitation support for exercise. The aim of this project was to gain people's perspectives to inform the development of a self-guided web-based exercise intervention. Shoulder Pain Intervention delivered over the interNet (SPIN) is a self-guided web-based intervention to prescribe, monitor, and progress evidence-based exercises for people living with SCI and shoulder pain. SETTING: Community in Auckland, New Zealand. METHODS: The Person-Based Approach was used as the framework. Using an Interpretive Descriptive methodology, data were collected in individual and focus group interviews, exploring participants' perceptions of this intervention idea. Data were analysed using conventional content analysis. RESULTS: Sixteen participants took part and asked Is it right for me?. This had three main sub-themes. Should I use it?, whether I believe it will work for me right now; Can I use it?, whether I can operate the intervention competently and confidently and Will I use it?, whether it will be responsive to my unique needs, and keep me coming back. CONCLUSIONS: Participants expressed their expectations and tipping points when considering using an intervention like this. These findings will inform and guide design and development of an acceptable technology-based intervention to increase the likelihood of engagement with a self-guided web-based exercise programme. The model developed from these themes could be used to inform future self-guided intervention development.

An evaluation of wrist and forearm movement during purposeful activities and range of movement exercises after surgical repair of a distal radius fracture: A randomized crossover study.

PURPOSE: Following surgical repair of distal radius fractures, range of movement (ROM) exercises are the primary approach for restoring movement during early rehabilitation. Specified purposeful activities can also be used, but the movement produced by activities is not well-understood. The study aimed to evaluate and compare movement during purposeful activity and ROM exercises METHODS: Thirty-five adults with a surgically repaired distal radius facture undertook two 10-minutes interventions: purposeful activity (PA) and active ROM exercises (AE), separated by a 60 minute washout, in random order. Data collection occurred during a single session on the same day. Electrogoniometry was used to measure time-accumulated position (TAP), a global metric of movement range and amount, maximum active end range, movement repetitions, excursions >75% of available ROM, and active time. Data were analyzed using linear mixed and generalized linear mixed regression models. RESULTS: Purposeful activities selected were predominantly household or food preparation. TAP was significantly higher during AE than PA: -1878 [-2388, -1367], p ≤.001, for wrist extension/flexion. PA produced significantly greater movement repetitions for wrist extension/flexion and deviation, excursions beyond 75% of available ROM, and active time, than AE. During PA the wrist was extending/flexing a mean of 97% [92, 101], of the time, compared with 43% [40, 47], during AE. There were no significant differences in maximum end range for wrist extension between PA, 33.7° [29.8, 37.5] and AE, 34.5° [30.7, 38.4], or for ulnar deviation. CONCLUSIONS: ROM exercises produced higher volumes of sustained joint position than purposeful activity but activities, selected for importance and challenge, produced significantly higher volumes of continuous, repetitious motion in equivalent ranges of movement as exercise repetitions. The study challenges therapists to consider the rehabilitative potential of movement produced by activity for restoring movement and function in the early postoperative weeks.

The effectiveness of peer-led interventions to improve work-related psychosocial outcomes and reduce turnover of support workers in residential aged care: A systematic review and meta-analysis.

Background: Support workers are central to the delivery of residential aged care, but the workforce is facing increasing work demands and widespread shortages. This contributes to high rates of burnout, decreased job satisfaction and high staff turnover. Peer-led interventions are reported to be effective but it is necessary to use evidence-based interventions to support this key workforce group. Objective: This study aimed to evaluate the scientific evidence on effectiveness of strategies improving psychosocial and turnover-related outcomes for support workers in aged care that could be incorporated into a peer-led intervention. Design: Systematic review and meta-analyses of experimental and quasi-experimental studies. Setting: Residential aged care. Methods: A systematic literature review was conducted using MEDLINE (via PubMed), EMBASE (via Scopus), and CINAHL (via EBSCO). We included studies examining the effectiveness of workplace interventions aiming to reduce aged care support workers' turnover rates and/or improve their work-related psychosocial outcomes (such as work stress, job satisfaction, self-esteem, and other). A number of meta-analyses using a mixed-effects model were performed to calculate standardized mean differences and odds ratios. Results: Fifty-one studies were included: 15 randomised controlled trials (RCTs), 19 non-RCTs and 17 Pre-Post studies. Most of the studies were rated as having 'high' or 'very high risk of bias'. The studies were clustered by intervention type: 1) knowledge-based, 2) interpersonal skills-based, 3) team-building, and 4) self-care. Knowledge-based interventions were the most used approach, with 26 studies in this category, and frequently reported improvements in stress- and satisfaction-related outcomes. There were twelve interpersonal skills-based and nine team-building interventions, which often reported decreased work stress, staff turnover, and intention to quit. There were four self-care interventions of which only one reported improvements in stress-related outcomes. Meta-analyses showed that only knowledge-based interventions resulted in statistically significant improvements: lower staff turnover rates (OR 0.47, 95 %CI: 0.37, 060), and higher scores for job/life satisfaction (SMD 0.26, 95 % CI: 0.05, 0.46) and staff attitude (SMD 0.23, 95 % CI: 0.05, 0.45). Conclusion: This review found numerous strategies that have been trialled to improve support workers' psychosocial- and turnover-related outcomes. Most studies reported improvements in outcomes. However, our meta-analyses suggest that the effect sizes were small and mostly non-significant, with the evidence being of low certainty. The evidence for effectiveness of knowledge-based interventions appears the most convincing, with statistically significant improvements reported for turnover rates, job/life satisfaction and staff attitude. More high-quality studies are needed to consolidate the existing evidence. PROSPERO registration number: CRD42017059007; 02 June 2017.Tweetable abstract: Knowledge-based interventions most promising in improving support workers' outcomes in aged care. #agedcare #staffturnover.

Flourishing together: research protocol for developing methods to better include disabled people's knowledge in health policy development.

BACKGROUND: To positively impact the social determinants of health, disabled people need to contribute to policy planning and programme development. However, they report barriers to engaging meaningfully in consultation processes. Additionally, their recommendations may not be articulated in ways that policy planners can readily use. This gap contributes to health outcome inequities. Participatory co-production methods have the potential to improve policy responsiveness. This research will use innovative methods to generate tools for co-producing knowledge in health-related policy areas, empowering disabled people to articulate experience, expertise and insights promoting equitable health policy and programme development within Aotearoa New Zealand. To develop these methods, as an exemplar, we will partner with both tangata whaikaha Maori and disabled people to co-produce policy recommendations around housing and home (kainga)-developing a nuanced understanding of the contexts in which disabled people can access and maintain kainga meeting their needs and aspirations. METHODS: Participatory co-production methods with disabled people, embedded within a realist methodological approach, will develop theories on how best to co-produce and effectively articulate knowledge to address equitable health-related policy and programme development-considering what works for whom under what conditions. Theory-building workshops (Phase 1) and qualitative surveys (Phase 2) will explore contexts and resources (i.e., at individual, social and environmental levels) supporting them to access and maintain kainga that best meets their needs and aspirations. In Phase 3, a realist review with embedded co-production workshops will synthesise evidence and co-produce knowledge from published literature and non-published reports. Finally, in Phase 4, co-produced knowledge from all phases will be synthesised to develop two key research outputs: housing policy recommendations and innovative co-production methods and tools empowering disabled people to create, synthesise and articulate knowledge to planners of health-related policy. DISCUSSION: This research will develop participatory co-production methods and tools to support future creation, synthesis and articulation of the knowledge and experiences of disabled people, contributing to policies that positively impact their social determinants of health.

The Effectiveness of Self-Guided Digital Interventions to Improve Physical Activity and Exercise Outcomes for People With Chronic Conditions: A Systematic Review and Meta-Analysis.

Objective: The aim of this systematic review was to determine the effectiveness of self-guided digital physical activity (PA) and exercise interventions to improve physical activity and exercise (PA&E) outcomes for people living with chronic health conditions. Digital health interventions, especially those with minimal human contact, may offer a sustainable solution to accessing ongoing services and support for this population. Methods: A comprehensive and systematic search was conducted up to December 2021, through seven databases, for randomized trials that evaluated the effect of self-guided web- or internet-based PA interventions on physical activity or exercise outcomes. Included studies had to have interventions with minimal human contact and interaction with participants needed to be automatically generated. All studies were screened for eligibility and relevant data were extracted. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool. Standardized mean differences and 95% confidence intervals (CI) were calculated. PA data were pooled, and forest plots were generated. Results: Sixteen studies met the eligibility criteria and included a total of 2,439 participants. There was wide variation in health conditions and intervention characteristics in mode and parameters of delivery, and in the application of theory and behavioral strategies. Self-reported PA in the intervention group was greater than controls at the end of the intervention [standardized mean difference (SMD) 0.2, 95% CI = 0.1, 0.3] and at follow up (SMD 0.3, 95% CI 0.2-0.5). The difference in objectively measured PA was small and non-significant (SMD 0.3, 95% CI -0.2 to 0.9). All interventions included behavioral strategies and ten of the sixteen were underpinned by theory. Conclusions: Self-guided digital PA&E interventions provided a positive effect on PA immediately after the intervention. An unexpected and positive finding was a sustained increase in PA at follow-up, particularly for interventions where the behavioral strategies were underpinned by a theoretical framework. Interventions with minimal contact have the potential to support sustained PA engagement at least as well as interventions with supervision. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42019132464.

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand.

BACKGROUND: Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanau (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. METHODS: Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whanau (family) centred initiative (Nga Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. DISCUSSION: AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. TRIAL REGISTRATION: The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).

Embedding the living well toolkit into service delivery - A complex process.

Objective: To embed the Living Well Toolkit package and to understand how it was implemented at each site and to explore the experiences of users. Methods: The toolkit package was introduced in four rehabilitation settings using a tailored implementation process negotiated with each site. The varied data sources were analysed drawing on directed content analysis. Results: Clients with neurological conditions and clinicians initially weighed the merits of the toolkit package. A positive weighing up was prerequisite for deciding to use. Clinicians described considerable thought and planning to make the toolkit package fit and flow in clinical practice. Users of the toolkit package described ways in which it shaped their thinking. Conclusion: Implementation of the toolkit package was a complex process for clinicians and services, involving ongoing work to optimise its impact relative to the client and context. Clinicians and clients who used the toolkit package described positive changes, congruent with person-centred communication. Innovation: The Living Well Toolkit is freely available for all to use. Clinicians who used reflective and responsive thinking to make the toolkit package work found it provided them with a broader perspective of the client.

What does real-world walking mean to people with stroke? An interpretive descriptive study.

PURPOSE: Understanding personal experiences of real-world walking for stroke survivors could assist clinicians to tailor interventions to their clients' specific needs. We explored the research questions: "What does real-world walking mean to people after stroke and how do they think it can be better?" METHOD: Using an Interpretive Descriptive methodology, we purposively sampled eight stroke survivors who reported difficulty walking in the real-world. We sought diversity on key participant characteristics. Participants were interviewed using a semi-structured guide. Data were analysed with thematic analysis. RESULTS: Many found real-world walking, particularly in the outdoors, created opportunities for freedom from dependence and a visible step by step progress, which generated hope for future recovery. Conversely, when participants did not experience sufficient progress, they expressed negative emotions. Participants strove to overcome challenges to their walking goals using everyday routines, planning skills, and confidence building experiences to motivate themselves. They also drew on, and extended, social resources highlighting the relational aspects of real-world walking. CONCLUSIONS: Walking in their real-world provided a meaningful, desirable, but challenging goal for participants that required significant emotional effort. Successful progress in real-world walking builds confidence and hope and can contribute to psychological wellbeing by providing opportunities for successful mastery and social connectedness.IMPLICATIONS FOR REHABILITATIONReal-world settings can be unpredictable which makes walking in the real-world after stroke demanding.Positive experiences of walking in the real-world can provide significant psychological benefits to stroke survivors.Many survivors need to carefully concentrate on the act of walking in outdoor settings.Pre-planning routes, confidence-building experiences and developing daily routines may help patients overcome these challenges.

Governing neurorehabilitation.

PURPOSE: Person centred approaches to rehabilitation are promoted as an ethical means of addressing paternalistic power relations in clinician dominated medical encounters and improving outcomes. However, they fail to account for the complex nature of power. We sought alternative ways to explain the use of power in health service provision. METHODS: A poststructural discourse analysis using the view of power offered by Michel Foucault was undertaken. Foucault's concept of governmentality is useful to explain the way health services deploy technologies of power to achieve objectives of the state. Governmentality refers to not just political structures but all the strategies and procedures for directing human behaviour. RESULTS: Our investigation uncovered a web of strategic relationships operating that were both potentially productive and problematic and illuminate how client centred approaches in neurorehabilitation intertwines its subjects in strategic power relationships that involve webs of obligations and responsibilities. CONCLUSION: The client-professional relationship promoted in neurorehabilitation as a moral way to practice can be a tool for mastery of one over the other, and assist the client to achieve their desired ends, but also has the potential to marginalise others who are unable to shape themselves into the desired ideal client.Implications for rehabilitationThis analysis shows how power is subtle and productive in that it produces knowledge and roles for both clients and practitioners.It demonstrates how neurorehabilitation's disciplinary practices assist the client to achieve their recovery goals.It reveals how certain clients might be marginalised when they cannot shape themselves into the ideal rehabilitation client.As a final point we hope that by being aware of how power works in neurorehabilitation, practitioners can become aware of opportunities for challenging disciplinary practices that do not serve the best interest of the client.

Person-Centered Rehabilitation Model: Framing the Concept and Practice of Person-Centered Adult Physical Rehabilitation Based on a Scoping Review and Thematic Analysis of the Literature.

OBJECTIVE: To develop a cross-professional model framing the concept and practice of person-centered rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature. DATA SOURCES: Key databases (PubMed, Scopus, Cumulative Index to Nursing and Allied Health), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual articles published from January 2007-February 2020. STUDY SELECTION: Two independent reviewers selected adult-based articles addressing at least 1 of the 6 categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual articles. DATA EXTRACTION: Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews. DATA SYNTHESIS: A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by 5 external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across 3 levels: (1) the person-professional dyad; (2) the microsystem level (typically an interprofessional team, involving significant others); and (3) a macrosystem level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR. CONCLUSIONS: The PCR Model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.

Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study.

Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, Seizing rehabilitation opportunities, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: Calming the mind, Reduced reactivity, Remedying physical symptoms, and Not quite there yet.Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.

A posthuman decentring of person-centred care.

In this paper, we examine person-centred care through a Deleuzian posthuman lens with the aim of exploring what becomes possible when the concepts of both person and care are de-centred. We do so through a consideration of the sets of relations that produce 'the client' in health care contexts. Our analysis maps particular entangled material-semiotic forces producing 'M/michael', a young man with a diagnosis of Duchenne muscular dystrophy, within a rehabilitation clinic. Drawing on Deleuzian notions of assemblage, affect, and becoming we explore 'person-care' as an active production that dynamically enacts persons-as-clients through clinical arrangements. Persons are thus reconceptualised in terms of locally produced subject positions and their care relations, rather than pre-existing beings who can be 'centred' within health services. Paradoxically, by de-centring persons and care, we work to conjure ways to strengthen the aspirations of person centredness to humanise health practices. In doing so, we consider different possibilities for re-imagining clinical work and contribute to debates regarding how healthcare conceptualises and addresses disability, health, and wellbeing. We suggest that such posthuman analyses can open up new ways of understanding and re/forming healthcare.

Understanding the therapeutic alliance in stroke rehabilitation.

PURPOSE: The quality of the therapeutic alliance between a client and their clinician is thought to play an important role in healthcare but there is limited research about this concept in stroke rehabilitation. This study explored the core components of a therapeutic alliance and the factors perceived to impact on its development in a stroke rehabilitation unit. METHODS: Interpretive description methodology was used to gather and synthesise participants' experiences of their therapeutic relationships. Ten individual client interviews and one clinician focus group were conducted. Data was were analysed using conventional content analysis. RESULTS: A therapeutic alliance appeared to consist of three overlapping core components: a personal connection, a professional collaboration, and family collaboration. Clients valued these components to different degrees and priorities could change over time. Alliance breakdowns were perceived to stem from a clinician's incorrect assumptions about their client's relationship preferences or lack of responsiveness to their needs. Recovery of the alliance seemed to depend on the strength of the pre-existing relationship and steps taken to repair it. CONCLUSIONS: Establishing and maintaining a therapeutic alliance appears to be an individualised and complex process. A clinician's ability to use their personal attributes therapeutically, and professional skills flexibly, appeared integral to relationship quality.IMPLICATIONS FOR REHABILITATIONDeveloping therapeutic relationships requires a person-centred and sometimes family/whanau-centred approach.The judicious use of self-disclosure may achieve emotional proximity and yet maintain professional boundaries.Maintaining relationship health requires a proactive approach to detect and manage relationship disruptions.

Scoping review of the person-centered literature in adult physical rehabilitation.

PURPOSE: To describe the amount, range, and key characteristics (e.g., publication years, methods, topics) of the person-centered rehabilitation literature in adults with physical impairments. METHOD: Following the published scoping review protocol, papers were identified through: three major databases, snowball searches and expert consultation. Two independent reviewers have identified English-language papers on adult person-centered rehabilitation according to six pre-defined inclusion categories - theoretical, quantitative and qualitive research papers are included; and then have extracted their key characteristics (e.g., aims, methods, participants). Descriptive statistics, regression and content analyses were used to synthesize the results. RESULTS: Of 5912 deduplicated records initially screened, 170 papers were included: 136 empirical, including 13 systematic reviews. Empirical papers had data from 15264 clients and 4098 providers, in total. Yearly publications grew significantly from 2009 to 2018 (r2 = 0.71; b = 1.98: p < 0.01). Publications were unevenly distributed by countries (e.g., United States' publications per population was 44 times lower than New Zealand's). Most papers focused in more than one profession, setting-type or health conditions. Finally, many empirical papers (n = 67) studied implementation of person-centered rehabilitation approaches, including its effect. CONCLUSION: This scoping review synthesizes key characteristics and publication trends in the person-centered rehabilitation literature on adults with physical impairments, a growing but unchartered territory thus far. This large and diverse body of literature can ground further person-centered rehabilitation practices and research, including toward building a transdisciplinary, trans-service model of person-centered rehabilitation.Implications for rehabilitationThe person-centered rehabilitation literature on adults with physical impairments, especially the empirical one, has been growing significantly over time, despite inequitably distributed per countries.Rehabilitation stakeholders, including practitioners, have a growing amount of literature in which they can rely for the operationalization and implementation of person-centered rehabilitation approaches into routine practice.Based on our work, person-centered rehabilitation emerges as a practice requirement that cuts across professional and other rehabilitation silos.