Disability and Rehabilitation

ObjectiveWe aimed to explore views of people with stroke regarding aerobic exercise participation during rehabilitation. DesignQualitative descriptive study informed by a pragmatic worldview. Setting and participantsPeople with stroke attended online or in-person one-on-one semi-structured interviews focused on their general attitudes about aerobic exercise, and their capability, motivation and opportunities to exercise that have or have not been provided during rehabilitation after stroke. Data analysisCodebook thematic analysis was performed by two independent coders. Results: Thirteen people, 2 to 10 months post-stroke participated in the interviews. Six themes were identified: 1) having an exercise program routine and trusting the physiotherapist during rehabilitation facilitated doing exercise ; 2) emotions can make exercise during rehabilitation more or less difficult; 3) limited physical ability post stroke leads to poor exercise self-efficacy and sense of control; 4) knowledge of what exercise is and its benefits affects perseverance in exercising during rehabilitation; 5) personal identity affects perseverance in doing exercises during rehabilitation; and 6) environmental factors facilitate exercise performance (consisting of two sub-themes of supportive social environment promotes exercise participation, and more resources (e.g., time, space, staff, other programs) facilitate exercising during and after rehabilitation). ConclusionsPeople with stroke are more likely to engage in aerobic exercise if it is incorporated into their treatment plan. This novel finding could help ensure physiotherapists prescribe aerobic exercise during stroke rehabilitation.

Purpose To explore patient and caregiver perspectives on factors influencing mobility during hospitalization after hip fracture surgery, and how these are experienced and negotiated in everyday hospital practice. Materials and methods A qualitative interview study informed by a hermeneutic-phenomenological perspective was conducted in a hospital setting in Denmark. Using purposive sampling with maximum variation, ten patients and nine caregivers were interviewed during hospitalization. Data were analyzed using reflexive thematic analysis following Braun and Clarke. Results Five interrelated themes were identified; (1) Body and mind in transition; (2) Communication as a prerequisite for safety and mobility; (3) Structural barriers and ambiguities in responsibility; (4) The physical environment and ward culture; and (5) Mobility as preparation for life after discharge. Across themes, mobility emerged as a socially shaped and negotiated practice through everyday interactions, communication, organizational routines, and situational support during hospitalization. Conclusions Mobility during hospitalization after hip fracture surgery emerged as a context-dependent and socially shaped practice rather than a purely physical task. These findings suggest that rehabilitation during hospitalization may need to attend not only to mobility prescription, but also to relational, communicative, and contextual aspects of everyday ward routines that shape patients' confidence and participation.

Objective: This analysis assessed the acceptability and recruitment implications of a high-throughput, community-based biomechanics protocol among individuals with knee osteoarthritis (OA). Design: During the Shared Strides Study, high-throughput markerless biomechanics assessment was conducted at community sites to help facilitate research engagement in the OA population. In this cross-sectional study, biomechanics data during a set of activities of daily living (ADLs) and questionnaire data were collected. Adults aged 40 years or older with knee OA participated at one of four sites across Gainesville, FL--two on-campus and two community-based. Eligible individuals were either screened over the phone and scheduled for a specific date and time or screened on site for potential same-day participation. Participant acceptability of the community-based biomechanics data collection approach was assessed using a 15-item custom questionnaire. Recruitment characteristics and participant preferences were compared across sites. Results: The high-throughput community-based data collection approach was well received. Compared with on-campus sites, community-based sites had higher engagement from walk-in participants and new research participants (40% of the sample). Familiarity with, and distance to, a data collection site were important factors in research engagement in this population. No differences in demographic characteristics existed between sites (p > 0.05), but recruitment resulted in a large sample size (n = 85) likely representative of the communities surrounding the selected sites. Conclusions: Integrating markerless motion capture with a community-based research approach may enhance the participant experience and facilitate larger, more heterogeneous sample sizes, ultimately reducing bias and homogeneity in current OA biomechanics research.

QuestionHow do physiotherapists use different motivational strategies for individuals in stroke rehabilitation? DesignA qualitative study using in-depth semi-structured online interviews. ParticipantsA criterion sample of 15 physiotherapists who have worked in rehabilitation for over 10 years and have an interest in an individuals motivation. InterventionNot applicable. Outcome measuresPhysiotherapists perspectives and experiences regarding motivational strategies used depending on the individuals condition. ResultsA total of nine themes emerged from the data upon thematic analysis and inductive coding. The participants used different strategies to encourage individuals active participation in physiotherapy depending on their (1) mental health problems, (2) physical difficulties, (3) level of cognitive function, (4) personality, (5) activities and participation, (6) age, (7) human environment, and (8) type of rehabilitation service where the individual undergoes treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. Conversely, for individuals with overconfidence, participants would provide them with a relatively difficult practice task to help them realize the necessity of practice through the experience of failure. The interviews also revealed (9) motivational strategies used regardless of the individuals condition. For instance, patient-centred communication was used to build a rapport with individuals, irrespective of their condition. ConclusionThis qualitative study is the first to demonstrate motivational strategies that physiotherapists use based on the individuals condition. Our findings provide a deeper understanding of the selection of motivational strategies in stroke rehabilitation.

Background and PurposeDespite evidence supporting the use of mechanically assisted walking training in stroke rehabilitation, it is not extensively used. The purpose of this study was to explore the perceptions of physiotherapists regarding their use of mechanically assisted walking training, specifically treadmill training, during inpatient rehabilitation after stroke. Better understanding of physiotherapists perceptions can inform the development of translation strategies. MethodsA qualitative study using focus groups comprising 14 physiotherapists (including students) working in stroke inpatient rehabilitation at two sites was conducted. Transcripts were analysed using an inductive approach to thematic analysis. ResultsPhysiotherapists perceived two main themes related to using mechanically assisted walking training during inpatient rehabilitation: therapeutic consequences (eg, patients able to walk earlier, further, longer; less fatiguing for therapist, ability to manipulate walking parameters) and practical considerations (eg, safety, efficiency, staff skill, access to equipment, weight and level of disability of patient, fear of treadmill). DiscussionTherapists perceptions of using mechanically assisted walking training during inpatient rehabilitation after stroke were mixed. There is a need to educate physiotherapy staff about the evidence of therapeutic value as well as how to perform mechanically assisted walking training.

BackgroundAnterior cruciate ligament (ACL) ruptures are highly prevalent among physically active individuals. Although patients often undergo successful surgical reconstruction, many experience psychological challenges that influence recovery and return to sport. ObjectiveThis study aimed to assess psychological readiness and injury-related fear among individuals who underwent ACL reconstruction. Study DesignCross-sectional study MethodsWe distributed a structured, self-administered electronic questionnaire to 96 participants in Riyadh, Saudi Arabia. We measured psychological readiness using the ACL Return to Sport after Injury (ACL-RSI) scale and assessed fear of reinjury using the Tampa Scale for Kinesiophobia-11 (TSK-11). ResultsParticipants reported moderate psychological readiness (ACL-RSI: Mean = 47, SD = 18) and kinesiophobia (TSK-11: Mean = 27, SD = 6). Participants over 40 years old demonstrated significantly lower readiness scores and higher levels of kinesiophobia than younger groups. ConclusionPsychological readiness and injury-related fear are critical components of recovery after ACL reconstruction. Rehabilitation programs should address both physical and psychological dimensions to improve patient outcomes. Future research should explore the effectiveness of targeted psychological interventions in ACL recovery.

BackgroundDysarthria is a neurological speech impairment which can have a pervasive impact on an individuals independence, psychological well-being and social participation following a stroke. Speech and language therapy (SLT) in the acute hospital phase aims to provide the stroke survivor with the means to communicate effectively and reintegrate socially following their discharge. However, there is limited understanding of how patients perceive their experience of SLT at this time and how effectively it addresses their needs. AimTo explore the patients experience of dysarthria in the acute hospital phase following a stroke and perceptions of the SLT received during this time. MethodsParticipants for this qualitative study were recruited as hospital in-patients from the acute SLT service caseload. Semi-structured interview data was analysed with reflexive thematic analysis and themes constructed. Results & DiscussionThe themes of speech as a competing priority, feeling disempowered in rehabilitation and the need for human connection and their relevance for clinical practice are discussed. Speech difficulties are perceived as one of several priorities competing for participants time and energy with the impact of speech often minimised. Feelings of disempowerment come from both internal and external factors, but the importance of hope and belief in potential recovery was emphasised. The expressed need for human connections highlights the need for positive social communication experiences and the value of a communication affirming rehabilitation setting. ConclusionsThese themes highlight the multidimensional impact of dysarthria and how it is inextricably linked to the wider psychological, and social dimensions of stroke. SLT during acute hospital rehabilitation must go beyond the physical impairment and address the patients evolving priorities, their self-esteem, capacity for positive self-management and social reintegration.

ImportancePatient motivation is an important determinant of rehabilitation outcomes. Differences in patients and clinicians perceptions of motivational factors can potentially hinder patient-centered care. ObjectiveTo compare patients and clinicians perceptions of the most important factors in motivating patients for rehabilitation. DesignThis multicenter descriptive cross-sectional survey was conducted from January to March 2022. SettingThirteen hospitals with a convalescent rehabilitation ward. ParticipantsPatients with neurological or orthopedic disorders undergoing inpatient rehabilitation and clinicians, including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists, were selected purposively based on the inclusion criteria. Main Outcomes and MeasuresPatients and clinicians were asked to choose the most important factor from a list of potential motivational factors. The main outcome was patients and clinicians perceptions of the relative importance of various motivational factors for rehabilitation. ResultsWe obtained data from 479 patients and 401 clinicians. Response rates in the patient and clinician surveys were 92.1% and 62.2%, respectively. The most common primary reasons for patients hospitalizations were stroke (45.5%) and fracture (42.2%). Approximately half of the clinicians were physical therapists (49.9%). "Realization of recovery," "goal setting," and "practice related to the patients experience and lifestyle" were the three factors most frequently selected as most important by both patients and clinicians, chosen by 10.4%-26.5% of patients and 9.5%-36.7% of clinicians. Only five were rated as most important by 5% of clinicians; however, nine factors were selected by 5% of patients. Of these nine motivational factors, "medical information" (odds ratio: 5.19; 95% confidence interval: 2.24- 11.60) and "control of task difficulty" (odds ratio: 2.70; 95% confidence interval: 1.32-5.80) were selected by a significantly higher proportion of patients than clinicians. Conclusions and RelevanceThe three most frequently endorsed motivational factors were identical for patients and clinicians. The preferences of patients were more diverse than those of clinicians, and some motivational factors were preferred by patients over clinicians. Therefore, when determining motivational strategies, rehabilitation clinicians should consider individual patient preferences in addition to utilizing the core motivational factors supported by both parties. Key PointsO_ST_ABSQuestionC_ST_ABSWhat are the similarities and differences between patients and clinicians perceptions of the relative importance of factors motivating patients for rehabilitation? FindingsIn this multicenter descriptive cross-sectional survey of 479 patients and 401 clinicians, the three most endorsed motivational factors--realization of recovery goal setting, and practice related to the patients experience and lifestyle--were identical for patients and clinicians. However, patients had more diverse preferences for motivational factors than clinicians. MeaningIn addition to utilizing the three core motivational factors, rehabilitation clinicians should consider individual patient preferences when determining which motivational strategies to use for enhancing patient-centered care.

ObjectiveTo assess the current provision and beliefs regarding benefits and risks, barriers, and potential future service models of cardiorespiratory training after stroke and transient ischaemic attack (TIA) in the United Kingdom. MethodsAn online survey of physiotherapists and exercise professionals working in stroke or cardiac rehabilitation. ResultsThe 253 respondents were separated into groups, Group 1: those integrating cardiorespiratory training into routine stroke rehabilitation (n=113); Group 2: those in specialist cardiorespiratory services including people after stroke or TIA (n=40); Group 3: those in stroke rehabilitation not integrating cardiorespiratory training (n=74); Group 4: those in specialist cardiorespiratory services not seeing people after stroke or TIA (n=26). Delivery of cardiorespiratory training varied in frequency and duration of supervised sessions, and people with minimal disability may be more likely to receive cardiorespiratory training. Identified stroke-specific risk factors for cardiorespiratory training varied both in the factors identified, and whether they were considered precautions or contraindications. The most frequently identified concerns were risk of serious adverse events, fatigue, and falls. The most common barriers to delivering cardiorespiratory training included commissioning of services, resources, skills and knowledge, and a lack of guidelines. ConclusionsMost respondents reported providing cardiorespiratory training after stroke or TIA, though many people who have a stroke or TIA may not receive this training. The results highlight a potential inequality where people with greater disability may be less likely to receive or be eligible for cardiorespiratory training. There are many factors making cardiorespiratory training a complex challenge to deliver in clinical practice.

Background/ aimsLittle is known about the experience of people post-stroke and their informal caregivers during the COVID-19 pandemic. The aim of this study was to understand the challenges faced by people post-stroke and informal caregivers during the pandemic, as well as the impact on their healthcare support, lifestyle, and self-care behaviors. MethodsA multi-perspective qualitative study was undertaken, with semi-structured interviews being carried out to sixteen participants: eight stroke patients and eight informal caregivers, mostly performed online. Reflexive thematic analysis was used, with data being independently coded and categorized before consolidated into themes and subthemes. FindingsThree themes were derived from the data analysis: i) Perceived impact of COVID-19 pandemic, ii) What helped? - strategies to manage the distress provoked by COVID-19, and iii) The value of rehabilitation and physical activity, with findings highlighting the negative psychological impact of the pandemic. In response to the perceived lack of support and access to health and social services, participants highlighted the use of digital approaches and professional support. ConclusionsFindings suggest the importance of self-management support and/or digital content in order to mitigate the impact of COVID-19. The involvement of peers, family members, friends or others seems to be an important strategy to increase motivation in remote rehabilitation and physical activity. Key points- Due to the impact of COVID-19 on people post-stroke and informal caregivers daily routines, both highlighted the importance of finding new and alternative ways of communicating, which included the use of digital approaches. - For some informal caregivers the pandemic was perceived as an opportunity to spend more time with the family and with the person with stroke. - People post-stroke admit having decreased their levels of physical activity during COVID-19 and increased the value given to rehabilitation and physical activity. - Involving peers or others, digitally or in-person, seems to be an important strategy when planning physical activity recommendations.

Age-related macular degeneration (AMD) is a blinding condition associated with depression and loneliness. This facilitates unhealthy lifestyle behaviours which drives AMD progression. We developed the first online lifestyle intervention for AMD, called Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly (MINGLE) to promote positive lifestyle changes, reduce loneliness and depression. This qualitative study explored enablers and barriers to participation in MINGLE for older Australians with AMD. Thirty-one participants with AMD were interviewed using a semi-structured in-depth approach. Thematic analysis revealed nine themes. Enablers to participation were: socialising and learning about AMD, motivation to improve health, program accessibility and structure. Barriers were: lack of time, unfamiliarity with technology, limited knowledge regarding holistic interventions, vision-related issues, mobility and negative perception of group interactions. Multiple factors influence the participation of AMD patients in MINGLE and these must be considered when developing and implementing the MINGLE program to maximise participation.

IntroductionDistal radius fractures are common upper extremity injuries requiring reliable outcome measures for accurate clinical assessment. This study aimed to validate the Croatian versions of the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE) and Mayo Wrist Score (MWS) in patients with distal radius fractures. MethodsDASH, PRWE and MWS croatian versions validity and reliability were evaluated in 128 patients using standardized translation, cultural adaptation, factor analysis, and internal consistency (Cronbachs ). ResultsPRWE-Cro and DASH-Cro demonstrated excellent validity and internal consistency ( > 0.95). QuickDASH-Cro showed high reliability and is recommended as a practical alternative. MWS was validated for the first time, showing good validity and acceptable internal consistency ( = 0.71). ConclusionPRWE-Cro and DASH-Cro are validated, reliable instruments suitable for both clinical practice and research in Croatian-speaking populations while MWS can be used as a quick screening tool.

IntroductionChronic low back pain (cLBP) is a leading cause of disability with disproportionately high impacts on marginalized populations, including non-English-preferring patients. These patients face significant barriers to accessing care and adhering to self-management strategies due to language barriers, socioeconomic challenges, and cultural differences. Despite the emphasis on self-management for cLBP, limited research has focused on understanding the specific needs and preferences of Spanish- and Cantonese-preferring patients. ObjectiveThis study aimed to explore the self-management priorities of Spanish- and Cantonese-preferring patients with cLBP. Using a human-centered design approach, we sought to identify patient preferences for self-management support materials and strategies that could be tailored to their unique needs. DesignQualitative research using thematic analysis of focus groups conducted in participants preferred language. SettingUrban, academic-affiliated county hospital between March and May 2024. PatientsSpanish- and Cantonese-preferring patients with cLBP InterventionsNot applicable. Main outcomeKey themes in participants experiences with cLBP care, barriers to self-management, and preferences for educational materials. ResultsFifteen patients participated across six focus groups (three focus group in each language). Four primary themes emerged from the focus groups: (1) the need for empathic, tailored educational supports that fit into patients lives, (2) a desire for self-management plans that account for social and economic constraints, (3) recognition of mental health and social isolation as factors that influence cLBP experience, and (4) a need for clearer guidance on self-management strategies and trustworthy resources. Both Spanish- and Cantonese-preferring participants expressed a preference for video-based resources, plain-language materials, and support for understanding the causes and management of their pain. ConclusionSpanish- and Cantonese-preferring patients with cLBP face significant barriers to self-management and would benefit from culturally and linguistically appropriate resources. This study highlights the need for healthcare systems to develop and deliver tailored, accessible self-management support materials that address the unique challenges faced by minoritized populations. Human-centered design offers a promising approach to reducing disparities in cLBP outcomes by creating patient-driven solutions that prioritize empathy, practicality, and cultural relevance.

ObjectiveTo evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. MethodsA sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. ResultsTwenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. ConclusionThe self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.

Objective: The onset of juvenile idiopathic arthritis (JIA) in the early years ([≤]5 years) may negatively impact movement skill (encompassing related concepts of gross motor skills, fundamental movement skills, and functional ability) development. Few studies have explored the perceptions and needs of parents and physiotherapists towards children's difficulty with these movement skills, essential to identify potential areas for added support. The objective of this study is to understand the perceptions of physiotherapists and parents towards movement skills of children with JIA. Methods: Seventeen parents and 24 physiotherapists completed an online questionnaire consisting of multiple choice and open-ended questions about the movement skills of young children with JIA. Demographic and multiple choice questions were quantitively analysed using descriptive statistics. Open-ended responses were analyzed using qualitative conventional content analysis. Results: About half (47%) of parents perceived their children to have movement difficulties, and 75% of physiotherapists described the movement skills of children with JIA as worse than other children of the same age. Our qualitative analysis revealed three general themes including: functional task difficulties; clinical variability in movement skills; and psychosocial components of movement skill difficulties. Conclusion: This study provides an analysis of perceptions of physiotherapists and parents towards the movement skills of young children with JIA. A significant proportion of parents and physiotherapists identify movement difficulties among children with JIA that impact daily life. Future interventions co-designed with both parents and care providers targeting movement skills are needed.

Objectives(1) determine if there is a correlation between disability, depression, and wellbeing in people with IBM, (2) determine if disability and depression can predict wellbeing in people with IBM, and (3) identify the prevalence of depression and impaired wellbeing in participants with IBM. MethodsIn this cross-sectional study, 101 participants with IBM completed the Neuromuscular Symptom Score (NSS), Personal Wellbeing Index (PWI), and Patient Health Questionnaire-9 (PHQ-9) surveys to serve as surrogate measures of physical disability, wellbeing, and depression respectively. ResultsLinear regression identified that PHQ-9 significantly predicts PWI, however NSS does not, with a negative predictive value of depression for wellbeing (-2.7513, p < 0.001) and a positive predictive value of disability for wellbeing (0.0575, p = 0.764). Moderate to severe depression was reported in 78.2% of participants, and all but one participant reported reduced wellbeing. ConclusionsDepression is a more significant predictor of wellbeing than disability in participants diagnosed with IBM. There was a high prevalence of depression and reduced wellbeing in participants, highlighting the importance of assessing these factors to optimise treatment in IBM.

Objectives: Among individuals attending stroke rehabilitation, we aimed to determine the proportion who participated in cardiorespiratory exercise, identify patient characteristics predicting participation, and describe exercise characteristics. Design, setting, and participants: This was an observational cohort study involving all patients admitted to four stroke rehabilitation centres in Ontario, Canada, during March or October 2019, or over 12 months starting in 2021. Main measures: Patient characteristics extracted during chart review included age, sex, marital status, employment status, date of stroke, time post-stroke at admission, length of stay for rehabilitation, past medical history that could affect exercise participation, Functional Independence Measure, Functional Ambulation Category, mobility aid use, Chedoke-McMaster Stroke Assessment, Montreal Cognitive Assessment, National Institutes of Health Stroke Scale, and details describing cardiorespiratory exercise completed. Results: 40.1% of stroke patients participated in cardiorespiratory exercise, with 26.4% having it included in their treatment plan. Diagnosed cardiac disease (OR=0.74), poor left ventricular function (OR=0.09), history of mental health conditions (OR=0.69), lower functional ambulation ability (OR=0.74), and wheelchair use at rehabilitation admission (OR=0.46) were associated with lower odds of participating in cardiorespiratory exercise after stroke (p-values<0.05). Use of a walker or rollator at rehabilitation admission (OR=3.22), having a cardiorespiratory exercise goal (OR=2.13), and longer lengths of stay (OR=1.01) were associated with higher odds of participating in cardiorespiratory exercise after stroke (p-values<0.05). Only 1.5% of patients (N=9/601) who participated in cardiorespiratory exercise completed it with recommended intensity and duration. Conclusion: Improving participation in cardiorespiratory exercise during stroke rehabilitation may require addressing cardiovascular, mental health, and mobility-related barriers.

ObjectiveThe purpose of this study was to demonstrate that the construct of falls efficacy, as measured by the Activities-Specific Balance Confidence (ABC) scale, is comprised of distinct factors in those with chronic stroke. DesignThis study is a cross-sectional analysis of pre-existing data from a research registry. SettingAcademic institution. Participants248 community-dwelling adults history of one or more strokes, verified by CT/MRI report or past provider. InterventionsNot applicable. Main Outcome Measure(s)Goodness-of-Fit indices (Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Fit Index (TLI)). ResultsTo test our hypothesis that the ABC scale is comprised of distinct factors linked to the balance domains, we proposed that the ABC scale items are indicative of three subdomains, 1) anticipatory control, 2) walking balance, and 3) reactive balance. A confirmatory factor analysis was performed to test this hypothesized structure. We assigned ABC Q1,2,8,10-12 to walking balance, Q3-7,9 to anticipatory control, and Q13-16 to reactive balance. All indicators significantly loaded as hypothesized. Modification indices suggested that Q6, which asks about standing on a chair and reaching for something, might be multidimensional and load onto both the anticipatory control and reactive balance latent constructs. Therefore, confidence in reaching while on a stool reflects confidence in both anticipatory and reactive balance. Conclusion(s)These results suggest that the items in the ABC scale measure three subfactors that align with anticipatory control, walking balance, and reactive balance.

Background: Occupational therapists can improve stroke survivors hand and arm movement and participation in daily activities through action observation (AO). AO involves watching another persons hand or arm complete a movement or task. While research generally supports the use of AO with stroke survivors, there are limited AO videos are available to occupational therapists which makes applying AO challenging. Objective: The purpose of this work is to develop structured and widely accessible tool to support access to AO for stroke survivors, occupational therapists, and researchers. Methods: To develop an AO video library for stroke rehabilitation, functional and non-functional upper limb task deficits were first identified through clinical observations and clinician interviews to establish a prioritized list of daily activities. In collaboration with media production specialists, healthy adult volunteers were recruited and filmed performing these tasks from both first- and third-person perspectives. The recorded videos were then systematically edited, enhanced with instructional title slides, and distributed via a public YouTube channel for clinical application and a categorized digital repository for research purposes. Results: Initial assessments revealed a complete lack of familiarity, awareness, and utilization of AO resources among local occupational therapists, despite high perceived clinical utility. To address this gap, a final library of 150 tasks was established, resulting in the production of 419 finalized, standardized videos featuring six healthy volunteers. For clinical application, these videos were hosted on a free, public YouTube channel organized into 18 functional playlists, while a parallel set was structured into distinct movement categories for research repository storage. Conclusion: By providing a structured and highly accessible tool, this repository enables clinicians, researchers, and caregivers to readily implement evidence-based action observation interventions in both clinical and home settings.

AimTo qualitatively assess causes, adaptations, and psychosocial impact of falls, and solutions for safer environments as shared by persons diagnosed with cerebral palsy (CP). MethodAmbulatory adults with CP (n=165) and caregivers of ambulatory children with CP (n=151) responded to four open-ended falls questions. Deductive and inductive content analysis was conducted. Results: Eight themes emerged (psychological, physical, avoid, adapt, people, environment, policy, healthcare). Participants elaborated on fall causes (aging, physical, mental, environmental, and situational), mechanics (most often trips), repercussions (psychological and physical), adaptations, difficulty getting up, and aspirations for themselves and society. Caregivers and adults detailed various adaptations to or deliberate avoidance of high-risk situations (e.g. uneven surfaces, crowds). Specific suggestions for environmental accessibility (e.g. more handrails), societal behavioral responses (give autonomy, be patient), healthcare practice, and policy were made. InterpretationThis study offers profound insights into how individuals with CP navigate the challenges of falls and how people and surroundings both positively and negatively affect their fall-related experiences. Many issues identified were multifactorial, requiring multidimensional, non-ableist solutions. Thus, the onus to address these issues is shared. Participants offered simple, but impactful, actions that could be taken immediately to support the creation of safer physical and psychological environments. WHAT THIS PAPER ADDS1. People should ask if and how to help when someone falls. 2. Falls trigger anxiety, embarrassment, and avoidance, often outweighing physical injuries impact. 3. Participation can be enhanced through more inclusive activities and environments. 4. Safe falling strategies should be taught at all ages. 5. Multifaceted solutions include conversations regarding falls with clinicians and addressing policy shortcomings.