Disability and 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: 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.

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.

Background The incidence of post-operative periprosthetic femoral fractures (POPFFs) is increasing. However, specific clinical guidance relating to patient management does not exist, resulting in variations in care and outcomes. This study aimed to elicit and synthesise expert knowledge in POPFF service delivery and explore views on variations in service provision and the factors influencing these. Methods Semi-structured interviews were undertaken with healthcare professionals with expertise in POPFF care from England and Wales to explore current practices, challenges, service variations and perceived future opportunities. Participants were identified through specialist research and clinical networks for POPFF and hip fracture care, authors of key publications on the subject, national leads for POPFF/hip fracture networks, and research team contacts. Interviews were analysed using thematic analysis. Results Ten interviews were undertaken with experts in POPFF services across a range of professional roles. Four themes were identified: conceptualisation of POPFF (by different professional groups and in different service settings) and understanding of POPFF patient needs; sources of variation in management and care of POPFF patients; service model rationales, advantages and disadvantages; and potential strategies to improve POPFF care. Conclusion When designing POPFF services, we suggest that four key areas need consideration: the extent to which POPFF patients are a distinct group with particular care needs; the necessity for and consequences of patient transfer between wards and hospitals; the resourcing of extensive multidisciplinary support for POPFF patients; and the need for national initiatives to encourage service developments. These findings should form the basis of future clinical guidance. Sensitivity to contextual factors driving variation in services is needed to ultimately improve care for POPFF patients.

ImportanceMedicare-Medicaid dual eligible beneficiaries experience pronounced disparities in stroke recovery. However, it remains unclear whether inpatient rehabilitation services and outcomes are comparable between dual-eligible beneficiaries enrolled in Medicare fee-for-service (FFS) versus Medicare Advantage (MA) plans. ObjectiveTo compare rehabilitation therapy utilization and associated outcomes among dual-eligible beneficiaries enrolled in FFS versus MA plans with stroke. DesignRetrospective cohort study. SettingInpatient Rehabilitation Facilities (IRF). ParticipantsMedicare beneficiaries admitted to IRF with stroke (n=125,782) between 2017 and 2019. ExposureDual-eligible beneficiaries enrolled in FFS versus MA plans. Main Outcome MeasuresTotal number of minutes of physical and occupational therapy provided within the first 2 weeks of IRF stay, self-care and mobility change scores, and 30-day all-cause hospital readmission. ResultsFor the first 2 weeks of therapy utilization, we did not find significant differences between the four groups. Using the non-dual FFS beneficiaries and low category of change as a reference, we found significantly lower likelihood of achieving high change in self-care scores for the dual FFS (OR=0.73, 95% CI=0.69-0.76), and dual MA (OR=0.93, 95% CI=0.88-0.98). However, non-dual MA patients had a higher likelihood of changes in self-care scores (OR=1.17, 95% CI=1.13-1.22). Similar trends were found for the mobility change scores, compared to non-dual FFS: dual FFS (OR=0.72, 95% CI=0.68-0.75), and dual MA (OR=0.91, 95% CI=0.86-0.96) and non-dual MA (OR=1.16, 95% CI=1.12-1.20). For 30-day readmission risk, dual FFS showed a higher likelihood of readmission (OR=1.19, 95% CI=1.08-1.31), while non-dual MA had a significantly lower likelihood (OR=0.77, 95% CI=0.71-0.83). Conclusions and RelevanceAlthough no differences in rehabilitation therapy utilization for stroke among dual-eligible beneficiaries, they had poorer functional recovery and higher 30-day readmission risk irrespective of FFS vs MA. Whereas non-dual-eligible MA beneficiaries experienced favorable outcomes. These findings underscore the importance of addressing post-IRF discharge needs among disadvantaged populations.

BackgroundWalk n Watch (WnW) is a structured, progressive walking exercise intervention developed for Canadian inpatient stroke rehabilitation. Although its mechanisms align with UK guidance for intensive walking therapy, stroke rehabilitation in the UK is delivered predominantly in the community. This change in service context has implications for safety, feasibility, and fidelity, necessitating structured pre-implementation intervention adaptation to support delivery. MethodsA prospective adaptation process used ADAPT guidance. A multidisciplinary coalition and learning collaborative (UK clinicians, clinical- academics, people with lived experience, and Canadian WnW developers) participated in stakeholder co-production activities. Informed by ADAPT steps 1-2, co-production focused on rationale, core components, contextual mapping and planning adaptations. Discussions were analysed through rapid deductive mapping using Consolidated Framework for Implementation Research (CFIR) domains. Candidate fidelity-consistent adaptations were refined by the learning collaborative. Conceptual outputs of the process were synthesised. ResultsThree intervention core components were confirmed: 1) prioritised, high-volume, weight-bearing walking-related activities at moderate effort; 2) structured progression of steps based on performance on a walking test (e.g. Six-Minute Walk Test); 3) objective monitoring of steps and cardiovascular intensity. Several contextual determinants across CFIR domains were likely to influence UK community implementation. Fidelity-consistent modifications to the adaptable periphery were specified across four areas: 1) therapy & practice, 2) environment & safety, 3) monitoring & feedback, and 4) workflow & documentation. Adaptations included hybrid supervision, planned out-of-session practice, and monitoring using validated proxies. A WnW Adaptation Model was produced. ConclusionsThis paper provides a transparent pre-implementation adaptation of WnW for delivery within UK community stroke rehabilitation. Anchoring adaptations to intervention mechanisms and principles through co-production and implementation science frameworks, this work establishes a foundation for piloting and hybrid effectiveness-implementation evaluation. The WnW Adaptation Model offers support for future implementation efforts. Discussion positions adaptation as a pragmatic means for applying optimisation principles. PLAIN LANGUAGE TITLEAdapting the Walk n Watch walking exercise programme for home-based stroke rehabilitation in the UK: A structured step-by-step process PLAIN LANGUAGE SUMMARYO_ST_ABSBackgroundC_ST_ABSWalk n Watch (WnW) is a structured exercise programme that helps people improve their walking. It was originally developed for people recovering from stroke in hospital in Canada. While the approach fits well with United Kingdom (UK) recommendations for intensive therapy, stroke rehabilitation in the UK often takes place at home. Because of this difference, WnW needs careful adaptation for safe and effective delivery. MethodsPublished ADAPT guidance was used to adapt WnW. UK therapists, researchers, people with stroke, and Canadian WnW developers undertook adaptation activities. Together, they identified which parts of WnW were essential, explored differences between the Canadian and UK settings, and planned changes. Discussions were reviewed using an established framework to develop adaptations that kept the most important parts of WnW intact (fidelity-consistent adaptations). The adaptation process was summarised. ResultsThree essential intervention parts were confirmed: 1) prioritised, high-volume, weight-bearing walking-related activities at moderate effort; 2) structured progression of steps based on performance on a walking test; 3) objective monitoring of steps and cardiovascular intensity. Several factors were likely to influence delivery in the UK community. Changes focused on four areas: 1) therapy & practice, 2) environment & safety, 3) monitoring & feedback, and 4) workflow & documentation. They included using both in-person and online sessions, planning safe between session practice, and using non-digital monitoring. A WnW Adaptation Model was produced. ConclusionsThis paper clearly describes the steps taken to adapt WnW for delivery in UK community stroke rehabilitation. By working closely with stroke experts and using established research frameworks, the adapted programme keeps the most important parts of WnW while allowing it to fit into real-life. The WnW Adaptation Model offers support for further testing and may assist others looking to adapt WnW. Discussion offers perspective on how adaptation aligns with optimising interventions.

OBJECTIVESDemonstrate correlations of clinic-based measures of International Classification of Functioning, Disability and Health (ICF) Body Structure and Function, capacity and performance with a school-based performance measure in children with Cerebral Palsy (CP) using a transdiagnostic approach. METHODS102 ambulatory children with CP underwent assessment of Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Pediatric Quality of Life Inventory Generic Core Scales (PedsQL), 3-Dimensional Gait Analysis, Gillette Functional Assessment Questionnaire (GFAQ), and Pediatric Outcomes Data Collection Instrument (PODCI) done in clinics, compared with School Function Assessment (SFA) done in schools. Here we report on SFA correlations. For this paper, Spearmans correlations were calculated. RESULTSAll measures showed some significant correlations with the SFA; greatest number of moderate to strong correlations were with PODCI, including PODCI comorbidities scales. PODCI performance questionnaire was correlated with all SFA scales. PODCI, as a performance measure, is broader, more holistic, than the capacity and BSF measures. Findings are demonstrative of a focus on the ICF approach, indicating separate domains of function and well-being, reflective of the transdiagnostic approach. CONCLUSIONSThe transdiagnostic approach, looking at a broader picture than simply diagnosis, thus paralleling concepts presented in the ICF, is beneficial in assessing functioning and well-being in children with CP.

Biomechanics studies using traditional optical motion capture have been limited by small, homogeneous sample sizes and a focus on single movements, restricting the ability to capture clinically relevant adaptations across daily tasks. These limitations are particularly consequential in heterogeneous musculoskeletal conditions such as knee osteoarthritis (OA), where variability in demographic and clinical characteristics necessitates large, representative samples to identify patient-specific biomechanical intervention targets. Markerless motion capture enables faster, high-throughput data collection and offers the potential for community-based assessments; however, its feasibility of use in clinical populations across diverse tasks remains unclear. This study evaluated the feasibility of community-based, high-throughput markerless biomechanics data collection in individuals with knee OA. Participants (n = 85) completed a series of activities of daily living using a portable markerless motion capture system deployed across two community-based and two on-campus sites. Feasibility was assessed using timing metrics related to research operations (transit, setup, calibration, breakdown), participant workflow (consent, questionnaires, motion capture), and task-specific durations. No significant differences in timing metrics were observed across sites despite logistical and operational challenges. These findings support the feasibility of using high-throughput, community-based markerless motion capture and suggest a viable pathway for addressing long-standing limitations in sample size and representativeness through scalable data collection workflows in biomechanics studies.

Background: Rheumatoid arthritis is a chronic inflammatory disorder in which exercise is increasingly recognized as an important component of long-term management. Yet, most reviews in this field evaluate the effects of single exercise modalities, while bibliometric studies primarily identify publication trends and research hotspots without showing whether highly visible themes also represent coherent and comparatively mature evidence domains. Methods: We searched the Web of Science Core Collection for publications on exercise interventions in rheumatoid arthritis from 2016 to 2025. CiteSpace (6.4.1) and VOSviewer (1.6.20) were used to analyze publication growth, collaboration networks, keyword co-occurrence, thematic clusters, and burst terms. We then applied structured content coding in Excel 2021 to classify exercise modalities, outcome domains, and mechanistic topics, and integrated these findings into a visual evidence-distribution profile. Results: Publication output increased from 16 studies in 2016 to 37 in 2025. The United States led in productivity, Karolinska Institutet was the most prolific institution, and Kitas, Duda, and Metsios were among the most influential authors. Keyword analyses identified a shift from function- and disease-focused themes toward quality of life, risk factors, and comprehensive management. The integrated analysis revealed an uneven evidence structure: aerobic and resistance training accounted for the most concentrated and recurrently studied exercise-outcome domains, whereas mind-body and water-based interventions formed visible but methodologically heterogeneous clusters. Newer modalities, including blood flow restriction training and high-intensity interval training, showed growing prominence but limited depth of evidence. Conclusion:Exercise research in rheumatoid arthritis has evolved toward broader and more patient-centered management targets, but the field remains imbalanced across intervention types and outcome domains. This study demonstrates the value of combining bibliometric mapping with structured content analysis to distinguish thematic visibility from evidentiary coherence in heterogeneous intervention fields and may offer a transferable analytical framework for research evaluation beyond rheumatoid arthritis. Keywords: Rheumatoid Arthritis; Exercise Intervention; Bibliometrics; Content Analysis; Rehabilitation

Background Gait training incorporating visual feedback or rhythmic auditory cueing has shown promising results in neurological conditions but has rarely been investigated in clinical rehabilitation for persons with Multiple Sclerosis (pwMS). Objective To evaluate the feasibility of treadmill training (TT) with visual feedback (VF) and TT with visual feedback plus rhythmic auditory cueing (VF+RAC) during clinical rehabilitation and explore its effects on gait parameters. Methods PwMS were randomly allocated 1:1 to perform ten 30-minute training sessions of TT with VF or VF+RAC during inpatient rehabilitation. The primary outcome was feasibility (adherence, compliance, safety, and acceptability). Secondary outcomes were session-by-session developments in spatiotemporal and qualitative gait parameters. Results Sixty of 68 randomized participants completed the intervention (VF: n=29; VF+RAC: n=31). Adherence and compliance rates were 93% and 86%, respectively, with no differences between groups. The most common adverse event in both groups was (leg) pain (21/38 total adverse events). One fall occurred in 629 sessions. Both interventions were greatly accepted and perceived as fun, motivating and helpful to achieve rehabilitation goals. Both groups increased in distance, gait speed, and average step length. Step length variability did not change in the VF-group, while the VF+RAC-group slightly improved. Step length difference was constantly low in the VF+RAC-group, while the VF-group differences were elevated. Conclusions VF and VF+RAC are feasible training options for pwMS in a rehabilitation setting and are greatly accepted by participants. Qualitative gait parameters should be investigated in studies powered to detect clinically relevant differences in the future.

Background: Post-stroke motor impairment is the leading contributor to long-term disability. Despite evidence that high dose, high intensity (HDHI) and virtual reality (VR) interventions are effective in reducing post-stroke motor impairment, access to such interventions is limited, especially in community-based models. The purpose of this study was to explore the effect of one community-based HDHI VR intervention, Next-Generation NeuroAnimation Therapy (NG-NAT), on motor impairment for community-dwelling stroke survivors. Methods: The study employed a retrospective pre-test post-test design of de-identified data sets of one cohort of stroke survivors who participated in an HDHI NG-NAT intervention at a community-based center from March to December 2025. The intervention consisted of three hours of daily therapy, five days a week, for three weeks. Two hours were allocated for NG-NAT gameplay, while one hour focused on non-VR activity. The NG-NAT was provided in a small studio with a large screen monitor and 12 motion caption cameras mapping client movements to play the game. The upper extremity Fugl Meyer Assessment was used to measure motor impairment at pre- and post-testing. Linear regressions were run to determine the relational strength between pre- and post-UEFMA scores. Wilcoxon Signed Rank Tests were run to calculate median differences in pre- and post-UEFMA scores and account for non-parametric data distributions at baseline and the small sample size. Effect size was explored using the Rank Biserial Correlation. Frequency of minimally clinically important differences (MCID), minimal detectable changes (MDC), recovery stage transition were calculated. Content analysis and co-review of documentation contextualized statistical findings. Results: Nineteen participants completed three weeks of intensive NG-NAT. All experienced positive UEFMA score improvements from pre- to post-testing with a median difference of 8 points. Fifteen achieved MDC and MCID; one experienced a ceiling effect. Eight participants transitioned into better recovery stages. There was a highly significant, positive relationship with narrow confidence intervals and pre-score predicted post-score (e.g., those with mild/moderate impairment improved better than those with severe impairment). Conclusion: This study provides evidence supporting the efficacy of NG-NAT as a community-based intervention to reduce motor impairment for individuals with stroke. Given its ability to deliver intense and engaging therapy, NG-NAT offers a promising adjunctive strategy to expand access for stroke survivors to improve clinically relevant health outcomes. These findings underscore the need for pragmatic trials evaluating effectiveness, implementation, and cost-effectiveness.

Background & Objective. Cardiac rehabilitation is an existing guideline-concordant intervention for heart failure that provides benefits but is grossly underutilized by both physicians and patients. We aimed to identify patient-reported barriers and facilitators of participation in cardiac rehabilitation. Design, participants, approach: Qualitative theory-guided in-depth interviews were conducted with adults with heart failure, recruited from ambulatory settings with oversampling of those with heart failure with preserved ejection fraction. Thematic analysis was applied to interview data. Depressive symptoms and perceived stress were assessed by Patient Health Questionnaire (PHQ-8) and Perceived Stress Scale (PSS), respectively. Key results: Twenty-two adults with heart failure, aged 27-85, completed the study; of them 59.1% were women, 68.2% - African American, 4.5% - Hispanic; 77.3% had public insurance or were self-pay; 68.2% had heart failure with preserved ejection fraction. Mean PHQ-8 score was 11.4 (SD= 2.9) and mean PSS score - 20.4 (SD=4.5). Patient-reported barriers to cardiac rehabilitation included unawareness of cardiac rehabilitation and its benefits, perceived inability to exercise, depression, and weight gain, specifically for heart failure with preserved ejection fraction. Perceived inability to exercise stemmed from uncontrolled heart failure symptom burden and exercise intolerance, medication side effects, non-cardiac pain, fear of exercise, and low motivation for exercise. Facilitators of participation included intrinsic and extrinsic motivating factors and specific features of programs, such as individualized and supervised interventions with moderate level of exercise. Conclusion: Participants reported multiple barriers to cardiac rehabilitation; some of them can be modified by providing counselling and referral to cardiac rehabilitation from primary care physicians and simultaneously addressing heart failure symptom burden, pain, stress and depression. Combining cardiac rehabilitation and weight management can benefit adults with heart failure with preserved ejection fraction specifically. Increasing insurance coverage for cardiac rehabilitation for heart failure is warranted.

IntroductionIndividuals with COPD can be classified according to their levels of physical activity (PA) and physical capacity (PC). The relationship between nutrition and body composition within these classifications remains unclear. ObjectivesTo compare the body composition and food intake of people with COPD and verify the associations. MethodsCross-sectional exploratory analysis study in which body composition and food intake were assessed in individuals with COPD. Classification was based on six-minute walk test (PC) and accelerometry(PA): Quadrant "can do, dont do" (I-preserved PC, low PA); quadrant "can do, do do" (II-preserved PC, preserved PA). Results72 individuals with COPD, 39 in quadrant I and 33 in quadrant II, with mean ages of (69 {+/-} 6) (67 {+/-} 7), respectively. Group I had a higher proportion of males, whereas group II had a higher proportion of females. A positive trend in skeletal muscle mass (p=0.011) (B= 2.883) and a negative trend in basal metabolic rate (p=0.010) (B=-0.092) for group I. ConclusionBrazilians with COPD classified in quadrants I and II showed similar results in terms of body composition and food intake. A positive trend in skeletal muscle mass was observed for the group I. These findings align with the pathophysiological model of COPD, in which the preservation of muscle mass and adequate protein intake support functional capacity and the maintenance of higher physical activity levels.

BackgroundStroke leads to both motor and cognitive impairments that can substantially limit daily activities and independence. Although these impairments are often treated separately in rehabilitation, growing evidence suggests they are interconnected. Understanding how cognitive and motor impairments relate to one another is essential for developing more effective, integrated rehabilitation strategies. ObjectiveThis longitudinal study addressed three key questions: (1) Do motor and cognitive impairments co-occur after stroke? (2) Does cognitive ability influence motor recovery? (3) Are cognitive and motor recovery trajectories associated? MethodsWe followed 148 individuals in the subacute phase of stroke, assessing them at 1 and 3 months post-stroke. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) and the clock drawing test. Motor impairment was assessed using the Fugl-Meyer Assessment (FMA) and grip strength. Activity was evaluated using the Action Research Arm Test (ARAT), 10-Meter Walk Test (10MW), and Timed Up and Go (TUG). ResultsAt one month post-stroke, cognitive and motor impairment and activity levels were not correlated, although strong within-domain correlations were observed. Baseline cognitive ability did not predict motor impairment recovery. However, improvements in cognitive ability from 1 to 3 months were moderately correlated with gains in motor activity measures (r = 0.22-0.29, p < 0.05). ConclusionsAlthough cognitive and motor impairments may arise independently after stroke, their recovery processes appear partially linked. These findings underscore the importance of addressing both domains in rehabilitation and advancing understanding of shared mechanisms that support recovery across functional systems.

Background: Mobility recovery after stroke is highly variable, yet is typically described using average patterns that obscure meaningful differences between individuals. Identifying distinct recovery trajectories may improve prognostication and guide rehabilitation strategies. Methods: We conducted a retrospective cohort study of adults admitted for stroke to a large health system between 2016 and 2024. Mobility was assessed using Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility, which was collected during routine clinical care. Growth mixture modeling was used to identify subgroups with distinct mobility recovery trajectories during the first 180 days after stroke. Subgroups were then characterized with baseline personal and clinical characteristics. Results: Seven hundred and fifty individuals contributed 3,389 mobility observations (median 4 per person). A five-class solution was selected based on model fit and classification quality. Distinct trajectories were identified: low stable (n=127), low rapidly improving (n=29), mid declining (n=169), mid improving (n=365), and high stable (n=60). Subgroups differed in both baseline mobility and patterns of change over time, with some demonstrating improvement, others remaining stable, and one declining. Individuals in improving subgroups were generally younger, more likely to be independent before stroke, received physical therapy on a greater proportion of hospital days, and were more frequently discharged to inpatient rehabilitation. In contrast, those in low or declining trajectories had lower baseline function, longer hospital stays, and were more likely to be discharged to skilled nursing facilities. Conclusions: The distinct mobility recovery trajectories identified in this work reflect the heterogeneity present in routine clinical practice. Subgroups differed in both recovery patterns and characteristics. Early identification of trajectory membership may improve prognostication and inform more targeted rehabilitation strategies.

Background and Purpose: Walking after stroke is often characterized by persistent biomechanical impairments and reduced walking capacity. While visual biofeedback can improve gait mechanics and fast walking can enhance capacity, it is unclear whether individuals post-stroke can effectively use biofeedback at higher walking speeds to address both deficits simultaneously. This study examined the effects of walking speed on the ability of participants with chronic stroke to reduce step length (SL) errors using visual biofeedback. Methods: Sixteen individuals with chronic stroke walked on a treadmill at slow, self-selected, and fast speeds with and without visual SL biofeedback. Absolute SL error relative to individualized targets was calculated for paretic and non-paretic limbs. Linear mixed-effects models with piecewise linear splines assessed the effects of speed, limb, and feedback condition. Post hoc comparisons were performed for significant interactions. Results: At lower speeds, increasing speed reduced SL error in both limbs (p < 0.001). At higher speeds, the effects of speed were dependent on limb and condition (p < 0.001). Paretic SL error increased with speed without feedback but remained stable with feedback (p < 0.001). Non-paretic SL error decreased with speed regardless of condition. SL error was greater in the paretic limb overall (p < 0.001). Discussion and Conclusions: Fast walking alone did not reduce paretic SL errors. Participants with chronic stroke can effectively use visual biofeedback to reduce paretic SL errors at higher speeds, supporting its integration into high-intensity gait training to simultaneously treat biomechanical impairments and walking capacity deficits after stroke.

Objectives: Explore feasibility and acceptability of upskilling a workforce to deliver a co-developed intervention, based on Acceptance and Commitment Therapy (ACT), to support psychological adjustment post-stroke targeting underserved groups. Design: Multi-site, single-arm feasibility study with embedded mixed-methods process evaluation (ISRCTN17628580). Setting: Four NHS community stroke services across England. Participants: 1. Stroke survivors [&ge;]18 years of age, [&ge;]4 months post-stroke, reporting psychological difficulties adjusting to stroke, able to consent and access remote group sessions in English; 2. Group facilitators from NHS stroke services, not ACT specialists. Intervention: WAterS-2: an eight-session, remotely-delivered ACT-informed group intervention. Outcome measures: Recruitment, fidelity, safety, acceptability and perceived value were assessed using fidelity checklists, post-intervention surveys and semi-structured interviews with stroke survivors and facilitators. Clinical outcomes including mood (HADS), wellbeing (ONS4), psychological flexibility (AAQ-ABI), measured post-group and three-months later. Results: Nineteen stroke survivors recruited (mean 9.6 months post-stroke; n=5 (26%) minoritised ethnicities; n=10 (52%) with aphasia). Thirteen facilitators - including two peer support workers - delivered the intervention with fidelity following structured training across four services. Drop-out was low (2/19; 11%); with 15 (79%) attending [&ge;]5/8 sessions. Remote data collection was feasible (79% follow-up completion), with no adverse events recorded. Acceptability was high: survivors valued peer connection, grounding and mindfulness practices. ACT metaphors were helpful for some but challenging for others, including some with aphasia. Online delivery was suitable but limited informal connection. Facilitators reported increased capability, incorporating ACT skills into routine care. NHS workforce pressures and geographically-constrained referral pathways limited recruitment reach. Conclusions: WAterS-2 is feasible, safe, acceptable and inclusive. A mixed workforce, including NHS peer support workers, can be upskilled to deliver with fidelity. Inclusion of underserved groups is achievable but requires active strategies beyond standard NHS referral routes. Findings inform a provisional logic model and a future pragmatic trial.

BackgroundModerate- to high-intensity walking training (M-HIT) is an established intervention for improving walking capacity in chronic stroke. Musculoskeletal (MSK) adverse events commonly occur during M-HIT, yet tools to identify individuals at higher risk are limited. Baseline clinical characteristics may provide insight into susceptibility to training-related MSK adverse events during M-HIT. Thus, this study aimed to develop and internally validate a model for predicting MSK adverse events during a 12-week M-HIT program in chronic stroke using baseline clinical characteristics. MethodsParticipants (n=100) from HIT-Stroke Trials 1 and 2 were included. Baseline clinical characteristics included measures of orthopedic history, pre-existing pain, motor function, recent exercise history, demographics and health characteristics, stroke chronicity, and psychological health. Logistic regression models evaluated all possible combinations of baseline characteristics with up to three predictors. Leave-one-out cross-validation was used for internal validation to mitigate overfitting. Predictive performance was quantified using the C-statistic, and the candidate model with the highest cross-validated C-statistic was selected as the final model. ResultsMSK adverse events occurred in 32.0% of participants. The optimal three-variable model included prior orthopedic condition (Odds ratio [OR] 3.02 [95% CI 1.14-8.64]), Fugl-Meyer lower extremity motor score (OR 1.14 [95% CI 1.02-1.28]), and self-reported participation in regular walking exercise (OR 0.17 [95% CI 0.05-0.49]) at baseline. This model demonstrated moderate discrimination (cross-validated C-statistic = 0.74; apparent C-statistic = 0.78). ConclusionsParticipants reporting at least one pre-existing lower extremity or lumbar spine orthopedic condition and those with better lower-extremity motor function exhibited greater odds of experiencing MSK adverse events during M-HIT, while participants reporting participation in regular walking exercise had lower odds. These findings suggest that baseline clinical characteristics may help identify individuals at elevated risk for MSK adverse events during M-HIT who may warrant closer monitoring or risk-reduction strategies. Future studies are needed for external validation. Clinical Trial Registrationhttps://ClinicalTrials.gov; Unique identifiers: NCT03760016, NCT06268041

BackgroundFunctional recovery after chronic stroke remains limited, requiring intensive and engaging rehabilitation approaches. Non-immersive virtual reality (NIVR) provides task-oriented, feedback-driven training that may enhance motor recovery in this population. ObjectiveTo evaluate the clinical effectiveness of a NIVR-based intervention (MindMotion GO) on upper limb motor function in patients with chronic left middle cerebral artery ischaemic stroke (LMCA stroke). MethodsA single-blind randomized controlled trial was conducted in 26 patients with chronic middle cerebral artery stroke. Five participants were lost to follow-up, resulting in a final sample of 21 patients allocated to the non-immersive virtual reality group (NIVR, n = 9) and conventional occupational therapy group (n = 12). Both groups completed an 8-week intervention consisting of two 30-40-minute sessions per week. The primary outcome was upper limb motor function assessed using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Secondary outcomes included health-related quality of life (SF-12v2), emotional status (Hospital Anxiety and Depression Scale), and caregiver burden (Zarit Burden Interview). Statistical analyses were performed using the intention-to-treat principle with non-parametric tests. ResultsThe NIVR group showed a clinically meaningful improvement in FMA-UE (median {Delta}21), exceeding the minimal clinically important difference (MCID = 7.35), whereas the control group showed smaller gains ({Delta}2.50) that did not reach clinical relevance. Both groups improved significantly over time; however, between-group differences were not statistically significant (P > 0.05). No significant changes were observed in quality of life, mood, or caregiver burden. ConclusionsNIVR using MindMotion GO is a safe and feasible intervention that can induce clinically meaningful improvements in upper limb motor function in chronic stroke patients. These findings support the incorporation of accessible, task-oriented virtual rehabilitation strategies in long-term stroke care.

ObjectivesTo explore patients and physiotherapists perspectives on a snack-based physical activity (PA) approach and mobile health technologies (mHealth) for non-specific chronic low back pain (NSCLBP). Snack-based PA refers to short, frequent bouts of activity (2-5 minutes) integrated into daily routines. DesignQualitative study using Interpretative Phenomenological Analysis (IPA) of semi-structured online interviews. SettingCommunity-based recruitment in the United Kingdom. Interviews were conducted online via Microsoft Teams between May and November 2024. ParticipantsSixteen participants were purposively sampled: eight adults with NSCLBP (lasting [&ge;]3 months in the previous year) and eight physiotherapists with [&ge;]2 years experience managing people with NSCLBP. ResultsThree shared themes were identified across both groups: (1) understanding the needs and requirements of PA; (2) perceptions of snack-based activity; and (3) factors influencing mobile health application use. Five subthemes were identified within themes one and three, together with two additional subthemes reported only by patients, relating to data sharing and technical issues. Both groups valued the time-efficiency and practical integration of snack-based activity, while highlighting the need for personalisation, age-appropriate content, accessibility and affordability. ConclusionsPhysiotherapists and patients emphasised the potential value of the snack-based PA approach in terms of adherence. However, both groups agreed that future intervention development should prioritise personalisation, user-friendly design, and equitable digital access. STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThis study uses Interpretative Phenomenological Analysis (IPA) to provide in-depth, dual-perspective insights from both people with non-specific chronic low back pain (NSCLBP) and physiotherapists on a novel snack-based physical activity approach for chronic non-specific low back pain. C_LIO_LIReporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist to ensure methodological transparency. C_LIO_LIThe sample included variation in patient age, ethnicity and physiotherapist experience, which broadened the range of views captured. C_LIO_LIAll participants were UK-based, which may limit the transferability of findings to other healthcare systems and cultural contexts. C_LIO_LIThe small sample size, although consistent with IPA methodology, and the use of single online interviews, may not capture longitudinal perspectives on sustained engagement. C_LI