14Th Congress of the European Forum for Research in Rehabilitation (EFRR)

Parallel Session 6.3 - Family / Carer / Peer Involvement

14th Congress of the European Forum for Research in Rehabilitation (EFRR)

Glasgow Caledonian University Glasgow, Scotland, UK 24 - 27 May 2017 Conference Information Conference Information

Index 01 Welcome to the 14th EFRR Congress in Glasgow 03 Committees and Support 04 Programme Overview Welcome 07 Glasgow Caledonian University to the 14th Congress of the European • How to get there Forum for Research in Rehabilitation • Campus Map 2017 in Glasgow! 09 Congress Information A-Z We would like to cordially invite you to take part in the 11 Other useful information 14th Congress of the European Forum for Research in • Continuing Professional Development (CPD) Rehabilitation, to be held in Glasgow, UK, from 24-27 Accreditation May 2017. • Awards • EFRR Conference Hotel Information This meeting is intended to provide everyone involved in rehabilitation research, practice, education, technology Scientiﬁ c Programme: Abstracts and policy making with an excellent opportunity to share cutting-edge research and best practice, and strengthen their 13 Wednesday 24th May networks in the vibrant city of Glasgow, UK. • Workshops The theme of this conference is “Working in partnership 15 Thursday 25th May across boundaries”, which reﬂ ects the EFRR’s endeavour to • Plenary Sessions and Oral Presentations improve the lives of people with disabilities and their families • Poster Sessions (p.36) through the advancement of research and education in all biopsychosocial aspects of rehabilitation. 71 Friday 26th May EFRR 2017 will be hosted jointly by the Society for Research • Plenary Sessions and Oral Presentations This requires working together across multiple boundaries, in Rehabilitation (SRR) www.srr.org.uk and the British • Poster Sessions (p.96) fostering strong and strategic collaborations between Society of Rehabilitation Medicine (BSRM) www.bsrm.org. research, clinical practice and industry, di§ erent clinical- uk who have a long and successful track record of hosting 129 Saturday 27th May academic disciplines and professional bodies, as well as conferences together. health and social care and non-governmental organisations. 131 Author Index We would like to take this opportunity to express our We are honoured and delighted to host the EFRR 2017 sincere thanks to the many colleagues, organisations and at Glasgow Caledonian University (GCU), in Glasgow, volunteers, who have so generously contributed their time United Kingdom. As a modern university with brand new and expertise, making this congress a reality. We hope that conference facilities, conveniently located within the city the 14th Congress of the EFRR 2017 will be an inspiring event mindmaze logotype 12 - 02 - 2015 centre, GCU looks forward to welcoming you. with excellent networking opportunities for junior as well as established colleagues. Aarne Ylinen Frederike van Wijck With Scotland being the host country, delegates will be EFRR President Conference Chair, EFRR Vice- guarenteed a distinctive Scottish touch to the meeting. The Welcome to the EFRR in Glasgow! President and SRR Senior Secretary

European Forum for Research in Rehabilitation

Merz Pharma UK Ltd MindMaze Healthcare UK PAL Technologies Ltd Sponsors Brain Injury Rehabilitation Trust The Huntercombe Group 260 Centennial Park, Elstree Hill South, G19 The Perfume Factory, 50 Richmond Street, Glasgow, G1 1XP 3 Westgate Court, Silkwood Park, Murdostoun Brain Injury and Neurological Care Elstree, Herts, WD6 3SR 140 Wales Farm Road, London, W3 6UG T: +44 141 303 8380 Wakeﬁ eld, WF5 9TJ Centre, Bonkle, Wishaw, Lanarkshire, ML2 9BY T: +44 (0)208 236 0000 T: +44 20 3051 2888 E: [email protected] T: +44 1924 266344 E: [email protected] Kay Forbes, Head of Therapy T: +44 (0) 7766087169 E: [email protected] E: uk.o [email protected] www.birt.co.uk [email protected] [email protected] www.paltechnologies.com www.huntercombe.com

01 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 02 Conference Information Conference Information

EFRR 2017 Committees and support EFRR 2017 Programme Overview:

Organising Committee Senior Advisory Committee BSRM Executive Committee Whole Congress • Frederike van Wijck, Conference Chair, • Hermie Hermens, • Diane Playford, President EFRR Vice-President and SRR Senior Secretary • Tracey Howe, • Krystyna Walton, President-Elect • Audrey Bowen, SRR President • John Hunter, • Lynne Turner-Stokes, Immediate Past Wednesday Thursday Friday Saturday • Philippa Dall, Senior Research Fellow, • Garth Johnson, President Glasgow Caledonian University • Lajos Kullmann, • Eliezar Okirie, Honorary Secretary 24 May 25 May 26 May 27 May • Patricia Dziunka, SRR Central Secretariat • Crt Marincek. • Lloyd Bradley, Deputy Honorary Secretary 09.00 07.30 08.00 09.00 - 09.45 • Nigel Harris, SRR and EFRR Past Secretary • Mike Barnes, Treasurer Registration opens Registration opens Registration opens Plenary 5: • Stefan Heiskanen, EFRR Member, • Judith Allanson, Elected Member/Chair Hamish Wood Building, Prof Matilde Leonardi Treasurer Trauma Rehabilitation Special Interest Group GCU, Main entrance 08.30 - 09.15 08.30 - 09.15 EFRR Council Welcome and Opening Plenary 3: 09.45 - 10.30 • Ben Stansﬁeld, Reader, Glasgow • Fahim Anwar, Elected Caledonian University • Aarne Ylinen, President 13.30 Prof Frederike van Wijck, Mrs. Kate Allatt Expert Panel Discussion: • Bhaskar Basu, Elected Welcome Tea/ Coee Dr John Hunter OBE Prof Frederike van Wijck (Chair) • Sandy Weatherhead, BSRM Executive • Frederike van Wijck, Vice-President & Prof Aarne Ylinen 09.20 - 10.20 Director • John Burn, Co-optee - European • Gülseren Akyüz, Past President representative 14.00-17.00 Parallel Sessions: 4.1, 4.2, 4.3 10.30 - 11.15 • Aarne Ylinen, EFRR President. • Susanne Weinbrenner, Secretary (including break from 15.15 - 15.55) 09.20 - 10.20 Coee/Tea, Exhibition, Posters • Mahesh Cirasanambati, Ex-ocio - Workshop 1: Parallel Sessions: 1.1, 1.2, 1.3 10.20 - 11.00 • Helena Burger, EFRR Council Member Chair, Musculoskeletal Special Interest Group Chronic Pain Syndromes Coee/Tea, Exhibition, Posters 11.15 - 11.45 • Gabor Fazekas, Member • Lorraine Graham, Ex-ocio - Chair, Prof Gülseren Akyüz & Dr Esra 10.20 - 11.00 What’s new and where to next? Scientiﬁc Committee • Sven-Uno Marnetoft, Member Special Interest Group for Amputee Medicine Giray Coee/Tea, Exhibition, Posters 11.00 - 12.15 Dr. Andrew Bateman Parallel Sessions: 5.1, 5.2, 5.3 • Frederike van Wijck, Conference Chair, • Matilde Leonardi, Member • Naveen Kumar, Ex-ocio - Chair, Spinal EFRR Vice-President and SRR Senior Secretary Cord Medicine Special Interest Group Workshop 2: 11.00 - 12.15 11.45 - 12.00 • Aivars Vetra, Member Priority Setting Partnerships Parallel Sessions: 2.1, 2.2, 2.3 12.15 - 13.45 Awards & Closing Remarks: • Gülseren Akyüz, EFRR Past President • Emer McGilloway, Ex-ocio - Chair, • Stefan Heiskanen, Treasurer. Dr. Alex Pollock Lunch, Exhibition, Posters Prof Frederike van Wijck 2013-2015 Vocational Rehabilitation Special Interest 12.15 - 13.45 EFRR AGM • Stephen Ashford, SRR Junior Secretary Group Workshop 3: Lunch, Exhibition, Posters 12.00 • Andrew Bateman, SRR President Elect • Meenakshi Nayar/Rebekah Implementing Evidence-Based SRR AGM 13.45 - 14.30 Conference Closes Practice: Plenary 4: • Audrey Bowen, SRR President SRR Council Davidson, Ex-ocio - National Trainee Representatives Prof Marion Walker MBE 13.45 - 14.30 Dr. Sven-Uno Marnetoft • Helena Burger, EFRR Council Member • Audrey Bowen, President & Dr Rebecca Fisher Plenary 1: • Margaret Phillips, Ex-ocio - Chair, • Gabor Fazekas, EFRR Past President • Chris Burton, Past President Prof Peter Langhorne 14.35 - 15.35 Research & Clinical Standards Sub-Committee 17.00 - 18.30 Parallel Sessions: 6.1, 6.2, 6.3 (2008-2009, 2011-2013) and Council • Andrew Bateman, President Elect & Academic A§airs Sub-committee Member Social Event: 14.35 - 15.35 • Frederike van Wijck, Senior Secretary • Naweed Sattar, Elected Member Wecome Reception Parallel Sessions: 3.1, 3.2, 3.3 15.35 - 16.15 • Joanna Fletcher-Smith, SRR Council • Anand Pandyan, Past Secretary Coee/Tea, Exhibition, Posters member • Manoj Sivan, Elected Member • Stephen Ashford, Junior Secretary 15.35 - 16.15 • Karen Homan, SRR Public Relations • Matthew Smith, Elected Member Coee/Tea, Exhibition, Posters 16.15 - 17.00 Ocer • Lisa Shaw, Treasurer • Elizabeth Stoppard, Ex-ocio - Chair, Parallel Sessions: 7.1, 7.2, 7.3 • Rosie Kneafsey, SRR Council member • Karen Homan, Public Relations Ocer Education Sub-committee 16.15 - 17.00 Plenary 2: • Praveen Kumar, SRR Council member • Joanna Fletcher-Smith, Member • Krystyna Walton, President-Elect and Ex- ocio as Chair, RCP Joint Specialty Committee Prof Gülseren Akyüz • Matilde Leonardi, EFRR Council Member • Praveen Kumar, Member • Sachin Watve, Elected Member. • Sven-Uno Marnetoft, EFRR Council • Diane Playford, BSRM President. 18.30 - 23.00 Member Social Event: Glasgow City Chambers Civic • Anand Pandyan, SRR Past Secretary Reception • Diane Playford, BSRM President EFRR 2017 Professional • Kate Radford, SRR Past President Congress Organiser • Lisa Shaw, SRR Treasurer • Abbey • Manoj Sivan, BSRM Executive Committee www.abbeyconference.ie/home Member • Aivars Vetra, EFRR Past President (2009- 2011) and Council Member Additional Congress Support • Tony Ward, BSRM member and • Glasgow Caledonian University representative on SRR Council Events Management Team: • Susanne Weinbrenner, EFRR Secretary Julie Duncan, Head of Events Team • Aarne Ylinen, EFRR President. Marysia Nellany, Events Ocer • Glasgow Caledonian University Information Services and Technical Support Teams: Mr Joseph Logan Mr Iain Brown • Glasgow City Marketing Bureau Wendy Russell, Manager International.

03 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 04 Conference Information Conference Information

EFRR 2017 Programme Overview: Day-by-Day

Wednesday 24 May Thursday 25 May Friday 26 May Saturday 27 May 09.00 Registration: Hamish Wood Building 07.30 - 08.30 Registration: Hamish Wood Building 08.00-09.15 Registration: Hamish Wood Building 09.00 - 09.45 Plenary 5: Poster set-up: The Saltire Centre Poster set-up: The Saltire Centre Poster set-up: The Saltire Centre Setting Rehabilitation Objectives with ICF: Empowering the Person 13.30 Welcome Tea/ Coee: The Saltire Centre 08.30 - 09.15 Welcome and Opening 08.30-09.15 Plenary 3: Room W011 Main Conference Hall Room W011 Main Conference Hall Language and eective co-design relationships Prof. Matilde Leonardi, Neurology, Public Health, 14.00 - 17.00 (including break from 15.15 - 15.55) Welcome to EFRR 2017 Room W011 Main Conference Hall Disability Unit, Coma Research Centre, Italian WHO- Prof Frederike van Wijck,Glasgow Caledonian Mrs. Kate Allatt UK Collaborating Centre Research Branch Foundation Workshop 1: Chronic Pain Syndromes: University, UK IRCCS, Carlo Besta Neurological Institute, Milan, Italy How to Manage? 09.20 - 10.20 Parallel Sessions: Room W118 Changing Perspectives in Rehabilitation 4.1 Standardisation and Guidelines 09.45 - 10.30 Expert Panel Discussion: The Role of Research in Prof Gülseren Akyüz and Dr Esra Giray, Marmara Dr John Hunter OBE, Retired Consultant in Room W011 Main Conference Hall Rehabilitation University School of Medicine, Istanbul, Turkey Rehabilitation Medicine, Edinburgh, UK 4.2 Physical Rehabilitation & Exercise (4) Room W011 Main Conference Hall Room W118 Chair: Prof. Frederike van Wijck, Glasgow Caledonian Workshop 2: What Matters Most in Rehabilitation The role of the EFRR in the ﬁeld of rehabilitation in 4.3 Patient Experiences, Partnership Working & University, UK with Council Members of EFRR and Research? Priority Setting Partnerships Europe Prioritisation (1) SRR Room W110 Prof Aarne Ylinen, EFRR President, University of Room W110 Dr. Alex Pollock, Glasgow Caledonian University, UK Helsinki and Helsinki University Hospital, Finland 10.30 - 11.15 Coee/Tea, Exhibition, Posters: The Saltire Centre 10.20 - 11.00 Coee/Tea, Exhibition, Posters: The Saltire Centre Workshop 3: Implementing Evidence-based 09.20 - 10.20 Parallel Sessions: 11.15 - 11.45 What’s new and where to next? Practice: Current Challenges 1.1 Mental Health and Psychometrics 11.00 - 12.15 Parallel Sessions: Room W011 Main Conference Hall Room W011 Main Conference Hall Room W118 5.1 Vocational Rehabilitation & Return to Dr. Andrew Bateman, SRR President Elect and Prof Marion Walker MBE & Dr Rebecca Fisher, 1.2 Physical Rehabilitation & Exercise (1) Work (1) Clinical Manager, Oliver Zangwill Centre for Nottingham University, UK Room W011 Main Conference Hall Room W011 Main Conference Hall Neuropsychological Rehabilitation, Cambridgeshire 1.3 Rehabilitation Models 5.2 Prosthetics & Orthotics, Physical Community Services NHS Trust, Princess of Wales 17.00 - 18.30 Social Event: Welcome Reception at Glasgow Room W110 Rehabilitation & Exercise (5) Hospital, Ely, UK Caledonian University All Delegates Welcome Room W118 The Saltire Centre 10.20 - 11.00 Coee/Tea, Exhibition, Posters: The Saltire Centre 5.3 Patient Experiences, Partnership Working & 11.45 - 12.00 Awards & Closing Remarks: Room W011 Main Prioritisation (2) Conference Hall 11.00 - 12.15 Parallel Sessions: Room W110 Prof Frederike van Wijck 2.1 Cognition and Cognitive Rehabilitation Room W118 12.15 - 13.45 Lunch, Exhibition, Posters: The Saltire Centre 12.00 Conference Closes 2.2 Physical Rehabilitation & Exercise (2) EFRR Annual General Meeting Room W011 Main Room W011 Main Conference Hall Conference Hall 2.3 Access to Services & Decision Making Room W110 13.45 - 14.30 Plenary 4: Vocational Rehabilitation and Return to Work: 12.15 - 13.45 Lunch, Exhibition, Posters: The Saltire Centre Room W011 Main Conference Hall Society for Research in Rehabilitation (SRR) Dr. Sven-Uno Marnetoft, Department of Health Annual General Meeting: Room W011 Main Sciences, Mid Sweden University and Caseman Conference Hall Rehabilitation Ltd.

13.45 - 14.30 Plenary 1: 14.35 - 15.35 Parallel Sessions: SRR Philip Nichols lecture: Evidence-based 6.1 Vocational Rehabilitation & Return to Rehabilitation: Are there any lessons from Stroke Work (2) Research? Room W011 Main Conference Hall Room W011 Main Conference Hall 6.2 Spasticity Prof Peter Langhorne, Glasgow University, UK Room W118 Statistical Process Control in Rehabilitation 14.35 - 15.35 Parallel Sessions: Room W118 3.1 Education 6.3 Family/ Carer/ Peer Involvement Room W118 Room W110 3.2 Physical Rehabilitation & Exercise (3) Room W011 Main Conference Hall 15.35 - 16.15 Coee/Tea, Exhibition, Posters: The Saltire Centre 3.3 Implementation & Service Improvement Room W110 16.15 - 17.00 Parallel Sessions: 7.1 Vocational Rehabilitation & Return to 15.35 - 16.15 Afternoon Tea and Coee, Posters, Exhibition Work (3) The Saltire Centre Room W011 Main Conference Hall 7.2 Special Topics 16.15 - 17.00 Plenary 2: Room W118 Global Developments in Rehabilitation Research 7.3 Communication & Swallowing Rehabilitation Room W011 Main Conference Hall Room W110 Prof. Gülseren Akyüz, Marmara University School of Medicine, Istanbul,Turkey

18.30 - 23.00 Social Event: Glasgow City Chambers Civic Reception All Delegates Welcome Dinner and Entertainment for ticket holders

05 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 06 Conference Information Conference Information

Glasgow Caledonian University How to get there

From the airport By car If you are coming from the airport there are a number The University’s postcode is G4 0BA, but this covers the of options for you to get into the city. Taxis are available, whole campus. The main entrance is located on Cowcaddens however there is also public transport from the airport Road, directly across from Buchanan Street Bus Station. into the city that is easy, accessible and right outside the • Parking: There is no onsite parking for visitors at Glasgow departure terminal. The bus is called the Glasgow Airport Caledonian University. Conference and Events at Glasgow express. www.ﬁrstgroup.com/greater-glasgow/routes-and- Caledonian University has negotiated a rate of £7.00 per maps/glasgow-airport-express/glasgow-airport-express- day for car parking at Glasgow Royal Concert Hall car tickets. It is not necessary to book beforehand online but to park to make the day of your event more comfortable do so is possible. They have very frequent service and varying for you and your event delegates. The university is easily ticket types including a return service to the airport as well as accessible from Junction 16 (Westbound) or Junctions passes for 4 and 5 day services that include transport around 15 & 17 (Eastbound) of the M8 motorway. Although no

the city as well. parking is available on campus, there is ample space 01 Hamish Wood Building (Rooms W) available at the nearby Royal Concert Hall car park. 02 The Saltire Centre Contains the University Library By rail • Upon your arrival at the car park you will be issued with 03 George Moore Building (Rooms M) The University is situated within easy walking distance of a ticket Contains the University Restaurant, 'Study Club' area and Campus Life desk 04 Govan Mbeki Building (Rooms A) both Glasgow Queen Street Station and Glasgow Central • Take this ticket and bring it along to the event at GCU as 05 Students’ Association Station. For details of train times, visit the National Rail this is where the ticket will need to be scanned 06 Arc Health and Wellbeing Facility (Rooms CEE) Enquiries Service. • There are two machines at GCU where the tickets can 14 07 Centre for Executive Education be scanned (please refer to the GCU campus map 08 William Harley Building (Rooms H) indicating the buildings where you can ﬁnd the machines 09 Britannia Building (Rooms B) By underground rail 10 Charles Oakley Laboratories (Rooms C) The University is very close to the Buchanan Street and highlighted): Hamish Wood building (8): Reception or 11 PhD Centre Cowcaddens underground railway stations - part of Saltire Centre (10) Ground Floor: Reception 12 Milton Street Building (Rooms MS) Glasgow’s famous Clockwork Orange subway system - • After your parking ticket has been scanned and your 10 13 Nursery 11 14 Caledonian Court generally recognised as the third underground railway system event has ﬁnished, take the ticket back to the Royal Student Accommodation 12 to be built in the world, after London and Budapest. Concert Hall Car Park where the ticket will be validated

and you will be charged £7.00 for the day. Access (lifts, ramps and automatic doors) 13 Walking 02 Food and drink Glasgow is an easy city to walk around. Use WalkIt.com to

plan your route and ﬁnd out how long it will take you, how 05 many steps you’ll use and even how many calories you’ll 04 burn (865 steps and 42 calories between Glasgow Queen 03

Street Station and the University!) 01

By bus 06

The University is only 200 yards (183 m) from Buchanan Bus 07 Station. 08

01 Hamish Wood Building: Rooms W 05 Students’ Association 10 Charles Oakley Labs: Rooms C 02 The Saltire Centre: Contains the 06 Arc Health and Wellbeing Facility 11 Teaching Block University Library 07 Centre for Executive Education: 12 Milton Street Building: Rooms MS 03 George Moore Building: Contains Rooms CEE 13 Nursery the Restaurant. Rooms M 08 William Harley Building: Rooms H 14 Caledonian Court Student 04 Govan Mbeki Building: Rooms A 09 Britannia Building: Rooms B Accommodation

07 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 08 Conference Information Conference Information

Congress Information Exhibitor Information Photography and video Websites • Access: The access times for set up are from 8am on Our congress photographers and dedicated congress blogger • European Forum for Research in Rehabilitation Congress A-Z Wednesday 24th May 2017. The exhibition will open at will be present during the event, and will be joined by sta§ 2017: www.efrr2017.com 11am on Wednesday 24th May 2017, please ensure your from Glasgow City Marketing Bureau. This material will be • European Forum for Research in Rehabilitation (EFRR): stand is set up in plenty of time. used for promotional purposes (including the websites and www.efrr.org Access or dietary requirements • Break down time: The deadline for vacating the Saltire social media operated by GCU, EFRR, SRR and BSRM, who • Society for Research in Rehabilitation (SRR): If you have not done so already, please make us aware of Centre is 1pm on Saturday 27th May 2017. All exhibition support this congress). If you have any concerns or do not www.srr.org.uk your access or dietary requirements beforehand so we can stands and materials must be removed/collected from wish to be included in any congress photos or videos, please • British Society of Rehabilitation Medicine (BSRM): note this. Also, please check in with us at the Registration the exhibition area by 1pm. Due to health and safety contact a member of Abbey sta§ at the Registration Desk. www.bsrm.org.uk desk or the catering sta§ before meals, so your ordered regulations, please do not break down your stand prior to options can be given to you. 11.30am on Saturday 27th May 2017. Registration Desk Wifi The registration desk will be open for the entire conference. Open Wi-Fi access is available to GCU visitors throughout Certificate of Attendance Lost and Found Please visit the desk in the Hamish Wood building if you have the GCU campus. GCU visitors can connect to the internet Delegates will be issued a certificate of attendance by If you have lost an item of your personal belongings or indeed any queries, or would like to register for any of the social via WiFi Guest by registering their personal devices.To email after the conference once they have completed the have found something, please visit the congress Registration events (see below). The desk is also open for queries about connect to the guest wireless from your Wi-Fi device, please Congress Evaluation Survey, asking for their feedback on the Desk for assistance. any personal belongings that may have been lost or found. do as follows: conference. The survey and the certificate will be mailed to The opening times for the registration desk are: • Select WiFi Guest from the Wi-Fi network list the email address used in the registration process. If you have Oral Presentation Information and Speaker’s Wednesday 24th May: 9:00-16:00 • Open your preferred web browser and select Get Online at any questions please contact us by email (efrr2017@abbey. ready room (W007) Thursday 25th May: 8:00-17:00 Glasgow Caledonian University. ie) or at the registration desk at the conference. Speakers are kindly requested to have their presentation Friday 26th May: 8:00-17:00 • If you are already registered with Cloud Wi-Fi, you may use checked and uploaded well in advance, but at least 1 hour Saturday 27th May: 9:30-12:00 your previous credentials to access the service, otherwise Cloak Room before they are presenting. A speaker’s room (W007, across select the Create Account option A cloak room is available for storage of personal items. This from the Main Conference Hall) has been made available for Social events • Enter all the required information and select Continue 5. is located in room W009. This will open 1 hour before the this purpose. To avoid queues, the following is suggested: If you haven’t already done so, please register your interest • Name the device so you can manage it later, or skip this first event and close 30 minutes after last event on each • Mornings: Speakers presenting before the lunch break are to attend the Welcome Reception, the Civic Reception step day of the congress. A GCU volunteer will stay in this room requested to have their presentation checked and uploaded (welcome to all) and the Conference Dinner and Scottish • You are now connected to WiFi Guest network and you with your belongings. Please note however that owners in the morning before the start of the 1st session. ceilidh evening (tickets £45 for professionals and £30 for can browse the Internet. are responsible for their own belongings during this event; • Afternoons: Speakers presenting after the lunch break are students). There is a printed ticket for the Conference Dinner Glasgow Caledonian University nor Abbey are able to take requested to have their presentation checked and uploaded and Scottish ceilidh evening. If you had ordered this with Please note: any responsibility for delegates’ personal belongings. in the morning or during the lunch break. your registration, a ticket should be included in your delegate • Visitors can only register two devices per email account. • The speaker’s room will be open as follows: materials upon registration. Alternatively, you are able to Existing users can connect directly by logging in with a Congress Evaluation Survey Wednesday 24th May: 13:00-17:00 purchase these tickets from the registration desk. There is previous account created in another establishment. Your views on any aspect of this congress are invaluable Thursday 25th May: 7:30-17:00 more information on this night on the conference website as • If for any reason you want to remove your details from the to us, and will help us shape the next EFRR in 2019. To Friday 26th May: 7:30-17:00 well as a dedicated page in this programme. Sky database you must contact the BskyB support team by this end, we are kindly asking all delegates to complete an Saturday 27th May: 8:30-11:15 email via: wifi[email protected] evaluation form, and will be grateful for any comments and/ Smoking or suggestions you may have. Poster Presentation Information GCU is a non-smoking campus. This means that smoking is • Eduroam: GCU also provides the eduroam wireless • Materials to fasten posters will be provided on-site. not allowed anywhere inside or outside on campus. network for event attendees at GCU who are already Enquiries • Set up/Take down/ Presentation times part of this network. Eduroam is GCU’s free wireless The Registration Desk, at the entrance of the Hamish Wood • If your presentation is on Weds. & Thurs., posters can be Social media internet network that can be accessed by event attendees Building, is open for any enquiries you may have. You may set up from 9:00-13:00 on Wednesday 24th May 2017. Our dedicated EFRR 2017 blogger will be active during the that have a wifi device with a compatible 802.11a/g/n also register on-site at this desk, or register for any of the Posters must be taken down by 17:30 on Thursday or congress. wireless network adapter. Eduroam users will be able to social events. they will need to be discarded. Poster viewings will take • The twitter handle for the conference is #efrr2017 connect immediately using the username and password place during the morning break, lunch, and the afternoon • www.facebook.com/events/891033494333102 they already have from their home institution (eduroam Event documents and name badge break of Thursday 25th May. On that day, you should be • www.facebook.com/SRRUK users should have set-up their computer at their home You can pick up your name badge at registration. Each available in close proximity to your poster to discuss your organisation before coming to GCU). Please note that delegate, exhibitor, and speaker should have a name badge research at these designated times. Taxi information only event attendees who already are part of the eduroam for admittance. Information on the badges includes first • If your presentation is on Fri & Sat., posters can be set Black taxis are licensed to operate in Glasgow and can be network from their own academic institution will be able to and surname, organisation, and country. Please do wear up from 7:30 on Friday 26th May 2017. They must be hailed anywhere. There is a Taxi Rank located in Buchanan use this option. your badge at all times as without this you may not be taken down by 13:00 on Saturday or they will need to Bus Station situated across from the university. If you require allowed into the conference sessions. If you should lose your be discarded. Poster viewings will take place during the any assistance, please mention this when you book your taxi. badge, please visit the registration desk and we can issue a morning break, lunch, and the afternoon break of Friday Most black taxis can accommodate wheelchairs. Telephone replacement badge. 26th May. On that day, you should be available in close Number for Glasgow Taxis: +44 (0)141 429 7070. proximity to your poster to discuss your research at these designated times.

09 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 10 Conference Information Conference Information

Other useful Information

Continuing Professional Development (CPD) EFRR Conference 2017 Social Programme Accreditation There’s a packed schedule of presentations and workshops in The 14th Congress of the European Forum for Research store at EFRR 2017, but rest assured, we’ve left plenty of time in Rehabilitation has been approved by the Federation of for evening entertainment and socialising. Some highlights of the Royal Colleges of Physicians of the United Kingdom this year’s congress include: for 13 category 1 (external) CPD credit(s). Full conditions • 24 May: Welcome Reception at Glasgow Caledonian of approval are listed in the guidelines on www.rcplondon. University. Free to all delegates ac.uk/cpd/manage-your-cpd/cpd-approval-live-events. • 25 May: Civic Reception at Glasgow City Chambers hosted by The Right Honourable Lord Provost of Glasgow. Awards Free, pre-registration necessary • The European Forum for Research in Rehabilitation 2017 • 25 May: Scottish Ceilidh Evening, It’s a once-in-a-lifetime Awards: Two prizes will be awarded for the best research opportunity to socialise, dine, and dance the night away oral presentation and the best research poster (not beneath the glittering chandeliers of one of Scotland’s most including Work in Progress) at the EFRR 2017 Congress. historic landmarks, and to fully immerse yourself in the The winners will be announced on Saturday 27th May culture of Glasgow. For the dancing, we would recommend at the EFRR Awards Ceremony at 11.45 in the Main comfortable clothing that allows room to move. Ladies Conference Hall, where the prizes will be awarded. The may prefer ﬂat shoes over high heel ones, while tight skirts winners will also be announced on the EFRR 2017 website are deﬁnitely best avoided! £45/£30 students, We do have www.efrr2017.com a limited number of tickets available at the registration • The Society for Research in Rehabilitation Verna Wright desk but when they’re gone they’re gone! We also have 3 Prize 2017: Two prizes will be awarded for the best discounted tickets for students, to enable as many people 2 research oral presentation and the best research poster as possible to join us for a celebration destined to live long (not including Work in Progress) at the EFRR Congress in our collective memories. co-hosted by the Society for Research in Rehabilitation. • 26 May: An evening free to explore Glasgow and take in These two prizes will only be awarded to paid-up associate some of the vibrant culture, dining and entertainment the members of the SRR. Both prizes are £150.00 and the city has to o§er. Visit the People Make Glasgow website, winners will be announced in the next SRR newsletter and www.peoplemakeglasgow.com for information on the best on the website www.srr.org.uk the prizes will be awarded places to eat and drink and event listings. at the next SRR meeting in Bristol 6th February 2018. 4 Naturally, the four days of the congress will feature numerous 1 In order to be considered for the prize, non-members whose opportunities to mingle with your fellow delegates at regular research abstracts (not Work in Progress) are accepted networking breaks and lunches, designed to stimulate for presentation must have joined the SRR as an Associate conversation and forge new connections. Member before the Congress. To join or for more information visit www.srr.org.uk

Hotel Information GLASGOW For accommodation booked through the conference AIRPORT organisers and website, please see below the addresses and the websites for the hotels. Directions, as well as other information can be found on their website. • Grand Central Hotel, 99 Gordon St, Glasgow G1 3SF T: +44 141 240 3700 www.grandcentralhotel.co.uk • Holiday Inn Theatreland Glasgow,* 161 West Nile Street A Glasgow Caledonian University D Buchanan Bus Station 3 Holiday Inn Express Theatreland Glasgow G1 2RL T: +44 141 352 8300 www.higlasgow.com B Central Train Station 1 Grand Central Hotel 4 Glasgow City Chambers • Holiday Inn Express Theatreland Glasgow,* 16 West Nile C Queen Street Train Station 2 Hoilday Inn Theatreland Street, Glasgow G1 2RL T: +44 141 331 6800 www.ihg. com/holidayinnexpress/hotels/us/en/glasgow/glwth/ hoteldetail Directions to Glasgow City Chambers • Glasgow City Chambers is approximately a ten minute walk follow the red line indicated on the map above or three minute *Please note that there are two Holiday in Hotels right next to each other. Be sure to check your reservation, which will specify which hotel you are staying taxi journey from the University. Black taxis are licensed to operate in Glasgow and can be hailed anywhere. There is a Taxi in as the booking systems are separate. Rank located in Buchanan Bus Station situated across from the university T: +44 141 429 7070

11 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 12 Parallel Workshops Parallel Workshops

Wednesday 24 May 2017 2:00 PM – 5:00 PM, Room W118 (GMI) including mirror therapy could be considered as a Learning outcomes: with participants. Examples will be drawn from recent new therapeutic method for NP. Psychotherapy, cognitive 1 To understand the reasons for doing research that reflects implementation research, using realist evaluation to Workshop 1: behavioral therapy (CBT) and relaxation therapy are also what is important to patients, carers, health professionals investigate delivery of stroke rehabilitation in hospital Chronic pain syndromes and recommended. Non-invasive (repetitive transcranial and other stakeholders stroke units in the UK. magnetic stimulation (rTMS), transcranial direct current 2 To recognise that there are a range of prioritisation neuropathic pain syndromes: stimulation (tDCS)) and invasive neurostimulation methods, and reflect on some of the advantages and Part 3: Consideration of implementation of rehabilitation how to manage? techniques (i.e. deep brain stimulation (DBS), motor cortex disadvantages of these di§erent methods evidence at a global level [Please note that this workshop is limited to 40 delegates] stimulation (MCS), and spinal cord stimulation (SCS)) are 3 To have knowledge of the essentials of good practice in • Embracing the conference theme of ‘working in partnership focused on treatment of NP. Neurostimulation techniques involving people in research across boundaries’, participants will consider how Speakers: Prof Güseren Akyüz1 and Dr. Esra Giray E2 promise hope for the future of NP treatment. 4 To have considered the key stages necessary to complete a Implementation might be investigated across countries. 1M.D, Prof, Marmara University School of Medicine, Dept of Physical Medicine and Rehabilitation and Division of Pain Medicine, Istanbul, Turkey, priority setting project. This will include discussion of the influence of contextual [email protected] 2M.D., Marmara University School of Medicine, Dept Learning outcomes of this workshop factors (e.g. demographics, culture, geography, healthcare of Physical Medicine and Rehabilitation, Istanbul, Turkey, esra86ozkan@ Upon completion of this workshop, the participants will be systems). What learnings are there from recent global hotmail.com able to: Workshop 3: studies? 1 Gain knowledge of the definition, classification, and Pain is an unpleasant sensory and emotional experience Implementing evidence-based pathogenesis of chronic pain syndromes and neuropathic Learning outcomes: that can be defined with existing or potential tissue damage pain syndromes practice: current challenges • Appreciation of the implementation landscape or with damage. Chronic pain syndromes are complex 2 Integrate knowledge of pain mechanisms and clinical • Understanding of theory and methodologies currently used conditions that present a major challenge to physicians Wednesday 24 May 2017 2:00 PM – 5:00 PM, practice through case examples in Implementation research because of their unknown etiology, and poor response to Main Conference Hall 3 Have an enriched experience of managing chronic pain • Knowledge of evidence based stroke rehabilitation and all kinds of therapies. It has been suggested that chronicity syndromes and neuropathic pain syndromes through real-life examples of how this was facilitated or challenged should be considered when pain persists longer than the Speakers: Professor Marion Walker MBE and interactive discussion. • Reflection on implementation at a global level. acceptable healing time. Dr Rebecca Fisher · University of Nottingham, UK The impact of chronic pain on patients’ lives varies from Wednesday 24 May 2017 5:00 PM – 6:30 PM, The Saltire minor limitations to complete loss of independence. The Wednesday 24 May 2017 2:00 PM – 5:00 PM, Room W118 The purpose of this workshop is to provide an interactive rehabilitation of chronic pain syndromes involves physical and engaging forum in which participants can discuss therapy, occupational therapy, manual therapy, hydrotherapy, Workshop 2: ‘Implementation’. This will include learning about Welcome Drinks Reception cognitive/behavioral therapy, biofeedback, psychotherapy implementation research relating to stroke rehabilitation and at GCU: All Welcome and some new therapies such as functional restoration and What matters most in rehabilitation exploration of the underpinning theory, and discussion of neurostimulation. Combination of several methods has been research? Priority setting practical examples of facilitating evidence based practice. All delegates are warmly invited to join the Welcome Drinks tried, but long term evidence-based studies are needed The workshop will be conducted in three parts: Reception in the Saltire at GCU, which is just across the Main for new treatment modalities. Neuropathic pain (NP) has partnerships Conference Hall. Enjoy meeting other delegates, viewing a complex, severe and persistent character with varying Part 1: Implementation - what is it? posters and exhibition stands over drinks and canapés while Speaker: Dr. Alex Pollock • Participants will be asked to share their understanding intensity and duration changes and it is usually unresponsive Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow listening to The Royal Conservatoire of Scotland Jazz Trio. to treatment. NP can accompany to many diseases and can Caledonian University, UK of implementation with a view to capturing an · also be related to an injury. ‘implementation landscape’. This will allow appreciation This workshop will explore research priority setting. In of the di§erent types of activities and methodologies that Thursday 25 May 2017 8:30 AM – 9:15 AM, NP syndromes according to anatomical involvement can part 1, using examples from a series of priority setting fall under ‘Implementation’ and facilitate use of a common Main Conference Hall be divided into three groups: peripheral nervous system, projects, including James Lind Alliance priority setting language with which to discuss ideas. Topics to include: central nervous system and mixed. Pharmacological and projects relating to stroke and prolapse in women, di§erent • Process evaluation: to understand the functioning of a Welcome and Opening Address non-pharmacological treatment options have been tried research prioritisation methods will be introduced. In part 2 complex intervention in trial conditions, by examining the quality and quantity of what is actually delivered in extensively. First-line medication choice in NP includes: participants will get the opportunity to think about and plan Welcome to EFRR 2017 at Glasgow Caledonian University the evaluation, hypothesised mechanisms of impact and tricyclic antidepressants (TCAs), serotonin-norepinephrine a priority setting project relevant to their own rehabilitation Prof. Frederike van Wijck reuptake inhibitors (SNRIs), anticonvulsants, opioids, field. contextual factors that might influence e§ectiveness. EFRR conference chair, EFRR vice-president and SRR Senior Secretary, cannabinoids and topical agents. Physical therapy modalities • Long-term implementation: to understand the long-term Glasgow Caledonian University, UK such as superficial and deep heat applications, traction, Part 1 and real-life e§ectiveness of the intervention. The broader laser, transcutaneous electrical nerve stimulation (TENS), • A journey into priority setting, Why prioritise? Whose applicability of an intervention outside of a research Changing perspectives in rehabilitation diadynamic and interferential electrical currents are more priorities? How to prioritise? context may be tested. Dr. John Hunter OBE Retired Consultant in Rehabilitation Medicine, Edinburgh, UK helpful when combined with therapeutic exercises. • Priority setting methods, JLA priority setting partnerships, • Improvement science: evidence based medicine/practice Q-methodology, Nominal group technique, Delphi, and quality improvement. Consideration of learning ‘the The role of the EFRR in the field of rehabilitation in Europe As it is well known, the main goals of pain rehabilitation • Questions & Answers right thing to do’ (actions informed by clinical guidelines) and how to ‘do the right thing’ (system-level quality Prof. Aarne Ylinen programs are to reduce pain and the amount of analgesic EFRR President, University of Helsinki and Helsinki University Hospital, medication, improve dysfunction, increase quality of life and Part 2 improvement). Helsinki, Finland physical capability. Since the new rehabilitation techniques • Involving people in research addresses the cortical neuroplastic changes, their roles in the • Good practice in involving people in research Part 2: Showcasing a practical example treatment of NP are being increased. Graded Motor Imagery • Practical work – design your priority setting project • Evidence based stroke rehabilitation in action and challenges faced by stroke teams will be discussed

13 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 14 Parallel Session 1.1 Parallel Session 1.1 Parallel Session 1.2

Parallel Session 1.1.1 Parallel Session 1.1.2 Parallel Session 1.1.3 Parallel Session 1.2.1 Mental Health and Psychometrics Mental Health and Psychometrics Mental Health and Psychometrics Physical Rehabilitation & Exercise (1), May 25, 2017, 9:20 AM - 10:20 AM, Room W118 May 25, 2017, 9:20 AM - 10:20 AM, Room W118 May 25, 2017, 9:20 AM - 10:20 AM, Room W118 May 25, 2017 9:20 AM - 10:20 AM, Main Conference Hall Brain Injury Sense of Self Scale: The measurement of conﬁdence: A randomised controlled trial to Personalized rehabilitation of Psychometric development of a new the development and psychometric test the feasibility of evaluating the patients with osteoarthritis [63]

measure of strength of self-identity evaluation of a stroke specific Regaining Confidence After Stroke 2 1 [138] [89] [57] MD, PhD Irina Cherkashina , Prof Gennady Ponomarenko , after traumatic brain injury measure of confidence Programme MD, PhD Denis Kovlen3 1Scientific Practical Centre of Medical and Social Expertise, Prosthetics Dr Emily J Thomas1,2, Associate Prof William M M Levack2, Dr Jane Horne1, Prof Pip Logan1, Prof Nadina Lincoln1 Mrs Kate Hooban2, Dr Jane Horne1, Prof Nadina Lincoln1, and Rehabilitation of the Disabled, Saint Petersburg, Russian Federation. 2 3 1University Of Nottingham, Nottingham, UK. 1 2Research Institute of Children’s Infections, Saint Petersburg, Russian Associate Prof William J Taylor , Prof Richard J Siegert Prof Pip Logan 3 1Solent NHS Trust, Southampton, UK. 2Rehabilitation Teaching and Research 1University of Nottingham, Nottingham, UK. 2Nottingham CityCare Federation. Military medical academy, Saint Petersburg, Russian Federation. Unit, University of Otago (Wellington), Wellington, New Zealand. 3AUT Background: Stroke survivors have identified improving Partnership University, Auckland, New Zealand. confidence as a research priority [Pollock et al 2012]. It is, Background: Osteoarthritis ranks 5th among all causes of however, dicult to assess confidence, as there are no known Background: Loss of confidence has been identified as one disability. Development of a personalised evidence-based Background: Change in self-identity is a problem for many measures. The need to design a patient reported measure to component of psychological distress, which can reduce approach to the rehabilitation of patients with osteoarthritis, people after traumatic brain injury (TBI) and potentially capture a broad meaning of confidence was identified. quality of life. The NHS Regaining Confidence After Stroke as well as determination of optimal conditions of its linked with adverse rehabilitation outcomes. (RCAS) course is a group therapy designed to teach coping implementation is an urgent task of rehabilitation research. Aim: To design, develop and psychometrically evaluate a strategies for anxiety, depression and loss of confidence. It Aim: The aim of this study was to develop a patient-reported stroke specific measure of confidence: the Confidence after has not been evaluated. Aim: Development and scientific justification of the concept outcome measure to assess problems with self-identity in Stroke Measure (CaSM). of personalised rehabilitation of patients with osteoarthritis people after TBI. Method: Feasibility randomised controlled trial with at the sanatorium. Methods: Items were generated based on the literature and community dwelling stroke patients. Participants were Methods: Data from prior qualitative research, a concept qualitative interviews, then piloted with expert groups to randomly allocated to the intervention (RCAS) or control Methods: The study involved 132 patients with osteoarthritis, analysis of existing studies, and cognitive interviews with 13 establish face validity. A 53- item CaSM was administered (routine care). Outcomes were measured at baseline, 3 and divided into observation group (Group 1, N=107), in which a people with TBI were used to generate items for preliminary to stroke participants, and healthy elderly participants in 6 months through postal questionnaires and 8 interviews. personalized rehabilitation carried out in a sanatorium and a questionnaire: the Brain Injury Sense of Self Scale (BISOSS). the community. A second copy was posted 4 weeks later. Videos were used to check fidelity of treatment. comparison group (Group 2, N=25) who used the standard This questionnaire was administered, along with the Glasgow Completed questionnaires were analysed for reliability methods of rehabilitation in a hospital. Before and after Outcome Scale and Sense of Coherence measure to 136 (internal consistency and temporal stability), construct Results: 640 stroke participants were invited, 93 responded rehabilitation the clinical, laboratory, instrumental, functional people with TBI by face to face interview. validity (factor analysis) and convergent validity. and 47 (74%) of the proposed 60 participants were parameters and quality of life (SF36) were evaluated. recruited. 22 were allocated to the intervention group and Limitations of life performance in patients of both groups was Results: Results support the notion that problems with Results: Stroke (n =101) and healthy elderly participants 25 to the control group. RCAS was delivered to 4 groups, assessed by domains contained in ICF core sets. self-identity are commonplace after TBI, with 40% of (n=101) returned questionnaires. Items demonstrating poor each with between 6 and 8 participants. A median of 8 out respondents reporting such problems. Participant responses response distributions and missing values were removed. of the possible 11 sessions were attended by participants. At Results: There were significantly (p<0.05) more changes indicated that BISOSS was comprised of three subscales A 45-item questionnaire was examined for item total the three and six month follow up, 35 (78%) and 30 (67%) in Group 1 after rehabilitation in terms of: pain by the visual (labelled: egocentric self, sociocentric self, and relational correlations of +0.3 and a further six items were removed. participants returned questionnaires. The General Health analogue scale (3.1±0.3 before; 1.8±0.3 after; p<0.05), self), which fit the Rasch model and demonstrated A Mann-Whitney U Test demonstrated a statistically Questionnaire had the best full completion rate (78%) analgesics per day (0.4±0.2 tab; 0.0±00 tab; p <0.05), unidimensionality, adequate precision, absence of di§erential significant gender di§erence in one item (p=0.04) and it and the COPE questionnaire the worst (63%). Participants WOMAC index (116.2±11.1; 89.4±15.1; p<0.05), Index of item functioning and adequate person separation index. was removed. An exploratory factor analysis technique reported in interviews that the intervention had improved Severity for Osteoarthritis by Lequesne (14.4±3.2; 8.3±3.0; BISOSS correlations with employment status, leisure was conducted on the remaining 38-items, once suitability their mood but barriers were group dynamics and the length p<0.05), Ashworth Scale (1.4±0.2; 0.3±0.1; p<0.05), body activities and family relationships were as predicted. for this technique was established. A 27-item three factor of the course. RCAS was delivered according to the manual weight (88.1±1.2 kg; 84.2±1.3 kg; p<0.05), the angle of joint 1 solution was derived. Self-Confidence, Positive Attitude and instructions when checked against videos. active flexion (131.2±1.3 °; 122.2±1.5 °; p<0.05), 15 meter Discussion and Conclusions: We have developed a valid Social Confidence explained 52% of variance. There was walk test (21.4±1.5 s; 14.0±1.6 s; p<0.05), as well as all measure of strength of self-identity after TBI that conforms good evidence for internal consistency (α=.94) and a test Conclusion: We do not recommend a definitive trial at quality of life SF36 parameters (p <0.05) compared to Group to measurement expectations for an interval scale. The re-test on the 27 items indicated good temporal stability present due to the low recruitment rate. We recommend that 2. The e§ectiveness of rehabilitation in Group 1 was 92%, in BISOSS demonstrates acceptable psychometric properties (r=0.85 p=0.001). the RCAS intervention is developed further before evaluation. Group 2 - 86%. and is strongly grounded in identity theory and language and experiences of people with TBI. Future research is Conclusion: The 27 item CaSM was shown to be a valid and Discussion and Conclusion: The e§ectiveness of required to determine responsiveness to change. BISOSS reliable measure appropriate for stroke survivors. personalised rehabilitation of patients with osteoarthritis in could be used to evaluate, for example: impact of TBI on · the sanatorium stage is greater than in the hospital. sense of self longitudinally; e§ectiveness of interventions on reconstructing self-identity or correlation with rehabilitation outcomes.

15 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 16 Parallel Session 1.2 Parallel Session 1.2 Parallel Session 1.3

Parallel Session 1.2.2 Parallel Session 1.2.3 Parallel Session 1.2.4 Parallel Session 1.3.1 Physical Rehabilitation & Exercise (1), Physical Rehabilitation & Exercise (1), Physical Rehabilitation & Exercise (1), Rehabilitation Models May 25, 2017 9:20 AM - 10:20 AM, Main Conference Hall May 25, 2017 9:20 AM - 10:20 AM, Main Conference Hall May 25, 2017 9:20 AM - 10:20 AM, Main Conference Hall May 25, 2017 9:20 AM - 10:20 AM, Room W110 Exercise motivation in patients with Barriers and solutions to Implementing evidence-based From lab to clinic: Towards a virtual inflammatory rheumatic diseases participation in exercise for people Constraint Induced Movement reality platform for routine clinical after inpatient rehabilitation: stages with Multiple Sclerosis (MS) [172] Therapy into practice: a mixed rehabilitation [163] of change, benefits, barriers, and methods study [131] Dr Fiona Moat1, Dr Lorna Paul1 Dr Lindsay Millar1, Mr Brian Scarisbrisk2, Dr Andrew sports activity [157] 1 3 1 Glasgow Caledonian University, Glasgow, UK. 1,2 2 2 Murphy , Prof Phil Rowe Dr. Kathryn Jarvis , Dr. Sue Hunter , Prof. Nicky Edelstyn 1 2 1University Of Liverpool, Liverpool, UK. 2Keele University, Keele, UK. University Of Strathclyde, Glasgow, UK. Biggart Hospital, Pretwick, UK. Dr Kerstin Mattukat1, Prof Dr Wilfried Mau1 Background: Although exercise is cited as a means of 3DIH Technology, Chengdu, China. 1Institute for Rehabilitation Medicine, Martin Luther University Halle- managing the symptoms associated with MS, many people Background: Constraint induced movement therapy (CIMT) Wittenberg, Halle (Saale), Germany. Background: Recent advances in technology have led to the find it dicult to exercise regularly. is a complex intervention to increase upper limb function widespread commercialisation of virtual reality (VR). Many Background: Regular physical activity is an important post-stroke. There is evidence of CIMT e§ectiveness in researchers have investigated the use of VR for rehabilitation; cornerstone in the treatment of rheumatic diseases. Aim: Identify the barriers and solutions to participation sub-acute stroke, but paucity of qualitative data exploring its however few have extended VR use into routine clinical Unfortunately, patients are often physically inactive, and data in exercise for people with MS who were not exercising acceptability and feasibility. Evidence-based CIMT protocols practice. This is mainly due to systems being too complex about their exercise motivation is very limited. regularly. are not used routinely by therapists in the United Kingdom; and time consuming or too simple to provide necessary reasons for this are unknown. information regarding patient function. Aim: To investigate assumptions about the stages of change Methods: 35 non-exercising people with MS were recruited (SOC) model regarding sports activities in patients with into five groups across Scotland. Nominal group technique Aim: Underpinned by the Promoting Action on Research Aim: Develop a VR platform that can provide an objective chronic polyarthritis (CP) or ankylosing spondylitis (AS) in a (NGT) was used to explore consensus. Decision rules were Implementation in Health Services (PARIHS) framework, this measure of patient function and can be integrated into rehabilitation setting. set for consensus where 50% of each group’s participants two-phased study explored implementation of CIMT into clinical practice with minimal disruption to routine care. had to have ranked an item for it to be considered a priority practice. Methods: Secondary data analysis of 294 participants in an within a group. At least 50% of groups had to agree on a Methods: Motion analysis is currently the gold standard exercise intervention study during inpatient rehabilitation priority for it to reach consensus across groups. Descriptive Methods: Phase 1-focus group: perceptions of feasibility, for non-invasive measurement of human movement and with cross-sectional (t1) and longitudinal analyses (t1–t2; statistics and a thematic analysis were also used. including facilitators and barriers, of implementing CIMT into therefore was implemented in this study to provide an 6-month follow-up). We examined exercise self-ecacy practice were explored in a group of eight therapists. objective measure of function. A bespoke, cluster based (SE), perceived benefits and barriers to regular exercises, and Results: Participants were aged between 51-65 years (51%). Phase 2-four, mixed-methods, case studies: pre- and protocol was developed and used to create an avatar sports activities for di§erences across the stages of change 69% were female with 31% male. 77% had either relapsing post-CIMT interviews and quantitative measurement of and three feedback scenarios for standard orthopaedic (Precontemplation, Contemplation, Preparation, Action, and remitting or secondary progressive forms of the disease and participation and upper limb function were undertaken to rehabilitation exercises (step up, sit to stand, weight Maintenance). were medically retired (46%). 80% of participants were (i) investigate the feasibility of providing CIMT protocols in transfer). A cohort study was carried out in a hospital clinic educated at University or College and 60% were diagnosed sub-acute stroke (ii) explore stroke survivors’ perceptions with 15 control and 15 intervention orthopaedic rehabilitation Results: At t1, 24% of the participants were physically ≥10 years ago. The construct ‘fatigue’ achieved consensus and experiences of CIMT. Qualitative data were transcribed patients to assess the e§ectiveness of feedback and the inactive (7% Precontemplation, 9% Contemplation, 8% as the top barrier to exercise. Other barriers identified were: and analysed by two independent researchers using integration of the system into routine practice. Preparation) and 76% were active (21% Action, 55% lack of support and advice; impairments and symptoms; inductive thematic analysis. Quantitative measures furthered Maintenance). With increasing stages, SE (p<0.001) and and time. No single item achieved consensus as a solution understanding and triangulated qualitative findings. Results/Findings: Visual feedback was successfully perceived benefits (p<0.01) increased while perceived to exercise. Solutions included: exercising with similar delivered using motion capture with minimal disruption to barriers decreased (p<0.01). Persons on the two upper others, a need for specialist support, adopting a positive Findings: Provision of evidence-based CIMT protocols routine practice. Further, provision of feedback may have stages reported more sports activities than persons on the attitude of self and others, help with accessing the exercise was feasible, although barriers persisted. Stroke survivors’ a positive e§ect on knee sagittal range of motion (RoM), three lower stages (p<0.001). Patients who remained in environment, and prioritising time. perceptions and experiences indicated barriers to, and although larger scale studies are required to confirm these active stages at t2 (46%) reported a higher SE, more benefits facilitators of CIMT including: the impact of the CIMT on findings. and fewer barriers compared to persons who remained in Discussion and Conclusion: The main finding identified that participation, mood, fatigue and pain; personal attributes inactive stages (10%). Persons who progressed through the advice on the management of fatigue should be given when such as motivation, determination and a hope for recovery; Discussion and Conclusion: Use of a motion analysis stages during follow-up (23%) perceived less barriers at t2 prescribing exercise for people with MS. the impact of the environment; intensity of training and protocol, which was designed for purpose, allowed compared to participants who relapsed (21%; p<0.05). · constraint. Incongruence between therapist and stroke integration of the system into routine practice. There was survivor perceptions were identified. minimal disruption to patient care and use of the system may Discussion and Conclusion: The data show a good fit to the improve functional outcome of orthopaedic rehabilitation SOC model. Future research should validate the model in a Conclusions: Findings traversed PARIHS (research, context, patients. more representative sample followed by creating e§ective facilitation), and should be considered when implementing future interventions to promote physical activity in the target CIMT. Future studies of CIMT should explore: impact of · group. CIMT protocol variations; interactions between CIMT and participation. ·

17 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 18 Parallel session 1.3 Parallel session 1.3

Parallel Session 1.3.2 Parallel Session 1.3.3 Parallel Session 1.3.4 Thursday 25 May 2017 Rehabilitation Models Rehabilitation Models Rehabilitation Models 10:20 AM- 11:00 AM, The Saltire May 25, 2017 9:20 AM - 10:20 AM, Room W110 May 25, 2017 9:20 AM - 10:20 AM, Room W110 May 25, 2017 9:20 AM - 10:20 AM, Room W110 Morning Coee, Exhibition Understanding the delivery of A UK wide online survey of Working across international and Poster Viewing hospital-based stroke rehabilitation; physiotherapy and occupational boundaries: challenges and patient and therapist activity therapy practice for the management opportunities in translating · patterns across four rehabilitation of hemiplegic shoulder pain [103] the holistic neuropsychological units in England [119] rehabilitation model from English to Dr Praveen Kumar1, Professor Candy McCabe1,2, Dr Ailie 1 1 3 Turkish [168] 1 1 1 Turton , Dr Mary Cramp , Mr Mark Smith Dr Niki Chouliara , Dr Rebecca Fisher , Dr Brian Crosbie , 1 2 2 3 University Of The West Of England, Bristol, UK. Royal United Hospitals Prof Peter Langhorne , Prof Thompson Robinson , Prof Nikola NHS Foundation Trust, Bath, UK. 3NHS Lothian, Leith Community Treatment Dr Özden Erkan Oğul1,2, Dr Andrew Bateman1 Sprigg1, Prof Marion Walker1 Centre, Edinburgh, UK. 1Oliver Zangwill Centre For Neuropsychological Rehabilitation, Ely, UK. 1School of Medicine, University of Nottingham, Nottingham, UK. 2Institute of 2Department of Ergotherapy, Faculty of Health Sciences, Medipol University, Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. Background: Hemiplegic shoulder pain (HSP) is a common Istanbul, Turkey. 3Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. complication of stroke that can lead to reduced quality of life. Introduction: We have explored developing a holistic Background: Previous studies suggest that stroke patients in neuropsychological rehabilitation service suitable for Turkish Aim: The primary aim of the present study was to identify England receive less rehabilitation than elsewhere in Europe. culture. Six core components of rehabilitation provide a how HSP is assessed, diagnosed and managed in routine Recent National stroke audits highlight variation between framework for analysis: shared understanding, meaningful clinical practice by physiotherapists (PTs) and occupational hospitals in how they implement evidence-based practice. activity, therapeutic milieu, family involvement, cognitive therapists (OTs) in the UK. A secondary aim was to identify This study aimed to explore patients’ and therapists’ activity rehabilitation, and psychological therapy. the challenges to services in the management of HSP. patterns in stroke rehabilitation units in England with the view to identifying transferrable lessons for improvement. Method: Using observation, made possible during a 3 month Methods: A questionnaire was developed from similar international visiting scholar placement in the UK. based surveys of musculoskeletal/neurological practice, a review Methods: In four East Midland stroke units, structured on our understanding of current literature and through of the literature and consultation with researchers and observations were conducted with 145 stroke patients, one clinical supervision and reflection with expert colleagues, we clinicians. The survey was distributed online to PTs and month post-stroke. Activity logs of 220 therapists and nurses appraised the core components to develop suggestions for OTs working in stroke rehabilitation via professional bodies’ were collected. Multilevel logistic regression modelling was translation of this rehabilitation approach to Turkish culture interest groups. performed to assess di§erences in activity patterns across and context. sites. Results: Sixty seven responses were received from PTs Results: Barriers and facilitators have been tabulated to (60%) and OTs (40%). The respondents gained knowledge Results: Patients spent more than a third of their day by provide a structure for discussion: State and public lack in HSP management through in-service training, clinical their beds, sleeping or lying with no activity. A health care of awareness of possibilities of holistic rehabilitation, supervision and reading (80%). HSP was routinely checked professional was present for 18% of observations and insucient time, and financial problems are diculties for (89%) and the mean time spent on assessment was 10 patients’ most frequent contact was with family members. every component of the holistic rehabilitation model. The minutes. Commonly used assessments were glenohumeral Patients were most physically active in the presence of tolerant structure of the Turkish culture will be advantageous subluxation (94%), strength (76%), range of movement therapists but the highest levels of self-care activities in supporting creation of the therapeutic milieu. We also (67%), spasticity (79%) and palpation (63%). Interventions were seen in the presence of nurses. The presence of discuss physical environment, availability of specialists, included education, exercise and self-management. Patients rehabilitation assistants accounted for significantly higher cultural expectations about rehabilitation activities, and were discharged when treatment options were exhausted levels of therapeutic input observed in two sites. Increased the impact of gender and religious di§erences between our (80%). Time constraints (62%); lack of diagnosis (54%) administrative responsibilities meant that therapists spent cultures. and training (60%) were the major challenges in providing less than 50% of their working day on “hands on” therapy. appropriate care for HSP. Discussion: In providing a neuropsychological rehabilitation Conclusion: Patients spend a disproportionate amount for people with cognitive impairments revealed after brain Conclusion: The results suggest that a wide range of of their day inactive in their rooms. Findings highlight the injury, the holistic approach has growing recognition around approaches are utilised by clinicians and that patients are potential to increase patients’ activity levels by actively the world. Despite the problems outlined there is now potentially receiving treatment irrespective of the underlying involving families in the rehabilitation process and reducing increasing recognition of the importance of rehabilitation problem due to lack of accurate diagnosis of the cause of the time therapists spend in administrative activities. Nursing in helping people overcome cognitive emotional and HSP. A comprehensive assessment tool and additional sta§ and rehabilitation assistants have a key role to play in social problems that arise after brain injury. Developing a training specific to HSP are required to improve the patients’ enhancing therapeutic input. framework for rehabilitation will give hope to brain injury outcome. · survivors that they may experience less disability in the · future.

19 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 20 Parallel session 2.1 Parallel session 2.1

Parallel Session 2.1.1 Parallel Session 2.1.2 Parallel Session 2.1.3 Parallel Session 2.1.4 Cognition and Cognitive Rehabilitation Cognition and Cognitive Rehabilitation Cognition and Cognitive Rehabilitation, Cognition and Cognitive Rehabilitation May 25, 2017 11:00 AM - 12:15 PM, Room W118 May 25, 2017 11:00 AM - 12:15 PM, Room W118 May 25, 2017 11:00 AM - 12:15 PM, Room W118 May 25, 2017 11:00 AM - 12:15 PM, Room W118 A new screening method for Development of a complex activity Present barriers, emergent and Rigorous reporting of stepped detecting problems in Mental Health and independence promotion future needs in digital society wedge cluster randomised controlled and Learning [122] intervention for people with mild - from the perspective of People with trials (SW-CRCTs): development cognitive impairment and dementia: Disabilities and the Elderly [181] of a flow diagram template [231] Dr Erja Poutiainen1, Mila Gustavsson-Lilius1, Tuula Mentula1, 1 1 2 Physiotherapy component [169] [Methodology session] Johanna Stenberg , Minna Parkkila , Marika Ketola 1 1 1 2 Dr Anne Kärki , Dr Merja Sallinen Rehabilitation Foundation, Finland, Helsinki, Finland. The Finnish 1 1,2 1 1,3 Rehabilitation education, Satakunta University of Applied Sciences, Pori, 1 2 Association for Mental Health, Finland. Ms Vicky Booth , Dr Victoria Hood , Mr Trevor Bramley , Finland. Dr Heather Gray , Dr Christopher J Weir , Dr Catriona Mrs Kate Robertson4, Ms Jude Hall1,2, Prof Rowan Harwood2, Keerie2, Dr Jean McQueen1, Mrs Brenda Bain1, Prof Marian C Background: Young adults with problems in mental health Prof Pip Logan1,4 Background: This study is part of the Entelis-project aiming Brady1 or learning are at risk for exclusion from work/education and 1University Of Nottingham, Nottingham, UK. 2Nottingham University to reduce the digital divide by removing barriers, increasing 1NMAHP Research Unit, Glasgow Caledonian University, Glasgow, Scotland, social community. However, these problems are frequently Hospitals NHS Trust, Nottingham, UK. 3Nottinghamshire Healthcare, UK. 2Edinburgh Clinical Trials Unit, Usher Institute of Population Health Nottingham, UK. 4Nottingham City Care, Nottingham, UK. digital competences and facilitating access to appropriate Sciences and Informatics, University of Edinburgh Medical School, Edinburgh undetected by professionals. New methods for screening assistive technologies for those who need them. EH4 2XU, Scotland, UK. of mental health problems and diculties in learning are Background: Older adults with mild dementia are at high needed. risk of falls, experiencing altered gait patterns and reduced Aim: The aim is to identify present barriers as well as Background: Stepped wedge cluster randomised controlled balance. A multicomponent intervention is required that emergent and future needs of people with disabilities trials (SW-CRCT) are increasingly used in rehabilitation Aim: To develop a screening method for early detection of impacts all risk factors and addresses the needs of older (PwDs) and the elderly concerning their use of ICT/ICT-AT in research. Current Consolidated Standards for Reporting Trials problems in mental health and learning in young adults. people with dementia in the community. A new complex education, work and wider social participation. (CONSORT) diagram templates are unsuited to depicting the intervention aimed at increasing activity and independence flow of participants through this trial design. Thus, reporting Method: The screening method was developed using for people with MCI and early dementia was developed Method: An eForm questionnaire with Likert-scale to CONSORT standards is challenging. A recent systematic the data collected from 630 predominantly unemployed ready for evaluation. statements and open-ended questions was distributed by review highlighted the poor-quality reporting of SW-CRCTs, adults of the age of 18–25. Additionally, 58 participants the Entelis-partners to organizations involved with ICT/ identifying that 33.3% failed to include a CONSORT flow who reported learning diculties in screening completed a Aim: To develop the physiotherapy component of the ICT-AT in the education of people with disabilities and diagram. comprehensive neuropsychological examination. Exploratory intervention. older adults. A total of 51 organizations from 21 countries factor analysis, Cronbach’s alpha and Pearson correlations responded. Aim: To develop a SW-CRCT flow diagram template were used in reliability and validity analyses. Method: Intervention development was guided by with capacity to accurately depict participant movement the Medical Research Council guidelines for complex Results: The results suggest that the lack of ICT (patients and sta§) through study phases and across sites Results/Findings: The screening questionnaire consisted interventions (2008). A mixed methods approach competencies among the PwDs/elderly and their caregivers in the Stroke Oral healthCare pLan Evaluation (SOCLE II; of 38 items (15 mental health and 23 cognitive items). incorporated: three systematic reviews (umbrella, realist restrict the use of technology in everyday life. More than NCT01954212). Five main factors were found: mental health (27.7% of the review and meta-analysis), two clinician workshops, 20 80% of the respondents saw that the users develop self- variance, Cronbach’s alpha 0.92), reading and language participant-carer interviews, cross-sectional survey (n=69), directed ICT/ICT-AT skills and mentioned that peer support Methods: Following ethical approval we recruited 325 (11.6%, 0.83), attention and execution (5.2%, 0.74), two expert opinion meetings, on-going patient and public models should be strengthened in education. The lack of patients and 112 sta§ across four study sites and collected mathematics (4.2%, 0.76) and visuoperceptual/motor involvement (PPI) and multi-phase proof-of-concept study confident use was seen as the major cause for abandoning data during usual care, intervention and enhanced (3.6%, 0.64). Mental health and cognitive sum scores (n=10). Data were synthesised to produce a manual. Ethical technology. 90% of the respondents considered training care study phases. Working collaboratively, a team of correlated significantly (r=0.40, p<0.001). All participants permission was given by the NHS Health Research Authority. families in ICT and assistive technology essential, pointing experienced rehabilitation researchers, trial methodologists with neuropsychological examination had cognitive out that when the supporters know little about ICT-AT it is and statisticians, explored various approaches to performance indicative of developmental learning deficit of Results: The final intervention includes strength, balance like “blind leading a blind”. inform the development of a unique flow diagram. We whom 54 % had also previously been diagnosed with mental and dual-task exercises. Potential content and theory from sought to develop a template that was flexible enough health problems. clinical experience and systematic reviews were compiled Discussion and Conclusion: The ICT/ICT-AT skills and to accommodate the reporting of complex pragmatic into a definitive dual-task and standard exercise list. competence development of PwDs and elderly should be SW-CRCTs, but which also enabled selective filtering of Discussion and Conclusion: The developed screening Findings regarding participants and outcomes identified by part of digitisation strategies enhancing digital inclusion. information to support the reporting of specific aspects of method is able to recognise young adults with problems the cross-sectional survey were confirmed through meta- Furthermore, there should always be other solutions for the trial. in mental health and/or developmental learning disability. analysis and expert discussion. Participant-carer interviews, people unable to use digital services or tools. Concomitant mental health problems are common in those PPI discussion and clinician workshops refined methods Results: Our SW-CRCT CONSORT flow diagram template with learning disability. Thus, this screening method, which is of delivery, materials and procedures. Concept testing elucidates the patients and sta§ in SOCLE II that were: able to identify symptoms both in mental health and learning assured content, depicting the Physiotherapy component as screened; consented; withdrawn (and later returned); appears a valuable tool for identifying young adults with a deliverable, feasible and acceptable to people with MCI. An discharged; trained; transferred and contributed to data risk of exclusion from work and society. intervention manual was produced with occupational therapy collection at specific time points. and psychological components. Conclusion: Using Microsoft Visio 2010 software our flow Discussion and Conclusion: A feasible, dementia-specific diagram template can be adapted by other rehabilitation physiotherapy intervention has been manualised to guide researchers to enhance the quality of their analysis and trial rehabilitation for people with dementia. The intervention is reporting to CONSORT standards. currently being trialled as part of a 1-year feasibility study.

21 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 22 Parallel session 2.2 Parallel session 2.2

Parallel Session 2.2.1 Parallel Session 2.2.2 Parallel Session 2.2.3 Parallel Session 2.2.4 Physical Rehabilitation & Exercise (2) Physical Rehabilitation & Exercise (2), May 25, 2017 Physical Rehabilitation & Exercise (2), May 25, 2017 Physical Rehabilitation & Exercise (2) May 25, 2017 11:00 AM - 12:15 PM, Main Conference Hall 11:00 AM - 12:15 PM, Main Conference Hall 11:00 AM - 12:15 PM, Main Conference Hall May 25, 2017 11:00 AM - 12:15 PM, Main Conference Hall Chronic stroke survivors’ lower Robot assisted symmetry training in Can real-time feedback in virtual Can virtual and augmented reality limb function improves with an a stroke patient [167] reality improve gait in children with decrease phantom limb pain and indoor cycling exercise programme Cerebral Palsy? [133] Dr. Andrej Olenšek1, Dr. Matjaž Zadravec1, Mr. Marko Rudolf1, improve activities and participation? delivered by local council leisure 1 1 1 Dr. Nataša Bizovičar , Dr. Nika Goljar , Dr. Zlatko Matjačić 1,2 2 [150] 1 Mr Adam Booth , Dr. Frans Steenbrink , Dr. Annemieke services [37] University Rehabilitation Institute, Republic Of Slovenia, Ljubljana, Slovenia. 1 1 1 Buizer , Dr. Jaap Harlaar , Dr. Marjolein van der Krogt 1,2 1 1VU Medical Center, Amsterdam, Amsterdam, Netherlands. 2Motekforce Prof Helena Burger , OT Zdenka Pihlar , PhD Max Ortiz- Dr Andy Kerr1, Prof Madeleine Grealy1, Dr Joanne Background: Gait asymmetry as a consequence of Link B.V., Amsterdam, Netherlands. Catalan3,4 Cummings1, ProfGillian Mead2, ProfPhillip Rowe1, Dr Mark hemiparesis after stroke is a common long-term disability 1University Rehabilitation Institute, Ljubljana, Slovenia. 2Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. 3Department of Signals and 3 in post stroke individuals. Considering substantial adverse Background: The use of virtual reality (VR) and real-time Barber Systems, Chalmers University of Technology, Gothenburg, Sweden. 1 2 University of Strathclyde, Glasgow, UK. University of Edinburgh, Edinburgh, e§ect gait asymmetry may have on gait function and feedback to challenge an altered gait shows potential to 4Integrum AB, Mölndal, Sweden. UK. 3NHS Lanarkshire, Lanarkshire, UK. quality of life, rehabilitation devotes considerable attention advance rehabilitation and diagnostics in children with specifically to symmetry training during gait. Cerebral Palsy (CP). Children with CP can improve knee/ Background: After amputation, up to 80% of patients had Background: Exercise is recommended for stroke survivors. hip extension in response to feedback, however, for a clinical phantom limb pain (PLP), and many of them reported that it Attending exercise classes, however, is not common in this Aim: The purpose of this study was to develop and application, feedback on a number of gait parameters is interferes with their activities and participation (AP). population due to a range of environmental, premorbid and implement our recently developed Balance Assessment required to accommodate the range of gait limitations in CP. stroke specific factors. Indoor cycling has been shown to Robot (BAR), an adaptive control scheme for gait symmetry Aims and objective: The aim of our study was to find out be acceptable, safe and e§ective for stroke survivors when training, and to evaluate its e§ectiveness in a clinical trial Aim: Can avatar based feedback improve gait in children with whether we can decrease PLP and improve AP by promoting delivered within the framework of controlled research. with a post stroke patient. CP? the use of Phantom Motor Execution (1).

Aim: The aim of our study was to assess the e§ect of a Methods: BAR is a robot for pelvis manipulation that is Methods: An avatar-based feedback game was developed Patient and methods: All patients (N=6) who visited our cycling based exercise programme on physical function when capable of providing perturbation forces to a user’s pelvis for an integrated treadmill system with VR environment outpatient clinic after upper limb amputation in 2015, delivered through existing local council services. during walking on an instrumented treadmill. In our clinical and motion capture (Motekforce Link, Amsterdam). Gait is were at least 18 years old, with persistent moderate/strong trial, BAR was used to provide repeatable force impulses visualised by an avatar in VR with real-time feedback on a PLP, and willing to participate were included in the study. Methods: Medically stable stroke survivors discharged to the patient in the direction of the impaired side at foot range of gait parameters associated with CP. Nine children Treatment consisted of 12 sessions. After placement of from NHS rehabilitation services and living within two local strike of the impaired leg to prolong the stance time on the with CP (Age:10.5±3.3yrs /GMFCSI-II) were included in an electrodes, patients practised motor execution in virtual council areas were invited to participate in an 8-week (2/3 impaired side. The amplitude of the force impulses was ongoing study. Three trials were carried out with feedback reality (VR), played games by using phantom movements, times per week) cycling exercise programme, delivered in continuously adjusted according to step length asymmetry on a single parameter; knee extension, ankle power and a and matched random target postures of a virtual arm. leisure centres by trained leisure sta§. Physical function was in preceding steps. After completing twenty three training further patient specific parameter (step length/pelvis tilt/ The diculty was increased when the previous level was assessed with the five times sit-to-stand test (FTSTST), gait sessions we compared symmetry parameters before and foot progression). successfully completed. PLP was assessed by the Weighted speed and the Nottingham Extended Activities of Daily Living after the training period. Pain Distribution before, at the end, after one, three and six (NEADL). Results: With feedback, peak knee extension around initial month. AP was assessed by the COPM. Results: At the beginning of the training program, the patient contact improved by 8.0±4.2°. Peak ankle power at push Results/Findings: Seventy-seven individuals were recruited spent 37% of the stride time on the impaired side, whereas o§ increased 54.4±28.5%. With patient specific feedback, Results: Treatment increased time without PLP on average (aged 63.7±12.6 years) with sixty-six (aged 64.0±12.4 years) at the end of the training program, stance time of the improvements were found in 5° reduced anterior tilt, step from 7% at the beginning to 31% at the end of treatment, completing the programme, including eight wheelchair impaired side increased to 47% of stride time. This reflects length increased 10.8% and a modest improvement of foot 45%, 66% and 73% after one, three and six months. COPM dependent individuals. Preferred walking speed (n=58) also in considerably more symmetrical centre of pressure progression during stance (2.4° reduced out-toeing). findings showed that Performance of activities improved increased from 0.67m/s (SD 0.36) to 0.82m/s (SD 0.51), the pattern. from 4.7 at the beginning to 7.6 at the end of the treatment FTSTST (n=66) decreased from 24.10s (SD 19.00) to 19.02s Conclusion: This study demonstrates the potential for (8.4 after six months) and satisfaction with performance (10.90). These di§erences were statistically di§erent (t-test, Discussion and Conclusion: Results confirm that over feedback in VR to develop immersive rehabilitation and drive from 4.5 to 8.4 (9.2). p<0.05). The NEADL remained largely unchanged (12.30 to the course of symmetry training, the patient substantially clinically relevant improvements of a number of key gait 13.04). improved temporal symmetry parameters of gait and suggest parameters in children with CP. This short term adaptability Discussion and Conclusion: This novel method was that the proposed robot-assisted gait may significantly may persist with a prolonged feedback training programme. successful in reducing persistent PLP and improved AP Discussion and Conclusion: This study demonstrated that contribute to improving gait symmetry in stroke patients. Additionally, patient specific compensations that may have in included subjects. Research on a greater number of a cycling based exercise programme delivered through local clinical diagnostic importance were observed during some participants is needed to draw more definitive conclusions. council services is feasible and can improve the physical trials. capacity of chronic stroke survivors. The improvements Reference: in walking and sit-to-stand are consistent with the lower 1 Ortiz-Catalan M, et al., Front. Neurosci. 2014; 8:24. limb focus of cycling. These findings can inform the implementation of exercise initiatives for stroke survivors. ·

23 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 24 Parallel Session 2.2 Parallel Session 2.3 Parallel Session 2.3

Parallel Session 2.2.5 Parallel Session 2.3.1 Parallel Session 2.3.2 Parallel Session 2.3.3 Physical Rehabilitation & Exercise (2) Access to Services & Decision Making Access to Services & Decision Making Access to Services & Decision Making May 25, 2017 11:00 AM - 12:15 PM, Main Conference Hall May 25, 2017 11:00 AM - 12:15 PM, Room W110 May 25, 2017 11:00 AM - 12:15 PM, Room W110 May 25, 2017 11:00 AM - 12:15 PM, Room W110 ‘Talking about walking’ with people Inequities in access to inpatient Decision–making governing the Equipment provision after stroke: who have had a stroke – what rehabilitation after stroke: An provision of rehabilitation for people Controversies in clinical reasoning [1] aspects of walking are valued? [191] international scoping review [76] with severe disabilities after stroke Dr Pauline Boland1, Dr William Levack2, Dr Fi Graham2, Dr [104] 3 1,2 2 1,2,3,4 2,3,4 Meredith Perry Dr Ingrid Wilkinson Hart , Dr Paul Taylor , Prof Jane Dr Elizabeth Lynch , Dr Julie Luker , A/Prof Dominique 1 1 1 2,3,5 4 Clinical Therapies, University Of Limerick, Limerick, Ireland. 2Rehabilitation, Burridge , Dr Julie Wintrup Cadilhac , A/Prof Susan Hillier 1 1 Teaching and Research Unit, University of Otago, Wellington, New 1 2 1 2 Ms Sushmita Mohapatra , Prof Marion Walker , Prof University of Southampton, Southampton, UK. Salisbury NHS Foundation University Of Adelaide, Adelaide, Australia. Florey Institute of 2 1 1 Zealand. 3Centre for Health, Activity and Rehabilitation Research School of Trust, Salisbury, UK. Neuroscience and Mental Health, Melbourne, Australia. 3NHMRC Centre Catherine Sackley , Dr Niki Chouliara , Dr Rebecca Fisher 1 2 Physiotherapy University of Otago, Wellington, New Zealand. of Research Excellence in Stroke Rehabilitation and Brain Repair, Melbourne, University Of Nottingham, Nottingham, United Kingdom. School of Australia. 4University of South Australia, Adelaide, Australia, 5Monash Medicine, Kings College London, London, UK. Background: Participants in a quantitative gait rehabilitation University, Melbourne, Australia. Background: Adaptive equipment is commonly prescribed pilot randomised controlled trial spoke about valued personal Background: Deciding who would benefit from rehabilitation as part of rehabilitation after stroke, to support people to aspects of walking, but these were not fully captured by the Background: Inequities in accessing inpatient rehabilitation post-hospital discharge after stroke can be dicult. Such take part in valued occupations, however the reasoning outcome measures. No peer reviewed publications were after stroke have been reported in many countries and decisions impact on whether a patient receives rehabilitation used by health professionals issuing equipment is not well found that focus on the experience of walking post-stroke or impact on patient outcomes. and influence the use of healthcare resources. Several understood. assess aspects of walking that are valued by individuals. variables have been reported to influence decisions for the Aims: To explore international recommendations provision of rehabilitation to stroke survivors. However, it Aim: To explore the perspectives of allied health Aims: To identify what aspects of walking are important and practice regarding access to post-acute inpatient is not known how these decisions are made in practice for professionals who prescribe equipment to better understand to individuals and consider if these are measured in rehabilitation after stroke. stroke survivors with severe disabilities. This is especially their reasoning in this process. rehabilitation clinical practice or research. important as stroke rehabilitation is now being transferred Methods: A computerised systematic database search was earlier into the community. Method: Six focus groups with 30 health professionals Methods: In depth interviews with a subgroup of participants conducted. Grey literature was also searched. Literature was (n=13 occupational therapists and n=17 physiotherapists) from the original trial were undertaken using an Interpretative included when available in English, and containing either Aims: To investigate the process of decision-making and were conducted, audio-taped and transcribed verbatim and Phenomenological Approach (n=4) to systematically explore recommendations regarding which patients with stroke factors influencing the provision of rehabilitation for people analysed using grounded theory. the experience of walking post-stroke. should receive inpatient rehabilitation, or data regarding with severe disabilities after stroke. the proportion of patients who accessed inpatient stroke Results: Client engagement, including willingness and Results/Findings: The participants gave examples of post- rehabilitation. Methods: Semi-structured interviews were conducted with capacity to engage, was the primary consideration of health stroke walking related changes in their self-perception, 22 key multi-disciplinary sta§ from an acute stroke unit. Their professionals. This engagement was influenced by clients’ roles and their embodied experience of walking that are Findings: Stroke guidelines specifying selection criteria for perspectives of the process deciding rehabilitation provision physical and cultural environment, other people such as rarely mentioned in the rehabilitation literature, apart from post-acute inpatient rehabilitation were identified for 15 for people with severe disabilities after stroke was explored. family members and caregivers and the relative risk versus in personal accounts written by people living with chronic countries or regions. Literature providing summary data of Data were thematically analysed using template analysis. benefit of equipment. Equipment provision was a§ected illness. They valued being able to walk distances at a the proportion of patients to access inpatient rehabilitation by tensions with the healthcare system when there were reasonable speed, being independent, safe and confident. was identified for 14 countries. Reports from developing Results:The variables considered by sta§ while deciding competing resource management issues. The way the They said that they missed their pre-stroke spontaneity, countries described a paucity of stroke rehabilitation rehabilitation care for people with severe disabilities after healthcare system prioritised allocation of equipment funding freedom/self-determination, agility, strength and their lost services. In clinical guidelines from Australia, New Zealand stroke were: medical factors, the severity of impact of could either align with, or oppose, a health professional’s own automatic body movement. and United Kingdom it is recommended that all patients stroke, patients’ potential to progress with rehabilitation, philosophy of practice. with stroke symptoms should access rehabilitation, whereas organisational factors, patient and their families’ wishes Discussion and Conclusion: Muscle strength, walking guidelines from the United States of America, Canada and and preferences, safety and needs. Decisions governing the Discussion and Conclusion: Recommendations made speed, balance and independence are routine assessments Europe included reservations or exclusion criteria for severe provision of rehabilitation evolved during the hospital stay when providing equipment are based on non-clinical factors in clinical practice/research post-stroke with walking stroke. Access to inpatient rehabilitation ranged from 13% in and were made in three distinct phases. The decision-making and client-related factors. An allied health professional is confidence also sometimes reported. Spontaneity, freedom/ Sweden to 57% in Israel. Di§erences in availability of early required several formal processes of communication within expected to take on multiple roles simultaneously including self-determination and ‘automaticity’ of body movement supported discharge/home rehabilitation programs and and outside the multi-disciplinary team, patient and family. as an assessor, a gatekeeper of resource, a consultant are not reflected in standard gait rehabilitation outcome variations in reporting methods may have contributed to or an advocate. While an inherent part of many allied measures. Participants’ accounts echoed the philosophical some, but not all, of the observed discrepancies in access to Conclusion: This study highlights the importance of patient health professionals’ practice, there is concern that their concept of ‘body transparency’ (a body that is transparent rehabilitation between regions. related and organisational factors in a multi-stage decision- responsibilities to the health service create moral distress or background in health and moves to the foreground of making process for rehabilitation post-hospital discharge. when this comes into conflict with their professional our attention in illness). This concept may be helpful in Conclusion: Recommendations regarding which patients Findings can inform the future provision of rehabilitation for philosophy. understanding the lived experience of walking impairment. with stroke should access ongoing rehabilitation are stroke survivors with severe disabilities. · inconsistent. Clinical practice guidelines from di§erent · countries regarding post-stroke rehabilitation do not always reflect evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue. ·

25 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 26 Parallel Session 2.3 Parallel Session 3.1

Parallel Session 2.3.4 Parallel Session 2.3.5 25 May 2017 12.15 PM-1:45 PM, Main Conference Hall Parallel Session 3.1.1 Access to Services & Decision Making Access to Services & Decision Making Education May 25, 2017 11:00 AM - 12:15 PM, Room W110 May 25, 2017 11:00 AM - 12:15 PM, Room W110 Society for Research in May 25, 2017, 2:35 PM - 3:35 PM, Room W118 Rehabilitation (SRR) Annual General What factors inform therapists’ Socio-economic assessment of Meeting Evidence-based health education decision-making? Selected ﬁndings personal exoskeleton systems [199] in asthma: Impact on asthma

from an ethnographic case-study 1,2, 2 knowledge and asthma control up Dr. Sandro-Michael Heining Dr. med. Klaus Weber , Prof. 25 May 2017 12.15 PM-1:45 PM, The Saltire [71] series in eight English stroke units Dr. med. Hans-Christoph Pape1 to one year (ReAcT) [127] 1USZ, Zurich, Switzerland, 2Generali Deutschland Schadenmanagement GmbH, Cologne, Germany. Lunch, Exhibition and Poster Viewing Prof Eva Maria Bitzer1, Kathirn Bäuerle1, Dr. Janine Feicke1, 2 1 1 1 Dr. Wolfgang Scherer , Prof. Dr. Ulrike Spoerhase Ms Louisa-Jane Burton , Dr David J. Clarke 1 2 1Academic Unit Of Eldery Care And Rehabilitation, University of Leeds, Background: Exoskeleton robotic suits just made the step out · University of Education, Freiburg, Germany. Rehabiliation Clinic Utersum, Utersum, Germany. Leeds, UK. of the laboratory towards clinical evaluation in 2013, while 25 May 2017 1:45 PM – 2:30 PM, Main Conference Hall patients desperately waiting for relief of their paraplegia try Background: National clinical guidelines recommend to acquire whatever therapy is available. With advancement Objectives: To modify and evaluate a patient education minimum daily amounts of Physiotherapy (PT), Occupational in robotic technology and power supply exoskeletons, robots Society for Research in program for adult asthma patients in consideration of Therapy (OT) and Speech and Language Therapy (SLT) after are no longer restricted to lower limb medical rehabilitation Rehabilitation Philip Nichols Lecture validated quality criteria for teaching. stroke. This has focused attention on how therapists make in clinical settings. Today, “personal” robotic systems are on decisions about therapy frequency and intensity. the market and the industry promises: “paraplegic can walk Professor Peter Langhorne, Professor of Stroke Care, Methods: This was a prospective single-centre controlled again.” Besides technical aspects including FDA approval, University of Glasgow, UK. trial in an inpatient rehabilitation centre. The control group Aim: To explore factors influencing therapists’ decision- there are also patient requirements that have to be met. Until patients (n=215) received the usual lecture-based education making about the frequency and intensity of in-patient post- now, only a handful of clinical studies have been published. Peter Langhorne is Professor of Stroke Care at the University program, and the intervention group patients (n=209) stroke therapy provision. Beyond technical issues such as walking forces, walking of Glasgow, UK. His research work has focussed on the received the modified patient education program. Data were speed and safety aspects, medical benefit and adverse e§ectiveness of di§erent treatment strategies for stroke assessed at admission, discharge, and 6 and 12 months post Method: As part of an ethnographic case-study series, reactions are still under investigation. Nevertheless more and patients, including service delivery (e.g. stroke units and discharge. The primary outcome was asthma control, and the we observed practice, including patient-specific therapy more patients submit claims to their health insurances for early supported discharge) and stroke rehabilitation (e.g. secondary outcomes were asthma knowledge, quality of life, sessions, in eight English stroke units. Therapists participated coverage of exoskeleton systems, hoping they could stand early rehabilitation). This work has involved the use of and program acceptance. Analysis of change was performed in semi-structured interviews exploring decision-making, and walk again. With individual costs exceeding 100.000€ various methodological approaches and collaboration with by ANCOVA for each follow-up time point, adjusting for which were analysed using the Framework approach. per case, the insurers reacted in a rather reserved way in more than 50 colleagues from around the world. He is the baseline values. the beginning, while German statutory accident insurance coordinating Editor of the Cochrane Stroke Group and is still Results/findings: Decisions about frequency and intensity according to German law had to react in a more facilitating trying to complete his Munros. Peter.Langhorne@glasgow. Results: Statistically significant increases in all health were shaped by four factors: Patient appropriateness way. ac.uk outcomes and in asthma control were maintained in both for therapy (overall and on-going), patient tolerance, groups (at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 organisational factors and clinical guidelines. OTs and PTs Aim: The authors will present state-of-the-art in technical, (95%-CI 0.8-2.3). We observed no significant di§erences routinely assessed all in-patients, except those determined medical and legal assessment of personal exoskeleton Evidence-based rehabilitation: are there any lessons from between the 2 programs for asthma control and quality of to be medically unfit; SLT input followed referral from systems. stroke research? The last twenty years have seen a steady life. Regarding practical asthma knowledge, after 12 months, other professionals. The frequency and intensity of therapy progress in the development and application of an evidence- a group*time interaction emerged with a small e§ect 2 sessions were determined more by daily fluctuations in Results/findings: In 2016 a German social welfare court based approach to stroke rehabilitation. Clinical practice size (P=0.06, η =0.01). High participant acceptance was patient tolerance (a§ected by medical condition, fatigue, declared that a personal exoskeleton system was medically guidelines in stroke rehabilitation are well established and reported in both groups. motivation), availability and physical preparedness, than necessary and should be covered by the insurance for a 44 research work is exploring the implementation of evidence. by clinical guidelines or research evidence. In the context year old male individual with spinal cord injury at T6 level. However, this journey has been complicated by major Conclusion: The modified program was not superior to of limited resources, therapists faced dicult prioritisation challenges and setbacks. This presentation will share some traditional patient education concerning asthma control. decisions around whether to provide shorter or less frequent Conclusion: The verdict included several key decisions of the experiences in stroke rehabilitation research, which I However, it permanently increased self-management interventions. Wider organisational policies to shorten regarding exoskeleton technology for individuals with spinal hope will be relevant to rehabilitation research in general. knowledge after 1 year. length of stay could impact on therapy intensity. Whilst cord injuries that will serve as precedent for future cases and some therapists felt that the therapy intensity guidelines challenges the German insurers. After discussing some background considerations and Practical Implications: Structured and behavioural patient encouraged equitable provision of therapy, di§erences were definitions, the first point will be to discuss some of the key education fosters patients’ disease management ability. observed in how experienced and inexperienced therapists challenges that face rehabilitation research over and above The possible ways of improving asthma control need to be understood and responded to them. that of “conventional” medical research. This will include explored. the diversity of participant populations, complexity of Discussion and conclusion: Both patient and organisational interventions, and challenges in defining outcomes. factors informed decision-making regarding therapy intensity The second section will consider some potential solutions in stroke units. The limited use of the evidence base to inform to the challenges of rehabilitation research and recognition decision-making was an unexpected finding. of some of their limitations. This will lead to a discussion of current developments in the research of complex healthcare interventions and some lessons for future research and clinical practice.

27 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 28 Parallel Session 3.1 Parallel Session 3.2

Parallel Session 3.1.2 before entering treatment (informed consent with Discussion and Conclusion: These short modules did not Parallel session 3.2.2 Education randomization, questionnaires) may have discouraged study succeed in improving self-management skills in the long Physical Rehabilitation & Exercise (3) May 25, 2017, 2:35 PM - 3:35 PM, Room W118 participation. Therefore we compare our participation rates term. Therefore, interventions should be developed to May 25, 2017 2:35 PM - 3:35 PM, Main Conference Hall to another sample recruited under naturalistic conditions. increase sustainability of e§ects. Evaluation of a video-based online Chances and drawbacks of online treatment preparation are Accelerometer-determined levels discussed. intervention to enhance patients Parallel session 3.2.1 of physical activity and sedentary treatment expectations for inpatient Physical Rehabilitation & Exercise (3) behaviour in older care home psychosomatic rehabilitation – Parallel Session 3.1.3 May 25, 2017 2:35 PM - 3:35 PM, Main Conference Hall residents [86] results of a randomized controlled Education May 25, 2017, 2:35 PM - 3:35 PM, Room W118 Ms Jennifer Airlie1,2, Prof Anne Forster2, Dr Karen Birch1 trial [46] Characterisation of a smartphone 1School of Biomedical Sciences, University Of Leeds, Leeds, UK. 2Academic and sensor-based system for Unit of Elderly Care and Rehabilitation, Bradford Teaching Hospitals NHS Dr Rüdiger Zwerenz1, Katharina Schury1, Jan Becker1, Eects of generic self-management monitoring shoulder range of motion Foundation Trust/ University of Leeds, Bradford, UK. Katharina Gerzymisch1, Dirk Schulz2, Dr. Peter Ferdinand3, modules in inpatient medical 4 5 during daily activities [184] Prof. Dr. Martin Siepmann , Stefan Schmädeke , Prof. Dr. rehabilitation in Germany [2] Background: Evidence supports the implementation of 1 physical activity (PA) as a preventative and therapeutic Manfred E. Beutel 1 1University Medical Center of the Johannes Gutenberg University Mainz, Ms Sara Cameron , Dr Mario E Giardini, Prof Phillip J Rowe 1 1 1 intervention for care home residents. However, little is 2 Prof. Dr. Dr. Hermann Faller , Andrea Reusch , Gunda Biomedical Engineering, University Of Strathclyde, Glasgow, UK. Department of Psychosomatic Medicine, Mainz, Germany. Media Center known about the level of residents’ PA. Understanding of the Johannes Gutenberg-University Mainz, Mainz, Germany. 3Knowledge Musekamp1, Bettina Seekatz1, Prof. Dr. Bettina Zietz2, Dr. Gero Media Institute of the University of Koblenz-Landau, Mainz, Germany. 2 3 3 the PA behaviours of this population is critical to 4 5 Steimann , Dr. Robert Altstidl , Dr. Günter Haug , Dr. Karin Background: In patients with shoulder movement Psychosomatic Clinic Campus Bad Neustadt, Germany. AHG Clinic for 1 inform development of appropriate interventions and Psychosomatic Rehabilitation, Germany. Meng impairment, assessing shoulder kinematics is essential 1 recommendations. University of Würzburg, Department of Medical Psychology, Medical for determining the severity of impairments, delivering Sociology and Rehabilitation Sciences, Würzburg, Germany. 2Rehabilitation Background: Preparation for inpatient psychosomatic 3 rehabilitation programmes, evaluating the e§ects of these Center Mölln, Clinic Föhrenkamp, Mölln, Germany. Rehabilitation Center Aim: To describe accelerometer-determined levels of PA and rehabilitation is often done with comprehensive written Bayerisch Gmain, Clinic Hochstaufen, Bayerisch Gmain, Germany. interventions, and designing orthotic devices. Yet, shoulder sedentary behaviour and their associations with personal information sent to future rehabilitants who additionally movement is currently assessed in laboratory settings, while characteristics of care home residents. search the internet for information. Nevertheless, patients Background: Patient education programs used in medical movement profile during daily activities is not known, and often have unrealistic expectations about psychosomatic rehabilitation in Germany are mostly disease-specific. not necessarily matches the laboratory measurements. Methods: 84 residents wore a hip accelerometer for rehabilitation. However, patients’ treatment expectations Moreover, many programs lack a strong focus on self- Inertial measurement units (IMU), such as those within seven days. Time spent sedentary (<100 counts per min are an important factor in psychotherapy and could be management to foster health behaviour change. smartphones, show promise as tools to measure dynamic (cpm)) and engaging in low (100-759 cpm), light (760- associated with treatment outcome. shoulder kinematics during both clinic assessments and daily 2019 cpm) and moderate-vigorous (MV: ≥2020 cpm) PA Aim: We developed and evaluated generic self-management life. was calculated. Care sta§ reported on residents’ level of Aim: Evaluation of a video-based online intervention to modules (SelMa) designed for use as an adjunct to disease- independence, mobility and ambulation. prepare future psychosomatic rehabilitants. specific programs. SelMa aims at providing skills that may Aim: The aim of this study is to establish the accuracy and help implementing health behaviour into everyday living, reliability of a smartphone and a low-cost IMU to measure Results: 62 residents (aged 85 ± 8yr) provided valid Method: Participants were randomized into a control group including goal setting, behaviour planning, anticipation of 3-dimensional angular displacement in both static and accelerometer data (≥8hr 25min on ≥2d). Mean wear time (CG = treatment as usual) and an intervention group (IG barriers and monitoring of goal attainment. dynamic conditions relating to shoulder range of motion. (WT) was 12hr 23min ± 1hr 28min. 94% (IQR: 9%) of = online intervention). Primary outcome was treatment WT was spent sedentary. <1% of WT was spent engaging expectancy, measured with the ‘Credibility Expectancy Method: In a cluster-randomized trial, we compared two Methods: Both the smartphone and the low-cost IMU were in MVPA. PA behaviour did not di§er across days (n=25, Questionnaire’ (CEQ) before admission to inpatient versions of SelMa (SelMa group, 3 hours; SelMa lecture, 1 characterised for accuracy and precision of rotation in each P>0.05) or time of day (n=62, P>0.05). A significant rehabilitation. Secondary outcome criteria included credibility hour) to usual care. All patients received additional disease- axis during static and dynamic conditions using a servo- di§erence (P< 0.01) in percentage WT spent sedentary (χÌ of and motivation for treatment as well as treatment specific education as part of a comprehensive 3-week assisted active gimbal model and a free swinging pendulum, (2)=15.609) and in low PA (χÌ (2)=15.885) was observed outcome of inpatient rehabilitation. inpatient rehabilitation program. We included patients with comparing the two systems to a gold standard optical between residents categorised as: a)ambulatory, b) coronary artery disease, metabolic syndrome, or chronic motion capture system (Vicon) in both static and dynamic ambulatory with assistance, c)unable to ambulate. Results: Of N = 2,937 future rehabilitants from three inflammatory bowel disease in two rehabilitation centres. conditions. rehabilitation clinics, N = 963 (32%) logged in to our website Our primary outcomes were goal setting and behaviour Discussion and Conclusions: 21/62 residents accumulated and N = 492 (51%; age 18-75; 2/3 female) consented to planning at the end of rehabilitation as well as goal Results: In static conditions, both systems can accurately ≥30min of PA daily. However, this was neither MVPA nor participate. We found no statistically significant di§erences attainment and health behaviour after 6 and 12 months. estimate angular displacement (maximum error = 2%). A accumulated in bouts of ≥10min as per PA guidelines. between IG and CG in the CEQ subscales ‘expectancy’ and maximum drift of 0.4° was observed in both systems over a Breaking up long bouts of sedentary time and increasing ‘confidence’ at admission to inpatient rehabilitation, but Results: Our sample comprised 698 patients (mean age 12 hour period. Dynamic test results will also be presented. the volume of low PA that residents engage in would be a participants were overall very satisfied (88%) with the online 50 years; 55% male). At the end of rehabilitation, SelMa prudent recommendation. intervention, would recommend it to other rehabilitants group, but not SelMa lecture, proved superior to usual care Discussion: This characterisation is suggestive of potential (86%) and told that it stimulated thinking about the regarding goal setting (d=0.26, p=0.007), but not behaviour use of IMUs in measuring shoulder range of motion. upcoming treatment (69%). planning (d=0.09, p=0.37). Significant e§ects were also This would facilitate monitoring and telerehabilitation observed in several secondary outcomes. Participants’ interventions in which shoulder kinematics could be Discussion and conclusion: Despite high satisfaction with satisfaction was higher in the group than the lecture format. assessed in a home environment. Furthermore, this device the online intervention, we found no e§ect on treatment In the intermediate and long term, however, no e§ects could be used for mid-term monitoring due to lack of drift. expectancy. We would presume that study requirements emerged. ·

29 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 30 Parallel session 3.2 Parallel session 3.3

Parallel session 3.2.3 Parallel session 3.2.4 Parallel Session 3.3.1 Parallel Session 3.3.2 Physical Rehabilitation & Exercise (3) Physical Rehabilitation & Exercise (3) Implementation & Service Improvement Implementation & Service Improvement May 25, 2017 2:35 PM - 3:35 PM, Main Conference Hall May 25, 2017 2:35 PM - 3:35 PM, Main Conference Hall May 25, 2017 2:35 PM - 3:35 PM, Room W110 May 25, 2017 2:35 PM - 3:35 PM, Room W110 The WATER study: Identifying Quantiﬁcation of spinal Implementing patient-centred Barriers and facilitators to the muscle activation, pain and exertion conﬁguration and postural capacity assessment of rehabilitation needs implementation of evidence-based for low back pain suerers when for evaluation of dierent muscle after stroke in Australia [74] complex health interventions for

performing rehabilitative exercises strengthening programs in the 1,2,3,4 2,3,5 adults with long term neurological [193] [217] Dr Elizabeth Lynch , A/Prof Dominique Cadilhac , in the water and land therapy of back pain Dr Julie Luker2,3,4, A/Prof Susan Hillier4 conditions (LTNC): A systematic 1University Of Adelaide, Adelaide, Australia. 2Florey Institute of review [55] Dr Stelios Psycharakis1, Dr Simon Coleman1, Ms Linda Linton1, Prof Stefan Dalichau1, Dr. Torsten Moeller1, Dr. Bettina Stein2, Neuroscience and Mental Health, Melbourne, Australia. 3NHMRC Centre of 2 1,3 2 Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, 1 2 3 Dr Konstantinos Kaliarntas , Dr Stephanie Valentin Dr. Klaus Schaefer 4 5 1 2 1 2 Australia. University of South Australia, Adelaide, Australia. Monash Mrs Jain Holmes , Dr Kate Radford , Prof Pip Logan University of Edinburgh, Edinburgh, UK. Edinburgh Napier University, Bg Ambulanz Bremen, Bremen, Germany. Berufsgenossenschaft Handel 1University Of Nottingham, Nottingham, UK. 2University Of Nottingham, 3 University, Melbourne, Australia. Edinburgh, UK. University of the West of Scotland, Edinburgh, UK. und Warenlogistik M5, 7, Mannheim, Germany. Nottingham, UK. 3University Of Nottingham, Nottingham, UK.

Background: Chronic low back pain (CLBP) is a major cause Background: Muscle training is considered an approved Background: It is recommended in Australia that all Background: Healthcare research does not always translate of disability and su§ering. Exercise has been shown to reduce procedure in the therapy of low back pain. But which form of patients with stroke not receiving palliative care have their into improved patient outcomes because of diculties pain, increase muscle function and improve quality of life. training is particularly e§ective is quite unknown. rehabilitation needs assessed by rehabilitation specialists. implementing complex health interventions. This review Aquatic exercise reduces spine and joint loads, may assist However, in 2011, only 49% of patients with stroke had their sought to understand facilitators and barriers a§ecting with balance, mobility and pain control, and is potentially Aim: The aim of this study was the evaluation of the rehabilitation needs assessed. implementation (determinants) in trials of complex more beneficial than land exercise. However, information e§ectiveness of di§erent muscle strengthening programs in rehabilitation interventions for adults with LTNC. on aquatic exercises targeting trunk supporting muscles is the therapy of back pain. Aim: To evaluate the e§ectiveness of 2 interventions for lacking, in particular for CLBP su§erers. improving rehabilitation assessment practices. Aim: To identify determinants of complex health intervention Methods: 112 male longshoremen aged from 29 to 63 years implementation. Aim: To quantify the activation of the main trunk supporting with chronic low back pain since > two years, matched by Method: 10 Australian hospitals were randomly assigned muscles for CLBP su§erers and healthy participants and pain intensity and functional limitations, were randomized to receive education-only or a multifaceted intervention. Method: Search terms related to implementation, complex for a range of aquatic and land exercises commonly used in to three test groups (TG) and one control group (CG). The Both interventions included education about nationally health intervention, adults and LTNC were developed. rehabilitation and strengthening programmes. test persons carried out a program for intensified muscle recommended patient-centred assessment criteria. Medical Three reviewers, using a screening tool, shortlisted studies. strengthening over a period of six months one to two times records were audited before and after the implementation A third resolved discrepancies. One reviewer extracted Methods: A wireless and waterproof electromyography weekly in a therapeutic practice (TG1), in a health club (TG2) period. Hospital clinicians participated in focus groups. data in two stages; 1) descriptive study data, 2) units of system was used to measure muscle activation for a group and in a gymnastic group (TG3). The CG did not complete Analysis of qualitative data was guided by the Theoretical text describing determinants. Data were synthesised by; 1) of 20 CLBP and 20 healthy participants. The participants any intervention. Ultrasound topometry for recording spinal Domains Framework. mapping determinants to the Conceptual Framework for performed 14 exercises in the water that focus on trunk configuration and postural capacity as well as determination Implementation Fidelity (CFIF) and Consolidated Framework stabilisation with upper or lower limb loading and are of low back pain intensity and functional limitations were Results: Data from 586 patients (284 pre-intervention, for Implementation Research (CFIR), then 2) thematically commonly used for LBP rehabilitation. A set of similar used as instruments of assessments. 302 post-intervention; median age 76 years, 59% male) analysed. exercises was used on land. Outcome measures included showed that the proportion of patients assessed for muscle activation, pain, perceived exertion and intensity. Results: The data obtained for the CG remained virtually rehabilitation increased significantly post-intervention Results: 28 studies, from 6603 records, reported unchanged over the period of investigation. In contrast (64% pre-intervention, 73% post-intervention, p=0.01). implementation determinants; 26 reported barriers and Results: There were almost no di§erences in muscle a decrease of back pain and functional limitations could The multifaceted intervention was not more e§ective than facilitators and two reported only barriers. Most studies activation between groups in the water or land. Incidence of be proved for all TG (p<0.05). Furthermore, the training the education-only intervention (p=0.51). Post-intervention, implied determinants but five used implementation theory pain in the water was halved. Di§erences in muscle activity programs induced both an improved postural capacity 7 sites reported documenting rehabilitation assessments to provide explicit examples. Most reported determinants between land and water exercises were found, but none of while performing the arm-raising test and an increasingly using the recommended criteria. However, 5 sites reported were related to adherence (24/28), intervention perceptions the two environments produced consistently greater muscle erect sagittal profile (p<0.05). The e§ect size was on a not using these criteria to determine whether to refer to (21/28), attrition (10/28), trial-related issues (7/28), training activation. homogenous level in all training groups (0.4 – 0.46). rehabilitation; instead referrals were influenced by the (2/28) and costs (2/28). 111 individual barriers and 59 perceived likelihood of being accepted by rehabilitation facilitators were mapped onto CFIF and CFIR constructs. Discussion and Conclusions: The aquatic environment Conclusions: The three muscle strengthening programs services. Six sites reported that their relationship with However constructs relating to the quality of intervention is appropriate and perhaps more beneficial for patients investigated have equally favourable e§ects on the rehabilitation services hindered changes in assessment delivery, organisational / contextual aspects and the with kinesiophobia or where pain is a limiting factor for parameters evaluated and are qualified as e§ective strategies practices (theoretical domain ‘social influences’). Participants developmental readiness or ‘trialability’ of interventions were rehabilitation progression. Evidence from the current in the therapy of chronic spinal disorders. reported that changing assessment practices would not untapped. study could be used to inform exercise prescription for · change rehabilitation access, but would highlight shortages strengthening and rehabilitation programs. of rehabilitation services (‘belief about consequences’). Discussion: Gaps in describing implementation determinants may be due to the lack of standardised reporting methods, Conclusion: The education-only and multifaceted researcher ignorance and historical reporting requirements. intervention were equally e§ective for improving CFIF and CFIR o§er trialists useful frameworks for describing rehabilitation assessment practices for patients with stroke the barriers and facilitators to complex intervention delivery in Australia. Action is required to achieve greater equity for in trials. patients with stroke in accessing rehabilitation. · 31 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 32 Parallel Session 3.3 Plenary Session

Parallel Session 3.3.3 Parallel Session 3.3.4 25 May 2017 3:35 PM- 4:15 PM, The Saltire the e§ectiveness of various treatments such as the use of Implementation & Service Improvement Implementation & Service Improvement an assistive devices within society. I believe that it is not May 25, 2017 2:35 PM - 3:35 PM, Room W110 May 25, 2017 2:35 PM - 3:35 PM, Room W110 Afternoon Tea, Exhibition unreasonable to expect that our analyses of rehabilitation data will be supported in the future by tools that take it far and Poster Viewing more initiative. Instead of software packages that blindly run Why do some in-patient stroke Mechanisms that matter: · analyses, we will have tools that actively assess our data, use survivors not receive the Multidisciplinary team delivery of that context to understand the data in ways we have not, and 25 May 2017 Plenary Session 4:15 PM - 5:00 PM, recommended frequency and evidence based stroke rehabilitation present views and analyses that we have not anticipated. Main Conference Hall intensity of therapy? [79] [88] Most rehabilitation researchers and practitioners would not be able to build such tools themselves, but we can call for Dr David Clarke1, Ms Louisa Burton1 Dr Rebecca J Fisher1, Dr Brian Crosbie1, Dr Niki Chouliara1, Global Developments in the technology and software research and development 1Bradord Teaching Hospitals NHS Foundation Trust and University of Leeds, Prof Peter Langhorne2, Prof Thomspon Robinson3, Dr Nikola necessary to deliver this desired future to rehabilitation Bradford, UK. Rehabilitation Research Sprigg1, Prof Marion F Walker1 professionals. 1University of Nottingham, Nottingham, UK. 2University of Glasgow, Professor Gülseren Akyüz, M.D. Background: Increased frequency and intensity of therapy Glasgow, UK. 3University of Leicester, Leicester, UK. can enhance recovery rates and improve outcomes in the Marmara University School of Medicine, Dept of Physical As a conclusion, we know that progress will not necessarily Medicine and Rehabilitation and Division of Pain Medicine, be smooth and unproblematic. Technology and other first six months after stroke. Survey and audit data indicate Background: Despite national stroke clinical guidelines and Istanbul, Turkey, [email protected] innovations are not going to rapidly deliver dramatic results that therapy provision targets are often not met. audit, the quality of rehabilitation delivered in UK hospitals in rehabilitation. If we keep looking into the future, there is remains variable, particularly time spent in therapy. With a Rehabilitation aims to enhance and restore functional ability a risk of loosing the opportunities to integrate our current Aim: To understand why National Clinical Guideline focus on activities of daily living, we aimed to understand and quality of life to people with physical impairments clinical knowledge into practice. Although developing recommendations for 45 minutes of each required therapy how stroke unit multidisciplinary teams (MDTs) deliver or disabilities. It does not reverse the damage caused by increasingly sophisticated research tools and methodologies daily are not met in many English stroke units. optimal rehabilitation that meets evidence based guidelines. disease or trauma, but rather helps restore the individual to has considerable value, our primary focus should be what optimal health, functioning, and well-being. The success of to do and how to do. We need to work in a multidisciplinary Method: Mixed-methods case-study evaluation in eight Method: Using realist research methods, forty semi- rehabilitation depends on many factors including the nature way, lead the residents, and guide the rehabilitation team English stroke units. structured interviews were conducted across four stroke and severity of the disease, disorder, or injury; the type and members for a successful outcome of rehabilitation units. Purposive sampling a§orded a broad perspective degree of any resulting impairments and disabilities; the programs. The emphasis will be on individualized prevention- Results: 77 patients, 53 carers and 197 sta§ took part in over of views across each MDT, across therapist and nursing general health of the patient, and family support. There based therapy and cost analyses will become more 1,000 hours of non-participant observations. 433 patient- disciplines. Initial analysis revealed themes including: MDT are many subtitles of Rehabilitation Medicine: Physical essential. The improvements in technology may be able to specific therapy observations were undertaken and therapy communication, delivering rehabilitation and evidence based rehabilitation; Occupational rehabilitation; Vocational turn the outcomes of disabling injury. In the next 20 years, records of 75 patients were subject to documentary analysis. practice. These themes were further analysed into Context, rehabilitation; Psychiatric rehabilitation which is a branch rehabilitation will have more global developments, however Follow-up interviews were conducted with 49 patients, 50 Mechanism and Outcome clusters, which were then of psychiatry dealing with restoration of mental health our main philosophy and approach must remain intact and carers and 131 sta§. We found seven main factors influenced compared with programme theories devised from the stroke and life skills after mental illness; Cognitive rehabilitation we must protect patients from marketing pressures and frequency and intensity of therapy provision: i) patient clinical guidelines e.g. independent living, therapy intensity. (neuropsychology) which is a therapy aimed at improving economical strains. factors, including stroke-related impairments and fatigue, ii) In this way, mechanism and context features that shape neurocognitive function that has been lost or diminished · stang levels and deployment iii) time spent in information delivery of in-hospital stroke rehabilitation were identified. exchange activities, iv) time spent in other non-patient by disease or traumatic injury; the rehabilitation of criminal behavior (penology); Visual rehabilitation. contact activity, v) limited use of therapy timetabling, vi) Results/Findings: Teams evidenced both enhancing and therapists’ limited knowledge of the evidence that more barrier mechanisms in delivering evidence based stroke Rehabilitation Medicine Specialists sometimes deal with therapy improves recovery rate and outcome, vii) influence of rehabilitation. Boundary working and skills and knowledge acute injuries, control the problem and find appropriate external audit of stroke service quality. transfer exemplify key mechanisms which enhanced patients’ methods in a short term, but the main area is long-term activities of daily living and self-management, particularly improvement. Therefore, the main target is to prevent further Discussion and conclusions: Therapists’ work organisation within the context of time and sta§ resource pressures. injuries and minimize the damage. This helps the patient and use of time across the working day were the major Barrier mechanisms included silo-working, perceived risks of to control his disease, results in less disability, dependence determinants influencing the frequency and intensity patient handling, divergent management and reduced MDT on external sources of support, and finally decreases the of stroke unit therapy provision. Therapists’ limited rehabilitation ethos. Application of the mid-range theory of economic burden on society. knowledge of the evidence for increased frequency and ‘Partnership Synergy’ to the findings identified boundary- intensity of therapy was an unexpected but contributory spanning leadership, encouraging di§erent perspectives Research is the Achilles heel of Rehabilitation area. It is factor influencing therapy provision. Patient-focused work and trust and respect as overarching features of enhancing not easy to do evidence-based studies and form control reorganisation and targeted sta§ and service development mechanisms. are required to address the factors limiting therapy provision groups in rehabilitation researches. Actually, it is hard to evaluate functional outcome and quality of life. Nowadays, in stroke services. Discussion and Conclusion: The explanatory power of these smartphone, tablet and external hard drive technologies · mechanisms has been used to engage teams in evidence enable rehabilitation professionals to gain easier access to based service development. Findings will assist stroke unit all kinds of data. These new data may help to understand MDTs striving to deliver optimal stroke rehabilitation.

33 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 34 Social Event Poster Presentations

25 May 2017 6:30 PM - 7.30 PM 24 - 25 May - Mental Health and Psychometrics 24 - 25 May - Mental Health and Psychometrics WHAT IS A CEILIDH? Originally the word Ceilidh Civic Reception at Glasgow City (pronounced kay-lee) descended from the Gaelic word for Psychosocial Consequences of Evaluating the benefits of people ‘gathering’ or ‘party’… However, these days when people Chambers: All Welcome think of a Ceilidh, they think of a fun filled night of dancing, Diagnosing Non-Specific Low Back with health conditions attending good music and great company! Pain Patients Radiologically In Saudi Mindfulness-Based interventions The 14th Congress of the European Forum for Research in · [3][Work in Progress] Rehabilitation will be honoured inside the hallowed halls of Arabia with a partner: a systematic review Glasgow City Chambers, a jewel in the crown of the city. [Work In Progress] [125] Mr Ahmed Alhowimel1,2, Dr Neil Coulson2, Dr Kathryn Please join us on the evening of 25 May for a Civic Reception 2 Radford 1 Dr Maggie Lawrence1, Dr Evelyn hosted by the Right Honourable Lord Provost of Glasgow to 1 Mr Ben Parkinson , Physical Therapy and Rehabilitation Department, Prince Sattam Bin Abdul- 1 1 which all EFRR delegates are invited — a chance to celebrate Aziz University, Saudi Arabia. 2Division of Rehabilitation and Ageing, School McElhinney , Dr Jo Booth 1Glasgow Caledonian University, Glasgow, UK. your participation in our memorable European Congress. of Medicine, University of Nottingham, UK. Background: Mood disturbance is common for people living Background: Almost 80% of people experience low with stroke and their caregivers. Mood disturbance can have back pain at least once in their life. A quarter su§ers from 25 May 2017 7:30 PM-11:00 PM a detrimental impact on peoples’ wellbeing and rehabilitation Nonspecific Chronic Low Back Pain (NS-CLBP), where outcomes. Mindfulness-based interventions (MBIs) use symptoms cannot be justified radiologically. There is meditation classes and home practice to help people focus Dinner and Traditional evidence that imaging negatively impacts outcomes (e.g. on the present moment and manage their health-related Scottish Ceilidh at Glasgow increased painkillers and doctors’ visits) in NS-CLBP patients. diculties. Research indicates that MBIs have therapeutic Despite clinical guidelines recommending against the use City Chambers benefit for people with long-term conditions (LTCs) and of imaging for this specific purpose, healthcare practitioners carers; however, problems with adherence have been For ticket holders, an informal meal followed by a traditional and patients still request imaging to explain symptoms. observed. Peer support may promote adherence, thereby Scottish Ceilidh with renowned ceilidh band ‘The Big enhancing therapeutic benefit. Early-stage research suggests Shoogle’ will take place straight after the Civic Reception. It’s Aim: that patients and carers may be able to support each other to a once-in-a-lifetime opportunity to socialise, dine, and dance • To explore psychosocial factors associated with MRI adhere to the standard MBI course, if they attend as a dyad the night away beneath the glittering chandeliers of one of diagnosis in NS-CLBP in Saudi Arabia (e.g. person/patient with a spouse/carer). Scotland’s most historic landmarks, and to fully immerse • To explore current practices in the use of MRI imaging yourself in the vibrant culture of Glasgow. amongst healthcare professionals in NS-CLBP. Aim: To evaluate the therapeutic impact of MBIs on people For the dancing, we would recommend comfortable clothing with LTCs attending with a partner. that allows room to move. Ladies may prefer flat shoes Method: The research adopts a sequential exploratory over high heeled ones, while tight skirts are definitely best mixed-method design. First, qualitative, semi-structured Method: This mixed methods systematic review searched avoided! interviews with NS-CLBP patients, physiotherapists, and electronic databases and other sources using key words doctors will be conducted using a purposeful sampling and subject headings. Research involving adults with LTCs of 8-10 people from each group. The interviews will be attending MBI with a partner was considered. All titles/ recorded and transcribed and analysed using framework abstracts identified were screened against predefined analysis. Validity will be ensured by data triangulation with inclusion/exclusion criteria. Methodological quality was participants. Subsequently, psychosocial outcome measures assessed using a standardized quality appraisal checklist. will be selected according to the emerging themes to inform Data extraction was completed using a tool designed a feasibility RCT. 20 NS-CLBP patients will be recruited for the review. Data analysis is currently in progress; the from an orthopaedic clinic in a private hospital in Saudi heterogeneous nature of the studies means the findings Arabia by their physician and randomly allocated to receive will be presented using descriptive statistics and a narrative MRI or not before undergoing physiotherapy. Psychosocial synthesis. and functional outcome measures will be completed by patients before randomisation and again immediately after Results, discussion and conclusion: 8 papers (n=328 physiotherapy. participants) are included in the review. Detailed results will be presented and discussed in the conference poster. Results: Our findings will inform the re-design of clinical care pathways for NS-CLBP in Saudi Arabia and research into the treatment of psychosocial problems that increase the health, societal, and financial burdens of NS-CLBP. ·

35 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 36 Poster Presentations Poster Presentations

24 - 25 May - Mental Health and Psychometrics 24 - 25 May - Mental Health and Psychometrics 24 - 25 May - Mental Health and Psychometrics 24 - 25 May - Mental Health and Psychometrics Mindfulness-Based Stress Optimising Mindfulness-based Agile Rehabilitation: combining The influence of dierent treatment- Reduction for people with Multiple stress reduction for people with psychotherapeutic live and e-health settings on the therapy-eect in Sclerosis - a feasibility Randomised Multiple Sclerosis [237] interventions in depression and people with depression [165] Controlled Trial [236] social anxiety – a protocol for an [Work in Progress] Robert Simpson1,2, Sharon Byrne1, Karen Wood1, Frances S 1 1 [23] 1 applicability and usability study Robert Simpson, Frances Mair , Stewart Mercer Mair , Stewart Mercer 1 1 1 Ms Friederike Deeken , Mr Andreas Häusler , Mr Michael 1General Practice and Primary Care, Institute of Health and Wellbeing, General Practice and Primary Care, Institute of Health and Wellbeing, [Work in Progress] 2 1 1 1 University of Glasgow, Scotland, UK. 2House 1, 1 Horselethill Road, General University of Glasgow, Scotland, UK. Department of Rehabilitation Rapp , Ms Anna Rezo , Mrs Andrea Block , Mr Michael Medicine, Queen Elizabeth University Hospital, Glasgow, Scotland, UK. 1 1 1 Practice and Primary Care, Institute of Health and Wellbeing, University of Dr. Kaisla Joutsenniemi1, Mr Ville Ritola1, Dr. Jan-Henry Rector , Ms Suanne Schulze , Mrs Pia Wippert Glasgow, Glasgow, Scotland, UK. 1University Of Potsdam, Potsdam, Germany. Stenberg1, Ms. Marianne Oksanen1 Objective: To gather views from patients with Multiple 1Helsinki University Central Hospital, Helsinki, Finland. Introduction: Multiple sclerosis (MS) is a stressful condition. Sclerosis (MS) and instructors following completion of a Background: Evidence demonstrates a connection between Mindfulness-Based Stress Reduction (MBSR) may help, but standard eight-week Mindfulness-Based Stress Reduction Background: Up to 15% of Finnish citizens currently su§er depression and increased number of days of incapacity. has been little studied in MS. (MBSR) course and optimise and test a modified version of from mental health disorders. The two most common Reasons for the increasing prevalence rates of depressive MBSR as required. causes are depression and anxiety disorders, which also disorders, de-stigmatisation and the higher utilisation of Objective: To test the feasibility and likely e§ectiveness of impact national health and economy. Availability of e§ective professional help and therefore higher number of patients MBSR for people with MS. Methods: Two successive groups of 25 MS patients psychosocial rehabilitation is currently limited. Lack of receiving a diagnosis are discussed. Furthermore there received MBSR in a wait-list randomised controlled trial. trained employees, long distances and long waiting times are is evidence from recent research, which shows existing Methods: Participant eligibility included: age >18 years, Two experienced MBSR instructors delivered the groups. major factors preventing people from receiving care. problems in the care of patients with depressive disorders. In any type of MS, an Expanded Disability Status Scale Seventeen participants and the two MBSR instructors were Germany, approximately not even one in five patients with (EDSS) ≤7.0. Participants received either MBSR or wait-list individually interviewed after the first (standard) course Aim: The purpose of the Agile Rehabilitation project is to depression receives a specialist mental health treatment control. Outcome measures were collected at baseline, and sixteen participants and the same two instructors improve the availability of mental health rehabilitation in and diculties related to the access to psychosomatic post-intervention, and three-months. Primary outcomes were interviewed following the second (optimised) course. Finland. The aim is to develop two new agile e-rehabilitation rehabilitation have been demonstrated. were perceived stress and quality of life (QOL). Secondary Interviews were inductively analysed using a thematic models. The first agile psychotherapy intervention will outcomes were MS symptoms, mindfulness, and self- approach. combine face-to-face and videoconferencing psychotherapy Aim: The purpose of this research project is to compare compassion. for 10 sessions and the second a 3-session low-iCBT self- di§erent treatment settings according to the influence of Results: MBSR was well received in both groups, with help treatment. The project will publish intervention guides depressive symptoms and working ability. Results: Fifty participants were recruited and randomised (25 participants describing a beneficial shift in awareness. An online free of charge to facilitate implementation. per group). Trial retention and outcome measure completion initial and at times unpleasant increase in awareness of Method: We are conducting an ongoing prospective rates were both 90% at post-intervention, and 88% at disability was generally superseded by a sense of acceptance Method: 20 outpatients su§ering from depression and/ controlled observational study with three treatment settings three months. Sixty percent of participants completed the and enhanced self-compassion. Further, participants or social anxiety disorder were recruited for both separate (psychosomatic rehabilitation; psychiatric institution; course. Large improvements in perceived stress were seen described improved relationships, ambulation and sleep, interventions, for a total of 40 participants. Diagnoses psychotherapeutic institution). Data is collected at four at post-intervention (ES 0.93; p<0.01), but not for QOL less stress and diminished pain. Mindful movement and were confirmed with a MINI-interview. 5 psychotherapists points in time. Besides sociodemographic information, (ES 0.17; p=0.48). Depression (ES 1.35; p<0.05), positive mindful walking were notably problematic in group One. This adhering to di§erent psychotherapeutic theories were depressive symptoms (BDI) and the ability to work (WAI) a§ect (ES 0.87 p=0.13), anxiety (ES 0.85; p=0.05), and component of MBSR was simplified in group Two. Following recruited to the agile psychotherapy intervention, and the are recorded. self-compassion (ES 0.80; p<0.01) also improved with large feedback from group One, a pre-course orientation session low-iCBT intervention was given by a trained psychologist. e§ect sizes. At follow-up, three-months post intervention, was introduced for group Two, and various organisational Data on symptoms were gathered at the beginning and Results/ Findings: Preliminary analyses were conducted with improvements in stress had diminished to small (ES 0.26; changes made to better accommodate participant the end of the interventions and usability data and alliance complete data of 69 patients from a rehabilitation clinic and p=0.39), were negligible for QOL (ES 0.08; p=0.71), but disabilities. Following this, feedback from group Two was measures after every session. a psychiatric institution. Univariate ANOVA with repeated were large for mindfulness (ES 1.13; p<0.001), positive a§ect positive in all these areas. measurements showed a significant main e§ect for time (ES 0.90; p=0.54), self-compassion (ES 0.83;p<0.05), Results/ Findings: Recruitment of patients and (F(1,67) = 12.615, p<0.05, ηÌ=0.158) on depression scores anxiety (ES 0.82; p=0.15), and prospective memory (ES 0.81; Discussion: Qualitative feedback suggests that MBSR psychotherapists is underway at the moment. (BDI). The interaction between time and setting resulted in a p<0.05). can be beneficial to people with MS. However, some core significant e§ect (F(1,67) = 15.701, p<0.05, ηÌ= 0.190). aspects of the course, such as mindful movement, required Discussion and Conclusion: The intervention models are Conclusions: Recruitment, retention, and data collection modification. Contextual and organisational issues also designed to fit well into the mental health rehabilitation Discussion and Conclusion: Preliminary analyses indicate demonstrate that a RCT of MBSR is feasible for people with appear important in this population. Making these changes system in Finland now and in the future. Agile models that high frequency and inpatient treatment resulted in MS. Trends towards improved outcomes suggest that a may improve uptake and engagement with the course. will increase the availability of systematic psychosocial a faster improvement in depression scores compared to larger definitive RCT may be warranted. rehabilitation throughout Finland. They will allow for more outpatient treatment. Based on the results, existing health individualised service, stepped care and access to evidence- care services can be used more e§ectively. Additionally, the based treatments. number of days of work incapacity and higher costs arising from deferred or inadequate treatment can be reduced.

37 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 38 Poster Presentations Poster Presentations

24 - 25 May - Mental Health and Psychometrics 24 - 25 May - Cognition and cognitive rehabilitation 24 - 25 May - Cognition and cognitive rehabilitation 24 - 25 May - Cognition and cognitive rehabilitation Psychosomatic aftercare in Cognitive performance of Cognitive and emotional Development and validation of the rehabilitation - data from a new unemployed young adults with self- functioning in sick-listed Long Term Memory Test (LTMT) for concept [Work in Progress] [87] reported problems in learning [85] participants in occupational the Arabic speaking population with rehabilitation [135] [Work in Progress] acquired brain injury [166] Prof. Dr. Philipp Martius1, M.A. Astrid Orban1, Master Johanna Stenberg1, Tuula Mentula1, Mila Gustavsson-Lilius1, 1 2 1 1 1,2 Psychology Isabelle Angenendt-Fischhold , Master Marika Ketola , Erja Poutiainen Dr Thomas Johansen , Dr Chris Jensen , Prof Winand H 1 1 1 1 1 1 2 Ms Bazah Almubark , Dr Allegra Cattani , Prof Tim Hollins , Psychology Veit Messerschmidt , Ms Cornelia Symannek , The Rehabilitation Foundation, Helsinki, Finland. The Finnish Association 3 1,4 for Mental Health, Helsinki, Finland. Dittrich , Dr Irene Øyeflaten 1 2 1 Dr Caroline Floccia Master Psychology Nina Ammelburg , Master Psychology National Advisory Unit on Occupational Rehabilitation, Rauland, Norway. 1Plymouth University , Plymouth, UK. Manuela Marquardt2, Master Psychology Sandra 2Department of Public Health and General Practice, Norwegian University of Background: With appropriate support, people with learning 3 2 2 Science and Technology, Trondheim, Norway. KCI Competence Center for Fahrenkrog , Prof. Dr. Karla Spyra Behavioral Economics, FOM Hochschule, Frankfurt am Main, Germany. 4Uni 1 problems including those with developmental learning Background: Memory deficits are a common consequence Dept. Psychomatic, Hoehenried Hospital DRV Bayern Sued, Bernried, Research Health, Bergen, Norway. Germany. 2Institute of Sociology, Dept. Rehabilitation, Charité University, disabilities can achieve success in the community. Even following acquired brain injury (ABI). To date, most existing Berlin, Germany. when the diculties have been duly recognized during memory tests were developed for the English speaking Background: Individuals on long-term sick leave attending the first school years, more support may be needed when population, and they are not appropriate for assessing occupational rehabilitation often complain about Background: In-patient psychosomatic rehabilitation entering work life. To prevent marginalisation from society, Arabic speaking patients. Therefore, the long term memory impairments in cognitive functioning. Knowledge about has been shown to be e§ective, but stability of treatment young adults struggling with unemployment and reporting test (LTMT) was designed focusing on 5 principal domains cognitive functioning in these individuals is limited. Such results is still not sucient. Transfer of rehabilitation-bound problems in learning should be assessed further. (episodic, semantic, recognition, prospective, and working knowledge is clinically relevant for improving occupational knowledge in everyday life seems crucial for lasting e§ects. memory) evaluated in 14 tasks. rehabilitation programmes. Aim: To investigate the typical cognitive characteristics Aim: A new after-care concept was implemented and of young unemployed adults with self-reported learning Aim: To develop a memory test that examines long term Aim: The aims of the feasibility and main study were to evaluated with (1) participation in psychological group diculties. memory; mainly episodic, semantic, recognition and investigate changes in cognitive and emotional functioning therapy for 4 months, or (2) social worker case management prospective memory, and short term memory namely on participants during occupational rehabilitation and assess to manage psychosocial issues. Method: The participants (N=58) were unemployed adults working memory in the Arabic speaking population with ABI. the methodological design (feasibility study only). of the age of 18–25 years, who reported problems in learning Method: Control-group-design with assessment at the and expressed an interest in attending a professional-led Methods: A total of 61 ABI patients (30 stroke and 31 Methods: The feasibility study included individuals attending beginning (T0), end of Rehabilitation (T1), 6m after (T2). The peer support intervention. Their cognitive performance traumatic brain injury) and 80 healthy adults were tested. occupational rehabilitation (N = 28) and individuals Control group comprised of non-participants. Descriptive was examined through comprehensive neuropsychological The study was completed in two stages: (1) development working full time (N = 25). The main study is a multi- data are presented with e§ect sizes (SRM) in a matched examination. of the long term memory test (LTMT), and (2) validity and centre study involving four occupational rehabilitation group comparison. Variables included: sociodemographic reliability study. clinics and individuals working full time. All participants data, questionnaires: HEALTH-49, COPING, ERI, EUROHIS- Results/ Findings: According to neuropsychological were administered cognitive and emotional computerised QoL, FBTM, PHQ-D, SIMBO. examination, a cognitive profile indicating a developmental Results/Findings: The test-retest reliability indicated high tests targeting memory, attention, executive function and learning disability was found in all participants. Only one stability of scores over time. High discriminative validity emotional processing and self-reported questionnaires at Results/ Findings: 218/88 participants were included in third had been diagnosed at school age. Verbal reasoning, was shown in which a significant di§erence between the pretest, posttest (feasibility study only), 3 and 12 months intervention setting 1 and 2 resp., full data are now available working memory, reading, mathematical skills and attention/ performance of patients and the control group was found on follow up. Outcome measures are speed and accuracy of of 87/45 participants. executive functions were typically impaired (i.e. ≤ -1 SD all principal domains and sub-domains apart from the faces responses on the cognitive and emotional tests and self- below the norms). Problems in visual reasoning, processing recognition/recognition sub-domain. reported work ability, subjective health complaints, and Discussion and Conclusion: Group therapy participants speed or verbal learning were less common. symptoms of depression and anxiety. function on a better overall level than Case Management Discussion and Conclusion: This study o§ers a valid and participants. Both groups improved from T0 to T1 and Discussion and Conclusion: Unemployed young adults reliable memory test that is hoped will be beneficial to Arabic Results: In the feasibility study it was found that the mean remained stable to T2 on most psychological and work- may have undiagnosed learning diculties behind their patients with ABI. gain scores in the intervention group were significantly higher related variables. Preliminary results showed stability or underachievement and employment problems. More e§ort than the control group in response latency on simple and further improvement in Intervention groups compared to the on early recognition and interventions is needed. choice reaction time and errors in spatial working memory. non-intervention Group and demonstrated e§ectiveness of · the concepts. The Bavarian Pension insurance has accepted Conclusion: The results of the feasibility study indicate the program as part of its aftercare activities. that the motivation of participants to complete testing was high. Improvements in memory and attention were evident · in rehabilitation participants indicating that rehabilitation

may have an e§ect on cognitive functions. The main study investigates the degree to which changes in cognitive functioning can predict return to work.

39 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 40 Poster Presentations Poster Presentations

24 - 25 May - Cognition and cognitive rehabilitation 24 - 25 May - Cognition and cognitive rehabilitation 24 - 25 May - Cognition and cognitive rehabilitation 24 - 25 May - Cognition and cognitive rehabilitation Translation, cultural adaptation and A new clinical algorithm to Eectiveness of memory Acquired brain injury management validation of the Cognistat for its use support partnership working rehabilitation in traumatic brain using Brain-in-Hand technology to in Arabic speaking population with across disciplines and settings for injury: A randomised controlled trial improve functional outcomes and acquired brain injury [212] identifying and managing cognitive (ReMemBrIn) [42] independence: series of case studies problems in Multiple Sclerosis (MS) [Work in Progress] [9] Ms Bazah Almubark1, Dr Allegra Cattani1, Dr Caroline Floccia1 Prof dasNair R, On behalf of the ReMemBrIn team1 1Plymouth University , Plymouth, UK. [147] [Work in Progress] 1University Of Nottingham, Nottingham, UK. Ms Jade Kettlewell1, Dr Kate Radford1, Prof Roshan das Nair1 1 l1 1 1 School of Medicine, University Of Nottingham, Nottingham, UK. Background: The use of cognitive assessments is important Dr Marcia Castie , Dr Nichola Chater , Mrs Lucy Gibbison Background: Memory problems, common in people with 1Northumberland Tyne and Wear NHS Foundation Trust, Newcastle Upon for the detection of cognitive impairment in acquired brain Tyne, Tyne & Wear, UK. traumatic brain injuries (TBI), are persistent, debilitating, Background: Acquired brain injury (ABI) is the leading injury (ABI) patients. The Cognistat is a commonly used and impact quality of life. Currently, many do not receive cause of death and disability in young adults. Over one cognitive screening tool that has been developed to detect Background: Members from di§erent disciplines (specialist treatment for memory problems. Research evidence has million people live with the long-term consequences of cognitive deficits among patients with neurological and nurse, clinical psychology, consultant in medicine been based on small, under-powered studies, with other ABI. Many assistive technologies exist to aid rehabilitation, psychiatric conditions. rehabilitation, occupational therapist) working with patients methodological limitations. but there is limited technology available to support self- with MS within a specialist neurorehabilitation centre management and functional outcomes. Brain-in-Hand Aim: To translate, culturally adapt and test the psychometric collaborated to develop an interdisciplinary algorithm/ Aim: To evaluate the clinical and cost-e§ectiveness of a (BiH) technology is a smartphone application that allows properties of the Cognistat for its use in Arabic-speaking model to identify and manage cognitive symptom in MS in a group-based memory rehabilitation programme for people users to create structured diaries with problems and populations with acquired brain injury. systematic way. with TBI. solutions, attach reminders, record task completion and has a symptom monitoring system. BiH was designed to Methods: A total of 107 healthy Arabic speaking adults Aim: The aim of the algorithm/model was to: Methods: This was multi-centre randomised controlled trial. support people with psychological problems, and encourage and 62 acquired brain injury patients were involved in the 1 Ensure cognitive problems are identified and addressed in We recruited participants if they had a TBI and memory behaviour monitoring and change. There is a timely need for study. After the completion of the cross-cultural adaptation a systematic way problems, were 18 to 69 years, able to travel to one of technologies to not only support these functions following process, psychometric properties of the adapted cognitive 2 Make e§ective use of limited specialist resources nine centres to attend group sessions, and gave informed ABI, but to promote independence and autonomy of daily tool were evaluated. 3 Improve communication between clinicians from di§erent consent. Participants were randomised in clusters of 4 to activities. disciplines as well as developing knowledge/confidence in 6 to the memory group or usual care. Intervention groups Results/Findings: The Arabic version of the Cognistat was addressing and managing cognitive problems. received 10 weekly sessions of a manualised memory Aim: We aim to evaluate the e§ectiveness of BiH in found to have acceptable internal consistency. The test-retest rehabilitation programme, including restitution strategies improving outcomes for people with an ABI, and to reliability showed high stability of scores over time. The Methods: The model was developed to meet NICE to retrain impaired memory functions and compensation assess patient, carer and healthcare professionals (HCPs) concurrent validity was examined through comparing the guidelines (2014) and was informed by international strategies to enable participants to cope with memory experiences of BiH. performance of patients on the adapted Arabic Cognistat and published recommendations (The Brief International problems. Participants received a postal questionnaire and MMSE. It was significant for orientation and comprehension. Cognitive Assessment for MS). The model guides any an assessment at 6 and 12 months post-randomisation. The Methods: Single subject mixed methods case study design, The results indicated high discriminative validity in which a clinician to enquire and discuss cognitive problems in routine primary outcome was the Everyday Memory Questionnaire with multiple participants. Up to 15 people with an ABI significant di§erence between the performance of patients clinical practice following a tiered approach: at 6 months. will be recruited to use BiH for 12 months. Participants will and the control group was found on all sub-tests. • Level 1: simple advice and providing patients with complete quantitative measures of self-perceived mood, psychoeducational resources Results: From 4189 people screened for eligibility, 466 quality of life, cognition, participation, and functional ability. Discussion and Conclusion: Data collected suggests that • Level 2: cognitive screening and advice by a trained people consented, and 328 participants randomised in 66 Semi-structured interviews with ABI users, carers and HCPs the Arabic version of the Cognistat is a valid and reliable clinician (specialist nurse or occupational therapist) to groups. Not having a demonstrable memory problem (n=37) involved in the person’s care will take place at 6 months cognitive screening tool. It is anticipated that the Arabic patients reporting cognitive problems/changes or having language problems (n=21) were the most common post-intervention to explore the acceptability of BiH, and the Cognistat will be widely used in the Arabic speaking • Level 3: more intensive/advice or treatment by reasons for exclusion. Participants attended an average of potential barriers and facilitators to future implementation. countries, allowing for a very precise evaluation of cognitive neuropsychology or neuropsychiatry for patients 6.3 sessions (SD=3.5), with being unwell the most frequent Interviews will be transcribed, analysed using framework, and deficits in acquired brain injury patients. presenting with more complex problems or requiring reason for missing sessions. The primary and secondary triangulated with participants for validity. specific interventions (e.g. work, relationship problems, outcomes were completed by 79% and 68% of those mood/behaviour, caring roles) as guided by the algorithm. randomised, respectively. Progress: We have recruited 10 participants, all completed baseline measures, 8 received BiH and completed the initial Results/Findings: Although the clinicians involved in Discussion and Conclusion: Database lock will take place in 6 week follow-up assessments. developing and applying the model work in the same centre, January 2017 and all analyses completed by April 2017. · we believe that this algorithm could be used by clinicians working across di§erent teams/settings/locations to enable collaborative care.

Conclusion: We are currently carrying out an audit to establish to how well the model is being used and to establish patient satisfaction with the cognitive screening process.

41 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 42 Poster Presentations Poster Presentations

24 - 25 May - Cognition and cognitive rehabilitation Conclusion: The early cranioplasty followed by an acute 24 - 25 May - Education 24 - 25 May - Education neurorehabilitation process might lead to a significant Eect of the early cranioplasty multiphase functional improvement in patients with severe Psychosocially skilled rehabilitation Students of today are the with neurorehabilitation on traumatic brain injury. practitioners: development of professionals of tomorrow [40] neurocognitive functions: Case an innovative curriculum for Mrs Rut Nordlund-Spiby1,3, Mrs Saija Koivu2, Mrs Anne 24 - 25 May - Education [235] report of a patient with severe physiotherapy students Kokko3, Mr Marko Vaappo3, Dr Ira Jeglinsky3 Traumatic Brain Injury [182] 1National Institute for Health And Welfare, THL, Helsinki, Finland. 2Valteri Helping physicians to improve their Dr Heather Gray1, Mrs Jennie Stewart1, Mr Douglas Centre for Learning and Consulting, Ruskis, Helsinki, Finland. 3Arcada 1 University of Applied Sciences, Helsinki, Finland. Ms. Viktória Tamás1, Ms. Mariann Németh5, Mrs. Noémi Lauchlan competence in assessing functional 1Glasgow Caledonian University, Glasgow, Scotland, UK. Kovács2, Mrs. Emese Tasnádi2, Mrs. Iringó Halasi1, Mr. Iván Background: Today the recommended habilitation practice Péley2, Mr. András Büki1,2,3,4 capacity [61] 1University Of Pécs, Department Of Neurosurgery, Pécs, Hungary. Background: Mental ill health accounts for almost 20% for children and youth with disabilities is interprofessional 2Rehabilitation Unit for Severe Brain Injuried Patients, Department of Dr Lars Sörensen1 of the burden of disease in the WHO European Region. and preferably done with the ICF as a common model. Neurosurgery, University of Pecs, Pécs, Hungary. 3János Szentágothai 1The Social Insurance Institution Of Finland, Naantali, Finland Additionally, long-term physical illnesses and worklessness Students studying social- and health care learn these topics Research Centre, University of Pecs, Pécs, Hungary. 4MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary, 5Rehabilitation are strongly associated with mental health problems. with focus on their own professional context. Department of Brain Injuries, National Institute for Medical Rehabilitation, Background: Recent studies have shown that Finnish Therefore, there is a need for those involved in rehabilitation Budapest, Hungary. physicians have diculties in assessing their patients’ to become psychosocially skilled practitioners. Aim: The aim of this project was to find new ways for functional ability. students to learn interprofessional ways of working. Background: Following decompressive craniotomy, trephined Aim: To develop a curriculum to develop undergraduate syndrome can be developed, characterised by sunken scalp Aim: The Finnish Association of Occupational Physicians students’ skills in psychosocial assessment and intervention. Methods: A university course within the context of with neurological and neuropsychological disturbances. decided to celebrate its 70th anniversary by publishing a habilitation for children and youth was planned in These cognitive and neurological dysfunctions can be special edition of its member magazine and sending it to Methods: A 20 Scottish Credit and Qualifications Framework collaboration with a special needs school. The course reduced later by reconstruction of the leak using autograft or all Finnish physicians of working age. The aim of the special credit module was developed (10 ECTS credits), comprising sandwiched theoretical studies and practical training. synthetic materials. magazine was to improve the physicians’ knowledge about 200 notional learning hours, including 48 hours of tutorials The learning outcomes focused on participating in assessing functional ability and use di§erent rehabilitation and supplementary online learning materials. Educational interprofessional work. Based on the children’s needs, the Aim: To demonstrate results related to the measures to increase their patients’ participation. materials used the UK’s National Health Service’s Improving students learned how to promote their function, activity and neuropsychological evaluation of a patient with severe Access to Psychological Therapies (IAPT) training manual. participation. The students’ learning was evaluated through traumatic brain injury with early cranioplasty. Methods: All major Social Security companies were asked to The Cognitive Therapy Scale-Revised (CTS-R) was used to examination tasks such as a seminar, practical skills, learning provide material to this special edition. summatively assess cognitive behavioural therapy (CBT) diaries and blog writing. Methods: A right-handed, 36-year-old male was admitted skills. to a neurosurgery department with bilateral multiple skull Results: We collected 19 articles including di§erent aspects Results: A total of 50 students have attended the course. fractures, left-side contusion, subdural and subarachnoid of evaluating functional ability, rehabilitation and social Results: Following the module, students demonstrated Both students and lecturers represented study programmes haematoma due to severe traumatic brain injury. Initial GCS insurance in this special edition of Occupational Physician increased skills in: addressing patients’ psychosocial in social services, physiotherapy, occupational therapy, value was 1T1. The patient underwent early decompressive -magazine. concerns; active listening skills; empathy; ability to use nursing and sports. The students have learned how to meet craniectomy. Three weeks after the surgery, the patient the 5 Areas CBT Model; and cited improved confidence children and youth with disabilities. The place for learning, was transferred to our neurorehabilitation unit for further Discussion and Conclusions: We published a special in discussing work-related issues with patients. However, i.e. the special needs school, gave best practice examples for care. Comparative neuropsychological assessments were edition (18,000 copies versus 2,200 in usual circulation) to whilst on clinical placement, students found diculties in observing interprofessional work. Thanks to this the students performed within two weeks pre- and post-cranioplasty improve physicians’ ability to use simple measures to assess incorporating psychosocial principles into their treatment learned how to evaluate their own interprofessional working and also around 3 months after the reconstruction involved functional ability and support their patients’ participation by sessions. skills as well as the professional’s way of working. the main cognitive domains: attention, executive functions, di§erent means of rehabilitation. We assume that in future memory, thinking, visuospatial abilities, language and physicians are more able to evaluate quality of life of their Discussion: The IAPT training manual, 5 Areas CBT Model Discussion and conclusion: This concept gave the students numeracy skills, psychomotor speeding. patients and not just make diagnoses and start di§erent and CTS-R were well-structured, non-threatening, and a great possibility to learn an interprofessional way of measures to cure diseases. ‘student-friendly’ teaching and assessment resources. In the working at three di§erent levels: as students, lecturers Results: Two weeks following cranioplasty, immediate future greater guidance will be provided on practical ways and professionals. Students of today are the professionals improvement was found in several neurocognitive functions in which psychosocial skills can be incorporated into routine of tomorrow, and they need possibilities to learn in including attention, psychomotor speeding, memory, rehabilitation. interprofessional contexts. inhibitory control, thinking, language and numeracy skills · compared to preoperatively. Significant improvement in Conclusion: This innovative curriculum can be adopted by neuropsychological performance was detected 3-4 weeks other education providers interested in developing students’ following surgery during the period when we made an skills in psychosocial assessment and intervention. The attempt to diagnose the primary neurocognitive impairments materials are also suitable for postgraduate students and considering the remaining postsurgical symptoms. Three qualified rehabilitation practitioners looking to undertake months following cranioplasty, further slightly improvement continuing professional development and become was observed in some neurocognitive abilities of the patient psychosocially skilled practitioners. compared with the 3-4 weeks postsurgical results.

43 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 44 Poster Presentations Poster Presentations

24 - 25 May - Education 24 - 25 May - Education 24 - 25 May - Education 24 - 25 May - Education The PROMI project for doctoral Changing attitudes and reducing Optimising Psychoeducation A qualitative review of patients’ students with disabilities – prejudices: The PROMI project for for Transient Ischaemic Attack experiences of Transient Ischaemic Promoting inclusive structures doctoral students with disabilities and Minor Stroke Management Attack diagnosis and subsequent and processes at universities [100] [90][Work in Progress] (OPTIMISM study): a feasibility risk factor reduction [80] [Work In [Work in Progress] randomised controlled trial [53] Progress] Mrs Susanne Groth1, Mrs Jana Felicitas Bauer1, Mrs Mathilde 1 1 [Work in Progress] 1 1 Niehaus , Mr Thomas Kaul 1 2 Ms Jana Felicitas Bauer , Ms. Susanne Groth , Prof. Dr. 1 Dr Maggie Lawrence , Mr Garth Ravenhill , Ms Loukia 1 2 University Of Cologne, Cologne, Germany. 1 Mathilde Niehaus , Prof. Dr. Thomas Kaul 1 1 1 Gkanasouli 1 Dr Eirini Kontou , Ms Carla Richardson , Dr Nikola Sprigg , 1 2 University of Cologne, Labour And Vocational Rehabilitation, Cologne, 1 2 Glasgow Caledonian University, Glasgow, UK. Norfolk and Norwich Germany. 2University of Cologne, Education and Rehabilitation of the Deaf Background: Taking a closer look at the German University Dr Shirley Thomas , Professor Caroline Watkins , Professor University Hospitals NHS Foundation Trust, Norwich, UK. and Hard of Hearing, Cologne, Germany. system, a lack of inclusion and equal opportunities for Marion Walker1 1University of Nottingham, Nottingham, UK. 2Universiy of Central Lancashire, students and university graduates with disabilities can Background: Every year approximately 50,000 to 60,000 Background: University graduates with disabilities have Preston, UK. be detected (Niehaus & Bauer, 2013). They are not only people in the UK have a Transient Ischaemic Attack (TIA). – due to their high educational level – rarely been the a§ected by structural discrimination but also confronted with Of these, 10% to 15% will go on to have a stroke. Worldwide focus of research so far. But a pilot study from Germany Background: Few studies have addressed the long-term attitudinal barriers like prejudices and stereotypes by their stroke is the second most common cause of death and a (Niehaus & Bauer, 2013) indicates that they encounter impact of TIA and minor stroke, but there is evidence that fellow students and the academic sta§. leading cause of long-term adult disability. Therefore it is various disabling barriers – despite their high qualification. people experience diculties that a§ect their quality of life. important that, following TIA, people receive early diagnosis One career option for university graduates is to obtain a There is a need for developing and evaluating interventions Aim: Therefore, the PROMI project has been initiated to and medical management, along with information about their doctoral degree. Doctoral degrees open up various career to address the physical, emotional and social needs of people support graduates with disabilities and to reduce prejudices individual risk of stroke and any lifestyle changes that might opportunities in most fields and are a formal precondition with TIA and minor stroke. and barriers at universities. It is funded by the German help reduce that risk. To design appropriate interventions, for scientific careers in Germany. Hence, it should be beyond Federal Ministry of Labor and Social A§airs. The project as part of TIA management and rehabilitation, we need question that admission to doctoral studies should be Aim: This single centre feasibility randomised controlled trial provides 45 severely disabled university graduates with the to understand patients’ experiences of TIA diagnosis and equally accessible for graduates with disabilities. But there aims to explore whether a time-limited intervention based possibility to attain a doctorate degree at 21 universities all factors that motivate their engagement with (behavioural) are no systematic data on the actual accessibility of doctoral on psychoeducation is appropriate and acceptable for people over Germany. secondary prevention interventions. However, little is known studies. Besides, universities have not engaged in the analysis with TIA and minor stroke. on this topic. and reduction of barriers or the promotion of inclusive Methods: By involving graduates with disabilities in everyday Methods: Forty participants within six months following a structures and processes so far. academic activities, awareness of their potential and confirmed diagnosis of TIA or minor stroke will be recruited Aim: To conduct a systematic review to examine the current performance is raised. Referring to Allport’s contact theory, from TIA clinics and stroke units. Participants will complete evidence. Aim: The PROMI project for doctoral students with it is expected that the intergroup contacts may entail a measures at baseline and then be randomly allocated to disabilities is designed as a combination of a research and reduction of prejudices and enhance the understanding and receive the intervention or usual care. The psychoeducational Methods: We will use a rigorous review method, meta- practice project to implement inclusive structures and respect for people with disabilities. As doctoral students are intervention will be delivered over six sessions in a group aggregation, to synthesis the literature. We will search processes at universities and to identify barriers and best usually well connected, they can serve as role models and setting. Outcome measures will be completed at 3 and 6 bibliographic databases including Medline, Cinahl, and practices. multipliers. months by an independent blinded assessor. PsycINFO. We will include qualitative studies that focus on the experience of adults who have been diagnosed with TIA. Methods: Funded by the Federal Ministry of Labour and Results: Doctoral students with disabilities are often faced Results/Findings: Ethical approval has been obtained. Two reviewers will work independently on all stages of the Social A§airs, the project provides 45 additional part-time with conflicting expectations. As a consequence, their Topics to be covered during the group psychoeducational review. We will use the Critical Appraisal Skills Programme jobs for severely disabled doctoral students at 21 cooperating working environment either tends to overburden the person intervention were identified from conducting a qualitative Qualitative Checklist to assess the methodological quality of universities nationwide. The formative and participatory concerned or tends to demand too little from him/her. study with service users and experts. The intervention is included papers. Descriptive statistics and narrative will be evaluation combines qualitative and quantitative data and Both practices cause disadvantages regarding learning and focused on providing education, advice and support following used to report the data; Synthesised Findings will be used to includes all relevant stakeholders. development possibilities of the person. a TIA and minor stroke. The participant and facilitator report the qualitative synthesis. First Results/Discussion: There has been a wide interest of intervention workbooks are currently under development. Discussion and Conclusion: Attitudinal barriers at Results/Findings: Preliminary searches identified 5 universities as well as university graduates with disabilities Recruitment for the trial is expected to start in September universities can only been removed slowly. The PROMI potentially relevant papers. Our preliminary analysis will be to participate in the PROMI project. This indicates that 2017. project aims at creating a better understanding of the presented in the poster. “inclusive university” is an upcoming topic that has been potential of doctoral students with disabilities and disability- Conclusion: The feasibility and acceptability of the proposed · raised by the UN-CRPD. The PROMI project develops related additional expenses. intervention will be assessed. Findings will determine the key transferable and sustainable solutions to enhance this topic. · components of this complex intervention and the sample size needed for conducting a definitive trial. ·

45 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 46 Poster Presentations Poster Presentations

24 - 25 May - Education 24 - 25 May - Education 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise Rehabilitation for people with The eects of a marketing campaign A multi-centre RCT of a falls A multi-centre cluster Randomised intellectual disabilities supporting aiming to raise youth awareness of prevention programme (PDSAFE) Controlled Trial to evaluate the their healthy lifestyle and rehabilitation services [45] for people with Parkinson’s: study Guide To Action Care Home Fall [15] [Work in engagement in work 1 1 design and baseline population Prevention Programme in care Progress] Ms Anna-Marie Paavonen , Ms Jenna Mäkinen , Docent [185] [Work in Progress] [98] [Work In Anna-Liisa Salminen1 characteristics homes for older people 1The Social Insurance Institution of Finland (Kela), Helsinki, Finland. Progress] D.Soc.Sc. Anne Rahikka1, M.Ed. OTR. Helena Launiainen1, Dr Kim Chivers-Seymour1, Dr Ruth Pickering1, Prof Lynn 1 2 1 3 Physiotherapist Annika Slunga Background: The Finnish youth is poorly informed about the Rochester , Dr Helen Roberts , Prof Alice Nieuwboer , Dr Prof Philippa Anne Logan1,2, Dr Allan Clark4, Prof Simon 1Miina Sillanpää Foundation, Helsinki, Finland. 1 1 1 rehabilitation services they are entitled to. The rehabilitation Claire Ballinger , Ms Carolyn Fitton , Ms. Ioana Marian , Dr Conroy6, Professor John RF Gladman1, Mrs Maureen 1 4 6 service system is perceived as complicated and the Sophia Hulbert , Dr Emma McIntosh , Dr Victoria Goodwin , Godfrey7, Dr Adam Gordon1, Dr Paul Leighton1, Mrs Kate 1 Background: There are approximately 40,000 people with Prof Sallie Lamb, Prof Ann Ashburn 3 4 4 application process burdensome. 1 2 Robertson , Dr Tracy Sach , Dr Erika Sims , Professor Ann intellectual disabilities (ID) in Finland, of which 25,000 University Of Southampton, Southampton, UK. Newcastle University, 4 2 5 3 Marie Swart , Mrs Marie Ward , Mrs Wynne Williams , Dr are working age adults. The life expectancy of people with Newcastle Upon Tune, UK. University of Leuven, Leuven, Belgium. Aim: We examined the e§ects of a marketing campaign 4University of Glasgow, Glasgow, UK. 5Oxford Clinical Trials Research Unit, Jane Horne1 ID has risen, though the risk for health conditions is high 6 1 2 (Mikä Kunto?) carried out by the Social Insurance Institution University of Oxford, Oxford, UK. University of Exeter, UK. University of Nottingham, Nottingham, UK. Nottingham CityCare because of a sedentary lifestyle, poor diet, and poor self-care. Partnership, Nottingham, UK. 3Nottinghamshire Healthcare NHS Foundation of Finland (Kela) in 2015–2016 which aimed to raise youth 4 5 It is essential to develop rehabilitation promoting a healthy Trust, Nottingham, UK. University of East Anglia, Norwich, UK. Church awareness of rehabilitation services. Background: People with Parkinson’s (PwP) are twice Farm Care Home, Nottingham, UK. 6University of Leicester, Leicester, UK. lifestyle and facilitating engagement in major life areas, such as likely to fall as the healthy older population. Evidence 7Lay person, Nottingham, UK. as work. Methods: Information on rehabilitation services was suggests that exercise-based interventions could reduce falls provided on a campaign website which was advertised on risk however trials have been limited. Background: Falls in care home residents are at ﬁve times Aim: The aim of rehabilitation is to develop multi- the communication channels favoured by the youth. more frequent than in adults in other community settings. methodological rehabilitation, which supports involvement in The data were collected using a telephone interview, online Aim: To present trial design and baseline population One in ten care home residents who fall sustain a fracture, work for people with ID by promoting health and wellbeing of questionnaires and statistics of Kela. The informants were characteristics of the PDSAFE Trial, a multi-centre RCT often with serious implications for the individual, NHS and adults with ID. young people aged 16–30 years (n = 584), rehabilitation of e§ectiveness and cost e§ectiveness of the PDSAFE Social Care. Community fall prevention interventions can providers (n = 19), youth workers in outreach youth work (n intervention to prevent falls among PwP. reduce falls by 30% however, evidence that falls prevention Methods: The intervention begins with intensive group = 102) and Kela employees responsible for the rehabilitation interventions reduce falls in care homes remain inconclusive. rehabilitation at the service centre. The rehabilitees learn phone services (n = 49). We measured the informants’ Methods: Participants in the control group receive usual care Trials in care homes have particular challenges which are of physical activity, nutrition, and self-care. During the awareness of the campaign, the number of contacts by and an information DVD. Participants in the experimental important to overcome to perform research applicable to the next ﬁve months, they pursue healthier lifestyle changes young people with the latter informants in matters of group receive usual care plus PDSAFE, a multimodal 405,000 patients who are UK care home residents. in their everyday life with the support of their counsellors rehabilitation and the number of rehabilitation decisions physiotherapist delivered, individually tailored and and close ones. The intervention ends with intensive group made before and after the campaign. progressive, home-based programme. The primary outcome Aim: To determine the clinical and cost e§ectiveness of an rehabilitation at rehabilitee’s own environment. The pre- and is repeat falling 0-6 months post randomisation. evidence-based Guide to Action Care Homes (GtACH) postintervention measurements are blood pressure and Results/Findings: A majority of the rehabilitation providers process for falls prevention in care homes (intervention) -sugar, weight, and BMI, six minute walk, one leg balance and and Kela employees had noticed the campaign. In contrast, Results: Between October 2014 and August 2016, 541 compared to usual care (control). hand grip test. three percent of the youth and half of the youth workers in participants were recruited from nine centres across England.

outreach youth work had noted it. The campaign only slightly Of whom 474 (88%) were randomised to either intervention Methods: 1308 residents from 66 UK care homes are being Results/Findings: The measurements show positive e§ects a§ected the number of contacts by the youth in matters of (n=238) or control groups (n=236). Mean age = 72 (range recruited with randomisation to intervention or control at on health and physical function after the intervention. rehabilitation. No notable increase in youth rehabilitation 47 to 91); 58 % were male; Mean time since PD diagnosis = care home level. The intervention is the GtACH systematic Also, the knowledge and skills of the health behaviour have decisions was found. 8 (range 0 to 36) years; Mean number of falls in previous 12 process delivered by trained and supported care home sta§. improved. months = 21 (range 1 to 1195); Mean MMSE score = 28. 24% It was developed by care home and NHS sta§, based on Discussion and Conclusion: Instead of a marketing lived alone; 70% with a spouse/partner; 6% with a friend/ NICE clinical guidelines. The control conditions reflect usual Discussion and Conclusion: The findings suggest that campaign it could be more ecient to increase rehabilitation family. Mean baseline UPDRS score = 33 (range 2 to 92). care home practice. The primary outcome is rate of falls at the health promotion is important for the target group. take-up by contacting potential users personally. The youth Baseline Hoehn & Yahr scores: 1 = 12%, 2 = 33%, 3 = 41%, 3 to 6 months post randomisation. Secondary outcomes The rehabilitation can lead to the improvements in health may benefit from personal counselling especially in detecting 4= 14%. include falls rates at 6-9 and 9-12 months; injuries; death; behaviour and wellbeing. We have a reason to believe that rehabilitation need and in case management. physical activity; activities of daily living ability; quality of rehabilitation may have positive e§ects on working ability, · Conclusions: PDSAFE is the largest rehabilitation trial life and use of services. A concurrent process evaluation is although more accurate further scientific research is needed. evaluating an intervention to reduce falls among PwP. included. Sucient numbers of participants have been recruited to achieve the target 80% power assuming a di§erence of 63% Results: Funded by the NIHR HTA - 13/115/29. Ethical to 50% in the percentage repeat falling between the two approval: 16/YH/0111 was received on 7 June 2016. Early groups. findings on overcoming challenges to implementation, adherence to the protocol and recruitment will be presented and discussed.

47 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 48 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise The eect of dietary restriction and Rehabilitation of patients suering Gait retraining in patients with knee Alanine aminotransferase blood physical activity on physical function gonarthrosis: how eective are osteoarthritis: Eect of dual-tasking levels and rehabilitation outcome in and body composition of obese strategies of aftercare? [216] on ability to walk with modified gait older adults with hip fracture [224] [173] [179][Work In Progress] elders with knee OA pattern 1 2 3 Prof Stefan Dalichau1 Dr Dan Justo , Dr. Irina Gringauz , Mr. Jonathan Weismann , 1 2 1 1 1 1Bg Ambulanz Bremen, Bremen, Germany. 2Berufsgenossesnschaft der Ms Asma Alrushud , Mr Conor Bentley , Dr Alison Rushton , 1 1 Dr. Abraham Adunsky , Dr. Gad Segal Ms Rosie Richards , Ms Marjolein Booij , Dr. Martin van der 1 1 2 2 Bauwirtschaft BV Nord, Bremen, Germany. 3Berufsgenossenschaft Holz und Department Of Geriatrics, Sheba Medical Center, Aliated to Sackler Dr Simon Jones , Dr Gurjit Bhogal , Mr Fraser Pressdee , Dr Metall BV Hamburg-Bremen, Bremen, Germany. Esch2, Dr. Josien van der Noort1, Prof. Jaap Harlaar1 School of Medicine, Tel-Aviv University, Ramat-Gan, Israel. 2Department Carolyn Greig1 1VU University Medical Center, Amsterdam, Netherlands. 2Reade Centre for Of Internal Medicine T, Sheba Medical Center, Aliated to Sackler School 1School of Sport, Exercise and Rehabilitation Sciences, College of Life and Background: According to current understanding, medical Rheumatology and Rehabilitation, Amsterdam, Netherlands. of Medicine, Tel-Aviv University, Ramat-Gan, Israel. 3Rappaport School of Environmental Sciences, University of Birmingham, Birmingham, UK. 2Royal Medicine, Technion Institute of Technology, Haifa, Israel. Orthopaedic Hospital, Birmingham, UK. rehabilitation must be judged by the quality of sustainability e§ects. Background: In patients with medial knee osteoarthritis (mKOA), simple gait modifications, such as altering the foot Background: Recent studies show that low Alanine Background: Knee OA is a common condition in older adults progression angle (FPA), may reduce the loading in the knee Aminotransferase (ALT) blood levels are associated with which a§ects approximately 3.64% of the global populationÒ. Aim: In a prospective comparative study, the aim was to joint, expressed by the knee adduction moment. Real-time frailty and poor outcome in older adults. The association Despite the clinical recommendation of exercise and diet for investigate whether and to what extent the sustainability- feedback can be used to teach the gait modifications to the between ALT blood levels and hip fracture rehabilitation people with knee osteoarthritis (OA) there are no published oriented model of outpatient workplace medical patients. outcome in older adults has never been studied. UK studies reporting ecacy of a combined intervention rehabilitation (AAMR) in osteoarthritis of the knee is able to programme of physical activity and dietary restriction on the achieve beneficial treatment e§ects over the long term. Aim: To determine how the foot progression angle changes Aim: To study the association between ALT blood levels prior musculoskeletal function of overweight and obese elders to rehabilitation and hip fracture rehabilitation outcome in Methods: A total of 41 male employees (52.5 years) from during gait retraining in people with mKOA, when real-time with knee OA. older adults. the building and metal trades with advanced gonarthrosis feedback is removed and when a secondary task is added, completed both the 3-week intensive initial phase and over a 6 week training program. Aim: To assess the feasibility and acceptability and collect Methods: Included were older adults (age >60 years) who the subsequent extended outpatient physiotherapy (EAP) preliminary data on the e§ectiveness of a combined dietary were admitted to rehabilitation at a tertiary medical centre once a week for 12 weeks (stabilisation phase). While the Methods: We trained 16 patients with mKOA to walk with restriction/ exercise intervention programme. during 2007-2012 following hip fracture surgery. Their experimental group (EG, n = 22) continued the training increased toe-in over a period of six weeks, using real-time biofeedback. We investigated the patients’ reliance on the rehabilitation outcome was assessed by the Functional Methods: The trial will begin in February 2017 and conclude program for another 18 months, the control group (CG, n = feedback by removing the real-time feedback at the end of Independence Measure (FIM) scoring system. Their in August 2017. It will take place at the Royal Orthopaedic 19) terminated all other sporting activities. sessions and by implementing a dual task condition. We ALT blood levels were documented between one and six Hospital (ROH) and University of Birmingham. Participants months prior to rehabilitation. Excluded were patients with Results:After completion of the initial work-up phase, explored the error between the target and actual FPA in three will receive a physiotherapy usual care programme for abnormally elevated ALT blood levels (>40 IU/L) possibly strength of the thigh muscles, endurance capacity and quality di§erent conditions i) with feedback, ii) without feedback and knee OA for one month, after which they will continue to consistent with hepatocellular liver injury. The cohort was of life increased and knee pain and functional limitations iii) during the dual task condition, at the start and end of the exercise in their local gyms for 3 months. Participants will divided into two groups: patients with ALT>10 IU/L and decreased in both groups (p <0.05). The positive e§ects training program. also follow dietary restriction throughout the 4 months of the patients with ALT≤10 IU/L. intervention. could be stabilised by carrying out the EAP. While the data of the CG after 18 months fell even below the status quo Results: The median error in the FPA was significantly di§erent between the three afore mentioned conditions in Results: Included were 490 patients: 402 (82.0%) females, Results/ Findings: Feasibility will be assessed via focus ante, the e§ects of the EG remitted but in comparison to week 1 (p=0.042), but not in week 6 (post-training). The mean age 82.9 ± 6.7 years. All motor rehabilitation outcome group (participants) and questionnaire (ROH physio sta§) the beginning of the AAMR still showed a trend towards median FPA error in the dual task condition was significantly measures were significantly higher in the ALT>10 IU/L group at the end of the trial. Secondary outcome measures will improvement. reduced between week 1 and week 6. (p=0.027). compared with the ALT≤10 IU/L group upon rehabilitation include WOMAC, body weight, BMI, body composition, discharge. A logistic regression analysis showed that patients Conclusion: The results of the EG were positive but did waist circumference, musculoskeletal function (including with ALT>10 IU/L were almost twice as likely to undergo a not meet the expectations. The content of the follow- Discussion and Conclusion: After the gait training program, knee ROM, lower limb muscle power, stair climb and timed successful rehabilitation by means of high total FIM score at up strategies used must be optimised. Furthermore, the patients significantly reduced the error in FPA during walking up-and-go), pain, QoL, and markers of joint remodeling. their discharge (odds ratio = 1.71, 95% confidence interval = advanced stage of osteoarthritis of the knee seems to with dual tasking providing evidence of motor learning and a reduction in cognitive demand; important parameters to 1.11 - 2.64, p = 0.014). Discussion and Conclusion: The result of this trial will inform negatively a§ect the long-term results. A more preventive ensure successful adoption of a modified gait pattern in the design of a combined intervention programme within the approach has to be discussed. activities of daily living. Conclusion: High-normal ALT blood levels prior to UK population. Also, it will help to identify optimal method(s) · rehabilitation are associated with a better rehabilitation for weight reduction plus the most e§ective way of delivering outcome in older adults with hip fracture. exercise to optimize patient outcome in a secondary health care setting. Trial registration: ISRCTN12906938

References: 1 Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 2013 Jan 4;380(9859):2163-96.

49 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 50 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise Early rehabilitation of patients with Comparison of pneumatic pump with Does exercise training positively Cardiac Rehabilitation for significant hip joint or knee endoprosthesis in manual lymphatic drainage in the influence on ventricular remodelling, improvement of risk parameter an innovative health and social care treatment of breast cancer patients serum cardiac parameters, profile in patients with Acute institution in Bulgaria [154] with high stage lymphedema [201] functional capacity during Coronary Syndrome [16] trastuzumab therapy in breast Prof Jeni Staykova1, Mr. Emil Yankov, Mrs Maria Titopoulou Dr Tugba Ozsoy1, Dr Canan Sanal Toprak2, Dr Yeliz Bahar Prof. Bernhard Schwaab1, Dr. Anselm Gitt2, Dr Christina 1Medical University - Sofia, Sofia, Bulgaria. Ozdemır1, Mr Binali Batman1, Dr Gulseren Derya Akyuz1 cancer women? - a preliminary Jannowitz3, Dr. Ohmar Wichelhaus3, Prof. Uwe Zeymer2 1Marmara University Medical School, Physical Medicine and Rehabilitation results of REH-HER study [65] 1Curschmann Klinik for Cardiac Rehabilitation, Timmendorfer Strand, Background: Hip joint and knee replacement Department, Istanbul, Turkey. 2Horasan State Hospital, Erzurum, Turkey. Germany. 2Klinikum der Stadt Ludwigshafen, Medizinische Klinik, Ludwigshafen, Germany. 3MSD Sharp & Dohme GmbH, Haar, Germany. (endoprosthesis) is one of the most common surgery Dr Katarzyna Hojan1, Dorota Horyńska-Kęstowicz1, Dr Ewa interventions in orthopaedics and traumatology. Physical Background: Postmastectomy lymphedema is characterised Leporowska2, Dr Sławomir Katarzyński3, Assos. prof. Maria Background: In patients (pts) after myocardial infarction therapy and rehabilitation are an indispensable part of the by lymphatic interruption due to cancer itself, operation, Litwiniuk4,5 1 (STEMI and NSTEMI) cardiac rehabilitation (CR) should help functional recovery for patients with endoprosthesis. chemotherapy or radiotherapy. Treatment goals are to reduce Department of Rehabilitation; Greater Poland Cancer Centre, Poznan, edema, control symptoms, maintain extremity functions Poland. 2Central Labolatory, Greater Poland Cancer Centre, Poznan, Poland. to improve quality of life and prognosis. 3Cardiothoracic Surgery Clinic, Poznan University of Medical Sciences, Aim: The aim of this study is to track and measure the results and prevent complications. Complete decongestive therapy Poznan, Poland. 4Clinic of Oncology, Poznan University of Medical Sciences, 5 Purpose: The aim of the PATIENT-CARE registry is to of an applied complex rehabilitation program during the early (CDT) is a gold standard in the treatment of lymphedema. Poznan, Poland. Department of Chemotherapy, Greater Poland Cancer Centre, Poznan, Poland. document clinical and demographic data, risk factors and post-surgery period (7-30 days after surgery) for patients CDT is a combined therapy with manual lymphatic drainage medication. with hip joint or knee alloplasty in a Multispecialty hospital (MLD), multilayer bandage, compression garment, exercises Background: Almost 30% of women with breast cancer for continued treatment and rehabilitation “Serdika”. and skin care. Intermittent pneumatic compression (IPC) can be used alone or combined with CDT. (BC) present with an aggressive form characterised by Methods: Since April 2016, 980 consecutive patients increased expression of human epidermal growth receptor were included in 18 German CRs. Pts characteristics, Methods: 137 patients (73 male and 64 female) participated 2 (HER2) proteins. A targeted treatment using monoclonal co-morbidities, physical examination, lipid profile and in the study. The rehabilitation program consisted of: Aim: The aim of this study was to assess and compare the antibodies against HER2 expression such as trastuzumab medication changes were documented at admission and kinesitherapy (positional therapy, isometric exercises for ecacy of these treatment modalities. has been shown to improve survival. It is also associated discharge to evaluate guideline-adherent therapy and gluteal and hip muscles, movement of the artificial hip joint with cardiotoxicity by reduced ejection fraction and physical lifestyle-changes during CR. or knee within the allowed volumes, mechanotherapy of the Methods: In this prospective randomized trial, the patients fitness, which has been well documented. replaced joints within the allowed volumes, exercises for the were divided into 2 groups as MLD (n=24) and IPC (n=22). Results: Mean age: 62 years, 73% men, 47% STEMI, 51% shoulder muscles, upper limbs and the healthy lower limb), Both groups received treatment 3 days per week for 5 weeks Aim: To investigate the e§ect of supervised exercise (aerobic NSTEMI. CR started ~19 days after MI. Pts. presented with hydropathis procedures (underwater remedial gymnastics) and multilayer bandage was applied in each session. A home and strength) training in mitigating trastuzumab on mediated diabetes 26%, hypertension 75%, positive family history and ergotherapy (provision of an ergonomic environment exercise programme and skin care education were given left ventricular remodelling, serum outcomes, and physical 39%, active smoker 24%, and former smokers 41 %. Nearly adjusted to prevent falls and complications, increasing to both groups. They were assessed before, 5 weeks and 3 capacity in women with HER2-positive BC. half of the pts (45%) were still employed, 44% already movement and physical activity and daily life activities). The months after the treatment with arm circumference, shoulder retired. Data at admission: BMI: 29 kg/m2, total cholesterol medical complex is an innovative health-care institution and range of motion (ROM), pain, tension and weightness Methods: 23 women with HER2-positive BC conducted (TC): 160 mg/dl, LDL-C: 95 mg/dl, triglycerides: 146 mg/ includes multispecialty hospital for continuous treatment sensation. Arm circumference was measured from 5 exercise training (5/week) after the first 3 months of dl, blood pressure (BP): 128/77 mmHg, plasma glucose and rehabilitation and a hospice, which provide quality di§erent areas, ROM was evaluated with a goniometer, pain, trastuzumab therapy. Patients underwent examination at (PG): 114 mg/dl, pulse: 69 bpm, exercise capacity: 106 Watt, recovery for patients in professional environment of care and tension and weightness sensation were assessed with visual baseline (T0), after 3 months (before starting physical LDL-C <70 mg/dl: 22%. Average CR duration was 22 days. subsequent resocialisation. analogue scale. training -T1), at 6 weeks of training (T2), and 6 months Data at discharge: BMI: 28,6 kg/ m2, TC: 137 mg/dl, LDL-C: (T3). Outcomes measures included: heart function 77 mg/dl, triglycerides: 123 mg/dl, BP: 122/73 mmHg, PG: Results: Ensuring an ergonomic environment and Results: Both groups had significant improvements in all arm (echocardiography examination), 6MW test, serum cardiac 111 mg/dl, pulse: 68 bpm, exercise capacity: 118 Watt, LDL-C independent practice of kinesitherapeutic and circumference, shoulder ROM, pain, tension and weightness markers: NT-proBNP, galacetin-3, leptin, as well as blood <70 mg/dl: 43%. Medication was optimized. Following the ergotherapeutic activities (learned during the early sensation outcomes at 5th week and 3rd month (p<0.05). counts, CRP, urea and creatynine. completion of a standardized training program, nutrition and rehabilitation period) stimulate the recovery of patients’ There were no other statistically significant di§erences psychosocial risk factors counselling, lifestyle education, self-reliance, significantly improve psycho-emotional between the groups (p>0.05). Results: Peak EF was lower (p < 0.05) and functional stress management and smoking cessation, the majority of balance and self-respect, and are an important basis for later capacity declined to a lesser extent (p < 0.05) after 3 months patients were discharged to full-employment. rehabilitation stages. Conclusion: This study suggest that MLD and IPC can be used interchangeably with similar e§ects. However, IPC of study. Exercise training resulted resting end-diastolic and end-systolic volumes (p > 0.05), whereas ejection fraction Conclusion: The risk factor profile of post-MI patients Conclusion: Early rehabilitation shortens the period of device’s cell count, session time and pressure should be did not change from baseline to post-intervention (p > 0.05). improved. Significant more pts achieved LDL-C goal <70 mg/ functional recovery overall. suitable and the massage therapist should be well educated Elevations in NT-proBNP, galacetin-3, and leptin levels, dl. Moreover, BMI, BP, PG, TC and exercise capacity were · and experienced. · parallel to the weight increase were observed in individual improved by CR. cases, but not at a group level. ·

Conclusion: Regular exercise training was well tolerated in this study group. Exercise training may prevent cardiotoxicity in women with BC undergoing trastuzumab therapy. This study needs to be continued in larger patient groups.

51 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 52 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise Group exercise class for people PHysical Activity for Non- Development of an intervention Additional trunk training in early with chronic stroke: A service ambulatory Stroke Survivors to promote physical activity and stroke trial (ATTEST): a mixed improvement programme [99] (PHANSS-1): Exploring the thoughts bladder health self-management method feasibility trial [129] [Work in and views of Health and Exercise among older community-living Progress] Dr. Praveen Kumar1, Mrs Rebecca Shelly2 1 2 [234] [211] [Work in Progress] University Of The West Of England, Bristol, UK. Bristol Area Stroke Professionals adults 1 1 2 Foundation, Bristol, UK. Dr Isaac Sorinola , Dr Claire White , Mr Gareth Jones , Dr 1 2 1 1 1 2 1 1 Caroline Burgess , Prof Anthony Rudd , Dr Jane Petty Ms Megan Lloyd , Prof Dawn Skelton , Prof Brian Williams , Mrs Lorna Booth , Professor Jo Booth , Professor Dawn 1 2 3 1 1 2 King’s College London, London, UK. Guy’s and St Thomas’s NHS Background: Individuals with stroke are less physically Prof Gillian Mead , Prof Frederike van Wijck Skelton , Professor Suzanne Hagen Foundation Trust, London, UK. active and have increased risk of secondary problems such 1Glasgow Caledonian University, Glasgow, Scoltand. 2Edinburgh Napier 1Glasgow Caledonian University, Glasgow, UK. 2NMAHP Research Unit, University, Edinburgh, Scotland. 3University of Edinburgh, Edinburgh, GCU, Glasgow, UK. as weakness, fear of falls, loss of confidence, social isolation Scorland. Background: Individuals with significant trunk deficits after and depression, leading to increased disability. Group Background: Mobility loss and urinary incontinence (UI) stroke have been reported to have a poor functional outcome. exercise classes have shown beneficial e§ects in people with Background: Stroke guidelines recommend walking- are two of the termed “Geriatrics Giants” older people often Current evidence suggest that additional trunk training could neurological conditions. based physical activity (PA), which is unsuitable for non- fear as they are both major causes of loss of independence. optimise functional outcomes in these individuals. However, ambulatory stroke survivors (SS). This is an important gap, However, both can be prevented and/or improved by despite this very little attention is focussed on the facilitation Aim: The aim of this pilot work was to assess the benefits of because sedentary behaviour, an independent risk factor changes in behaviour. UI and Lower Urinary Tract Symptoms of trunk performance during early stroke rehabilitation. To group exercise class in people with chronic stroke. for ill-health, places non-ambulatory SS at higher risk. carry enormous social stigma causing embarrassment, which facilitate the development of a definitive clinical trial, it is When designing a new PA intervention for this population, often leads to low levels of help-seeking behaviour. People important to establish the feasibility and acceptability of Methods: People with chronic stroke were recruited from the it is important to seek service provider views to ensure may be too embarrassed to take part in an intervention delivering a trunk training intervention to individuals with community. Pre and post rehabilitation outcomes included: acceptability. focused solely on bladder health, but may engage with an significant trunk impairments in the early phase post stroke. Timed up and Go (TUG), Berg Balance Scale (BBS) Score, intervention aiming to improve overall physical functioning. Motor Assessment Scale (MAS-upper limb section), and Aim: To explore the views of exercise professionals (EP) An existing intervention, The Functional Fitness MOT Aim: To assess the feasibility of recruiting 20 eligible adults patients’/family members’ perception of perceived benefits. and health professionals (HP) on needs, goals, barriers, (FFMOT), is an awareness intervention to promote within 7 days of stroke and delivering 16 hours of additional Patients received 8 weeks (1 hour/week) of group exercise motivators and preferred format of PA. physical activity to improve general physical functioning in trunk training to inform the development of a definitive RCT. class which included warm up and flexibility exercises in community-living older adults. sitting, dynamic balance exercises, gait re-education and Methods: Qualitative study. EPs recruited through Later Life Methods: Individuals with severe trunk deficits are upper limb exercises. Patients were encouraged to maintain a Training, HPs recruited through the Scottish Stroke Allied Aim: To develop the FFMOT to include bladder health recruited to receive a trunk training intervention during diary of exercises/ activities practised at home. Health Professionals Forum. Individual telephone interviews promotion. early stroke rehabilitation. Primary outcomes included with EPs (N=4) and HPs (N=4). Verbatim transcripts were assessment of the feasibility of recruitment, delivery and Results: Ten patients (8 men and 2 women) with mean analysed using framework analysis with embedded constant Methods: Design: A two-phase mixed methods research outcome assessments, and acceptability of trunk training age 53±8 years were included in the exercise class. comparative method. design will address the aim of the project. Participants: Older intervention (by participants, physiotherapists and service Compliance was good and 2 patients missed 2 sessions due adults and intervention deliverers. managers). Secondary outcomes included measures of trunk to prior medical appointments. Pre and post rehabilitation Results: Key themes: Gate keepers to PA, barriers and Screening Phase: impairment, mobility and quality of life assessed at baseline, measurements showed mean di§erence of 1.5 seconds facilitators to PA delivery and participation, and pragmatic PA • Systematic literature review: To identify a brief, valid and post intervention and six months post stroke. on TUG and 4 points on BBS but no di§erence for MAS programme delivery and content. An overarching theme of reliable bladder symptom screening tool that could be score. Both patients and family members reported following a general lack of PA service provision for this population was included within the intervention. Results: Preliminary findings regarding feasibility suggest benefits: socialisation, increased confidence in mobility, reported by both groups. PA interventions should be adapted • Online survey and interview study: To investigate the that whilst recruitment has been dicult, outcome increase in distance walked outdoor and more engagement to individual needs of SS and preferably delivered as a chair- acceptability of including the identified screening tool and assessment is manageable and acceptable. Similarly, with exercises. based class. to identify barriers and facilitators to discussing bladder intervention delivery appears to be acceptable and feasible health. provided there is good communication and some flexibility Conclusion: The 8 weeks of group exercise programme Discussion and conclusion: Service providers expressed the within the existing MDT. Updated results will be presented showed some improvement in balance, mobility and need for a novel PA programme for non-ambulatory SS, while Intervention Development Phase: and discussed. confidence in people with chronic stroke. The other perceived noting the practical barriers to implementing this within the • Behaviour Change Technique (BCT) analysis study: To benefits included motivation and socialisation. current health system. These results inform the design of a establish BCTs used in previous successful bladder self- Conclusion: The authors will report on the results of this novel PA intervention for non-ambulatory SS. management interventions. study and reflect on the feasibility data that will guide the Findings suggest that a chair-based group programme would • Co-creation study: To inform the practicalities of the development of a definitive ecacy RCT. be the most acceptable form of PA, according to service intervention, feasible BCTs to be applied, and barriers and providers. Future studies need to explore the feasibility motivators involved in behaviour change related to this · and acceptability of this form of PA programme with non- type of intervention. ambulatory SS. · Results from the preceding studies will be used to guide the overall intervention design.

53 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 54 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise Technology for training the sit-to- Mental imagery practice with Preparing stroke survivors to self- An investigation into the stand movement in stroke survivors: task oriented-training enhanced manage a non-functional upper limb- rehabilitation needs and coping A systematic literature review [30] rehabilitation to improve ADL a survey of occupational therapists strategies of participants recovery, quality of life & and physiotherapists in Ireland [239] provided with augmented upper Mr Siu Ho1, Dr Avril Thomson1, Dr Andy Kerr1 1 [58] University Of Strathclyde, Glasgow, UK. participation after stroke 1 1 limb physiotherapy after stroke. [Work in Progress] Ms Fiona Haughey , Dr Jacinta Morgan , Dr Fiona [228] McLeod2, Dr Tadhg Stapleton Methodological considerations Background: Regaining the sit-to-stand (STS) transfer is 1National Rehabilitation Hospital, Dun Laoghaire, Co Dublin, 2School of [Work in Progress] critical in stroke rehabilitation. Due to the increasing number Mrs Najla Alhashil1, Mr Mazyad Alotaibi1, Dr Joanna Health Professionals (Faculty of Health and Human Sciences), Plymouth, 1 1 1 3 of people surviving a stroke and budget constraints, it is Fletcher-Smith , Dr Eirini Kontou , Dr Kate Radford Devon, UK. Trinity College Dublin, Ireland. 1 2 1 Ms Stefanie Schnabel , Dr. Lisa Kidd , Prof Frederike van likely that stroke survivors will receive less than optimal Division of Rehabilitation and Ageing, School of Medicine, Nottingham 1 University, Nottingham, UK. Wijck rehabilitation experience. Technology may o§er solutions. Background: Stroke is the third most common cause of 1Glasgow Caledonian University, Glasgow, UK. 2Robert Gordon University, physical disability in Ireland. It is estimated that 30%-40% Aberdeen, UK. Background: Rehabilitation is important for promoting post Aim: This systematic review explores existing literature and of stroke-survivors do not recover upper limb (UL) function stroke recovery. One cost-e§ective method is the use of Background: Over 70% of stroke survivors experience upper identifies technologies for training the movement. Moreover, resulting in a non-functional UL. Guidelines recommend mental imagery. However, its impact on outcomes over and limb dysfunction during their early recovery stage. There is this study provides a comprehensive analysis of the that stroke-survivors are supported to self-manage their above more traditional approaches such as task-oriented growing evidence that intensive, task-specific arm exercise suitability of these systems for use in stroke rehabilitation, UL. Similarly stroke-survivors have reported that a self- training remains unclear. improves function. However, because of reduced in-patient and propose suggestions and strategies for future research. management approach could assist them in living with a hemiplegic UL. stay, self-practice at home becomes essential. It is not clear Aim: To conduct a systematic review to determine whether yet, how stroke survivors cope with intensive arm training Methods: Systematic searches were undertaken of published mental imagery-assisted task oriented training improves realised through self-practice. This study is nested within peer-reviewed journal articles and papers in the following Aim: The study aims to explore the practices of Occupational activities of daily living (ADL), mobility, Quality of Life (QOL) the Early VERsus Later Augmented arm Physiotherapy after databases from inception until March 2016: PubMed, Web Therapists (OTs) and Physiotherapists (PTs) working in and participation outcomes after stroke. stroke study (EVERLAP), a 3-arm RCT comparing usual care of Science, SportDiscus, IEEE Xplore and Google Scholar. Ireland in preparing stroke-survivors to self-manage a non- with augmented arm physiotherapy delivered either early These five databases were chosen due to their popularity and functional UL. Method: The search strategy will include terms relating (starting within 3 weeks post stroke) or later (starting at 3 coverage of physiotherapy and rehabilitation. to mental imagery and task oriented training. Academic Methodology: An on-line survey was designed and piloted. months post stroke). databases will be searched including PubMed, Medline, Results/Findings: The initial number of identified articles Convenience sampling was used to recruit participants and CINAHL, in addition to the Cochrane library and Aim: The overall aim of this study is to explore the was 344. The title and the abstract of each article were working in Ireland with stroke- survivors through the PT grey literature resources. Any studies reporting mental acceptability, relevance and appropriateness of the EVERLAP read carefully, unrelated and duplicated articles were and OT neurology advisory groups and OT and PT manager imagery and task oriented interventions with stroke will be augmented arm physiotherapy programme. The research excluded, which reduced the number of articles to 31. They groups (n=391). selected. Two reviewers will screen all titles and abstracts questions explore: how do stroke survivors cope with were assigned to main categories; 1) dynamic mechanical individually using PICO-S screening and selection tool. Full the dose and duration of this upper limb physiotherapy systems that detect and respond to users’ movement and Results: The response rate was 25.3% (n=97). The majority texts of shortlisted articles will be obtained and assessed programme? What are their self-management needs and deliver controlled mechanical support, 2) passive mechanical report preparing stroke-survivors to self-manage their non- for inclusion in the review by the same two reviews. A third how well are these met? systems that simply lift the patient to standing without functional UL (n=76, 78.3%). No association was found reviewer will resolve discrepancies. A hand search will be matching the ability of the patient. between profession or work-setting and the provision of self- conducted for the included studies’ references lists and management training. There was a commitment to providing Methods and Discussion: The research questions will citation search. Two reviewers will independently assess be investigated from the perspectives of stroke survivors Discussion and Conclusion: Dynamic mechanical systems information on physical skills namely positioning (n=91, quality using the Physiotherapy Evidence Database (PEDro) and their family members/carers in a qualitative oriented are sophisticatedly engineered but lack clinical utility due to 93.8%). However, less than one third provided information rating tool. Findings will be synthesised narratively. The approach, using semi-structured interviews. The paradigm, their high cost and non-portability, whilst technical expertise on key self-management skills including empowering stroke- di§erent types of mental imagery practice and task oriented conceptual framework, methodology, method underpinning is a prerequisite for their operation. Passive mechanical survivors to recognise UL changes (n-28, 28.9%). Less than interventions and their content will be identified. Key features the study and ethical considerations will be discussed. systems are a§ordable but do not provide the stimulus half provided opportunities for supervised practice (n=38, of the interventions (e.g. duration, does, intensity etc.) will be Of the 75 participants recruited for EVERLAP, we aim at required for rehabilitation, nor reproduce ideal STS transfers. 39.2%) or performance feedback (n=35, 36.1%). described using TIDieR. interviewing 40 participants (20 from the early and 20 from Future technologies must also provide biofeedback on the late group) and if available, their family member/carers. performance, which is critical to therapy outcomes. Discussion and Conclusion: Respondents report to prepare Discussion and Conclusion: The implications for the use of The topic guide includes questions on coping, self-practice, · stroke-survivors to self-manage their non-functional UL. mental imagery assisted task oriented training in post stroke However, there is incongruence between reported practices, decision-making and acceptability. rehabilitation clinical practice will be discussed. self-management principles and the needs of stroke- · survivors. Therapists may benefit from training in this area. Results and Discussion: The results will be presented and discussed after the interviews have been conducted and analysed. · ·

55 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 56 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise Results: Ethical approval has been granted (14/WS/1136). At Discussion and Conclusion: The bilateral in-phase and anti- determine which RT dose is more e§ective than usual care; time of abstract submission, 35 participants were recruited phase functional, discrete grasp task in stroke individuals which robotic device provides better clinical outcomes, and EVERLAP: Early VERsus Later (average 3.2 per month from all 5 centres), 7 withdrew. displayed distinctly di§erent coupling patterns. However, assess RT cost-e§ectiveness. Eleven serious adverse events (SAEs) occurred (two in the the non-functional continuous wrist flexion-extension · Augmented Physiotherapy same two participants); none were unexpected and related was undertaken close to perfect synchrony (in-phase) compared with usual upper limb to the intervention. and asynchrony (anti-phase). Thus, interlimb coupling is 24 - 25 May Physical Rehabilitation & Exercise physiotherapy, protocol for an task-dependent; coordination in a non-functional cyclical exploratory RCT of arm function Discussion: Study ends March 2018. movement should not be generalised to a functional discrete Home-based neurologic music after stroke [232] [Work in Progress] task during rehabilitation. therapy for arm hemiparesis 24 - 25 May Physical Rehabilitation & Exercise following stroke: results from a Prof. Frederike van Wijck1, Mrs. Gillian Alexander2, Dr. 24 - 25 May Physical Rehabilitation & Exercise [238] Lynne Baillie3, Mrs. Brenda Bain1, Dr. Mark Barber4, Dr. feasibility study Marissa Collins1, Dr. Philippa Dall1, Prof. Cam Donaldson1, Comparing interlimb coupling 5 6 Dr Alexander Street Mr. Alexander Fleming , Prof. Malcolm Granat , Dr. Andrew between bilateral in-phase and anti- The eectiveness of robot-assisted Anglia Ruskin University, Cambridge, UK Kerr7, Prof. Peter Langhorne8, Dr. Alexander McConnachie8, upper limb therapy in adults with 3 5 1 phase modes of a functional task and Dr. Nicolas Micalef , Mrs. Kathleen Molloy , Dr. Alex Pollock , Background: Impairment of arm function following stroke 7 3 a non-functional movement in acute acute stroke: a systematic literature Prof. Phillip Rowe , Dr. Stephen Uzor , Miss Heather Jane is common and resistant to some existing interventions. 1 [218] review and meta-analysis [28] Young stroke Lab-based studies indicate that music interventions may be 1Glasgow Caledonian University, Glasgow, UK. 2NHS Greater Glasgow 1 1 and Clyde, Glasgow, UK. 3Heriot Watt University, Edinburgh, UK. 4NHS 1, 2, 1 1 Mrs Elena Ierardi , Prof. Frederike van Wijck beneficial, but no studies have examined treatment e§ects in 5 6 Dr Pei Ling Choo Dr Helen L. Gallagher , Dr Jacqui Morris , 1 Lanarkshire, Airdrie, UK. Di§erent Strokes, Glasgow, UK. University of 2 1 Glasgow Caledonian University, Glasgow, UK. the community, where most rehabilitation is delivered. Salford, Salford, UK. 7University of Strathclyde, Glasgow, UK. 8University of Prof Madeleine Grealy , Prof Frederike van Wijck 1 2 Glasgow, Glasgow, UK. Glasgow Caledonian University, Glasgow, UK. University of Strathclyde, Glasgow, UK. Background: Two out of three patients have upper limb Aim: We assessed the feasibility of a randomized controlled paresis in the acute phase after stroke. Robot-assisted trial (RCT) to evaluate neurologic music therapy (NMT) as a Background: The majority of stroke patients experience Background: Bilateral upper limb training (BT) is a potential therapy (RT) is a new challenge in post-stroke rehabilitation, home-based intervention for arm hemiparesis in stroke. reduced arm function, which often persists, a§ecting stroke rehabilitation intervention. Understanding the but there are no published systematic reviews on RT within independence and quality of life. Our Cochrane overview interlimb coupling patterns in a functional task and non- the acute phase post-stroke. Method: Eleven people with stroke and arm hemiparesis, (Pollock et al., 2014) indicated that augmenting exercise functional movement in acute stroke would provide insight 3-60 months post stroke were recruited post-community therapy time can be beneficial, suggesting that a total of into the optimal delivery of BT. Aim: The aims of this systematic review were to: rehabilitation, and randomised into either immediate or at least 20 extra hours may improve arm outcomes. The • Compare the e§ectiveness of RT with: conventional delayed NMT. Participants performed pre-designed exercises question is whether starting augmented arm therapy early is Aim: To compare interlimb coupling between bilateral in- rehabilitation, placebo, no treatment, delayed treatment in using spatially arranged musical instruments and iPads, in more e§ective than starting later. phase and anti-phase modes of a functional discrete task terms of UL functional recovery within adult patients in the synchrony with strongly pulsed musical structures played and a non-functional cyclical movement in acute stroke acute post-stroke phase; live to a metronome by the interventionist. Treatment Aim: The aim of this study is to test the feasibility of individuals. • Identify which robotic device provides better clinical was delivered twice weekly for six weeks. Feasibility was a definitive RCT by comparing three groups: 1. Usual outcomes; determined by attrition rates, completion of treatment arm physiotherapy (UAPT); 2. UAPT + augmented arm Method: 13 acute stroke individuals underwent 3D motion • Assess RT safety. and data collection. Structured interviews pre- and post- physiotherapy starting within 3 weeks post-stroke; 3. UAPT + capture of the bilateral in-phase and anti-phase modes of intervention period examined participant tolerance and augmented arm physiotherapy at 3 months post-stroke. both a standardised, discrete grasp task and standardised, Method: Ten electronic databases were searched from preference. Action Research Arm Test and Nine Hole Peg continuous wrist flexion-extension movement. Interlimb their first date of publication to October 2016 (AMED, Test data were collected at weeks 1, 6, 9 and 15, pre- and Methods: coupling of the grasp task was assessed through graphing CINAHL, the Cochrane Library, MEDLINE, PEDro, ProQuest post-intervention by a blinded assessor. • Design and setting: multi-centre, single-blinded, time series of instantaneous velocity. Interlimb coupling of Health&Medical Complete, ProQuest Nursing&Allied Health exploratory RCT in hospitals, rehabilitation units, continuous wrist flexion-extension was assessed through Source, Compendex, IEEE and Web of Science). Included Results: Ten participants completed treatment and data community settings. continuous relative phase, coordination stability and phase papers’ reference lists and relevant literature were also collection. Di§erent home environments presented no • Participants: adults with reduced arm function after stroke error. hand-searched. Quality appraisal was performed using the significant challenges to intervention delivery or data (N=75). Cochrane Collaboration’s Risk of Bias Tool. collection. Outcome measures were sensitive enough to • Augmented arm physiotherapy content: evidence-based Result/Findings: During the bilateral in-phase grasp task, detect change. Observations and interview analysis indicated interventions aimed at improving functional activity of the both arms were coupled through similar velocity profiles, Results: Eleven articles were included. RT was compared high levels of motivation, repetition of target movements and a§ected arm. To encourage self-management, participants but during the anti-phase mode, the non-paretic arm was with conventional therapy, occupational therapy, RT in tolerance. Primary data analysis has estimated a sample size may choose a workbook, DVD and/or a novel mobile significantly slower than the paretic arm. During bilateral di§erent modalities, or electrical stimulation. RT-related of 45 for a larger study. reminder service. in-phase and anti-phase continuous wrist flexion-extension, adverse events were few. RT may improve some aspects of Augmented arm physiotherapy dose: 27 extra hours over 6 strong interlimb coupling was maintained (mean (SD) UL function and impairment compared to robot exposure Conclusion: A home-based RCT would be feasible weeks. continuous relative phase of 1.9°(6.8°) and 178.9°(16.4°) to the una§ected UL or delivered in high dose compared to comparing community rehabilitation with NMT plus • Assessment: Feasibility: recruitment, retention, adverse respectively). Coordination stability was similar during low-dose RT. RT may not a§ect UL spasticity. RT may not community rehabilitation. The Action Research Arm Test events, resource impacts, participant views. Outcome bilateral in-phase and anti-phase continuous wrist flexion- be more e§ective than conventional therapy in improving score should be modified for inclusion (23/57, >6 in the measures: Action Research Arm Test (primary) and a extension (Z=-1.490, p=0.136). Phase error was significantly function and activities. Gross Movement subscale). standardised and self-reported impairment, activity and smaller during bilateral in-phase than anti-phase self-paced participation measures, assessed 4x (baseline, before and continuous wrist flexion-extension (Z=-2.353, p=0.019). Discussion and Conclusion: Further research is needed to: after the intervention, 6 months follow-up).

57 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 58 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Physical Rehabilitation & Exercise Robot Assisted Training for the Recruitment to Stroke Rehabilitation Rehabilitation for post-stroke The Aordance Eect: investigating Upper Limb after Stroke (RATULS): Randomised Controlled Trials: visual field loss: a mixed methods its value in upper limb stroke Study progress [32] [Work in Progress] Secondary Analyses of Recruitment exploration of scanning training [213] rehabilitation [44] [Work in Progress] E°ciency [109] Dr Helen Bosomworth1, Mrs Lydia Aird2, Dr Natasha Dr Christine Hazelton1, Dr Alex Pollock1, Dr Glyn Walsh2, Prof Mrs Paula Rowe1, Dr Kielan Yarrow1, Dr Corinna Haenschel1, 1 3 4 1 1 Alvarado , Dr Sreeman Andole , Dr David L Cohen , Dr Jesse Mr Kris Mcgill1, Prof. Marian Brady1, Prof. Jon Godwin1, Prof. Marian Brady Mr Maciej Kosilo 5 1 1 6 1 1 Dawson , Prof Janet Eyre , Dr Tracy Finch , Prof Gary A Ford , 2 NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK. City, University of London, London, UK. Catherine Sackley 2Department of Vision Sciences, Glasgow Caledonian University, Glasgow, 1 1 12 1 2 Dr Richard Francis , Ms Jenni Hislop , Mr Steven Hogg , Glasgow Caledonian University , Glasgow, UK. Kings College London, UK. Ms Denise Howel1, Dr Niall Hughes7, Dr Hermano Igo Krebs8, London, UK. Background: The intrinsic properties of objects are said to 2 1 1 automatically “a§ord” actions. Evidence from fMRI, EEG Dr Christopher Price , Prof Lynn Rochester , Dr Lisa Shaw , Introduction: Visual field loss (VFL) persists in 20% of stroke 1 1 9 Introduction: High-quality cost e§ective clinical research and TMS confirms that a§ordances play a part in how we Ms Elaine Stamp , Dr Laura Ternent , Prof Duncan Turner , survivors, reducing ability in activities of daily living (ADL) 1 10 11 relies upon ecient recruitment to randomised controlled prepare to handle tools and other objects. This project was Prof Luke Vale , Prof Frederike van Wijck , Prof Scott Wilkes , and quality of life (QoL). Scanning training is a promising 1 trials (RCTs). Recruitment and funding extensions are undertaken to ascertain whether these a§ordances may have Prof Helen Rodgers rehabilitation method, with a range of interventions in use. 1Newcastle University, Newcastle Upon Tyne, UK. 2Northumbria Healthcare common. Inecient recruitment results in underpowered an e§ect in upper limb rehabilitation after stroke. NHS Foundation Trust, Northumbria, UK. 3Barking, Havering and Redbridge trials, inconclusive results and wasted research e§ort. University Hospitals NHS Trust, Essex, UK. 4London North West Healthcare Ecient recruitment to stroke rehabilitation RCTs is Aim: To explore the e§ects and feasibility of home-based 5 6 Aim: In stroke rehabilitation, objects are often placed within NHS Trust, London, UK. University of Glasgow, UK. Oxford University, UK. scanning training for rehabilitation of VFL. 7NHS Greater Glasgow and Clyde, Glasgow, UK. 8Massachusetts Institute of considered particularly challenging but has yet to be reachable grasp of the patient. However, if the patient is Technology, Boston, USA. 9University of East London, London, UK. 10Glasgow investigated. not fully able to make such a grasp, naturally occurring Caledonian University, Glasgow, UK. 11University of Sunderland, Sunderland, Methods: Using an n-of-1 design we combined qualitative 12 a§ordances could possibly be utilised by re-introducing UK. Lay representative, Newcastle Upon Tyne, UK. interviews and quantitative outcomes to explore the Aims and Objectives: We examined the (i) recruitment objects after short delays. If the onset and duration of experiences of stroke survivors using scanning training eciency (ii) trial features associated with recruitment a§ordances can be observed in stroke survivors, the timing of Background: Intensive, task-specific training is promising interventions. Eleven home-dwelling stroke survivors took eciency and (iii) quality of reporting of recruitment object removal and re-introduction may be better tailored for to improve arm recovery and function after a stroke. The part: 6 right sided VFL, 6-16 months post stroke. Four information for stroke rehabilitation RCTs. rehabilitation. RATULS trial is evaluating the clinical and cost-e§ectiveness interventions were delivered in randomised order: paper- of robot assisted training for upper limb recovery after stroke. based (Rainbow Readers), computer software (VISIOcoach), Methods: Trials published between 2005-2015 from 35 Method: A pilot study involved 29 healthy, young, right- Recruitment commenced in April 2014 and here we report web-based (MyHappyNeuron) and specialised equipment electronic databases (e.g., CINAHL, Medline, EMBASE); handed participants viewing objects in 3D while EEG progress over the first two and a half years. (NeuroVision Training). Semi-structured qualitative clinical trial registers; and hand-searching other resources recorded brain activity. They sat in Posture 1 (right) or interviews were analysed thematically to explore participant were screened for inclusion. We employed no language Posture 2 (left) hand close to the objects. Now stroke Aim: To determine whether robot assisted training with perspectives. Quantitative measures assessed training e§ect restrictions. Trials of non-pharmacological stroke survivors with remaining upper limb deficits and age- the InMotion robotic gym system (In Motion commercial (visual search, reading, quality of life) and feasibility (diaries rehabilitation interventions with patient populations were matched controls are taking part in an extension of that version) improves upper limb function post stroke. of adherence). included. We extracted data on recruitment eciency (i) study. Rate: percentage of those screened that were subsequently Method: A multi-centre randomised controlled trial, cost randomised (ii) Speed: average monthly recruitment Results: Quantitative measures demonstrated no treatment e§ectiveness analysis and process evaluation. Results: In the pilot, significant activity was observed within numbers across sites (iii) Dropout rates. Data on recruitment e§ect at individual patient level. Qualitatively, participants Inclusion criteria: Adults 1 week – 5 years post first ever 300ms when participants viewed objects compared to an sta§, sites, setting, country, intervention type, control reported improved confidence and ability in daily activities. stroke, with moderate/severe arm weakness (Action empty desk. Moreover, in Posture 1, left hemispheric activity comparison, targeted impairment, funding source and ethical Intervention use varied from 0-300% of recommended Research Arm Test (ARAT) 0-39). Randomisation groups: di§ered even between objects. review were extracted by two independent reviewers. A third timings; enjoyment and levels of cognitive challenge were key • Robot assisted training using the InMotion robotic gym reviewer resolved any disagreements. aspects a§ecting motivation and adherence. system for 45 minutes, three times per week for 12 weeks Discussion and Conclusion: This study is investigating activity and timings in the stroke survivor and age-matched (27 hours). Conclusions: Scanning training is a feasible way to address Results: After screening 12,939 titles, 1,270 abstracts, 788 groups. Site of lesion and compensatory use of left hand are • Enhanced upper limb therapy for 45 minutes, three times the impact of VFL on daily life, but its e§ects remain unclear. full texts two independent reviewers included 515 trials. further factors in the stroke group. However, knowledge of per week for 12 weeks (27 hours). Conflicting inter-method evidence of training e§ect suggests Randomised stroke survivors represented 39% of those the timing of a§ordances may be helpful to improve upper • Usual NHS care. that researchers must ensure that outcome measures screened. Intervention type, targeted impairment, control limb rehabilitation, particularly in conjunction with computer- Outcomes are measured by a blinded assessor at 3 and 6 accurately capture rehabilitation e§ect. We propose a new condition, recruitment time point and setting were found to based interventions. months. The primary outcome is the Action Research Arm model of scanning training e§ect: further research is required impact on recruitment rates. · Test (ARAT) at 3 months. Target sample size is 720. to confirm and refine this. Using mixed methods is a new Conclusions: Recruitment ineciencies are common among approach in this field, but has provided unique insight into Study progress: At 31.07.16, four study centres had recruited stroke rehabilitation trials. VFL and its rehabilitation. 425 participants (83% predicted), median age 61 years [IQR · 51-69], 239 (58%) male, median baseline ARAT 3 [IQR · 0-10]. Three and 6 month face to face assessment data were available for 295/341 (86%) and 233/292 (80%). 127 participants had concluded robot assisted training and attended 4572/4097 (90%) sessions. 117 participants had concluded enhanced upper limb therapy and attended 4180/3759 (90%) sessions.

59 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 60 Poster Presentations Poster Presentations

24 - 25 May Physical Rehabilitation & Exercise 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models The neuroprotective eects and The association between length Rehabilitation of patients after A trial to evaluate an extended motor functional improvement of of stay and functional outcomes surgical intervention for benign rehabilitation service for stroke pregabalin after cerebral ischemia among patients with stroke brain tumours [203] patients (EXTRAS): study progress discharged from inpatient [11] [Work in Progress] by occlusion of the middle cerebral Dr Zoltan Denes1, Dr Szilvia Tarjanyi1, Dr Helga Nagy1, rehabilitation facility [69] 1 artery in rat [7] Dr Gabor Fazekas 1 2 3 1 Dr Lisa Shaw , Mr Robin Cant , Prof Avril Drummond , Prof National Institute For Medical Rehabilitation, Budapest, Hungary. 4 5 1 1 1 1 Dr Saad Bindawas , Mr. Vishal Vennu , Mr. Hussam Gary Ford , Prof Anne Forster , Ms Denise Howel , Ms Anne- Dr Go Eun Kim , Dr Dae Yul Kim 6 7 8 1 2 2 Marie Laverty , Prof Chris McKevitt , Dr Peter McMeekin , Asan Medical Center, Seoul, South Korea Mawajdeh , Dr. Hisham Alhaidary Background: After brain tumour operation, functional 1King Saud University, Riyadh, Saudi Arabia. 2Rehabilitation Hospitals, King Dr Chris Price1,6, Prof Helen Rodgers1,6 Fahad Medical City, Riyadh, Saudi Arabia problems may be amenable to rehabilitation activities. 1Newcastle University, Newcastle Upon Tyne, UK. 2Lay member. 3University Introduction/Background: Activation of presynaptic voltage- of Nottingham, Nottingham, UK. 4Oxford University, Oxford, UK. 5University gated calcium channels and release of glutamate play a Aim: Examination of rehabilitation results from patients after of Leeds, Leeds, UK. 6Northumbria Healthcare NHS Foundation Trust, Background: There are limited studies regarding stroke 7 8 central role in neuronal necrosis after cerebral ischemia. Northumberland, UK. King’s College, London, London, UK. Northumbria rehabilitation in Saudi Arabia, where stroke is increasingly operation for benign brain tumour. University, Newcastle Upon Tyne, UK. The aim of this study is to evaluate the e§ect of pregabalin emerging as a major health problem. on cerebral outcome after cerebral ischemia through an Method: A retrospective, descriptive study at Brain Background: Development of longer term stroke established rat model. Aim: To examine the association between length of stay Injury Rehabilitation Unit between 1 January, 2001 and 31 rehabilitation services is limited by lack of evidence of (LoS) and functional outcomes among patients with stroke in December, 2013. Medical documentation of patients, who e§ectiveness for specific interventions and service models. Material and Methods: Male Sprague–Dawley rats were Saudi Arabia. were admitted for post-acute inpatient, multidisciplinary randomized to receive oral administration of 5 mg/kg of rehabilitation after surgical treatment for benign brain Aim: To determine the clinical and cost e§ectiveness of an pregabalin or an equal amount of normal saline during 1 or Method: In this retrospective study we reviewed all patients’ tumour, was reviewed. extended stroke rehabilitation service. 5 days after middle cerebral artery occlusion. Behavioural records with stroke (n = 414) between November 2008 tests were assessed at postoperative day 1, 7. Histologic and December 2014, who were discharged from a tertiary Results: Patients were admitted after consultation from Method: Study design: Multicentre randomised controlled examinations of the peri-lesional cortex and ipsi-lateral inpatient rehabilitation facility (IRF) in Riyadh, Saudi di§erent hospitals with the aim of providing rehabilitation. trial with health economic and process evaluations. hippocampus were performed at postoperative day 2, 8. Arabia. According to LoS, we classified patients into three In this period 51 patients were treated after operation for Participants: Adults with a new stroke (and carer if groups: Group A (LoS ≤ 30 days), Group B (LoS between benign brain tumour. Patients arrived at the unit after an appropriate) discharged from hospital under the care of an Results: Total 34 rats were sacrificed. Ten rats were 31-90 days), and Group C (LoS > 90 days). The functional average of 43 days following the surgical intervention (range: ESD team. administrated with 5mg/kg of pregabalin during 1 day outcomes were evaluated using the total Functional 10-126 days), and the mean length of rehabilitation stay was • Intervention: An extended stroke rehabilitation service (P5D1), seven rats were administrated with an equal Independence Measure (FIM) along with the motor-FIM and 56 days (range: 12-193 days). The main clinical symptoms for 18 months following completion of routine ESD. The amount of normal saline during 1 day (SD1). Ten rats were cognitive-FIM. were: hemiparesis (34), tetraparesis (3), paraparesis (1), extended rehabilitation service involves regular contact administrated with 5mg/kg of pregabalin during 5 days dysphagia (17), cognitive problems (16), ataxia (12), aphasia (usually by telephone) with a senior ESD team member (P5D5), and 7 rats were administrated with normal saline Results/Findings: Patients’ mean age was 58 years (SD= (6). The mean Barthel Index at the time of admission was who leads and coordinates further rehabilitation. during 5 day (SD5). The outcomes of behavioural tests 16) and about 56% of the sample was men. The average 40 points, whereas this value was 78 points at discharge. • Control: Usual care post ESD. were not statistically di§erent between P5D1 and SD1, P51 LoS was 48 days (SD = 31). In multivariate regression After inpatient rehabilitation, 45 patients functionally • Randomisation: Central independent web-based service. and SD5. In immunohistochemistry, more BDNF staining analyses, shorter length of stay (≤ 30 days) was significantly improved, the status of 2 patients did not show clinically • Primary outcome: Nottingham Extended Activities of Daily cell numbers in the peri-lesional cortex were found in the associated with higher total-FIM score [β = 18.7, standard relevant changes, and 4 patients deteriorated. During the Living (NEADL) Scale at 24 months post randomisation. P5D1 group compared with the SD1 (P=0.001), whereas error (SE) = 4.9, p =0.0002] as well as with higher motor- rehabilitation period, 5 patients required urgent transfer to • Secondary outcomes: For patients: health status, quality no di§erence was observed in the ipsi-lateral hippocampus FIM (β = 14.2, SE = 4.1, p = 0.0006) and cognitive-FIM brain surgery units, and after rehabilitation 46 patients were of life, mood, experience of services and resource usage. (P=0.282). More BDNF staining cell numbers in the ipsi- (β = 4.6, SE = 1.4, p =0.001) scores compared to longer discharged to their homes. For carers: quality of life, experience of services and carer lateral hippocampus were present in the P5D5 group LOS (Group C), even after adjustment for demographic and stress. compared with the SD5 (P=0.04), whereas no di§erence health variables. Conclusion: After operation for benign brain tumour, • Process evaluation: Semi-structured interviews with was observed in the peri-lesional cortex (P=0.10). functional impairments are prevalent that require inpatient participants and sta§ to gain insight into perceptions and Discussion and Conclusion: Our results indicate the rehabilitation treatment following medical consultation. experience of study treatments. Conclusion: Pre-emptive treatment with oral pregabalin shorter LoS was associated with improvement in functional Multi-professional consultation (surgeon, pathologist, • Sample size: Allowing for 25% attrition, 510 participants conveyed a beneficial influence on histologic cerebral outcomes for patients with stroke discharged from IRF. Thus, oncologist, PRM specialist) is necessary to determinate the provide 90% power to detect a di§erence in mean NEADL outcome in rats after cerebral ischemia. hospitals in Saudi Arabia should be encouraged to deliver goal of the rehabilitation program. Inpatient multidisciplinary score of 6 with a 5% significance level. cost-ecient quality stroke care. rehabilitation was useful, however the unplanned transmission rate was high (5/51). Study progress: Between November 2012 and September · 2015, 573 participants from 18 NHS stroke services were randomised into the trial (male 342 (60%); median [IQR] age 71 [61-79]; median [IQR] NEADL 41 [27-53]). Intervention delivery and outcomes continue until March and September 2017 respectively. Trial results are expected in 2018. ·

61 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 62 Poster Presentations Poster Presentations

24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models Organisation of a Norwegian Brain Rasch Analysis of the Rasch Analysis of the Extended- Injury Rehabilitation Network: the Rehabilitation Complexity Scale Rehabilitation Complexity Scale Outcomes and suitability of opportunities created by a closed in Stroke Patients [26] in an Acquired Brain Injury (ABI) an intensive multidisciplinary social media platform [180] Population [229] rehabilitation program for adults Mr Bilal Mateen1, Prof Diane Playford2 1 2 with a traumatic brain injury [108] 1,2 2 University College London, London, UK. University of Warwick, Coventry, 1 2 Dr Andrew Bateman , Dr Jan Egil Nordvik , Ms Ingvild UK. Mr Bilal Akhter Mateen , Prof E Diane Playford [Work In Progress] Grimstad2, Dr Stein Arne Rimehaug2 1University College London, London, UK. 2Warwick University, Coventry, UK. 1 Oliver Zangwill Centre For Neuropsychological Rehabilitation, Ely, UK. 1 1 2Regional Kompetansetjeneste Rehabilitering, Oslo, Norway. Background: The heterogeneous nature of stroke Ms Anna-Marie Paavonen , Docent Anna-Liisa Salminen Background and Purpose: Acquired Brian Injury (ABI) 1 presentations means that it is not possible to deliver a one The Social Insurance Institution of Finland (Kela), Helsinki, Finland. comprises a range of conditions, which are each individually size fits all service, as the type and degree of disability vary Background: South East Norway has developed a brain injury associated with a variety of di§erent impairments. Diculty substantially from person to person. The Rehabilitation Background: The rehabilitation for adults su§ered from rehabilitation network that has five objectives: reporting the complexity of rehabilitation required by each Complexity Scale (RCS) was developed to allow clinicians traumatic brain injury (TBI) is organised by multiple 1 Dissemination: sharing guidelines, clinical pathways and individual, in a standardised manner, led to the development to classify and report the complexity of an individual’s institutions in Finland. experiences from projects. of the Rehabilitation Complexity Scale (RCS). The Extended- 2 Surveys: both in specialty health services and municipal rehabilitation needs in a standardised manner. Rehabilitation Complexity Scale (E-RCS) was developed Aim: We examined the outcomes and suitability of an contexts. in response to demonstrations that the (RCS) was not intensive multidisciplinary rehabilitation programme 3 Develop information: for patients and professionals. Aim:In this study we sought to examine the psychometric psychometrically robust. We sought to evaluate the E-RCS which aims to secure or restore the functional abilities of 4 Research and innovation: cooperate, where appropriate, properties of the RCS using a Rasch-model based analysis. using the Rasch-model in an ABI population undertaking adults with TBI in the post-acute phase. The rehabilitation and implement research. neuro-rehabilitation, and thus determine the optimal scoring programme is organised by the Social Insurance Institution of 5 Quality: ensuring equal services and o§ers to all in the Methods: 138 patients with a confirmed diagnosis of stroke method. Finland (Kela). region. were admitted for neurorehabilitation between May 2012, and January 2016. Inclusion was limited to adults (age 18+ Methods: 220 patients with a confirmed diagnosis of years) with an imaging-confirmed diagnosis of stroke. The Methods: The study uses multiple methods. The data Aim: The network of clinicians aims to meet twice per year ABI were admitted for neuro-rehabilitation between May Rasch model was applied to the data using the Rumm2030 were collected using postal questionnaires, Kela’s register for face-to-face discussions and workshops. 2012, and January 2016. Inclusion was limited to adults program. of customer information and semi-structured interviews. (age 16+ years) with an imaging-confirmed diagnosis. The The informants were patients over 16 years of age who Method: Techniques such as action learning and co-coaching Rasch model was applied to the data using the Rumm2030 had undergone the rehabilitation program (n = 12), a have been used alongside traditional seminars. Results: The results suggest that the original RCS is a program. Both descriptive and cluster analysis were multidisciplinary team of the rehabilitation providers (n = 6), Between meetings we have used a social media project unidimensional measure. However, it did not fit the Rasch conducted using SPSS, version 22. neurologists referring patients to the rehabilitation program management platform to communicate within a closed “safe model (p < 0.05), and had poor reliability (Person-Separation Index – 0.492). Correcting for the disordered thresholds led (n = 5), medical experts of Kela (n = 2) and employment space” and tackle shared objectives. Results: The E-RCS appears to be a unidimensional measure, to a marginal improvement in the overall fit, such that the pension providers (n = 2). In addition we analysed the We have encouraged participants to develop their leadership but does not fit the Rasch model (p < 0.05), and has poor chi-squared probability of misfit was 6%, but the reliability rehabilitation related documents of the patients (plans, of a theme and have teleconference discussions with other reliability (Person-Separation Index – 0.65). Correcting for remained low (PSI – 0.490). The RCS in its original format goals and feedback; n = 10). We measured the perceived clinicians. the disordered thresholds led to substantial improvement appears to be a unidimensional measure. benefits of the programme and how the program has met in the overall fit, such that the chi-square probability of fit the needs of the patients. Furthermore we evaluated how the Results: Topics we have been tackling include driving became 57%, and rectified the borderline significant DIF, but programme has found its place in the Finnish rehabilitation assessment, apraxia, vision, fatigue, inclusion of aphasic Conclusions: In conclusion, whilst the Rasch-modified the reliability decreased to 0.59 (PSI). service system for TBI patients. patients, post traumatic amnesia assessment, return to work, version of the RCS produced in this study appears to meet implementing cognitive rehabilitation. These topics reflect the assumptions of the model, its poor reliability and other Conclusions: This study proposes a new scoring method Results and Conclusion: Most of the patients found the the interests of members. limitations mean that the tool should be used with caution, for the E-RCS in the ABI population, which results in a programme useful. The programme helped the patients to This poster will show how the chat-room, planning and topic and its results should be interpreted in light of these faults. unidimensional construct, that satisfies the assumptions of understand how the TBI symptoms are a§ecting their life discussion tools facilitate progress toward the objectives, · the Rasch model. However, the results identify an important and they learned to recognise their personal strengths to overcoming the geographical and organisational boundaries limitation of the E-RCS; its low reliability, where the PSI falls manage everyday life. In contrast, the patients felt that the represented in this network. The network participants’ short of threshold required for both individual and population programme did not support them to re-enter work life. For a engagement in the work can also be audited. level measurement. majority of the patients, however, re-entering work life was not the primary goal for the rehabilitation. Conclusion: Working across international, organisational

and city boundaries we are using a social media approach to develop a network of clinicians. The online record of discussions and ﬁles is becoming a rich resource for the network members. The approach may be of beneﬁt to other groups within the EFRR membership.

63 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 64 Poster Presentations Poster Presentations

24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models Requirements and current provision Bowel care in early Traumatic Brain Single Case Experimental Design Multidisciplinary medical of rehabilitation services for children Injury patients: challenges and – a bridge between Science and rehabilitation in Latvia [195] after severe acquired brain injury in pitfalls [96] Practice? [140] [Work in Progress] the UK: population-based study [204] Prof Aivars Vetra1,2,3, Stud. med. Janis Jun Vetra1, Assist. Kitija Dr Harry Mee1, Dr Fahim Anwar Dr Peter Tucker1,2, Dr Katie Byard1, Dr Sophie Gosling1, Dr Irbe1,2 1 3 1 2 1 2 2 Cambridge University NHS Trust, Cambridge, UK. Riga Stradins University, Riga, Latvia. Riga Eastern University hospital, Riga, Jennifer Limond 3 Dr Simon Shaw , Dr Louise Hayes , Dr Mark Pearce , Dr Rob 1 2 3 Latvia. National Rehabilitation Center “Vaivari”, Jurmala, Latvia. 3,4 Recolo UK Ltd, London, UK. University of Bath, Bath, UK. University of Forsyth Exeter, Exeter, UK. 1Royal National Orthopaedic Hospital, London, UK. 2Institute of Health and Background: Altered bowel habit can be distressing and can Society, Newcastle,UK. 3Institute of Neuroscience, Newcastle University, UK. be a major cause of concern. It can cause serious medical Background: The last twenty years of medical rehabilitation 4Newcastle upon Tyne Hospitals NHS Foundation Trust, UK. Newcastle, UK. and surgical complications and is preventable. Patients who Background: There is a need for good quality evidence in in Latvia are characterised by rapid changes in its have su§ered traumatic brain injuries (TBI) are often on paediatric neurorehabilitation. Single-Case Experimental organisation. This is related to: 1) the development of Background: Survival after significant acquired brain injury opiate medications for pain relief because of injuries they Designs (SCEDs) are ideal for reporting behavioural medical technology; 2) evidence-based understanding of has improved. Except for the most severely disabled children, have sustained. It is also common for patients to be in a interventions due to their flexibility, but the scientific calibre the development of human functioning and the ICF; 3) an life expectancy after ABI is near-normal, making a strong state of confusion, known as post traumatic amnesia, after a of such studies is variable (Tate et al. 2008). Standards increase of public awareness, regulations and information health-economic case for early e§ective rehabilitation. head injury and therefore it is likely they are unaware of their for conducting and reporting SCED studies have recently technology. Therefore, the organisation of medical In contrast to adult rehabilitation services, the service bowels habits. improved significantly (Evans et al. 2014). These may be rehabilitation services is changing from the principle of specification of paediatric rehabilitation has received little helpful to build quality studies in everyday clinical practice. “complete the treatment, start rehabilitation” to the principle attention in the UK. Aim: To produce a bowel regime for healthcare professionals of starting rehabilitation “as soon as possible”. As a result, a to follow for those patients on the major trauma Aim: To test the feasibility of delivering publishable review is required of the cooperation between rehabilitation Aim: We sought to estimate rates of severe paediatric rehabilitation ward who have su§ered a TBI. neuropsychological rehabilitation in normal clinical practice professionals and: 1) other specialities to actively participate Acquired Brain Injury (ABI) requiring rehabilitation and to in at least one case. in treatment processes during the acute period; 2) General describe current provision of services for these children in the Methods: Audit was done over a 2-month period to record Practitioners; 3) local and national social services, as well as UK. the current documentation of bowel habits for all patients on Methods: A child with a brain injury referred to Recolo NGOs. the major trauma rehabilitation ward. Data was also collected UK Ltd for neuropsychological rehabilitation will receive Methods: Analysis of Hospital Episode Statistics data as to whether the patient su§ered a TBI, whether they were intervention delivered by an Associate Psychologist. The Aim: Our report aims to discuss the potential of between April 2003 and March 2012; supplemented by a UK in PTA and if they were on any laxatives. intervention will be delivered within normal litigation multidisciplinary rehabilitation team in rehabilitation. provider survey completed in 2015. A Probable Severe ABI funded therapy. The Research Lead will compile the report. Requiring Rehabilitation (PSABIR) event was inferred from Results: Total of 71 patients, 34/71 (48%) su§ered a TBI. Independent raters will evaluate the process and report. Methods: Analysis of the literature and other information, the co-occurrence of a medical condition likely to cause ABI From those who su§ered a TBI: 15/34 (44%) had a period of Costs will be monitored by the business team. including a survey for physicians and health care organisers, (such as meningitis) and a prolonged inpatient stay (>= 28 PTA, 13/34 (38%) had no bowel data recorded and 20/34 and results of the Ministry of Health working group. days). (59%) had laxatives prescribed. Due to inadequate recording Procedure: of data numbers of patients su§ering constipation was • Recruitment Results: Results: During the period studied, 4508 children aged unattainable. • Permissions 1 The idea of a need for a multidisciplinary team in cases 1-18 years in England had PSABIRs. Trauma was the most • Design using SCED scale (Tate et al. 2008) of debilitating diseases requires greater responsiveness common cause (30%) followed by brain tumours (19%) and Discussion and Conclusions: Documentation of bowel habit • Goal setting, rehabilitation planning, delivery via Goal among professionals and managers of medical institutions; anoxia (18.3%). An excess in older males was attributable is inadequate in a high risk group of patients for developing Attainment Scaling GAS (Turner-Stokes 2009) 2 Social services have a di§erent style of cooperation with to trauma. We estimate the incidence of PSABIR to be at constipation. A simple, easy to follow bowel regime is being • Baseline / intervention clinical data health services (including General Practitioners) least 2.93 (95% confidence interval 2.62-3.26) per 100,000 developed on the back of this data to ensure patients with • Activity data (Northwick Park Therapy Dependency 3 Information about human functioning and the ICF is not young people (1-18 years) pa. The provider survey confirmed a TBI have their bowels closely monitored and laxatives are Assessment NPTDA) sucient for physicians, but it is sucient for di§erent marked geographic variability in the organisation of services prescribed for appropriate reasons. • Report writing therapy professions in Latvia. in the UK. · • Rating report against SCED scale and Single-Case Reporting Guideline In BEhavioural Interventions (SCRIBE; Discussions and Conclusion: Multidisciplinary rehabilitation Conclusion: There are at least 350 PSABIR events in children Tate et al 2016) requires the provision of training for health care organisers, in the UK whilst there is a significant national variation in • Replication and follow-up planning. practitioners and students in various medical and social the organisation and delivery of rehabilitation services after professions during their studies. paediatric ABI. These services have developed in an ad hoc Results: Results will include dependent variables within the · manner in contrast to nationally coordinated approach to ITU SCED; therapy dependency; SCED and SCRIBE report rating; and major trauma provision. costs.

Acknowledgements: This paper reports independent Discussion: Results will be discussed in relation to this research funded by the NIHR Programme Grants for Applied question: “Is it feasible to produce publishable results from Research Programme Development Grant scheme (RP- normal clinical practice in neuropsychological rehabilitation?” DG-0613-10002). The views expressed are those of the Limitations, a§ordability and transfer of the process will be authors and not necessarily those of the NHS, NIHR or the considered. Department of Health. ·

65 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 66 Poster Presentations Poster Presentations

24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Rehabilitation Models 24 - 25 May Access to Services & Decision Making Delayed discharge from Rapid A UK survey of Occupational Monitoring essential legal, policy Older adults and Inpatient Specialist Access Acute Rehabilitation Ward: Therapy practice for adults with and programmatic aspects of Neurological Rehabilitation [210] A missed opportunity [95] lower limb amputation during the rehabilitation: Towards a shared Dr Lloyd Bradley1 perioperative stages of rehabilitation framework with indicators [194] [Work 1Western Sussex Hospitals Nhs Trust, Chichester, UK. Dr Harry Mee1, Dr Fahim Anwar 1Cambridge University NHS Trust, Cambridge, UK. [209] in Progress] Background: Following an acute neurological illness, 1,2 2 1 1 Background: The acute rehabilitation ward’s main aim is to Mrs Victoria Challenger , Professor Pip Logan Dr Dimitrios Skempes , Prof Jerome Bickenbach , Mr Per Von inpatient rehabilitation may facilitate recovery and manage 1Nottingham University Hospitals, Nottingham, UK. 2University of Groote1, Prof John Melvin2, Prof Gerold Stucki1 the consequences of any ongoing impairments. In the assess patients, stabilise them surgically and medically and Nottingham, Nottingham, UK. 1 2 Swiss Paraplegic Research, Nottwil, Switzerland. Thomas Je§erson UK. commissioning of inpatient specialist neurological initiate rehabilitation with the aid of the full MDT operating University, USA. rehabilitation (ISNR) is based on outcomes and processes a dual care approach with the rehabilitation physicians and Background: Although occupational therapists routinely treat for “working age adults” (18-65 years)1. However, changes in the surgical teams. Quick and appropriate referrals and/ patients with lower limb amputations during all stages of Background: At the international level there is a dearth of life expectancy and the broader economy make the idea of a or discharges once initial assessments and rehabilitation their recovery and rehabilitation, little is known about current valid indicators to monitor legal, policy and programmatic universally defined limit to “working age” largely redundant. have been established are vital to allow an adequate flow practice. aspects of rehabilitation. While research on health systems of patients through the major trauma pathway. Delays performance assessment has increased exponentially over It is not known what the outcomes of ISNR are for people above the traditional age of retirement. at point of referral and repatriation are common and this Aim: Therefore, to address this gap, a descriptive survey the last decade, far too little attention has been paid to review looked to capture these issues over a 2-month period strategy was used with the aims of identifying, describing rehabilitation. Aim: To determine whether there is a di§erence between between September 2016 and November 2016. and documenting occupational therapy practice for adults outcomes for younger (<50), middle aged (51-64) and older with new lower limb amputations in the United Kingdom. Aim: To develop indicators for health related rehabilitation Aim: To capture the discharge destinations and time delays to assist country e§orts to monitor progress in the (65+) adults undergoing ISNR. for patients being discharged or transferred from the major Methods: An online questionnaire was designed, piloted implementation of the Convention on the Rights of Persons Methods: A retrospective review of all admissions to an ISNR trauma centre rapid access rehabilitation ward. and advertised, asking occupational therapists to report with Disabilities (CRPD). unit over 5 years using data which are routinely collected and on their own practice during the preoperative and acute submitted to the UK Rehabilitation Outcomes Collaboration Methods: Audit was undertaken over a 2-month period postoperative stages of lower limb amputation. Methods: Concept mapping. 241 participants recruited where the discharge destination and time to discharge from through purposive sampling were invited to participate for each patient on admission and discharge. admission from all patients was recorded who were admitted Results: 58 occupational therapists responded. 93.1% of in an online brainstorming session and generate ideas Results/Findings: There were 297 patients included (76 to the major trauma centre rapid access rehabilitation ward. questionnaires were completed by occupational therapists at that complete the following focus statement: “A specific aged <50, 93 aged 51-64, 152 aged 65+). There was no band 6 level or above. The majority of respondents worked indicator that would help assess the implementation of significant di§erence between the groups for average length Results: 74 patients were discharged in total over 2-month for the National Health Service (87.9%), with the remainder the health related rehabilitation aspects of the CRPD is...” of stay (67, 67, 69 days) and FIM (Functional Independence period, including 3 categories of patients: major trauma, working for the Ministry of Defence. Occupational therapy All participants were asked to provide their consent to Measure) gain (32, 28, 27). Rehabilitation eciency (change neuro-rehabilitation and other. Total average length of stay in practice during the early stages of rehabilitation focused participate and complete a brief demographic questionnaire. in FIM/length of stay) was significantly greater for the hospital was 28 days and on the rehabilitation ward 15 days. on the assessment of functional tasks, assessing the home younger age group than the middle aged (p=0.02) and 36/74 (49%) delayed discharge post medically fit date, total environment, equipment provision and practising patient Results: 59 participants brainstormed their initial ideas the older group (p=0.004) but there was no di§erence in delayed days 260 – average delay - 7 days. 35/71 (49%) transfers. 60.3% of respondents stated they considered between December/January 2017. This yielded 275 rehabilitation eciency between the middle aged and older were discharged home with no formal rehabilitation follow up psychological aspects of recovery as important and 74.1% statements. After removal of duplicate statements (n=62) group (p=0.5). required. provided advice and education around limb care. the preliminary set of indicators was assessed by two reviewers for relevance to the focus question. This process Discussion/Conclusion: Those considered above “working Discussions and Conclusions: Almost half of patients were Conclusions: The findings shed light on the routine practice resulted in 42 indicators being removed. The remaining age” make similar gains from ISNR as middle aged adults. delayed at discharge. This causes delays and reduces flow of occupational therapists who were mainly responding 187 ideas were edited for clarity and comprehension Age, alone, should not exclude admission for ISNR. of the major trauma centre pathway. New measures such to the physical challenges of an amputation. The number and synthesized into a set of 107 unique indicators. The as earlier funding decisions or prompter referrals should be of responders indicates that occupational therapists are sorting and rating activities that will follow will generate a Reference: reviewed to aid reduction in delays. interested in research on this topic. Further research is robust map of conceptual categories of the indicators that 1. Lynne Turner-Stokes et al. BMJ Open 2016;6:e010238 · needed to investigate the underlying components and will ultimately inform the key domains of the monitoring · mechanisms that contribute towards the successful delivery framework. of occupational therapy assessments and interventions used for this patient group. Conclusion: The framework will indicate areas of importance · and feasibility for documenting information on rehabilitation policy and services and serve as basis for the global assessment of rehabilitation systems.

67 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 68 Poster Presentations Poster Presentations

24 - 25 May Access to Services & Decision Making 24 - 25 May Implementation & Service Improvement 24 - 25 May Implementation & Service Improvement 24 - 25 May Implementation & Service Improvement Measuring access to equitable social Use of an interactive education A feasibility study to investigate Development of a Tracheostomy care in England [170][Work in Progress] session to facilitate clinician’s whether school sta can Decannulation Risk Management implementation of Fast muscle independently implement an Tool in complex neuro-disability [126] Ms Dhatshayini Devamanoharan1, Professor Rory O’Connor1 1University of Leeds, Leeds, UK. Activation and Stepping Training evidence-based physiotherapy [Work In Progress] [186] [112] (FAST) in practice programme in schools 1 1 Background: Research has been very limited in the area Ms Katrina Clarkson , Mrs Aideen Steed , Mrs Anna Leah [Work in Progress] 2 1,3 1 of measuring access to social care in the UK. Eligibility Dr Kimberly J Miller1, Dr Courtney L Pollock2, Dr Jayne Cooper , Dr Stephen Ashford , Mr Mark Wright , Ms Nicola 1 1 1,3 3 assessments used by local authorities in England have Garland 1,2 1 2 Perkins , Mrs Rita Santhirarajah , Prof Lynne Turner-Stokes , 1 Dr Nick Preston , Prof Rory J O’Connor , Dr Sally Barber , 2 never been tested for their validity or accuracy in identifying Faculty of Health Sciences, Simon Fraser University , Burnaby, Canada. 2 2,3 Ms Claire Fitzgerald 2Department of Biomedical Physiology & Kinesiology, Simon Fraser Prof John Wright , Prof Mark Mon-Williams 1Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital,London 1 the needs of disabled people. Therefore, it is necessary to University, Burnaby, Canada. 3Faculty of Health Sciences, Western Academic Department of Rehabilitation Medicine, University of Leeds, North West Healthcare, Harrow, Middlesex, UK. 2Physiotherapy 2 University, London, Canada. Leeds, UK. Bradford Institute for Health Research, Bradford Teaching Department, Northwick Park Hospital, London North West Healthcare NHS investigate the existing assessment method and improve 3 Hospitals NHS Trust, Bradford, UK. School of Psychology, University of 3 accountability of the procedure. Trust, Harrow, Middlesex, UK. Department of Palliative Care, Policy and Leeds, Leeds, UK. Rehabilitation, Faculty of Life Science and Medicine, Kings College London, Background: It is challenging to translate evidence for higher Cicely Saunders Institute, London, UK. Objectives: This study aims to produce a useful, scientifically intensity post-stroke balance training that incorporates Background: Developmental coordination disorder (DCD) robust and meaningful measurement to help individuals with demanding fast movements and intentional loss of balance, a§ects up to 5% of children in the UK and has a profound Background: Standard tracheostomy decannulation criteria disabilities achieve eligible outcomes. like Fast muscle Activation and Stepping Training (FAST), impact on children’s life chances: children show restricted do not fully consider the complexities for those with highly into practice. Interactive education sessions addressing participation in social and leisure activities, more obesity complex neuro-disability as a result of acquired brain injury. Method: The study will consist of a province-based cross- barriers and brainstorming solutions may be a useful strategy and poorer academic attainment. If left untreated, these sectional study that will consist of 800 carers and disabled to facilitate practice implementation. motor diculties cause ongoing physical and mental health Aim: To develop a risk management tool to guide clinicians in individuals from Yorkshire. Individuals with all types of problems into adulthood. High quality evidence suggests assessing and minimising risk associated with tracheostomy disabilities will be recruited for the study through three Leeds Aim: To evaluate behavioural intentions to use FAST in that specific physiotherapy interventions have large benefits decannulation. NHS Trusts. The study will be in two phases: (I) A cognitive clinical practice following an interactive education session for the motor skills of children with DCD (Preston et al.), but debriefing session to test the accessibility of the proposed addressing barriers to implementation. NHS service managers report insucient resources to deal Method: Development of the tool was undertaken in questionnaire (II) Analysis of data from selected carers and with demand. three stages. Stage one included a group of tracheostomy disabled individuals using Rasch analysis. Method: An interactive education session at a national specialist clinicians on a regional hyperacute rehabilitation physiotherapy conference was used to disseminate FAST to Aim: To conduct a feasibility study to investigate whether unit surveying variability in decannulation management. Results: According to an initial small scale study with 75 targeted knowledge users. Barriers and potential solutions an evidence-based physiotherapy programme can be Stage two involved identifying current clinical practice disabled individuals and carers, the questionnaire proved to using FAST in practice were brainstormed. Immediately independently implemented in schools by teaching sta§. through evaluation of the clinical record, available literature to be well targeted with no floor and ceiling e§ects. Data afterward, participant intentions to use FAST in practice were and national guidelines. Clinical risk factors and safety from the large study will be analysed in detail and will be rated from 1-7 (1=low to 7=high) on Continuing Professional Plan: This research follows MRC Guidance on developing and processes were identified and mapped against a risk matrix. presented to demonstrate levels of funding required by Development (CPD) Reaction questionnaire items. Barriers evaluating complex interventions. Children, teaching sta§ Stage three involved consultation by a wider group of expert di§erent types of disability. and facilitators to implementation in practice were also and sports coaches will contribute to the development of the clinicians across multidisciplinary professions in the North surveyed. programme and its associated manual and online support. West London region. Consensus was agreed and risk factors Conclusion: Preliminary calculations illustrated that This aims to optimise the programme’s usability for teaching and safety processes finalised. The tool was presented to the prototype algorithm is able to suit a wide range of Results/ Findings: Questionnaires were completed by sta§ and engagement with children. The feasibility study Clinical Governance Patient Safety Committee for comments funding levels. Detailed analysis with a larger sample size 15/25 attending physiotherapists. Median (range) ratings will take place in fifteen schools over ten weeks, with 2–3 and ratification. will contribute in further evaluating the capacity of the were high for participant intentions to implement FAST in sessions per week, each taking 30–60 minutes. Independent questionnaire in producing meaningful measurements. practice 5.8(4-7), beliefs about usefulness/benefits 6(5-7) physiotherapists will visit schools to evaluate fidelity of Results/Findings: In additional to standard decannulation · and ethics/acceptability 6.5(5-7) of FAST. Lower ratings the programme. Children’s motor skills will be evaluated criteria, 14 further risk factors and 10 safety processes were for confidence/capability to implement 5(2-6) and social before and after the feasibility study using the Movement identified. These items and the risk matrix formed the basis influence (current use by colleagues) 3.2(1-6) identified Assessment Battery for Children. of the tool. Risk factors are utilised in producing a risk score priority areas for tailored knowledge translation strategies. for decannulation. Depending on the score, safety processes Gaps in knowledge/confidence to intensively challenge Results/ Findings: If this school-implemented physiotherapy are implemented to reduce the risk. patient balance were identified, with additional training programme produces changes in children’s motor skills of materials and mentorship recommended by participants as moderate e§ect size, a multicentre randomised controlled Discussion and Conclusion: The tool was piloted with 8 potential solutions. Education and ‘buy in’ were identified as study will be conducted to evaluate the programme’s long patients who were successfully decannulated using this important facilitators to address barriers anticipated with the term impact on children’s motor skills, participation in life risk assessment tool. There have been no adverse incidents acceptability of FAST for patients/families. situations, body weight and academic attainment. or recannulations. Early indications are improved multi- · disciplinary working, consistency of clinical documentation Discussion and Conclusion: Interactive education sessions and optimised patient outcomes. Further evaluation will be directly addressing barriers to implementation can positively undertaken to examine its predictive validity. influence intentions to use new interventions and direct strategies to translate evidence into clinical practice. · ·

69 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 70 Plenary Session Parallel Session 4.1 Parallel Session 4.1 Parallel Session 4.1

26 May 2017 Plenary Session 8:30 AM – 9:15 AM, Parallel Session 4.1.1 - Standardisation and Guidelines Parallel Session 4.1.2 - Standardisation and Guidelines Parallel Session 4.1.3 - Standardisation and Guidelines Main Conference Hall May 26, 2017, 9:20 AM - 10:20 AM, Main Conference Hall May 26, 2017, 9:20 AM - 10:20 AM, Main Conference Hall May 26, 2017, 9:20 AM - 10:20 AM, Main Conference Hall Language and eective co-design Developing The National System of The development of a Stroke in Development of the International relationships comprehensive rehabilitation [72] Childhood Guideline using an Classiﬁcation of Functioning,

1,2 1,2 evidence based collaborative Disability and Health (ICF) Core Set Kate Allatt: Motivational Speaker, Trainer and Lecturer, Dr Alexander Shoshmin , Dr Yanina Besstrashnova , Dr 3 approach [120] for patients with Major Traumatic and author of ‘Running Free Breaking Out Of Locked In Oksana Vladimirova 1St. Petersburg Scientific and Practical Center of Medical and Social Injuries [144] Syndrome.’ Expertise, Prosthetics and Rehabilitation of the Disabled named after G.A. Dr Lorna Wales1 Albrecht, St.Petersburg, Russian Federation. 2WHO Collaborating Centre 1The Children’s Trust, Tadworth, UK. Dr Karen Homan1, Dr Helene L Soberg2, Prof Eva Grill3, Dr Kate will deliver an interactive mind-blowing patient for the Family of International Classifications in Russia, Russian Federation. 3Saint-Petersburg Postgraduate Institute of Medical Experts, St.Petersburg, Ralf Strobl3, Prof Karim Brohi1 rehabilitation case study. She will challenge both the Russian Federation. Background: Stroke in childhood is very di§erent from adults 1Centre for Trauma Sciences, BartsHealth NHS Trust, Blizard Institute, theory of rehabilitation and the clinical language used and a§ects 13 out of every 100,000 children in the UK Queen Mary University of London, Whitechapel, London, UK. 2Department in rehabilitation. Kate’s story is not a one-o§ as you will every year. The results of a stroke can be wide reaching and of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Background: Development of comprehensive rehabilitation Norway. 3Institute for Medical Information Processing, Biometrics and hear. She also explores the use social media as a free as a national health strategy and a state system based on can present young people with challenges that persist as a Epidemiology – IBE, German Center for Vertigo and Balance Disorders, intervention to improve patient outcomes. Finally, she will the biopsychosocial model is necessary to help many people lifelong condition. Ludwig-Maximilians-Universität München, Munich, Germany. suggest practical ways in which researchers and health care with health conditions worldwide. professionals could try to improve real partnership with Aim: A joint venture between the Stroke Association and the Background: Major trauma is a leading contributor to the patients and enjoy e§ective co-design relationships. Aim: The purpose of the project was to create national Royal College of Paediatricians and Child Health (RCPCH) global burden of disease and mortality for working aged guidelines on designing a regional program template to was formed with the aim of producing an update to the adults. There are many generic outcome measures, however Learning Outcomes: After this plenary session, delegates develop rehabilitation in Russia. previous Stroke in Childhood guidelines (2004). the application of these in trauma remains non-standardised will have a better understanding of: and ambiguous, limiting comparison of the burden of injuries. 1 How language a§ects rehabilitation levels. Methods: The methodology was partly based on the Methods: A Guideline Development Group (GDG) was 2 How social media prescribing can improve rehabilitation principles of structured conceptualisation applied to established with stakeholders from all health professional Aim: To develop international standards (ICF Core Set) for outcomes and reduce NHS cost burden. legislation and practice. groups and parent representatives. Subgroups were formed patients with traumatic injuries to describe functioning and 3 E§ective co-design relationships in rehabilitation. to concentrate on areas such as diagnosis, rehabilitation, outcome. · Results/Findings: 87 legal acts and 54 regional programs information and support. RCPCH supported each subgroup on rehabilitation were analysed. The rehabilitation systems with literature reviews, quality review, data extraction and Methods: The development of the ICF Core Set involved a were studied in 5 Russian regions. The national guidelines synthesis. GDG facilitated two parent groups. Consensus formal decision-making and consensus process, integrating on designing a regional programme template to develop from GDG and wider community was achieved using Delphi evidence from four preparatory studies. Preparatory studies, rehabilitation were created for Russia. The template included study. published elsewhere, included qualitative patient interviews the initial evaluation of the rehabilitation system (available (n=34); a systematic review of outcome measures frequently assets and human resources, real need for rehabilitation); Results: A systematic literature review was carried out and used in major trauma rehabilitation; an on-line survey with recommended measures to meet resources and needs research evidence was summarised. Research evidence was international health care professionals with an average of (for instance changes in legislation at the federal, regional combined with GDG expert consensus and parent feedback/ 8 years’ trauma experience (n=329) and empirical data and municipal levels); creation of a system to monitor and experiences. The GDG carried out a Delphi study for topics of collected from patients (n=108). An algorithm was applied to adaptation of the rehabilitation system. Transport and service controversy. The GDG produced a summary document with the ICF categories identified in all studies to present the most facilities accessibility were not considered because that study guideline statements from diagnosis through rehabilitation to essential categories for discussion at the consensus meeting. was completed earlier. long term care and education. Results: Twenty-seven experts selected 75 second level Discussion and Conclusion: Development of the Conclusion: The new Stroke in Childhood guideline provides ICF categories from a possible 143 for the Comprehensive rehabilitation system smooths out a contradiction between health, education and social care professionals with a robust Core Set and 19 categories for the Brief Core Set. The two approaches evaluating needs in rehabilitation: a document to inform integrated intervention for this group largest number of categories were from the Activities and statistical one based on population density and registration of children/young people. Whilst the guideline will focus Participation component (n=29). Twenty Body Functions, of real requests. If there is development of rehabilitation on young stroke survivors, many of the recommendations eight Body Structures, and 18 Environmental Factors were only at medical facilities, this results in restrictions by their will be applicable to children and young people with other included. scope while educational, vocational and social aspects are acquired brain injuries. either out of focus or limited by a multi-disciplinary team’s · Conclusion: The Comprehensive and Brief ICF Core Set for responsibilities within a rehabilitation department. Major Trauma is designed for physicians, nurses, therapists Poor description of existing resources (therefore excluded and other health professionals working in acute trauma from rehabilitation) and problems in inter-agency settings. ICF Core Sets can be used as minimum standards cooperation were discovered. to capture patient-relevant functioning and inform treatment · priorities which in turn will enable national and international comparison of major trauma outcome. ·

71 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 72 Parallel Session 4.1 Parallel Session 4.2 Parallel Session 4.2

Parallel Session 4.1.4 - Standardisation and Guidelines Parallel Session 4.2.1 - Physical Rehabilitation & Exercise Parallel Session 4.2.2 - Physical Rehabilitation & Exercise Parallel Session 4.2.3 - Physical Rehabilitation & Exercise May 26, 2017, 9:20 AM - 10:20 AM, Main Conference Hall May 26, 2017, 9:20 AM - 10:20 AM, Room W118 May 26, 2017, 9:20 AM - 10:20 AM, Room W118 May 26, 2017, 9:20 AM - 10:20 AM, Room W118 Approach to determining Early electrical stimulation to Barriers and facilitators to applying The Trail Making Test; A predictor comprehensive rehabilitation prevent complications in the arm early electrical stimulation to the of falls in the acute neurological interventions based on the ICF core post-stroke (ESCAPS): Results of stroke-aected arm: Qualitative in-patient population [27] a feasibility randomized controlled findings from the ESCAPS study [143] set for patients with osteoarthritis 1,3 1 [139] [Methodology session] [Methodology session] Mr Bilal Mateen , Mr Matthias Bussas , Dr Catherine [66] trial Doogan3, Dr Denise Waller3, Dr Alessia Saverino5, Dr Franz 1,2 3,4 1 1 1 2 Kiraly , Prof Diane Playford Prof Gennady Ponomarenko1, Dr Alexander Shoshmin1,2, Dr Dr Joanna Fletcher-Smith , Dr Nikola Sprigg , Dr Dawn- Dr Joanna Fletcher-Smith , Dr Dawn-Marie Walker , 1University College London, London, UK. 2The Alan Turing Institute, 2 4 1 1 1 1,2 3 Marie Walker , Mrs Kate Allatt , Prof Marion Walker , Prof Dr Nikola Sprigg , Professor Marion Walker MBE , Prof London, UK. 3National Hospital for Neurology & Neurosurgery, London, UK. Yanina Besstrashnova , Dr Irina Cherkashina 4 5 1St. Petersburg Scientific and Practical Center of Medical and Social Marilyn James1, Miss Janet Boadu1, Dr Sonia Ratib1, Mrs Carla Marilyn James1, Mrs Kate Allatt3, Dr Sonia Ratib1, Mrs Carla Warwick University, Coventry, UK. St Georges Hospital, London, UK. Expertise, Prosthetics and Rehabilitation of the Disabled named after G.A. 1 3 1 1 4 2 Richardson , Professor Anand Pandyan Richardson , Miss Janet Boudu , Prof Anand Pandyan Albrecht, St. Petersburg, Russian Federation. WHO Collaborating Centre 1University Of Nottingham, Nottingham, UK. 2University of Southampton, 1University Of Nottingham, Nottingham, UK. 2University of Southampton, Background: Falls are associated with high direct and indirect for the Family of International Classifications in Russia, Russian Federation. Southampton, UK. 3Keele University, Newcastle-under-Lyme, UK. 4PPCI Southampton, UK. 3PPCI Representative, Sheeld, UK. 4Keele University, 3 costs, and significant morbidity and mortality for patients. Federal State Budgetary Institution “Research Institute of Children’s Representative, Sheeld, UK. Newcastle-under-Lyme, UK. Infections”, St. Petersburg, Russian Federation. Pathological falls are usually a result of a compromised motor system, and/or impaired cognition. Background: Post-stroke upper limb complications include Background: Stroke survivors receive inadequate therapy Background: Rehabilitation assumes consideration of a muscle weakness (which a§ects around 70%), muscle targeted specifically at the arm after stroke. Qualified patient as a part of the biopsychosocial system interacting Aim: Our aim was to demonstrate that cognitive and motor atrophy, pain and contractures. Evidence-based treatments physiotherapists/occupational therapists were trained to with the environment. Core sets of the International tests can be used to create a robust predictive tool for falls in are needed to reduce such complications and improve arm support patients in self-managing early therapeutic electrical Classification of Functioning, Disability and Health (ICF) the in-patient neurological population. function. stimulation (ES) to the stroke-a§ected arm as part of a together with a patient’s categorical profile provide the feasibility randomised controlled trial (ESCAPS study – see complete description of functioning that includes the clinical Methods: The Trail Making test (a measure of attention and Aim: To evaluate the feasibility of a randomised controlled previous abstract). ES could potentially enable patients to picture, environmental factors, personal factors, and form the executive function), a patient reported measure of physical trial (RCT) to test whether early intensive neuromuscular self-manage additional independent arm rehabilitation. framework and examination standards, but do not identify electrical stimulation (ES) can prevent complications in the function (Walk-12), a series of questions (concerning recent rehabilitation interventions. falls, surgery and physical function) and demographic arm post-stroke; and to inform economic data collection for a Aim: To explore the barriers and facilitators to implementing information were collected from a cohort of 323 patients at definitive trial. [REC reference:15/EM/0006]. therapeutic electrical stimulation treatment from the patient Aim: The purpose of the study was to determine the most a tertiary neurological centre. The principal outcome was a and therapist perspective [REC reference: 15/EM/0006]. probable comprehensive rehabilitation interventions for Methods: A single-centre unblinded feasibility RCT fall during the in-patient stay (n = 54). Data-driven predictive patients with osteoarthritis. modelling was employed to identify the model which was including 40 patients with arm weakness (NIHSS arm Methods: From the 40 participants recruited to the study a most accurate in predicting falls. score >1) recruited within 72 hours post-stroke. Outcomes purposeful sample of patients/carers (n=12) and therapists Methods: Responsibilities were allocated between specialists including arm function, pain, spasticity and contractures (n=16) was recruited to explore barriers and facilitators to of the rehabilitation team. According to the ICF core set for Results: The Trail Making test was identified as the best were measured at 3, 6 and 12 months. Participants were ES. Intervention (n=9) and control group (n=3) patients and osteoarthritis, they assessed body functions and structures, predictor of falls. Moreover, addition of other variables randomised to control (usual care) or treatment (usual care carers (n=3) were interviewed. 16 therapists took part in elements of activities and participation, environmental did not improve the prediction (Wilcoxon signed-rank p < and ES to the wrist flexors and extensors 30 minutes twice three focus groups. Interviews and focus groups were audio factors, and selected interventions. Rehabilitation objectives 0.001). The best statistical strategy for predicting falls was daily, five days per week for 3 months). Feasibility questions recorded and transcribed verbatim. Framework analysis was and expected outcomes were explained to patients. the random forest (Wilcoxon signed-rank p < 0.001). Tuning focussed on feasibility and acceptability of the recruitment used to allow the amalgamation of di§erential data. strategy and treatment regime; compliance; and determining of the model resulted in the following results: 68% (± 7.7) Results/Findings: 132 patients with osteoarthritis took part sensitivity, 90% (± 2.3) specificity, with a positive predictive suitable primary and secondary outcome measures. Results/Findings: The barriers cited by therapists in the study in a control group (n=107) and a comparison value of 60%, when the relevant data are available. outweighed the barriers mentioned by patients. Therapists’ group (n=25). To increase their motivation, the rehabilitation Results/Findings: Of 2,310 patients screened, 230 were barriers included lack of confidence and sta§ knowledge goals were determined using the patient self-evaluation. Conclusion: This study identifies a simple yet powerful potentially eligible, 40 were recruited [20 Men; mean age (mentioned 29 times) and perceived time pressures (n=11). Application of interventions based on the ICF core set gave machine learning based predictive model for the in-patient 72 (SD 13.0)] in 15 months. Attrition at 3 month follow-up This resulted in 7/9 patients mentioning lack of sta§ support more evident rehabilitation outcomes. neurological population, utilizing a single neuropsychological was 12.5% [5/40; death (2), end-of-life care (2), unable to as a main barrier. On the contrary, no patients mentioned The categories of the ICF core set for osteoarthritis were test of executive function and attention, the Trail Making test. contact (1)]. Number of ES treatments ranged from 10 – 166 time as a barrier. All interviewed intervention patients mapped to the most probable interventions. [mean 65 (SD 53)]. reported being able to self-manage ES. Discussion and Conclusion: Thus, using the ICF core Discussion and Conclusion: An RCT of early ES to prevent Discussion and conclusion: Although initially the perceived set in conjunction with the most probable rehabilitation complications in the arm post-stroke is feasible. Patients can barrier for therapists was time restrictions, after analysing the interventions in patients with osteoarthritis enables the be recruited within 72 hours post-stroke and therapy/nursing data it appears that confidence/knowledge is the real barrier development of a comprehensive rehabilitation program, sta§ can be trained to deliver the intervention. Functional and time is the manifestation of this underlying self-doubt. distributes responsibilities inside a team, and evaluates the assessment, biometric, quality of life, and health economic Patients were able to confidently self-manage treatment. This outcomes. This approach simplifies routines for specialists data can be collected. qualitative work will inform the design of a definitive trial. and provides the framework to develop standards for individualised rehabilitation programmes. *Note: also see subsequent abstract for qualitative findings *Note: also see previous abstract for quantitative findings of of this study this study

73 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 74 Parallel Session 4.2 Parallel Session 4.3 Parallel Session 4.3

Parallel Session 4.2.4 - Physical Rehabilitation & Exercise, Parallel Session 4.3.1 - Patient Experiences, Partnership Parallel Session 4.3.2 - Patient Experiences, Partnership Parallel Session 4.3.3 - Patient Experiences, Partnership May 26, 2017, 9:20 AM - 10:20 AM, Room W118 Working & Prioritisation (1), May 26, 2017, 9:20 AM - Working & Prioritisation (1), May 26, 2017, 9:20 AM - Working & Prioritisation (1), May 26, 2017, 9:20 AM - 10:20 AM, Room W110 10:20 AM, Room W110 10:20 AM, Room W110 Fear of falling and participation following the use of Functional “Beginning a Dialogue” - identifying Improving the relevance of stroke Therapy for the upper limb Electrical Stimulation (FES) for key issues and challenges faced upper limb rehabilitation research after stroke: a longitudinal, foot drop in people with multiple by people with stroke and outcomes to stroke survivors, carers phenomenological study of the sclerosis [110] their supporters, clinicians and and health professionals [113] experiences and perceptions of [73] [91] researchers 1 1 stroke survivors Dr Tamsyn Street1, Professor Ian Swain2, Dr Paul Taylor3 Ms Julie Duncan Millar , Dr Myzoon Ali , Prof Frederike van 2 1 1Salisbury NHS Foundation Trust, Salisbury, UK. 2Bournemouth University, 1,2 3 Wijck , Dr Alex Pollock 1 2 2 3 Dr Elizabeth Lynch , A/Prof Susan Hillier 1 Dr Judith Purton , Dr Susan Hunter , Professor Julius Sim Bournemouth, UK. Odstock Medical, Salisbury, UK. 1University of Adelaide, Adelaide, Australia. 2Florey Institute of Neuroscience Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow 1School Of Health Sciences, York St John University, York, UK. 2School of 2 and Mental Health, Melbourne, Australia. 3University of South Australia, Caledonian University, Glasgow, UK. School of Health and Life Sciences, Health and Rehabilitation, Keele University, Keele, UK. Glasgow Caledonian University, Glasgow, UK. Background: A fear of falling may be detrimental to people Adelaide, Australia. participating in activities due to a reduced confidence, Background: Approximately 70% of people will have upper Background: Stroke upper limb (UL) rehabilitation is a however, fear of falling may also act as a protective factor. Background: A full day workshop was convened in Adelaide, limb dysfunction after a stroke and 40% may be left with a research priority. It is unclear which of the numerous A fear of falling may also increase the risk of falling due to South Australia (SA), hosted by the Peter Couche Foundation persistent lack of function. People’s experiences of stroke in outcomes currently captured in UL randomised controlled anxiety on attentional processes and sti§ening strategies. and supported by the South Australian Health and Medical general have been researched extensively but the specific trials (RCTs) are relevant to those involved in stroke FES has been associated with a reduced frequency of falling. Research Institute and the 3 Adelaide universities. impact of upper limb dysfunction and in particular the rehabilitation. So if individuals have a reduced falls risk this may reduce fear experiences and perceptions of patients regarding therapy for of falling and increase participation. Aim: To identify the key issues and challenges faced by the the upper limb have not been explored. di§erent stakeholder groups and to generate meaningful Aim: To identify the outcomes that matter most to stroke survivors, carers and health professionals after stroke Aim: To examine whether FES leads to a reduction in fear of research questions to be answered by people in SA. Aim: To explore people’s experiences and perceptions of a§ecting the UL. falling and an increase in participation. therapy for the upper limb during the first 18 months after Method: Invitations were disseminated via email lists and stroke. Method: We conducted 16 focus groups using Nominal Method: 48 people with multiple sclerosis (41 female, 7 stroke groups. People with stroke, carers of people with Group Technique (NGT) with stakeholders; 8 with stroke male, mean age 54 years, age range: 40-70 years) and stroke, clinicians and researchers were invited to attend the Method: A qualitative, phenomenological study, using a survivors with UL impairment and carers, and 8 with health drop foot. The FES-I was completed at baseline and after free event. Organisers coordinated small working groups, series of four semi-structured interviews with participants professionals. We purposively sampled urban and rural sites. 20 weeks. A further questionnaire which was adapted to each including a representative from each stakeholder group at two-, six-, twelve-, and eighteen months post stroke. NGT was used to identify and rank stakeholder statements examine participation in the areas identified in the FES-I was to answer: Data were analysed thematically using modified framework about outcomes relating to UL impairment that were most also included. 1 What are the key research questions we need to ask analysis. regarding the prevention and management of stroke? important to them. Using qualitative content analysis of the ranked statements, we identified priority outcomes. These Results: A significant di§erence (Z = 5.09, p<0.001) was 2 What actions can we take to begin to find the answers to Findings: Four main themes were: outcomes were then grouped into overarching themes, found between fear of falling prior to using FES and after these research questions? 1 Changing Priorities: mobility is an immediate priority stratified by stakeholder group. using FES for 20 weeks (md=8, IQR=2.75-14). The item with to people after stroke but the upper limb becomes very the largest change was “walking around the neighbourhood” Findings: 80 people attended the workshop. Key research important on returning home. Results/Findings: NGT participants were stroke survivors, followed by “visiting a friend”. A significant di§erence (Z = questions were grouped into themes that included: how 2 Short-term therapy services: focused on mobility, not the (n=35), carers (n=8) and health professionals (n=58). Stroke 3.98, p<0.001) was also found between participation prior to raise community awareness of stroke; how to improve upper limb, terminating soon after hospital discharge, survivors and carers identified 46 priority outcomes, while to using FES and after using FES (md=5, 1-9.25). The item rehabilitation services especially on weekends; how to people feel abandoned. health professionals identified 34 priority outcomes. which acquired the largest di§erence in participation was promote therapists’ and researchers’ awareness of long- 3 Lack of information: poor access to information about the The 5 overarching themes identified by stroke survivors “cleaning the house”, followed by “answering the telephone term/lifelong stroke; and how to provide evidence-based, upper limb. and carers included: ‘Physical implications’; ‘Emotional before it stops ringing”. individually tailored interdisciplinary care. Identified actions 4 Patients as active participants: people want to be active implications’; ‘Those around me’; ‘Loss of independence, included increasing opportunities for the di§erent groups partners with therapists in self-managing recovery of the choice and control’; and ‘My life has changed’. Health Discussion and Conclusions: The results suggest that FES to collaborate (e.g. create a consumer advisory group for upper limb. professionals identified three themes: ‘The arm’; ‘Overall for foot drop enables people to reduce their fear of falling and research, organise networking events) and coordinating function and quality of life’; and ‘Supporting and educating’. increase their levels of participation. fundraising to support better research in SA. Discussion and Conclusion: Stroke services should listen to · people’s experiences of therapy and their priorities regarding Discussion and Conclusion: The overarching themes that Discussion and Conclusion: The one-day workshop has the upper limb after stroke. Models of service that capitalise were identified by di§erent stakeholders evidence the wide- successfully coordinated people interested in stroke care on people’s desire to be active partners to self-manage their ranging impact of UL impairment following stroke; these and stroke research to identify state-wide research priorities. upper limb after stroke should be explored so that longer warrant consideration in future research. Our findings will be Steps to action items are underway. term access to therapy could be achieved. used to inform the development of international consensus · · recommendations for outcome measure use in future stroke UL rehabilitation RCTs. ·

75 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 76 Parallel Session 4.3 Parallel Session 5.1

Parallel Session 4.3.4 - Patient Experiences, Partnership Friday 26 May 2017 10:20 AM- 11:00 AM, The Saltire TBI, intending to RTW and living within reasonable distance, Parallel Session 5.1.3 - Vocational Rehabilitation & Return Working & Prioritisation (1), May 26, 2017, 9:20 AM - were individually randomised to receive ESTVR or UC. Follow to Work (1), May 26, 2017, 11:00 AM - 12:15 PM, Main 10:20 AM, Room W110 Morning Coee, Exhibition up at 3, 6 and 12 months was by postal questionnaire in Conference Hall and Poster Viewing two centres and face-to-face in one. Protocol Integrity was Patient perspectives on navigating assessed using predefined feasibility criteria along with Eects of vocational retraining on economic data completeness. the field of Traumatic Brain Injury · disability pensions and employment Parallel Session 5.1.1 and 5.1.2 - Vocational Rehabilitation rehabilitation: a qualitative thematic Results: 78 patients were recruited (approx. 2.2 / site/ in work disabled patients: average & Return to Work (1), May 26, 2017, 11:00 AM - 12:15 PM, [24] month) in 12 months (representing 39% of eligible, 5% of analysis Main Conference Hall treatment eects by using inverse screened); 56% mild TBI. 52/68(67%) returned 12 month 1 4 3 probability of treatment weighting Mrs Heidi Gra , Mrs Ulla Christensen , Mrs Ingrid Poulsen , questionnaires (23/39 UC, 29/39 ESTVR) and 21/23(91%) [56] Mrs Ingrid Egerod2 Facilitating Return to Work through of UC RTW at 12 months. Two disengaged from ESTVR. 1Centre Of Head And Orthopaedics, Department of Anaesthesiology, RTW was related to participation and work self-ecacy. It Rigshospitalet, Copenhagen, Denmark. 2Neurointensive Care Unit, Early Specialist Health-based Prof Matthias Bethge1 Rigshospitalet, Copenhagen, Denmark. 3Research Unit on Brain Injury interventions (FRESH): Feasibility was feasible to measure and value health economic data. 1University Of Lübeck, Lübeck, Germany. Rehabilitation Copenhagen (RUBRIC) Department of Neurorehabilitation, 4 [11/66/02] Traumatic Brain Injury, Rigshospitalet, Hvidovre, Denmark. Section of randomised controlled trial Discussion: FRESH was feasible but problems recruiting Social Medicine, Department of Public Health, University of Copenhagen, [142] [Methodology session] Background: Vocational retraining (VR) for people with Copenhagen, Denmark. people with more severe TBI due to repatriation from major disabilities aims at supporting them in obtaining competitive trauma centres and attrition, particularly in UC inflated employment. Dr Kate Radford1, Dr Chris Sutton2, Prof Tracey Sach3, Background: Patient experiences of the transition from estimates of RTW in UC. These need to be overcome before Dr Julie Phillips1, Mrs Jain Holmes1, Prof Dame Caroline hospital to home after a Traumatic Brain Injury (TBI) have performing a definitive trial. Participation in work/other Aim: The study analysed the e§ects of VR on disability Watkins2, Mrs Denise Forshaw2, Mr Trevor Jones1, Dr Karen been associated with life changes and loss of identity. Close activities might be a more sensitive outcome measure than pensions and employment in work-disabled and unemployed Ho§man4, Prof Rory O’Connor5, Mrs Ruth Tyerman6, Mr relatives are important for a successful transition as they RTW. patients who completed a medical rehabilitation programme. Jose Antonio Merchán-Baeza7, Mr Richard Morris1, Prof provide support that increases patient wellbeing. Transitions · Avril Drummond9, Prof Marion Walker1, Prof Lelia Duley10, Dr and trajectories of the TBI rehabilitation are not well- Method: We included unemployed persons aged 18 to David Shakespeare8 described in the Nordic Countries, and studies are lacking 1Division of Rehabilitation and Ageing, School of Medicine, University 59 years who had completed a rehabilitation programme that describe the experiences from the patient perspective Of Nottingham, Nottingham, UK. 2Lancashire Clinical Trials Unit, Faculty due to musculoskeletal or mental disorders in 2008 or including barriers at various stages of the trajectory. of Health and Wellbeing, University of Central Lancashire, Preston, UK. 2009. Treated persons started a VR after their medical 3Norwich Medical School, University of East Anglia, Norwich, UK. 4Queen Furthermore, knowledge is needed regarding patients’ needs Mary University London, London, UK. 5Leeds Institute of Rheumatic and rehabilitation. Inverse probability of treatment weighting to navigate in the healthcare system and the influence of the Musculoskeletal Medicine, University of Leeds, Leeds, UK. 6Programme was used to balance treated and untreated samples. The close family. Manager ‘Working Out’, Community Head Injury Service, The Camborne primary outcome was the rate of disability pensions (time Centre, Aylesbury, Buckinghamshire, UK. 7Institute of Biomedical Research in Málaga, University of Málaga, Málaga, Spain. 8Lancashire Teaching of follow-up: 2009-2012 and 2010-2013, respectively). Aim: To provide an understanding of the lived experience of Hospitals, Royal Preston Hospital, Preston, UK. 9School of Health Sciences, Secondary outcomes were employment of at least 30 days rehabilitation in patients with TBI from hospital discharge up University of Nottingham, Nottingham, UK. 10Nottingham Clinical Trials during follow-up and days in employment (time of follow-up: Unit, Faculty of Medicine & Health Sciences, University of Nottingham, to four years post-injury. Nottingham, UK. 2011/2012 and 2012/2013, respectively).

Method: A qualitative design with semi-structured in-depth The aims of this Methods session are for delegates to: Results: Data of 1,238 persons were included. 466 patients interviews. Twenty participants with TBI were included at 1-4 • Understand the purpose of a feasibility trial started a VR. Weighting reduced imbalances in baseline years post-injury. Qualitative thematic analysis was applied • Identify their fit with the Medical Research Council characteristics. The risk of a disability pension was reduced for data analysis. Framework for developing and evaluating complex from 16.7% to 11.3% (absolute risk reduction: 5.3%, p=0.031; interventions number needed to treat: 19 persons). Employment of at Results/Findings: Three themes emerged during analysis: • Appreciate the importance of feasibility studies in least 30 days was increased from 33.9% to 48.1% (absolute A new life, Family involvement, Rehabilitation impediments. progression to the definitive trial risk increase: 14.1%, p=0.007; number needed to treat: 7 Participants reassessed their values and found a new persons). Days in employment increased from 188 to 236 life after TBI. Family caregivers negotiated rehabilitation Background: Return to work (RTW) is an important days (p=0.118). services and helped the participant to overcome barriers rehabilitation goal after traumatic brain injury (TBI). to TBI rehabilitation. Although participants were entitled to Vocational rehabilitation (VR) is rare in the UK and evidence Discussion and conclusion: Biased estimations of treatment rehabilitation they had to fight for their healthcare services. of its e§ectiveness is lacking. e§ects due to unobserved heterogeneity of the treatment groups may be possible. Considering this limitation, our Discussion and Conclusion: Individuals with TBI found Aim: To assess the feasibility of a randomised controlled findings support the use of VR in unemployed patients who ways of coping after injury and created a meaningful life. trial (RCT) to assess e§ectiveness and cost e§ectiveness are unlikely to resume job activities corresponding to their Barriers to TBI rehabilitation were overcome with help from of an early Specialist TBI VR Intervention plus usual NHS former job. family caregivers rather than health care professionals. rehabilitation (ESTVR) compared to usual NHS rehabilitation Future studies need to find ways to ease the burden on alone (UC) on work and health outcomes at 12 months post family caregivers and pave the way for more accessible TBI TBI. rehabilitation. Method: Adults (16+ years) admitted with TBI to 3 major trauma centres for ≥48 hours, who were working prior to

77 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 78 Parallel Session 5.1 Parallel Session 5.2

Parallel Session 5.1.4 - Vocational Rehabilitation & Return Parallel Session 5.1.5 - Vocational Rehabilitation & Return Parallel Session 5.2.1 – Prosthetics & Orthotics and Physical Parallel Session 5.2.2 – Prosthetics & Orthotics and to Work (1), May 26, 2017, 11:00 AM - 12:15 PM, Main to Work (1), May 26, 2017, 11:00 AM - 12:15 PM, Main Rehabilitation & Exercise, May 26, 2017, 11:00 AM - 12:15 Physical Rehabilitation & Exercise, May 26, 2017, 11:00 AM Conference Hall Conference Hall PM, Room W118 - 12:15 PM, Room W118 Development of a classification People with disabilities and their Scottish Specialist Prosthetics Establishing the cost/ utility of system of services in vocational participation in labour market Service development and outcomes the use of FES for the correction of rehabilitation (LBR) [114] programmes: are there exclusion [146] dropped foot in Multiple Sclerosis mechanisms? [19] (MS) and Stroke [136] Mrs Janett Zander1, Mr Uwe Egner1, Prof.F. Michael Dr Lynne Hutton1, Ms Morag Marks1, Ms Catriona 2 1 2 2 Radoschewski 1 1 1 Mawdsley , Ms Helen Scott , Mr David Morrison , Mr John 1,2,3 1 2,3 1 2 Dr Nancy Reims , Angela Rauch , Ulrich Thomsen Dr Paul Taylor , Dr Tamsyn Street , Prof Ian Swain German Federal Pension Insurance, Berlin, Germany. Charité, Berlin, 1Institute for Employment Research, Nuremberg, Germany. Colvin2 1Department Of Clinical Science And Engineering, Salisbury, UK. Germany. 1NHS Lothian, Edinburgh, UK. 2NHS Greater Glasgow and Clyde, Glasgow, 2Bournemouth University, Bournemouth, UK. 3Odstock Medical Limited, UK. Salisbury, UK. Background: Societal participation of people with disabilities Background and Aim: German Pension Insurance (GPI) is is one central concern of modern welfare states. To achieve a major provider of vocational rehabilitation in Germany. Background: In 2013 the Scottish Government responded Background: FES is an e§ective intervention for dropped foot participation in working life, a system of special active labour In 2010 GPI decided to develop a classification of services to the Murrison report by agreeing to fund the provision of and has a mean usage of 4.9 years. The National Institute market programmes (vocational rehabilitation) targets for vocational rehabilitation (LBR). The goal was to make “state of the art” prosthetic components to veterans and for Health and Clinical Excellence applies a cost-utility people with disabilities. They can either participate in general these services transparent for GPI and rehabilitation centres. civilians in Scotland. ceiling of £20,000 per Quality Adjusted Life Year (QALY) programmes designed for all unemployed people or in Individualisation and flexibility of services can only be for an intervention to be considered. Previously the QALY rehabilitation-specific programmes. documented quantitatively and qualitatively with such a tool. Aim: This presentation will describe how we developed and gain derived from the e§ect of FES on walking speed was now run the Specialist Prosthetics Service (SPS) in Scotland, estimated as 0.041, giving a cost per QALY of £15,406. Aim: Our research focuses on identifying the selection Methods: In a scientific project over 30 months, a with an emphasis on the partnership working required. process into di§erent types of labour market measures and classification of vocational education measures was Whilst the service is delivered from the prosthetic centres Aims: To produce a new estimate of QALY gain using the on highlighting possible influences of social determinants. developed. An analysis of international literature, a survey of in Edinburgh and Glasgow, this requires the partnership of Euroqol EQ-5D-5L. qualifications and expert discussions were the basis of a first the national multidisciplinary team, five prosthetic services, Method: We observed young adults with no or only little draft of the classification. This was adapted via a user survey, government/ National Services Division, commercial Method: 45 people with MS (mean age 53, range 40-70 working experience. The study was based on administrative followed by an intensive trial in vocational rehabilitation companies and patients from across Scotland. years) and 26 with stroke (mean age 59.5, range 44-72 data of the German Federal Employment Agency and centres. After this, LBR was documented in 30 centres for years) who had foot drop completed the EQ-5D-5L before included all persons entering rehabilitation in the years 2010 each participant in an 18-month pilot project. Method: We will describe the development of SPS, including and after using FES for 20 weeks. QALY gain was calculated to 2013. Using multivariate logistic regression, the general the evolution of our eligibility criteria for consideration by multiplying the change in EQ-5D-5L utility score by the probability of participation in labour market programmes was Results: In the pilot project we had 39.533 data records of of provision of microprocessor knees, multi-articulating average FES use time, from the previous long term audit, observed. Using multinomial logistic regression, the selection documented services from 1.077 participants. 61.2% were hands, SMART ankles etc. and our outcomes (qualitative discounted at 3.5% per year. The mean cost of FES provision in the first programme type was examined. men. The largest age group was 40-44 years. 312 (50%) of and quantitative). As we are not working for any specific was divided by the new QALY gain to give the mean cost per 628 LBR-Codes were used, indicating a good result. Most prosthetic company we have had the opportunity to utilise QALY. Results: Analyses show that general participation, as well often codes from the chapters skills diagnostics, assessment, a large variety of prosthetic components, and develop as participation in certain measures is associated with support planning (31%) were applied, followed by services expertise in choosing the most appropriate component to Results: The mean EQ-5D-5L derived utility value pre sociodemographic factors (sex, age, education), by the for soft skills and health competences (both 12%). On meet the individual’s functional needs. intervention (MS 0.542, stroke 0.498) increased after 20 type of disability and by the regional programme provider average 16 di§erent LBR-Codes were used per participant, weeks (MS 0.656, stroke 0.612) providing a utility value of structure. In general, persons between 17 and 20 years, with large di§erences between di§erent education measures Results/Findings: The Service has been providing 0.114 for both conditions (MS p<0.001, Stroke p<0.005). coming from special schools or living in rural areas or and rehabilitation centres, most often: Preparation for the assessment, prosthetic limbs and training in their use for over Extrapolated over 4.9 years the utility gain (QALY) was small cities are more likely to participate in programmes. qualification (n=3.996). three years with a variety of outcome measures collated for 0.542. From the long term audit the mean cost was £3095, Persons with mental disabilities are more likely to enter a each patient. Over 200 patients have been provided with giving a mean cost per QALY of £5,705. sheltered workshop and the number of local providers is Discussion and Conclusion: Internationally, LBR is the first new prostheses and their experience and outcome measures associated with a higher selection to vocational preparation classification system in vocational education centres. The will be presented. Discussion and Conclusion: The new value for QALY gain programmes, to company-external vocational training and to pilot project showed a di§erentiated structure of services in derived using an accepted health economic assessment sheltered workshops. di§erent measures. Additionally we found that rehabilitation Discussion: The challenges of developing a national service indicates that original value significantly underestimated the services in vocational rehabilitation are generally will be discussed, with particular reference to working in benefit of FES to health related quality of life. Conclusion: The results show that the allocation process individualised. partnership with colleagues and patients over a large and is determined by structural and social selection processes · diverse geographical area. The opportunities for the future · suggestive of exclusion mechanisms. will also be discussed. ·

79 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 80 Parallel Session 5.2 Parallel Session 5.2 Parallel Session 5.3

Parallel Session 5.2.3 – Prosthetics & Orthotics and Parallel Session 5.2.4 – Prosthetics & Orthotics and Parallel Session 5.2.5 – Prosthetics & Orthotics and Parallel Session 5.3.1 - Patient Experiences, Partnership Physical Rehabilitation & Exercise, May 26, 2017, 11:00 AM Physical Rehabilitation & Exercise, May 26, 2017, 11:00 AM Physical Rehabilitation & Exercise, May 26, 2017, 11:00 AM Working & Prioritisation (2), May 26, 2017, 11:00 AM - - 12:15 PM, Room W118 - 12:15 PM, Room W118 - 12:15 PM, Room W118 12:15 PM, Room W110 Eects of Lycra sleeves on Dynamic Lycra Orthoses as an Eectiveness of therapeutic riding, Identifying key components of shoulder girdle: A study to inform adjunct to upper limb rehabilitation equine assisted interventions and a biopsychosocial intervention management of glenohumeral after stroke. A qualitative simulated riding on functioning for stroke carers (BISC): carer subluxation in post-stroke study examining feasibility and and disability in persons with perspectives and expert consensus hemiplegia [101] acceptability [145] rehabilitation needs: a systematic [92] review and meta-analyses [230] Dr Praveen Kumar1, Miss Ashni Desai1, Miss Zennor Dillon1, Dr Jacqui Morris1, Dr Alex John1, Mrs Lucy Wedderburn2 Dr Laura Condon1, Dr Penny Benford1, Sheila Birchall1, 1 1 1Glasgow Caledonian University, Glasgow, UK. 2NHS Tayside, Dundee, UK. 3 1 Miss Lottie Elliot , Miss Felicity Hamilton Dr Eeva Aartolahti1, Dr Tuulikki Sjögren1, MSc Aki Rintala1,2, Christine Cobley , Dr Rebecca Fisher , Dr Joanna Fletcher- 1University Of The West Of England, Bristol, UK. 1 4 1 Dr Arja Piirainen1, MSc Ilkka Raatikainen1, Prof Ari Heinonen1 Smith , Mr Chris Greensmith , Dr Eirini Kontou , Dr Niki Background: Upper limb (UL) impairment after stroke 1Unit of Health Sciences, Faculty of Sport and Health Sciences, University Of Sprigg2, Dr Shirley Thomas1, Prof Marion Walker1 Background: Glenohumeral subluxation (GHS) is reported is a major cause of disability. Therapy guided, intensive Jyväskylä, Jyväskylä, Finland. 2KU Leuven, Center for Contextual Psychiatry, 1University Of Nottingham, UK. 2Nottingham City Hospital, UK. 3University in up to 81% of patients with stroke. Our previous feasibility task-orientated practice positively influences recovery, Leuven, Belgium. of Sheeld, UK. 4Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK. study on people with chronic stroke (n=5) reported but adequate therapy resources are not always available. Background: Equine assisted interventions are used in reduction in GHS following wearing of the Lycra sleeve. Dynamic lycra orthoses (DLO) are individually tailored lycra physical, mental, and social rehabilitation. To date, there is no Background: Informal caregivers of stroke survivors are However, the mechanism of the Lycra sleeve in reducing GHS compression garments designed to correct UL position published systematic review of randomised controlled trials at increasing risk of experiencing deterioration in their is unclear. during movement and provide sensory feedback, as (RCTs) aiming to determine the e§ectiveness of therapeutic physical and mental health, due in part to the increased therapists would, and may therefore be an e§ective adjunct riding, equine assisted, and simulated riding interventions on load attributed to caring responsibilities. In turn, this may Aim: The aim of this study, therefore, was to investigate the to practice. However, e§ectiveness has not been established. disabling health conditions. negatively impact upon the wellbeing and rehabilitation of e§ect of the Lycra sleeve on the acromion-greater tuberosity Before testing e§ectiveness, evaluation of perceived the stroke survivor. Current provision does not prioritise the (AGT) distance, muscle activity around the shoulder region feasibility, acceptability and usefulness is necessary. Aim: To determine the e§ectiveness of therapeutic riding, biopsychosocial needs of stroke carers with few existing and scapular position in healthy people prior to testing this equine assisted or simulated riding interventions on intervention studies. on people with stroke. Aim: To examine perceived feasibility, acceptability, and functioning in persons with rehabilitation needs. usefulness of the DLO with stroke survivors receiving Aim: To identify the key components of a biopsychosocial Methods: A non-randomized quasi-experimental design was rehabilitation, to inform design of a future feasibility trial. Methods: Systematic review followed the PRISMA intervention. used. Healthy participants aged over 18 years were recruited guidelines. Search was conducted in MEDLINE, CINAHL, from the university. Time frames for the measurements Methods: EMBASE, PsycINFO, and ERIC to March 2016. All selected Method: 16 stroke carers attended a focus group to discuss were as follows: pre-application of sleeve and immediately • Participants: Stroke survivors (n=17), with persistent UL studies were RCTs including either equine or riding simulator. the psychosocial impact and support needs of becoming an after application of the sleeve. Measurements for the activity limitation, 2-4 weeks after stroke, purposively informal stroke carer. In parallel, 10 UK experts with expertise three variables; AGT distance, muscle activity and scapula sampled for severity of activity limitation. Results: Searches yielded 35 studies with 1288 participants, in stroke psychological research and/or clinical management position were taken with portable diagnostic ultrasound, a • Intervention: Tailor made DLO gauntlet, involving thumb, including hippotherapy, therapeutic horseback riding, other participated in a Nominal Group process to reach consensus tape measure, and electromyography respectively using the wrist and elbow, worn for eight hours per day for eight equine assisted, or simulated riding interventions. Qualitative on priority areas for intervention content. standardised protocols. weeks. synthesis indicated low evidence on body functions, activities • Data Collection: Semi-structured interviews at end of and participation in most patient groups. In addition, there Results/Findings: Thematic analysis of stroke carer Results: Thirty participants with mean age 25±5 years were intervention exploring experiences of wear and perceived was moderate evidence that therapeutic horseback riding perspectives identified 5 emergent themes: 1) Diculty in recruited. There was a statistically significant reduction in benefits. has positive e§ect on hyperactivity and irritability in autism emotional responses; 2) Adjusting to change; 3) Problem AGT distance (p=0.000) post-sleeve which is similar to • Data Analysis: Framework analysis structured the analytic spectrum disorders compared to activity group without solving; 4) Need for practical information; and 5) Peer our previous study on chronic patients with stroke. There process. Constant comparison was used to identify themes a horse. Based on meta-analysis, consisted of 2 studies support. In addition, the Nominal Group process also was also evidence of biceps (p=0.001), triceps (p=0.000), and facilitate interpretation. with 162 participants, there was moderate evidence that identified 5 priority areas: 1) Acknowledging “normal” supraspinatus (p=0.005) and deltoid (p=0.002) activation • Results: Most participants could don the DLO with hippotherapy and therapeutic horse riding did not have e§ect emotions; 2) Education about biopsychosocial e§ects and change in scapula position (p=0.029) following ease and adapted patterns of wear to their needs and on gross motor function (GMFM-66) in children with CP of stroke; 3) Exploring adjustment and loss reactions; 4) application of the Lycra sleeve. perceptions of usefulness. Control of movement, task (mean di§erence (MD) 0.67 points; 95% CI -4.31 to 5.66, Recognising signs and symptoms of not coping; 5) Knowing performance, jerkiness and muscle tightness were p=0.79) compared to control group with aerobic home when and how to access practical and emotional support. Conclusion: Findings from this study suggest possible perceived benefits, as was greater sensory awareness of exercise or usual care. mechanisms behind the usefulness of Lycra sleeves and the limb. However, six more severely a§ected participants Conclusions: Both stakeholder groups identified provide a platform for research on people with stroke. Future discontinued wear due to onset of UL oedema. Discussion and Conclusion: There is a lack of high quality complementary areas of user needs which, along research should investigate the underlying mechanism of the research on the e§ectiveness of therapeutic riding, other with existing literature, have defined key components Lycra sleeve on people with stoke with GHS in the di§erent Discussion: DLO wear appeared feasible, acceptable and equine assisted interventions, and simulated riding on of intervention content for the development of the phases of rehabilitation. perceived benefits were reported for some participants. functioning in persons with rehabilitation needs. Thus, the biopsychosocial treatment manual. The manual is now fully Testing e§ects in survivors with di§erent degrees of severity final answer on the e§ectiveness of horseback riding on developed and is currently being implemented in a feasibility is now required. functioning remains open. randomised controlled trial with stroke carers across the UK

· East Midlands region.

81 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 82 Parallel Session 5.3 Parallel Session 5.3

Parallel Session 5.3.2 - Patient Experiences, Partnership Parallel Session 5.3.3 - Patient Experiences, Partnership Parallel Session 5.3.4 - Patient Experiences, Partnership Parallel Session 5.3.5 - Patient Experiences, Partnership Working & Prioritisation (2), May 26, 2017, 11:00 AM - Working & Prioritisation (2), May 26, 2017, 11:00 AM - Working & Prioritisation (2), May 26, 2017, 11:00 AM - Working & Prioritisation (2), May 26, 2017, 11:00 AM - 12:15 PM, Room W110 12:15 PM, Room W110 12:15 PM, Room W110 12:15 PM, Room W110

Assessing technical di°culties and Focus groups for co-design of soft “It’s like pushing an elephant up Rehabilitation goals in hospice their potential assistive solutions in robotic trousers for improving the stairs”: Understanding cancer palliative care: what matters to toilet use of the elderly and people mobility in everyday living [117] survivorship care and rehabilitation patients with advanced progressive with disabilities [54] needs assessment in shared care disease? [48] Dr Ailie Turton1, Dr Sarah Manns1, Mr Luke Hampshire2, 2 3 contexts [207] Dr Gabor Fazekas1, Mr Tamas Pilissy1,2, Mr Andras Toth1,2, Professor Rory O’Connor , Dr Tim Helps , Prof Jonathan Ms Lucy Fettes1, Ms Helena Talbot-Rice3, Ms Rebecca 3 1 3 4 4 5 Ms Anna Sobjak , Ms Ramona Rosenthal , Ms Theresa Rossiter 1 2 Tiberini , Ms Caroline Quilty , Ms Karen Turner , Ms Moira 1 2 Dr Charlotte Handberg , Professor Sally Thorne , Associate 3 4 4 University of the West of England, Bristol, UK. University of Leeds, Leeds, 6 7 7 Luftenegger , Mr Paul Panek , Mr Peter Mayer UK. 3University of Bristol, Bristol, UK. 1 O’Connell , Ms Julie Bennington , Dr Jason Boland , Ms 1 2 Prof Thomas Maribo National Institute for Medical Rehabilitation, Budapest, Hungary. Budapest 1Department of Public Health, Section for Clinical Social Medicine 1 1 3 Alanah Wilkinson , Dr Irene Higginson , Dr Lynne Turner- University of Technology and Economics, Budapest, Hungary. CS Caritas and Rehabilitation, Faculty of Health, Aarhus University, Denmark and 1,2 1 1,2 4 Socialis GmbH, Vienna, Austria. Institute for Design and Assessment of 2 Stokes , Dr Matthew Maddocks , Dr Stephen Ashford Background: It is estimated that 6.5 million people in DEFACTUM, Aarhus C, Denmark. School of Nursing, University of British 1 2 Technology, Vienna University of Technology, Vienna, Austria. Cicely Saunders Institute, London, UK. Regional Hyper-acute Rehabilitation Great Britain currently have mobility impairments and Columbia, Vancouver, Canada. Unit, London Northwest Healthcare NHS Trust, London, UK. 3St increased prevalence of immobility is predicted. Current Christopher’s Hospice, London, UK. 4St Joseph’s Hospice, London, UK. Background: Despite recent revolutions in diverse areas of assistive equipment for improving mobility is experienced as Background: An increasing body of evidence endorses 5Marie Curie Hospice Hampstead, London, UK. 6Royal Trinity Hospice, London, UK. 7St Andrew’s Hospice, London, UK. rehabilitation and assistive technology, water flush toilets undignified or stigmatising and somewhat constraining. A survivorship care and rehabilitation as beneficial in the remain practically unchanged since their invention. radical change in development of assistive and rehabilitative trajectory of cancer survivorship. To unknown reasons the Introduction: Goal setting is a core part of rehabilitation devices is needed. cancer survivors are often not receiving a needs assessment practice. It can be used to understand what hospice patients Aim: The European iToilet project aims to develop an in relation to their survivorship care and rehabilitation needs want to achieve and direct rehabilitation in a manner that intelligent assistive toilet system that can help elderly and Aim: The purpose of this collaborative study was to capture and are repeatedly being lost in the “gap” between the values patient priorities. disabled people as required. As a first step toward this goal, meaningful information from people living with impaired hospitals and primary care. user requirements were assessed. mobility, to inform ‘yet-to-be-designed’ soft robotic trousers Aim: To determine the timescale and nature of patient for improving mobility in everyday living. Aim: To analyse and describe health professionals’ attitudes identified rehabilitation goals within hospice services, Method: Focus group interviews and questionnaires and perspectives on the complexities of cancer survivorship according to the WHO International Classification of were conducted in Austria and Hungary with primary (41 Methods: and rehabilitation needs assessment in a shared cancer care Functioning, Disability and Health (WHO-ICF). participants with movement disorders), secondary (21 Two focus groups were held in a robotics lab. Participants context. caregivers) and tertiary users (12 healthcare managers). were: people with mobility impairments due to stroke or Methods: Adults with advanced progressive disease Altogether 74 participants gave their opinion on technical age related pathologies; clinical and engineering members Methods: The study was designed as a 5-month attending five UK hospices set goals using Goal Attainment diculties and their potential assistive solutions in toilet use. of the research team and an artist. The topic guide included ethnographic field study in haematology wards and primary Scaling (GAS) with hospice sta§ who had received identifying the advantages and disadvantages of existing care settings. Symbolic Interactionism was the theoretical standardised training. Two independent raters mapped goals Results: Combining the excerpts from the interviews with assistive technology, the acceptability of the idea of framework and Interpretive Description the methodology. onto 1 or more WHO-ICF codes. WHO-ICF codes were the ratings in the questionnaires, an intelligent assistive wearable soft robotic trousers and what was needed from The participants were 41 healthcare professionals and data ranked by frequency counts. toilet must have the following out of 35 problems/features, the materials. A researcher facilitated the discussion, with consisted of participant observations and semi-structured in order of priority: 1) handrails on both sides that can be engineers explaining the possibilities of the technologies focus group interviews. Results: 102 patients (mean (SD) age 67 (15) years, 67 removed/folded if needed (especially for wheelchair users), they could be developing. An artist provided a silent ‘running (66%) cancer, 62 (61%) outpatients) took part and set 2) height and tilt adjusting mechanism to help sitting down commentary’ and a summary to check that views had been Findings: The analysis revealed how the health professionals 173 individual goals (median (range) per patient 2 (1-4)) and standing up, 3) fixed toilet paper holder on both sides captured. at hospitals and in primary care represented two di§erent that mapped onto 266 WHO-ICF codes, spanning 13 of 30 and 4) emergency detection and call. Besides, 4) simplicity perspectives on cancer survivorship and rehabilitation needs possible WHO-ICF domains. Goals had a median (range) (straightforward operation) and 5) custom settings (e.g. Findings: Participants liked the idea of assistive trousers but assessment. Although both hospital and primary care health timescale of 28 (3-84) days and most frequently related height) with user identification were also categorised as very had many and varied requirements for them. In addition to professionals were motivated to serve the patients’ best to mobility (WHO-ICF code d4, n=79), mental functions important features. 13 problems/features were classified as improving mobility, the trousers will be required to look and interests, their perceptions of what was of importance for the (b1, n=40), general tasks and demands (d2, n=37), medium priority requirements. feel normal, be easy to put on and o§ and to look after, as patients was inadvertently complicated and compromised community, social and civic life (d9, n=33), functions of well as being safe, reliable and adaptable. by di§erences of opinions and attitudes creating barriers to a the cardiovascular and respiratory system (b4, n=20), and Conclusion: Target user needs need to be matched by an seamless link between the two sectors. self-care (d5, n=18). Thirty-eight goals (22%) had a primary intelligent assistive toilet: as much physical and tailored Discussion and Conclusion: The findings of this study are focus on impairment, whilst 94 (54%) and 41 (24%) assistance as possible, to all kinds of movements and being used by engineers to more directly address the needs Discussion and Conclusion: focused on activity and participation respectively. postures during toileting, needs to be provided. Secondary of potential users, using various new technologies. Knowing that survivorship care is beneficial for patients’ and tertiary users looked at toilet use scenarios also from · functioning emphasises the importance in securing Conclusions: Patients receiving palliative care, through care control, safety and product lifetime perspectives, systematic needs assessment. The culture among the hospice services, are able to engage in setting functional nevertheless their user requirements conformed to the user health professionals in both contexts seemed to narrow the goals that can be mapped onto the WHO-ICF in a manner requirements expressed by the primary users. discourses to resist that wider patient-centred perspective. consistent with other rehabilitation areas. ·

83 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 84 Parallel Session 6.1 Parallel Session 6.1

Friday 26 May 2017 12.15 PM-1:45 PM Parallel Session 6.1.1 - Vocational Rehabilitation & Return Parallel Session 6.1.2 - Vocational Rehabilitation & Return Parallel Session 6.1.3 - Vocational Rehabilitation & Return Main Conference Hall to Work (2), May 26, 2017, 2:35 PM - 3:35 PM, Main to Work (2), May 26, 2017, 2:35 PM - 3:35 PM, Main to Work (2), May 26, 2017, 2:35 PM - 3:35 PM, Main Conference Hall Conference Hall Conference Hall European Forum for Research in Rehabilitation (EFRR) Annual To tell or not to tell? Factors Diagnostic accuracy of a screening Job Matching: an interdisciplinary General Meeting associated with the (non-)disclosure predicting long term return to work scoping study with Implications of a chronic disease at work [128] (RTW) problems in patients with for Vocational Rehabilitation neurological diseases [31] Counselling [81] Friday 26 May 2017 12.15 PM-1:45 PM, The Saltire Ms Jana Felicitas Bauer1, Prof. Dr. Mathilde Niehaus1, Ms 2 2 Laura Jakob , Ms Raija Stump 1 2 2 1,2, 3 1 Mr Uwe Egner , Mrs Dolores Claros-Salinas , Dr Marco M.sc. Marina Nützi1, , Dr. Bruno Trezzini Lorenzo Medici , University Of Cologne, Chair Of Labour And Vocational Rehabilitation, 1 1,2 Lunch, Exhibition Cologne, Germany. 2University of Cologne, Cologne, Germany. Streibelt Dr. Urban Schwegler 1German Federal Pension Insurance, Berlin, Germany. 2Schmieder Clinics, 1Swiss Paraplegic Research, Nottwil, Switzerland. 2Department of Health and Poster Viewing Konstanz, Germany. Sciences and Health Policy, University of Lucerne, Switzerland. 3VIA MEDICI, Background: Most employees with a chronic disease are at Berufs- und Laufbahnberatung, Wetzikon, Switzerland. some point in their working life confronted with the complex Objectives: A screening instrument (SIMBO) was developed Friday 26 May 2017 Plenary Session, Main Conference Hall decision of whether to communicate their condition at work. to observe the future non return to work (RTW) risk in the Background: Matching a person’s capabilities and 1:45 PM – 2.30 PM, Main Conference Hall As (non-)disclosure can lead to a variety of consequences setting of rehabilitation. In further studies predicting short characteristics with the demands and characteristics of that can either foster or counteract work disability; the term RTW problems, an appropriate threshold of 27 points their job is crucial for sustainable employment of persons Vocational Rehabilitation and Return considerations are dicult. Despite the high relevance of this was validated for patients with musculoskeletal, mental, with disabilities. Job matching (JM) has been studied decision in terms of work disability, little is known about the internal and neurological diseases. in di§erent research fields, particularly in industrial and to Work decision process resulting in (non-)disclosure or the factors organizational psychology (IOP) and vocational psychology associated with it. Aim: To analyse whether the SIMBO can predict long term (VP), and to a lesser extent also in the return to work (RTW) Dr. Sven-Uno Marnetoft Associate Professor, Rehabilitation Science, Department of Health Sciences, RTW problems in patients with neurological diseases. context, including the field of vocational rehabilitation (VR) Mid Sweden University, Östersund, Sweden, and Director, Caseman Aim: Therefore the aim of the present study is to explore counselling. However, no comprehensive overviews exist that Rehabilitation Ltd. , Östersund, Sweden the decision process of employees with a chronic disease Methods: Patients completed the SIMBO on admission map the scientific knowledge on JM across these research · and their satisfaction with (non-)disclosure. Furthermore and were followed 18 to 24 months (mean 21 months). The fields. personal and work related factors associated with (non-) primary outcome was failed stable RTW (not employed or disclosure are identified. employed with at least 3 months’ sick leave in the follow Aim: To review and contrast conceptual and empirical up). AUC were calculated to test the predictive quality of the knowledge on JM from IOP, VP, and RTW research as Method: N =274 employees with a chronic disease (physical SIMBO score. The preliminary cut-o§ of 27 points was used well as to discuss and derive potential implications for VR or mental) were surveyed via an online questionnaire. They to test sensitivity, specificity as well as positive and negative counselling. were invited to participate in the study via rehabilitation likelihood. clinics, workers‘ councils, self-help newsgroups, medical Method: A scoping review across eight electronic databases practices etc. Results: Of 535 eligible patients, 415 responded in the from psychology, economics, and medicine was conducted, follow-up (78%, age 49.0±8.9, female 57%, cerebrovascular covering studies in English and German published between Findings: 89% of the respondents had already disclosed their diseases 25%, multiple sclerosis 34%, other 41%). 46% 1945 and 2015. condition at work. The satisfaction with the decision was reported failed stable RTW. The AUC was 0.79 (CI95 0.75 independent of the chosen alternative (disclosure or non- to 0.83). Using the recommended cut-o§, sensitivity and Results: A total of 312 studies were analysed. IOP and VP disclosure). Anticipated positive and negative consequences specificity rates were 75% (CI95 69% to 81%) and 68% studies (n=281) predominantly investigated the e§ects of of (non-)disclosure varied a lot between respondents. Both (CI95 61% to 73%), respectively. This resulted in a positive JM on work-related outcomes such as job satisfaction, job disclosure and satisfaction with the decision to disclose were and negative likelihood of 2.32 (CI95 1.88 to 2.86) and 0.37 tenure, and career development. Studies from RTW and VR significantly associated with a positive team climate at work (CI95 0.28 to 0.48). counselling research (n=31) focused on the development and an inclusive organisational culture. of JM tools for persons with disabilities. Limited cross- Conclusion: The study confirms the diagnostic accuracy fertilisation between IOP and VP and the RTW context Discussion and Conclusion: As we have to assume that non- of the SIMBO predicting long term RTW problems after became evident. disclosed employees are underrepresented in our sample, rehabilitation. This underlines that the SIMBO provides core our conclusions have to be cautious. The findings indicate information regarding an e§ective rehabilitation process. Discussion and Conclusion: Unlike in IOP and VP, there that both disclosure and non-disclosure can be individually · is a dearth of JM research in the RTW context. Integrating good alternatives for a§ected persons. Team climate and the broad organisational and occupational JM knowledge organisational culture appear to be important parameters. from IOP and VP with the biopsychosocially-oriented RTW · context could provide a sound basis for developing JM applications in VR counselling that promote sustainable employment for persons with disabilities.

85 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 86 Parallel Session 6.1 Parallel Session 6.2

Parallel Session 6.1.4 - Vocational Rehabilitation & Return Parallel Session 6.2.1 – Spasticity Parallel Session 6.2.2 - Spasticity Parallel Session 6.2.3 and 6.2.4 to Work (2), May 26, 2017, 2:35 PM - 3:35 PM, Main May 26, 2017, 2:35 PM - 3:05 PM, Room W118 May 26, 2017, 2:35 PM - 3:05 PM, Room W118 May 26, 2017, 2:35 PM - 3:35 PM, Room W118 Conference Hall How should improvement in leg Prospective, single-arm, Statistical process control in ICF-Oriented questionnaires function be measured in people with dose-titration study of rehabilitation: our contributions measuring work-related functioning spasticity? Development of the Leg Incobotulinumtoxina (Xeomin; Up [196][Methodology session] – results of a systematic literature Activity measure (LegA) [17] To 800U) for the treatment of upper review [121] and lower limb spasticity [198] Prof Gaj Vidmar1,2,3, Prof Helena Burger1,2, Mrs Neža Majdič1 1 1 1University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia. Dr Stephen Ashford , Prof Lynne Turner-Stokes , Ms Heather 2 3 1 1 1 2 3 University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia. University Mrs Annika Sternberg , Mr Matthias Bethge Williams , Dr Ajoy Nair , Ms Samantha Orridge 1 2 of Primorska, Faculty of Mathematics, Natural Sciences and Information 1 1 Dr Jörg Wissel , Dr Djamel Bensmailb , Dr Astrid Universität zu Lübeck, Lübeck, Germany. King’s College London & London Northwest Heath Care Nhs Trust, London, Technologies, Koper, Slovenia. UK. 2Alderbourne Rehabilitation Unit, Hillingdon Hospital, London, UK. Scheschonka3, Dr Birgit Flatau-Baqué3, Dr Olivier Simon3, Dr 3Kings College Hospital, London, UK. 4 Background: The assessment of work-related functioning is David Simpson Background: Statistical process control (SPC) and statistical an important tool to define needs in the context of vocational 1Vivantes Hospital Spandau, Berlin, Germany. 2Raymond-Poincaré Background: There was no comprehensive instrument to Hospital, Garches, France. 3Merz Pharmaceuticals GmbH, Frankfurt am quality control (SQC) have gained wide popularity and high rehabilitation. The “Work Activity and Participation 4 measure function in the context of the spastic lower limb Main, Germany. Mount Sinai Medical Center, New York, United States of appreciation in health care during the last 15 years. However, Outcomes Framework“ (AlHeresh and Keysor, 2015) is an America. identified in our systematic review. Function in the leg may they have hardly found any application in rehabilitation: apart ICF-oriented model to describe work related outcomes using from our own work, the only published scientific article on range from passive caring for the limb in severely disabled Background: Botulinum toxin treatment for disabling upper the concepts work activity limitations and work participation this topic is from 2017. We have been introducing SPC and patients, to using the limb for active mobility in more able and/or lower-limb spasticity may require doses exceeding restrictions. SQC at our Institute over the recent years in various forms for patients following acquired brain injury. those currently approved. practical and research purposes. Aim: To identify ICF-oriented questionnaires measuring Aim: Development of a measure of lower limb function in the Aim: TOWER, a prospective, multicentre, dose-titration work-related functioning and to describe the results in Aim: Here we focus on three of our completed projects: context of acquired brain injury and resulting spasticity. study, investigated the safety and ecacy of increasing relation to the concepts work activity limitations and work • Auditing of eciency and e§ectiveness of rehabilitation by incobotulinumtoxinA (Xeomin) doses (400U up to 800U) participation restrictions. means of assessment using the Functional Independence Method: We developed a new questionnaire, the Leg for spasticity. Activity measure (LegA), with content drawn from identified Measure at admission and discharge from inpatient Method: Web of Science and Pubmed databases were existing measures and analysis of our database of patient rehabilitation searched for English or German studies published between Methods: Eligible patients (18–80 years) had upper and identified goals. The measurement properties of the tool • Evaluation of a falls prevention programme for stroke 2001 and 2015. The study population was working age. lower limb spasticity of the same body side (cerebral causes) were examined in a multicentre observational cohort study, rehabilitation inpatients Included questionnaires measured work-related functioning and were clinically deemed to require total doses of 800U conducted at three sites. • Monitoring of falls across all our hospital wards. as defined by the “Work Activity and Participation incobotulinumtoxinA. Treatment comprised 3 consecutive Outcomes Framework” and were useable for patients with injection cycles (ICs) with 400U, 600U, and 600–800U Results: 64 people participated; mean age 50 years, ranging Methods and Results: We will show that basic statistical musculoskeletal disorders. The instruments were described incobotulinumtoxinA, respectively, each followed by 12–16 18-84 years; half (n=32) were men. Expected convergent methodology – appropriate summary statistics and and categorized into three groups: (1) instruments referring weeks’ observation. Outcomes included adverse events and divergent relationships were seen, Rivermead Mobility exploratory graphical displays combined with regression to work activity limitations, (2) instruments focussing (AEs), antibody testing and resistance to passive movement Index (rho -0.87) and Goal Attainment Scaling (rho -0.16). modelling and control charts – can yield important on work participation restrictions and (3) instruments scale (REPAS; based on Ashworth Scale [AS] assessments). Principal components analysis (PCA) confirmed that ‘active practical insight and provide valuable decision-support in considering both. rehabilitation practice. We also briefly report on our research function’, ‘passive function’ and ‘impact on life’ formed Results: One-hundred fifty-five patients enrolled. separate constructs corresponding to each sub-scale. project on multivariate SPC for mixed-type data (i.e., a mix Results: 16 questionnaires met the inclusion criteria. Four IncobotulinumtoxinA dose escalation did not lead to Cronbach’s alpha was 0.86, 0.97 and 0.87 respectively for of qualitative, ordinal and numeric characteristics) with instruments were classified into group (1), seven instruments increased incidences of AEs (IC1: 36.1%; IC2: 37.5%; IC3: the ‘active function’, ‘passive function’ and ‘impact on life’ application to lower-limb prosthetics. into group (2) and five instruments into group (3). Most 25.7%) or treatment-related AEs (TRAEs; IC1: 4.5%; IC2: sub-scales. Item level test-retest agreement ranged from questionnaires focussing on work participation restrictions 5.3%; IC3: 2.9%). Most common AEs were falls (7.7%), 91-97% (weighted Kappa 0.75-0.95). Following treatment used the concepts presentism and absenteeism. arthralgia and diarrhoea (each 6.5%). AE discontinuations for spasticity (physical interventions and botulinum toxin; were low (3.2%). No serious TRAE occurred. No secondary n=64), the LegA ‘passive function’ and ‘impact on life’ sub- Discussion and conclusion: Translated versions of the non-response due to neutralising antibodies. AS responses scales identified significant di§erence. questionnaires are needed to achieve a common language (≥1 point improvement) were seen in 364/608 (59.9%) of work functioning. The results are limited to instruments patterns treated in IC1 (155 patients), 431/743 (58.0%) Discussion and Conclusions: The LegA was reliable in measuring work-related functioning as defined by the “Work patterns in IC2 (152 patients) and 537/811 (66.2%) consistently recording results at di§erent levels of ability. Activity and Participation Outcome Framework”. patterns in IC3 (140 patients). Mean (standard deviation) The LegA could be used to identify functional improvements improvements in REPAS score from each injection to 4 weeks when these occurred as a result of treatment for spasticity. Reference: AlHeresh RA, Keysor JJ (2015). The Work post-injection increased from 4.6 (3.9) in IC1 to 5.9 (4.2) in · Activity and Participation Outcomes Framework: a new look IC2 and 7.1 (4.8) in IC3 (p<0.0001 for all). at work disability outcomes through the lens of the ICF. Int J Rehabil Res 38, 107-12. Conclusion: Higher than currently approved incobotulinumtoxinA doses (400U up to 800U) enabled a more comprehensive treatment approach for patients with spasticity without compromising safety or tolerability.

87 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 88 Parallel Session 6.3 Parallel Session 6.3

Parallel Session 6.3.1 - Family / Carer / Peer Involvement, Parallel Session 6.3.2 - Family / Carer / Peer Involvement, Parallel Session 6.3.3 - Family / Carer / Peer Involvement, Parallel Session 6.3.4 - Family / Carer / Peer Involvement, 2.35 PM – 3.35 PM, Room W110 2.35 PM – 3.35 PM, Room W110 2.35 PM – 3.35 PM, Room W110 2.35 PM – 3.35 PM, Room W110 Rehabilitation task shifting - Results Identifying young carers of stroke Managing visitors during the The influence of the social network from the ATTEND Trial [82] survivors in the East Midlands; hospital stay: The experience of on physical activity three months phase one a prospective survey [34] family caregivers of patients with after rehabilitation of women with Prof Marion Walker7, Prof Richard LIndley1, Prof Craig 1 1 1 TBI [6] breast cancer or musculoskeletal Anderson , Dr Laurent Billot , Dr Maree Hackett , Dr Stephen Mrs Trudi M Cameron1, Dr Rebecca Fisher1, Professor Jo 1 1 1 3 2 1 diseases [35] Jan , Dr Li Qiang , Dr Liu Heuiming , Prof Anne Forster , Prof Aldridge , Prof Marion Walker 1 2 4 2 6 1 2 Dr Tolu Oyesanya , Dr Barbara Bowers Peter Langhorne , Prof Lisa Harvey , Prof Pallab Maulik , Prof University Of Nottingham, Nottingham, UK. Loughborough University, 1 2 Shepherd Center, Atlanta, United States, University of Wisconsin-Madison, 1 1 5 8 Loughborough, UK. Madison, United States. Prof Wilfried Mau , Dr Juliane Lamprecht Gudlavelleti Murthy , Prof Jeyaraj Pandian 1 1The George Institute for Global Health, Sydney, Australia. 2UNiversity of Institute of Rehabilitation Medicine, Martin-Luther-University Halle- 3 4 Wittenberg, Halle, Germany. Sydney, Sydney, Australia. University of Leeds, Leeds, UK. University of Background: Little is known about young carers (<25 years) Glasgow, Glasgow, Scotland, UK. 5Indian Institute of Public Health, India. Background: Family caregivers of patients with moderate- 6 7 who provide support for stroke surviving family members. George Institute for Global Health, India. University of Nottingham, to-severe traumatic brain injury (TBI) regularly visit the Background: The social network plays an important role Nottingham, England, UK. 8Christian Medical College Ludhiana, Ludhiana. Caring can be a positive experience, however some young patient during the hospital stay and are involved in their during and after medical rehabilitation. Even though a carers experience detriment to their health, well-being, social care. As impairments caused by the TBI often preclude the deeper understanding of the structure, quantity and quality Background: Rehabilitation for stroke survivors in India is engagement, educational attainment, and employment patient from stating preferences for visitors, family caregivers of patients’ social relationships can be valuable during a limited. Task-shifting of rehabilitation practices from health opportunities. Significant numbers of young carers do not often make decisions about visitors during the hospital stay. whole rehabilitation process, these aspects have not yet been care workers to family members may be a successful disclose their caring role, are not recognised as carers, and do However, limited literature investigates this process. investigated in depth. alternative. The e§ectiveness of training family members to not receive the statutory assessments and support to which provide home-based stroke rehabilitation is uncertain. they are entitled. As part of a programme of work numbers Aim: The purpose of this study was to describe family Aim: To explore the social network in employed women with of young people caring for stroke survivors, tasks and time caregivers’ experience of visitors while the patient with a musculoskeletal disease (MSD) compared to women with Methods: We randomly assigned 1,250 patients with taken is explored. moderate-to-severe TBI is hospitalised. breast cancer (BC) at the outset of inpatient rehabilitation acute stroke (and their carers) to structured family-led (T1) and to analyse the influence of di§erent relationship rehabilitation training or usual care across 14 hospital stroke Aim: To explore the lives of young carers of stroke survivors Methods: Authors used grounded theory to conduct 24 characteristics on the physical activity (PA) three months units in India. The primary objective was to determine interviews with 16 family caregivers. after rehabilitation (T2). whether family-led rehabilitation, initiated in hospital and Methods: Mixed method exploratory sequential design; continued at home, would be superior to usual care. The clinicians were asked to deliver questionnaires to all patients Results/Findings: Findings showed family caregivers Method: 75 BC patients and 134 women with MSD primary outcome was death or dependency, defined by referred to stroke specific domiciliary care teams in the East manage welcome and unwelcome visitors throughout the participated in a multi-centre follow-up study. The social scores 3 to 6 on the modified Rankin Scale (range, 0 [no Midlands of the UK. hospital stay to protect the patient’s physical and emotional network was recorded with an ego-centred network symptoms] to 6 [death]) as assessed by blinded observers safety and to conserve their own energy. The approach to generator [Lamprecht et al. 2016] at T1. For the prediction at six months. Secondary outcomes included hospital length Findings: Of the 75 responses, 12 stroke survivors received managing welcome visitors was managing welcome visitors of PA (kcal/week) [Frey et al. 1999] at T2, the di§erent of stay, measures of self-care and extended activities of daily support from n=24 family members aged <25 years; range alone. Approaches to managing unwelcome visitors included: relationship characteristics were included in a multiple living, health-related quality of life, mood, and carer strain at 9-24 years; mean 16.5 years. There were four primary 1) managing unwelcome alone, 2) managing unwelcome regression analysis controlling for education, age, disease 3 and 6 months. practical and emotional carers. Three provided more than visitors with others, and 3) managing unwelcome visitors group, and level of PA at T1. 20 hours a week of practical and emotional support. Stroke by collaborating with sta§. Family caregivers reported the Results: At six months, 285 of 607 (47.0%) patients who survivors reported more emotional and psychological perception that sta§ had limited involvement in management Results: Compared to women with MSD women with BC are received family-led rehabilitation were dead or dependent support needs than practical and physical support needs. of unwelcome visitors. more likely to name female family members as emotionally compared to 287 of 605 (47.4%) who received usual care significant and report a larger social network. More available (odds ratio 0.98; 95% confidence Interval 0.78 to 1.23, P = Discussion and Conclusion: Some young people provide Discussion and Conclusion: These findings have practice male family members (p=0.03) as well as high contact 0.87). There was no di§erence in length of hospital stay (9.3 substantial emotional and practical support for stroke implications for educating hospital sta§ about assisting frequency (p=0.02) predict PA at T2. Both groups increased versus 9.5 days, P = 0.58), nor any significant di§erence in survivors. Emotional support needs can be significantly families to manage unwelcome visitors and policy their PA at T2 but the MSD were more physically active in any of the other outcomes at 3 and 6 months. associated with poorer outcomes for carers. Specific needs implications for improving hospital visiting policies. general than the BC (p=0.005). of young carers, and impact of caring require more in Conclusions: Task-shifting of stroke rehabilitation to family depth exploration to provide a foundation for intervention Discussion and conclusions: The results underline the members compared to usual care in India did not improve developments to enhance life chances for young carers. importance of the family network for maintaining PA outcome after stroke unit admission. · after medical rehabilitation. This should be addressed in · rehabilitation programs.

89 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 90 Parallel Session 7.1 Parallel Session 7.1 Parallel Session 7.2

Friday 26 May 2017 3:35 PM- 4:15 PM, The Saltire Parallel Session 7.1.2 - Vocational Rehabilitation & Return Parallel Session 7.1.3 - Vocational Rehabilitation & Return Parallel session 7.2.1 - Special Topics to Work (3), May 26, 2017, 4:15 PM - 5:00 PM, Main to Work (3), May 26, 2017, 4:15 PM - 5:00 PM, Main May 26, 2017, 4:15 PM - 5:00 PM, Room W118 Afternoon Tea, Exhibition Conference Hall Conference Hall and Poster Viewing Medical rehabilitation as an Mechanisms to promote job Development, implementation and attractive field of work for Medical · retention in work-related benefits of using an ICF Core Set for Doctors? - A qualitative survey [123] Parallel Session 7.1.1 - Vocational Rehabilitation & Return rehabilitation. A Qualitative Vocational Rehabilitation [200] to Work (3), May 26, 2017, 4:15 PM - 5:00 PM, Main Comparative Analysis (QCA) case Prof Eva Maria Bitzer1, Mareike Lederle1, Dr. Christiane Conference Hall Mrs Valentina Brecelj1, Prof Gaj Vidmar1 Niehues2, Dr. Silke Brüggemann2 study [22] 1University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia. 1University of Education, Freiburg, Germany. 2German Statutory Pension Insurance Scheme, Berlin, Germany. 1 1 Exit from Work and Return to Work. Dr Pirjo Juvonen-Posti , Mrs Sanna Pesonen , Prof Riitta Background: We have been using the ICF in vocational 2 3 4 A ‘Negotiation-Arena’ of Coping Seppänen-Järvelä , Mr Matti Tuusa , Mr Vesa Syrjä , Mr rehabilitation (VR) in Slovenia since 2006, but only the Background: In the German Health system there is an 3 1 with a Vulnerable Health and Job Mikko Henriksson , Dr Minna Savinainen coding of body functions is required. For comprehensive increasing competition in the recruitment of specialised sta§, 1Finnish Institute Of Occupational Health, Helsinki, Finland. 2Finnish Social especially for rehabilitation centres, which are deemed less Condition [107] Insurance Institute, Helsinki, Finland. 3Rehabilitation Foundation , Finland, assessment of the individual’s functioning, specific categories 4National Institute of Welfare and Health, Finland. from all ICF domains should be included to support the attractive. Ms Susanne Bartel1 VR process, but the entire ICF is too time-consuming for 1Federal Association Of Vocational Rehabilitation Centres, Germany, Berlin, Background: A new vocational rehabilitation concept, aimed everyday use. Aim: This study examines the attractiveness of the field Germany. at close collaboration with employers, employees, and actors of medical rehabilitation from the point of view of medical from occupational health and rehabilitation, was conducted Methods: The study included 108 users, mainly persons professionals. Background: Individuals who are su§ering from a chronic in the years 2012-2014. with severe and total health impairments. First, a systematic disease and who have to regain participation in working life literature review was conducted. Next, we checked the Methods: We conducted 16 semi-structured interviews are facing a two-folded challenge. Not only do they have Aim: The aims of this study were to discover mechanisms appropriateness of the existing WHO Core Set for VR with doctors from seven rehabilitation centres with di§erent to cope with their illness but also they have to deal with a which promoted job retention, and to study how a mixed and decided which ICF categories (90 of them) are to be medical specialisations. The interviews were digitised and vulnerable occupational situation. In general, there is a great methods approach along with the Qualitative Comparative included in the Core Set through a multi-stage decision- transcribed. A structured content analysis was carried out need for research to understand the complex conditions Analysis (QCA) can be used in the case study evaluation. making and consensus process. In the second phase using the software MAXQDA 11. of health-related exit and reorientation processes in one’s we tested and validated the VR Core Set draft. Pearson professional life and to get an insight into the biographical Method: The concept was evaluated by using multiple- correlation and intraclass correlation were used to quantify Results: 745 codes were identified and assigned to the impacts of such a health-related disruption. constituency and mixed methods approaches. In the case the agreement of the qualifiers with the disability level categories “attractiveness”, “less interesting aspects” and study the data consisted of interviews of 11 rehabilitees and classification. “special features” of rehabilitation. Regarding medical Aim: This study examined how the process of a forced career the stakeholders of their rehabilitation processes. The data rehabilitation, the interviewees appreciated especially the change is being experienced and shaped. It explored which also included rehabilitation documents and rehabilitees’ Results: The result is the ICF Core Set for VR with domains predictable, flexible working environment with little time and how multifarious dimensions influence that process of survey questionnaires gathered before and after the that are the most relevant for the VR process. It could be pressure. Other than working with rehabilitative patients, career change and strategies of reorientation as well as forms intervention. First the data were constructed to multiple- useful for individual planning, goal setting and monitoring of working as part of an interdisciplinary team was of high of participation. constituency case descriptions. In the second phase the the improvements in the users’ functioning, thus improving importance for the interviewees. Among the special features across-case analysis along the QCA was conducted. employability of the users and their (re)employment. of rehabilitation in comparison with acute care were the Methods: This work follows the methodological approach The users’ problems were rated as the most severe in the higher relevance of the bio-psycho-social model of health and research style of the Grounded Theory. 11 patients Results: Along the factors promoting or inhibiting Activities and Participation component (average qualifier and illness as well as the higher proportion of communication su§ering from a chronic disease resulting in a disruption of rehabilitation processes and work career impacts, we above 1). and organisation. their professional life were interviewed twice over a course of discovered the interwoven and dynamic mechanisms in the two years to depict the processual character of reorientation. process. We realised that the outcomes emerge through Conclusion: The developed Core Set can be used together Conclusion: Medical rehabilitation in Germany is an contextual mechanisms, just as realistic evaluation theory with other existing instruments as a tool for guiding the VR attractive field of work for medical doctors. This fact should Results: As a result of this study, a ‘negotiation-arena’ depicts it. The outcomes and impacts of rehabilitation process. This would allow a comprehensive assessment be considered more with regards to rehabilitation’s public model of coping with a vulnerable health and job condition were due to interaction between the intervention and other of the user’s level of functioning and provide the basis for image. was developed. It depicts di§erent reference points and components and subsystems of the complex system. specific goal setting for each individual VR user. · framework conditions showing how the persons a§ected try · to balance their health issues with the job demands. Discussion and Conclusion: Mixed methods along with the QCA made it possible to discover mechanisms and Discussion: Coping with a vulnerable health and job pathways for job retention with di§erent promoting or condition is a complex challenge. This process is particularly preventing factors in rehabilitation. For better understanding distinct during medical rehabilitation and continues after of the outcomes of social interventions such as work-related returning to work. How these results could be implemented rehabilitation in the complex system it is essential to find out in rehabilitation and return to work concepts is to be the obstacles and promoting factors of the processes. discussed. ·

91 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 92 Parallel Session 7.2 Parallel Session 7.3

Parallel session 7.2.2 - Special Topics Parallel session 7.2.3 - Special Topics Parallel Session 7.3.1 - Communication & Swallowing Parallel Session 7.3.2 - Communication & Swallowing May 26, 2017, 4:15 PM - 5:00 PM, Room W118 May 26, 2017, 4:15 PM - 5:00 PM, Room W118 Rehabilitation, May 26, 2017, 4:15 PM - 5:00 PM, Rehabilitation, May 26, 2017, 4:15 PM - 5:00 PM, Room W110 Room W110 Mortality associated with Implementing research into practice: multimorbidity in patients with The German Model Of Work-Related Deafness and ageing in Germany Interventions for dysarthria due to stroke: A study of 8751 UK Biobank Medical Rehabilitation [206] [134] stroke and other adult-acquired, non-progressive brain injury a participants [225] [Methodology session] 1 1 1 Prof Matthias Bethge1 Prof Thomas Kaul , Anne Gelhardt , Nele Büchler , Frank 1 1 Cochrane systematic review [155] 1 1 University Of Lübeck, Lübeck, Germany. Menzel Dr Katie Gallacher , Dr Ross McQueenie , Dr Barbara 1University Of Cologne, Köln (Cologne), Germany. Nicholl1, Dr Bhautesh Jani1, Dr Duncan Lee1, Prof Frances Mrs Claire Mitchell1,2, Prof Audrey Bowen1, Prof Sarah Tyson1, 1 Background: German work-related medical rehabilitation 1 Mair Background: Deaf population is a minority group with a Dr Paul Conroy 1University Of Glasgow, Glasgow, UK. (WMR) was developed to support work participation in 1University Of Manchester, Manchester, UK. 2Manchester Royal Infirmary, patients with musculoskeletal disorders and poor work unique language (i.e. sign language) and cultural tradition. Manchester, UK. In Germany, there are about 80.000 Deaf people. Since 10 Background: 94% of those who have su§ered a stroke are ability. Randomised controlled trials have shown that WMR years we have researched the situation of the elderly Deaf. multimorbid. Current stroke rehabilitation guidelines do not programmes increase return-to-work rates compared to Background: Dysarthria is an acquired speech disorder take account of mutimorbidity. Little is known about the conventional medical rehabilitation. Therefore, a guideline following neurological injury that reduces intelligibility of Aims and Methods: We analysed quantitative and influences of multimorbidity on mortality in stroke. was established which describes main components of WMR speech due to weak, imprecise, slow and/or unco-ordinated (social counselling, psychological work-related groups, qualitative data. The main objective was to analyse the life muscle control. The impact of dysarthria goes beyond situation, resources and to explore the quality and quantity of Aim: To ascertain associations between number and type of functional capacity training) to support its implementation. communication and a§ects psychosocial functioning. This o§ers for elderly Deaf people to manage their life: long term conditions and all-cause mortality in stroke. The guideline was disseminated by the German Pension full Cochrane review has been updated with a broader Insurance Agency. • Information, consulting scope1. • Health care Methods: Cohort study: UK Biobank. • Living and housing in old age Participants: 8751 aged 40-73 in UK with stroke or TIA. Aim: Implementation of the guideline was analysed by Aim: To assess the e§ects of interventions to improve • Health care with dementia. Self reported data: morbidities; sex; age; socio-economic assessing the dose delivered in rehabilitation centres which dysarthric speech following stroke and other non-progressive status (Townsend score); alcohol intake (never/ special were approved to provide WMR programmes. adult-acquired brain injury such as trauma, infection, tumour Results: occasions only, one-three times a month, at least once a and surgery. • The family network of the elderly Deaf is not highly week) and smoking status (never, current/previous). Data Method: Participants of WMR programmes in 2014 were meshed were linked to national mortality registries; mean follow matched with similar patients who received a conventional Methods: We searched the Cochrane Stroke Group Trials • The Deaf community is a positive social network. up 7 years. Cox proportional hazards regression examined medical rehabilitation in 2011 before the guideline was Register, CENTRAL, MEDLINE, Embase, CINAHL, Linguistics • If the mobility decreases, the contact to the Deaf associations between multimorbidity and all-cause mortality published. Patient characteristics and dose delivered were and Language Behavioral Abstracts and PsycINFO. We community decreases, too (adjusted for age, gender, deprivation, smoking status and extracted from administrative records. searched major trials registers, hand-searched the reference • Deaf elderlies are more isolated and not well informed alcohol intake). lists of relevant articles and sought other published, Results: Data of 9,046 patients from 59 rehabilitation regarding statutory benefits and subsidies. unpublished or ongoing trials, May 2016. • They experienced barriers to get necessary information. Results: Mean age 60.9 years (SD 6.7). Mortality rate centres were included. In 2014, the dose of work-related • Specific information in sign language is not available over seven years was 8.4% (734 participants). Increasing therapies was 4-times increased (2011: 2.2 h; 2014: 8.9 Results: We included five small randomised controlled trials • Professionals of social and healthcare are not suciently multimorbidity was associated with higher all-cause h). The dose of social counselling increased from 51 min with a total of 234 participants. Two studies were assessed informed about the specific needs of Deaf people mortality, with mortality risk more than double for those with to 84 min, the dose of psychological work-related groups as low risk of bias; none of the included studies were • There are only a few services specifically targeted at Deaf ≥5 morbidities compared to those with none (fully adjusted from 39 min to 216 min, and the dose of functional capacity adequately powered. Our primary analysis of a persisting people. HR; 95% CI: 2.38; 1.69-3.33). The figure shows HR for all- training from 39 min to 233 min. However, there was clear e§ect at the activity level of measurement found no evidence cause mortality in relation to number of co-morbidities (0 heterogeneity in meeting the guideline’s recommendations in favour of dysarthria intervention. There was a statistically Conclusion: It is necessary to set up a network of expertise co-morbidities referent). Presence of the following conditions between centres, especially the recommendation for significant e§ect favouring intervention at the immediate, of di§erent areas such as social work, health care, medicine, alongside stroke/ TIA significantly increased the risk of providing functional capacity training. impairment level of measurement but the data are graded administration and sign language community to support all-cause mortality: cancer (fully adjusted HR; 95% CI: 2.16; very low quality. Deaf elderlies. We set up competence centres for the elderly 1.80-2.60), coronary heart disease (CHD)(1.60; 1.36 -1.88), Discussion and conclusion: Top down dissemination of Deaf, their families and institutions, where they can get diabetes (1.72; 1.45-2.04) or chronic obstructive pulmonary the guideline a§ected rehabilitation practice, and the dose Conclusion: We found no definitive, adequately powered information and consulting. Other goals of the competence disease (COPD) (1.48; 1.13-1.92). of major components of WMR has clearly increased since RCTs of interventions for people with dysarthria. The benefits 2011. However, there is still a discrepancy between schedules centre are to develop further networks and support specific and risks of interventions remain unknown and the emerging o§ers. Discussion and Conclusion: Multimorbidty in stroke has followed in randomised controlled trials and usual care. This evidence justifies higher quality and adequately powered a positive relationship with mortality. Further work will may reduce e§ect sizes. clinical trials into this condition. examine di§erent combinations of conditions and other health-related outcomes. References: 1 Mitchell C, Bowen A, Tyson S, Butterfint Z, · Conroy P. Interventions for dysarthria due to stroke and other adult-acquired, non-progressive brain injury. Cochrane · Database of Systematic Reviews 2017, Issue 1.

93 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 94 Parallel Session 7.3 Poster Presentations

Parallel Session 7.3.3 - Communication & Swallowing Universität zu Berlin, Germany. 34Carnegie Mellon University, USA. 35Azienda 26 - 27 May 2017 Standardisation & Guidelines 26 - 27 May 2017 Standardisation & Guidelines Rehabilitation, May 26, 2017, 4:15 PM - 5:00 PM, Room Ospedaliera Spedali Civili, Brescia, Brescia, Italy. 36Anadolu University Faculty of Health Sciences, Anadolu, Turkey. 37Hospitales NISA, Valencia, Alicante, W110 Spain. 38University of Rehabilitation Sciences, Tehran, Tehran Province, Pilot testing ICF-based Scientific basis of methodology of Iran. 39University of Sheeld, Sheeld, UK. 40University of Lisbon, Lisbon, Portugal. 41University of Zagreb, Zagreb, Croatia. 42Seoul National University Documentation Tools in medical, clinical guidelines development and Rehabilitation and recovery Bundang Hospital, Bundang, South Korea. 43University College London, social, and vocational rehabilitation implementation for physical and of peopLE with Aphasia after London, UK. 44University of Toronto, Toronto, Canada. 45La Trobe University, Melbourne, Australia. 46Groupe Hospitalier Pitié-Salpêtrière, Paris, France. in Estonia [130] [Work in Progress] rehabilitation medicine [68] StrokE (RELEASE): Creating an 47Rehanova Köln, Köln, Germany. 48Radboud University, Nijmegen, 49 50 Netherlands. University of Georgia, USA. Warrington Hospital NHS 1 1 2 1 international, multidisciplinary, Foundation Trust, Warrington, UK. 51University of Alabama, USA. 52University Ms Kairit Püüa , Mr Toomas Urbanik MD, PhD Denis Kovlen , Prof Gennady Ponomarenko 1 1 of Nottingham, UK. 53Rijndam Revalidatiecentrum, Rotterdam, Netherlands. Rehabilitation Competence Center, Astangu Vocational Rehabilitation SPb Scientific Practical Centre of Medical and Social Expertise, Prosthetics [226] 2 individual patient database 54Erasmus University, Rotterdam, Netherlands. 55College of Allied Health Center, Tallinn, Estonia. Tallinn University, Tallinn, Estonia. and Rehabilitation of the Disabled, Saint Petersburg, Russian Federation. 2 [Methodology session] Sciences, N. Carolina, USA. Military medical academy, Saint Petersburg, Russian Federation Background: The number of persons with disabilities Background: There are a large number of clinical guidelines Dr Louise Rebecca Williams1, Ms Kathryn VandenBerg1, Background: Annually an estimated 360,000 Europeans in Estonia shows a steady growth trend. Studies have (CG) for the treatment of various diseases, but only a few of Dr Myzoon Ali1, Mr Andrew Elders1, Prof Jon Godwin2, experience an impairment of language following stroke, identified that rather than being an integrated system, them contain evidence-based information about the use of Dr Stefanie Abel3, Dr Masahiro Abo4, Dr Frank Becker5, known as aphasia. Aphasia impacts on societal participation, Estonia’s rehabilitation services are fragmented across medical physical factors. Dr Audrey Bowen3, Dr Caitlin Brandenburg6, Dr Caterina activities of daily living, emotional wellbeing, and the social, health, and labour market sectors, and the help Breitenstein7, Prof David Copland6, Dr Tamara Cranfill8, returning home and to work. Systematic review evidence provided does not support objectives of independent Aim: The scientific reasoning for methodology for Dr E. Susan Duncan9, Dr Joanne Fillingham10, Dr Federica demonstrated the benefits of speech and language therapy functioning. The three types of rehabilitation services (social, the development, evaluation of clinical ecacy and Galli11, Dr Marialuisa Gandolfi12, Dr Bertrand Glize13, Dr Erin on language recovery. The factors that impact on optimum medical, and vocational) are financed through di§erent implementation of CG on the evidence-based use of medical Godecke14, Dr Katerina Hilari15, Dr Jacqueline Hinckley16, recovery are not yet well understood. Secondary analysis of state agencies and operate under di§erent legislation; physical factors. Dr Simon Horton17, Prof David Howard18, Dr Petra Jaecks19, a large individual patient dataset would provide insights to services overlap significantly, and lack coordination. To Dr Beth Je§eries20, Dr Luis Jesus21, Dr Monika Jungblut22, these factors. address these diculties, a team of rehabilitation and IT Methods: Searching and scientometric analysis of PEDro; Dr Eun Kyoung Kang23, Dr Maria Kambanaros24, Prof Eman experts from Astangu Vocational Rehabilitation Center UpToDate and Cochrane Central Register of Controlled Trials; Khedr25, Dr Tarja Kukkonen26, Prof Matt Lambon Ralph3, Dr Aim: To create a large, international, research-based archive developed an interactive assessment instrument based PubMed; Embase; Web of Science; Database of Abstracts of Marina Laganaro27, Prof Ann-Charlotte Laska28, Prof Sam- of individual patient data (IPD) relating to aphasia after on ICF-based Documentation Tools. Additionally, relevant Reviews of E§ects (DARE); National Guideline Clearinghouse Po Law29, Dr Béatrice Leeman31, Prof Alex Le§30, Dr Roxele stroke for secondary analyses. ICF activity and participation codes were connected with database; Health Technology Assessment Database; Ribeiro Lima32, Dr Antje Lorenz33, Prof Brian MacWhinney34, ISO-9999 (a classification of assistive technology). The AMED and OpenGrey databases for the period from 1976 Dr Flavia Mattioli35, Dr I Mavis36, Dr Marcus Meinzer6, Dr Method: We conducted a systematic literature search interactive assessment instrument enables multidisciplinary to 2016 were performed. The e§ectiveness of various CG Enrique Noé Sebastián37, Dr Reza Nilipour38, Dr Nam-Jong for eligible datasets which included 10 or more people rehabilitation teams to assess an individual’s functioning implementation strategies into practice, as well as the impact Paik42, Dr Rebecca Palmer39, Dr Brigida Patricio21, Dr Isabel with aphasia, their time since stroke and aphasia severity. and need for assistive technology, create a functional of the introduction of CG on the quality of care were studied. Pavão Martins40, Dr Marie di Pietro-Bachmann31, Dr Cathy Databases searched include the Cochrane Stroke Group profile, intervention table, and evaluate the results of the Price43, Dr Tatjana Prizl Jakovac41, Prof Elizabeth Rochon44, Dr Trials, MEDLINE, AMED, CINAHL, Cochrane Library interventions. All data are recorded in a database. Results: CG on the use of medical physical factors for Miranda Rose45, Dr Charlotte Rosso46, Dr Ilona Rubi-Fessen47, Databases (CDSR, DARE, CENTRAL, HTA), LLBA, cardiac, neurological, trauma, pulmonary and arthrologic Dr Marina Ruiter48, Dr Rebecca Shisler Marshall49, Dr EMBASE, and SpeechBITE along with major trials registers. Aim: The specific project aims are to: patients were designed using our methodology. The Claerwen Snell50, Dr Jerzy P Szaflarski51, Dr Shirley Thomas52, Contributions were also invited from studies profiled within 1 Pilot the ICF as a standard language and conceptual basis use of medical physical factors and physical exercises Dr Ineke van der Meulen53, Dr Mieke van de Sandt- the Cochrane review of speech and language therapy for for measurement of functioning, significantly (11-28%, p<0.05) increased the clinical ecacy Koenderman53, Dr Evy Visch-Brink54, Prof Linda Worrall6, Prof aphasia after stroke and the EU-funded Collaboration of 2 Improve rehabilitation management, and of appropriate disease treatment. The most e§ective CG Heather Wright Harris55, Prof Marian Cecilia Brady1 Aphasia Trialists. Data extracted included individual, aphasia 3 Improve data exchange across di§erent rehabilitation 1NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK. and stroke data, and intervention characteristics using services. introduction strategy is the one based on systematic training 2Glasgow Caledonian University, Glasgow, UK. 3University of Manchester, the Template for Intervention Description and Replication of doctors, introducing control methods and informing Manchester, UK. 4The Jikei University School of Medicine, Tokyo, Japan. patients about the evidence-based non-pharmacological 5University of Oslo Sunnaas Rehabilitation Hospital, Oslo, Norway. checklist. The overall goal is to improve client outcomes by developing 6University of Queensland, Australia. 7University of Muenster, Münster, a working interactive tool for rehabilitation teams and a methods of the treatment of their disease. Using of CG leads Germany. 8Eastern Kentucky University, USA. 9Louisiana State University, Emerging Results: Two independent reviewers screened database for state agencies. to the growth of the all primary components of care quality. USA. 10NHS England, London, UK. 11Marche Polytechnic University University Hospital, Ancona, Italy. 12University of Verona, Verona, Italy. 13Centre 5276 records, identifying 874 relevant records. Following Hospitalier Universitaire de Bordeaux, Bordeaux, France. 14Edith Cowan initial approaches to researchers, 220 records generated Method: Pilot testing of the assessment instrument and Conclusion: Further research and development of CG on the University, Joondalup, Australia. 15City, University of London, London, UK. expressions of interest. To date we have received 78 datasets service process is scheduled for May–December 2017. All application of medical physical factors in the treatment of the 16University of South Florida, USA. 17University of East Anglia, Norwich, most common diseases in accordance with our methodology UK. 18Newcastle University, Newcastle, UK. 19Bielefeld University Clinical (n=4211 IPD) from 61 aphasia research teams across 24 partners (the Social Insurance Board, Labour Market Oce, Linguistics, Germany. 20University of York, York, UK. 21University of Aveiro, countries. and rehabilitation service providers from di§erent regions of are needed. Aveiro, Portugal. 22Interdisciplinary Institute for Music and Speech Therapy, Estonia) will undergo training. · Duisburg, Germany. 23Kangwon National University Hospital, Gangwon, South Korea. 24Cyprus University of Technology, Limassol, Cyprus. 25Assiut Discussion/Conclusion: Collaborative e§orts created a large, University Hospital, Egypt. 26University of Tampere, Tampere, Finland. international database which will inform our understanding Results: The results will be presented in January 2018. 27Université de Genève, Genève, Switzerland. 28Karolinska Institute, Solna, of language recovery after aphasia and the components of · Sweden. 29University of Hong Kong, Pokfulam, Hong Kong. 30Aphasia Lab, University College London, London, UK. 31Hôpitaux Universitaires de Genève, e§ective therapeutic interventions. Genève, Switzerland. 32IELUSC, Joinville, Joinville, Brazil. 33Humboldt- ·

95 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 96 Poster Presentations Poster Presentations

26 - 27 May 2017 Vocational Rehabilitation and of persons with chronic diseases, since employment needs 26 - 27 May 2017 26 - 27 May 2017 Return to Work might di§er. Countries should consider the importance of Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work employment for all by ensuring reasonable accommodations Comparison of the available for all levels of persons’ functioning for achieving smart, Work-related di°culties in patients The visual ICF based template to strategies for professional sustainable and inclusive growth. with Multiple Sclerosis and with support planning of rehabilitation integration and reintegration of sequelae of Traumatic Brain Injury: and return to work after traumatic persons with chronic diseases in 26 - 27 May 2017 a comparison from two literature brain injury (TBI) [219] Europe: results from the first year of Vocational Rehabilitation and Return to Work reviews [161] Mrs Riitta Pulkkinen1, Mrs Marjatta Musikka-Siirtola1, Mrs EU Project Pathways [159] 1 1 1 1 1 Riikka Kilpinen , Mrs Riitta Mäkilä , Mrs Minna Nissinen Employment di°culties for Ms Matilde Leonardi , Ms Erika Guastafierro , Mr Alberto 1 1 1 1 Tampere University Hospital, Tampere, Finland. Ms Matilde Leonardi1, Ms Sabrina Ferraina2, Ms Asel Raggi , Ms Venusia Covelli , Mr Davide Sattin , Ms Silvia neurological patients: main results 1 1 Kadyrbaeva2, Ms Beatriz Olaya3, Ms Anastasia Vlachou4, Schiavolin , Ms Chiara Scaratti 1 Background: Traumatic brain injury (TBI) is a significant 5 6 from the European Federation of Foundation IRCCS Neurological Institute ‘’Carlo Besta”, Milan, Italy. Ms Helena Burger , Ms Olga Svestkova , Ms Beata Tobiasz- cause for disability. Brain Injury Outpatient Clinic at Tampere Adamczyk7, Ms Carla Sabariego8, Ms Carolina Avila9, Neurological Associations’ Survey Background: Traumatic Brain Injury (TBI) and Multiple University Hospital (Tays) has an ongoing project with Ms Sonja Gruber10, Mr Rune Halvorsen11, Mr Klemens [162] Sclerosis (MS) a§ect young persons of working age, causing an objective to support return to work (RTW) after mild Fheodoro§12, Ms Roberta Ayadi1, Ms Laura de Torres1, Ms 1 1 or moderate TBI. The visual ICF based template has been 1 Ms Matilde Leonardi1, Ms Chiara Scaratti , Mr Alberto Raggi , a broad range of work-related diculties. Previous studies Chiara Scaratti developed to support rehabilitation and service planning. 1Foundation IRCSS Neurological Institute ‘’Carlo Besta’’, Italy. 2European Ms Ann Little2, ms Donna Walsh2, Ms Heather Clarke2, have identified di§erent variables that are predictors or Association of Service providers for Persons with Disabilities (EASPD), 1 associated with these problems. Significance of personal and environmental factors is 3 4 Ms Laura De Torres Belgium. Parc Sanitari Sant Joan De Déu, Spain. Panepistimio Thessalias, 1Neurological Institute C. Besta Irccs Foundation Neurology, Milan, Italy. important to consider when planning patients’ RTW. Parallel 5 6 Greece. University Rehabilitation Institute, Slovenia. Vseobecna Fakultni 2European Federation of Neurological Associations, Brussels, Belgium. vocational and medical rehabilitation streams instead Nemocnice V Praze, Czech Republic. 7Uniwersytet Jagiellonski, Poland. Aim: To address the content of work-related diculties and 8Ludwig-Maximilians-Universitaet Muenchen, Germany. 9Universidad explore which variables are associated with or determinants of sequential activities are important to succeed. Each Autónoma De Madrid, Spain. 10Carinthia University Of Applied Sciences, Background: Approximately 175.8 million of European of these diculties in persons with MS or with sequelae of rehabilitation plan is based on the person’s strengths, even if Austria. 11Hogskolen I Oslo Og Akershus, Norway. 12Gailtal Klinik - citizens su§er from a neurological disease. Despite some barriers are neglected. Neurologische Rehabilitation, Austria. TBI, taken as paradigm of relevant neurological disorders aspects being well-studied in the literature, patients’ a§ecting people in working age. perspective are less frequently taken into account. Aim: Background: Individuals with chronic diseases, diseases Patients’ associations such EFNA (European Federation 1 Process of rehabilitation structuring of long duration and generally slow progression that Method: Two systematic reviews on associates or of Neurological Associations) play a critical role reporting 2 Defining concrete targets and methods are not passed from person to person (WHO), often determinants of work-related diculties in patients with MS patient’s needs that provide crucial information that can 3 Regarding the patient´s personal and environmental experience work-related problems, such as unemployment, and sequelae of TBI were compared. Variables that were impact on several domains. Employment is a crucial area, facilitators absenteeism, reduced productivity and stigmatisation in the commonly reported in the two reviews, covering the period and people with neurological diseases often experience 4 Using technology. workplace, leading to negative consequences at individual, between January 1993 and February 2015, were extracted. work-related problems, leading to negative consequences at national and European level, and actions to improve the individual, national and European level. Method: participation of these persons in the labour market are Results: Common variables were included in 18 papers • Assessment forms for the patient and family members required. on MS, for a total of 12,387 patients (73.4% females; Aim: This study aims to analyse in depth some aspects aggregate mean age 45.6 years) and 19 on TBI, for a total • Rehabilitation counselling related to employment of patients a§ected by a neurological • Social work Aim: In the frame of the EU Pathways Project, the aim of the of 16,042 patients (27.9% females; aggregate mean age disease, so as to propose more tailored interventions. • Neuropsychological examination present study is to map the available professional integration 32.1 years). Work-related diculties were referred for MS • Neurological examination and reintegration strategies for people with chronic diseases patients as unemployment, lower amount of worked hours Method: An European survey, exploring socio-demographic, in Europe. or job cessation; for TBI patients as rates of return to work. clinical, social support, impact on various domains, Common determinants were old age, low educational level Results: Each structured, visualised rehabilitation plan is psychological and somatic symptoms, work and education based on the ICF framework. The multiprofessional team Method: A systematic review on the existing strategies and cognitive dysfunctions. Common associates were low variables, was conducted by EFNA between Nov 2014 and and the patient define the main target containing three available in Europe was done and quantitative and qualitative level of education, cognitive dysfunctions and attention. Feb 2015. 4847 participants with di§erent neurological sub-targets. This increases the patient’s commitment data were collected at national level through questionnaires disorders from 27 European countries were involved. to their targets, and all the stakeholders share the same and in depth interviews with relevant stakeholders, resulting Discussion and Conclusions: What counts is functioning objective. The plan is visualised for both the patient and the in coverage of 33 European countries. The countries represent and the role of the environment and not the diagnosis. Results: 42% of the sample is in paid employment; of these, multiprofessional team in the rehabilitation meeting, allowing the five European welfare models: Scandinavian, Continental, Rehabilitation researchers should give attention to 11% perceive a relevant workplace stigma. Some socio- the participants to share a common opinion of the situation, Anglo-Saxon, Mediterranean, and Post-Communist models. vocational issues and use both diseases-specific assessment demographic variables such as being female, younger than instruments addressing the diculties in work-related and it is assured that the same information will be available 50, with middle-low education, a§ected by a disease that to the other stakeholders. Results: The pathways mapping of policies, systems and activities as well as environmental assessment to identify caused pain during more than one year, resulted as potential services revealed that people with chronic diseases are often barriers and facilitators for employment, in order to develop risk factors related to stigma at work. Conclusion: When planning RTW, a structured, achievable considered as part of the group of persons with disabilities and tailored rehabilitative programs. rehabilitation plan is needed. This makes planning patient- only in this case there are specific actions for them. European Discussion: Social cohesion and people’s quality of life are oriented, and promotes the patient’s participation in the countries put in place several actions to support a greater a§ected by employment. Stigma in the workplace is a barrier rehabilitation process. Tays has also a further target to create labour market participation, but these di§er in each country. for many neurological patients in Europe, and public health a visual template as a part of the patient archive. actions should be done to make the work environment a Conclusion: Strategies targeting the so called “persons facilitator. with disabilities” do not necessarily address all the needs

97 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 98 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Return to Work of patients with mild How much, how often, when and Factors aecting delivery of early Comparison of job types performed to moderate Traumatic Brain Injury - where? A description of Early specialised vocational rehabilitation before and after sustaining a spinal a retrospective cohort study [50] Specialist Traumatic brain injury to people with traumatic brain injury cord injury: A study from Switzerland Vocational Rehabilitation delivered in a feasibility trial [153] [124] Ms Veera Toivanen1, Mr Aarne Ylinen1,2, Mrs Taina Nybo1,2 1 2 l [164] University Of Helsinki, Helsinki, Finland. Helsinki University Hospital, in the FRESH tria 1 1 1 1,2 1,2 2,3 Helsinki, Finland. Mrs Jain Holmes , Dr Julie Phillips , Mr Trevor Jones , Mr Dr Urban Schwegler , Marina Nützi , Albert Marti , Dr 2 1 1,2 Mr Jose Antonio Merchán-Baeza1,3, Dr Julie Phillips2,3, Ms Jose Antonio Merchán-Baeza , Mr Richard Morris , Mrs Ruth Bruno Trezzini 3 1 1 2 2,3 2,3 Tyerman , Dr Kate Radford Swiss Paraplegic Research, Nottwil, Switzerland. University of Lucerne, Background: We retrospectively studied the return to work Jain Holmes , Dr Kate Radford 1 Department of Health Sciences and Health Policy, Lucerne, Switzerland. 1 University Of Nottingham, Department of Rehab and Ageing, School University of Málaga, Department of Physiotherapy, Institute of Biomedical 3 (RTW) of working-age traumatic brain injury (TBI) patients 2 Swiss Paraplegic Association, Nottwil, Switzerland. Research in Málaga (IBIMA), 29071, Málaga, Spain. 2University of of Medicine, Nottingham, UK. University of Málaga, Department of who were employed or studying at the time of injury. Nottingham, School of Medicine, Medical School, Division of Rehabilitation Physiotherapy, Institute of Biomedical Research in Málaga , Málaga, Spain. 3 and Ageing, Queens Medical Centre, NG7 2UH, Nottingham, UK. 3on behalf ’Working Out’, Community Head Injury Service, The Camborne Centre, Background: Persons with spinal cord injury (SCI) tend to Aylesbury, UK. Aim: To examine how and when people return to work after of the FRESH study team. drop out of their jobs earlier than non-disabled persons and mild to moderate TBI, along with finding factors that could frequently report a lack of suitable jobs as a major barrier to Background: Distinguishing between the e§ectiveness and predict slower recovery. Background: Early Supported Traumatic brain injury employment. So far, only few studies analysed and compared factors a§ecting the delivery of complex interventions is Vocational Rehabilitation (ESTVR) targeted at supporting pre- and post-injury jobs of individuals with SCI, leading to a critical to evaluation and clinical implementation. An Early Methods: Patients (n=257) with mild (N=101) and moderate return to work/education and preventing job loss was lack of evidence regarding more or less suitable jobs for the Specialist Traumatic brain injury Vocational Rehabilitation (N=126) TBI were treated at the outpatient TBI clinic of the delivered in three centres in the Facilitating Return to work a§ected persons. Such evidence, however, is essential for (ESTVR) was delivered in a feasibility randomised Helsinki University Hospital in 2013. Data were collected through the Early Specialist Health Based interventions devising e§ective vocational rehabilitation strategies aiming controlled trial (HTA FRESH 11/66/02). It was not known if from the medical records. The outcome variable was RTW (FRESH) feasibility trial. at sustainable return to work of persons with SCI. occupational therapists (OTs) could be trained to deliver it and the follow-up time was 1 year. and what factors might a§ect fidelity. Aim: To describe ESTVR. Aim: The study analyses and compares job types performed Results/findings: 35,2% of all patients had returned to work by persons with SCI living in Switzerland before and after SCI Aim: To describe factors a§ecting ESTVR delivery in a multi- in 1 week, 57,4% in one month and 70,3% in two months. In Methods: Four occupational therapists (OT) delivered onset. centre feasibility RCT. one year the RTW percentage was 80,9%. Patient’s younger ESTVR for ≤ one year to participants who were working prior age, lack of neuroradiological findings and only a few or no to their traumatic brain injury (TBI). ESTVR content was Methods: Our cross-sectional descriptive study is based Methods: A mixed methods process evaluation was used co-injuries predicted good recovery and faster RTW. We measured using content proformas (n= 699) and therapists’ on data from the 2012 conducted Swiss SCI community to examine whether ESTVR was delivered as intended, also observed a negative correlation between RTW and clinical notes for 38 participants. Data were analysed using survey (SwiSCI). The International Standard Classification of acceptability and factors likely to a§ect implementation. self-reported subjective fatigue or headache in the follow-up. Excel. Occupations (ISCO-08) was used for classifying the pre- and OTs underwent 3 days’ training and were mentored to Furthermore, the mechanism and the severity of the injury post-injury jobs indicated by the study participants. deliver ESTVR. Fidelity was measured quantitatively using were associated with RTW. On the other hand, the patient’s Results: OT commenced a mean 26.8 working days after content proformas, fidelity checklists, clinical notes and gender or educational history did not predict RTW. TBI (SD 19.6 [range 4-92]) and lasted approximately eight Results: Pre-injury jobs were mainly assigned to the ISCO- mentoring records. Implementation factors were explored in months, mean 173.4 working days (SD 89.2 [range 8-327]). 08 major group “Craft and related workers” (26.6%), interviews with 4 OTs, trial participants (15 ESTVR, 15 TAU), Discussion and Conclusion: The prognosis after mild Participants received a mean of 6.3 face to face visits (SD 6.11 followed by “Professionals” (15.6%), and “Technicians and 6 employers and 13 NHS sta§. Data were examined against a to moderate TBI is good. Most of the patients make a [range 0 to 40]). Most visits occurred in months 1-3 then associate professionals” (13.7%). After SCI onset individuals logic model depicting the core ESTVR process and essential favourable recovery and return to work without problems. declined in frequency. The main focus of the intervention was predominantly worked in jobs pertaining to “Professionals” resources. In the future, the predictors of slow recovery should be preparing and supporting a return to work. OTs had direct (31.2%), “Clerical support workers” (19.1%), and “Technicians recognised and considered in order to plan e§ective contact with 14 employers; 1/3 time was in face- to-face and associate professionals” (18.5%). Only 5.4% of the Results: Analysis of 38 clinical records (one per participant), vocational rehabilitation for those patients with mild to contact with participants, 1/3 in liaison and 1/3 admin and individuals worked as craft and related workers post-injury. 699 content proformas and 12 fidelity checklists suggest moderate TBI who are in need of support. travel. London therapists incurred more travel time. ESTVR was delivered as intended. Interviews highlighted · Intervention took place in the home (55%), community Discussion and Conclusion: Our findings contribute to an acceptability to recipients and factors a§ecting intervention (13%), or workplace (11%). There were minor di§erences enhanced understanding of return to work pathways of fidelity. These were similar across sites and included between therapists. persons with SCI. We provided a list of potentially suitable individual participants’ needs, employer access, mentoring (and less suitable) jobs for persons with SCI in Switzerland and local rehabilitation service provision and OT expertise. Discussion and Conclusion: Measuring and describing that informs the development of job matching applications While these resulted in variation, the core ESTVR process intervention will inform clinical implementation and fidelity in for vocational rehabilitation. was followed in each case. The deployment of experienced a definitive trial. · OTs, administrative support and access to NHS systems also a§ected delivery. · Conclusion: Data from multiple sources can identify factors likely to a§ect intervention fidelity in a definitive trial and clinical implementation in the NHS. ·

99 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 100 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Influence of the type of occupation Cross-Company Occupational Towards personalisation? HR professional experiences on the knee osteoarthritis in men [59] Mobility - an innovative work-place Working capacity counselling with a work-related vocational prevention model [70] [Work in Progress] within Finnish multi-sectoral Joint rehabilitation concept [10] Dr Sung Hyun Kim1 1 Service Employment Enhancing 1 Asan Medical Center, Seoul, South Korea 1 Dr Riitta Seppänen-Järvelä Ms Susanne Bartel 1 1Federal Association Of Vocational Rehabilitation Centres, Germany, Berlin, Employability [160] [Work in Progress] Social Insurance Institution of Finland, Helsinki, Finland. Background: Occupation is one of the main determinants Germany. of lifetime physical loading. Therefore, the development of Ms Laura Tarkiainen1, Ms Eveliina Heino1, Dr Marketta Background: This paper is based on the evaluation research osteoarthritis of the knee could be a§ected by the types of Background: Facing the demographic changes in German Rajavaara1 of a new concept for vocational rehabilitation. Close occupation. society, innovative age and aging management concepts are 1University Of Helsinki, Helsinki, Finland. collaboration with employers, employees, occupational becoming increasingly important for companies. The decline health services and rehabilitation service providers was one Aim: The aim of this study is to investigate the relationship in activity-related performance potential, due to higher age, Background: The Finnish Multi-sectoral Joint Service of the key elements in the new work-related rehabilitation between the types of occupation and the development of is often associated with health-stressing working conditions Employment Enhancing Employability was legislated in concept. osteoarthritis of the knee, based on a nationwide survey. and the lack of opportunities to develop professionally and the beginning of 2015. It is a service in which employment, personally. Mobility between workplaces or occupations rehabilitation and municipal social and health services are Aim: The central concern of this paper was through human Methods: We conducted a cross-sectional study using between companies can counteract the process by creating brought together in order to promote the employability of resource (HR) professionals’ perceptions to produce representative samples from the 5th Korea National Health new employment alternatives for employees. unemployed persons in collaboration across organisations knowledge about vocational rehabilitation as a multi-agency and Nutrition Examination Survey conducted in 2012. Men and professions. Concurrently, The Social Insurance activity. ≥ 50 years of age were divided into 4 occupational groups: Aim: The aim of the seven project partners from the Institution of Finland (Kela) has developed personal white-collar workers, pink-collar workers, blue-collar workers, business, educational and research sector is to develop and counselling for clients having problems with their working Method: The project was evaluated by using a multiple- agribusiness and low-level workers. Knee osteoarthritis was test models of cross-company occupational changes in capacity. This counselling is part of to the multi-sectoral joint constituency approach. Evaluation consisted of multiple graded according to Kellgren-Lawrence grade, and grade ≥ 2 regional corporate networks. The project “TerrA” is funded by service. perspectives, which meant that rehabilitation processes and was defined as knee osteoarthritis. Using multivariate logistic the Federal Ministry of Education and Research from 2016 outcomes were examined from the stakeholders’ viewpoints. regression analysis, the relationships between occupational to 2019. Initially, framework conditions and tools for cross- Aim: In this study, we focus on the role of work capacity In this paper, the focus was on the HR professionals’ groups and the development of the knee osteoarthritis, company occupational mobility will be developed in a model counselling and rehabilitation in this joint service, in experiences about organising and planning of the severe knee osteoarthritis, chronic knee pain, moderate to region and transferred to other regional corporate networks particular the experiences of the counselling ocers at The rehabilitation courses. Data consisted of individual interviews severe chronic knee pain were analysed. in Germany, subsequently. Social Insurance Institution of Finland (Kela). of selected (N=10) HR professionals. The data was analysed by using the Atlas/ti qualitative analysis program. Results: The prevalence of knee osteoarthritis in our study Initial Results: Di§erent typologies of occupational mobility Method: The data collection was done by telephone population was 19.3% (n=207). Types of occupation were were defined and existing instruments compiled. Key interviews of 34 sta§ members working in counselling Results: The data showed that the HR professionals were associated with elevated risk of the knee osteoarthritis. The cornerstones of necessary framework conditions (e.g. tasks in the joined service. The data are analysed with aware of the condition of personnel in terms of work risks for developing knee osteoarthritis increased in AL. The employment law and cost models) could be identified and content analysis method in order to recognise the tensions disability. In the participating organisations there were risks for developing severe knee osteoarthritis also increased case management pathways developed. Impulses from in personalised mass-production of joint services aiming to di§erent information and management systems to keep in AL workers. The risks for presence of chronic knee pain corporate networks as well as discussion with stakeholders enhance local employment. track of personnel. In order to define the target group and increased in PC workers, BC workers and AL workers. The such as employee representatives and social insurances will to select the participants for the rehabilitation course, risks for presence of moderate to severe chronic knee pain provide a formative base for the developed model. Results/ Findings: According to preliminary results there HR professionals either worked actively in close co- increased in BC workers and AL workers. are various ways to o§er counselling depending on the operation with occupational health care service providers Discussion: Overall,‘TerrA’ provides a holistic work-place local service structure and co-operation practices between or co-operated dynamically within the work organization, Conclusion: WC workers are least a§ected by knee prevention model in which cross-company occupational di§erent service providers. In individual cases, the integration especially with middle managers. From the HR professional’s osteoarthritis and chronic knee pain and AL workers are at mobility is implemented to maintain workability and of rehabilitation services with employment, health and perspective, rehabilitation was “one tool in the toolbox” greatest risk of this condition. employability up to the age of retirement. The project is social services, is to a great extent dependent on the local in managing personnel’s work ability. They understood particularly innovative as it connects corporate networks accessibility of rehabilitation opportunities. rehabilitation as a process-like employee-centred activity. with prevention service providers. · Discussion and Conclusion: The findings are reflected in Discussion: The findings showed the HR professionals’ relation to practices of other Nordic countries. In addition, agency within the work-related rehabilitation field is the results may be helpful in the development of joint becoming more and more visible. rehabilitation services crossing professional boundaries in the · near future. ·

101 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 102 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Vocational Rehabilitation and Return to Work Stressors of major organizational ICF-classification-based assessment Screening instruments for predicting Center of knowledge in work changes and it’s relation to sickness data – user experiences by parties return to work in long-term sickness incapacity focuses on rehabilitation absence [141] involved in rehabilitation-to-work absence [132] initiatives with “work as outcome [39] [18] 1 2 measure” Dr Ásta Snorradóttir1, Dr Guðbjörg Linda Rafnsdóttir2, Dr Dr Chris Jensen , Dr Christina Stapelfeldt , Dr Claus Vinther 2 4 3 Birgit Aust3 Mr Tuomas Leinonen1, Ms Merja Haverinen1 Nielsen , Dr Maj Britt Dahl Nielsen , Dr Reiner Rugulies , Dr Dr Saskia Decuman1, Mr François Perl1 2 1University of Iceland, Faculty of Social Work, Reykjavik, Iceland. 2University 1Kumppaniksi association, Kajaani, Finland. Anne-Mette Momsen 1National Institute Of Health And Disability Insurance, of Iceland, Faculty of Social and Human Sciences. 3National Research Centre 1National Advisory Unit On Occupational Rehabilitation, Rauland, Norway. for the Working Environment, Cophenhagen, Denmark. 2DEFACTUM, Central Denmark Region, Aarhus, Denmark. 3The National Bruxelles, Belgium. Background: Kumppaniksi has used an ICF-based Research Centre for the Working Environment, Copenhagen, Denmark. functioning capability assessment method since 2006 to 4COWI Consult, Copenhagen, Denmark. Background: Research shows that major organisational Background: For years, high rates of work disability are support rehabilitation-to-work and aid multidisciplinary changes can be stressful for employees and a§ect their seen especially in people su§ering from disabling chronic cooperation. The method includes self-assessments and Background: Screening for multiple symptoms in the early health and well-being, leading to long term sickness absence pain, psychiatric disorders, burn-out etc. A holistic evidence observations by external persons. The assessment results are phase of sickness absence by questionnaires may be helpful or even premature exit from the labour market. It is important based approach towards reintegration into a paid job is often used for planning rehabilitation pathways. Kumppaniksi has to identify high risk of long-term sickness absence. to investigate how the work environment can be improved lacking. had several years of experience in cooperating with diverse during changes to minimise the e§ect on employees. parties; now we studied ways for partners to apply our data Aim: To describe the predictive and discriminative abilities Aim: Establishing a coordinated research centre on more e§ectively. of two instruments on symptoms and one item on self-rated Aim: The aim of this qualitative study was gain rehabilitation programmes which include early return to work health. understanding of the experience of organisational changes interventions in people with work disability. Aim: We wished to learn what more information our partners and shed light on what factors are related to increased stress might need concerning a Kumppaniksi functioning capability Methods: A longitudinal cohort study of 305 participants during such times and what factors are helpful in coping with Method: In 2013 a centre of knowledge in work incapacity assessment and if we could produce these data during a with at least 8 weeks of sickness absence were recruited the changes. was established with as main aims networking in the short examination period. from job centres. The Symptom Check List of somatic field of work disability and rehabilitation and supporting distress (SCL-SOM) (score 0–48 points), the Bodily Distress Method: Twenty semi-structured interviews with Icelandic research in this domain. The latter is done by the yearly Method: We carried out our study by interviewing our Syndrome Questionnaire (BDSQ) (0–120 points) and a bank employees who had experienced major organisational publication of a study programme, which will be financed partners’ sta§ members and compiling ICF-compatible one-item self-rated health question (SRH) (1–5 points) were changes were conducted. Thematic analysis approach was and methodologically followed-up (also by a committee customer-group-specific statistical data. used. Di§erent cut-points were analysed to find the highest applied to analyse the data. representing the stakeholders). number of correctly classified return to work (RTW) cases Results and Discussion : Our study brought up the following: during a one-year follow-up period, identified in a register on Results: The results show that interviewees referred to Results/ Findings: 23 studies have been launched. Four • Assessing functioning capability in accordance with the public transfer payments. both instrumental and emotional support as the most are finished and 19 are underway (7 have just started). ICF facilitates information exchanges important factor in overcoming the stress in relation to the The studies focus on those functional problems having the • A rehabilitee’s self-assessment does not suce to produce Results: The adjusted relative risk regarding prediction of organisational changes. Supervisors play an important role highest chance of long term work incapacity. The studies reliable functioning capability data -particularly for mental RTW was 0.89 (95% CI: 0.83–0.95), 0.89 (95% CI: 0.83– in enhancing social support during such times. Negative are intervention studies, integrating “care” and “work” with a health rehabilitees and long-term-unemployed rehabilitees. 0.95) and 0.78 (95% CI: 0.70–0.86) per 5-, 10- and 1-point experience of supervisors, as in being disrespectful or focus on the development of validated assessment tools. All This is because even a short period of unemployment increase in the SCL-SOM, BDSQ and SRH, respectively. unsupportive was found to contribute to increased stress and studies are followed-up by experts of our department who (approximately 4 months) may cause one’s idea of one’s After mutual adjustment for the other instruments, only was found to be an underlying factor in long-term sickness guarantee exchange of knowledge across studies with the own functioning capability to become obscure the prediction of RTW from SRH remained statistically absence due to exhaustion among employees. Social support research teams and policy makers. • Even a relatively short period of rehabilitation to work (1–3 significant 0.81 (95% CI: 0.72–0.92). The highest sensitivity at work was contributed to the decision of returning to the months) brings up new, observation-based information (86%) was found by SRH at the cut-point ≤5, at which 62% workplace following long-term sick leave due to exhaustion. Discussion and Conclusion: Due to the strict selection about the rehabilitee’s functioning capability, which is were correctly classified. and follow-up, the return on investment is maximal for impossible to obtain through discussions and individual Discussion: The role of supervisors in leading the our department and policy in general. All studies lead to measurements. This is particularly true for limitations that Discussion and Conclusion: All three instruments predicted employees during organisational changes is very important. recommendations. For example one of the studies focuses a§ect the guidance of the rehabilitee’s practical work RTW. The SRH may be a better alternative to SCL-SOM or Supervisors can make a di§erence in reducing stress and on the development of a questionnaire which assesses • Customer-group-specific summaries produce information BDSQ for estimating the chances of RTW among sickness preventing sickness absence from stressors involved in predictors for long term work disability. The questionnaire relating to the limitations that always need to be absentees. major organisational changes and increase the likelihood of will be implemented on a large scale within the Belgian social considered when planning and implementing rehabilitation returning to work. security context. activities for those particular groups. Reference: Momsen et al. Screening instruments for · · predicting return to work in long-term sickness absence. · Occup Med (London), 2016. ·

103 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 104 Poster Presentations Poster Presentations

26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise The Eectiveness of peroneal nerve A clinically meaningful training Identification of treatment Investigation of treatment response Functional Electrical Stimulation eect in walking speed using parameters for use with to a strength training session (FES) for the reduction of Functional Electrical Stimulation for Neuromuscular Electrical with Neuromuscular Electrical bradykinesia in Parkinson’s Disease: motor incomplete spinal cord injury Stimulation for Strength Training Stimulation [188] A pragmatic feasibility study for a [93] [187] Dr Leanne Gri¬ths1, Dr Caroline Stewart2, Prof Anand 3 single blinded Randomised Control 1 2 Dr Tamsyn Street , Ms Christine Singleton 1 2 Pandyan Dr Leanne Gri¬ths , Dr Caroline Stewart , Professor Anand 1 2 Trial (STEPS) [137] [Work in Progress] 1Salisbury NHS Foundation Trust, Salisbury, UK. 2West Midlands St Mary’s University, Twickenham, Twickenham, UK. RJAH Orthopaedic 3 3 Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Pandyan NHS Foundation Trust, Oswestry, UK. Keele University, Keele, UK. 1 2 1,2,3 1 4 Trust, Birmingham, UK. St Mary’s University, Twickenham, Twickenham, UK. RJAH Orthopaedic Dr Paul Taylor , Mrs Trish Sampson , Mr Ben Beare , Dr 3 NHS Foundation Trust, Oswestry, UK. Keele University, Keele, UK. Val Stevenson4, Mrs Coralie Seary4, Dr Diran Padiachy1, Mr Background: Neuromuscular Electrical Stimulation (NMES) 1 1 5 Background: Those with a motor incomplete spinal cord can be used to help strengthen muscles in patients who James Lee , Mr Paul Strike , Prof Maggie Donavon-Hall , Dr Background: There is growing evidence that progressive 6 2 injury (SCI) may have a greater capacity for recovery of the are unable to participate in progressive strength training Elsa Marques , Prof Peter Thomas , Mrs Shela Snell strength training is beneficial in the rehabilitation of the 1Department Of Clinical Science And Engineering, Salisbury, UK. lower limb than other diagnoses treated using peroneal protocols. Currently there is no guidance on stimulation 2 3 frail elderly and the neurological patient. Neuromuscular Bournemouth University, Bournemouth, UK. Odstock Medical Limited, functional electrical stimulation due to the processes of protocols that can be applied to provide an adequate Salisbury, UK. 4The National Hospital for Neurology and Neurosurgery, neuroplasticity. Electrical Stimulation (NMES) has the potential to provide a 5 6 “overload stimulus” [i.e. a fatiguing contraction] that would London, UK. Southampton University, Southampton, UK. Bristol University, technological solution for people who are unable to engage Bristol, UK. mimic the e§ects of progressive strength training protocols. Aim: The study aimed to investigate the presence of with existing protocols for progressive training. However, there are no guidelines for setting stimulation parameters Background: Parkinsonian gait is characterized by a training e§ect for rehabilitation of function in motor Aim: To test whether a treatment protocol of 45 isometric when using NMES for muscle strength training purposes. bradykinesia, hypokinesia, festination and akinesia, frequently incomplete spinal cord injury (SCI) through daily use of contractions, using previously optimized parameters leading to falls and reduced quality of life. Two small and functional electrical stimulation (FES). (maximum tolerable intensity, pulse width 450µs, frequency Aim: To establish treatment parameters for using NMES for short term observational studies have suggested that these 50 Hz, duration stimulus 3s ramp time 0.5s and 10s rest), strength training symptoms may be improved by electrical stimulation of the Method: Thirty-five participants with (mean age 53 years, with NMES can lead to a stimulus that “overloads a muscle”. common peroneal nerve, timed to swing phase of gait. range 18-80: mean years since diagnosis 9, range 5 months Method: A cross sectional study design was used. The aim -39 years) with motor incomplete SCI formed a referred Method: A cross sectional study design was used. The aim was to recruit a sample of 20 participants and study the Aims: STEPS is a feasibility study to inform the design of a sample for treatment. The data were analysed for a training was to deliver a single NMES treatment session of 45 muscle e§ects of a fixed stimulation intensity (maximal tolerated) future multi-centre clinical and cost e§ectiveness study. We e§ect (di§erence between unassisted ten metre walking contractions to the gastrocnemius. Maximal moment of each NMES stimulus, on gastrocnemius, whilst systematically aim to: determine recruitment and retention rates, obtain speed at baseline and after six months) and an orthotic e§ect contraction was identified and linear regression analysis used varying the frequency between 20 to 100 Hz. Pulse width participants views of the acceptability of the intervention, (di§erence between with and without FES) which was further to quantify the fatiguing e§ects of the stimulation protocol. was fixed at 450 µs. The stimulus duration was 3s and ramp study design and suitability of primary outcome measure, analysed for clinically meaningful changes (i.e. >0.05m/s times 0.5s. and collect data from which a future study can be powered. and >0.1 m/s). Results: A sample of 20 healthy participants (mean age 39 years (SD 6.2)) were recruited. The NMES protocol produced Results: 20 healthy participants (mean age 39 years (SD Method: 68 people with Parkinson’s will be randomly Results: A significant clinically important di§erence a fatiguing series of contractions, i.e. the force reduced over 6.2)) were recruited. The force production increased with allocated to receive either standard care or standard care (0.013m/s, CI: 0.04-0.17) for initial orthotic e§ect was found the 45 contractions (a mean of 0.13 Nm reduction in force increasing frequencies with the greatest force increment with FES for 18 weeks at two clinical centres. Assessments on day one (P=0.013) and a total orthotic e§ect (0.11m/s, CI: production per muscle contraction). recorded between 40 and 60 Hz (6.2Nm) with the plateau will be made at baseline, 6, 18 and 22 weeks. Assessments: 0.04-0.18) after using FES for six months (P =CI: 0.02-0.16) point being 60Hz. 10m walking speed, Timed up and Go, Unified Parkinson’s was also found (P =0.025). A significant clinically important Discussion: The treatment protocol was tolerated by all Disease Rating Scale, PDQ39 quality of life, Mini BEStest di§erence in training e§ect (0.08m/s, CI: 0.02-0.16) was participants. A mean decline of maximal moment over the Discussion/ conclusions: NMES was tolerated by all Balance evaluation, Falls Ecacy Scale-International, New also found (P = 0.025). full training protocol indicates that the parameters required participants. Although a plateau point of 60Hz was identified Freezing of Gait questionnaire, Use of Health resources the muscle to work at a sucient level to cause a fatiguing there was evidence that this point can lie anywhere between questionnaire, EQ-5D-5L, a falls diary and qualitative semi- Discussion and Conclusions: The results suggest that response. This indicates that the protocol has potential to 40 and 60 Hz and this appears to be subject dependent. In structured interviews. daily independent use of FES produces significant clinically produce a response that is likely to replicate the e§ects of selecting an optimum frequency for an individual, especially meaningful changes in walking speed for motor incomplete progressive strength training. Further work is required to test patients with deconditioned muscles, one should consider Results: This RfPB funded study has recruited 34 participants SCI. Further research exploring the mechanism for the this protocol. using the lower of this frequency range to minimise the (January 2016) and is scheduled to be completed March presence of a training e§ect may be beneficial in targeting e§ects of over fatiguing muscles. 2018. The anticipated recruitment rate has been achieved. therapies for future rehabilitation. One amendment has been made to the protocol, increasing · the walking speed limit for inclusion in the study.

Discussion and Conclusion: Early indications are that the study and intervention are feasible although three drop outs have occurred due to PD related medical issues.

105 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 106 Poster Presentations Poster Presentations

26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise 26 - 27 May 2017 Physical Rehabilitation & Exercise Determining cost eectiveness Strength of muscular contraction No eect of local anaesthetic on The dierentiation of ependymal for early electrical stimulation to elicited with electrical stimulation [4] discomfort during quadriceps muscle cells in the postnatal neurogenic prevent complications in the arm activation capacity assessment [75] niche of the spinal cord [208] Dr Primož Novak1, Prof Gaj Vidmar1, Mrs Slavica Bajuk1, Mr post-stroke a feasibility trial [97][Work 1 1 Igor Tomšič , Prof Martin Štefančič 1 2 1 1 Dr Theodoros M Bampouras , Ms Natasha Donaldson , Dr Dr Rebecca Jameson In Progress] University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia. 1 Susan Dewhurst1 University of Leeds, Leeds, UK. 1University Of Cumbria, Lancaster, UK. 2Leeds Beckett University, Leeds, UK. Prof Marilyn James1, Miss Janet Boadu1, Dr Joanna Fletcher Background: Neuro-muscular electrical stimulation is Background: Spinal cord injury and myelination disorders 1 1 1 - Smith , Dr Nicola Sprigg , Prof Marion Walker , Dr Sonia frequently used for therapeutic purposes. Data on muscle Background: Electrical muscle stimulation (EMS) is routinely result in motor impairment, dysaesthesia, chronic pain and 1 1 Ratib , Mrs Carla Richardson , Dr Dawn-Marie Walker3, Prof strength improvement using electrical stimulation of di§erent used in rehabilitation to assess muscle activation capacity autonomic dysregulation. Such sequelae are a consequence 2 Anand Pandyan intensities di§er widely in the literature. With increasing (MAC). The discomfort associated with EMS, however, may of neuronal death, axonal damage and demyelination. 1University Of Nottingham, Nottingham, UK. 2University of Keele, Keele, UK. intensity, stimulation becomes unpleasant and painful. The Restoration of neurological function may be achieved by 3University of Southampton, Southampton, UK. impact on the assessment outcome. Commercially available, pain threshold di§ers between individuals; di§erent muscle non-invasive, numbing agent topically applied could reduce harnessing postnatal neurogenesis within the spinal cord. force contraction can therefore be expected at pain threshold. Previous studies have demonstrated that the ependymal Background: Paralysis, pain and contractures are some of the discomfort through anaesthetising the cutaneous cell population surrounding the spinal cord central canal the main post-stroke upper limb complications. Loss of arm nociceptors. Aim: The goal of our study was to find out what is the can proliferate under cholinergic modulation. Endogenous and hand function reduces independence and may severely strength of quadriceps contraction, evoked by electrical retinoic acid (RA) has been identified within the neurogenic a§ect patient quality of life (QoL). It can result in productivity Aim: The aim of the study was to examine the e§ect of local stimulation bellow the pain threshold (i.e., electrical zones of the adult murine brain and recent studies have losses and increases the demand for NHS and social care anaesthetic on discomfort felt during quadriceps MAC. stimulation of maximal tolerance), compared to the strength demonstrated that RA can enhance the proliferation of services. achieved at maximal voluntarily isometric contraction of the Methods: Sixteen males (21.3±1.8 years, 1.81±0.05 m, ependymal progeny within the spinal cord. same muscle group. Aim: To evaluate the feasibility in terms of cost e§ectiveness 78.9±12.0 kg) performed maximum voluntary isometric Aim: The aim of this study is to determine whether RA, in of delivering a randomised controlled trial (RCT) comparing knee extensions (MVC) with no agent (NONE), local Methods: Twelve healthy male volunteers, aged 22 to combination with cholinergic modulation, can enhance the early intensive neuromuscular electrical stimulation (ES) and anaesthetic (ANAES), or placebo gel (PLAC) applied under 73 years, were included in the study. Torques of knee di§erentiation of proliferating ependymal cells within the usual care. [REC reference: 15/EM/0006]. the electrodes. MAC was assessed via the delivery of a extensors at maximal voluntarily isometric contraction and doublet during the MVC plateau phase (superimposed spinal cord. during electrical stimulation of maximal tolerance without Methods: The study was conducted using a RCT design twitch, ST) and at rest (resting twitch, RT), and calculated as voluntarily contraction were measured for both knees. Method: C57/Bl6 mice received in vivo intraperitoneal (n=40) in a single centre. Participants were randomised (1-(ST/RT))*100. Discomfort was assessed by marking on a injections of RA and the alpha7 nicotinic acetylcholine to receive usual care and ES treatment or usual care only clear 10cm scale, with ‘No pain’ at one end and ‘Worst pain’ Results: Average knee extensors torque during electrical receptor modulator PNU120596 (PNU). The number of (control). The analysis took a NHS and societal perspective at the other, immediately after each trial. MVC torque, RT stimulation of maximal tolerance was 34.2 Nm (15% of the proliferating cells within the spinal cord was determined including costs of intervention and healthcare resource use, torque, MAC, and discomfort were analysed with a repeated value of maximal voluntarily isometric contraction) on the using intraperitoneal delivery of the cell proliferation marker and the cost of time o§ work and additional out of pocket measures ANOVA and pairwise comparisons with Bonferroni right side and 39.9 Nm (18% of value of maximal voluntarily 5-ethynyl-2’-deoxyuridine (EdU), and the phenotype of these expenses. Information was gathered via detailed resource adjustment. Significance was set at P≤0.05. isometric contraction) on the left side. Neither of the cells was confirmed by immunohistochemistry. use questionnaires at baseline, 3, 6 and 12-month follow-up. parameters exhibited a clear correlation with age. The e§ects were captured using the EQ5D at baseline, 3, 6 Results/findings: No di§erence in MVC torque, RI torque Results: The results showed a significant reduction in and 12 month follow-up. and discomfort between conditions was found. There Discussion and conclusion: With electrical stimulation of was, however, a significant di§erence (P=0.038, Cohen’s EdU labelled cells for the RA group in comparison to PNU maximal tolerance, quadriceps contraction of approximately treatment alone. Results/Findings: This is currently an ongoing study. d=0.67) in MAC between NONE (77.8±9.1%) and ANAES 1/6 of the torque achieved at maximal voluntarily isometric The results of this work in progress will be presented and (83.6±8.0%). contraction of the same muscle was evoked. There were Discussion and Conclusion: The study has demonstrated discussed. large di§erences in response between participants, therefore Discussion and Conclusion: The main finding is that local that RA has a negative e§ect upon neurogenesis in the electrical stimulation parameters should be adjusted to each thoracic and lumbar murine spinal cord. This result may due Discussion and Conclusion: The study is testing the anaesthetic does not reduce the discomfort experienced patient. to suboptimal factors within the microenvironment of the acceptability and feasibility of using the resource use during EMS. Further, it does not appear to a§ect the · spinal cord, injection timing, the interaction of RA and PNU questionnaire and the EQ5D with this patient group. It is quadriceps’ ability to voluntarily generate force or their or a RA degrading enzyme. Future studies should aim to testing the ability of the measures to deliver findings that mechanical behaviour, as indicated by the unaltered MVC overcome such limitations noted. reflect both cost e§ectiveness and cost utility. The data will and RI torque; it does, however, overestimate muscle · highlight any areas for concern and modification and provide activation. indicative data for a full health economic trial in this field. ·

107 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 108 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Rasch analysis of the upper-limb What is the duration of upper limb Development of a computerised A pilot study exploring the use of sub-scale of the STREAM Tool in an use and arm movement ratio of adaptive test for measuring motor balance and dynamic vision outcome acute stroke population [25] aected versus non-aected arm function, balance, and activities of measures in people living with after stroke? [190] [Work in Progress] daily living in patients with stroke Neurofibromatosis II [29] Mr Bilal A. Mateen1, Dr Karen Baker2, Prof. E. Diane Playford3 1 2 [77] University College London, London, UK. University of Hertfordshire, 1 1 1 1 Hertfordshire, UK. 3University of Warwick, Coventry, UK. Mr Deirion Sookram , Prof Frederike van Wijck , S Philippa Ms Rebecca Smith , Mr Jeremy Corcoran , Dr Victoria 1 1 1 1 Dall Mr Gong-Hong Lin1, Ms Yi-Jing Huang1, Prof. Ching-Lin Williams , Dr Angela Swampillai , Mrs Sue Wood , Dr Shazia 1 1 Glasgow Caledonian University, Glasgow, UK. 1 Afridi Background: Stroke is a leading cause of disability worldwide. Hsieh 1 1 Guy’s And St Thomas’ NHS Foundation Trust, London, UK. The Stroke Rehabilitation Assessment of Movement School of Occupational Therapy, College of Medicine, National Taiwan Background: To understand upper limb (UL) use in people University, Taipei City, Taiwan. (STREAM) is an outcome measure used to assess upper with stroke, activity limitation measures should include Background: Neurofibromatosis II (NF2) may cause impaired limb rehabilitation outcome in stroke patients. quantification of UL movement in free-living conditions. Background: The Functional Assessment of Stroke (FAS) has hearing, balance and vision, with significant impact on been developed for measuring motor functions of upper- and quality of life. No battery of responsive, validated or reliable Aim : The purpose of this study is to provide a Rasch-model Aims: The aims of this study are to: (1) describe the duration lower-extremities (UE and LE), balance, and basic activities performance-based outcome measures evaluating balance based analysis of the upper limb sub-scale of the STREAM. of UL use and arm movement ratio (AMR, i.e. use of the of daily living (BADL) in patients with stroke. However, a total or discerning static from dynamic vision exists for the NF2 a§ected versus non-a§ected UL) in stroke patients, as of 29 items in the FAS takes a lot of time to administer. population. Such measures are useful for monitoring disease Methods: 125 individuals completed the Upper Limb measured by accelerometers, (2) describe the feasibility of progression, assisting with therapeutic decision-making, and sub-scale of the STREAM questionnaire and the Chedoke wearing three activPAL3™ accelerometers for seven days. Aim: We aimed to develop and validate a computerised determining intervention ecacy - desirable psychometric Arm-Hand Activity Inventory (CAHAI). Recruitment of adaptive test (CAT) of the FAS (CAT-FAS) in patients with properties given the availability of new pharmaceutical participants was limited to adults (18+) with an imagining- Method: Baseline data of eleven participants recruited stroke. treatments for NF2. confirmed diagnosis of stroke. Recruitment occurred as part of a multi-centre, single-blinded, exploratory between 48 hours and 12 weeks post-stroke, from 3 wards, RCT (EVERLAP) were analysed. Participants wore three Methods: The data were retrieved from a previous study Aim: To explore the feasibility and utility of balance and at a tertiary neurological centre in the UK. activPAL3s™ for seven consecutive days; one on each with 301 participants. We developed the CAT-FAS through vision performance-based outcome measures in the NF2 forearm to measure UL duration, and one on the strongest 3 stages: (1) development of the item bank: we examined population. ResultS: The upper limb sub-scale of the STREAM appears thigh to calculate the functional day (i.e. time spent out of the item-model fit of each item of the item bank (collected to be a unidimensional measure. However, when scored bed). Raw analog to digital (AD) units sampled at 20 Hertz from the original tests: Fugl-Meyer Assessment, Postural Methods: Patient involvement sessions highlighted that using the originally proposed method (0-2), or using the were processed against an activity threshold of 0.5 AD units. Assessment Scale for Stroke patients, and Barthel Index) balance and visual impairments significantly impact quality response pattern (0-5), neither variant fit the Rasch model Every 0.05 second above the threshold during the functional using Rasch analysis and removed the items having poor of life. Discussions with NF2 experts derived 3 balance and (p < 0.05), although the reliability was good (Person- day was summed for each UL duration. Participants tracked item-model fit. (2) Determination of the CAT-FAS’s stopping 1 dynamic vision measure. Participants were recruited from Separation Index – 0.847 and 0.903 respectively). Correcting time exiting and entering bed using an activity diary. rules. (3) Validation of the CAT-FAS. specialist clinics at Guy’s Hospital, London. for the disordered thresholds, and thereby producing the new Descriptive statistics were calculated. scoring pattern, led to substantial improvement in the overall Results/ Findings: The final item bank contained 58 items. Results: 5 females and 5 males with an average age of 28 fit, such that the chi-square probability of fit became 22%, Results: The mean AMR across all participants was 52.0% The CAT-FAS using the optimum stopping rule had good years participated. Participants demonstrated impaired however, the reliability was slightly reduced (PSI – 0.806). (± 56.1). The mean duration was 2.0 (± 1.9) hours or 16.8% Rasch reliability (0.90–0.94) and needed few items for static and dynamic balance, indicative of patients’ high falls (± 15.2) of waking time for the a§ected arm, and 3.8 (± 2.0) administration (8.4 items on average). In addition, the risk. Dynamic visual acuity testing demonstrated markedly Discussion and Conclusions: The study proposes a new hours or 32.9% (± 14.7) of waking time for the non-a§ected concurrent validity (Pearson’s r = 0.86–0.98 with the FAS impaired gaze stability owing to significant loss of vestibulo- scoring method for the upper limb sub-scale of the STREAM arm. Accelerometers were not removed for 61 out of 72 and the original tests) and responsiveness (standardized ocular reflex function. outcome measure in the acute stroke population, based on (84.7%) possible days. response mean = 0.58–0.73) of the CAT-FAS were good. the 5-point response pattern. Moreover, this study identified Discussion and Conclusion: Patients with NF2 have several limitations to the use of the STREAM in practice, Conclusion: Within primarily inpatient settings, stroke Discussion and Conclusion: impaired dynamic vision, and poor static and dynamic including substantial clustering of scores resulting in limited patients use their a§ected arm just over half as much as their Our findings suggest that the CAT-FAS is promising for balance in comparison to patients with isolated peripheral discriminative power, and insucient reliability. non-a§ected arm. ActivPAL3™ accelerometers show good precisely, eciently, and validly assessing patients’ UE/LE vestibular disorders and to age-matched older adults. The · compliance. motor function, balance, and BADL. Moreover, the CAT-FAS measures deployed in this study may assist in screening is recommended as an outcome measure to detect subtle falls risk, triaging for appropriate therapy, and in evaluating functional changes in patients with stroke. pharmacotherapy. Most of the study participants were receiving a new pharmacological treatment (Avastin) indicating a particularly high tumour burden and thus limiting generalisability of results. Further testing of the psychometric properties of these measures is warranted in a larger sample. ·

109 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 110 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Comparisons of the responsiveness Quantifying the free-living sit-to- Investigating the sensitivity of Changes in ankle kinematics over the of the Berg Balance Scale and stand and stand-to-sit transitions measures of postural stability: the duration of a Six Minute Walk Test in Postural Assessment Scale For [215] use of inertial measurement units people with Multiple Sclerosis [171] Stroke Patients to their short forms [13] Prof Malcolm Granat1, Dr Chris Pickford1, Dr Kristen Ms Georgia Andreopoulou1, Dr Judy Scopes1, Ms Brikena [78] 1 2 3 1 2 1 Hollands , Dr Matthew Banger , Dr Terrence Quinn , Dr Andy Mr Antoine Brabants2, Prof Jim Richards1, Dr Kevin Campbell , Dr Julie Hooper , Prof Thomas H. Mercer , Dr 2 1 3 1 1 1 1 1 Kerr Deschamps , Dr Jessie Janssen , Dr Ambreen Chohan , Dr Marietta L. van der Linden Ms Yi-Jing Huang , Mr Gong-Hong Lin , Dr Ching-Lin Hsieh 1University Of Salford, Salford, UK. 2University of Strathclyde, Glasgow, UK. 1Centre for Health Activity and Rehabilitation Research, Queen Margaret 1 1 School of Occupational Therapy, College of Medicine, National Taiwan 3University of Glasgow, Glasgow, UK. Louise Connell University, Musselburgh, UK. 2NHS Lothian, Edinburgh, UK. University, Taipei City, Taiwan. 1University Of Central Lancashire, Preston, UK. 2Parnasse – ISEI, Brussels, Belgium. 3KU Leuven, Leuven, Belgium. Background: Standing up and sitting down are two of Background: A lack of evidence for the comparisons of Background: Many people with multiple sclerosis (pwMS) the most demanding and common manoeuvres that an responsiveness among the Berg Balance Scale (BBS), Background: Ability to measure change is important in report foot drop, which increases over the duration of a individual performs, and are important for maintaining Postural Assessment Scale for Stroke Patients (PASS), their rehabilitation, with wearable sensors having the potential certain task such as walking, which can be a sign of motor functional independence. Their deterioration may indicate simplified 3-point scales (BBS-3P and PASS-3P), and short to improve traditional measures of postural stability. Pelvis fatigability. the onset of frailty, and physical and cognitive decline. forms (SFBBS and SFPASS) can impose diculty when acceleration has been demonstrated to be more sensitive Currently, there has been no work in quantifying these selecting the most optimal balance outcome measure. compared to traditional force plates measures, however the Aim: The aim of this study was to quantify motor fatigability transitions in the free-living condition. use of measures of angular velocity has been largely ignored. as an increase in the degree of foot drop over the duration of Aim: We aimed to compare the responsiveness of the BBS a 6 minute walk test (6minWT) in pwMS. Aim: We aimed to quantify sit-to-stand (Si-St) and stand- and PASS to those of the simplified 3-point scales and short Aim: This study aimed to assess pelvis acceleration and to-sit (St-Si) transitions using accelerometer data derived forms at both group and individual levels in patients with angular velocity data using inertial measurement units in Method: Fifteen pwMS took part in a single visit. Sagittal from a thigh-worn activity monitor and use velocity of these stroke. healthy individuals during two balance conditions to identify ankle kinematics were recorded during the 6minWT using transitions to look at the way in which healthy volunteers and the most sensitive measures of postural stability. an ankle electrogoniometer. Ankle angle at initial contact stroke survivors performed these manoeuvres. Methods: The data were retrieved from a previous study (AAIC) and peak dorsiflexion in swing (DFswing) were wherein a total of 212 patients with stroke were assessed Method: We recruited 17 healthy individuals (9 males and derived for 10 gait cycles of the first and last minute to Methods: Free-living Si-St and St-Si acceleration data at both 14 days and 30 days after stroke. Group-level 8 females) aged between 18 and 65. Participants were quantify the change in foot drop. Participants also rated their were recorded from 21 healthy volunteers and 33 stroke responsiveness of the 6 scales was calculated by the free from musculoskeletal injuries or neurologic disorders. perceived exertion (RPE). survivors using activPAL3 activity monitors over a seven- standardized response means (SRMs). Individual-level Participants were asked to perform a single-leg stance on a day period. Thigh inclination was calculated from the 3-axis responsiveness was calculated by the proportions of patients thin carpet (Firm) and on an Airex Balance-pad (Foam) on Results/findings: Group results for gait kinematics showed accelerometer data, and the peak velocity derived. Individual whose change scores exceeded the minimal detectable each leg while a Delsys sensor (Trigno™ System, Delsys Inc.) an average decrease at the end of the 6minWT of 1.4° and mean velocities were compared between populations. change of the 6 scales. Group- and individual-level was attached on their pelvis. 1.6° for AAIC and DFswing respectively, however only the responsiveness was compared using bootstrap approach. decrease in DFswing was statistically significant (p=0.003). Results: A total of 10,454 transitions (Si-St and St-Si Results: Significant di§erences were seen between the two The RPE at the sixth minute [mean=12.1(sd=2.4)] was combined) and 11,237 transitions were recorded in healthy Results/ Findings: At the group level, the BBS-3P, PASS, surfaces for the pelvis accelerations and angular velocity data statistically higher than the RPE at the first minute volunteers and stroke survivors, respectively. Healthy PASS-3P, and SFPASS (SRM=0.57-0.65) were significantly in all three planes (p<0.01). Linear acceleration showed a [mean=7.9(sd=1.8)] of the 6minWT (p<0.001). Based on volunteers had significantly higher overall mean peak velocity more responsive than the other scales (SRM=0.50-0.58). At 58%, 4%, 44% change in the three directions between firm the spatiotemporal parameters pwMS walked with reduced for both transitions compared with stroke survivors (healthy, the individual level, the BBS-3P, PASS, and PASS-3P (48.1%- and foam surface. The most sensitive measures in relation cadence and increased stance phase at the end of the ~75 deg/sec versus stroke, ~45 deg/sec; Si-St, p<0.01 and 58.0%) showed significantly superior responsiveness to the to percentage change and e§ect size were found from the 6minWT. St-Si, p<0.01). Peak velocity of transition was associated with other scales (36.3%-42.5%). angular velocity data, with 166%, 280%, 363% changes increased variation in peak velocity for both groups. in the sagittal, coronal and transverse planes of the pelvis Discussion and conclusion: DFswing was significantly Discussion and Conclusion: The BBS-3P, PASS and PASS-3P respectively. lower at the end of the 6minWT which is in agreement with Discussion: Si-St and St-Si transitions could be quantified showed the best responsiveness at both group and individual previous studies. Future studies should consider a longer and there were significant di§erences in the peak velocity levels. In addition to the simplicity of the scoring criteria of Discussion and conclusion: Angular velocity of the pelvis duration or faster speed tests in order to provide a clear between the groups. Variation in an individual’s peak the BBS-3P and PASS-3P, we suggest using the BBS-3P and was more sensitive to change and discriminative than insight of motor fatigability in pwMS and whether it can be velocity may be associated with the ability to perform these PASS-3P as outcome measures to sensitively detect group linear acceleration during two balance tasks in healthy a§ected by treatment options of foot drop such as FES. transitions. This could be used to monitor functional decline change and individual patients’ progress for inpatient stroke individuals. Further investigation in patient populations · and also determine the e§ectiveness of interventions. rehabilitation. and implementation issues for clinical practice should be · · considered. ·

111 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 112 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Prosthetics & Orthotics Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment Physical Rehabilitation & Exercise: Assessment A service evaluation of mirror The development of a wearable An optimal protocol for estimating A comparison and clinical use of therapy in an out-patient lower limb sensor to capture the free-living knee joint centre using functional measuring techniques of conduction prosthetics clinic [202] ambulatory profile of gait impaired methods [223] time in the cauda equine [149] users [233] [Work in Progress] Mrs Annegret Hagenberg1, Ms Marion Gimson2, Dr Dr Lin Meng1, Dr Craig Childs1, Dr Arjan Buis1 Dr Ana Golež1, Assist. prof. dr. Blaž Koritnik, Assist. prof. dr. Kristo§er Bothelius3, Dr Louise Connell4 1 1 2 1,2 1 2 University Of Strathclyde, Glasgow, UK. Zoran Rodi University Of Leicester, Leicester, UK. Physiotherapy, Specialist Mobility Dr Nicholas Smith , Dr Andy Kerr , Dr Douglas Maxwell , Dr 3 1Clinical Institute of Clinical Neurophysiology, University Medical Cetre, Centre, Chas. A. Blatchford & Sons, Leicester, UK. Department of 2 4 David Loudon Ljubljana, Slovenia. Psychology, Uppsala University, Uppsala, Sweden. School of Health Science, 1University Of Strathclyde, Glasgow, UK. 2PAL Technologies Ltd, Glasgow, Background: Gait analysis is a common clinical tool to University of Central Lancashire, Preston, UK. UK. evaluate the rehabilitation outcomes of patients with Background: Because of the aging population, there is an walking dysfunctions. Errors associated with skin movement Background: Unpleasant phantom perceptions occur in increasing number of patients with intermittent neurogenic Background: Personal wearable activity trackers (e.g. Fitbit) and anatomical landmark displacement can lead to the most people with amputations. Mirror therapy (MT) is used claudication because of lumbosacral spinal stenosis. We allow free-living measurement of ambulatory activities. misallocation of the functional joint centres, which has the in various ways to treat phantom pain by representational have no clinically useful electrophysiologic examination for However, they lack the sensitivity to accurately capture the potential to influence measurements of joint angles and restitution of the missing limb. The evidence is promising measuring conduction time in the cauda equina. slow-stepping of people with gait impairments. The US moments. The reduction of these errors is a high priority in but incoherent. Detailed reports from practice are rare but Department of Veterans A§airs, acknowledging the potential gait analysis to enhance clinical decision-making. Functional needed to inform research design. of activity trackers for lower-limb prosthetic rehabilitation, methods enable the localisation of more accurate hip Aim: The aim of our study was to compare di§erent techniques for measuring conduction time in the cauda o§er reimbursement for devices which meet specific clinical joint centres compared to regression prediction methods. Aim: To report treatment outcomes, compliance and equina and to present an example of the method for a routine criteria. However, the accuracy of determining the functional knee practicalities encountered in MT practice at a prosthetics diagnostic procedure for these patients. joint centre (FKJC) has not been investigated. mobility service Aim: To develop a wearable device to capture clinically useful Method: Percutaneous electrical stimulation, percutaneous information on impaired gait, and present this in an intuitive Aim: We aim to determine an optimal protocol for FKJC Method: Retrospective review of treatment records was magnetic stimulation of the cauda equina and measuring fashion to both clinicians and patients. estimation. conducted from 9 consecutive patients following a service compound muscle action potentials and F-waves (peripheral implementation of MT over 2 months. One session and a motor conduction time) were used. Conduction time in the Methods: To capture clinically relevant data, an inertial Method: Experiments were conducted using two rigid patient-led home programme were o§ered with follow-up cauda equina was calculated at rest and after 10 minutes of measurement device is being developed. As such devices segments representing a femur and a tibia that were appointments, using just looking, movement, objects and walk. have high power consumption, and aren’t compatible with connected using a hinge joint to simulate the knee. Clusters sensory stimulation as deemed suitable. long-term monitoring, a protocol that captures basic data at consisting of four markers on each rigid plate were placed at Results: 36 healthy volunteers, and 25 patients with typical low-power throughout the day, and intelligently punctuates the frontal and lateral sides of each segment. A 12-camera Findings: Straight-forward improvements were recorded clinical symptoms of lumbosacral spinal stenosis, were this at key moments with detailed data, has been developed. Vicon optical tracking system was used (capturing at 100 for two patients: daily pain relief to improve sleep at night included. In healthy subjects there were no statistically Hz). Four algorithms, sphere fitting (SF), geometrical SF, and restauration of normal limb length. Three patients may significant changes in cauda equina conduction time after Results: Sensor location is key to quantifying the subtle centre transformation technique (CCT), and symmetric have required more guidance, as pain increased temporarily electrical stimulation (2.9 ± 1.6 ms) and magnetic stimulation accelerations of slow-stepping. We found thigh-mounted centre of rotation estimation (SCoRE), were tested using with the home programme - but for two patients this was (3.4 ± 1.3 ms) at rest, but it was statistically significantly sensors to have a peak magnitude of 30% of the acceleration marker data from di§erent clusters. balanced with alterations of the technique, equipment and longer in patients with lumbosacral spinal stenosis (5.2 ± 1.2 measured at the foot, while the trunk signal was below positioning at the clinic. Two patients had initial benefit ms) after a 10-minute walk. the sensor resolution. Furthermore, wrist placement was Results: The results show that the CCT is the best but did not continue at home. Finally, two patients su§ered dominated by noise from upper body movement. We found performing algorithm among all algorithms chosen. It emotional distress on seeing the limb and loss of movement Discussion: Magnetic stimulation of the lumbosacral spine shank placement to be optimal, o§ering minimal acceleration achieves the best prediction with an error up to 2mm when ability coinciding with pain relief. Medical and personal can reliably evoke motor responses in the abductor hallucis dissipation (54% of foot) while also providing dynamic the frontal femur cluster and lateral tibia cluster were utilised. problems as well as lack of appeal of MT often restricted muscle, yielding a good estimation of conduction time in the angular data, allowing pathological segment orientation to be continuation. determined, not available with foot mounting. Discussion and conclusion: We analysed and compared cauda equina. We noted statistically significantly prolonged cauda equina conduction time in patients with intermittent functional methods and marker cluster placements for the Discussion: Despite the limitations of a retrospective neurogenic claudication due to lumbosacral spinal stenosis Discussion and Conclusion: We have demonstrated the determination of FKJC in mechanical experimental set-up. review of notes, the multitude of treatment factors involved after a walk in comparison to being at rest and to healthy feasibility of using a shank mounted sensor to quantify An optimal protocol for FKJC estimation was determined. was apparent. An interdisciplinary research approach participants. We got the best sensitivity and specificity after the free-living ambulatory profile of people with gait · and development of standardised outcome measures to magnetic stimulation of the cauda equina after a 10-minute impairments. Using wireless communication, this profile may capture the variations are needed. This complex intervention walk. be analysed and presented in a timely and clinically relevant requires further development before the e§ectiveness can be manner, intuitive to both clinician and patient. suciently assessed. ·

113 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 114 Poster Presentations Poster Presentations

26 - 27 May 2017 Prosthetics & Orthotics 26 - 27 May 2017 Prosthetics & Orthotics 26 - 27 May 2017 26 - 27 May 2017 Patient Experiences, Partnership Working & Prioritisation Patient Experiences, Partnership Working & Prioritisation Congenital absence of the ﬁbula: The eect of an external breast Excellent results following prosthesis on muscles spine activity Building partnerships between Shared understanding about amputation with severe limb during functional body tests in post- professionals and rehabilitation rehabilitation is built in partnership deformity [205] mastectomy women [36] clients [43] [64]

1 2 1 Dr Simon Shaw1, Mr Peter Calder2, Mr Andy Roberts3, Miss Dr Katarzyna Hojan1, Dr Faustyna Manikowska2 Mrs Niina Henttonen , Mrs Elina Huttunen , Ms Maria Mrs Niina Henttonen 3 1 2 1 1 1Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Muhonen Kiipula Foundation, Finland. Sally Tennant , Dr Imad Sedki , Prof Rajiv Hanspal , Miss 2 1 2 2 Poland. Motion Analysis Laboratory,Department of Pediatrics Orthopedics Kiipula Foundation, Finland. KELA, The Social Insurance Institution of Deborah Eastwood and Traumatology, Poznan University of Medical Sciences, Poznan, Poland. Finland. 3Social Services in the City of Jyväskylä, Finland. 1The Limb Rehabilitation Unit, Royal National Orthopaedic Hospital, London, Background: The relationship between professional and UK. 2The Catterall Unit, Royal National Orthopaedic Hospital, London, UK. Background: When the relationship between professionals rehabilitation client plays an important role in the recovery 3DMRC Headley Court, Epsom, UK. Background: Recent papers indicated that one-sided and rehabilitation clients is based on partnership, there is process. Recovery can be promoted focusing on this mastectomy, as well as wearing an external breast an appreciation for both parties’ expertise and it has an relationship. Background: Complete fibula absence presents with prosthesis, may produce deleterious e§ects on posture and empowering impact for clients. Partnership also enables significant lower limb deformity. A good functional the musculoskeletal system. clients to be active actors in their rehabilitation processes, as Aim: The aim of the study was to promote recovery in outcome can be achieved through parental counselling and it is required in the new paradigm on rehabilitation. partnership built between rehabilitation professionals and multidisciplinary collaboration. Amputation o§ers a definitive Aim: This study aimed to evaluate the changes in their clients. The purpose was to produce a description of treatment with minimal complications. electromyographic (EMG) activity of the erector spinae Aim: The aim was to study partnership from three di§erent a shared understanding of rehabilitation and describe good muscles in post-mastectomy women and after wearing perspectives. The first study produced a description of a partnership practices at Kiipula Rehabilitation Centre. Aim: This study compares outcomes with an amputation breast prostheses of di§erent weights during functional body shared understanding of rehabilitation and a description protocol to those using an extension prosthesis. movement tests. of good partnership practices by which rehabilitation can Methods: Action research approach was applied. A be promoted in Kiipula Rehabilitation Centre. The second multidisciplinary development team was assembled from Method: 32 patients were identified. 9 patients (5M: 4F) Methods: 51 women with one-sided mastectomy without study produced a description of factors that enhance a ten rehabilitation workers. The rehabilitation clients (n=24) (median age now 23 and 22yrs at presentation) utilised an back pain had spinal muscle activity of their bilateral erector child’s agency and thereby also partnership in rehabilitation. participated in the development process as producers extension prosthesis. 23 patients (16M: 7F), median age spinae measured by EMG. The levels of muscle activation The third study produced a description of how to enable of knowledge and additionally collaborated with the now 8 years and 10 months at presentation underwent 24 were compared between both sides of the body during partnership in service development in social and health care professionals. Data were collected using a variety of co- amputations during childhood: 21/23 had no tibial kyphus the execution of the dynamic EMG tests, assessed during services. configuration methods and were analysed by using inductive correction. Mobility was assessed using SIGAM and K symmetrical and asymmetrical tasks in both static and driven content analysis. scores. Quality of life was assessed using a PedsQL inventory dynamic activities with di§erent weight of breast prostheses. Methods: Action research approach was applied in all questionnaire; pain by a verbal severity score. Range-of-motion measurements were taken for forward three studies. Mixed methods were used in data collection: Results: A shared understanding about rehabilitation was bending, backward bending, lateral bending, and rotation. 1) co-configuration methods with rehabilitation clients formed on the basis of the viewpoints of both professionals Results: 19 Syme and one Boyd amputation in 19 patients and professionals, 2) narrative literature review, 3) and rehabilitation clients. The shared understanding of were performed early (median age, 1 year). 3 Syme and Results: The di§erences in level of erector spinae activity photographing, 4) theme interview. Data were analysed rehabilitation involved maintaining conditions for the upkeep one trans-tibial amputation in 4 patients took place in older during trunk movements with di§erent types of external by using inductive and theory driven content analysis and of working capacity, increasing personal resources and children (mean age 6.6 years). breast prostheses were not statistically significant. The deductive thematising. making positive changes compared to earlier approaches. K Scores (mean 4 versus 2) and pain scores were weight of the external prosthesis did not a§ect the symmetry Good existing practices included: having a personal instructor significantly higher lower in the amputation group allowing of the activation level of erector spinae muscle between sides Results: The main results of these studies showed that for the rehabilitation process, conversations between the high impact activity following amputation compared to of the body. The di§erences between mean muscle activation partnership between professionals and rehabilitation clients rehabilitation client and a multidisciplinary team, giving community ambulation with an extension prosthesis. The levels during wearing prostheses of di§erent weights were must be confidential, personal and reciprocal. Exploitation responsibility to the rehabilitation client, and setting targets. SIGAM and PedsQL scores were all better in the amputation not statistically significant on the same side of the erector of digital technology should be included in rehabilitation The necessary partnership practices included: an online group, but not significantly. spinae muscle in functional tests. processes. Mutual targets of rehabilitation are needed to community, exploitation of digital technology, and a personal These findings are integral for the development of best build partnership between professionals and rehabilitation and confidential relationship between the rehabilitation client Discussion and Conclusion: This study provides outcome standards of practice in the supply of prostheses for women clients. and the professional. data to inform parents considering the dicult option of post-mastectomy. amputation surgery which has excellent short term functional Conclusions: Shared understanding about rehabilitation is Conclusions: Shared understanding about rehabilitation outcome with prosthetic support. The tibial kyphus does not Conclusion: Wearing breast prostheses of di§erent weights built on partnership. Partnership is a dialogic relationship is achieved only if rehabilitation clients and professionals need routine correction and facilitates prosthetic suspension. did not a§ect changes of erector spine muscle activity in in which shared understanding doesn’t mean united work as partners. A shared understanding of rehabilitation An accommodative extension prosthesis o§ers reasonable functional tests. perspectives, but finding mutual new perspective on is important for the mutual target setting and promoting long term function but outcome scores are lower; however rehabilitation. recovery. age was a significant confounding variable. · · ·

115 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 116 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 Patient Experiences, Partnership Working & Prioritisation Patient Experiences, Partnership Working & Prioritisation 26 - 27 May 2017 26 - 27 May 2017 Patient Experiences, Partnership Working & Prioritisation Patient Experiences, Partnership Working & Prioritisation Supporting the child’s participation Factors associated with stress in and inclusion in their everyday life - children receiving rehabilitation [60] Revolutionising rehabilitation The contribution of patient and perspectives of parents, therapists in critical care (CC): The role of public involvement in designing Dr Sung Hyun Kim1 and teachers [156] 1Asan Medical Center, Seoul, South Korea. Therapy Support Workers (TSW) an intervention for stress urinary [14] incontinence in women [177] 1 Mrs Anu Kinnunen Objective: The aim of this study is to investigate factors [Work In Progress] 1Savonia University Of Applied Sciences, Kuopio, Finland. 1 2 associated with stress in children receiving rehabilitation, and Mrs Eleanor Douglas , Mrs Cath McLoughlin , Mr John 2 Ridgway 1 1 discuss the relationship between stress in children and in 1 Professor Catherine Sackley , Dr Sarah McLachlan Backround: This study was undertaken in a regional project University of Nottingham/Nottingham University Hospitals NHS Trust, 1Department of Physiotherapy, King’s College London, London, UK. caregivers. 2 “Pönkkää Lapsen Osallisuuteen” in Northern Savo area in Nottingham, UK. Nottingham University Hospitals NHS Trust, Nottingham, UK. Finland. It focuses on children’s own participation in their Method: This study was a prospective study. Children, Background: Stress urinary incontinence (SUI) is the most everyday life. The main target group was parents, therapists whose ages were between 18 months and 18 years and who Background: Consistently providing the UK nationally common form of urinary incontinence in women. It is and teachers of a child with special needs in school age. received rehabilitation, and their caregivers were enrolled. recommended rehabilitation guidelines to provide 45 associated with poor quality of life, avoidance of physical The Korean versions of the Child Behavior Checklist and the minutes of each indicated therapy 5 days a week to patients activity and financial burden. Although pelvic floor muscle Aim: The aim of this project was to find best practice to Adult Self Report were used to assess stress in children and recovering from critical illness was identified as an area of training (PFMT) is e§ective in preventing and treating SUI, support children’s participation in their everyday life and how their caregivers. The Beck Depression Inventory was used to service improvement by the therapy team. few women seek help. Research has indicated promise in adults can work together in a more supportive way. assess depressive mood of the caregivers, and questionnaires PFMT interventions delivered outside health settings, but it is were distributed to caregivers, in which questions included Aim: This project aimed to improve patient outcomes by critical to involve patients and the public in developing such Method: The data were collected from parents, therapists marital status, education level, duration of caregiving to increasing the frequency and intensity of early rehabilitation. interventions. and teachers in Northern Savo area through group children, and annual income. Information about the number discussions. There were 10 participants. Groups gathered five of rehabilitation therapies, the number of rehabilitation Methods: The Trust’s ‘Dragons Den’ initiative funded the Aim: To involve patients and the public in developing a times during 2015 to 2016, starting in December 2015 and institutes, home treatment by caregivers, and their diagnoses employment of two TSW for one year. The TSW delivered funding application for a PFMT intervention for SUI, to be ending in April 2016. These discussions were transcribed and were also collected. individually prescribed rehabilitation programmes under the delivered through hairdressing and beauty salons. analysed. supervision of registered therapists. Physical and cognitive Results: Thirty nine children and their caregivers were patient outcomes were collected at the initial and final Method: PPI representatives were recruited through a UK Results: The results showed that key in supporting a child’s included. Most of the children had more behavioural treatment. Length of stay in CC was collected and compared charity website, Beauty Therapy Association newsletter, and participation or inclusion is recognising the personality of the problems than typically developing children. Twenty nine retrospectively to data from the previous year. letters to hairdressing salons. Discussions with researchers child. Adults should listen to understand him/her and explore children had internalising problems and 25 children had initially took place on the telephone, followed by a face-to- what is truly meaningful for the child. It is relevant how we externalising problems. Relationships between stress of the Results/Findings: The service met the national guidance face advisory group meeting. listen and communicate with the child. Also important is children and their caregivers were investigated: internalising for 284 patients. These patients demonstrated a clinically to see the child as a member of a group of children in their problems of children was associated with the total problems significant mean improvement from baseline to discharge Results: Eight women with SUI, two beauticians and one natural environment. Adults working together should create a of caregivers, internalising problems of caregivers and in the Chelsea Critical Care Physical Assessment Tool (5.7 salon manager contributed to the funding application. meaningful way to work together and focus on the language externalizing problems of caregivers; internalising problems – 24.7), Functional Independence Measure and Functional Discussions confirmed the perceived need for an intervention they speak with each other and with the child. of caregivers was associated with the total problems of Assessment Measure (125.6) and a positive trend was in the community and indicated that women would feel children, and internalising problems of children . observed between earlier rehabilitation and the first day the comfortable being approached by their hairdresser or Discussion: A child with special needs should be seen as patient stood. The mean length of stay in CC reduced from beautician. The beauticians and salon manager advised an individual and unique person with their own voice. Adults Conclusion: Children receiving rehabilitation are more 5.1 days in 2014 to 4.2 days in 2015. that it would be feasible to deliver the intervention through around the child should create new meaningful methods stressed than typically developing children, and it is salons. PPI representatives influenced the intervention design to support the child growing up as a member of society. associated with stress of their caregivers. Discussion and Conclusion: Service evaluation data by suggesting that one arm of the trial should be dropped, Working together for the child means seeing, speaking and indicate that increasing the frequency and intensity of early and their comments also helped to determine mode of appreciating each other and the child. rehabilitation has positive functional outcomes for patients intervention delivery and outcome measures. and reduces length of stay in CC. The employment of TSW in CC appears to be a cost-e§ective way to improve the Discussion: PPI representatives played a critical role in quality and frequency of rehabilitation delivered to patients shaping the development of the grant application for a PFMT recovering from critical illness. Further investigation is intervention. Involvement will continue through activities warranted regarding the patients hospital length of stay and such as designing participant materials, data analysis and long term outcomes. dissemination of findings. · ·

117 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 118 Poster Presentations Poster Presentations

26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 26 - 27 May 2017 Family/Carer/Peer Involvement Patient Experiences, Partnership Working & Prioritisation Patient Experiences, Partnership Working & Prioritisation Patient Experiences, Partnership Working & Prioritisation A Cluster Randomised Controlled Co-creation in the UX design of the “It all depends on yourself” – the Designing barrier-free websites for Trial (cRCT) with embedded process Abilitator, an online self-assessment challenge of supporting work people with intellectual disabilities: evaluation: Organising support questionnaire supporting social ability through collaboration and How can people with intellectual for carers of Stroke survivors inclusion and employability [106] rehabilitee’s activation [183] disabilities participate in research? (OSCARSS) [178] [Work in Progress] [Work in Progress] [227] 1 1 Mrs Hilkka Ylisassi , Mrs Erja Sormunen , Mrs Eija Mäenpää- Dr Emma Patchick1, Ms Katy Rothwell1, Ms Kate Woodward- 1 1 1 Senior Specialist Jussi Konttinen1, Psychologist Matti Moilanen , Mr Jouko Remes , Mr Kari-Pekka Martimo Marie Heide1, Elena Brinkmann1, Lena Bergs1, Prof. Dr. Nutt1, Dr Sarah Rhodes2, Dr Gail Ewing3, Professor Gunn 1Finnish Institute Of Occupational Health, Helsinki, Finland. Joensuu1, Senior Specialist Pirjo Juvonen-Posti1, Research Mathilde Niehaus1 Grande4, Professor Audrey Bowen1 1 1University of Cologne, Unit of Labour and Vocational Rehabilitation, 1on behalf of the NIHR Collaboration for Leadership in Applied Health Scientist Miia Wikström , Project Manager Minna 2 2 Background: A customer’s activity plays a central role in Cologne, Germany. Research and Care (CLAHRC) Greater Manchester, Manchester, UK. Centre Savinainen for Biostatistics, Faculty of Biology, Medicine and Health, The University of 1 2 the process of rehabilitation. When the societal aim is to Finnish Institute of Occupational Health, Helsinki, Finland. Finnish Institute Manchester, Manchester, UK. 3Centre for Family Research, University of of Occupational Health, Tampere, Finland. improve work ability, the plan is to support the active role of a Background: Many people with intellectual disabilities have Cambridge, Cambridge, UK. 4Division of Nursing, Midwifery & Social Work, customer through the collaboration across stakeholders. been and still are excluded from an active involvement in University of Manchester, Manchester, UK. Background: The European Social Fund (ESF) Priority 5 recent research – the research is rather about them but not programme supports the employability and social inclusion Aim: We studied the stakeholders’ views on collaboration with them. Representatives of participation-oriented research Background: The Carer Support Needs Assessment Tool of groups in risk of marginalization. In Finland The Social and the role of a rehabilitee in the rehabilitation process. approaches and self-help movements call for more inclusion (CSNAT), developed in palliative care, provides a framework Inclusion and the Changes in Work Ability and Capacity of people with intellectual disabilities, with little e§ect so far. for comprehensive, carer-led, needs assessment and support (SOLMU) project develops a self-assessment questionnaire, Method: We interviewed nine rehabilitees and their provision. The framework has been adapted for stroke the Abilitator, for measuring the work ability and functional supervisors, the representatives of their occupational health Aim: In accordance with the Committee on the Rights of through collaboration with researchers, Stroke Association capacity of the participants in ESF projects. services and rehabilitation. Rehabilitees were attending Persons with Disabilities (CRPD), the project Online-Dabei and a service user group of carers. a one-year course for employees with musculoskeletal pursues a participatory approach to develop websites that fit CSNAT-Stroke will be implemented within commissioned Aim: To build a web application of the Abilitator and disorders. Qualitative methods were used to categorise the the specific needs of people with intellectual disabilities. services delivered by the Stroke Association and evaluated in to ensure the adoption of the application by good user opinions concerning collaboration and the role of rehabilitees. OSCARSS. experience (UX) design. Methods: As a first step, expert interviews were conducted Results: The stakeholders rated collaboration as important to figure out criteria of accessibility. The interview guidelines Aim: To explore the e§ectiveness of CSNAT-Stroke for Method: We use a multi-actor co-creation approach where for the fluent process. Collaboration was seen as transferring were based on the criteria of BITV 2.0/WCAG 2.0 and carers of stroke survivors, compared to a control of standard experts, scientists and an agile software development team information, and only rarely as shared activity between included individuals with intellectual disabilities as experts practice. work closely together engaging users and other stakeholders the stakeholders. Stakeholders even reported that there in their own cause. As a second step, a reference group of by workshops and interviews. was no need for collaboration during rehabilitation. Both about 10 young people (aged 17-25 years) with intellectual Method: OSCARSS is a mixed-methodology, longitudinal, the rehabilitees and the other stakeholders strongly disabilities was implemented to discussing barriers and multi-site cluster randomised controlled trial (cRCT) with Results:The first version of the application has been emphasised the responsibility and active role of the providing solutions for barrier-free websites. health economic analysis, qualitative interviews and an published in Finnish, Plain Finnish and English and it is rehabilitees themselves in taking care of their work ability. embedded process evaluation. Stroke Association services currently used in ESF projects in Finland. The focus of this In this connection, an active role was related mainly to the Results: During the expert interviews and the reference form clusters(N=36), that have been randomised to version was on a user-friendly, straightforward questionnaire improvement of physical condition. group, the participants mentioned barriers and solutions either CSNAT-Stroke(N=18) or standard practice(N=18). with plain, minimalistic appearance. regarding the usage of language and the construction of Sta§ training will be completed before clusters go ‘live’ to Discussion: In line with the present trend in rehabilitation, navigation. The most important points are: less text on a deliver carer support as per allocation and invite carers to Discussion and Conclusion: To get these hard-to-reach the stakeholders emphasise the rehabilitee’s active role. website and more headings and subheadings; explanations OSCARSS. The cRCT will measure perceived carer burden; groups to use the application, it has to be usable and Despite this, collaboration across stakeholders actualised of dicult words, for example in a glossary. health; satisfaction; well-being; economic burden in terms of accessible. It also has to be useful and credible. Prioritising inadequately. As rehabilitees’ active role refers to informal care provision and healthcare utilisation; Qualitative the most needed features is a challenge. It is dicult to solve improving physical condition, the impact of work on work Discussion and Conclusion: The main objective of our interviews will explore carer experience and perceptions of all UX challenges at once, making incremental development ability remained aside. In order to improve work ability, research approach, i.e. the involvement of participants with impact. Carer needs identified and support inputs provided a necessity. Early and frequent co-creation with users has rehabilitation should focus on work in addition to functional intellectual disabilities, can be considered successful. The will inform future service development. Participating carers been beneficial. The application will be further developed ability. Impacts on workplace require interaction between young people were more confident over the course of time; will be followed up for six months. The process evaluation during 2017 and the validity, reliability and responsiveness stakeholders. It is possible to create forms and sites for they were interested in the topics and participated actively. will collect quantitative and qualitative data to explore of the questionnaire will also be studied. Further studies collaboration, e.g. by structural changes in the rehabilitation · intervention fidelity and sta§ experiences. will show whether it is possible to achieve improvements process. in social inclusion of hard-to-reach groups with co-created · Results: Ethics has been secured and clusters have been online services with strong focus on UX design. randomised. As of 23 January 2017, 19/36(53%) clusters · have been trained. Training will be followed by a 15 month data collection period, aiming to recruit 972 carers across both arms of the trial.

Conclusion: Training is ongoing and results will be available in 2018.

119 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 120 Poster Presentations Poster Presentations

26 - 27 May 2017 Family/Carer/Peer Involvement 26 - 27 May 2017 Family/Carer/Peer Involvement 26 - 27 May 2017 Family/Carer/Peer Involvement 26 - 27 May 2017 Family/Carer/Peer Involvement Biopsychosocial intervention for Identifying the needs of young carers “I’m trying to be the safety net”: Peer mentoring following acquired community-dwelling informal of stoke survivors (East Midlands); Family protection of patients with brain injury: a systematic review [67]

stroke carers (BISC): A feasibility phase two semi-structured moderate-to-severe TBI during the 1 1 [94] [33] [Work in Progress] [5] Mr Richard Morris , Dr Joanna Fletcher-Smith , Dr Kathryn Randomised Controlled Trial interviews hospital stay Radford1 [Work in Progress] 1University Of Nottingham, Nottingham, UK. Mrs Trudi M Cameron1, Dr Rebecca Fisher1, Prof Jo Aldridge2, Dr Tolu Oyesanya1, Dr Barbara Bowers2 1 1Shepherd Center, Atlanta, United States. 2University of Wisconsin-Madison, 1 1 1 Professor Marion Walker Background: There are approximately 350,000 hospital Dr Laura Condon , Dr Penny Benford , Sheila Birchall , 1 2 Madison, United States. 3 1 University Of Nottingham, Nottingham, UK. Loughborough University, admissions for acquired brain injury (ABI) related diagnoses Christine Cobley , Dr Rebecca Fisher , Dr Joanna Fletcher- Loughborough, UK. 1 4 1 annually in the UK. A significant number of people with Smith , Mr Chris Greensmith , Dr Eirini Kontou , Dr Niki Background: Research has shown that during the hospital 2 1 1 ABI require extensive rehabilitation. Peer mentoring is an Sprigg , Dr Shirley Thomas , Dr Phillip Whitehead , Prof Background: Little is known about young carers (<25 years) stay, family caregivers of patients with traumatic brain 1 innovative approach to promoting successful adjustment to Marion Walker who provide support for stroke surviving family members. injury (TBI) perceive one their roles is to protect the patient; 1University Of Nottingham, Nottingham, UK. 2Nottingham City Hospital, life after injury. Nottingham, UK. 3University of Sheeld, Sheeld, UK. 4Nottinghamshire Caring can be a positive experience, however some young however, research on this topic is limited. Healthcare NHS Foundation Trust, Nottingham, UK. carers experience detriment to their health, well-being, social Aim: This systematic review sought evidence for the engagement, educational attainment, and employment Aim: The purpose of this article is to describe family e§ectiveness of peer mentoring following ABI. The primary Background: Informal caregivers of stroke survivors are opportunities. Significant numbers of young carers do not caregivers’ experience of protecting patients with TBI during outcome of interest was participation in activities. at increasing risk of experiencing deterioration in their disclose their caring role, are not recognised as carers, and the hospital stay. physical and mental health, due in part to the increased load do not receive the statutory assessments and support to Methods: Literature searches were conducted using terms attributed to caring responsibilities. Current provision does which they are entitled. The impact of a stroke surviving Methods: Grounded theory was used to conduct twenty-four related to peer mentoring and any form of ABI. We searched not prioritise the biopsychosocial needs of stroke carers with family member, on children and young people identified from interviews with 16 family caregivers. 12 databases, two trials registers and PROSPERO. Studies few existing intervention studies. phase one of the study and the e§ect on their daily lives is of any design published up to 28.10.2016 were included, explored from the perspective of both the stroke survivor and Results/Findings: Findings showed family caregivers worked with abstracts and grey literature excluded. Two reviewers Aim: To assess the feasibility of delivering a needs-led the young carer. Expert views were also sought on needs and to protect the patient’s physical and emotional safety, using independently screened titles and abstracts, then full texts biopsychosocial intervention to community-dwelling informal services for young carers. some of the following strategies: 1) influencing the selection of shortlisted studies. One reviewer hand searched reference stroke carers. of sta§, 2) breaking the patient’s bad habits, 3) anticipating lists and citations. Two reviewers independently extracted Aim: To explore the lives of young carers of stroke survivors how to orchestrate the home environment, 4) connecting on data and assessed studies using the Mixed Methods Method: We are conducting a feasibility randomised in the East Midlands (UK). an emotional level, and 5) managing visitors. Appraisal Tool. controlled trial with a concurrent process evaluation. We aim to recruit 40 stroke survivor/carer dyads where the Methods: Mixed method exploratory sequential design; Discussion and Conclusion: The findings have practice Results/findings: The search returned 1,590 articles. After survivor is within 1 year of first stroke and being cared for at semi-structured interviews with stroke survivors and implications for educating interdisciplinary healthcare removal of duplicates 909 remained and 810 were excluded home. Dyads are randomised to either treatment (6-week their young carers, who were identified from phase one of providers about the experience of family caregivers, and on titles and abstracts. Of the 99 shortlisted, eight studies intervention) or control group (usual care). Treatment will the study. The viewpoints of experts were also explored for developing an adversarial alliance between healthcare met the inclusion criteria. Seven were conducted in the ideally be delivered in a group or, on exception, on a 1:1 basis. through semi-structured interviews. Audio recordings providers and family caregivers during the hospital stay, to United States and one in Canada, with a variety of study Treatment sessions cover: stress & coping, planning, problem were transcribed and analysed utilising inductive thematic improve support provided to them during this time. designs including two, small-scale, randomised controlled solving, & dealing with negative emotions. Outcomes are analysis. · trials (RCTs). The heterogeneity of methods and outcome assessed at 6 months and include measures of anxiety and measures meant that meta-analysis was not possible and it depression (HADS), cognitive function (MOCA), activities Findings: To date seven stroke survivors with 11 young carers was dicult to draw comparisons. However, positive results of daily living (Barthel Index), caregiver burden (CBS), and 10 experts have been interviewed. were shown in areas such as quality-of-life. and quality of life (EQ-5D). Ethical approval, REC (ref: 14/ EM/1264). Discussion and conclusions: Phase three of the study will Discussion and conclusion: There is a lack of high-quality emerge from the findings of phases one and two as analysis evidence for the e§ectiveness of peer mentoring after ABI. Trial Status: Recruitment is currently ongoing and is due is on-going. Overall findings will inform the development of Outcomes suggest this is a promising area for future research to end in July 2017. To date we have approached 93 stroke interventions to support young carers in the future. and large-scale RCTs are required. survivor/carer dyads, recruited 19 and followed up 16%. ·

Intervention delivery is currently underway in a group-based format, with full trial results due in December 2017.

Conclusion: The trial ﬁndings, along with a concurrent process evaluation addressing recruitment, implementation and treatment ﬁdelity, will determine whether it is feasible to conduct a powered study of this type in this population. ·

121 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 122 Poster Presentations Poster Presentations

26 - 27 May 2017 Family/Carer/Peer Involvement 26 - 27 May 2017 Communication & Swallowing 26 - 27 May 2017 Communication & Swallowing 26 - 27 May 2017 Communication & Swallowing A peer group intervention to support A multi-centre randomised ReaDySpeech computer therapy for Very Early Rehabilitation in SpEech unemployed young adults with controlled trial to compare the people with dysarthria after stroke: (VERSE) after stroke: trial progress mental health problems and learning clinical and cost eectiveness of could we recruit and retain to this and therapy fidelity status [102] di°culties [84] Lee Silverman Voice Treatment feasibility trial? [38] [Work in Progress] versus standard NHS Speech and Johanna Stenberg1, Mila Gustavsson-Lilius1, Tuula Mentula1, Mrs Claire Mitchell1,3, Stroke Association John Marshall Assoc Prof Erin Godecke1,11, Prof Elizabeth Armstrong1, Minna Parkkila1, Marika Ketola2, Erja Poutiainen1 Language Therapy versus control in Memorial Professor of Neuropsychological Rehabilitation Dr Tapan Rai2, Prof Sandy Middleton3, Assoc Prof Natalie 1The Rehabilitation Foundation, Helsinki, Finland. 2The Finnish Association Parkinson’s Disease (PD COMM) Audrey Bowen1, Professor of Rehabilitation Sarah Tyson2, Dr Ciccone1, Prof Audrey Holland4, Assoc Prof Anne Whitworth5, for Mental Health, Helsinki, Finland. [214] [Work in Progress] Paul Conroy1 Assoc Prof Miranda Rose6, Ms Fiona Ellery7, Prof Graeme 1Division of Neuroscience and Experimental Psychology, University of 8 9,11 10,11 2 Hankey , Prof Dominique Cadilhac , Prof Julie Bernhardt Background: Young adults with mental health problems or Manchester MAHSC, Manchester, UK. Division of Nursing, Midwifery 1 2 Prof Catherine Sackley1, Prof Marian Brady2, Dr Christina Edith Cowan University, Australia. University of Technology Sydney, & Social Work, University of Manchester MAHSC, Manchester, UK. Australia. 3Nursing Research Institute, St Vincent’s & Mater Health Sydney learning diculties are more likely to be unemployed. These 3 4 4 4 3 Smith , Dr Caroline Rick , Prof Carl Clarke , Smitaa Patel , Manchester Royal Infirmary, Central Manchester University Hospitals NHS 4 problems combined with long term unemployment can and Australian Catholic University, Australia. University of Arizona, US. Natalie Ives4, Dr Susan Jowett4, Max Hughes4, Rebecca Foundation Trust MAHSC, Manchester, UK. 5Curtin University of Technology, Australia. 6La Trobe University, Australia. marginalise young adults in society. New approaches are 4 4 5 7Neuroscience Trials Australia, Australia. 8School of Medicine and Woolley , Pui Au , Dr Patricia Masterson Algar , Prof 9 needed to support those young adults. 5 Background: Dysarthria, disordered speech production Pharmacology, The University of Western Australia. Monash University, Christopher Burton Australila. 10The Florey Institute of Neuroscience and Mental Health, 1 2 resulting from neuro-muscular impairment, is common King’s College London, London, UK. Glasgow Caledonian University, Australia. 11Centre of Research Excellence in Stroke Rehabilitation and Brain 3 4 Aim: : To evaluate the potential of a professional-led peer Glasgow, UK. University College London, London, UK. University of after stroke. This causes significant problems for patients Recovery; The Florey Institute of Neuroscience and Mental Health, Australia. group intervention to support unemployed young adults. Birmingham, Birmingham, UK. 5University of Bangor, Bangor, UK. a§ecting intelligibility, psychological well-being and social engagement. An on-line therapy programme, ReaDySpeech, Background: Limited evidence is available to support very Background: Many people with Parkinson’s experience Method: The participants were unemployed adults of the which may support intensity/duration of intervention, has early intensive aphasia rehabilitation as a best-practice communication and voice problems Evidence to underpin age of 18–25 years, who had mental health problems or/ been used in this feasibility trial and we report our initial standard stroke care; therapy fidelity is rarely reported in the delivery of SLT for people with Parkinson’s is limited. and learning diculties. Three peer support groups were ran findings. aphasia research. This omission contributes to the lack of Recently, Lee Silverman Voice Therapy has shown promise in in parallel for those reporting 1) mental health problems, 2) clarity surrounding the ecacy of aphasia therapy. VERSE is our pilot trial. The National Institute for Health Research has learning diculties, and 3) both mental health problems and Aim: To find out if it is feasible to recruit and retain a PROBE trial designed to determine whether two di§erent funded a full-scale phase III trial, PD COMM. learning diculties. The groups consisted of 10–15 weekly participants in the ReaDySpeech trial. types of intensive aphasia therapy, provided for 20 sessions, sessions containing psychoeducation, thematic discussions beginning within 14 days of acute stroke, provides greater Aim: To compare the clinical and cost-e§ectiveness of and exercises. The utility of the model was investigated by Method: A feasibility, multi-centre randomised controlled ecacy and cost-e§ectiveness than usual care. VERSE Lee Silverman Voice Treatment and standard NHS speech analysing change in self-reported well-being and work-life/ trial, was carried out to recruit patients with dysarthria at therapy fidelity processes underpin important rehabilitation and language therapy (SLT) versus control for people with study skills during intervention. In addition, systematic least one week post-stroke. Participants were externally factors. participant-reported post-intervention feedback was Parkinson’s. randomised in a 2:1 ratio to receive ReaDySpeech or usual collected. speech/language therapy. The researcher carrying out the Methods: 246 participants with acute post-stroke aphasia Methods: The 53 month study is being set up in 40 baseline and outcome measures was blinded to allocation. are required. Participants are stratified by aphasia severity hospitals around the UK. recruiting people who have self Results/Findings: The majority of participants reported and randomised to receive usual care (usual ward based or carer-reported problems with their speech or voice. 546 intervention-related improvement in self-esteem, Results: Between September 2015 and October 2016, 40 aphasia therapy), usual care-plus (usual ward based therapy participants will be randomised to Lee Silverman Voice hopefulness, social functioning and general coping. In participants were recruited to the ReaDySpeech study from provided daily) or VERSE therapy (a prescribed aphasia Therapy (16 sessions over 4 weeks), NHS standard SLT (6 – addition, a positive change was seen in self-reported life 4 sites. We found that 74 patients of the 116 screened (64%) therapy provided daily). The primary outcome is the Aphasia 8 sessions over 8 weeks) or no intervention during the study. satisfaction, clarity of goals, education based work-life skills, were eligible for the study and the main reason for exclusion Quotient of the Western Aphasia Battery at three months. The primary outcome is intelligibility with a battery of perceived health and resources and life situation (p <0.05). was impaired cognition in 16 out of 42 excluded (38%). Secondary outcomes include resource use, quality-of-life and patient-reported secondary measures, including health We recruited 40 of the eligible 74 (54% consent rate). The depression measures. One therapy session per week for all economic and carer quality of life questionnaires. The context Discussion and Conclusion: The intervention model had a primary reason given by 13 of the 34 declining participation trial patients is video-recorded and an independent assessor in which the intervention will be delivered and the views positive e§ect on unemployed young adults’ subjective well- was that they did not want to use a computer (58%). We evaluates therapy fidelity. being and supported them in clarifying their strengths and of participants, carers and therapists will be captured with followed up 37 of the 40 recruits to outcome assessment interviews and reports. Assessments will be completed goals. (7.5% attrition). Results: 15 sites are actively recruiting. Since July 2014, before randomisation and 3, 6 and 12 months later. · 5,846 people with confirmed stroke have been identified; Discussion: The results indicate that patients with dysarthria 1,489 patients had aphasia (25%) and 293 (19%) were Results: The trial has received HRA approval. following stroke are willing to be randomised to a trial trial eligible. Of those, 136 (46%) have been recruited investigating computerised therapy. The retention rate to (September 2016). Over 300 video-recorded therapy Discussion and Conclusions: PD COMM will determine follow up indicates that this trial could be feasible to run on a sessions have been reviewed for protocol adherence (90%) whether Lee Silverman Voice Therapy or standard NHS SLT larger scale. and treatment di§erentiation (100%). are e§ective and cost-e§ective to inform health care for · people with Parkinson’s disease. Discussion: The post-stroke aphasia rate is lower than · predicted. Therapy fidelity data shows high protocol adherence and strong treatment di§erentiation. When complete, this trial will provide Level 1 evidence to support clinical practice guidelines.

123 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 124 Poster Presentations Poster Presentations

26 - 27 May 2017 Communication & Swallowing 26 - 27 May 2017 Communication & Swallowing 26 - 27 May 2017 Communication & Swallowing 26 - 27 May 2017 Community Rehabilitation Eye-gaze technology in Rett Re-establishing daily oral intake in a Clinical usefulness of conducting Bathing adaptations in the homes syndrome: Presentation of the first man with severe chronic dysphagia, both Video Fluoroscopic Swallowing of older adults (BATH-OUT): A three subject getting eye-gaze seven years post traumatic brain Study (VFSS) and Salivary Gland feasibility Randomised Controlled technology as communication injury (TBI): A trans-disciplinary Scan (SGS) in children [8] Trial (RCT) and qualitative interview devices [176] [Work in Progress] approach to rehabilitation [47] [Work in study [49] [Work in Progress] Dr Go Eun Kim1, Dr In Young Sung1, Dr Eun Jae Ko1 Progress] 1Asan Medical Center, Seoul, South Korea. Mrs Lotta Lintula1, MD, PhD Auli Siren1 Mrs Miriam Golding-day1, Dr Phillip Whitehead1, Prof Marion 1 1 1 2 Outpatient Clinic For Patients With Intellectual Disability, Tampere 1 Walker , Prof Marilyn James , Mr Antony Dawson , Mr Stuart University Hospital, Tampere, Finland. Mrs Sarah Haynes Introduction/Background: There are two studies used in 1Ascot Rehab, Bagshot, UK. Belshaw1 children to evaluate swallowing function: a video fluoroscopic 1The University Of Nottingham, Nottingham, UK. 2Nottingham City Council, Background: Rett syndrome (RTT) is a neurodevelopmental swallowing study (VFSS) to assess the swallowing process, Nottingham, UK. Background: KG was admitted from home to a neuro- disorder. Individuals with RTT have severe limitations to and a salivary gland scan (SGS) to detect salivary aspiration. Background: The onset of bathing disability in older adults is rehabilitation unit 7 years post TBI following collapse of communicate through speech, hand signs and gestures. Since there is no previous study investigating the usefulness an indicator and potential precursor of further disability (1). his care package. He required oral suctioning for saliva However, eye gaze has been described as their strength. of conducting both VFSS and SGS in children, the aim of this management and gastrostomy for nutrition and hydration. Thus, we applied eye-gaze technology in three girls with RTT study is to show the usefulness of VFSS and SGS. Aim: The aim of this study is to establish whether it is His postural management significantly compromised and used ICF to describe progress in their communication feasible to conduct an RCT of adaptations to bathing facilities his function. He was deemed to have no potential for skills. Methods: Children who conducted both VFSS and SGS to determine whether they maintain function, improve improvement in terms of saliva control and oral intake. simultaneously under the suspicion of aspiration or Quality of Life (QoL), and lead to reductions in health and Aim: To evaluate RTT subjects´ ability to learn to use eye- dysphagia were selected as participants for the retrospective social care service use. Aim: A decision was made to explore the possibility of gaze technology and its influence on their communication study. restoration of eating in a young man with chronic dysphagia skills, and their possibilities to take part in social situations as Method: We are conducting a feasibility randomised and severe physical, cognitive and behavioural diculties an active partner. Results: There were 110 children included in the study. controlled trial (RCT) with nested qualitative interview study. following a severe traumatic brain injury, 7 years ago. Aspiration pneumonia was significantly correlated with We aim to recruit 40-60 adults aged 65+ years, who have Method: Participants had two three-month eye-gaze – ASHA-NOMS scores, abnormal findings in in VFSS and SGS. been referred for an accessible showering facility. Participants Method: Facial Oral Tract Therapy (FOTT) was used technology learning periods during the first year and after More abnormal findings in the two studies showed and their carers are randomised to either usual adaptations to deliver intensive oral therapy and 24 hour postural that permanent eye-gaze computer access for 2 – 3 years. significant linear associations with the presence of aspiration (3-month wait) or immediate adaptations (no wait). management. This relied on an intensive transdisciplinary For the whole observation period their skills in using gestures, pneumonia. However, the findings of SGS were weakly Outcomes are assessed at 3 and 6 months and include: approach incorporating environmental modifications, pointing and eye-gaze in communication were supported consistent with those of VFSS (Kappa=0.21,p=0.03), which QoL, independence in Activities of Daily Living (ADL) and therapeutic handling and graded functional activity. by special education, occupational and speech therapy. imply both studies were not reliable enough to one another. bathing, falls, and health, social care and patient resource Habilitation goals were coded by ICF -classification. Parents The results of VFSS correlated with aspiration pneumonia use. Preliminary health economic feasibility will also be Results/ Findings: KG is eating daily portions of puree with were interviewed. in children with normal results in SGS, and results of SGS established. Ethical approval SCREC (ref:16/IEC08/0017). FOTT trained sta§. His chest has remained clear with no tended to correlate with aspiration pneumonia in children oral suctioning. The team is working with the case manager Results: All participants improved in their ability to use with normal results in VFSS.Seventeen children had Results/Findings: Recruitment commenced in August 2016 and professional deputies to provide a training package for gaze as an intentional tool to control the computer screen, aspiration pneumonia although they had normal SGS results, and is due to end in April 2017. To date we have approached the new care team to enable him to eat when he returns although all were also reported to have occasional dyspraxia and 10 of them (58.8%) had abnormal findings in VFSS. 39 citizens, recruited 39 and followed up 75%. We have home. The outcomes of this training will be presented and in using eye-gaze. After a three-year habilitation period all Likewise, 12 had aspiration pneumonia although they had currently recruited 100% of eligible participants approached, discussed. the participants are able to use eye-gaze technology as a normal VFSS results, and 5 of them (41.7%) had abnormal and a higher than expected number of carers with 15 having communication device to some extent.Results of analysis findings in SGS. been recruited so far. Discussion and Conclusion: This study demonstrates the based on ICF coding will be presented and discussed. benefits of intensive transdisciplinary rehabilitation, leading Conclusion: VFSS and SGS are valuable tools for dysphagia Conclusion: This is the first randomised study of housing to functional eating and positive quality of life outcomes Discussion and Conclusion: The ability to use and aspiration pneumonia. Since one study may not be adaptations in the UK and is using a novel waiting list control. in preparation for return home. With intense, collaborative communication devices varied depending on alertness and enough to predict aspiration pneumonia, conducting both The findings will determine whether it is feasible to conduct a intervention and FOTT expertise, KG has returned to daily motivation. In future habilitation, the focus is on constructing studies will be useful in evaluating dysphagia and aspiration powered definitive study of this type. oral intake. It is now crucial to upskill his care team to enable individual contents for each subject´s eye-gaze computer pneumonia in children. him to maintain function when he returns home. and to find suitable ways to use the device in all participants´ References:1.Gill TM, et al. The epidemiology of bathing · surroundings. disability in older persons. J Am Geriatr Soc 2006;54:1524– · 30. ·

125 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 126 Poster Presentations Poster Presentations

26 - 27 May 2017 Community Rehabilitation 26 - 27 May 2017 Community Rehabilitation 26 - 27 May 2017 Community Rehabilitation 26 - 27 May 2017 Community Rehabilitation Using frailty and mobility outcome Home-based physiotherapy for Multidisciplinary post-discharge Exploring the contribution of allied measures to characterise community community-dwelling older people rehabilitation of community-dwelling health professionals in the delivery dwelling people with learning with signs of frailty. Randomized older adults after hip fracture [52] of anticipatory care to adults [41] disabilities referred to a specialist controlled trial, NCT02305433 1 2 receiving home based interventions [189] [Work in Progress] [Work in Progress] Mrs Monica Milter Ehlers , Mr. Claus Vinther Nielsen , Mrs. [197] health team Tove Lise Nielsen3, Mrs. Merete Bender Bjerrum4 1Department of Public Health, Section for Clinical Social Medicine and Dr Ingrid Wilkinson Hart1, Mrs Kim Dempsey1, Mrs Sharon M.Sc Sara Suikkanen1, M.Sc Paula Kärmeniemi1, Ph.D Rehabilitation, Aarhus University, and Acute Services and Rehabilitation, The Mrs Lorna Pirrie1,2, Dr Jenny Preston2, Ms Linda Miller2, Kupai1, Mr Christopher Learoyd1, Miss Marie Phillips1, Mrs Katriina Kukkonen-Harjula1, Ph.D Sanna Kääriä2, Prof Kaisu Municipality of Aarhus, Denmark. 2Department of Public Health, Section Professor Jean Rankin1 1 1 4 3 1 for Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark. 1University of the West of Scotland, Paisley, Renfrewshire, UK. 2NHS Ayrshire Victoria Singleton-legg , Mrs Sandra Stephen , Mrs Ira Pitkälä , Prof Sarianna Sipilä , Ph.D Markku Hupli 3Department of Public Health, Section for Clinical Social Medicine and 1 and Arran, Ayrshire, UK. 1 1 1 Rehabilitation, South Karelia Social And Health Care District, Lappeenranta, Rehabilitation, Aarhus University, Denmark. 4Department of Public Health, Stokes , Mrs Jane Tunnicli§e , Mrs Emma Veal , Mrs Carrie 2 1 Finland. Department of Social services and Health Care, Pietarsaari, Finland. Section of Nursing Science, Aarhus University, Denmark. Whiston 3Gerontology Research Center, Department of Health Sciences, University 1 Background: Wiltshire Community Team for Adults with Learning Disabilities, Wiltshire 4 of Jyväskylä, Jyväskylä, Finland. Faculty of medicine, Department of General HS Scotland is moving from a previously reactive healthcare Health and Care, Trowbridge, UK. Practice and Primary Health Care, University of Helsinki, Helsinki, Finland. Background: The cooperation between outgoing, system to one that is more preventative, anticipatory and multidisciplinary rehabilitation teams and diversities in their primarily community based. As a result, Allied Health Background: Frailty is defined as ‘a state of vulnerability to Background: There is an increasing need to develop planning and performance of post-discharge rehabilitation of Professionals (AHPs) are developing their roles within poor resolution of homeostasis following a stress’ as a result rehabilitation models to postpone disabilities and older community-dwelling adults after hip fracture has not anticipatory care. However, there is a lack of evidence that of ‘cumulative decline in multiple physiological systems over institutional care in older persons with signs of frailty. One been investigated in previous studies. considers the contribution from community based AHPs to a lifespan’ (Clegg et al, 2013). Vulnerability to a decline in alternative is home-based physiotherapy with emphasis on anticipatory care. health as defined above has been seen in people who have functional-based exercises. Aim: To investigate and discuss how an outgoing, learning disabilities (LD). People with LD tend to become multidisciplinary hospital-based and a municipal team plan Aim: To explore the contribution of AHPs in the delivery less mobile, frail and die at an earlier age than people without Aim: We study the e§ects of home-based physiotherapy and perform post-discharge rehabilitation of community- of anticipatory care to adults receiving home based LD (Heslop, 2014 and Schoufour, 2013). Although it has not for 12 months with 12 months’ follow-up in older persons dwelling adults aged 65 years and older after hip fracture. interventions. been established in the literature, it would seem reasonable with signs of frailty, to restore and increase their functional that premature frailty and earlier death may be linked in capacity prolong living at home. Methods: The recorded and transcribed focus-group Methods: Data from this qualitative study were gathered people with LD. Therefore as a specialist community team interviews were analysed according to deductive content from 23 community AHPs during three consecutive and for adults with learning disabilities, we would like to identify Method: Three hundred persons (>65 y) with signs of frailty analysis, and the International and Danish definition of discrete study phases. Participants were purposively sampled frailty in our clients and ultimately try to reduce the risk of were recruited. Frailty was screened by FRAIL questionnaire rehabilitation including the International Classification of and included NHS employed physiotherapists, occupational health decline in this vulnerable group. and verified by Fried´s frailty phenotype criteria. Persons Functioning, Disability and Health (ICF) model was used as therapists, podiatrists, dietitians and speech and language were randomised to a physiotherapy (n=150) or a usual care theoretical framework. therapists who delivered care within patients’ homes. Data Aim: Application of the evidence based concept of frailty to (n=150) arm. GAS was used to set goals for physiotherapy. collection occurred between November 2013 and February characterise a patient population and reduce risk of health Each physiotherapy session lasts for 60 minutes, twice a Results/Findings: The planning and performance of post- 2014 within NHS Ayrshire and Arran. Phase I comprised of decline. week for 12 months at the participant’s home. The content is discharge rehabilitation di§ered between the teams as one a nominal group technique session involving AHPs (n=7). individualised, structured, progressive and based on Otago team used a biomedical and the other a biopsychosocial Structured observations of a home based treatment session Methods: We have begun to score frailty across our client method, with exercises for strength, muscle endurance, approach to rehabilitation. Neither of the teams assessed (n=8) were video or audio recorded for Phase II. Phase III group and will categorise clients as relatively fit (lowest balance and flexibility. The components are also trained the mental functions of the older adults, and information on adopted a phenomenological approach involving audio FI score), vulnerable, mildly, moderately and severely frail functionally, combined to activities of daily living. RPE scale planning, performance and goal-setting was sparingly shared recorded face-to-face semi-structured interviews (n=8). (highest FI scores). We are collecting functional ambulation and repetition maximum test are used to evaluate training between the teams.

category (FAC) scores alongside FI and aim to score every intensity and progression. Assessments (e.g. SPPB, MNA, Findings: Community AHPs perceived a range of their client on the multidisciplinary team’s caseload. FIM, MMSE, GDS-15, 15D) are performed by the assessor at Discussion and Conclusion: Lack of information about clinical interventions as anticipatory care and delivered these baseline, 3, 6, and 12 months at the person’s home. core services and di§erent approaches to towards the through a two-part process of recognising need followed Discussion and Conclusion: This is the ﬁrst time that a FI older community-dwelling adults´ rehabilitation resulted in by appropriate intervention. Thematic analysis identiﬁed has been assessed and reported alongside mobility across a Results/ Findings: Recruitment was completed in August fragmented and overlapping elements of training and care. facilitators and barriers to anticipatory care that emerged population of people with LD in clinical practice. Describing 2015 and by the end of 2016, 207 persons have completed A structure based on the older community-dwelling adults´ within three key themes of relationships, personal attributes the population in these terms may help clinicians understand the 12-months intervention, 58 are still on intervention phase, goals, the components of the ICF-model, and the services and organisational factors. the population better, reduce risk for individuals and improve 16 have died and 19 have discontinued. provided by each individual team could promote between-

care by targeting interventions. team cooperation and thus optimise the rehabilitation Conclusion: Community AHPs deliver a variety of Discussion and Conclusion: Our trial will provide new process. anticipatory care interventions and adopt a multifaceted knowledge whether long-term home-physiotherapy approach to recognising need. Addressing the identiﬁed improves functional capacity of persons at risk for disabilities Reference: Ehlers MM, Nielsen CV, Nielsen TL, Bjerrum MB. facilitators and barriers to delivery will optimise AHP to postpone institutional care. Multidisciplinary post-discharge rehabilitation of community- delivered anticipatory care of this particular patient group. · dwelling older adults after hip fracture (in review).

127 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 128 Poster Presentations Plenary Session Plenary Session

26 - 27 May 2017 Community Rehabilitation Saturday 27 May 2017 Plenary Session towards the same goals, ensures that important actions are Saturday 27 May 2017 10:30 AM- 11:15 AM 9:00 AM – 9:45 AM, Main Conference Hall W011 not overlooked, and allows monitoring of change to abort The Saltire Centre Mechanisms influencing the ine§ective activities quickly. Setting rehabilitation objectives with Morning Coee, Exhibition implementation of rurally based The process of goal setting in rehabilitation with the ICF community stroke services [51] [Work ICF: empowering the person implies the adoption of the biopsychosocial model, allows and Poster Viewing in Progress] intervention both at person and at environmental levels Prof. Matilde Leonardi and requires monitoring and allows a team to use the Neurologist, Paediatrician and Child Neurologist, Head of Neurology, Public Saturday 27 May 2017 Plenary Session Mrs Jo Howe1, Professor Marion Walker1, Dr David Clarke2, Health, Disability Unit , Scientific Director Coma Research Centre and same language and to work towards the common goal of 11:15 AM – 11:45 AM, Main Conference Hall Dr Rebecca Fisher1 Director Italian WHO-Collaborating Centre Research Branch, Foundation increasing each patient’s participation in life. 1University Of Nottingham, Nottingham, UK. 2University of Leeds, Leeds, UK. IRCCS, Carlo Besta Neurological Institute, Milan, Italy. Reference:Wade, D. T. (2009). “Goal setting in rehabilitation: What’s new and where to next? The compounding e§ects of morbidity, epidemiological Background: National clinical stroke guidelines in the an overview of what, why and how.” Clin Rehabil 23(4): 291- transition and ageing on global health are important and UK recommend the commissioning of Early Supported 295 A heady compilation of the main events, key messages and Discharge (ESD) services. ESD is a complex intervention have several consequences. Ageing is strongly correlated impact from the EFRR 2017 Congress, presented using an comprising multiple components; rehabilitation is delivered with an increase in dementia, depression and all other exciting mix of novel technologies. mental and neurological illnesses, an increase in all the other in the patient’s home by stroke specialist multidisciplinary Saturday 27 May 2017 Plenary Session Non-Communicable diseases NCDs (e.g. musculoskeletal teams (MDTs). ESD commissioning has increased, but 9:45 AM – 10:30 AM, Main Conference Hall W011 Presenter: service delivery models vary and inequity in provision and rheumatological conditions, diabetes and obesity) and Dr. Andrew Bateman PhD MCP exists. Additionally the randomised controlled trials of with an increase in disability prevalence worldwide. Since SRR President Elect and Clinical Manager, Oliver Zangwill Centre for population ageing is accompanied by an epidemiological Expert Panel Discussion: the Role of Neuropsychological Rehabilitation, Cambridgeshire Community Services ESD, on which the guidelines are based, were conducted in NHS Trust, Princess of Wales Hospital, Ely, UK predominantly urban settings. Some rural MDTs experience shift from the predominance of infectious diseases and high Research in Rehabilitation challenges in delivering ESD whereas others are able to fulfil maternal and child mortality to that of non-communicable diseases (especially chronic ones), health and social care the requirements determined by the Stroke Sentinel National In this session, delegates’ top priorities for rehabilitation Saturday 27 May 2017 Plenary Session systems need to be reoriented to deal with increased Audit Programme (SSNAP). Therefore questions remain research, collated throughout the Congress, will be 11:45 AM – 12:00 Noon, Main Conference Hall about the implementation of evidence based ESD in rural populations of persons with disabilities and NCDs. presented and discussed by a panel of experts with a view to contexts. collectively shape the future of rehabilitation research. According to the International Classification of Functioning, Awards and Closing Remarks Aim: To explore mechanisms facilitating or hindering the Disability and Health (ICF, WHO, 2001), the focus of Chair: Chair: implementation and sustainability of ESD within rurally attention should move from disability/ person with disability Prof. Frederike van Wijck, to the ENVIRONMENT in which people live. The ICF EFRR Conference chair, EFRR vice-president and SRR Senior Secretary, Prof. Frederike van Wijck, based communities in England. EFRR Conference chair, EFRR vice-president and SRR Senior Secretary, provides a comprehensive, universal and globally accepted Professor in neurological rehabilitation, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK. Professor in neurological rehabilitation, School of Health and Life Sciences, Methods: A realist approach to evaluation of three model and taxonomy to describe functioning, and could be Glasgow Caledonian University, Glasgow, Scotland, UK. EFRR Author index useful as one of the instruments to enable a biopsychosocial established rural community stroke services incorporated Panel: approach to the person to be taken, and goals to be set as within a literal replication multiple case study design will Dr. Susanne Weinbrenner MD, PhD, MPH be adopted. This will involve exploration of contexts and part of a rehabilitation plan. EFRR Secretary and Chief Medical Ocer and Head of Department “Social mechanisms influencing the delivery of ESD within the three Medicine and Rehabilitation”, German Statutory Pension Fund, Deutsche Rentenversicherung Bund, Berlin, Germany. services which have been chosen on their ability to adhere to The rationale for goal setting in neurorehabilitation could a number of key guidelines and SSNAP criteria. Documentary be dual, i.e.: (1) to describe an intended future state that involves a change from the current situation or, in some Prof. Matilde Leonardi analysis, observations and interviews with therapists, EFRR Council Member and Neurologist, Paediatrician and Child Neurologist, commissioners and patients and carers will be conducted. circumstances, to describe the maintenance of a current Head of Neurology, Public Health, Disability Unit , Scientific Director Coma state in the face of expected deterioration; (2) to describe Research Centre and Director Italian WHO-Collaborating Centre Research Branch, Foundation IRCCS, Carlo Besta Neurological Institute, Milan, Italy. Discussion & Conclusion: Findings from this research will the intended result of one or more interventions. In a inform commissioning of rurally based community stroke multidisciplinary team, the process of sharing goal setting should ensure that: (1) all actions undertaken by each Dr. Gábor Fazekas MD, PhD care and assist ESD services experiencing challenges in EFRR Past President (2008-2009, 2011-2013) and Council Member, and meeting current guideline and audit requirements. Although individual are contributing towards the goal; (2) important, Specialist of neurology and PRM, Szt. Janos Hospital and National Institute primarily focussed on rural England it is hoped that the necessary actions are not overlooked; (3) the e§ectiveness for Medical Rehabilitation, Budapest, Hungary. results will be meaningful to ESD services in other countries. of the rehabilitation process is monitored and (4) a patients’ anxiety is reduced and insight into and acceptance of limited Associate Professor Kate Radford PhD recovery is increased. SRR Past President, Faculty of Medicine & Health Sciences, School of Medicine, University of Nottingham, UK Whenever a patient’s problems are suciently complex to require the involvement of two or more service providers from di§erent professions and / or the process is continued for more than a few days, a formal goal-setting process may be needed to derive a set of goals that motivates the patient, ensures that individual team members work

129 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 130 Index Index

A Boland J, 84 Cranfill T, 95 Gandolfi M, 95 Ho S, 55 Kilpinen R, 98 Marquardt M, 39 Nielsen CV, 128 Püüa K, 96 Scheschonka A, 88 Sutton C, 77 Von Groote P, 68 Aartolahti E, 82 Boland P, 26 Crosbie B, 19, 33 Garland J, 69 Ho§man K, 72, 77 Kim DY, 61 Marques E, 105 Nielsen TL, 128 Schiavolin S, 98 Svestkova O, 97 Abel S, 95 Booij M, 50 Cummings J, 23 Gelhardt A, 94 Hogg S, 59 Kim GE, 61, 126 Marti A, 100 Nieuwboer A, 48 Q Schmädeke S, 29 Swain I, 75, 80 W Abo M, 95 Booth A, 24 Gerzymisch K, 29 Hojan K, 115 Kim SH, 101, 117 Martimo K-P, 119 Nilipour R, 95 Qiang L, 89 Schnabel S, 56 Swampillai A, 110 Wales L,72 Adunsky A, 50 Booth J, 36, 54 D Giardini ME, 30 Hojan K, 52 Kinnunen A, 117 Martin Štefančič M, Nissinen M, 98 Quilty C, 84 Schulze S, 38 Swart AM, 48 Walker D-M, 107 Afridi S, 110 Booth L, 54 Dahl Nielsen MB, 104 Gibbison L, 41 Holland A, 124 Kiraly F, 74 107 Noé Sebastián E, 95 Quinn T, 111 Schury K, 29 Symannek C, 39 Walker D-M, 73 Aird L, 59 Booth V, 21 Dalichau S, 31, 49 Gimson M, 114 Hollands K, 111 Ko EJ, 126 Martius P, 39 Nordlund-Spiby R, 44 Schwaab B, 52 Syrjä V, 91 Walker D-M, 74 Airlie J, 30 Bosomworth H, 59 Dall P, 57, 109 Giray E, 13 Hollins T, 40 Koivu S, 44 Masterson Algar P, 123 Nordvik JE, 63 R Schwegler U, 86, 100 Szaflarski JP, 95 Walker M, 14, 19, 26, Akyüz G, 13, 34, 51 Bothelius K, 114 das Nair R, 42 Gitt A, 52 Holmes J, 32, 77, 99, Kokko A, 44 Mateen BA, 63, 64, Novak P, 107 Raatikainen I, 82 Scopes J, 112 33, 46, 73, 74, 77, 82, Aldridge J, 89, 121 Boudu J, 74 Dawson A, 126 Gkanasouli L, 46 100 Kontou E, 46, 55, 82, 74, 109 Nützi M, 86, 100 Radford K, 32, 36, 42, Scott H, 80 T 89, 107, 121, 126, 129 Alexander G, 57 Bowen A, 94, 95, 120, Dawson J, 59 Gladman JRF, 48 Hooban K, 16 121 Matjačić Z, 23 Nybo T, 99 55, 77, 99, 100, 122 Seary C, 105 Talbot-Rice H, 84 Waller D, 74 Alhaidary H, 61 124 De Torres L, 97 Glize B, 95 Hood V, 21 Konttinen J, 119 Mattiol F, 95 Radoschewski M, 79 Sedki I, 115 Tamás V, 43 Walsh D, 97 Alhashil N, 55 Bowers B, 90, 122 Decuman S, 104 Godecke E, 95, 124 Hooper J, 112 Koritnik B, 114 Mattukat K, 17 O Rafnsdóttir GL, 103 Seekatz B, 29 Tarjanyi S, 62 Walsh G, 60 Alhowimel A, 36 Brabants A, 112 Deeken F, 38 Godfrey M, 48 Horne J, 15, 16, 48 Kosilo M, 60 Mau W, 17, 90 O’Connell M, 84 Raggi A, 97, 98 Segal G, 50 Tarkiainen L, 102 Ward M, 48 Ali M, 76, 95 Bradley L, 68 Dempsey K, 127 Godwin J, 59, 95 Horton S, 95 Kovács N, 43 Maulik P, 89 O’Connor RJ, 69, 70, Raggi A, 98 Seppänen-Järvelä R, Tasnádi E, 43 Watkins C, 46, 77 Allatt K, 71 73, 74 Brady MC, 22, 59, 60, Denes Z, 62 Golding-day M, 126 Horyńska-Kęstowicz Kovlen D, 16, 96 Mavis I, 95 77, 83 Rahikka A, 47 91, 102 Taylor P, 105 Weber K, 27 Almubark B, 40, 41 95, 123 Desai A, 81 Golež A, 114 D, 52 Krebs HI, 59 Mawajdeh H, 61 Oksanen M, 38 Rai T, 124 Shakespeare D, 77 Taylor P, 25, 75, 80, 105 Wedderburn L, 81 Alotaibi M, 55 Bramley T, 21 Deschamps K, 112 Goljar N, 23 Howard D, 95 Kukkonen T, 95 Mawdsley C, 80 Olaya B, 97 Rajavaara M, 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110, 111 Middleton S, 124 Perkins N, 70 Rose M, 95, 124 Sorinola I, 54 Tyson S, 94, 124 Yarrow K, 60 Bateman A, 20, 63, 130 Chater N, 41 Fahrenkrog S, 39 Hampshire L, 83 Jensen C, 40, 104 Lincoln N, 15, 16 Millar L, 18 Perl F, 104 Rosenthal R, 83 Sormunen E, 119 Ylinen A, 99 Batman B, 51 Cherkashina I, 16, 73 Faller H, 29 Handberg C, 84 Jesus L, 95 Lindley R, 89 Miller KJ, 69 Perry M, 26 Rossiter J, 83 Spoerhase U, 28 U Ylisassi H, 119 Baue JF, 85 Childs C, 113 Fazekas G, 62, 83 Hanga K, 96 Joensuu M, 119 Lintula L, 125 Miller L, 128 Pesonen S, 91 Rosso C, 95 Sprigg N, 19, 33, 46, 73, Urbanik T, 96 Young HJ, 57 Bauer JF, 45 Chivers-Seymour K, 48 Feicke J, 28 Hankey G, 124 John A, 81 Little A, 97 Milter Ehlers M, 128 Petty J, 54 Rothwel K, 120 74, 82, 107, 121 Uzor S, 57 Bäuerle K, 28 Chohan A, 112 Ferdinand P, 29 Hanspal R, 115 Jones G, 54 Litwiniuk M, 52 Mitchell C, 94, 124 Phillips J, 77, 99, 100 Rowe P, 18, 23, 30, Spyra K, 39 Z Beare B, 105 Choo PL, 57 Ferraina S, 97 Harlaar J, 24, 50 Jones S, 49 Lloyd M, 53 Moeller T, 13 Phillips M, 127 57, 60 Stamp E, 59 V Zadravec M, 23 Becker F, 95 Chouliara N, 19, 26, 33 Fettes L, 84 Harris HW, 95 Jones T, 77, 100 Logan P, 15, 16, 21, 32, Mo§at F, 17 Pickering R, 48 Rubi-Fessen I, 95 Stapelfeldt C, 104 Vaappo M, 44 Zander J, 79 Becker J, 29 Christensen U, 77 Fheodoro§ K, 97 Harvey L, 89 Joutsenniemi K, 38 67, 48 Mohapatra S, 26 Pickford C, 111 Rudd A, 54 Stapleton T, 56 Vale L, 59 Zeymer U, 52 Belshaw S, 126 Ciccone N, 124 Fillingham J, 95 Harwood R, 21 Jowett S, 123 Lorenz A, 95 Molloy K, 57 Pihlar Z, 24 Rudolf M, 23 Staykova J, 51 van de Sandt- Zietz B, 29 Benford P, 82, 121 Clark A, 48 Finch T, 59 Haug G, 29 Jungblut M, 95 Loudon D, 113 Momsen A-M, 104 Piirainen A, 82 Rugulies R, 104 Steed A, 70 Koenderman M, 95 Zwerenz R, 29 Bennington J, 84 Clarke C, 123 Fisher R, 14, 19, 26, 33, Haughey F, 56 Justo D, 50 Luftenegger T, 83 Mon-Williams M, 70 Pilissy T, 83 Ruiter M, 95 Steenbrink F, 24 van der Esch M, 50 Bensmailb D, 88 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132 Congress of the European Forum for Research in Rehabilitation (EFRR). Glasgow Caledonian University 133 Parallel Session 6.3 - Family / Carer / Peer Involvement

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