Low- and middle-income countries worldwide, including Africa, are facing rising incidences of stroke and increased need for stroke rehabilitation. This study aimed to explore rehabilitation professionals' perceived challenges and opportunities for achieving equitable stroke rehabilitation in northeastern Tanzania. In this descriptive qualitative study, semi-structured individual interviews were conducted with eight physiotherapists and four occupational therapists. An interview guide covering the theme of stroke rehabilitation was used. The face-to-face interviews were audio recorded, transcribed verbatim, and analysed using inductive qualitative content analysis. The overarching theme Raising awareness of rehabilitation while overcoming systemic barriers for stroke rehabilitation was based on five categories: 1) Influenced by the cultural context, 2) Awareness of rehabilitation opportunities, 3) Economic and social resources, 4) Inequitable accessibility to healthcare, and 5) Lack of coordination and consensus in healthcare structure. The therapists expressed multidimensional needs to facilitate rehabilitation after stroke. Main challenges included systemic barriers within the environment, resources, and healthcare structure. Possible assets included advocacy for rehabilitation, community solidarity, and creative use of self-made aids and adaptations. Furthermore, the development of a culturally adapted national guideline and expanding the National Health Insurance Fund could facilitate more equitable care and rehabilitation services.

The number of children with chronic conditions is increasing, affecting a growing number of caregivers. Informal caregiving adversely impacts health, social contacts, and the economy, highlighting the importance of improved caregiver well-being. Semi-structured interviews were conducted with caregivers identified through a patient database at a Swedish hospital. Using a phenomenological approach with a thematic analysis, we explored the experiences of caregivers of children with the example of the condition Legg-Calvé-Perthes disease. The caregivers were highly worried and feared the unknown. Every uncertainty was experienced as consuming. By gathering information, they tried to regain control. Lacking information and communication from health care professionals created frustration. Half of the caregivers described that it negatively affected their mental health. Counselors and physiotherapists became crucial by taking on a coordinative and holistic role. Despite hardships, most caregivers found meaning in life and adapted to the new reality. The disease often had no negative effects on career or finances, and sometimes improved family relationships. Numerous parallels with our findings are evident across a broader caregiver population, indicating similar support requirements regardless of disease. Our 'Care for Caregivers Framework' illustrates caregivers' experiences and highlights possible areas for future research.

To describe the implementation of goal-directed therapy (GDT) and provision of assistive devices (ADs) within the Akwenda Intervention Program, a structured community-based rehabilitation program, and to examine goal attainment, AD use, and caregiver perspectives in a rural setting in eastern Uganda. This study included 50 children and young people aged 2-23 years with cerebral palsy. The intervention formed part of an 11-month multi-component program including caregiver training, therapist-led sessions, communication and advocacy, GDT, and AD-provision. Therapists received structured training in collaborative goal setting using Goal Attainment Scaling (GAS). ADs, including wheelchairs, standing frames, posture support chairs, walkers, orthoses, and toileting devices, were provided with training and follow-up. Goal attainment was evaluated using GAS, while AD use and caregiver satisfaction were assessed through usage diaries and a structured questionnaire. A total of 146 goals were set, of which 63% were achieved. Most goals targeted activity (56%) and participation (32%). Participants with milder motor impairments demonstrated higher goal attainment than those with more severe impairments (p = 0.04). Goal attainment was moderately associated with reduced caregiver assistance in self-care (r = 0.41, p = 0.006) and reduced caregiver burden (r = 0.40, p = 0.008), but not with other child-related outcomes. Twenty-four participants received 66 ADs, of which 85% remained in use after six months. Caregiver satisfaction exceeded 80% across domains. GDT and AD-provision were feasible to implement within a community-based rehabilitation program in a rural Ugandan setting, supporting meaningful functional outcomes.

Essential Needs for People with Type 2 Diabetes Integrating Physical Activity into Daily Life Post-Rehabilitation: A Focus Group Study Purpose: To inform rehabilitation initiatives for individuals with type 2 diabetes (T2D), this study examined the perceived needs for integrating physical activity into daily life following municipal rehabilitation. Methods: Three focus group interviews involving 15 people with T2D were conducted to allow participants to share their lived experiences. Data were analysed following Braun and Clarke’s model for thematic analysis. Results: Four themes were identified (1): the intertwining of T2D with other diseases and the ongoing struggle to act (2), challenges in everyday life (3), the experience of being left alone to manage T2D, and (4) the need for support in coping with mental and daily challenges. Participants described complex physical, psychological, and social barriers to maintaining physical activity after rehabilitation, alongside a strong need for ongoing, individually tailored support, particularly psychosocial support. Conclusions: These findings highlight that integrating physical activity into daily life after rehabilitation is a complex process, shaped by interconnected physical, psychological, and social factors. Rehabilitation initiatives should therefore incorporate long-term, person-centred, and psychosocially informed support to better address individuals’ everyday challenges.

Purpose We examined walking ability, fatigue, health-related quality of life, anxiety, depression, cognitive, and physical function as correlates of self-reported sedentary behavior in adults with multiple sclerosis (MS). Methods 465 adults with MS completed surveys including the Marshall Sitting Questionnaire (MSQ), Multiple Sclerosis Walking Scale (MSWS-12), Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale, Short Form Health Survey-12 physical and mental (SF-12 PCS and MCS), along with clinical characteristics and demographics surveys (e.g., MS type, patient-determined disease steps). Zoom-based assessments of the California Verbal Learning Test II [CVLT-II], the Symbol Digit Modalities Test, and the 30-second Sit-to-Stand were completed. Statistical analyses included bivariate correlations and a multivariable linear regression that identified correlates of sedentary behavior in MS. Results The bivariate analyses indicated weak, but significant associations among MSQ and FSS (r = .092), SF-12 MCS (r = −0.111), and CVLT-II (r = −0.092). The multivariate regression demonstrated that SF-12 MCS scores entered the model in Step 1 (b = −0.111, p < .05), and CVLT-II entered the model in Step 2 (b = −0.090, p > .05). Conclusion We identified FSS, SF-12 MCS, and CVLT-II as correlates of sedentary behavior in adults with MS. SF-12 MCS was the strongest predictor of sedentary time.

Purpose Inherited retinal diseases (IRDs) are invisible disabilities that cause progressive vision loss. Living with an IRD impacts life beyond visual impairment, requiring adaptation to shifting identity and social roles. This study investigated the barriers and facilitators people with IRDs face in communicating about their condition and needs. Methods Semi-structured interviews were undertaken with 16 individuals with IRDs (aged 20–69 years) and 5 family members. Interviews were transcribed and analysed using thematic analysis. Results Five key themes were identified describing communication challenges across various relationships and social contexts: (1) clinician communication, highlighting the impact of interactions with healthcare professionals; (2) intrinsic barriers from participants’ own feelings coming to terms with their diagnosis; (3) family communication, influenced by family dynamics and their personal experience with the condition; (4) comprehension gap, capturing others’ misconceptions of vision loss as a spectrum and an invisible disability; and (5) disclosing vision loss, describing decisions about when and how to share an IRD diagnosis with others. Conclusions Support for individuals with vision loss requires coordinated action across multiple networks, including clinician education, accessible mental health services for individuals and carers, and efforts to improve societal understanding of the experience of vision loss.

Purpose To study the impact of congenital myopathies in adult patients’ lives and their coping mechanisms to live a fulfilling life, in an era with no treatments on the horizon. Methods We conducted a qualitative study with semi-structured interviews among Dutch adult patients with congenital myopathies, exploring their experiences of living with the condition. Data from the interviews were analysed through open coding and thematic analysis using Atlas.ti version 24.0.0. Results Sixteen adult patients (50% females; age range of 26–72 years) were interviewed during January-April 2024. Six main themes were identified: disease management, self-management, personal development, social participation, support, and illness acceptance. Coping strategies were related to aspects of the disease, personal traits of patients and their social environment. Conclusion This study provided a comprehensive perspective going beyond physical functioning, that also considered personal, social, and environmental factors that are crucial for coping with the disease and understanding its impact. These experiences offer valuable insights for clinicians, patients and family members, helping to support patients in finding fulfilment in life.

Purpose To evaluate the per-protocol effect of early mobilization on in-hospital adverse events among patients with acute stroke who had premorbid disability, using a target trial emulation framework. Methods This retrospective observational study conducted at a single center in Japan included patients with acute stroke, all of whom had a premorbid disability. Early mobilization was defined as mobilization within 2 days of hospital admission. The primary outcome was the occurrence of any adverse event―such as death or neurological or non-neurological adverse events—between day 4 and day 30 following admission. Sunday to Thursday admission was used as an instrumental variable (IV) to estimate the causal effect of early mobilization, based on reduced rehabilitation staffing on weekends. A two-stage least squares regression model was applied, adjusting for relevant clinical covariates. Results Among 165 patients, 58% received early mobilization. Admission from Sunday to Thursday increased the probability of early mobilization by a mean of 0.53 points (F-statistic = 44.79). IV analysis indicated that early mobilization reduced the probability of adverse events by 28 percentage points (absolute risk difference) [95% confidence interval: −55 to −2 percentage points]. Conclusion Early mobilization appeared to reduce adverse events in patients with acute stroke and premorbid disability.

Purpose This project explores the use of mixed and augmented reality technologies in the development of a motivating stroke rehabilitation application that supports adherence and that is based on the indigenous Māori health model Te Whare Tapa Whā which incorporates taha tinana (physical health), taha wairua (spiritual health), taha whānau (family health), and taha hinengaro (mental health). Methods With expert stakeholder input and Māori design partners, we designed APO: a mixed reality, social, puzzle prototype application using a smartphone and tangible wooden blocks with digital photo overlays. We conducted co-creation sessions with seven people living with stroke who used the prototype and provided feedback. Results Using reflexive thematic analysis based on both APO and existing rehabilitation practices, we conceptualise three themes: creative pursuits with physical aspects encourage regular paretic limb use, social interactions around shared media represent meaningful connections with friends, family and communities, and, routines of use, particularly through spacing out activities through the week, can help balance participants’ feelings of exertion. Conclusion By using the insights from the co-creation study, we then refined the APO design to further support the multi-faceted aspects of rehabilitation and health for people living with stroke.

Purpose The study investigates the clinical impact of the Oxford Visual Perception Screen (OxVPS), a standardised assessment for post-stroke visual perception difficulties. Methods In this mixed-method study, OxVPS use, benefits, and changes to practice were explored through repeated cross-sectional user surveys 3 (n = 234), 6 (n = 136), 12 months (n = 70) post-registration and interviews with 33 health professionals. Results At 3–6 months, 85% of participants reported using OxVPS, compared to 94% at 12 months. Between 54% and 67% of participants said that OxVPS had influenced their clinical practice. The survey data revealed that OxVPS amplified awareness of visual perception difficulties in 89%-98% of participants, and interviews highlighted increased knowledge. For 48% of participants, OxVPS had become the standard screening tool. Both interviews and surveys showed ease of implementation: participants found OxVPS quicker (71%-76%), easier to use (72%-81%), more suitable for their patients (77%- 85%), and more user-friendly (74%-78%) than other screening tools. OxVPS allowed 93%-94% of participants to screen patients in a more standardised way and supported rehabilitation planning. Ninety-four percent would recommend OxVPS to a colleague. Conclusions Clinicians find OxVPS quicker and easier to use compared to other assessments, and supportive of rehabilitation planning. Consequently, more patients are assessed in a standardised way.