Community-dwelling Stroke Survivors Research Articles

Occupational balance and stroke impact among community-dwelling stroke survivors 65 years or older: a cross-sectional study.

Occupational balance has been investigated in different populations but less in stroke survivors. Previous studies have focussed on occupational balance among stroke survivors of working age (15-64 years of age), showing they did not perceive they had occupational balance. There is, therefore, a lack of knowledge of how older stroke survivors perceive their occupational balance. The aims of this study were to describe occupational balance in community-dwelling stroke survivors 65 years or older and to investigate if there were any associations between their perceived stroke impact and occupational balance. A cross-sectional study was performed with 58 stroke survivors, with a median age of 75 years at stroke onset and a median time since stroke onset of 11 months. The participants were recruited from a local stroke register and answered questionnaires on occupational balance and stroke impact. Data were analysed with descriptive statistics, correlations and logistic regression. The participants had a median score of 29 (min 12 to max 33), indicating a very high occupational balance, a low stroke impact, and a good recovery (median 82.5; min 0 to max 100). An association between participation and occupational balance (OR 1.13; 95% CI 1.04-1.23) was found. The stroke survivors perceived a low stroke impact and a high occupational balance. It is possible that older community-dwelling stroke survivors, of whom many have retired, juggle less occupations leaving them with more time to engage in those occupations they want to, leading to a better occupational balance.

Gait Function and its Association with Functional Independence, Quality of Life, and Community Reintegration in Stroke Survivors.

Background and Aims: The major outcome of stroke rehabilitation is the recovery of the ability to walk. However, a large proportion of stroke survivors are discharged to the community with gait deficiency which impairs their functional independence, and quality of life increasing the burden of care on caregivers especially their lack of functioning in the community. This study assessed the gait functional performance in community-dwelling stroke survivors and explored its association with functional independence, quality of life, and community reintegration in community-dwelling stroke survivors. Materials and methods: This study involved 115(59 males and 56 females) community-dwelling stroke survivors. Their gait functional performance was assessed using the 10-meter walk test (10MWT) while their functional independence was assessed with the functional independence measure (FIM). Their quality of life (QoL) was assessed using the Stroke-specific QoL scale while community functioning and productivity were assessed using the community integration questionnaire (CIQ). Their scores on the assessments were compared with the normative data of their age and sex-matched healthy individuals. Data was analysed using Spearman’s correlation coefficient and Chi-Square at p<.05. Results: Participants’ ages ranged between 27 to 78 years (mean=60.48±37.84 years). More participants (56.7%) had right hemispheric lesions and 43.3% had lesions in the left hemisphere. Their gait function, functional independence performance, QoL, and community reintegration functions were significantly (p<0.05) lower than their age and sex-matched normative data. There was a significant (p<0.05) association and relationship between their gait functional performance and each of the functional independence performance, QoL, community reintegration, and productivity. Conclusion: Gait functional performance in community-dwelling stroke survivors is significantly lower than in age and sex-matched healthy individuals and it is significantly associated with low functional independence performance, low quality of life, poor community functioning, and lack of productivity in stroke survivors, Abnormal gait pattern is related to poor functional independence, poor quality of life and low productivity.

What influences stroke survivors with physical disabilities to be physically active? A qualitative study informed by the Theoretical Domains Framework.

Although the benefits of regular physical activity (PA) after stroke are well established, many stroke survivors do not achieve recommended PA levels. To date, studies exploring determinants to PA have not used a behaviour change theory and focused on stroke survivors with physical disabilities. As a precursor to an intervention development study, we aimed to use the Theoretical Domains Framework (TDF) to identify factors influencing PA in stroke survivors with physical disabilities in Singapore. Between November 2021 and January 2022, we conducted interviews with 19 community-dwelling stroke survivors with a weak arm and/or leg. An interview guide based on the TDF was developed. We analysed the data deductively by coding interview transcripts into the theoretical domains of the TDF, and then inductively by generating themes and belief statements. To identify relevant TDF domains, we prioritised the domains based on the frequencies of the belief statements, presence of conflicting belief statements and evidence of strong belief statements. Eight of the 14 TDF domains were relevant, and included environmental context and resources, knowledge, social influences, emotion, reinforcement, behavioural regulation, skills and beliefs about capabilities. The lack of access, suitable equipment and skilled help often limited PA participation at public fitness spaces such as parks, gyms and swimming pools (environmental context and resources). While a few stroke survivors expressed that they had the skills to engage in regular PA, most expressed not knowing how much and how hard to work, which exercises to do, which equipment to use and how to adapt exercises and equipment (knowledge and skills). This often left them feeling afraid to try new activities or venture out to new places for fear of the unknown or adverse events (e.g., falls) (emotion). For some, doing the activities in a group encourage them to get out and engage in PA (social influences). In stroke survivors with physical disabilities, environmental context and resources had a significant influence on PA participation, and this often had a spill over effect into other domains. Our results inform a complex behaviour change intervention to improve PA after stroke, and has implications for intervention design for people with physical disabilities.

Associations of Circadian Rest-Activity Rhythms With Affect and Cognition in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Study

Background Rest-activity rhythm (RAR) is a modifiable behavioral factor associated with affect and cognition. Identifying RAR characteristics associated with affect and cognition among stroke survivors provides insight into preventing poststroke affective and cognitive impairment. Objective To examine the associations of RAR characteristics with affect and cognition among community-dwelling stroke survivors. Methods Forty participants with mild stroke (mean age = 52.8; 42.5% female; 55% White) reported their affect and cognitive complaints using ecological momentary assessment and wore an accelerometer for 7 consecutive days and completed the National Institutes of Health Toolbox Cognition Battery. RAR characteristics were extracted using parametric and non-parametric approaches. Multivariable linear regressions were used to identify RAR characteristics associated with affect and cognition. Results Later onset of rest (B = 0.45; P = .008) and activity (B = 0.36; P = .041) were positively associated with depressed affect. These associations were reversed for cheerful effect (rest onset: B = −0.42; P = .017; activity onset: B = −0.39; P = .033). Cheerful affect was also positively associated with relative amplitude (ie, distinctions in activity levels between rest and activity; B = .39; P = .030). Intra-daily variability (ie, RAR fragmentation; B = 0.35; P = .042) and later onset of activity (B = .36; P = .048) were positively associated with cognitive complaints. Less erratic RAR was positively associated with fluid cognition (B = 0.29; P = .036); RAR fragmentation was positively associated with crystallized cognition (B = 0.39; P = .015). Conclusions We identified RAR correlates of affect and cognition among stroke survivors, highlighting the value of managing RAR and sleep in stroke rehabilitation. Future studies should test whether advancing the onset of rest and activity, promoting a regular active lifestyle, and improving rest and sleep in the nighttime protect stroke survivors from affective and cognitive impairment.

Abstract HUP15: An Exploring Qualitative Study of Real Life Experiences and Needs of Psychosocial Recovery Among Chinese Community Dwelling Stroke Survivors

Introduction: Stroke survivors may face challenges in managing their psychosocial functions. However, little is known about psychosocial experiences and needs of community-dwelling stroke survivors, particularly in China. Purpose: This study explored the experiences and needs of psychosocial recovery among Chinese community-dwelling stroke survivors. Methods: Semi-structured and individual interviews were conducted with participants in Macao from community healthcare centers and supported groups using convenience sampling. Participants were asked about their experiences, challenges, and strategies for managing post-stroke psychosocial functions, and desired support for psychosocial recovery. Interview data were transcribed verbatim and analyzed thematically. Results: Twenty-six participants (mean age: 69.96±14.06 years old; mean post-stroke duration: 83.88±66.8 months) were recruited to participate in interviews. Regarding the experiences and challenges, most participants faced obstacles in managing emotions and barriers to rebuilding social lives due to the impacts of physical disabilities. Generally, most participants recognized that they were a minority of people in society, and some experienced further invalidation by society. The majority of participants lost motivation and expectations to face challenges, hesitated to disclose their conditions to others, and had less confidence in social interactions as they felt that they were different from others. Meanwhile, some participants adopted strategies to improve their psychosocial functions, including appreciation for oneself and important persons or events supporting them, adjustments to the disparity between expectations and reality, and reinterpretations of unpleasant experiences. Furthermore, communal creative activities offered by health professionals and peer support were recommended. Conclusion: To promote post-stroke psychosocial recovery in communities, health professionals should consider designing meaningful group activities for stroke survivors to meet their psychosocial needs. These findings will guide the development of interventions for enhancing psychosocial functions among Chinese community-dwelling stroke survivors.

Abstract WP113: An Exploring Qualitative Study of Real Life Experiences and Needs of Psychosocial Recovery Among Chinese Community Dwelling Stroke Survivors

Introduction: Stroke survivors may face challenges in managing their psychosocial functions. However, little is known about psychosocial experiences and needs of community-dwelling stroke survivors, particularly in China. Purpose: This study explored the experiences and needs of psychosocial recovery among Chinese community-dwelling stroke survivors. Methods: Semi-structured and individual interviews were conducted with participants in Macao from community healthcare centers and supported groups using convenience sampling. Participants were asked about their experiences, challenges, and strategies for managing post-stroke psychosocial functions, and desired support for psychosocial recovery. Interview data were transcribed verbatim and analyzed thematically. Results: Twenty-six participants (mean age: 69.96±14.06 years old; mean post-stroke duration: 83.88±66.8 months) were recruited to participate in interviews. Regarding the experiences and challenges, most participants faced obstacles in managing emotions and barriers to rebuilding social lives due to the impacts of physical disabilities. Generally, most participants recognized that they were a minority of people in society, and some experienced further invalidation by society. The majority of participants lost motivation and expectations to face challenges, hesitated to disclose their conditions to others, and had less confidence in social interactions as they felt that they were different from others. Meanwhile, some participants adopted strategies to improve their psychosocial functions, including appreciation for oneself and important persons or events supporting them, adjustments to the disparity between expectations and reality, and reinterpretations of unpleasant experiences. Furthermore, communal creative activities offered by health professionals and peer support were recommended. Conclusion: To promote post-stroke psychosocial recovery in communities, health professionals should consider designing meaningful group activities for stroke survivors to meet their psychosocial needs. These findings will guide the development of interventions for enhancing psychosocial functions among Chinese community-dwelling stroke survivors.

Abstract TP73: Outcomes in Mexican American Informal Stroke Caregivers and Differences by Ethnicity

Background: Informal home care is the most prevalent type of post-acute care (PAC) in Mexican American (MA) stroke survivors, but data on the impact on caregivers is not available. The objective was to investigate strain, positive aspects of caregiving, familial obligations/support, and depression in stroke caregivers and ethnic differences in a population-based study. Methods: Data are from Brain Attack Surveillance in Corpus Christi PAC Study. Community-dwelling stroke survivors and their caregivers were recruited (n=307). Caregiver eligibility included: 1) residence in study county, 2) not cognitively impaired, 3) not providing care pre-stroke. Caregiver interviews at ~90 days included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (MCSI range 0-26, higher more), PAC scale by Tarlow et al (range 5-45, higher more), familial obligations/support scales by Sabogal et al (range 1-5, higher greater), and PHQ-8 (range 0-30, higher worse). Patient data were from interviews and medical records. Propensity score (PS) methods were used to balance caregiver and patient factors among MA and non-Hispanic white (NHW) caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and disability. PS were then included as a covariate in regression models considering the association between ethnicity and outcomes. Results: MA caregivers were younger, more likely female, and more likely a child than NHWs. Median MCSI, PAC scale, PHQ-8 were 11 (IQR:6-17), 36 (IQR:30-40), and 11 (IQR:9-15) in MAs and 13.5 (IQR:9-18.3), 30 (IQR:25-36.3) and 13 (IQR:10-16) in NHWS. MA ethnicity was associated with less caregiver strain (β=-2.22, 95% CI:-4.19, -0.26) and depression (β=-2.05, 95% CI:-3.48, -0.63) and more positive aspects of caregiving (β=2.96, 95% CI:0.91, 5.01), but not associated with familial obligations/support. Conclusions: Informal stroke caregivers report moderate levels of strain and depressive symptoms, with NHW caregivers reporting higher levels. MA caregivers report greater positive aspects of caregiving suggesting a possible intervention target to improve outcomes in MAs.

'Smart reminder': A feasibility pilot study on the effects of a wearable device treatment on the hemiplegic upper limb in persons with stroke.

Emerging literature suggests that wearable devices offer a promising option for self-directed home-based upper limb training for persons with stroke. However, little research is available to explore integrating smartphone applications with wearable devices to provide upper limb telerehabilitation to stroke survivors at home. This study examined the feasibility and potential therapeutic effects of a wearable device integrated with a smartphone-based telerehabilitation system to provide upper limb rehabilitation to stroke survivors at home. Twelve stroke survivors from community support groups participated in a treatment consisting of 4-week telerehabilitation using a wearable device and 4-week conventional therapy successively in a single-blind, randomised crossover study. A 3-week washout period was administered between the two 4-week treatments. The primary outcome measures were the Fugl Meyer Assessment, the Action Research Arm Test, and the active range of motion (ROM) of the upper limb. Secondary outcome measures included the Motor Activity Log and exercise adherence. Results showed that the active ROM of participants' hemiplegic shoulder improved more significantly after 4 weeks of telerehabilitation with the wearable device than with conventional therapy. No significant differences were found in other outcome measures. A 4-week telerehabilitation programme using a wearable device improves the hemiplegic upper limb in community-dwelling stroke survivors and may be feasible as an effective intervention for self-directed upper limb rehabilitation at home.

Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study.

Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptomsare less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery. To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors. A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data. Community. Community-dwelling stroke survivors (N = 40). Not applicable. EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary. Between-person sleep quality was negatively associated with next-day depressed affect (B = -.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = -.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047). This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.

Investigating the Telerehabilitation With Aims to Improve Lower Extremity Recovery Poststroke Program: A Feasibility Study.

The purpose of this study was to examine the feasibility of a progressive virtual exercise and self-management intervention, the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke program (TRAIL), in individuals with stroke. A single group pre-post study design was used. Thirty-two participants were recruited who were aged 19years or older, had a stroke within 18months of the beginning of the study, had hemiparesis of the lower extremity, and were able to tolerate 50minutes of activity. Participants completed TRAIL, a synchronous exercise and self-management program delivered via videoconferencing. Participants received 8 telerehabilitation sessions over 4weeks that were 60 to 90minutes, with a trained physical therapist in a ≤2 to 1 participant-to-therapist ratio. Feasibility indicators in the areas of process (recruitment and retention rates, perceived satisfaction), resources (treatment fidelity and adherence, participant and assessor burden, therapist burden), management (equipment, processing time), and scientific indicators (safety, treatment response, treatment effect) were collected throughout the study using a priori criteria for success. The treatment effect was examined on the Timed "Up & Go" test, the virtual Fugl-Meyer Lower Extremity Assessment, the 30-Second Sit-to-Stand Test, the Functional Reach, the Tandem Stand, the Activities-Specific Balance Confidence Scale, the Stroke Impact Scale, and the Goal Attainment Scale. Forty-seven individuals were screened, of which 32 (78% male; median age of 64.5years) were included for the study from 5 sites across Canada. Nine feasibility indicators met our study-specific threshold criteria for success: retention rate (0 dropouts), perceived satisfaction, treatment fidelity, adherence, therapist burden, equipment, and safety. In terms of treatment response and effect, improvements were observed in Timed "Up & Go" test (Cohen d= 0.57); Fugl-Meyer Lower Extremity Assessment (d= 0.76); 30-Second Sit-to-Stand Test (d= 0.89); and Goal Attainment Scale (d= 0.95). The delivery of TRAIL, a lower extremity stroke rehabilitation program using videoconferencing technology, is feasible and appears to have positive influences on mobility, lower extremity impairment, strength, and goal attainment. Community-based telerehabilitation programs, such as TRAIL, could extend the continuum of care during the transition back to community postdischarge or during global disruptions, such as Coronavirus Disease 2019 (COVID-19). Delivery of synchronous lower extremity rehabilitation via videoconferencing to community-dwelling stroke survivors is feasible.

Abstract 15657: Stroke Survivors’ and Caregivers’ Experience of Using Game-Based Virtual Reality Training Modules Designed for Promoting Social Participation

Introduction: Virtual reality (VR) technology may provide a promising alternative to promote stroke survivors’ social participation. Three innovative social participation-focused, game-based VR training modules for community-dwelling stroke survivors were developed. Aim: This study sought to understand the survivors’ and caregivers’ perceptions of the usefulness of VR-based interventions in supporting post-stroke recovery and their experience of using the specially developed VR modules. Methods: A qualitative study with semi-structured, in-depth, individual interviews was conducted with a convenience sample of 10 stroke survivor-caregiver dyads (n=20). Each survivor and caregiver attended a first interview about their perceptions and expectations of VR-based interventions. They were then invited to experience all games of the VR modules and were interviewed again about their experience and satisfaction with using the VR modules, and suggestions on areas for improvement. All interview data were transcribed verbatim and analyzed thematically. Results: Most of the survivors (mean age=60.80; SD=6.71) were female (70%), had an ischemic stroke (50%), and walked with a stick (70%). The mean years after stroke was 4.80 (SD=4.16). Most of the caregivers were female (80%) and had a mean age of 56.20 years (SD=7.73). All survivors had no prior VR experience. Three themes were identified: A modern strategy instilling enjoyment into the regular physical training; confidence boosting for reengaging into life situations and outdoor activities; and tailored modifications needed for reviewing training progress, supporting more social interactions and controller-free experience. They suggested enabling availability of the modules in survivors’ home or community settings for increasing the convenience to access the modules. Conclusions: The findings showed that the new VR training modules are acceptable to the survivors. Feedback elicited informed refinement of the modules and the usefulness of the modules in improving social participation of survivors will be evaluated in a large-scale randomized controlled trial.

Insufficiencies in sensory systems reweighting is associated with walking impairment severity in chronic stroke: an observational cohort study.

Walking and balance impairment are common sequelae of stroke and significantly impact functional independence, morbidity, and mortality. Adequate postural stability is needed for walking, which requires sufficient integration of sensory information between the visual, somatosensory, and vestibular centers. "Sensory reweighting" describes the normal physiologic response needed to maintain postural stability in the absence of sufficient visual or somatosensory information and is believed to play a critical role in preserving postural stability after stroke. However, the extent to which sensory reweighting successfully maintains postural stability in the chronic stages of stroke and its potential impact on walking function remains understudied. In this cross-sectional study, fifty-eight community-dwelling ambulatory chronic stroke survivors underwent baseline postural stability testing during quiet stance using the modified Clinical test of Sensory Interaction in Balance (mCTSIB) and assessment of spatiotemporal gait parameters. Seventy-six percent (45/58) of participants showed sufficient sensory reweighting with visual and somatosensory deprivation for maintaining postural stability, albeit with greater postural sway velocity indices than normative data. In contrast, survivors with insufficient reweighting demonstrated markedly slower overground walking speeds, greater spatiotemporal asymmetry, and limited acceleration potential. Adequate sensory system reweighting is essential for chronic stroke survivors' postural stability and walking independence. Greater emphasis should be placed on rehabilitation strategies incorporating multisensory system integration testing and strengthening as part of walking rehabilitation protocols. Given its potential impact on outcomes, walking rehabilitation trials may benefit from incorporating formal postural stability testing in design and group stratification.

Advance directives among community-dwelling stroke survivors.

Advance directives (ADs) are integral to health care, allowing patients to specify surrogate decision-makers and treatment preferences in case of loss of capacity. The present study sought to identify determinants of ADs among stroke survivors. In this cross-sectional study (Care Attitudes and Preferences in Stroke Survivors [CAPriSS]), community-dwelling stroke survivors were surveyed on ADs; validated scales were used to query palliative care knowledge and attitudes towards life-sustaining treatments. Logistic regression was used to determine variables associated with ADs. Among 562 community-dwelling stroke survivors who entered the survey after screening questions confirmed eligibility, 421 (74.9%) completed survey components with relevant variables of interest. The median age was 69 years (IQR 58-75 years); 53.7% were male; and 15.0% were Black. Two hundred and fifty-one (59.6%) respondents had ADs. Compared to stroke survivors without ADs, those with ADs were more likely to be older (median age 72 vs. 61 years; p<0.001), White (91.2% vs. 75.9%, p<0.001), and male (58.6% vs. 46.5%, p = 0.015), and reported higher education (p<0.001) and income (p = 0.011). Ninety-eight (23.3%) participants had "never heard of palliative care". Compared to participants without ADs, participants with ADs had higher Palliative Care Knowledge Scale (PaCKS) scores (median 10 [IQR 5-12] vs. 7 [IQR 0-11], p<0.001), and lower scores on the Attitudes Towards Life-Sustaining Treatments Scale (indicating a more negative attitude towards life-sustaining treatments; median 23 [IQR 18-28] vs. 29 [IQR 24-35], p<0.001). Multivariable logistic regression identified age (OR 1.62 per 10 year increase, 95% CI 1.30-2.02; p<0.001), prior advance care planning discussion with a physician (OR 1.73, 95% CI 1.04-2.86; p = 0.034), PaCKS scores (OR 1.06 per 1 point increase, 95% CI 1.01-1.12; p = 0.018), and Attitudes Towards Life-Sustaining Treatments Scale scores (OR 0.91 per 1 point increase, 95% CI 0.88-0.95; p<0.001) as variables independently associated with ADs. Age, prior advance care planning discussion with a physician, palliative care knowledge, and attitudes towards life-sustaining treatments were independently associated with ADs.

O.5.2-5 Piloting a text message intervention to increase physical activity and exercise after post-stroke rehabilitation: the KATS study (Keeping Active with Texting after Stroke)

Abstract Purpose After stroke rehabilitation, people feel abandoned by services and struggle to undertake physical activities to support recovery and health. Text messaging interventions can reach many people at low cost but have not been used widely after stroke. This study pilot-tested a text message intervention (KATS) to promote post-rehabilitation activity. Methods We developed KATS using: formative research on post-stroke activity; stakeholder engagement (people with stroke and rehabilitation therapists) to identify priorities; the Health Action Process Approach to structure the behaviour change intervention; and stakeholder review before pre-testing. KATS components included: increasing motivation; goal setting and planning; self-monitoring; coping planning; and maintaining regular activity. KATS comprised 95 messages, delivered by computer programme, over 12 weeks. Text messages explained and modelled KATS components using Behaviour Change Techniques effective for changing health behaviours. Messages used conversational language to encourage engagement, some asked questions on current activities. Quotes from survivors modelled behaviours, providing encouragement and authenticity. Some messages were personalised to include participants’ names. We piloted KATS with community-dwelling stroke survivors, using mid and end-of-intervention interviews to explore experiences of KATS. We analysed qualitative data using Normalisation Process Theory to examine how participants made sense of KATS and embedded it in everyday activities. Results Following piloting, from 24 interviews with 12 participants, we derived four analytical themes: (1) Making sense of KATS: Timing and complementarity in the rehabilitation journey; (2) Engaging with KATS: Connection and identification with others; (3) Making KATS work: flexibility and tailorable guidance; (4) Appraising the worth of KATS: encouragement and friendliness. Participants differentiated KATS from current rehabilitation practice, finding it relevant, fitting, and worthwhile. They reported variations in engagement with behaviour change techniques, but participants could tailor KATS use, making it work for them in different ways. Conclusions KATS was seen as useful and acceptable to stroke survivors. Perceived benefits went beyond promoting physical activity, to feeling supported and connected. Future research will test effectivenes of KATS in promoting physical activities and explore associations with functional, social and emotional secondary outcomes. The study illustrates the importance of co-design in interventions for clinical populations. Funder Scottish Government Chief Scientist Office.

An Exploratory Study of Young Stroke Survivors' Lived Experiences: A Multi-Methods Study Using Developmental Theory.

Young adults make up 10% of strokes that occur in the United States each year. Little research has shown the developmental and occupational disruption as a result of stroke for this population. The objective of this study was to describe young stroke survivors' perceived disruptions using developmental theory. A multiple methods study was conducted with community-dwelling stroke survivors between the ages of 18 and 40 using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews. Five themes were reported from the qualitative data: stroke and health, work and school, romantic relationships, parenting, and other social relationships. PROMIS measure results were not significantly different from the normed population despite challenges revealed during qualitative interviews. Qualitative data showed variations in post-stroke deficits and occupational performance that could not be meaningfully captured by the PROMIS measures alone. Occupational therapy practitioners should use developmental theory to guide their understanding of occupational disruptions in young stroke survivors.

Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data.

Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.

Dietary Behavior Performance Among Chronic Community-Dwelling Stroke Survivors: A Qualitative Study

Abstract Date Presented 04/22/2023 Dietary behavior performance and training is limited after stroke. Qualitative findings identify unmet clinical needs that should be addressed and can inform clinical practice and future research regarding dietary behavior intervention. Primary Author and Speaker: Ryan R. Bailey Contributing Authors: Sarah Waddoups

Development of a Self-Rehabilitation Intervention for Functional Mobility among Community-dwelling Stroke Survivors in LMICs: Protocol for a Formative Study (Preprint)

Development of a Self-Rehabilitation Intervention for Functional Mobility among Community-dwelling Stroke Survivors in LMICs: Protocol for a Formative Study (Preprint)

PCR150 Effects of Smoking on the Prevalence of Self-Reported Antihypertensive Medication Use Among Community-Dwelling Stroke Survivors

To evaluate the effects of cigarette smoking on the prevalence of antihypertensive medication use among community-dwelling stroke survivors.

Exploring the experience of cognitive changes among community-dwelling stroke survivors: a qualitative study

Purpose Cognitive deficits are common among stroke survivors and impact their functional independence. Despite the prevalence of cognitive deficits after stroke, cognitive function is largely overlooked in post-stroke care. The aim of this qualitative study was to explore the experiences of individuals living with post-stroke cognitive changes to understand the impact of these changes on their daily lives. Materials and Methods Semi-structured interviews were conducted with a purposeful sample of thirteen community-dwelling adults 50 years and older with chronic stroke who self-identified cognitive changes post-stroke. Interviews were transcribed and an inductive thematic analysis was completed. Results Four key themes were identified: 1) inability to maintain everyday activities; 2) experiencing emotional responses to living with post-stroke cognitive changes; 3) a shrinking social world and; 4) seeking care for cognitive health post-stroke. Conclusions Post-stroke cognitive changes were described by participants as a driving force behind negative shifts in their daily lives, emotional health, and social connections after stroke. Despite seeking care for their post-stroke cognitive changes, many participants were unable to find support in mainstream healthcare. There is a demonstrated need to further elucidate the gaps in care for post-stroke cognitive deficits and implement community interventions targeting cognitive health post-stroke. IMPLICATIONS FOR REHABILITATION Clinicians should consider how cognitive changes post-stroke may affect daily life and the uptake in support services to help improve accessibility and alter the delivery of care accordingly. Clinicians should regularly complete cognitive screenings among their clients living with stroke and probe them for the effects of cognitive deficits within their daily life. There is a demonstrated need for community interventions that target cognitive health for individuals living with stroke, and clinicians should consider advocating for and spearheading such programs within the community.