Community Rehabilitation Services Research Articles

Spanish Version of the Netherlands Empowerment List: Adaptation, Psychometric Validation, and Gender Differential Item Functioning Analysis

AbstractThere is a lack of valid instruments to measure empowerment in Spanish-speaking populations. This study aimed to adapt the Netherlands Empowerment List (NEL), a 40-item scale, into Spanish and to test its psychometric properties examining its dimensional structure, internal consistency, temporal stability, relationships with other variables, and differential item functioning by gender. Participants were 406 users of mental health community rehabilitation services (52.5% male), with a mean age of 47.8 years. Results confirmed a six first-order factor structure of the scale. Internal consistency was excellent for the total score and ranged from excellent to adequate for subscale scores. Temporal stability was excellent for four subscales and good for the remaining two. The analysis of relationships between the Spanish NEL with other variables (i.e., empowerment, recovery, hope, perceived social support) provided additional evidence of its validity. Although four items showed uniform differential item functioning by gender, the effect size was negligible. The Spanish NEL yields valid and reliable scores, and it may be used to assess empowerment in Spanish-speaking countries.

How Much Does Dysphagia Cost? Understanding the Additional Costs of Dysphagia for New Zealand in Patients Hospitalised with Stroke

Introduction: Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand. Methods: Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between May 1, 2018, and October 30, 2018, including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a speech language therapist review. Patients that required a nasogastric feeding tube in hospital were classified as “severe.” Optimal linear propensity score matching was utilised to provide a group of patients to compare with stroke and dysphagia. All costs were converted to 2021NZD. Results: Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age: 78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12 months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95% CI: 0.028–0.100), and severe dysphagia by 0.12 index points (95% CI: 0.03–0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was NZD 24,200 on average per patient. This estimate includes the additional hospitalisation costs (NZD 16,100), community rehabilitation services (NZD 570), hospital level aged residential care (NZD 4,030), and reduced HRQoL (NZD 3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was NZD 34,000 per patient. Conclusion: We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed...

EVALUATING FEASIBILITY OF A SECONDARY STROKE PREVENTION PROGRAM

INTRODUCTION & AIMS While 80% of strokes are preventable, stroke remains the second leading cause of disability and death worldwide. Recurrent stroke has an accumulative effect that increases the level of disability and demands on healthcare. Healthy lifestyles that include regular exercise can reduce stroke risk, but stroke survivors lack guidance to modify their lifestyle after hospital discharge. Models of community care may support secondary stroke prevention with guidelines recommending physical activity and cardiovascular exercise, and referrals to support behaviour change to address modifiable risk factors. Our aim was to evaluate the implementation of a secondary stroke prevention program provided within a community rehabilitation service to see if it was feasible to deliver and acceptable for participants. METHOD We evaluated the implementation of a secondary stroke prevention program involving supervised exercise, multidisciplinary education and health coaching to address modifiable risk factors. The group-based program involved face-to-face and telehealth sessions. The primary outcomes were feasibility, examined via service information (referrals, uptake, participant demographics, costs), and participant acceptability (satisfaction and attendance). Secondary outcomes examined self-reported change in lifestyle factors, and pre-post scores on standardised clinical tests, [e.g., waist-circumference, 6-Minute-Walk (6MWT)]. RESULTS We ran seven programs in 12-months, and 37 people participated. Attendance for education sessions was 79%, and 30/37 participants completed the full program. No adverse events occurred. Participant satisfaction was high for ‘relevance’ (100%), ‘felt safe to exercise’ (96%) and ‘intend to continue’ (96%). Most participants (88%) changed (on average) 2.5 lifestyle factors (diet, exercise, smoking, alcohol). Changes in clinical outcomes seemed promising, with some being statistically significant, e.g. 6MWT (MD 59m, 95%CI 38m to 80159m, p<0.001), and waist-circumference (MD –2.1cm, 95%CI -3.9cm to -1.4cm, p<0.001). CONCLUSION The program was feasible to deliver, acceptable to participants and seemed beneficial for health. Access to similar programs may assist in secondary stroke prevention.

Cross-cultural adaptation and psychometric validation of a Spanish version of the Maryland Assessment of Recovery Scale (MARS-12).

The aim of this study was to adapt and validate a Spanish version of the Maryland Assessment of Recovery Scale (MARS-12). It was carried out in strict accordance with internationally recognized guidelines for test adaptation. A preliminary Spanish version of the MARS-12 was first produced through a standardized translation/back-translation process, ensuring semantic, linguistic, and contextual equivalence with respect to the original scale. Its psychometric properties were then examined in a sample of 325 people with serious mental illness recruited from six different provinces in the Basque Country (northern Spain) and Catalonia (north-eastern Spain). They were users of a total of 20 community rehabilitation and psychiatry services. Confirmatory factor analysis supported a unidimensional structure, consistent with the original scale. Scores on the MARS-12 were positively correlated (.83) with scores on the Questionnaire about the Process of Recovery, supporting convergent validity, while validity evidence based on relationships with other variables was provided by positive correlations between MARS-12 scores and scores on the Dispositional Hope Scale (.82) and on the three dimensions of the Multidimensional Scale of Perceived Social Support (range .30 to .41). Reliability of MARS-12 scores was high (McDonald's ω = .97), as was temporal stability across a one-week interval (.89). The Spanish version of the MARS-12 is a valid and reliable scale that may be used by mental health professionals to assess recovery among Spanish people with serious mental illness.

Development of a Conceptual Framework for Adult Community Rehabilitation Policy, Planning, Care, and Research: A Multimethod Qualitative Approach

To address recognized gaps in community rehabilitation service coordination and advance delivery of rehabilitation services for adults living outside of institutions, we have developed a conceptual framework to inform the design of community rehabilitation policy, planning, care, and research. Employing a multimethod qualitative approach, we developed a draft framework based on a document review as well as interviews with community rehabilitation service and system providers, older people receiving community rehabilitation services, and family caregivers. We then consulted with community rehabilitation service and system providers, older adults, and family caregivers to revise the framework. We identified 194 relevant documents and 30 programs, and we analyzed interview data from 29 service and system providers as well as 6 dyads of older persons and family caregivers. We developed a definition of community rehabilitation and identified 11 components for the draft framework, which was presented to 16 participants for consultation. We used their feedback to revise the terms and definitions for the 11 components. We organized the final set of components into two categories: principles (culturally safe; equity-focused; evidence-informed; person and family-centred; restorative) and organization (appropriate; coordinated; continuity; evaluated; stepped; team-based). The contextualized, action-oriented conceptual framework for adult community rehabilitation (CFACR) is supported by older people, family caregivers, and community rehabilitation health system providers. Continued work to refine and validate the components in more population groups and contexts will facilitate implementation and application of the CFACR.

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

Home-based multi-sensory and proximal strengthening program to improve balance in Charcot-Marie-Tooth disease Type 1A: A proof of concept study.

People with Charcot-Marie-Tooth Disease (CMT) frequently report problems with balance, which lead to an increased risk of falls. Evidence is emerging of training interventions to improve balance for people with CMT, but to date all have relied on clinic-based treatment and equipment. This proof-of-concept study explored whether a multi-modal program of proprioceptive rehabilitation and strength training can be delivered at home, to improve balance performance in people with CMT Type 1A. Fourteen participants with CMT Type 1A were recruited into this randomized, two-arm study. Baseline assessments included measures of disease severity, posturography, physical function, and patient-reported outcome measurements. All participants received one falls education session. Participants were randomized to either 12 weeks of balance training or 12 weeks of usual activities. The intervention comprised a home-based, multi-sensory balance training and proximal strengthening program, supported by three home visits from a physiotherapist. Thirteen participants completed the study. The intervention was successfully implemented and well tolerated, with high participation levels. Functional measures of balance and walking showed strong effect sizes in favor of the training group. Posturography testing demonstrated moderate improvements in postural stability favoring the intervention group. Inconsistent changes were seen in lower limb strength measures. The intervention was feasible to implement and safe, with some evidence of improvement in balance performance. This supports future studies to expand this intervention to larger trials of pragmatic, home-delivered programs through current community rehabilitation services and supported self-management pathways.

Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study

ObjectivesThis study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.DesignWe used a qualitative descriptive design over two rounds of data collection...

The use of EQ-5D-5L as a patient-reported outcome measure in evaluating community rehabilitation services in Alberta, Canada

BackgroundThe purpose of this study was to describe the characteristics and health-related quality of life (HRQL) of patients accessing community rehabilitation services in Alberta, Canada, using routinely collected EQ-5D-5L data, and explore factors associated with the impact of these services.MethodsA retrospective, longitudinal, observational design was used. Patients completed the EQ-5D-5L and demographic questions at intake and end of rehabilitation care. Change in EQ-5D-5L dimensions from intake until end of rehabilitation was examined using the Pareto Classification of Health Change. Change scores were calculated for the EQ-5D-5L index, VAS, and total sum scores. Change groups in the EQ-5D-5L index and VAS scores, were defined by minimally important differences of 0.04 and 7.0, respectively. One level change was considered important for the total sum score. Effect size of the change in index, VAS, and total sum scores was also examined. Chi-squared tests were conducted to examine whether change in EQ-5D-5L varied by age, gender, region, and having anxiety/depression at intake.ResultsThree service programs were examined; pulmonary rehabilitation (n = 542), group-based community exercise (n = 463), and physiotherapy for bone and joint care (n = 391). At intake, HRQL in all programs was lower than that of the general Alberta population norms and improved by end of rehabilitation. The mean (SD) change in index, VAS, and total sum scores were 0.02 (0.13), 6.0 (18.3), and − 0.5 (2.4) in pulmonary rehabilitation, 0.06 (0.13), 6.6 (18.7), − 1.2 (2.4) in community exercise, and 0.13 (0.16), 1.2 (0.9), and − 2.8 (2.8) in physiotherapy, respectively. Based on change of the index score, 24% deteriorated, 38% improved, and 38% had no change in pulmonary rehabilitation; 17% deteriorated, 51% improved, and 32% had no change in community exercise; 5% deteriorated, 72% improved, and 23% had no change in physiotherapy. Similar trends were seen in the VAS and total sum scores. Older age, urban region, and having anxiety/depression at intake were associated with positive change in EQ-5D-5L.ConclusionsThe results of this study are intended to inform program/service level decisions by describing the characteristics and HRQL of patients accessing community rehabilitation, as well as the predictors of change in health status, which will help direct future program growth and service changes.

Exploring the needs of stroke patients after discharge from rehabilitation centres in Saudi Arabian communities: An IPA qualitative exploratory study design.

There are about 29 strokes per 100,000 people, annually, in the Kingdom of Saudi Arabia (KSA). These patients require long-term rehabilitation services to enhance recovery and independence in the community. Currently there are limited long-term rehabilitation services in KSA and research is needed to establish pathways for provision of community-based rehabilitation (CBR). To develop effective new CBR models, understanding the experiences and needs of stroke patients in KSA who have undergone poststroke care services is essential. This study aims to gain insight into stroke patients' needs after their discharge from rehabilitation centres in Saudi Arabia. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Participants were eligible if they had a stroke, completed their in-hospital rehabilitation sessions and had been discharged within the past three years. Semi-structured interviews were conducted using interview guides. Transcripts were translated and analysed using interpretive phenomenological analysis. Twenty-four (15 males and 9 females) participants were recruited from two hospitals in KSA. The key findings suggested that patients experienced limited community rehabilitation services postdischarge unless they were financially able to pay for private therapy. Coping barriers including Medical, Psychological, Social, and Financial and facilitators including Faith, Recovery, Social support and leisure were identified. Participants suggested strategies to improve services within hospital and community for rehabilitation, needs of staff, access to services and ongoing care. Further work is required to develop, implement and evaluate a community rehabilitation intervention that includes education, and self-management elements to support stroke survivors in the community in KSA.

Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation

Purpose This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation. Materials and methods This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months. Results Environmental context and resources, the clinician’s social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals’ capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation. Conclusions A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting.

Improving the Quality of Valproate Prescribing in Adult Mental Health Services - POMH Topic 20b - Enhanced Community Rehabilitation Service (ECRS), Bognor Regis, West Sussex

Aims:/BackgroundThe licensed indications for Sodium Valproate are narrow however the medication is commonly prescribed amongst mental health services in the UK. Such practice can be associated with ineffective and poorly tolerated treatment, especially given the limited evidence re efficacy of 'off label' use of Valproate.Aims and auditable outcomes •Annual review of risk benefit balance for those on continued Valproate treatment to include asking about adverse effects, medication adherence and therapeutic benefit Any 'off label' prescription of Valproate, should be explained to the patient and documented•Clinician's reasons for initiating Valproate treatment should be documented in clinical records•Plasma level monitoring of Valproate treatment should not be used unless there is evidence of concerns about medication adherence, dose related side effects and/or ineffectiveness•Prior to initiating Valproate, the following should be documented in the clinical records: Full Blood Count (FBC), Liver Function Tests (LFTs) and Weight and/or BMI•Review within first three months of Valproate treatment should include: Screening for common side effects and assessment of the response of treatmentMethodsOnly 7 of 51 patients on the ECRS caseload were eligible for the study i.e. currently prescribed Valproate, irrespective of age.Audit forms provided by POMH team. Clinical records used to complete included all electronic/paper notes, letters, and other patient information available to clinical team.Due to nature of information required we involved doctors and nurses from the clinical team.Results6/7 (86%) of patients had clinical reasoning for Valproate prescription documented in their clinical records - 5/7 (71%) were prescribed 'off-label' - mainly as adjunct for refractory Schizophrenia.7/7 (100%) of patients had a documented review in the past year which included asking about adherence to their Valproate medication.2/7 (29%) of patients had plasma monitoring of Valproate treatment in the past year as part of routine hospital admission blood tests. No evidence of concerns for the other patients documented otherwise.5/7 (71%) had treatment initiated with Valproate more than 5 years ago, hence unable to see if prescription initiations were explained to patients due to lack of historical records.ConclusionFirst cycle of this internal audit which forms part of a wider national prescribing audit, demonstrates that the ECRS team are generally meeting current standards for Valproate prescription.Despite the majority (71%) being initiated >5y ago - 86% of our patients have documented clinical reasons for ongoing prescription, with100% having a documented review in the past year.

A good life for people living with disability: the story from Far North Queensland

Purpose People with disability in regional, rural and remote Australia have poorer service access compared to people from metropolitan areas. There is urgent need for reform. This study’s aim was to explore the needs and aspirations of people with lived experience of disability in Far North Queensland (FNQ) to inform a new service framework. Materials and methods Twenty-five individuals with diverse experience of disability were engaged in semi-structured interviews. Participants were recruited from four sites that differed geographically, culturally, and socioeconomically. Using an inductive then deductive thematic approach to data analysis, statements of needs and aspirations were compiled and aligned with three pre-determined vision statements. Results Needs and aspirations aligned well with the vision statements which were to: feel “included, connected, safe and supported”; have “opportunities to choose one’s own life and follow one’s hopes and dreams”; and have “access to culturally safe services close to home.” To realise this vision in FNQ, support to navigate and coordinate services across sectors is essential. Conclusion People of FNQ of all abilities, need and aspire to experience “a good life” like their fellow Australians. Any new service model must focus on providing service navigation and co-ordination amid the complexities of service delivery in FNQ.

Quality of Life and Its Influencing Factors Among Schizophrenia Patients Living in Urban and Rural Areas

To investigate the status quo of the quality of life of schizophrenia patients in a city in Sichuan Province and to explore, thereof, the urban-rural differences in the factors influencing their quality of life. A total of 824 schizophrenia patients were selected for the study through multistage stratified cluster random sampling method. All the subjects were selected from a pool of patients covered by the Sichuan Provincial Information System for the Comprehensive Management of Severe Mental Disorders. Questionnaire surveys were conducted with the Schizophrenia Quality of Life Scale (SQLS), the Social Support Rating Scale (SSRS), the general circumstance questionnaire, and the lifestyle questionnaire. In addition, univariate and multiple linear regression models were used to analyze the influencing factors of quality of life among schizophrenia patients living in urban areas and those in rural areas. Rural patients had poorer quality of life than urban patients did in all measurement domains ( P<0.05). Marital status, vocational skills, physical exercise, and social support were influencing factors of the quality of life among urban patients ( P<0.05). Age, marital status, annual household income, vocational skills, participation in community rehabilitation activities, and the time required to walk to the nearest medical institution were influencing factors of the quality of life among rural patients ( P<0.05). Targeted measures for the enhancement of the quality of life of schizophrenia patients should be formulated on the basis of urban and rural characteristics in terms of economic support, vocational skills training, input in mental health services, community rehabilitation services, and social support.

The RECAPACITA project: Description of the clinical, neuropsychological and functional profile of a sample of people with severe mental disorder and legal capacity modification in Spain

Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment. ObjectivesTo describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. Methods: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected. ResultsIn the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the “Clinical Global Impression Scale” (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: −1.9), and long-term spontaneous recall (Pz: −2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7). ConclusionsMost of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal point of view of the CM processes of people with SMD.

View of the Work Community and Vocational Rehabilitation Services Among Adults With Autism Spectrum Disorder

Many adults diagnosed with autism spectrum disorder (ASD) face challenges in establishing and maintaining employment. These difficulties may be related to ASD symptomology or employer attitudes; however, vocational rehabilitation (VR) can provide employment-related resources. This study sought to understand how adults with ASD view their integration into workplace communities and VR services. Qualitative data were collected from 24 adults with ASD, and analysis identified themes surrounding the importance of workplace contributions, interesting work, and positive workplace relationships contributing to feeling integrated into the workplace community. Responses were also examined for perspectives on the role of VR in supporting workplace integration. Findings indicate the importance of attending to individual employment preferences and the need for long-term VR follow-along services to explore opportunities for employment growth. Implications and future recommendations for research and practice are also discussed.

Different meanings… what we want in our lives… a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service

Purpose Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland. Materials and methods Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis. Results Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people’s lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities. Conclusions These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.

Effectiveness of a recovery workshop implemented in community mental health services in Catalonia (Spain): study protocol for a non-randomized controlled trial

BackgroundMany countries today are undergoing a paradigm shift in mental health policies towards a recovery-oriented and rights-based approach. From this perspective, self-determination and self-management are fundamental factors for recovery. Despite this shift, there is still a lack of evidence on the effectiveness of training programmes aimed at promoting self-determination and self-management in recovery processes implemented in southern European or Spanish-speaking countries. The aim of this paper is to present a study protocol that evaluates the effectiveness of a 12-session recovery workshop implemented in community mental health services in Catalonia (Spain).Methods/designThis is a 12-week follow-up multi-centre non-randomized controlled trial design. At least 160 users will be recruited from 13 Community Rehabilitation Services (CRS) in Catalonia. Eligible participants are adult (≥ 18 years old) users of a CRS, who sign a written consent to participate. The experimental group participates in a recovery workshop, in which people learn to develop and implement their own plan of personal recovery, which includes a Wellness Toolbox, a Maintenance Toolkit, a Personal Growth Plan, a Mirror of Relapses, a Crisis Plan, and a Learning Agenda. The control group participates in the usual activities of the CRS. Data is collected using a questionnaire of sociodemographic characteristics, personal recovery, empowerment, hope and perceived social support. The users’ measurements are taken at the baseline and one week after the end of the workshop. The primary outcome measures include the Self-Identified Stage of Recovery and the Maryland Assessment of Recovery in Serious Mental Illness Scale (short version). The secondary outcome measures include the Netherlands Empowerment List, Dispositional Hope Scale, and Multidimensional Scale of Perceived Social Support. Descriptive statistics for characterizing the sample size will be performed. Multivariate analyses for repeated measures designs will be used to evaluate the primary and secondary outcomes. Between-group and within-subject comparisons will be conducted.DiscussionThe results of the study will provide information on the usefulness of recovery workshops in a Mediterranean cultural context. Additionally, if this workshop is effective, it will be proposed for inclusion within the portfolio of community mental health services in Catalonia.Trial RegistrationISRCTN11695542 (Registration date: 5 July 2022).

Post-Stroke Experiences and Rehabilitation Needs of Community-Dwelling Chinese Stroke Survivors: A Qualitative Study

Stroke survivors encounter significant limitations in daily life activities and face increased risk of health complications such as stroke recurrence. Considering the escalating demand for personalised community rehabilitation services, this qualitative study was conducted to understand the current recovery experiences, needs, and expectations of community-dwelling stroke survivors. Fifty stroke survivors were recruited from two tertiary teaching hospitals and community centres in two provinces in mainland China. Semi-structured interviews were carried out, and participants were asked to describe their experiences of stroke, current lifestyles, exercise habits, and rehabilitation needs and expectations. Resulting data were thematically analysed. The majority of participants were first-time stroke survivors (80%) and lived with their family or caregivers (92%). Four main themes and twelve sub-themes emerged from the data: (1) shifts in social life, (2) shaken sense of self and perceived helplessness, (3) complex rehabilitation needs, and (4) perceptions and patterns of physical activity. Findings suggest that though survivors recognised their need for further rehabilitation, their demands remained unmet due to a combination of personal and external factors such as limited mobility and the absence of supportive companions and accessible facilities. The enhancement and diversification of home rehabilitation strategies are therefore necessary to make community rehabilitation more accessible and equitable.