Rehabilitation Knowledge Research Articles

Ab. No. 97 The Effect of Different Scapular Positions on Serratus Anterior and Biceps Brachii Muscle Activity During a Forward Reach Task in Healthy Individuals

Introduction: To study the effects of scapular protraction/retraction and neutral position on serratus anterior and biceps brachii muscle activity during a forward reach task in healthy individuals. Normal functioning of the scapula plays a key role in shoulder kinematics. Forward reaching is an integral activity for ADL’s and is a key neuro rehabilitation component. For example, posture that is usually adapted by people with stroke leads to inappropriate positioning of scapula that in turn can disrupt the muscle timing and activation slowing the rehabilitation process. Understanding the muscle activity in healthy individuals can give us a deeper insight to expand our knowledge for rehabilitation. Methods: 19 healthy subjects were selected under convenience sampling. Subjects were asked to perform a forward reach task. Three trials were taken for each scapular position. Surface electrodes recorded EMG activity of serratus anterior and biceps brachii muscle during the task. Average values were taken for analysis. Shapiro - Wilk test was done to analyse normality. The difference between the three positions of scapula (protraction, retraction and neutral) was established for serratus anterior (Fisher’s ANOVA) and biceps (Kruskal-Wallis) along with Post hoc analysis. Correlation between two muscles (serratus and biceps) was established using Spearman’s Correlation Coefficient. Results: Serratus muscle activity (F=0.135, p= 0.874) and biceps (F=0.29, p=0.7). did not achieve statistical significance among the three positions. Statistically significant correlation was found across the positions between biceps and serratus (r2 =0.58,p<0.001). Conclusion: Mean activity of serratus anterior muscle did not change with different scapular positions. However, biceps brachii muscle activity was highest with scapula being in retraction and lowest in protraction. Moderate correlation was found between SA and biceps across positions. Implications: The starting position of scapula may have implications on muscle activation and therefore can impact rehabilitation outcomes.

Reinforcement learning in large, structured action spaces: A simulation study of decision support for spinal cord injury rehabilitation

Reinforcement learning (RL) has helped improve decision-making in several domains but can be challenging to apply; this is the case for rehabilitation of people with a spinal cord injury (SCI). Among other factors, applying RL in this domain is difficult because there are many possible treatments (i.e., large action space) and few detailed records of longitudinal treatments and outcomes (i.e., limited training data). Applying Fitted Q Iteration in this domain with linear models and the most natural state and action representation results in problems with convergence and overfitting. However, isolating treatments from one another can mitigate the convergence issue, and treatments for SCIs have meaningful groupings that can be used to combat overfitting. We propose two approaches to grouping treatments so that an RL agent can learn effectively from limited data. One relies on domain knowledge of SCI rehabilitation and the other learns similarities among treatments using an embedding technique. After re-interpreting the data using these treatment grouping approaches in conjunction with our process that isolates the treatment groups, we use Fitted Q Iteration to train an agent that learns to select better treatments. Through a simulation study designed to reflect the properties of SCI rehabilitation, we find that agents trained after using either grouping method can help improve the treatment decisions of individual physiotherapists, but the approach based on domain knowledge offers better performance. Our findings provide a proof of concept that applying RL has the potential to help improve the treatment of those with an SCI and indicates that continued efforts to gather data and apply RL to this domain are worthwhile.

A Review on Optimising Limb Function with Inspiratory Muscle Training: Unlocking Potential with Enhanced Performance

Introduction: The potential of Inspiratory Muscle Training (IMT) to enhance limb function holds broad significance across sports science, rehabilitation, and physical therapy. The present review elucidates the link between respiratory muscle function and limb performance, suggesting that integrating IMT into training protocols and rehabilitation programs, particularly in sports and preventive healthcare, could yield improved outcomes. Recognising the vital role of respiratory muscle function in overall performance may inspire innovative approaches to training and rehabilitation strategies. Aim: To investigate the effect of inspiratory muscle training in optimising limb function and its impact on overall performance enhancement. Materials and Methods: Full text published articles from year 2004 to 2024 from different databases like Google Scholar, PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane library were included. The search items like “Inspiratory muscle training,” “Limb function”, “Respiratory muscle strength” using Boolean operators AND, OR were used. The study involving both male and female individuals were included. Results: From a total of 345 studies, seven full text studies were relevant and meeting the inclusion criteria were selected. IMT was proven to improve limb function especially in athletes. Conclusion: The findings are expected to provide valuable insights into the potential of IMT as a novel intervention for optimising limb function and enhancing overall performance. The conclusion drawn will contribute to the body of knowledge in sports science, rehabilitation and physical therapy, prepare the way for clinical applications.

Cardiac Rehabilitation Knowledge, Attitudes, and Practice among Patients with Heart Failure and Cardiology Healthcare Providers

Cardiac Rehabilitation Knowledge, Attitudes, and Practice among Patients with Heart Failure and Cardiology Healthcare Providers

Efforts and Effectiveness in Improving Knowledge and Skills of Vocational Assessment for Teachers Supporting Career Decisions of Students with Intellectual Disabilities

Background: The number of options available to people with disabilities has gradually increased in Japan. At educational institutions where students with disabilities are enrolled, teachers must understand the various ways of life and provide appropriate guidance and support based on the actual conditions of individual students so that students can independently choose their career paths through self-selection and self-determination.
 Objective: This study aimed to examine the effect of an intervention using a vocational assessment training program on eight teachers at a special needs school in Japan.
 Methods: The level of knowledge and skills was assessed before and after the intervention. Intervention effects were analyzed through the Self-Assessment for Students and Counselors-Revised tool using the Wilcoxon signed-rank test, with corresponding samples for differences in mean scores before and after the intervention. In addition, the difference in the mean pre- and post-intervention scores for teachers with 10 or more years of upper secondary school experience (high experience group) and those with less than 10 years of upper secondary school experience (low experience group) was calculated.
 Principal Verdicts: Indicated that the training program intervention helped teachers recognize the importance of vocational assessment and subsequently improve their teaching. Furthermore, the number of years of experience in upper secondary schools influenced the effectiveness of the intervention.
 Conclusions: It was suggested that this training program would be effective for professionals who have acquired basic knowledge and skills in vocational rehabilitation.

COVID-19 prevention and rehabilitation related knowledge and practices among Egyptian post-COVID-19 patients.

Even with the mild form of COVID-19, people need to practice the proper preventive measures to achieve health, safety and control spread of infection. Few studies assessed sound disinfection and rehabilitative knowledge. This study aims to assess the self-reported, knowledge of specific disinfection measures among post-recovery COVID-19 patients and identifying the most requested knowledge items regarding the prevention and post COVID rehabilitation measures. This is an exploratory cross-sectional study using an electronically open survey. A pre-tested e-questionnaire was employed for data assembling. The sample size was calculated and a total of 417 people completed the questionnaire. Knowledge score was calculated for preventive and disinfection measures during and after COVID 19 infection. It comprised three sections: socio-demographics, study participants' knowledge regarding precautions, disinfection, and rehabilitation measures, as well as sources of knowledge about COVID-19. All participants infected with COVID-19 (82%) reported self-isolation for ten days after confirming the infection, with only 18% required hospitalization. Regarding the information needed by the participants, the highest requests were for the rehabilitation information after COVID-19 and preventive measures. Females under 30 years old and those with a college education or higher were significantly more likely to request rehabilitation information after COVID-19 (P-value 0.05). Nevertheless, males were significantly more interested in information regarding preventive measures; They were over 30 years old and had education below university (P-value 0.05). Participants (above 30 years old) had significantly higher knowledge of preventive and disinfection measures during and after COVID-19 infection (P = 0.030). After the COVID-19 experience, most participants demonstrated a great desire for rehabilitation information and proper preventive measures. This paves the way for delivering self-management and rehabilitation knowledge and emphasizing the significance of various prevention modalities.

A call for action: Increasing the pediatric rehabilitation medicine workforce.

Pediatric Rehabilitation Medicine (PRM) is a unique blend of traditional medical rehabilitation knowledge and skills primarily focused on temporary and/or permanent disability conditions of childhood onset throughout the age continuum, with an emphasis on promoting function and participation. Although there are two established pathways to enhance knowledge and skills in PRM, one a combined residency with Pediatrics and the other a PRM fellowship, there has been a relative decline in participants in this training, as has been seen across other subspecialties in Physical Medicine and Rehabilitation (PM&R) and other medical specialties. Based on pediatric rehabilitation physician surveys and the increasing prevalence of children with disabilities, there has been a call to consider opening PRM fellowships to physicians not trained in PM&R. This commentary proposes establishing a commission to lead a transparent and inclusive process to assure that all options to address issues related to optimizing PRM care are considered and provide a course of action to address the needs of children and adults with childhood onset disabilities.

Developments in rehabilitation psychiatry within the RANZCP and the creation of a mental health rehabilitation curriculum.

This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation. Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules. A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts. As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised.

Interactive game experience: a preliminary investigation of the impact of virtual reality on exercise rehabilitation behaviors

ABSTRACT Tennis elbow, known as lateral epicondylitis in medical terms, which affects the daily life function of most patients. Many patients are becoming less willing to practice traditional rehabilitation due to time and space constraints and the need to go to the hospital for rehabilitation. In this study, the concept of user experience, and the remote therapy model were used to design a virtual reality interactive game system which incorporated lateral epicondylitis exercise rehabilitation knowledge on user learning. The usability of this system was evaluated by a digital content instructor and a rehabilitation practitioner before being put into practice to test the user experience. The system could provide four rehabilitation modes for the user to choose from, with the guidance of a virtual physiotherapist or therapist, to achieve optimal results. This study found that virtual reality provided good interaction satisfaction for the users, but that a long operation time or too much information might bring users the feeling of troublesome. The integration of digital information content and control on the length of operation time were important factors when designing this kind of games.

Resourcefulness as a mediator in the relationship between self-perceived burden and depression among the young and middle-aged stroke patients: A cross-sectional study

ObjectiveTo explore the relationships among self-perceived burden, resourcefulness and depression, and to study further whether resourcefulness mediates the effects of self-perceived burden on depression in young and middle-aged stroke patients. MethodsA cross-sectional survey was conducted with 1050 young and middle-aged stroke patients. We used a general demographic questionnaire, Self-Perceived Burden Scale (SPBS), Resourcefulness Scale© (RS) and Hamilton Depression Scale (HAMD) to assess self-perceived burden, resourcefulness, and depression. Statistical methods included correlation analysis, multiple linear regression, and structural equation model. Results1018 valid questionnaires were collected with a response rate of 96.95%. Resourcefulness was inversely correlated with self-perceived burden (r = −0.367, p < 0.01) and depression (r = −0.625, p < 0.01); Self-perceived burden was positively associated with depression (r = 0.698, p < 0.01). Multiple linear regression analyses showed that resourcefulness mediated the effects of self-perceived burden on depression; The structural equation model demonstrated that the resourcefulness mediated the relationship between self-perceived burden and depression. ConclusionResourcefulness is a mediator between self-perceived burden and depression. Medical staff adjust the psychological state of stroke patients based on the theory of resourcefulness, thereby improving their problem-solving ability, actively encouraging patients to establish problem-solving strategies, providing disease rehabilitation knowledge and skills, and promoting the improvement of resourcefulness level.

Rehabilitation following shoulder arthroplasty: a survey of current clinical practice patterns of Italian physiotherapists

BackgroundThe incidence of Total Shoulder Arthroplasty (TSA) and Reverse Total Shoulder Arthroplasty (RTSA) is constantly increasing. As a result, the interest in post-surgical rehabilitation has grown, since it is crucial in order to achieve full recovery and successful outcomes. The first aim of this study is to investigate the Italian physiotherapists (PTs) clinical practice in the management of patients with TSA and RTSA and to compare it with the best evidence available in the literature. The second purpose of this study is to assess any existing difference between the survey answers and the different sample subgroups.Materials and methodsThis cross-sectional observation study was designed following the CHERRIES checklist and the STROBE guidelines. A 4-sections survey with a total of 30 questions was developed for investigating post-surgery rehabilitation management in patient with TSA and RTSA. The survey was sent to Italian PTs from December 2020 until February 2021.ResultsSix-hundred and seven PTs completed the survey regarding both TSA and RTSA; 43.5% of participants (n = 264/607) stated that TSA is more likely to dislocate during abduction and external rotation. Regarding reverse prosthesis, 53.5% (n = 325/607) affirmed RTSA is more likely to dislocate during internal rotation, adduction and extension.In order to recover passive Range of Motion (pROM), 62.1% (n = 377/607) of participants reported that they gain anterior flexion, abduction, internal rotation, external rotation up to 30°, with full pROM in all directions granted at 6–12 weeks. Regarding the active ROM (aROM), 44.2% (n = 268/607) of participants stated that they use active-assisted procedures within a range under 90° of elevation and abduction at 3–4 weeks and higher than 90° at 6–12 weeks, with full recovery at a 3-month mark. Sixty-five point seven percent of the sample (n = 399/607) declared that, during the rehabilitation of patients with TSA, they tend to focus on strengthening the scapular and rotator cuff muscles, deltoid, biceps and triceps. Conversely, 68.0% (n = 413/607) of participants stated that, for the rehabilitation of patients with RTSA, they preferably focus on strengthening the periscapular and deltoid muscles. Finally, 33.1% (n = 201/607) of participants indicated the instability of the glenoid prosthetic component as the most frequent complication in patients with TSA, while 42.5% (n = 258/607) of PTs identified scapular neck erosion as the most frequent post-RTSA surgery complication.ConclusionsThe clinical practice of Italian PTs effectively reflects the indications of the literature as far as the strengthening of the main muscle groups and the prevention of movements, which may result in a dislocation, are concerned. Some differences emerged in the clinical practice of Italian PTs, regarding the restoration of active and passive movement, the starting and progression of muscle strengthening and the return to sport (RTS). These differences are actually quite representative of the current knowledge in post-surgical rehabilitation for shoulder prosthesis in the rehabilitation field.Level of evidenceV

Awareness and knowledge of breast cancer rehabilitation among Saudi Arabia physical therapists.

This study aimed to evaluate the physical therapists' knowledge and awareness of breast cancer, treatment modalities, contraindications, and clinical guidelines. A cross-sectional survey was conducted from December 2020 to May 2021 in Saudi Arabia. The sample size was determined using the Raosoft sample size calculator, which indicated the need for 67 participants. All physical therapists of both sex in private and public hospitals in Ha'il and non-Ha'il regions were included in the study. Data was collected by a structured Google form questionnaire, consisting of 4 main domains with a maximum score of 43. 57 physical therapists participated in the current study, out of which 31 were from the Ha'il region (42.1% male, 57.9% female) with a mean age of 29±7 years and a mean experience 6±7years. The referral of breast cancer patients was only 22.8%. Interestingly only 22.8% of the hospital has specific setups for oncology rehabilitation, and 12.3% have reported positive about continuing professional development (CPDs) workshops for breast cancer organized by their hospitals. 5.3% of patients with breast cancer are aware of the benefit of oncology rehabilitation, while 22.8% of patients come for follow-up sessions in the rehabilitation department. According to multiple regression, only gender was statistically significant for prediction, p<0.05. Females increased the mean score by 5.996 more than males. Female therapists are 38.2% more aware than males. Although physical therapists have a low level of knowledge and an average level of awareness, with a higher number of women than men, attitudes toward physical therapy are quite high, and the profession is practiced exceptionally well.

Physical Rehabilitation of Motor Functional Neurological Disorders: A Narrative Review.

Functional Neurological Disorders (FNDs) are one of the most common and disabling neurological disorders, affecting approximately 10-30% of patients in neurology clinics. FNDs manifest as a range of motor, sensory, and cognitive symptoms that are not explained by organic disease. This narrative review aims to assess the current state of knowledge in physical-based rehabilitation for motor/movement FNDs in the adult population, with the goal of improving research and medical care for this patient population. To ensure optimal outcomes for patients, it is critical to consider several domains pertaining to FNDs, including which field of discipline they should belong to, how to investigate and test, methods for rating outcome measures, and optimal courses of treatment. In the past, FNDs were primarily treated with psychiatric and psychological interventions. However, recent literature supports the inclusion of physical rehabilitation in the treatment of FNDs. Specifically, physical-based approaches tailored to FNDs have shown promising results. This review utilized a comprehensive search of multiple databases and inclusion criteria to identify relevant studies.

Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project.

This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0-22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation ( P < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P < 0.05). This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future.

Effects of a virtual simulation-based interprofessional education activity for rehabilitation nursing using shared resources: A quasi-experimental study

BackgroundInterprofessional education (IPE) is crucial for effective clinical practice but remains challenging to be implemented. The IPE activity using virtual simulation (VS) may potentially solve the time and space challenges of in-person interprofessional simulations. Using shared VS resources may increase the popularity of virtual teaching in conditions of limited resources. ObjectivesUsing shared resources, this study aimed to design and implement a VS-based IPE activity for undergraduate healthcare students, exploring the effects. DesignA quasi-experimental design was used, with assessments conducted before and after the activity. SettingsOne university and its affiliated hospitals in south China. ParticipantsForty-two undergraduate students majoring in nursing, clinical medicine, and rehabilitation therapy participated in this study. MethodsA test composed of ten questions was used to evaluate knowledge of rehabilitation. The Chinese version of Critical Thinking Disposition Inventory (CTDI-CV) and the Chinese version of Assessment of Interprofessional Team Collaboration in Student Learning Scale (AITCS-II (Student)-CV) were used to evaluate critical thinking and interprofessional collaboration. Participants' opinions about the activity were assessed, considering satisfaction, perceived effectiveness, the ease of shared VS platform use, and suggestions about the activity. ResultsSignificant improvements were shown in pre- and post-test total scores on knowledge of rehabilitation, mean scores for overall critical thinking disposition, and mean item scores on overall interprofessional team collaboration. ConclusionsThe study provides a reference for designing and implementing VS-based IPE but the effects of this innovative pedagogy on students' rehabilitation knowledge, critical thinking, and interprofessional collaboration ability still need to be further confirmed. Most of the students gave positive feedback on the activity. Technical issues should be addressed to decrease their impacts on the VS practice experience.

The Mediating Role of Sleep Quality in the Association Between Negative Affect and Cognitive Function Among Patients With Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy.

Cognitive function impairment is a severe yet largely unrecognized adverse reaction among patients with nasopharyngeal carcinoma (NPC) following radiotherapy. The aims of this study were to examine the level of cognitive function, explore the influencing factors of the cognitive function of NPC after intensity-modulated radiotherapy (IMRT), and identify the mediating role of sleep quality between negative affect and cognitive function. In total, 200 patients with NPC after IMRT were recruited from a tertiary cancer center in Southern China between September 2020 and March 2021. Participants completed the demographic and disease-related questionnaire, Montreal Cognitive Assessment Scale, Profile of Mood States-Short Form, and Pittsburgh Sleep Quality Index. The mean Montreal Cognitive Assessment Scale scores were 24.42 after adjustment, with 54.5% of patients having cognitive function impairment. Education level, income, seeking rehabilitation knowledge, radiation dose, sleep quality, and negative affect entered the final regression model and explained 82.6% of cognitive function variance. The total and direct effects of negative affect and indirect effects via sleep quality on cognitive function were significant ( P < .05). Clinicians should pay close attention to patients with poor educational levels, low income, and having difficulties seeking rehabilitation knowledge and patients who accept higher radiation doses. Improving their sleep quality and positive affect may contribute to preventing or reducing cognitive function impairment. Clinical nurses should pay more attention to cognitive function among NPC patients after IMRT and take effective measures or interventions to prevent and reduce their cognitive function impairment.

Cancer Rehabilitation Veterans Affairs Extension for Community Healthcare Outcomes Virtual Education Program: A Model for Virtual Learning in the COVID-19 Era.

Rehabilitation is important in the care of patients with cancer for improving function, pain, and quality of life. However, only a small number of clinicians are formally trained in cancer rehabilitation. Virtual learning environments may play a promising role in cancer rehabilitation education, especially in the coronavirus pandemic era where in-person learning is not readily available. A national, interprofessional cancer rehabilitation education program involving a monthly longitudinal webinar series and a 2-day virtual bootcamp was developed through the US Department of Veterans Affairs Extension for Community Healthcare Outcomes to improve Department of Veterans Affairs clinician understanding of cancer rehabilitation and ultimately increase the availability of cancer rehabilitation services in the Veterans Health Administration. From March 2020 to July 2022, 923 individuals participated with an average of 72 participants per session and 204 participants per session in the bootcamp. Participants' most common disciplines were physical therapy, occupational therapy, nursing, medicine (physicians), advanced practice providers, speech therapy, and pharmacy. Participants reported improved knowledge of cancer rehabilitation and anticipated that the knowledge would change their practice. Virtual education can be a useful means to educate Department of Veterans Affairs-based healthcare professionals about cancer rehabilitation and improve access to rehabilitation services for veterans with cancer.

Evaluation of a knowledge translation intervention for HIV and rehabilitation advocacy in physiotherapy in three sub-Saharan African countries

Purpose To evaluate a knowledge translation intervention to determine knowledge, attitudes and self-efficacy related to HIV and rehabilitation advocacy in physiotherapy students. Methods A pre and post-test study was conducted at three physiotherapy-training programs in Sub Saharan Africa – the University of the Witwatersrand (Wits), the University of Zambia (UNZA) and Kenya Medical Technical College (KMTC). For each site, the knowledge, attitude and self-efficacy of physiotherapy students were tested pre- and post-intervention using a standardized questionnaire. Results Students’ knowledge improved with regard to being able to describe the challenges faced by their patients, knowing what resources are available and understanding their role as an advocate. In terms of self-efficacy, they felt more confident clinically, as well as being a resource person to colleagues and an advocate for their patients. Conclusion: This study highlights the need to contextualize knowledge translation interventions to meet the unique needs of individual academic sites. Students who have clinical experience working with people living with HIV are more likely to embrace their role as advocates in the area of HIV and rehabilitation. Implications for Rehabilitation The knowledge translation process used in this study gives a concrete example of how to use research evidence on HIV knowledge in rehabilitation applied within the advocacy process. Applying the principles of advocacy translates to understanding the management of HIV practically. Clinical experience in managing people living with HIV strengthens knowledge and improves the attitude of physiotherapy students Physiotherapy students need guidance in realizing their potential as advocates for holistic rehabilitation care for people living with HIV.

Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial

Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.

The Subjective Will and Psychological Experience of Home-Based Exercise in Lung Cancer Patients During Interval of Chemotherapy: A Qualitative Study.

This qualitative study explores the subjective will and psychological experience of home exercise in patients with lung cancer during the interval of chemotherapy. Semi-structured interviews were conducted with 15 lung cancer patients undergoing chemotherapy. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected and described in detail, and the authenticity of the theme was verified. The analysis revealed the home-based exercise experience of patients' in the interval period of chemotherapy, and identified three themes: 1) the perception experience of home-based exercise (beneficial home-based exercise experience, negative home-based exercise experience); 2) the influencing factors of home-based exercise (exercise rehabilitation knowledge, disease symptoms and adverse effects of chemotherapy, exercise history, exercise self-efficacy, social support, restrictions on objective conditions); 3) Patients with lung cancer expected to get professional guidance about home-based exercise rehabilitation knowledge from medical care providers. Patients' perception and attitude towards home-based exercise behavior is affected by many factors during the interval of chemotherapy, and they expect professional guidance from medical care providers. Medical care providers should know the problems and the influencing factors in the process of home-based exercise of patients, and formulate personalized exercise measures for patients based on their own characteristics and needs, so as to relieve the symptoms of discomfort and improve the quality of life of patients with lung cancer.