Participation Of Survivors Research Articles

Effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for stroke survivors: study protocol for a randomized controlled trial

BackgroundEnhancing social participation is not only the main goal of stroke survivors' community rehabilitation but also a protective factor affecting their physical and emotional health. The current state of stroke survivors' social participation is not encouraging due to the high disability incidence of stroke. Spouses may play a facilitating role in the social participation of patients by providing them with support and assistance. However, there remains a lack of evidence specifically regarding dyadic coping interventions of social participation for stroke survivors, and the intervention strategies are still underdeveloped without clear theoretical frameworks. Therefore, this proposed study aims to develop and evaluate the effectiveness of the Dyadic Coping Intervention of Social Participation (DCISP) for survivors of first-episode homebound stroke.MethodsA single-blind (assessor-blinded), randomized controlled trial will be conducted to verify the effectiveness of DCISP. The randomized controlled trial will be preceded by a feasibility study (N = 20) of DCISP in stroke survivors. Stroke survivors will be randomly classified (1:1) into either a control (N = 50) or an experimental group (N = 50). In addition to routine care, participants in the experimental group will receive six 40 ~ 45 min sessions of guidance, once every two weeks. The primary outcome is social participation of stroke survivors, measured using Impact on Participation and Autonomy Questionnaire (IPA) and Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), and the secondary outcomes will be measured by Knowledge Questionnaire for Stroke Patients (SPKQ), Stroke-specific Quality of Life Scale (SS-QOL), Dyadic Coping Inventory (DCI), Modified Rankin Scale (mRS) and Zarit Caregiver Burden Interview (ZBI-22). These will be measured at baseline(T0), during the intervention (T1 = 1 month), and after intervention completion (T2 = 3 months, T3 = 6 months).DiscussionFindings from the study will provide evidence of the effects of DCISP on improving the social participation of first-episode homebound stroke survivors. The results of this study may support the implementation of survivor–spouse dyads care support in stroke survivors and provide a reference for clinical rehabilitation nursing practice, offering new insights into nursing interventions for stroke patients.Trial registrationChinese Clinical Trial Registry (ChiCTR) ChiCTR2400083072. Registered on 20 July 2023.

Protocol of a randomized controlled trial on the effectiveness and cost-effectiveness of the PLACES intervention: a supported employment intervention aimed at enhancing work participation of unemployed and/or work-disabled cancer survivors

BackgroundApproximately onethird of cancer survivors encounter challenges reintegrating into the workforce, often experiencing involuntary unemployment and/or partial or full work disability following diagnosis and treatment. Returning to paid employment presents evident challenges due to uncertainties regarding work ability, perceived employer discrimination, and a lack of support, thereby risking social exclusion. However, interventions addressing return to paid employment among unemployed and/or work-disabled cancer survivors are scarce. Here, we describe the protocol of a randomized controlled trial (RCT), including a process and economic evaluation, evaluating the effectiveness and cost-effectiveness of the PLACES (unemPLoyed cAnCEr survivors Support) intervention aimed at supporting unemployed and/or work-disabled cancer survivors returning to paid employment.MethodsA two-armed RCT with a 12-month follow-up period will be conducted. Eligible participants: (1) are of working age (18–65 years), (2) are diagnosed with cancer between 6 months and 10 years ago, (3) are unemployed and/or partially or fully work-disabled, (4) have completed cancer treatment, and (5) are seeking paid employment and are motivated to initiate work immediately. Participants will primarily be identified through the Dutch Social Security Agency and the Netherlands Cancer Registry and recruited via healthcare professionals. Participants randomly allocated to the intervention group (n = 82) will receive the PLACES intervention: a tailored supported employment intervention based on the principles of Individual Placement and Support (IPS). This includes support in seeking, returning to, and maintaining paid employment. Participants allocated to the control group (n = 82) will receive care as usual. All participants will be asked to complete questionnaires, at baseline (T0), and after 3 (T1), 6 (T2), and 12 (T3) months of follow-up. The primary outcome is paid employment [yes/no]. Secondary outcomes are time until paid employment, change in working hours, work ability, quality of (working) life, and self-efficacy regarding return to work. Additionally, process and economic evaluations will be conducted.DiscussionWe hypothesize that the PLACES intervention will be effective in obtaining paid employment, enhancing work ability, and improving quality of life. In addition, we expect the intervention to be cost-effective. If proven effective and cost-effective, actions should be taken to implement the intervention in usual care.Trial registrationNCT06028048.

Barriers to and enablers of physical activity participation in lung cancer survivors.

Although physical activity physical activity has been shown to have significant benefits for individuals living with cancer, engaging lung cancer survivors (LCS) in increasing routine physical activity participation has been particularly challenging. To describe enablers of, barriers to, and patterns of physical activity among LCS and to characterize interest in a physical activity program as a first step to improving physical activity engagement. The study consisted of a cross-sectional survey (n = 100) of adult LCS recruited from a thoracic oncology clinic assessing multiple domains of physical activity (engagement, perceived barriers, benefits, physical function, psychosocial factors, self-efficacy, and programmatic preferences). Only 12% of LCS in our cohort (average age 67 years, 54% male, 81% with stage III or IV disease) met American College of Sports Medicine (ACSM) physical activity guidelines. Participants engaged in moderate-to-vigorous physical activity, with an average (SD) of 48.4 (91.8) minutes per week. The most commonly reported barriers to physical activity were fatigue (49%), dyspnea (39%), and difficulty with daily activities (34%). Regression analysis demonstrated a positive association between moderate-to-vigorous physical activity and higher income (r = 0.241, p = .016), physical function (r = 0.281, p = .005), and physical activity self-efficacy (r = 0.270, p = .007). Qualitative results demonstrated a strong interest in physical activity programming that is lung-cancer specific with a high level of support and guidance. This study identified that LCS had low levels of physical activity with fatigue, dyspnea, socioeconomic, and functional limitations contributing. The majority of LCS are interested in an exercise program and believe that exercise engagement will produce functional benefits. The present study presents a framework to guide development of community-based interventions to increase LCS physical activity participation among LCS.

Barriers to participation in clinical trials of rural older adult cancer survivors: A qualitative study.

Currently, 64% of cancer survivors are aged 65+. Older cancer survivors have unique complications after chemotherapy and are often excluded from cancer clinical trials. Although there is research on barriers to clinical trial participation of older adult cancer survivors, to date no research has explored barriers to clinical trial participation unique to rural older adult cancer survivors. This study is a secondary qualitative analysis from a study exploring survivorship challenges of rural older adults. Eligible participants were rural residents over age 65 who have completed curative-intent chemotherapy in the past 12 months. Participants (n=27) completed open-ended semi-structured interviews that included questions on barriers to clinical trial participation. Transcripts were coded independently by two coders using thematic analysis. We have adhered to the standards for reporting qualitative research. Participants reported a variety of barriers that included limited knowledge and fear about clinical trials, transportation challenges, their physicians not informing them of clinical trials, and thinking they are too old to participate in clinical trials. However, participants also reported facilitators to participating in clinical trials, including acknowledging benefits to their own health and society, and understanding the importance of clinical trials. Rural older cancer survivors face numerous interpersonal, intrapersonal, and organizational barriers to clinical trial participation. Aging- and location-sensitive interventions that focus on patients, their caregivers, and health care providers may lead to improved participation of rural older adult survivors into clinical trials.

Social characteristics and social benefit use among premenopausal breast cancer survivors in Denmark: a population-based cohort study.

In 2020, one million women aged < 55years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation. We conducted a nationwide population-based cohort study, including women aged 18-55years diagnosed with stage I-III breast cancer in Denmark during 2002-2011. Statistics Denmark provided information on cohabitation, education, and social benefit use from 1year pre-diagnosis to 10years post-diagnosis. We calculated weekly proportions ofself-support, unemployment, disability pension, flexi jobs, and sick leave according to education and cohabitation. Of 5345 women, 81.8% were self-supporting, 4.5% received disability pensions, 1.6% had flexi jobs, 3.6% were on sick leave, and 5.5% were unemployed 1 yearpre-diagnosis. Ten years post-diagnosis, the proportions were 69.0%, 13.0%, 10.5%, 3.4%, and 2.0% of 3663 survivors. Disability pensions and flexi jobs increased from 12.1 to 26.4% and 2.8 to 13.5% in women with short education, from 4.1 to 12.8% and 1.8 to 12.2% in women with medium education, and from 0.8 to 6.0% and 0.9 to 6.9% in longer educated. Disability pensions increased more in women living alone (7.8 to 19.9%), than in cohabiting women (3.6 to 11.3%). Use of social benefits reflecting lost ability to work was highest in less educated women and in women living alone. Awareness of these groups is crucial when tailoring efforts to support work participation in cancer survivors.

A systematic investigation of detectors for low signal-to-noise ratio EMG signals

Background Active participation of stroke survivors during robot-assisted movement therapy is essential for sensorimotor recovery. Robot-assisted therapy contingent on movement intention is an effective way to encourage patients’ active engagement. For severely impaired stroke patients with no residual movements, a surface electromyogram (EMG) has been shown to be a viable option for detecting movement intention. Although numerous algorithms for EMG detection exist, the detector with the highest accuracy and lowest latency for low signal-to-noise ratio (SNR) remains unknown. Methods This study, therefore, investigates the performance of 13 existing EMG detection algorithms on simulated low SNR (0dB and -3dB) EMG signals generated using three different EMG signal models: Gaussian, Laplacian, and biophysical model. The detector performance was quantified using the false positive rate (FPR), false negative rate (FNR), and detection latency. Any detector that consistently showed FPR and FNR of no more than 20%, and latency of no more than 50ms, was considered an appropriate detector for use in robot-assisted therapy. Results The results indicate that the Modified Hodges detector – a simplified version of the threshold-based Hodges detector introduced in the current study – was the most consistent detector across the different signal models and SNRs. It consistently performed for ~90% and ~40% of the tested trials for 0dB and -3dB SNR, respectively. The two statistical detectors (Gaussian and Laplacian Approximate Generalized Likelihood Ratio) and the Fuzzy Entropy detectors have a slightly lower performance than Modified Hodges. Conclusions Overall, the Modified Hodges, Gaussian and Laplacian Approximate Generalized Likelihood Ratio, and the Fuzzy Entropy detectors were identified as the potential candidates that warrant further investigation with real surface EMG data since they had consistent detection performance on low SNR EMG data.

A systematic investigation of detectors for low signal-to-noise ratio EMG signals.

Active participation of stroke survivors during robot-assisted movement therapy is essential for sensorimotor recovery. Robot-assisted therapy contingent on movement intention is an effective way to encourage patients' active engagement. For severely impaired stroke patients with no residual movements, a surface electromyogram (EMG) has been shown to be a viable option for detecting movement intention. Although numerous algorithms for EMG detection exist, the detector with the highest accuracy and lowest latency for low signal-to-noise ratio (SNR) remains unknown. This study, therefore, investigates the performance of 13 existing EMG detection algorithms on simulated low SNR (0dB and -3dB) EMG signals generated using three different EMG signal models: Gaussian, Laplacian, and biophysical model. The detector performance was quantified using the false positive rate (FPR), false negative rate (FNR), and detection latency. Any detector that consistently showed FPR and FNR of no more than 20%, and latency of no more than 50ms, was considered an appropriate detector for use in robot-assisted therapy. The results indicate that the Modified Hodges detector - a simplified version of the threshold-based Hodges detector introduced in the current study - was the most consistent detector across the different signal models and SNRs. It consistently performed for ~90% and ~40% of the tested trials for 0dB and -3dB SNR, respectively. The two statistical detectors (Gaussian and Laplacian Approximate Generalized Likelihood Ratio) and the Fuzzy Entropy detectors have a slightly lower performance than Modified Hodges. Overall, the Modified Hodges, Gaussian and Laplacian Approximate Generalized Likelihood Ratio, and the Fuzzy Entropy detectors were identified as the potential candidates that warrant further investigation with real surface EMG data since they had consistent detection performance on low SNR EMG data.

Cognitive impairment in cervical cancer survivors—Exploring the discrepancy between subjective and objective assessment

AbstractObjectiveCancer‐related cognitive impairment has severe implications for the quality of life and societal participation of cervical cancer survivors (CCS). However, there is no research on the association between subjective and objective cognitive impairment (CI) in cervical cancer. This cross‐sectional study aimed to examine the frequency and severity of objective CI in CCS reporting significant subjective CI and explore the discrepancy between subjective and objective CI.MethodsSixty‐five CCS reporting significant subjective CI, defined as 1.5 SD below the normative mean, underwent neuropsychological (NP) assessment covering attention, verbal memory, processing speed, verbal fluency, and executive functions. CCS were compared to healthy age‐matched controls (n = 74). A subjective versus objective discrepancy score was calculated based on the standardized scores within each group.ResultsThe CCS group performed significantly poorer across all NP tests compared to healthy controls (all p‐values &lt;0.001) and 81.5% had scores below cut‐off as defined by the International Cognition and Cancer Task Force. However, compared to published normative data, most CCS performed within the clinically normal range. Processing speed and verbal memory were the most affected cognitive domains. By calculating a discrepancy score, both groups on average displayed a quite accurate concordance between subjective and objective cognitive functioning.ConclusionAlthough CI is evident in CCS, our results confirm that objective and subjective CI represent different constructs and highlight the limitations of normative data. Differentiating subjective and objective CI is important when tailoring effective interventions in the survivorship care of CCS.

A systematic investigation of detectors for low signal-to-noise ratio EMG signals

Background Active participation of stroke survivors during robot-assisted movement therapy is essential for sensorimotor recovery. Robot-assisted therapy contingent on movement intention is an effective way to encourage patients’ active engagement. For severely impaired stroke patients with no residual movements, a surface electromyogram (EMG) has been shown to be a viable option for detecting movement intention. Although numerous algorithms for EMG detection exist, the detector with the highest accuracy and lowest latency for low signal-to-noise ratio (SNR) remains unknown. Methods This study, therefore, investigates the performance of 13 existing EMG detection algorithms on simulated low SNR (0dB and -3dB) EMG signals generated using three different EMG signal models: Gaussian, Laplacian, and biophysical model. The detector performance was quantified using the false positive rate (FPR), false negative rate (FNR), and detection latency. Any detector that consistently showed FPR and FNR of no more than 20%, and latency of no more than 50ms, was considered an appropriate detector for use in robot-assisted therapy. Results The results indicate that the Modified Hodges detector – a simplified version of the threshold-based Hodges detector introduced in the current study – was the most consistent detector across the different signal models and SNRs. It consistently performed for ~90% and ~40% of the tested trials for 0dB and -3dB SNR, respectively. The two statistical detectors (Gaussian and Laplacian Approximate Generalized Likelihood Ratio) and the Fuzzy Entropy detectors have a slightly lower performance than Modified Hodges. Conclusions Overall, the Modified Hodges, Gaussian and Laplacian Approximate Generalized Likelihood Ratio, and the Fuzzy Entropy detectors were identified as the potential candidates that warrant further investigation with real surface EMG data since they had consistent detection performance on low SNR EMG data.

“No one told me”: exploring factors influencing physical activity participation in Black Nova Scotian cancer survivors

BackgroundFew studies have examined differences in cancer survivors' physical activity and exercise behaviors by race/ethnicity and none have explored this relationship in a Canadian context.PurposeTo explore the underlying factors that influence physical activity and exercise participation in African, Caribbean, and Black (ACB) cancer survivors.MethodsSemi-structured interviews were conducted with eight ACB cancer survivors residing in Nova Scotia, Canada. Interviews broadly explored three main topics: (1) Exploring physical activity and exercise knowledge; (2) Barriers and facilitators to physical activity and exercise; and (3) Perceptions of cancer specific exercise trials and programs. Participant interviews were audio-recorded and transcribed verbatim and analyzed using an inductive thematic analysis.ResultsAn overall storyline of “No One Told Me” along with four primary themes emerged from the participant interviews. Theme 1, “the journey” describes the lack of knowledge sharing between healthcare providers and cancer survivors. Theme 2, “what's there for me” unravels participants understanding of physical activity and exercise, knowledge of available support, and guidance to maintain and/or improve wellbeing through exercise. Theme 3, “one step at a time” spotlights participants thoughts and perceptions of participating in physical activity and exercise. Theme 4, “See ME,” considers recommendations to increase awareness and participating in physical activity and exercise trials/programs and the importance of providing safe and welcoming spaces for all.DiscussionThis study offers insight into the barriers confronted by ACB cancer survivors when considering participation in physical activity and exercise. Participants were largely aware of the benefits of being physically active but described a lack of perceived knowledge sharing and welcoming spaces. Further investigation is needed to identify strategies to improve representation of ACB cancer survivors in clinical exercise studies and community, cancer-specific exercise programming.

A predictive model for social participation of middle-aged and older adult stroke survivors: the China Health and Retirement Longitudinal Study.

This study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors. The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA). A total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631-0.707) and 0.635 (95% CI 0.573-0.698), respectively. Hosmer-Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance. The nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

Cognitive Function and Participation of Stroke Survivors Living With Companion Animals: A Cross-Sectional Study.

Companion animals (CAs) may benefit human health, but few studies have examined their impact on stroke survivors. This study examines participation, quality of life (QoL), attachment, cognition, and executive function differences between stroke survivors living with and without CAs. In this cross-sectional, community-setting study, 25 stroke survivors with a CA and a matched group of 27 without a CA completed standard tools. Stroke survivors with a CA scored significantly higher in participation and 1 cognitive performance test. No significant differences were found in other cognitive measures or QoL, and attachment to a CA was not correlated with participation or QoL within the research group. However, lower attachment avoidance correlated with better participation in survivors living with dogs. Living with CAs, especially dogs, might be associated with some cognitive function and participation benefits among stroke survivors. The link between CAs and cognitive function is unclear: Survivors with higher cognitive functioning might be more capable of caring for a CA, or having and caring for a CA might promote better cognitive function. Attachment patterns also might explain stroke survivors' participation levels. Further study is warranted.

Social participation of school-aged survivors of pediatric brain tumors: A daily diary report.

Difficulties with social functioning are common among survivors of pediatric brain tumors. Social participation is an understudied measure of social functioning that is associated with emotional health across the lifespan. This paper uses a diary method to assess the social participation of survivors of pediatric brain tumors in middle childhood. Survivors of pediatric brain tumors (N=47; age 10.6±1.4years; 51.1% male, 89.4% White) who were 5.3 (SD=2.4, range: 2-9.9) years post therapy completed a daily diary assessment of social interaction (5-7days) and an objective measure of facial affect recognition. The participant's caregiver completed the NIH Toolbox Emotion Measures and a background information questionnaire. Overall, frequency and quality of reported social interactions were low for survivors, with a large subset of survivors (n=16, 34%) endorsing fewer than 10 social interactions over the course of a typical school week, and almost half of parents (48.9%) reporting that their child participates in zero social activities outside of school during a typical week. Participants engaged in more positive social participation exhibited stronger social skills (facial affect recognition (F(2,44) =4.85, p<.05). School-aged survivors of pediatric brain tumors seemed to be infrequently engaged in social participation and quality interaction with peers. More specifically, the interactions most commonly reported on the diary assessment are not indicative of friendship development and maintenance. Survivors of pediatric brain tumors would likely benefit from interventions designed to increase quality time spent with peers.

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.

Ultraleftism to Missary of Commoners: Case of Victims of Sexual Violence During Insurgency

A decade-long armed conflict resulted in the prevalence of survivors of sexual violence in Nepal. The survivors include those who sustained physical and/or mental harm and social distress due to sexual violence or having such family members. The insurgency launched by the then CPN (Maoist) in 1996 was an act of ultra-leftism. The victims of conflict-related sexual violence (CRSV) are being deprived of justice even after a decade and a half without realization of the agreed transitional justice process as per the Comprehension Peace Accord (CPA). Despite the examples of good practices that exist globally, the CRSV survivors in Nepal have not been acknowledged adequately as a crucial facet of the conflict resolution processes neither in any peace dialogue nor in the CPA and peace-building initiatives pursued afterward. Findings concluded that the conflict resolution processes so far do not mean anything to them as they have neither been part of nor benefited from the claimed ‘peace-building initiatives’in Nepal. This article has revealed that the situation is worrying sum as leaving the survivors behind does not simply lead to failure of the conflict resolution process in Nepal. In explaining PMPD Bhandari states that the communist party can resolve any problem with the help of people amidst the political and organizational works without imposing the security forces. Therefore, while illustrating the severity of incidents and concerns of CRSV survivors, the article has drawn the attention of all stakeholders to ensure the effective participation of the CRSV survivors’ and integrate their issues and concerns into peace-building processes.

Disaster Response and Management: The Integral Role of Rehabilitation.

With the increasing frequency of disasters and the significant upsurge of survivors with severe impairments and long-term disabling conditions, there is a greater focus on the importance of rehabilitation in disaster management. During disasters, rehabilitation services confront a greater load due to the influx of victims, management of persons with pre-existing disabilities and chronic conditions, and longer-term care continuum. Despite robust consensus amongst the international disaster response and management community for the rehabilitation-inclusive disaster management process, rehabilitation is still less prioritised. Evidence supports the early involvement of rehabilitation professionals in disaster response and management for minimising mortality and disability, and improving clinical outcomes and participation in disaster survivors. In the last two decades, there have been substantial developments in disaster response/management processes including the World Health Organization Emergency Medical Team (EMT) initiative, which provides a standardized structured plan to provide effective and coordinated care during disasters. However, rehabilitation-inclusive disaster management plans are yet to be developed and/or implemented in many disaster-prone countries. Strong leadership and effective action from national and international bodies are required to strengthen national rehabilitation capacity (services and skilled workforce) and empower international and local EMTs and health services for comprehensive disaster management in future calamities. This narrative review highlights the role of rehabilitation and current developments in disaster rehabilitation; challenges and key future perspectives in this area.

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest

The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens. To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA. This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing. Randomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher). Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes. At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%). In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common. ClinicalTrials.gov Identifier: NCT02908308.

Relationship between Participation in Daily Life Activities and Physical Activity in Stroke Survivors: A Protocol for a Systematic Review and Meta-Analysis.

Stroke survivors undertake low levels of physical activity and participation in daily life activities, but the correlation between these two domains still carries some degree of uncertainty. This systematic review and meta-analyses-based data synthesis will aim to describe and estimate the relationship between participation in daily life activities and physical activity in stroke survivors. Six databases (MEDLINE/PubMed, Web of Science, Scopus, PEDro, SPORTDiscus, and Rehabilitation & Sport Medicine Source) will be searched. Studies assessing participation alongside physical activity levels in adult stroke survivors in English or Spanish will be included. The study selection, assessment of the risk of bias, and data extraction will be conducted independently by two investigators. If available, correlation values between physical activity and participation outcomes will be extracted. The Hedges-Olkin method will be used for pooling correlation values between participation and physical activity measures. Subgroup analyses will be performed according to the time elapsed since the stroke (i.e., ≤6 months and >6 months). This will be the first systematic review with a meta-analysis to provide information on the relationship between physical activity and participation in stroke survivors. Findings are likely to inform the design of health prevention protocols and the development of healthy behavior change interventions.

Environmental determinants for participation among stroke survivors in Africa, a scoping review.

In this review, we aimed to determine the environmental factors that are influencing the participation of stroke survivors in Africa. Four electronic databases were systematically searched from inception to August 2021, and identified articles were screened by the two authors of this review based on predetermined criteria. No date restrictions were imposed, and we included any type of paper, including gray literature. We followed the scoping review framework by Arksey and O'Malley, which was later revised by Levac et al. The whole finding is reported using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR). A total of 584 articles were generated by the systematic search, and one article was added manually. After eliminating the duplicates, the titles and abstracts of 498 articles were screened. From the screening, 51 articles were selected for full article review, of which 13 met the criteria to be included. In total, 13 articles were reviewed and analyzed based on the international classification of functioning, disability, and health (ICF) framework of the environmental determinants. Products and technology; natural environment and human-made changes to environment; and services, systems, and policies were found to be barriers for stroke survivors to participate in their community. Conversely, stroke survivors are getting good support from their immediate family and health professionals. This scoping review sought to identify the environmental barriers and the facilitators that are determining the participation of stroke survivors in Africa. The results of this study can serve as a valuable resource for policymakers, urban planners, health professionals, and other stakeholders involved in disability and rehabilitation. Nonetheless, additional research is necessary to validate the identified facilitators and barriers.

Evaluating the implementation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in three rehabilitation settings in Quebec: a mixed-methods study protocol

IntroductionStroke is a leading cause of morbidity and mortality worldwide, placing an immense burden on patients and the health system. Timely access to rehabilitation services can improve stroke survivors’ quality...