Patients with intensive care unit-acquired weakness often fail to reach preadmission baseline values of functional ability at the time of hospital discharge. Progressive mobilization is the use of mobility early in the inpatient stay with intent to maintain muscle mass and strength. The nurse is uniquely positioned to encourage mobilization as a primary caregiver who can oversee patient mobility outside of scheduled rehabilitation sessions. The adverse effects of immobilization involve several complex mechanisms that contribute to protein imbalance, muscle deterioration, and progressive weakness that impacts body systems. Immobility may lead to functional decline and the development of intensive care unit-acquired weakness that impacts patients for years to months after discharge from the hospital. The multidisciplinary health care team may enable mobility by adopting mobility care bundles, using mobility score tools, embracing mobility assist devices, encouraging time spent outside of patient rooms, using descriptive mobility criteria to identify mobility strategies, and employing mobility coordinators.

Exploring a Culture of Nurse-Led Mobility to Advance Patients on the Recovery Continuum.

Background Hemiplegic stroke survivors frequently exhibit reduced toe clearance during the swing phase of gait, increasing the risk of tripping and falls. Although various task-specific training (TST) interventions aim to address swing-phase biomechanical deficits, the magnitude and certainty of their effects on direct toe-clearance outcomes remain uncertain. Objective To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating task-specific interventions targeting swing-phase mechanics to improve direct measures of minimum toe clearance (MTC) in adults with poststroke hemiplegia. Methods PubMed, EMBASE, Cochrane CENTRAL, CINAHL, and Web of Science were searched from inception to June 2025 for RCTs involving adults with hemiplegic stroke. Eligible studies assessed interventions explicitly targeting swing-phase mechanics and reported direct toe-clearance measures or biomechanically relevant proxy outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool and the Physiotherapy Evidence Database (PEDro) scale . Data were pooled using random-effects meta-analysis. A priori subgroup analyses (intervention modality, stroke phase) and sensitivity analyses were performed. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework . Results Eighteen RCTs ( n = 972) were included, with 12 contributing to quantitative synthesis. TST interventions significantly improved MTC compared with control conditions [standardized mean difference (SMD) = 0.68, 95% CI (0.45, 0.91); p < 0.001), with moderate heterogeneity ( I 2 = 62%). Although biofeedback interventions demonstrated the largest point estimate (SMD = 0.85), followed by functional electrical stimulation (SMD = 0.62) and robotic-assisted gait training (SMD = 0.51), subgroup differences were not statistically significant ( p = 0.12). No significant differences were observed between subacute and chronic stroke subgroups. Sensitivity analyses excluding high-risk-of-bias trials yielded similar results. Improvements were also observed in gait speed, functional mobility, and balance. Funnel plot asymmetry and Egger's test suggested possible publication bias . Using GRADE, the certainty of evidence was moderate for MTC and gait speed and low for timed up and go and fall outcomes . Conclusions Task-specific gait training improves toe clearance and related functional gait outcomes in individuals with hemiplegic stroke, with moderate-certainty evidence for direct toe-clearance improvements. These findings support the integration of TST approaches across the stroke recovery continuum, while underscoring the need for standardized outcome reporting and longer-term trials assessing falls and real-world mobility.

Inpatient rehabilitation plays a pivotal role in the stroke recovery continuum. We have previously shown how rehabilitation clinical guidelines and health care design guidelines may not fully align to support recovery needs. Building on our previous work describing the current stroke inpatient rehabilitation service, we aimed to articulate and propose recommendations for an optimal inpatient service through the integration of stakeholder feedback, clinical guidelines, and health care design principles. We used value-focused thinking, living-lab, and codesign principles to evaluate a re-imagined stroke rehabilitation service. Participants reviewed 21 care process activity blocks derived from our previous work, with proposed changes to the admission, discharge processes, and weekday routines (morning, afternoon, and evening) of a typical Australian inpatient stroke service. Participants used an agreement scale to rate the proposed changes against predefined objectives focusing on safety, efficiency, emotional well-being, and opportunities for practice, rest, and autonomy. The reimagined stroke service was reviewed and iteratively refined through further validation sessions with selected participants. Twenty-six stakeholders participated in our evaluation, including stroke survivors, caregivers, clinicians, researchers, and health care facility designers and planners. Nineteen activity blocks were rated, generating 152 individual votes and 15 recommendations for service improvement. Overall, the agreement rate across all proposed changes was 76%. The highest agreement was observed in the evening (100%) and admission (81%) blocks, with strong endorsement for improved information delivery and environmental flexibility. Lower agreement was noted for discharge (61%), reflecting the complexity and varied perspectives on transition planning. Validation with 7 participants confirmed the relevance and feasibility of most proposed changes, especially those that support personalization, autonomy, and early engagement. Stakeholder-informed redesign of stroke rehabilitation services can enhance alignment between clinical processes and environmental enablers. These findings offer a practical foundation for codesigned models of care that are both evidence-based and experientially grounded.

Accurate assessment of cardiorespiratory fitness is a critical component of cardiopulmonary exercise testing (CPET) and prescription for people with stroke. However, post-stroke disability and neuromuscular impairments are common and may disproportionately affect females throughout the continuum of recovery. There is a need to evaluate alternative whole-body CPET protocols and to characterize the sex-specific CPET responses throughout the continuum of stroke recovery. To characterize the sex-specific CPET responses on a whole-body recumbent stepper CPET using American College of Sports Medicine (ACSM) criteria in people with subacute (7-90 d) and chronic (≥6-60 months) stroke. Participants underwent a whole-body recumbent stepper symptom-limited CPET. Each CPET was assessed for ventilatory threshold (VT), peak oxygen uptake ( ) and ACSM maximal oxygen uptake criteria, including respiratory exchange ratio ≥1.10; plateau, heart rate (HR) within 10 beats of HRmax, and ratings of perceived exertion (RPE) ≥17/20 or ≥7/10. Sex differences by stroke chronicity were evaluated via t tests, rank-sum tests, χ 2 , or Fisher exact tests. In total, 145 participants underwent a symptom-limited CPET. In subacute stroke ( n = 69), no sex differences were found for VT or ( P > 0.05), but females were more likely to achieve a plateau ( P = 0.002). In chronic stroke ( n = 76), no sex differences were observed for VT or criteria ( P > 0.05), but females had lower ( P = 0.002). Irrespective of sex, achieving the RPE ( n = 41 subacute [61%], n = 38 chronic [54%]) or respiratory exchange ratio criteria ( n = 28 subacute [41%], n = 39 [51%]) was the most commonly met ACSM criteria. This whole-body CPET protocol is appropriate for eliciting peak and maximal efforts in people post-stroke; however, clinicians should consider biological sex and stroke chronicity.

PurposeSurvivors of critical illness often experience persistent physical, functional and/or cognitive impairments (i.e. Post-Intensive Care Syndrome). Currently, there is very limited rehabilitation provided as part of standard care for this population. Evaluation of physical activity (PA) and function, and the feasibility of collecting data, specifically in people after critical illness could provide insights into their activity levels after critical illness. The aim was to assess and describe PA and function in the year following hospital discharge in patients who have been mechanically ventilated in intensive care.MethodsA prospective, observational study. (Ethical approval/REC Reference: 17/N1/0115). Patients discharged from hospital following intensive care unit (ICU) admission were invited to attend up to four assessments: within 2 weeks, 6 weeks, 6 months and 1 year, following hospital discharge. Seven-day accelerometer-based PA (daily step count), modified shuttle walk test (MSWT) and handgrip strength (HGS) were assessed at each timepoint. Results were compared against research guidelines and normative data.ResultsParticipants (n = 14) were: age: 53.9 ± 14.5 years; sex: 8 male/6 female; ICU length of stay: 9.00 days (IQR: 4.50 days); mechanical ventilation duration: 58.50hrs (IQR: 132.75hrs); Acute Physiologic Chronic Health Evaluation: 15.36 ± 8.51. There were several challenges with data collection e.g. participants using mobility aids could not perform MSWT. Participants performed below research guidelines/normative values for mean daily steps (763 – 7744 steps), MSWT (40 – 800m), and HGS (8 – 52kg) across the 12-month study period.ConclusionsIn the year following hospital discharge, PA and function varied among ICU survivors and remained low. Assessments using accelerometry and handgrip dynamometry were feasible. A more consistently administered test is needed to evaluate exercise capacity across the recovery continuum in this heterogenic population. These findings could be used to guide future development of personalised rehabilitation interventions and goal-setting in this population. Patients have also highlighted that they feel that the provision of physical rehabilitation could support their recovery.Support/Funding SourceThe Department of Employment and Learning with Seed Funding from the Northern Ireland Clinical Research Facility.

BackgroundIncorporating the perspectives of patients and care partners is crucial in the development of core outcome sets. One effective approach for achieving this involvement is by seeking input to refine the outcomes for consensus.The objectives of the study were to: i) to determine patient and care partner views on outcomes that should be measured in trials of physical rehabilitation interventions across the critical illness recovery continuum; (ii) to map these views with a pre-established list of thirty outcomes for potential inclusion in a core outcome set for these trials; and (iii) to identify any new outcomes that could be considered for inclusion. MethodsA qualitative semistructured telephone interview study was conducted with a convenience sample of post–critical illness patients and care partners, as part of core outcome set development work. Anonymised interview transcripts were analysed using a framework approach, and exemplary narrative quotes from participants were reported used to illustrate outcome reporting. FindingsFourteen participants were recruited (male:female ratio = 8:6, age range [minimum–maximum]: 50–80 years, 13 former patients, one spouse). Time since intensive care unit discharge ranged from less than 1 year to 10 years at the time of interview. Participants described a range of outcomes that could be measured in trials of physical rehabilitation after critical illness that mapped closely with the pre-established list. No new outcomes were introduced by participants during the interviews. Experiences described by participants commonly reflected outcomes related to physical ability and performance, functional level, activities of daily living, and emotional and mental wellbeing. Participants spoke to how the different outcomes directly impacted their day-to-day lives and highlighted their priorities centred around resumption of tasks and activities that had value to them at personal, functional, and societal level. ConclusionQualitative interviews confirmed the relevance of existing outcomes for potential inclusion in a core outcome set for trials of physical rehabilitation interventions across the critical illness recovery continuum. The added significance of our findings is to provide real-world meaning to these outcomes. RegistrationCOMET Initiative, ID288, https://www.comet-initiative.org/studies/details/288.

Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care. However, it is unclear how the concepts of person-centered care have been described in reports of stroke transitional care interventions. A secondary analysis of a systematic review and meta-analysis was undertaken. We retrieved all included articles (n=17) and evaluated the extent to which each intervention explicitly addressed 7 domains of person-centered care: alignment of care with patients' values, preferences, and needs; coordination of care; information and education; physical comfort; emotional support; family and friend involvement; and smooth transition and continuity of care. Most of the articles included some aspects of person-centeredness; we found that certain domains were not addressed in the descriptions of transitional care interventions, and no articles mentioned all 7 domains of person-centered care. We identified 3 implications for practice and research: (1) delineating person-centered care components when reporting interventions, (2) elucidating social and cultural factors relevant to the study sample and intervention, and (3) clearly describing the role of family and nonmedical support in the intervention. There is still room for greater consistency in the reporting of person-centeredness in stroke transitions of care interventions, despite a long-standing definition and conceptualization of person-centered care in academic and clinically focused literature.

Burn nurses care for patients throughout the recovery continuum.

IntroductionTelerehabilitation is an accessible service delivery model that may support innovative lower extremity rehabilitation programmes that extend the stroke recovery continuum into the community. Unfortunately, there is limited evidence on...

Discourse analysis has recently received much attention in the aphasia literature. Even if post-stroke language recovery occurs throughout the longitudinal continuum of recovery, very few studies have documented discourse changes from the hyperacute to the chronic phases of recovery. To document a multilevel analysis of discourse changes from the hyperacute phase to the chronic phase of post-stroke recovery using a series of single cases study designs. Four people with mild to moderate post-stroke aphasia underwent four assessments (hyperacute: 0-24h; acute: 24-72h; subacute: 7-14 days; and chronic: 6-12 months post-onset). Three discourse tasks were performed at each time point: a picture description, a personal narrative and a story retelling. Multilevel changes in terms of macro- and microstructural aspects were analysed. The results of each discourse task were combined for each time point. Individual effect sizes were computed to evaluate the relative strength of changes in an early and a late recovery time frame. Macrostructural results revealed improvements throughout the recovery continuum in terms of coherence and thematic efficiency. Also, the microstructural results demonstrated linguistic output improvement for three out of four participants. Namely, lexical diversity and the number of correct information units/min showed a greater gain in the early compared with the late recovery phase. This study highlights the importance of investigating all discourse processing levels as the longitudinal changes in discourse operate differently at each phase of recovery. Overall results support future longitudinal discourse investigation in people with post-stroke aphasia. What is already known on the subject Multi-level discourse analysis allows for in-depth analysis of underlying discourse processes. To date, very little is known on the longitudinal discourse changes from aphasia onset through to the chronic stage of recovery. This study documents multi-level discourse features in four people with mild to moderate aphasia in the hyperacute, acute, subacute and chronic stage of post-stroke aphasia recovery. What this paper adds to existing knowledge The study found that most discourse variables demonstrated improvement throughout time. Macrostructural variables of coherence and thematic units improved throughout the continuum whereas microstructural variables demonstrated greater gains in the early compared to the late period of recovery. What are the potential or actual clinical implications of this work? This study suggests that multilevel discourse analysis will allow a better understanding of post-stroke aphasia recovery, although more research is needed to determine the clinical utility of these findings. Future research may wish to investigate longitudinal discourse recovery in a larger sample of people with aphasia with heterogenous aphasia profiles and severities.

Cognitive communication disorder (CCD) following traumatic brain injury (TBI) is well documented and these communication problems impede successful re-integration into community living. While there is growing evidence for intervention to both detect and treat the impact of these deficits across the rehabilitation continuum, there are barriers to accessing services. Cognitive communication impairments may be missed because the person can talk, and this may mask the subtle but debilitating impact of a CCD. Referral to a speech and language therapist (SLT) may be overlooked or not timely, which prevents the individual accessing evidence-based interventions. Inadequate treatment provision and an under- or overestimation of communication capability can potentially undermine the effectiveness of wider team assessment and intervention. To report stakeholder views on specialist SLT input for CCD within a multidisciplinary team intervention for a community-dwelling individual with severe TBI. The investigation explored perspectives on understanding of CCD, on practice and on outcomes, in order to inform professional groups on perceived impacts of the evidence-to-practice gap. A semi-structured interview methodology was employed with 11 stakeholder participants involved in a single case. Data were evaluated using a thematic framework method. Themes were inductively derived from the stakeholder narratives. Stakeholders reported the following outcomes from specialist SLT input for CCD within a collaborative team approach: improved engagement with rehabilitation and support teams, improved health-related quality of life and well-being, and increased client participation in community activities of personal relevance. Stakeholders also reported inequities in wider service provision where limitations in professional understanding of CCD and knowledge of best practice recommendations preclude access to specialist SLT services. CCDs are under-recognised and this can have a devastating effect on people with CCD and on those around them. Stakeholder reports provide evidence for the effectiveness of SLT practice recommendations for the treatment of CCD following TBI. They also provide additional evidence of persisting barriers to accessing treatment. Future research to explore ways to close this evidence-to-practice gap is required. What is already known on this subject Cognitive communication difficulties are a well-documented consequence of TBI. There is evidence for the effectiveness of person-centred interventions for CCD across the recovery continuum. International evidence-based practice recommendations are in place for CCD assessment and management. Barriers to accessing SLT expertise for CCD have previously been reported. What this paper adds to existing knowledge This investigation explores the views of a diverse group of stakeholders involved in a single case of a community-dwelling individual with severe TBI. Stakeholders report positive real-world outcomes from SLT interventions for CCD within a coordinated multidisciplinary rehabilitation team. Stakeholder reports also indicate inequities in wider service provision and CCD knowledge gaps amongst professional groups providing rehabilitation services for people with TBI. What are the potential or actual clinical implications of this work? CCDs are under-recognised, with devastating effect for people with CCD and those around them. These findings underscore the importance of raising professional awareness of CCD and best practice recommendations, in order to improve access to SLT expertise for people with CCD following TBI.

This study examined the perceptions of health care experiences by individuals with traumatic brain injuries (TBIs) across the recovery continuum, regarding care received by a variety of health care providers following their TBI. It sought to identify whether perceptions differed across mild, moderate, and severe participants, as well as acute, subacute, and chronic recovery. Eighteen individuals with TBI were interviewed, using the Sydney Psychosocial Reintegration Scale-Second Edition (SPRS-2) and a semistructured interview about health care perceptions. A qualitative investigation employing two methods, interpretive phenomenological analysis (IPA) and Systemic Functional Linguistics (SFL; modality and appraisal analysis), provided a micro and macrolevel discourse analysis. IPA analyses of SPRS-2 interviews differed across severity levels but included changes to relationships, identity, and changes to social engagement and activity. IPA results revealed three core themes related to the health care experiences across severity that encompassed (a) frustrations with providers and (b) lack of support in the chronic phase, and (c) that finding support is crucial. SFL results provided insight into how individuals appraised such experiences in light of their identity and personal perspectives. Key differences between individuals with mild, moderate, and severe TBI diagnoses were found, with those who experienced a mild TBI expressing the most discontent with services received. Participants were most satisfied with acute care and least satisfied with chronic phase support. The results of this study have significant implications for health care professionals interacting with individuals who have experienced a TBI. Facilitating improved communication, referrals, increased access to mental health counseling, and resources such as groups to support identity expression could improve the health care experience.

BackgroundEvidence has shown that family and friend caregivers of stroke survivors are significantly and negatively impacted by caregiving. The negative effects of caregiving may persist over time suggesting that caregivers might benefit from ongoing engagement with supportive services. However, little is known about caregivers’ use of formally funded health and social services, or the factors influencing their access to and use of these services. The aim of this study is to increase understanding of the factors that influence stroke caregivers’ access and use of formal health and social services, from the perspective of stroke caregivers and healthcare providers.MethodsA qualitative study was conducted with stroke caregivers and health providers in Ontario, Canada using interpretive description. In-depth interviews were conducted with caregivers of survivors who experienced a stroke between six months to five years previous and healthcare providers who support caregivers and stroke survivors. All participants provided written informed consent. Interview data were analyzed using constant comparison to identify codes and develop key thematic constructs.ResultsA total of 40 interviews were conducted with 22 stroke caregivers at an average 30-months post-stroke and 18 health providers. Factors that influenced stroke caregivers’ access and use of services included: finances and transportation; challenges caregivers faced in caring for their health; trust that they could leave their family member and trust in health providers; limited information pertaining to services and a lack of suitable services; and the response of their social networks to their caregiving situation.ConclusionStroke caregivers experience significant challenges in accessing and using formal health and social services. These challenges could be addressed by increasing availability of subsidized community-based supports such as respite and counselling tailored to meet the ongoing needs of caregivers. Systemic change is needed by the health system that readily includes and supports caregivers throughout the stroke recovery continuum, particularly in the community setting.

ABSTRACT Background Care partners are an integral part of the recovery process for people with aphasia after stroke, and they often depend on speech-language pathologists (SLPs) to provide the education, support, and training that care partners need across the recovery continuum. However, it is not clear how SLPs provide informational counseling across the recovery continuum or how they choose the type, quantity, and timing of the information they share with care partners. Aims The aims of this study were to (1) identify what informational support speech-language pathologists currently provide to care partners of people with aphasia at each phase of the recovery continuum and (2) ascertain the perceived barriers/facilitators to providing tailored informational supports. Methods and Procedures Ten practicing SLPs working with people with aphasia across various settings participated in individual semi-structured interviews. The interviews were audio-recorded, transcribed, and analysed using open-coding methods. Outcomes and Results We delineate our results by each phase of the recovery continuum, from acute care to long-term life with aphasia. We discuss how SLPs apply their own judgment and experience in sharing information, how they supplement informational gaps, prepare care partners for assuming the caregiving role, and how they address care partner communicative, informational, and psychological needs once the person with aphasia returns home. We also discuss perceived barriers to providing timely care partner information. Conclusions Our study supports and builds upon previous care partner work, , specifically, how SLPs integrate care partners into aphasia rehabilitation. SLPs are working to provide aphasia education in sometimes suboptimal circumstances. Across all phases of recovery, SLPs were hindered by lack of time and resources. Additional study is needed to determine how best to provide information to care partners, especially those who are not able to be present for treatment sessions.

Abstract Background and Aims Renal function recovery after acute kidney injury (AKI) is associated with patient outcomes. The study objectives were to assess the patterns of AKI recovery within 6 months following discharge for AKI and subsequent incidence of chronic dialysis. Method A retrospective cohort of 234,867 hospitalized adult patients was examined for AKI between January 1, 2010, and December 31, 2017 in the largest healthcare delivery system in Taiwan. Renal function recovery at 3- and 6-month post discharge, incident chronic kidney disease and chronic dialysis initiation were analyzed over 7 years of follow-up. Renal recovery was defined by < 1.5× baseline SCr (prior to the hospitalization). Independent associations between renal function recovery patterns and renal outcomes was assessed by Cox proportional hazard model controlling for potential confounders, and subdistribution hazard ratio (SHR) with [95% CI] was analysed for competing risk of early death. Results Among 3 months AKI survivors (n=24,132), 14.28% (n=3,430) did not recovery back to baseline, and 16% of recovery did not sustain. Three distinct renal function recovery continuums at 6 months post hospital discharge were: persistent non-recovery (10.18%), non-recovery (14.33%), and recovery (75.5%). Comparing to survivors without AKI (n=50,387), the impact of renal recovery continuum on chronic dialysis initiation varied by patient’s baseline renal disease (SHR was 2.82 [95%CI, 2.42-3.28] in CKD, and 0.8 [95%CI, 0.27-2.38] for non-CKD. Persistent non-recovery was significantly associated with a greater increased risk of chronic dialysis than non-recovery in any patients with AKI. Comparing to patients with sustained AKI recovery, risk of CKD onset increased 5-fold in persistent non-recovery and 3-fold risk in non-recovery. Conclusion The continuum of AKI recovery post 6 months is associated with increased risk of chronic dialysis, particularly in patients with baseline CKD. These study results suggested that patients ever with AKI should receive close renal function monitoring for post-discharge management.

New treatments that can facilitate neural repair and reduce persistent impairments have significant value in promoting recovery following stroke. One technique that has gained interest is transcranial direct current stimulation (tDCS) as early research suggested it could enhance plasticity and enable greater behavioral recovery. However, several studies have now identified substantial intersubject variability in response to tDCS and clinical trials revealed insufficient evidence of treatment effectiveness. A possible explanation for the varied and negative findings is that the physiologic model of stroke recovery that researchers have used to guide the application of tDCS-based treatments in stroke is overly simplistic and does not account for stroke heterogeneity or known determinants that affect the tDCS response. Here, we propose that tDCS could have a more clearly beneficial role in enhancing stroke recovery if greater consideration is given to individualizing treatment. By critically reviewing the proposed mechanisms of tDCS, stroke physiology across the recovery continuum, and known determinants of tDCS response, we propose a new, theoretical, patient-tailored approach to delivering tDCS after stroke. The proposed model includes a step-by-step principled selection strategy for identifying optimal neuromodulation targets and outlines key areas for further investigation. Tailoring tDCS treatment to individual neuroanatomy and physiology is likely our best chance at producing robust and meaningful clinical benefit for people with stroke and would therefore accelerate opportunities for clinical translation.

After amputation, people with lower-limb loss (PLL) face challenges to regain their previous physical activity level. Assessing the scope of evidence regarding physical activity in PLL can identify sources of evidence and gaps within the literature that can influence amputation-related research, outcome assessment choices, and wellness activities. The purpose of this scoping review was to map the evidence regarding steps per day as a physical activity measure for PLL. Specific aims were to (1) identify research designs, (2) catalog population subgroups, (3) document steps per day measurement methods, and (4) provide descriptive data for steps per day in PLL. The MEDLINE, CINAHL, Embase, Web of Science, and AMED databases; and the Journal of Prosthetics and Orthotics archive were searched without language or time limits. Exclusion criteria included no PLL subjects, not peer-reviewed, and no direct step count measure. Inclusion criteria allowed any sample size, nonprosthetic use, and self-reported step count. As a scoping review, only descriptive statistics were compiled, and no methodologic quality assessment was performed. Twenty-one articles using crossover (8), cohort (4), cross-section (8), and case-study (1) designs were included that reported accelerometer (19) or pedometer (2) data. Studies often mixed amputation etiologies (15/21) and most (13/21) excluded transfemoral amputations. Studies primarily examined people with transtibial amputations (81.2%) and people at independent community walking levels (Medicare functional classifications: K3 = 49.2%, K4 = 36.3%). All 21 studies had fewer than 100 participants, and overall included 515 subjects (343, 66.6% male), mean (SD) age 53.2 (22.1) years. Mean (SD) number of pooled steps per day for PLL was 5087 (2998): 5929 (3047) for transtibial amputations and 3553 (2030) for transfemoral amputations. Most PLL have low activity levels compared with the 10,000 steps per day generally recommended or 6000 common in people with diabetes. Research with larger samples, defined subgroups, and data along the recovery continuum would enhance knowledge of physical activity level in PLL. This scoping review has identified gaps in the research related to steps per day as a measure of physical activity in people with lower-limb loss to guide future research. People with lower-limb loss take fewer steps per day than suggested for general health. Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.

BackgroundA coordinated stroke rehabilitation care team is considered optimal for supporting stroke survivors from diagnosis to recovery. Despite this recognition, many stroke survivors cannot access essential rehabilitation services. Furthermore, there is a lack of understanding of stroke patients’ and their caregivers’ rehabilitation needs and wishes. We sought to gain insight into healthcare and social structures from the perspective of patients and caregivers that can better support long-term stroke recovery.MethodsWe conducted individual interviews with 24 participants comprised of stroke survivors, spousal caregivers, stroke support group coordinators, and speech pathologist. Participants were recruited through three stroke survivor support groups. An empowerment lens was integrated into data analysis and data interpretation.ResultsTwo dominant themes captured participants’ experiences through stroke survivors’ trajectory of care. 1) Experiences of managing stroke. This theme identified stroke survivors and spousal caregivers’ experiences with stroke recovery, rehabilitation, and fulfilling unmet needs. 2) Resources of support. This theme described the social and financial support structures drawn upon to assist with stroke rehabilitation.ConclusionsThe study highlighted a lack of teamwork between stroke survivors, spousal caregivers, and health professionals. This fragmented care was compounded by inequities in rehabilitation programs and health services resulting in what appeared to be a disempowering rehabilitation process. Although stroke recovery groups were a significant source of support for stroke survivors and spousal caregivers, participants perceived they were overlooked, by stroke recovery healthcare providers, as a site for stroke recovery healthcare services. An empowerment approach to stroke rehabilitation involves collaboration between stroke survivors, caregivers, healthcare providers, health services, and existing community stroke support structures. Framing stroke based care through an empowerment lens may serve to address stroke rehabilitation inadequacies and inequities.

Experiences of suffering multiple trauma: A qualitative study