Lisa Kidd

Stroke is a leading cause of long-term disability worldwide, often resulting in complex and enduring challenges that affect many aspects of daily life [1]. Stroke-related visual impairment (SRVI) i...

Introduction: Stroke is the second leading non-communicable cause of death and third leading cause of death and disability worldwide with prevalence expected to rise 120% between 2015 and 2035. The first 6 months after stroke is the optimum time for neuroplasticity and a critical period for rehabilitation. UK national clinical guidelines recommend stroke survivors should receive at least 3 h/day of multidisciplinary rehabilitation at least 5 days/week. Workforce shortages and service variability make achieving this standard consistently challenging. Goal setting, telerehabilitation, and self-management strategies are advocated, yet their combined use in community-based rehabilitation has not been tested. This study aims to conduct a randomised feasibility-controlled trial with embedded process evaluation to assess the feasibility of delivering a 16-week, personalised, home-based physiotherapy, prior to progression to a full-scale trial. Methods and analysis: This trial will recruit 60 participants with moderate post-stroke disability across Scotland. Participants will be randomised to the PRACTISE intervention or control (usual physiotherapy). PRACTISE (Personalised community-based telerehabilitation post stroke to increase rehabilitation time and improve motor recovery) is a 16-week, personalised physiotherapy programme involving goal setting, supported self-management and exercise via an online video-based platform. PRACTISE consists of five home-based physiotherapy sessions and four online/telephone sessions with participants encouraged to engage in a personalised exercise programme up to five times/week for up to 3 h/day. Both groups will receive other usual stroke care. Feasibility outcomes will include recruitment, retention, and completion rates. A process evaluation will assess acceptability and implementation factors. Clinical outcomes, recorded at weeks 0, 8, 16, and 24 by a blinded assessor, include the Canadian Occupational Performance Measure (primary outcome) and measures of limb function, fatigue, quality of life, functional ability, treatment burden, falls, self-efficacy, caregiver strain, and healthcare resource use (secondary outcomes). Exercise dosage and adherence will be monitored via exercise diaries. Discussion: Intensive post-stroke rehabilitation is recommended but challenging to achieve. PRACTISE combines goal setting, self-management, and online exercise prescription to support stroke survivors to achieve recommended rehabilitation doses. This study will examine the feasibility, acceptability, and mechanisms of the intervention to inform potential refinement and progression to a full-scale trial. Trial registration: Prospectively registered at https://clinicaltrials.gov . (NCT06871878).

Objective: To explore and describe the components and underpinning theories of nurse-initiated transitional (hospital-to-home) care and to evaluate the effects of interventions on activities of daily living (ADLs), quality of life (QoL), depression, anxiety, self-efficacy, stroke-related knowledge, patient satisfaction and healthcare service utilisation in older stroke survivors and self-efficacy, caregiver burden, QoL and satisfaction with care in caregivers. Data sources: MEDLINE, CINAHL, Cochrane Library, Health and Medical Collection, Nursing and Allied Health, Web of Science, Health Source: Nursing/Academic Edition and Scopus databases were searched in February 2024 and updated in March 2026. Review methods: Randomised controlled trials (RCTs) and cluster-RCTs were included. Risk of bias was assessed using the Cochrane Risk of Bias tool, and evidence quality was rated with GRADE. Meta-analysis was undertaken using random-effects models. Results: Seventeen trials were included. Transitional care interventions were guided by various theoretical frameworks and had multiple components. Interventions improved ADLs at 1 month (standardised mean difference (SMD) 0.54; 95% CI 0.12–0.97, four studies) and 3 months (SMD 0.43; 95% CI 0.12–0.74, seven studies), increased patient satisfaction and reduced hospital readmissions up to 3 months. Interventions may improve the Mental Component Score at 1 month, Role Limitations due to Physical Problems and General Health of QoL at 6 months. The certainty of evidence was low to very low. Conclusion: Nurse-initiated transitional care can improve ADLs and QoL, while reducing hospital readmissions among older stroke survivors during the hospital-to-home transition. Multicomponent interventions combining home visits and follow-up phone calls may enhance improvements in ADLs. High-quality studies are needed to clarify long-term effects. PROSPERO ID: CRD42024517619.

Background: The coronavirus disease (COVID-19) pandemic has had a negative impact on the health and mental health of adolescents and adolescents with autism spectrum disorders (ASD) and their caregivers, have been disproportionally affected. The purpose of this study was to investigate the impact of COVID-19 on Thai caregivers and adolescents with ASD. Methods: This study used an online survey with closed and free text questions to investigate how the pandemic had impacted on social skills development and psychological variables, and perceived needs for support. The survey link was shared to parents via the Yuwaprasart Withayopathum Child and Adolescent Hospital and the social media platforms of known ASD stakeholder networks in Thailand. Binary logistic regression was used to investigate the relationships between sociodemographic characteristics, service use, and social skills problems experienced by adolescents during the pandemic. Content analysis was applied to analyse free-text data. Results: A total of 376 caregivers of adolescents with ASD aged 10–19 years completed the survey, of which 364 were included in the analysis. In total, 38.7% of caregivers reported that during the pandemic the social skills of their adolescent family member had worsened. Most families reported that they were able to continue to access support from healthcare and educational services, albeit in different ways than pre-pandemic, during the acute stages of the pandemic which benefited the maintenance of ASD symptoms and social skills. Factors identified as reducing the odds of a worsening in social skills during the pandemic included; regular access to treatment for adolescents (odds ratio [OR] = 0.55, confidence interval 95% (CI) 0.32–0.98, p = 0.044), caregivers feeling that they had sufficient support from hospitals (OR = 0.46, 95% CI 0.26–0.81, p = 0.007) and older age of adolescents (OR = 0.53, CI 0.29–0.99, p = 0.047). The qualitative free text comments showed that the caregivers felt that greater information on managing adolescent behaviours, opportunities for adolescents to practice social skills, and the provision of greater emotional support and material assistance from healthcare professionals during the pandemic would have helped them to care for the adolescents with ASD. Conclusion: Regular access to services, support from hospitals during the pandemic and older age in adolescence may have helped prevent the worsening of the social skills problems of adolescents with ASD.

Telerehabilitation (TR) shows promise as a method of remote service delivery, yet there is little guidance to inform implementation in the context of the National Health Service (NHS) in England. This paper presents the protocol for a realist synthesis study aiming to investigate how TR can be implemented to support the provision of high-quality, equitable community-based stroke rehabilitation, and under what conditions. Using a realist approach, we will synthesise information from (1) an evidence review, (2) qualitative interviews with clinicians (n ≤ 30), and patient–family carer dyads (n ≤ 60) from three purposively selected community stroke rehabilitation services in England. Working groups including rehabilitation professionals, service-users and policy-makers will co-develop actionable recommendations. Insights from the review and the interviews will be synthesised to test and refine programme theories that explain how TR works and for whom in clinical practice, and draw key messages for service implementation. This protocol highlights the need to improve our understanding of TR implementation in the context of multidisciplinary, community-based stroke service provision. We suggest the use of a realist methodology and co-production to inform evidence-based recommendations that consider the needs and priorities of clinicians and people affected by stroke.

The past decade has seen a growing recognition of the role of supported self‐management in the provision of long‐term care and support for stroke survivors in primary and community care. However, its implementation and delivery across different contexts and models of community stroke care is inconsistent and patchy. This realist evaluation explored how and in which circumstances supported self‐management is enacted and delivered within community stroke rehabilitation. Specifically, the study aimed to identify and explore contexts, mechanisms, and outcomes related to the delivery of collaborative supported self‐management. It comprised a realist synthesis, Q‐methodology study, and realist‐informed interviews and focus groups with stroke survivors (n = 20), community‐based stroke practitioners (n = 20), and community service delivery managers/clinical leads (n = 8) in stroke. The findings revealed that delivering supported self‐management effectively and consistently in community stroke rehabilitation starts with embedding the ethos of collaborative supported self-management across staff, teams, and the organisation and involves collaborative relationships with stroke survivors that aim to build trust, confidence, and resilience. The findings identified specific mechanisms and facilitatory and inhibitory contexts that influence how well this is enacted and achieved in practice. A realist approach in this study is novel and has helped to generate new insights and perspectives how and when supported self‐management approaches work in community stroke rehabilitation. The findings expand on and complement existing research on the efficacy of supported self‐management in stroke and are of clinical importance for informing how collaborative, relational supported self‐management approaches can be implemented, personalised, and tailored to people’s needs and evaluated within current healthcare systems.

Introduction A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively. Methods and analysis Qualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30–40) and a range of clinicians (n=30–40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants’ experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021–January 2023. Ethics and dissemination The study has approval from National Health Service (NHS) West Midlands—Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service–provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.

Introduction: A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care and little understanding about how supported self-management works and is delivered across different settings, models used and contexts of community stroke rehabilitation.Methods and analysis: Using a mixed method, realist approach across two phases, this protocol describes a study on community-based supported self-management. The aim is to identify the mechanisms and outcomes of supported self-management in stroke and to understand how supported self-management is implemented in different contexts of community stroke rehabilitation. Phase 1 involves (1) a realist synthesis, (2) a scoping and mapping of current community rehabilitation settings and (3) a Q-methodology study to develop initial programme theories about how community-based supported self-management works, for whom and in what contexts. Phase 2 involves realist informed interviews/focus groups with stroke survivors, community rehabilitation practitioners and team managers from across Scotland to test and refine programme theories and an explanatory model for how supported self-management works across different contexts of community-based stroke rehabilitation.Ethics and dissemination: Ethical approval and R&D approvals have been granted from East of Scotland Research Ethics Committee (REC reference number: 19/ES/0055) and participating NHS boards. An understanding of how, for whom and in what contexts community-based supported self-management works will help to strengthen its delivery in practice. Such an understanding will enable the design of context-specific recommendations for policy and practice that genuinely reflect the challenges in implementing supported self-management in community stroke care. Results will be disseminated to clinical partners working in community stroke rehabilitation, stroke survivors and families and to policymakers and third sector partners involved in the provision of long-term support for people affected by stroke.PROSPERO registration number: CRD42020166208.

Objectives: Pulmonary rehabilitation (PR) involves a significant component of education, but little has been published on what educational content is covered or how it is delivered. This survey study set out to investigate how PR education is delivered in practice.Methods: A survey was designed to investigate the current educational delivery and which topics respondents reported should be included in a PR programme. The survey was sent to 11 Scottish PR Action group regional leads.Results: Nine completed the questionnaire (81.8%). Education was reported to be predominately group‐based and face‐to‐face (n = 9, 100%) consisting of between 6 and 12 sessions. Most educational topics lasted 15 min or less, some topic areas were not consistently covered. The educational content was variable and not personalised to individual needs. Three health areas undertook informal literacy assessment at baseline assessment and when tailoring COPD plans. Often attendance at educational sessions was not needed to ‘complete’ PR.Conclusions: Content and delivery of educational topics were varied, and no consistent outcome measure to assess the effectiveness of education was used.Practice implications: Education needs to be delivered in a patient‐centred way tailoring for literacy skills using a range of different teaching approaches and aids.