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This paper considers a specific and innovative methodological approach to investigating the impacts of a particular mode of therapeutic 'green exercise' in enhancing the mental health1 and wellbeing of a group2 of volunteers attending a unique community-based project in a woodland setting in the North of England, UK. The paper was influenced by the distinct lack of studies embracing an ethnographic methodology in understanding the specific impacts of green exercise therapeutic interventions. Hitherto, research has largely focused upon the use of quantitative or less context-sensitive qualitative methodologies; pertinently, prior studies have typically underemphasised the mediating and moderating influences underpinning reported positive outcomes from green exercise (Rogersen et al, 2020; Clatworthy et al, 2013; Gladwell et al, 2013; Okvat & Zutra, 2011). The study employed ethnographic data collection including: compilation of fieldwork notes and reflective diaries, including an audio-recorded conversation between the two researchers; taking photographs of participants at work; using participants' own photographs of the occupations they engaged with (that held specific value and meanings regarding place and connection to nature); and an embedded, innovative use of a 'think aloud' method, which elicits participant responses 'in the moment' as volunteers were working on autotelic activities within a nature-based environment, including, but not exclusively: dry-stone walling, gardening, horticulture and pond construction. Two field-based researchers, with a background in sports development and occupational therapy respectively, firstly familiarised themselves with the volunteers and the setting over a six-week pre-data collection period, in order to gain an insider perspective regarding the social dynamics of the group, and the special ethos and cultural dynamics of the centre. Findings suggest that such a methodological approach to investigating the impacts of a green exercise modality is not only productive, but also essential in fully appreciating the mechanisms and processes underpinning enhancements to mental health and wellbeing. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapy provision for aphasia (a language disorder) post stroke has been studied over time through surveys completed by speech and language therapists. This paper revisits provision based on what was received by 278 patients in 21 UK speech and language therapy departments in 2014–2016. Aims: To explore the speech and language therapy received by community dwelling people with post stroke aphasia in the UK. Methods and procedures: A quantitative content analysis was conducted by two speech and language therapist researchers. Therapy goals recorded were coded into categories and subcategories. Descriptive statistics were used to identify the frequency with which goal categories were targeted, average therapy time received, length and frequency of therapy sessions, personnel involved and mode of delivery. Outcomes and results: Forty-five percent of participants were in receipt of therapy in the three month window observed. Six goal categories were identified. Rehabilitation was the most frequent (60%) followed by enabling (17.2%), review (4.3%), assessment (3.6%), supportive (3.5%) and activity to support therapy (2.8%). The median amount of therapy received in three months was 6.3 hours at an average of one 60-minute session every two weeks. Seventy-seven percent of therapy sessions were delivered by qualified speech and language therapists and 23% by assistants. Ninety percent of sessions were one to one, face to face sessions whilst 9.5% were group sessions. Discussion: In line with previous reports, speech and language therapy for community dwelling stroke survivors with aphasia is restricted. Rehabilitation is a large focus of therapy but the intensity and dose with which it is provided is substantially lower than that required for an effective outcome. Despite this, one to one face to face therapy is favoured. More efficient methods to support more therapeutic doses of therapy are not commonly used in routine clinical services. [ABSTRACT FROM AUTHOR]

A correction to this paper has been published: https://doi.org/10.1007/s12529-021-09981-1 [ABSTRACT FROM AUTHOR]

Background: The National Institute for Health and Clinical Excellence (NICE) Clinical Guideline (CG) 83: Rehabilitation after Critical Illness was published to focus attention on a group of patients who can potentially endure a multitude of physical and non-physical complications following a serious illness. Historically the sequelae of critical illness have not been adequately assessed or managed despite growing knowledge in this area of health care. Aim: To share the lessons learned during the ongoing implementation of NICE CG83 across five hospitals within one critical care network in a single county. Design: The critical care network director appointed a passionate and experienced champion to examine the current position within each hospital, make recommendations and provide expert knowledge and practical assistance to improve the rehabilitation of patients in accordance with the NICE guideline. The 'Quick wins' were successfully addressed to encourage the implementation process whilst allowing time for new services and processes to be developed. Results: Success was achieved by addressing the patient, relative and inter-professional communication issues as a network. All hospitals introduced discharge booklets and improved their discharge information and then chose different strategies to address the recommendations of the guideline in the most effective way possible. Strategies such as early intervention physiotherapy, the assessment and management of delirium, follow-up clinics and outpatient rehabilitation classes were among those implemented. Conclusion: This paper outlines the processes developed, the difficulties encountered and showcases the valuable work that has been achieved. Relevance to clinical practice: Increasingly, hospitals have an obligation to comply with NICE guidelines for the benefit of patients. Rehabilitation following critical illness is important for patients to regain their former or best possible quality of life in a timely manner. [ABSTRACT FROM AUTHOR]

Background: Clinicians manage midportion Achilles tendinopathy (AT) using complex clinical reasoning underpinned by a rapidly developing evidence base. Objectives: The objectives of the study were to develop an inclusive, accessible review of the literature in combination with an account of expert therapists' related clinical reasoning to guide clinical practice and future research. Methods: Searches of the electronic databases, PubMed, ISI Web of Science, PEDro, CINAHL, EMBASE, and Google Scholar were conducted for all papers published from inception to November 2011. Reference lists and citing articles were searched for further relevant articles. Inclusion required studies to evaluate the effectiveness of any conservative intervention for midportion AT. Exclusion criteria included in vitro, animal and cadaver studies and tendinopathies in other locations (e.g. patella, supraspinatus). From a total of 3497 identified in the initial search, 47 studies fulfilled the inclusion criteria. Studies were scored according to the PEDro scale, with a score of ≥8/10 considered of excellent quality, 5-7/10 good, and ≤4/ 10 poor. The strength of evidence supporting each treatment modality was then rated as `strong', `moderate', `limited', `conflicting' or `no evidence' according to the number and quality of articles supporting that modality. Additionally, semi-structured interviews were conducted with physiotherapists to explore clinical reasoning related to the use of various interventions with and without an evidence base, and their perceptions of available evidence. Results: Evidence was strong for eccentric loading exercises and extra- corporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited evidence. There was conflicting evidence for topical glycerin trinitrate. Taping techniques and soft-tissue mobilization were not yet examined but featured in case studies and in the interview data. Framework analysis of interview transcripts yielded multiple themes relating to physiotherapists' clinical reasoning and perceptions of the evidence, including the difficulty in causing pain while treating the condition and the need to vary research protocols for specific client groups - such as those with the metabolic syndrome as a likely etiological factor. Physiotherapists were commonly applying the modality with the strongest evidence base, eccentric loading exercises. Barriers to research being translated into practice identified included the lack of consistency of outcome measures, excessive stringency of some authoritative reviews and difficulty in accessing primary research reports. The broad inclusion criteria meant some lower quality studies were included in this review. However, this was deliberate to ensure that all available research evidence for the management of midportion AT, and all studies were evaluated using the PEDro scale to compensate for the lack of stringent inclusion criteria. Conclusion: Graded evidence combined with qualitative analysis of clinical reasoning produced a novel and clinically applicable guide to conservative management of midportion AT. This guide wilt be useful to novice clinicians learning how to manage this treatment-resistant condition and to expert clinicians reviewing their evidence-based practice and developing their clinical reasoning. Important areas requiring future research were identified including the effectiveness of orthoses, the effectiveness of manual therapy, etiological factors, optimal application of loading related to stage of presentation and how to optimize protocols for different types of patients such as the older patient with the metabolic syndrome as opposed to the athletically active. [ABSTRACT FROM AUTHOR]