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Background and Purpose: The AFFINITY trial (Assessment of Fluoxetine in Stroke Recovery) reported that oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. After trial medication was ceased at 6 months, survivors were followed to 12 months post-randomization. This preplanned secondary analysis aimed to determine any sustained or delayed effects of fluoxetine at 12 months post-randomization. Methods: AFFINITY was a randomized, parallel-group, double-blind, placebo-controlled trial in adults (n=1280) with a clinical diagnosis of stroke in the previous 2 to 15 days and persisting neurological deficit who were recruited at 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10) between 2013 and 2019. Participants were randomized to oral fluoxetine 20 mg once daily (n=642) or matching placebo (n=638) for 6 months and followed until 12 months after randomization. The primary outcome was function, measured by the modified Rankin Scale, at 6 months. Secondary outcomes for these analyses included measures of the modified Rankin Scale, mood, cognition, overall health status, fatigue, health-related quality of life, and safety at 12 months. Results: Adherence to trial medication was for a mean 167 (SD 48) days and similar between randomized groups. At 12 months, the distribution of modified Rankin Scale categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio, 0.93 [95% CI, 0.76–1.14]; P =0.46). Compared with placebo, patients allocated fluoxetine had fewer recurrent ischemic strokes (14 [2.18%] versus 29 [4.55%]; P =0.02), and no longer had significantly more falls (27 [4.21%] versus 15 [2.35%]; P =0.08), bone fractures (23 [3.58%] versus 11 [1.72%]; P =0.05), or seizures (11 [1.71%] versus 8 [1.25%]; P =0.64) at 12 months. Conclusions: Fluoxetine 20 mg daily for 6 months after acute stroke had no delayed or sustained effect on functional outcome, falls, bone fractures, or seizures at 12 months poststroke. The lower rate of recurrent ischemic stroke in the fluoxetine group is most likely a chance finding. Registration: URL: http://www.anzctr.org.au/ ; Unique identifier: ACTRN12611000774921.

Background: Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population.Methods: AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921.Findings: Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [Interpretation: Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke.Funding: National Health and Medical Research Council of Australia.

Background Occupational Therapy forms part of the EHDN Multidisciplinary Treatment and Care Working Group. The mission of this group is to improve quality of treatment and care for HD families. Occupational therapists from the UK and Netherlands have joined together with the vision that a Huntington patient should be able to receive comparable assessment, treatment and care regardless of place of residence and that this should be done by experts. In short: Every Huntington patient must receive comparable, high-quality occupational therapy. Aims/Methods To connect all occupational therapists working within care organizations and/or expertise centres affiliated with EHDN. For occupational therapists to join the working group to share clinical experience in the assessment, treatment and care of a person with HD. To be involved in case discussions, new developments, research and collaborate in evaluating the best practice guidelines for occupational therapists working with patients with HD. Outcomes To coordinate occupational therapy processes and guidelines which are evidence based, best practice and consensus driven within the field of occupational therapy. To make these accessible to patients and families with HD. To collaborate with other all disciplines of the MDT and care working group and other EHDN working groups.

Background In 2012 a working party of Occupational Therapists, allied to the EHDN, produced the Best Practice Guidelines for Occupational Therapy (OT) for people with HD. Since then these guidelines have been condensed into easy to use summaries – the Clinical Tips for OT in HD. These are hosted by a number of HD patient and professional HD focussed organisations in Europe. For example they form the basis for a series of webinars broadcast through the Huntington’s Disease Association (UK) in 2021. Aims/Methods As the application of OT covers the many complex daily issues of living faced by people with HD and their families, its scope has increased since the original guidelines were produced by the working OT working group specialised in HD. The OT working group, part of the EHDN multidisciplinary working group, is active again. The vision of the group is that every Huntington patient should be able to receive comparable diagnostics, treatment and care - regardless of place of residence - and that this should be done by experts. In short: Every Huntington patient must receive comparable, high-quality occupational therapy. Outcomes We are experts in meaningful activities of daily living with patients with Huntington’s disease. We hope by joining forces sharing experiences, developing, and evaluating the best practice Huntington’s European guidelines, that every patient, in Europe, can receive the best occupational therapy possible. Do you want to share OT experiences working with HD? Please contact us.

Providing meaningful activity and promoting quality of life with individuals with advanced Huntington’s disease can be challenging for care providers. Obtaining information from families about a person’s past interests is invaluable in providing purposeful activity; however this information is not always available. This poster demonstrates how tools have been used and developed to obtain good case histories of individuals. It shares how The Pool Activity Level (PAL) Instrument for Occupational Profiling has helped in activity planning and how The Bradford well-being profile tool has been adapted to record participation in activity to give qualitative date on well-being during an activity. This information has enabled teams to plan and offer activities that are meaningful and appropriate for an individual taking into account their preferences and ability to engage in an activity.

Introduction: Reactive airways disease or exacerbation of asthma are frequently admitted to the Emergency Short-Stay Unit (ESSU) and require education prior to discharge.[1]A busy emergency environment can lead to inconsistent quality of education, incomplete or missed caregiver education[2], and can increase length of stay if education is required for simultaneous patients.Adverse outcomes from inadequate education include increased morbidity, such as incorrect home management by caregivers, unplanned representations or readmissions, and potential mortality, given that caregiver understanding is paramount.[3] The benefits of video education includes empowering caregivers to access information, multimodal reinforcement of key messages [4], consistent delivery of information, broaching sensitive issues (e.g. passive smoking), and has the potential to save resources, such as staff time. Aims: To pilot the implementation of asthma video education at the bedside in the ESSU To quantify the benefits through feedback: especially its non-inferiority to face-to-face education and caregiver satisfaction Intervention: A series of asthma education videos were sourced, with permission, from Asthma Australia and combined into a single video to be viewed at the bedside.[5] The video via the Patient Entertainment System directly complements the face-to-face education that is provided to every caregiver/child that is admitted to the ESSU.[6] The pilot project ran over 1 month in 2016, where the video was voluntarily viewed by the caregivers in conjunction with the standard education checklist on the clinical pathway. After viewing the video, the caregiver was given standard face-to-face asthma education and invited to participate in the survey, which was comprised of questions with a 5 point Likert scale. Results: Video education was successfully implemented in the paediatric ESSU and was well received by both caregivers and nursing staff. The feedback received deemed that use of the video was non-inferior to conventional bedside face-to-face delivery of asthma education. 63 caregivers provided surveys over the 1 month period: 100% found the video useful 78% agreed that it significantly improved their understanding of childhood asthma 100% felt confident in recognising deterioration in their child’s asthma and administering their child’s asthma medication. There was no preference to either video or face-to-face education, both were considered equally valid and complemented written handouts. Discussion: This pilot project has demonstrated the opportunity to develop similar videos for other conditions. Video education complements face-to-face education, which still affords families the opportunity to ask questions and clarify their understanding. Video education is a means to ensure education is still delivered in a busy emergency environment, where patients can be missed. The video has been adopted for routine use within the ESSU and could become part of the clinical pathway, including discharge checklist. The video is now available throughout Queensland, with a child friendly version and other videos being developed. Conclusion: Video education is a valuable tool for delivery of bedside education, which empowers families to understand and manage their health needs [7-8]. Technology is an under-utilised resource for delivery of education, particularly in this digital technology age.

Purpose – The purpose of this paper is to describe Norfolk and Suffolk NHS Foundation Trust's journey of developing more recovery-focused services from two perspectives: that of the Trust project lead for recovery and that of a Recovery College Student and Peer Support Worker. Design/methodology/approach – First person, narrative account from the Trust project lead for recovery and that of a Recovery College Student and Peer Support Worker. Findings – Reflective account describing process and progress made towards establishing a Recovery College and Peer Support Worker Posts in Clinical Teams. Originality/value – An original viewpoint on the process of developing more recovery-focused services.

SUMMARY This paper introduces the ‘Guidelines for Occupational Therapists working with people with Huntington’s disease’ which is currently being developed by the European Huntington’s Disease Network (EHDN) Standards of Care Occupational Therapists working group. This article aims to describe the everyday functional problems experienced by people with Huntington’s disease, the role of the occupational therapist, the systematic literature review which preceded the formulation of the guidelines and use excerpts from the guideline to illustrate some of the issues raised.

PurposeThis paper aims to provide a summary of current policy and research related to pre‐school overweight and obesity, and to provide a rationale for why early years settings are being placed at the forefront of strategies to address the problem.Design/methodology/approachThe paper is based on a narrative review of current research, policy and practice.FindingsToday 22.9 per cent of four and five year olds are overweight or obese. The Healthy Weight, Healthy Lives strategy is a cross‐government initiative, which aims to make England the first major country to reverse the obesity epidemic. The pre‐school period represents a critical time for interventions, which could prevent excess weight gain and its associated physical and psychological damage to health.Practical implicationsPractitioners in early years settings have a significant contribution to make to promoting the healthy weight of children.Originality/valueConcerns about overweight in childhood have received much attention. This paper seeks to raise awareness of the importance of the pre‐school period, and to provide a useful review of current research, policy and sources of support for those who are best placed to address the issue.

Background Stand-alone clinical tips for occupational therapists working with Huntington’s disease have been written. These consist of 8 specific domains: 1. Eating and drinking, 2. Self-care, 3. Domestic skills, 4. Community living skills and outdoor mobility, 5. Social and leisure 6. Work, 7. Sleep routine and management, 8. End stage and palliative care. These provide best practice guidance on the clinical management of HD for practitioners to make decisions regarding best patient care. These have been produced by a UK HD special interest group for occupational therapists based on the ‘Occupational Therapy for people with Huntington’s disease: Best Practice Guidelines’. Contributions have been made by occupational therapists with expertise and knowledge gained through working with people with HD and their families. Conclusions HD clinical tips for occupational therapists are a useful resource for any occupational therapist who, during their career, may come across a person or family with HD. The tips include why a person may have problems in specific activities due to this condition and clinical suggestions for assessment, intervention and advice for working with people with HD and their families.

Background Occupational Therapy is an essential component of the management of patients with Huntington9s disease throughout the progression of the disease. Occupational therapists aim to enable individuals to maximise function in everyday activities and to maintain independence. Aims The European Huntington9s Disease Network9s (EHDN) Occupational Therapist group has brought together a group of international OT9s to provide guidelines to encourage thorough assessment and management of individuals throughout the course of their disease. The guidelines were developed to promote independence for individuals with HD as well as their carers and family and to maximise quality of life. Method A systematic literature search was performed electronically. Due to the limited scope of the literature found, observational studies and qualitative studies were included in the review process. Recommendations were formulated based upon clinical experience and expert consensus from within the EHDN Standards of Care Occupational Therapist group. Results The first edition of the guideline has been produced and is awaiting publication. The main guideline incorporates the areas of self care, work and leisure. It details possible difficulties, specific interventions and rationale in those areas. Furthermore, the guideline also advises on occupational therapy assessment tools and points to consider when using specific types of equipment. Conclusion This document was produced within a short time line and will be refined further and updated as necessary. It is currently being prepared for verification by the College of Occupational Therapists in the UK and will also be implemented across Europe.