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Purpose: Constraint-induced movement therapy (CIMT) is an evidence-based intervention for arm recovery after acquired brain injury. Clinician knowledge, time and confidence in delivering CIMT are established barriers to the routine use of CIMT in practice. CIMT delivery via telehealth is one option to help overcome these barriers. This study aimed to understand clinician experiences of using an educational website and if the education and online resources contributed to their self-reported use of constraint-induced movement therapy via telehealth (TeleCIMT) in practice. Materials and Methods: Data were collected from a purposive sample of therapists registered to use the TeleCIMT website and website analytics. An online survey explored participants' experience with CIMT delivery (both face to face and via telehealth), their perceptions of the website, and barriers and enablers to TeleCIMT implementation using the Capability, Opportunity, Motivation-Behaviour model. Website analytics were used to evaluate website traffic and resource use. Data were analysed using descriptive statistics (quantitative data) and content analysis (qualitative data). Results: Forty therapists responded to the survey; 72.5% (n = 29) of the respondents were occupational therapists, and 37.5% (n = 15) had delivered TeleCIMT. Most of the participants agreed that the website was easy to navigate (n = 26, 90%) and felt that they had the knowledge (n = 28, 96.6%) and skills (n = 24, 82.7%) to deliver TeleCIMT. The enablers to TeleCIMT included motivation to implement learnings from the website, confidence in delivering the programme, and the convenience of remote delivery. The perceived barriers to TeleCIMT use included limited access to technology and the availability of a client supporter to enable engagement in TeleCIMT. The resources used most frequently by the respondents were the participant preparation pack and participant programme pack. Shorter video learning modules (<11 min in duration) had greater engagement than longer video learning modules. Conclusions: Whilst online education and resources may enhance clinician knowledge of constraint-induced movement therapy and telehealth delivery, other barriers such as lack of technology access, may need to be addressed through additional learning and implementation strategies to support the routine use of TeleCIMT in practice.

Purpose: Constraint-induced movement therapy (CIMT) is a recommended intervention for arm recovery after acquired brain injury but is underutilised in practice. The purpose of this study is to describe the development of a behaviour change intervention targeted at therapists, to increase delivery of CIMT., Methods: A theoretically-informed approach for designing behaviour change interventions was used including identification of which behaviours needed to change (Step 1), barriers and enablers that needed to be addressed (Step 2), and intervention components to target those barriers and enablers (Step 3). Data collection methods included file audits and therapist interviews. Quantitative data (file audits) were analysed using descriptive statistics. Qualitative data analysis (interviews) was informed by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel., Results: Fifty two occupational therapists, physiotherapists and allied health assistants participated in focus groups ( n  = 7) or individual interviews ( n  = 6). Key barriers ( n  = 20) and enablers ( n  = 10) were identified across 11 domains of the TDF and perceived to influence CIMT implementation. The subsequent behaviour change intervention included training workshops, nominated team champions, community of practice meetings, three-monthly file audit feedback cycles, poster reminders and drop-in support during CIMT., Conclusion: This study describes the development of a behaviour change intervention to increase CIMT delivery by clinicians., Trial Registration: Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617001147370.

Purpose: To increase the number of constraint-induced movement therapy (CIMT) programs provided by rehabilitation services., Methods: A before-and-after implementation study involving nine rehabilitation services. The implementation package to help change practice included file audit-feedback cycles, 2-day workshops, poster reminders, a community-of-practice and drop-in support. File audits were conducted at baseline, every three months for 1.5 years, and once after support ceased to evaluate maintenance of change. CIMT participant outcomes were collected to evaluate CIMT effectiveness and maintenance (Action Research Arm Test and Motor Activity Log). Staff focus groups explored factors influencing CIMT delivery., Results: CIMT adoption improved from baseline where only 2% of eligible people were offered and/or received CIMT ( n  = 408 files) to more than 50% over 1.5 years post-implementation ( n  = 792 files, 52% to 73% offered CIMT, 27%-46% received CIMT). Changes were maintained at 6-month follow-up ( n  = 172 files, 56% offered CIMT, 40% received CIMT). CIMT participants ( n  = 74) demonstrated clinically significant improvements in arm function and occupational performance. Factors influencing adoption included interdisciplinary collaboration, patient support needs, intervention adaptations, a need for continued training, and clinician support., Conclusions: The implementation package helped therapists overcome an evidence-practice gap and deliver CIMT more routinely.

Objectives: Existing research qualitatively explores consumer preferences for stroke rehabilitation interventions. However, it remains unclear which intervention characteristics are most important to consumers, and how these preferences may influence uptake and participation. Discrete choice experiments (DCE) provide a unique way to quantitatively measure preferences for health and health care. This study aims to explore how DCEs have been used in stroke rehabilitation and to identify reported consumer preferences for rehabilitation interventions., Material and Methods: A systematic review of published stroke rehabilitation DCEs was completed (PROSPERO registration: CRD42021282578). Six databases (including CINAHL, MEDLINE, EconLIT) were searched from January 2000-March 2023. Data extracted included topic area, sample size, aim, attributes, design process, and preference outcomes. Descriptive and thematic analyses were conducted, and two methodological checklists applied to review quality., Results: Of 2,446 studies screened, five were eligible. Studies focused on exercise preference ( n  = 3), the structure and delivery of community services ( n  = 1), and self-management programs ( n  = 1). All had small sample sizes (range 50-146) and were of moderate quality (average score of 77%). Results indicated people have strong preferences for one-to-one therapy (over group-based), light-moderate intensity of exercise, and delivery by qualified therapists (over volunteers)., Conclusions: Few DCEs have been conducted in stroke rehabilitation, suggesting consumer preferences could be more rigorously explored. Included studies were narrow in the scope of attributes included, limiting their application to practice and policy. Further research is needed to assess the impact of differing service delivery models on uptake and participation.

Purpose: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures., Method: Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence., Results: Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast)., Conclusions: Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures., Implications for Cancer Survivors: There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties., (© 2022. The Author(s).)

Aim: To explore the experiences of adults who completed a constraint-induced movement therapy (CIMT) programme, and the barriers and enablers to their participation., Methods: Qualitative design using semi-structured interviews. Stroke and brain injury survivors ( n = 45) who had completed CIMT as part of their usual rehabilitation were interviewed 1 month post-CIMT. Interviews were audio-recorded, transcribed and imported into Nvivo for analysis. Inductive coding was used to identify initial themes. Themes were then deductively mapped to the Capability, Opportunity, Motivation - Behaviour system, a behaviour change model, to identify barriers and enablers to CIMT programme adherence and engagement., Results: Enablers influencing participation included being provided with education about the programme (Capability - psychological), seeing improvements in arm function (Motivation - reflective), being committed to the programme (Motivation - reflective) and having strong social support from staff, family and allied health students (Opportunity - social). The structured programme was a motivator and offered a way to fill the time, particularly during inpatient rehabilitation (Opportunity - physical). Barriers to participation included experiencing physical and mental fatigue (Capability - physical) and frustration early in the CIMT programme (Motivation - automatic), and finding exercises boring and repetitive (Motivation - automatic)., Conclusion: Therapist provision of educational supports for CIMT participants and their families is important to maximise CIMT programme uptake. During CIMT delivery, we recommend the provision of positive feedback and coaching in alignment with CIMT principles, and the inclusion of social supports such as group-based programmes to enhance participant adherence.

Objective: Pathogenic PRRT2 variants cause self-limited (familial) infantile epilepsy (SeLIE), which is responsive to sodium channel blocking antiseizure medications. The interictal EEG is typically normal. We describe a cohort of infants with PRRT2-related SeLIE with striking peri-ictal EEG abnormalities., Methods: We included all infants diagnosed with PRRT2-related SeLIE during July 2020 to November 2021 at the Royal Children's Hospital, Melbourne. Clinical features and results of aetiologic investigations were collected from electronic medical records. All EEGs were reviewed independently by two epileptologists., Results: Ten infants presented with focal seizures at a median age of 5 months (range: 3-6 months). Eight had a family history of epilepsy, paroxysmal kinesigenic dyskinesia (PKD) or hemiplegic migraine. Seven of the eight infants with an EEG performed within 24 h of the most recent seizure had epileptiform discharges. Their EEGs showed focal sharp waves, spikes, polyspikes or fast activity independently over the left and right temporo-occipital regions. Conversely, the two infants with last known seizure greater than 24 h prior to their EEG had no epileptiform discharges. Oxcarbazepine was commenced in two infants and was effective. Eight infants were initially treated with levetiracetam, and all were subsequently switched to oxcarbazepine due to ongoing seizures or side effects., Significance: Posterior polymorphic focal epileptiform discharges on a peri-ictal EEG recording are a feature of PRRT2-related SeLIE. This finding, particularly in the presence of a family history of infantile epilepsy, PKD or hemiplegic migraine, suggests a diagnosis of PRRT2-related SeLIE and has important treatment implications., (© 2023 The Authors. Epileptic Disorders published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Background: Breast lymphedema after breast cancer is challenging to quantify. Three-dimensional (3D) surface imaging is one available technique to measure breast volume, however, the measurement properties of available software programs have not been fully determined. The aim of this study was to determine equivalency of measurements with two software programs as well as reliability, standard error of measurement (SEM), and smallest detectable change (SDC). Methods and Results: Retrospective three-dimensional surface imaging (3D-SI) of 100 breasts taken before or after breast conserving surgery for breast cancer were retrieved for reliability analysis. Three assessors followed a standardized measurement technique using two software programs, Vectra ® 3D Analysis Module (VAM) and Breast Sculptor ® . Mean breast volume was 489.9 ± 206 cc using VAM and 480.1 ± 229.1 cc using Breast Sculptor. Lin's concordance showed poor agreement between programs (0.81-0.88). Measurements using VAM had excellent intra- and inter-rater reliability with SEM = 4.1% for one assessor and 8.7% for multiple assessors. Breast Sculptor also had excellent intra-rater and substantial inter-rater reliability but the SEM was much larger at 14.5% (intra-rater) and 19.1% (inter-rater). The SDC value was lowest for VAM and a single rater with 56 cc indicating a meaningful change beyond measurement error. Conclusion: Breast volume measurements captured with 3D-SI using VECTRA-XT are highly reliable, but the volumes, SEM, and SDC varied between the two software programs. Measurement error was lowest with VAM software. Although the usefulness of VECTRA-XT and VAM software to detect change in breast volume is promising, further solutions to reduce measurement error are required to improve clinical utility to measure breast lymphedema.

Background: Difficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice., Methods: A prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants ( n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the online support package., Discussion: The COVID-19 pandemic resulted in a rapid transition to delivering telehealth. The proposed study will investigate the feasibility and acceptability of delivering a complex intervention via telehealth to stroke survivors at home, and the support that therapists and patients require for delivery. The findings of the study will be used to inform whether a larger, randomized controlled trial is feasible., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Christie, Fearn, McCluskey, Lannin, Shiner, Kilkenny, Boydell, Meharg, Howes, Churilov, Faux, Doussoulin and Middleton.)

Background: Constraint-induced movement therapy (CIMT) is a recommended intervention for improving arm recovery following stroke and traumatic brain injury; however, delivery in practice remains rare., Purpose: The aim of this study was to investigate the costs and cost effectiveness of CIMT delivery, and the use of a CIMT implementation package designed to improve CIMT uptake and delivery by therapists in Sydney, Australia., Methods: This economic evaluation was conducted with a subset of CIMT programmes (n = 20) delivered by neurological rehabilitation teams at five varied hospitals within a mixed methods implementation study (ACTIveARM). The costs of delivering the CIMT implementation package and publicly funded CIMT were calculated using a bottom-up approach. A cost-effectiveness analysis was conducted, using decision analytic modelling. We compared the uptake and outcomes of people who received CIMT from health services that had received a CIMT implementation package, with those receiving standard upper limb therapy. An Australian health care system perspective was used in the model, over a 3-week time horizon (the average timeframe of a CIMT programme). All costs were calculated in Australian dollars (AUD). Inputs were derived from the ACTIveARM study and relevant literature. The Action Research Arm Test was used to measure arm outcomes. Sensitivity analyses assessed the impact of improving CIMT uptake, scale-up of the implementation package and resource adjustment, including a 'best-case' scenario analysis., Results: The total cost of delivering the implementation package to nine teams across five hospitals was $110,336.43 AUD over 18 months. The mean cost of delivering an individual CIMT programme was $1233.38 AUD per participant, and $936.03 AUD per participant for group-based programmes. The incremental cost-effectiveness ratio (ICER) of individual CIMT programmes was $8052 AUD per additional person achieving meaningful improvement in arm function, and $6045 AUD for group-based CIMT. The ICER was most sensitive to reductions in staffing costs. In the 'best-case' scenario, the ICER for both individual and group-based CIMT was $245 AUD per additional person gaining a meaningful change in function., Conclusion: Therapists improved CIMT uptake and delivery with the support of an implementation package, however cost effectiveness was unclear., Clinical Trial Registration: https://anzctr.org.au/Trial ID: ACTRN12617001147370., (© 2022. Crown.)

Previous research indicates that drug use is common among incarcerated populations. However, much less research attention has been focused on drug use among female inmates, especially while in prison. The goal of this research was to examine the prevalence and correlates of in-prison drug use among women prisoners. Data were drawn from a random sample of women incarcerated in four regions of Spain in 2014. Self-report assessments of alcohol and drug use were collected. Descriptive analyses and logistic regression models were employed to examine relationships in the data. Overall, the results revealed a high prevalence of substance use while in prison. More than half of study participants (52%) reported using drugs in prison within the past 6 months, with alcohol (33.8%) and cannabis (28.2%) the most commonly reported drugs used. Logistic regression models indicated that age and prior drug use history were significantly associated with in-prison substance use. Notably, criminal history was not a significant predictor of in-prison substance use. Our findings suggest that substance use while in prison may represent a barrier to these women's rehabilitative goals. Study findings are discussed in terms of developing effective drug treatment programs for women prisoners in the Spanish Prison System.

Studies conducted worldwide indicate that near-lethal suicide attempts are common among incarcerated populations. However, little research attention has been focused on the Spanish prison population. To address this gap in the literature, data were drawn from a sample of men ( N = 2,270) incarcerated in seven prisons in Spain. We compared sociodemographic, criminal/offense, health and mental health, and life events in prison variables between inmates who reported making near-lethal suicide attempts ( n = 616) and those who did not ( n = 1,654) during their current incarceration term. A series of binary and multiple logistic regression analyses indicated that a variety of variables were associated ( p values < .001) with near-lethal suicide attempts, including prior-to-prison employment status, family members in prison, recidivist in prison, childhood trauma, work status in prison, and disciplinary infractions. Our study findings are discussed in light of developing more effective strategies and prevention interventions to reduce attempted suicide in the Spanish Prison System.

This analysis examined the association between drinking severity, food insecurity, and drinking related health comorbidities among 258 African American women who drank heavily from the "Sister to Sister" study. Women were stratified by drinking status: 23% were heavy drinkers (women who drank 30 to 52 weeks in the 12 months prior to study participation and consumed the equivalent of at least 20 alcoholic beverages at one sitting) and 77% were less heavy drinkers (women with all other combinations of drinking habits who drank less than 30 weeks in the 12 months prior to study participation). Heavy drinkers were more likely to not check nutrition labels, skip meals to buy drugs/alcohol, and report a history of stomach disease, diabetes, memory, weight, and kidney problems compared with less heavy drinkers. The heavy drinkers were at increased nutrition risk due to food insecurities and were more susceptible to drinking related health comorbidities compared with less heavy drinkers.