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BackgroundOral care is important to prevent buccal and systemic infections after an acquired brain injury (ABI). Despite recent advancements in the development of ABI clinical practice guidelines, recommendations for specific clinical processes and actions to attain adequate oral care often lack information. ObjectiveThis systematic review will (1) identify relevant ABI clinical practice guidelines and (2) appraise the oral care recommendations existing in the selected guidelines. MethodsA search strategy was developed based on a recent systematic review of clinical practice guidelines for ABI. The protocol includes a search of MEDLINE, EMBASE, and DynaMed Plus databases, as well as organizational and best-practice websites and reference lists of accepted guidelines. Search terms will include medical subject headings and user-defined terms. Guideline appraisal will involve the Appraisal of Guidelines for Research and Evaluation II ratings, followed by a descriptive synopsis for oral care recommendations according to the National Health and Medical Research Council evidence levels. ResultsThis project started in April 2019, when we developed the search strategy. The preliminary search of databases and websites yielded 863 and 787 citations, respectively, for a total of 1650 citations. Data collection will start in August 2020 and we expect to begin disseminating the results in May 2021. ConclusionsNursing staff may not have detailed recommendations on how to provide oral care for neurologically impaired patients. The findings of this review will explore the evidence for oral care in existing guidelines and improve outcomes for patients with ABI. We expect to provide adequate orientations to clinicians, inform policy and guidelines for best practices, and contribute to future directions for research in the ABI realm. International Registered Report Identifier (IRRID)PRR1-10.2196/17249

Background: Translating research into clinical practice is challenging. One implementation intervention that supports translation is employment of a change champion. It is important to understand how individuals are prepared for the change champion role. This rapid systematic review aimed to identify the education, training, and support provided to individuals in change champion roles within implementation trials. Method: Rapid review approach. We searched the Scopus database to identify systematic reviews on champions, knowledge brokers, facilitators, and implementation support practitioners. The most recent reviews on each topic were screened to find eligible studies. To identify studies published after these reviews, we searched Medline, PsycINFO, OVID, CINAHL, ProQuest, SCOPUS, and EBSCO. We included randomised and cluster randomised controlled trials that reported on implementation interventions in healthcare settings involving a local change champion. Results: Fifteen cluster randomised controlled trials were included. Specific champion training was provided in 12 studies (80%), but none reported incorporating adult learning principles into their education program. Some form of post-training support was reported in 11 studies (73%). Only two studies included content on behaviour or organizational change in the champion preparation program. Most programs were not individualized, and details of training and support were poorly reported. Conclusions: Training needs and educational outcomes of change champions are poorly reported in implementation trials. Training tends not to align with adult learning. More rigorous development and reporting of programs to prepare change champions to support implementation of evidence in healthcare is recommended. Registration: PROSPERO registration number CRD42022368276. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is a leading cause of adult disability, and the transition from hospital to home can be fraught with challenges. The HOME Rehab trial is designed to address if better health outcomes for stroke survivors can be achieved with a contextually relevant and tailored occupational therapy discharge planning and support intervention. Process evaluations inform clinical trial findings and future scale up, as well as how to implement a successful intervention effectively into policy and practice. This paper describes the protocol we are using in the HOME Rehab process evaluation planning and activities. Methods: Using a theoretically informed approach, mixed methods are being used to collect data and address all aspects of the RE-AIM framework. Quantitative data will comprise clinician surveys, trial logs and fidelity checklists as well as screening and recruitment numbers. Semi-structured interviews with trial participants and carers and focus groups with occupational therapists will provide qualitative data. A concurrent triangulation approach will be taken to draw on the strengths of multiple methods to cross-validate findings. The RE-AIM framework will be used to interpret the qualitative and quantitative data together as well as highlight areas of convergence or divergence in the findings. Multiple data sources will be integrated to refine the interpretation of outcomes, understand the context of program delivery, and identify key findings. Drawing on, and integrating data from, multiple perspectives and methods will strengthen the overall findings and provided detailed insights into the causal mechanisms as well as the contextual factors that may influence intervention outcomes. Discussion: Process evaluations can optimize study outcomes by improving how a complex intervention is implemented, informing the actions of policymakers and clinicians. For the HOME Rehab intervention, the process evaluation may provide valuable data necessary to explain the trial findings, as well as inform future scale-up and implementation if the HOME Rehab intervention is shown to be effective. Clinical trial registration: https://www.anzctr.org.au , identifier ACTRN12618001360202. [ABSTRACT FROM AUTHOR]

Purpose: Self-awareness is a multifaceted phenomenon that comprises two main concepts: general awareness and online awareness. The latter is an emerging concept that requires further consensus on its definition. The aim of this paper is to define the key components of online awareness and identify approaches for measuring this concept for adults with neurological conditions. Materials and methods: Concept analysis using Rodgers' evolutionary method was used to systematically review and summarise relevant literature. Papers were included if they provided a definition of online awareness or method for assessing online awareness for an adult neurological population. Results: Fifty-six papers were included in this review, with 21 online awareness assessment approaches identified. Online awareness was described to occur within the context of task performance, with the definition framework comprising four main aspects: 1/appraisal; 2/anticipation and prediction; 3/monitoring; and 4/self-evaluation. Self-regulation is a related concept that is considered to sit outside the conceptual boundaries of online awareness. Conclusions: The findings of this analysis highlight the complexity of online awareness and its importance in rehabilitation. Psychometrically robust measures of online awareness that are inclusive of the essential elements of this concept are needed to advance practice in this area. IMPLICATIONS FOR REHABILITATION: Online awareness or awareness of performance within the context of an activity should be included in the comprehensive assessment of self-awareness for individuals with neurological conditions. Online awareness is a task-specific phenomenon that is activated in the context of task performance, and requires assessment across a range of tasks and environments. When assessing online awareness, careful consideration is required when selecting tasks to ensure they have the right level of challenge to elicit the need to monitor performance. The heterogeneity of existing online awareness assessments highlights the need to interpret outcomes with caution. Future efforts should be directed towards development of an online awareness assessment that includes key attributes of this concept. [ABSTRACT FROM AUTHOR]

Background: Non-invasive ventilation (NIV) uses positive pressure to assist people with respiratory muscle weakness or severe respiratory compromise to breathe. Most people use this treatment during sleep when breathing is most susceptible to instability. The benefits of using NIV in motor neurone disease (MND) are well-established. However, uptake and usage are low (~ 19%) and there is no consensus on how to best implement NIV in MND in Australia. Consequently, clinical practice models are highly variable. Our team has recently provided evidence that specific and individualised NIV titration using a sleep study (polysomnography; PSG) leads to better outcomes in people with MND. However, for this clinical practice model to result in sustained benefits, evidence of effectiveness across multiple sites, as well as culture and practice change, must occur. Methods: A two-arm, assessor-blinded, individual participant randomised controlled trial in MND care centres across Australia will be undertaken. Two-hundred and forty-four participants will be randomised (1:1) to either the intervention group (PSG-assisted commencement of NIV settings; PSG) or a control group (sham PSG). Participants will be asked to use their NIV device for 7 weeks and will then return for follow-up assessments. Respiratory, sleep and patient-reported outcome measures will be collected at baseline and follow-up. The primary aim is to determine if the proportion of participants using NIV for > 4 h/day during the intervention period is higher in the PSG than the control group. A process evaluation, health economic evaluation and 12-month cohort follow-up will be undertaken and reported separately. Discussion: The results of this trial will demonstrate the effects of PSG-assisted titration of NIV on usage of NIV in people with MND. We hypothesise that the PSG intervention will improve synchrony between the user and the machine, which will lead to greater NIV usage compared to the control group. Trial registration: ClinicalTrials.gov NCT05136222. Registered on November 25, 2021. [ABSTRACT FROM AUTHOR]

We examined the effect of botulinum toxin-A on upper limb impairments and activity limitations in chronic stroke. This study is a secondary analysis of control group data from a national, multicenter, Phase III randomized trial with a masked outcome assessment. We studied 71 stroke survivors who received a botulinum toxin-A injection in any muscle(s) that crosses the wrist due to significant spasticity after a stroke greater than 3 months previously. We measured upper limb activity, spasticity, range of motion, grip strength, pain and other outcomes at injection and three months later. The median difference between injection and 3 months later was 0.0 blocks/s (interquartile range (IQR) 0.0) on the Box and Block Test, 0/4 (IQR 1) on the Tardieu Scale, 4 degrees (IQR 26) of wrist extension, 0.0 kg (IQR 2) of grip strength, 0.0 (IQR 1.5) on the 10 cm visual analogue scale for pain, 0/100 (IQR 21) on the 10 cm visual analogue scale for overall health, 0/3 (IQR 0) for self-care and −2 (IQR 8) for burden of care. In chronic stroke survivors who have little activity in their upper limb, botulinum toxin-A is not effective in improving any measured outcomes and does not appear to be clinically justified in this population with severe activity limitations. [ABSTRACT FROM AUTHOR]

Evidence is increasing for digital health programs targeting the secondary prevention of stroke. We aimed to determine the feasibility of the novel Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) by combining person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS messages, a mobile application (app), and a wearable device. We conducted a 12-week mixed-methods, open-label feasibility study. Participants (6 months–3 years after stroke or TIA, access to the internet via a smartphone/tablet) were recruited via the Australian Stroke Clinical Registry. Participants set one or two secondary prevention goals with a researcher and provided access and training in technology use. Feasibility outcomes included recruitment, retention, usability, acceptability, and satisfaction. Secondary outcomes included goal attainment, health outcomes, and program costs. Following 600 invitations, 58 responded, 34/36 (94%) eligible participants commenced the program (one withdrawal; 97% retention), and 10 were interviewed. Participants (27% female, 33% TIA) generally rated the usability of the mobile application as 'Good' to 'Excellent' (System Usability Scale). Most (94%) agreed the program helped with engagement in health self-monitoring. Overall, 52 goals were set, predominantly regarding exercise (21/52), which were the most frequently achieved (9/21). At 12 weeks, participants reported significant improvements (p < 0.05) in self-efficacy (Cohen's d = 0.40), cardiovascular health (d = 0.71), and the mental health domain of the PROMIS GH (d = 0.63). CAPS was acceptable, with good retention and engagement of participants. Evaluation of this program in a randomised controlled trial is warranted. [ABSTRACT FROM AUTHOR]

Background: People with communication disability after stroke experience low rates of return to vocational roles. Vocational rehabilitation is recommended; however, there are no clear guidelines informing vocational rehabilitation for people with communication disability. Understanding the needs and experiences of this population is critical to improving vocational stroke rehabilitation outcomes. Aims: This study aimed to: (1) investigate the experience of vocational rehabilitation for people with communication disability after stroke, (2) identify gaps and, (3) provide preliminary recommendations for tailored service delivery. Methods: Seven participants with an identified communication impairment following stroke were recruited from a larger clinical trial of early vocational rehabilitation (20% of total sample, n = 34). To address the study aims, a qualitative design was employed. Semi‐structured, in‐depth interviews were conducted and analysed using thematic analysis. Data were integrated with demographic and intervention audit data to contextualise participant experiences, identify vocational rehabilitation gaps and inform preliminary recommendations. Results: Participants were five men and two women aged 24–69 years whose communication profiles included difficulties with auditory comprehension and information processing, reading comprehension, thinking, executive function and self‐regulation, as well as difficulties with verbal and written expression. Vocational rehabilitation was perceived as beneficial but participants identified gaps including limited access to psychological and peer‐based support during early rehabilitation, limitations to accessing specialist vocational rehabilitation programs, barriers to accessing ongoing rehabilitation after resumption of vocational activity, and limited preparedness for the degree of impact that their communication changes had on execution of vocational roles and responsibilities. Conclusion: Vocational environments are communicatively demanding and people living with acquired communication difficulties face a range of vocation‐related participation barriers even when communication difficulties are mild. Greater emphasis on evaluating the vocational communication environment and targeted communication training and preparation for colleagues within the workplace is recommended to reduce barriers faced. Interdisciplinary rehabilitation, inclusive of psychological care, may support working‐age stroke survivors to recognise and acknowledge changes in their communication function, lead to improved engagement in the rehabilitation process, and ensure early identification of factors likely to influence successful return‐to‐vocational activity. WHAT THIS PAPER ADDS: What is already known on the subject: Stroke is common amongst people of working age yet fewer than half of stroke survivors will return to pre‐stroke vocational roles. Communication difficulties affect anywhere between 24% and 45% of people after stroke and include changes to language abilities, motor speech, vision, hearing and cognition. This group experiences much lower rates of return to vocational roles when compared to people with stroke who do not have a concomitant communication difficulty. Vocational rehabilitation is recommended. However, currently there is limited evidence to inform vocational rehabilitation guidelines for people with stroke and communication difficulties. Achieving a successful return to vocational activity is associated with improved life satisfaction for people with communication difficulties after stroke and is a key research priority for this population. What this study adds: This study investigated the experiences of people with communication difficulty after stroke who reported a goal of returning to pre‐stroke vocational activity. Data associated with types of interventions received, the experiences and perceptions of vocational rehabilitation, and experiences of returning to vocational activity were analysed to identify core rehabilitation needs and develop preliminary recommendations to inform future vocational rehabilitation guidelines for this population. What are the clinical implications of this work?: The present study provides preliminary evidence that people experiencing communication difficulties after stroke require a more integrated rehabilitation pathway. During early stages of vocational rehabilitation psychological and peer‐based support is indicated to support adjustment to changed communication function and to enable productive goal setting and engagement in rehabilitation. Clinicians need to complete a detailed analysis of the vocational communication environment and consider the communication activities involved in the individual's future vocational duties in order to plan meaningful rehabilitation. A multidisciplinary approach is required and additional training for clinicians is indicated to support clinicians to work collaboratively within the vocational setting. [ABSTRACT FROM AUTHOR]