Effects of a nurse-led acupressure programme for stroke patients in China. Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale Virtual Immersion for Post-Stroke Hand Rehabilitation Therapy Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial. A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers. Training of Reaching in Stroke Survivors With Severe and Chronic Upper Limb Paresis Using a Novel Nonrobotic Device: A Randomized Clinical Trial Effects of peripheral sensory nerve stimulation plus task-oriented training on upper extremity function in patients with subacute stroke: a pilot randomized crossover trial Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Team functioning and patient outcomes in stroke rehabilitation. Combining rTMS and Task-Oriented Training in the Rehabilitation of the Arm after Stroke: A Pilot Randomized Controlled Trial Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomized controlled trial Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial A Low-Cost Adaptive Balance Training Platform for Stroke Patients: A Usability Study Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial Effect of mental practice on the improvement of function and daily activity performance of the upper extremity in patients with subacute stroke: a randomized clinical trial. The implementation of snoezelen in psychogeriatric care: an evaluation through the eyes of caregivers. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation Clinical application of circuit training for subacute stroke patients: a preliminary study SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial European Stroke Organisation recommendations to establish a stroke unit and stroke center. Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Varied overground walking-task practice versus body-weight-supported treadmill training in ambulatory adults within one year of stroke: a randomized controlled trial protocol Effectiveness of general practice nurse interventions in cardiac risk factor reduction among adults Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study. An effectiveness study comparing acupuncture, physiotherapy, and their combination in poststroke rehabilitation: a multicentered, randomized, controlled clinical trial. Preliminary results on nursing workload in a dedicated weaning center Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. Effects of individualized versus group task-oriented circuit training on balance ability and gait endurance in chronic stroke inpatients Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect? Effect of Training with Whole Body Vibration on the Sitting Balance of Stroke Patients Content validity and satisfaction with a stroke caregiver intervention program. Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation Effects of a range-of-motion exercise programme. Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review
AIM AND OBJECTIVE To examine the effects of a nurse-led acupressure programme on the recovery of motor function and daily activities of stroke patients . BACKGROUND Stroke is one of the main causes of death and permanent physical disability in the world . The traditional Chinese medicine ( TCM ) is widely used for the treatment and rehabilitation of people with stroke in China . Physiotherapy or occupational therapy can not be performed several times a day . Therefore , research ers and healthcare providers have been seeking effective and efficient alternative strategies for the rehabilitation of stroke patients . Acupressure , non-invasive and widely accessible to any healthcare professionals , is one of the promising alternatives . METHODS Seventy-eight stroke patients were recruited and r and omly assigned into an intervention or control group , with 39 patients in each . The intervention group received acupressure plus routine care , while the control group received only routine care only . The acupressure treatment was carried out by nurses . Patient 's activities of daily living ( ADL ) and motor function from both groups were evaluated at the point of recruitment , and at the end of the first and third month after stroke . RESULTS The ADL and the Fugl-Meyer motor scores in the intervention group were significantly higher than those in the control group at the end of the third month ( p<0.05 ) . CONCLUSION Nurse-led acupressure programme had positive effects on the recovery of motor function and daily activities of stroke patients . Our study suggests that nurse-led acupressure programmes play an important role in the recovery of stroke patients . RELEVANCE TO CLINICAL PRACTICE Healthcare providers need to think about alternative care methods including acupressure for the rehabilitation of stroke patients . Acupressure is one of the promising alternatives nursing intervention for stroke patients in practice Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 Rationale Stroke is the leading cause of death and disability in rural China . For stroke patients residing in re source -limited rural areas , secondary prevention and rehabilitation are largely unavailable , and where present , are far below evidence -based st and ards . Aim This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery , and evaluate its feasibility and effectiveness in rural China . Methods and design This 2-year r and omized controlled trial is being conducted in 2–3 county hospitals located in northwest , northeast , and southwest China . Eligible and consenting stroke in patients ( 200 in total ) have been recruited and r and omized into either a control or intervention group . Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group . They also provide telephone follow-up care three times post discharge . The recruitment , baseline , intervention , follow-up care , and evaluation are guided by the RECOVER mobile phone app specifically design ed for this study . Study outcome The primary outcome is patients ’ Barthel Index ( activities of daily living : mobility , self-care , and toileting ) at 6 months . Process and economic evaluation will also be conducted . Discussion The results of our study will generate initial high- quality evidence to improve stroke care in re source -scarce setting s. If proven effective , this innovative care delivery model has the potential to improve the health and function of stroke patients  , relieve caregiver burden , guide policy-making , and advance translational research in the field of stroke care Stroke is the leading cause of serious , long-term disability in the United States . Impairment of upper extremity function is a common outcome following stroke , often to the detriment of lifestyle and employment opportunities . While the upper extremity is a natural target for therapy , treatment may be hampered by limitations in baseline capability as lack of success may discourage arm and h and use . We developeda virtual reality ( VR ) system in order to encourage repetitive task practice . This system combined an assistive glove with a novel VR environment . A set of exercises for this system was developed to encourage specific movements . Six stroke survivors with chronic upper extremity hemiparesis volunteered to participate in a pilot study in which they completed 18 one-hour training sessions with the VR system .  Performance with the system was recorded across the 18 training sessions . Clinical evaluations of motor control were conducted at three time points : prior to initiation of training , following the end of training , and 1 month later . Subjects displayed significant improvement on performance of the virtual tasks over the course of the training , although for the clinical outcome measures only lateral pinch showed significant improvement . Future expansion to multi-user virtual environments may extend the benefits of this system for stroke survivors with hemiparesis by furthering engagement in the rehabilitation exercises INTRODUCTION The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living ( ADLs ) . Motor imagery ( MI ) is an active process during which a specific action is reproduced within working memory without any actual movements . MI training enhances motor learning , neural reorganization and cortical activation in stroke . The efficacy of MI training involving lower extremity mobility tasks need to be assessed . AIM To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects . MATERIAL S AND METHODS A R and omized Clinical Trial was conducted in Department of Physical Therapy , Tertiary Care Hospitals , Mangalore , India which includes 40 hemi paretic subjects ( > 3 months post-stroke ) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and r and omly allocated into task-oriented training group ( n=20 ) and task-oriented training group plus MI group ( n=20 ) . Subjects in both groups underwent task orientated training for lower extremity 45 - 60 minutes , 4 days per week for 3 weeks . In addition , the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice  . Isometric muscle strength of Hip , Knee and Ankle using a h and -held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention . RESULTS Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p < .05 . The experimental group had shown a significant improvement in paretic hip muscles ( both flexors and extensors ) , knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses . CONCLUSION Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients AIMS To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan . BACKGROUND Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical , cognitive and emotional needs of the stroke survivors . However , little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families . DESIGN A r and omised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers . METHODS The control group ( n = 86 dyads ) received only routine hospital discharge planning services  and the experimental group ( n = 72 dyads ) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program . Outcome variables were measured at baseline , before discharge and one month after hospital discharge . Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale , Preparedness for Caregiving Scale , Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale . RESULTS Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before , and greater satisfaction of discharge needs one month after discharge than before discharge . Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group . However , no significant difference was found between caregiver groups in perceived balance of competing needs . CONCLUSIONS This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge . RELEVANCE TO CLINICAL PRACTICE This caregiver-oriented discharge planning program , with its emphasis on individualised health education and home visits following discharge may improve caregivers ' preparation and the satisfaction of their needs during the discharge transition Background and Purpose — Severe upper limb paresis is a major contributor to disability after stroke . This study investigated the efficacy of a new nonrobotic training device , the Sensorimotor Active Rehabilitation Training ( SMART ) Arm , that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension , permitting stroke survivors with severe paresis to practice a constrained reaching task . Methods — A single-blind , r and omized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis . Thirty-three participants completed the study , of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation , 13 received training using the SMART Arm alone , and 10 received no intervention ( control ) . Training consisted of 12 1-hour sessions over 4 weeks . The primary outcome measure was “ upper arm function , ” item 6 of the Motor Assessment Scale . Secondary outcome measures included impairment measures ; triceps muscle strength , reaching force , modified Ashworth scale ; and activity measures : reaching distance and Motor Assessment Scale . Assessment s were administered before ( 0 weeks ) and after training ( 4 weeks ) and at 2 months follow-up ( 12 weeks ) . Results — Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up . There was no significant difference between these 2 groups . There was no change in the control group . Conclusions — Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis , highlighting the benefits of intensive task-oriented practice , even in the context of severe paresis Objective : To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation . Design : A pilot r and omized crossover trial . Setting : Two rehabilitation hospitals . Subjects : Twenty-two patients with subacute stroke . Interventions : Participants were r and omly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation . The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week , followed by another week with task-oriented training alone . The delayed group underwent the same training in reverse order . Main measures : Outcome measures were the level of fatigue and Wolf Motor Function Test . Patients were assessed at baseline , one and two weeks . Results : All participants completed the study with no adverse events . There was no significant difference in level of fatigue between each treatment . From baseline to one week , the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test ( decrease in mean time ( ± SD ) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds , respectively ) but the difference did not reach significance after Bonferroni correction ( P = 0.041 ) . Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01 ) . Conclusion : Peripheral sensory nerve stimulation is feasible in clinical setting s and may enhance the effects of task-oriented training in patients with subacute stroke Background Over fifty percent of stroke patients experience chronic arm h and performance problems , compromising independence in daily life activities and quality of life . Task-oriented training may improve arm h and performance after stroke , whereby augmented therapy may lead to a better treatment outcome . Technology-supported training holds opportunities for increasing training intensity . However , the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date . The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm h and training in chronic stroke patients . Methods In a single-blind r and omized controlled trial , 22 chronic stroke patients were r and omly allocated to receive either task-oriented robot-assisted arm-h and training ( experimental group ) or task-oriented non-robotic arm-h and training ( control group ) . For training , the T-TOAT ( Technology-supported Task-Oriented Arm Training ) method was applied . Training was provided during 8 weeks , 4 times/week , 2 × 30 min/day . Results A significant improvement after training on the Action Research Arm Test ( ARAT ) was demonstrated in the experimental group ( p = 0.008 ) . Results were maintained until 6 months after cessation of the training . On the perceived performance measure ( Motor Activity Log ( MAL ) ) , both , the experimental and control group improved significantly after training ( control group p = 0.008 ; experimental group p = 0.013 ) . The improvements on MAL in both groups were maintained until 6 months after cessation of the training . With regard to quality of life , only in the control group a significant improvement after training was found ( EuroQol-5D p = 0.015 , SF-36 physical p = 0.01 ) . However , the improvement on SF-36 in the control group was not maintained ( p = 0.012 ) . No between-group differences could be demonstrated on any of the outcome measures . Conclusion Arm h and performance improved in chronic stroke patients , after eight weeks of task oriented training . The use of a Haptic Master robot in support of task-oriented arm training did not show additional value over the video-instructed task-oriented exercises in highly functional stroke patients . Clinical trial registration informationCurrent Controlled Trials IS RCT Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov OBJECTIVE To evaluate the relationship between rehabilitation team functioning and stroke patient outcomes .  DESIGN Prospect i ve observational study . SETTING Veterans Administration ( VA ) inpatient and subacute rehabilitation units . PARTICIPANTS Forty-six VA rehabilitation teams , including 530 rehabilitation team members from 6 disciplines ( medicine , nursing , social work , physical therapy , occupational therapy , speech language pathology ) and 1688 stroke patients treated by the teams . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Ten scales assessing team member perceptions of team functioning ( communication , perceived effectiveness , physician involvement , physician support , teamness , utility of quality information , innovation , interprofessional relationships , order and organization , task orientation ) and 3 primary patient outcome variables-functional improvement , discharge home , and length of rehabilitation stay ( LOS ) . RESULTS Three of the 10 measures of team functioning were significantly associated with patient functional improvement ( P < .05 ) : task orientation , order and organization , and utility of quality information . One measure of team functioning-effectiveness-was significantly associated with LOS ( P < .05 ) . None of the team variables predicted discharge destination . Aspects of team functioning that were important to outcomes differed depending on the outcome of interests . Efforts directed toward improving team activities and relationships , including collaborative planning and problem solving and the use of feedback information , may enhance rehabilitation treatment effectiveness . CONCLUSIONS Characteristics of team functioning predict selected rehabilitation outcomes Introduction . Repetitive transcranial magnetic stimulation ( rTMS ) is a promising technique for promoting rehabilitation of arm function  after stroke . The feasibility and impact of rTMS as an adjunct to traditional task-oriented training to improve arm function have not yet been demonstrated . Objective . Evaluate the feasibility of a r and omized controlled trial aim ed at determining the efficacy of rTMS as an adjunct to task-oriented therapy in facilitating restoration of arm function after stroke . Methods . Stratified block-r and omized controlled trial set in the general community . Eleven stroke persons with mild to severe arm deficits were recruited and r and omized to receive 8 sessions of real-rTMS or sham-rTMS followed by ninety minutes of arm tasks design ed to improve function . Results . Medium to large , statistically significant effect sizes ( 0.49 to 1.63 ) were observed in both groups on several measures of arm function at the postintervention evaluation . Three out of four subjects in the real-TMS condition showed increased levels of corticomotor excitability after the first stimulation session . Conclusions . Preliminary evidence suggests that an rTMS protocol potent enough to induce transient increases in cortical excitability of the lesioned hemisphere is feasible but did not show promising results as an adjunct to task-specific training . This trial is registration with Clinical Trials.gov NCT00850408 Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation . A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain . This trial investigates whether mental practice can contribute to a quicker and /or better recovery of stroke in two Dutch nursing homes . The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual . In addition , we will investigate prognostic variables and feasibility ( process evaluation ) . Methods A r and omised , controlled , observer masked prospect i ve trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery . Over a six weeks intervention period the control group will receive multi professional therapy as usual . Patients in the experimental group will be instructed how to perform mental practice , and will receive care as usual in which mental practice is embedded in physical , occupation and speech therapy sessions . Outcome will be assessed at six weeks and six months . The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale . Secondary outcomes are : Motricity Index , Nine Hole Peg Test , Barthel Index , Timed up and Go , 10 metres walking test , Rivermead Mobility Index . A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility . All patients are asked to keep a log to determine unguided training intensity . Discussion Advantages and disadvantages of several aspects of the chosen design are discussed . Trial registration IS RCT Objective : To evaluate the efficacy of an in-hospital programme based on task-oriented exercises associated with early full weight-bearing in patients with multiple comorbidities undergoing total hip replacement . Design : R and omized controlled trial . Setting : Specialised rehabilitation centre . Subjects : A total of 100 patients ( mean age of 69 ( 8) years ; 40 males , 60 females ) . Interventions : The experimental group underwent task-oriented exercises and was encouraged to ab and on any walking aids by the end of their in-hospital stay . The control group underwent open chain kinetic exercises , and was recommended to use partial weight-bearing and walking aids until three months after surgery . Both groups individually followed programmes of 90-minute sessions five times a week for three weeks . Outcome measures : Western Ontario and McMaster Universities Osteoarthritis Index , Pain Numerical Rating Scale , Functional Independence Measure , and Short-Form Health Survey . The participants were evaluated before , after training , and after a further 12 months . Results : There were no significant between-group differences at baseline . After training , a between-group difference of 12 points was found for the Western Ontario and McMaster Universities Osteoarthritis Index – functional subscale , indicating a clinical ly tangible treatment effect on disability . The Functional Independence Measure increased by 31 and 15 points in the experimental and control group , respectively . A linear mixed model revealed significant effects of time , group , and time by group interaction on disability , pain , activities of daily living , and most of the physical quality of life domains . Conclusion : Task-oriented exercises associated with early full weight-bearing improve disability , pain , activities of daily living , and quality of life after total hip replacement BACKGROUND Family caregivers provide the foundation for long-term home care of stroke survivors . The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external re sources to cope with this situation , thereby placing their own health at risk . We conducted a r and omised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers . OBJECTIVES To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence , problem-solving coping abilities , caregiver 's depressive symptoms , caregiving burden and re sources ( family functioning , social support ) and physical health ( such as caregiving-related injury ) , as well as potential placement of stroke survivors . DESIGN A prospect i ve multi-centre and single-blinded r and omised controlled trial stratified by survivors ' history of stroke . SETTING AND PARTICIPANTS Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong . METHODS The design of the trial was based on the relational/problem-solving model . Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of question naires before r and omisation , immediately , one- and three-months post-intervention . The control group received usual care , whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme ( two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions ) . Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests . RESULTS We recruited 128 caregiver-survivor dyads . The intervention group demonstrated significantly greater improvements throughout the study ( p < 0.01 ) in terms of caregiving competence , problem-solving coping abilities and social support satisfaction . This group also displayed significantly greater improvements in terms of family functioning ( p < 0.05 ) at one-month post-intervention , an increased number of social support ( p < 0.001 ) and a lower level of burden at three-month post-intervention . However , there was no significant effect on enabling stroke survivors to remain in their home . Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities , which suggested its mediating effect on caregiving competence of stroke caregivers . CONCLUSIONS Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Stroke patients usually suffer from asymmetric posture due to hemi-paresis that can result in reduced postural controllability leading to a balance deficit . This deficit increases the risk of falls , which often makes them dependent on caregivers for community ambulation , thus deteriorating their quality of life . Conventional balance training involves rehabilitation exercises performed under physiotherapist ’s supervision , where the scarcity of trained professionals as well as the cost of clinic-based rehabilitation programs can deter stroke survivors from undergoing regular balance training . Thus , research ers have been exploring technology-assisted solutions , e.g. , home-based virtual reality ( VR ) setup . In this paper , we developed a VR-based balance training ( VBaT ) platform , where VR-augmented user-interface using Nintendo Wii balance boardwas tested in a laboratory setting for its feasibility . The VBaT offered tasks of varying difficulties to the participants that adapted to individual performance capability during balance training . We performed a preliminaryusability study with 7 stroke survivors ( post-stroke period > 6 months ) . Preliminary results indicate the potential of theVBaT system to cause improvement in overall average task performance over the course of training while using the VBaT. Thus the VBaT system is proposed to be a step toward an effective balance training platform for people with balance disorder Background Currently , the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions . Circuit Class Therapy ( CCT ) is well suited to accomplish multiple task-specific activities . However , while repetitive task practice is achievable with circuit class therapy , in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units , result ing in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction . To accomplish multiple repetitions , stroke survivors may require augmented duration of practice . To date , no study has examined the effect of augmented duration of CCT in stroke rehabilitation , and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors . Methods / design Using a r and omised controlled trial with blinded outcome assessment , this study is aim ed at determining the effectiveness of structured augmented CCT in stroke rehabilitation . Sixty-eight stroke survivors ( to be recruited from a tertiary health institution in Kano , Northwest , Nigeria ) will be r and omised into one of four groups : three intervention groups of differing CCT duration s namely : 60 min , 90 min , and 120minuntes respectively , and a control group . Participants will take part in an 8-week structured intensive CCT intervention . Participants will be assessed at baseline , post-intervention , and six-month follow-up for the effectiveness of the varied duration s of therapy , using st and ardised tools . Based on the WHO-ICF model , the outcomes are body structure/function , activity limitation , and participation restriction measures . Discussion It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors . Trial registration Pan African Clinical Trial Registry ( PACTR ) : OBJECTIVES More than 50 % of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life . This study aims to evaluate the effectiveness of a task-oriented mental practice ( MP ) approach as an addition to regular arm-h and therapy in patients with subacute stroke . METHODS A multicenter , prospect i ve , single-blind , r and omized clinical trial was performed . Patients trained for 6 weeks , at least 3 times per day . In the experimental group , patients performed video-instructed MP . In the control group , patients performed neurodevelopmental therapy-based exercise therapy . The primary outcome measures are Fugl-Meyer test , Frenchay arm test , Wolf motor function test , and accelerometry . RESULTS The patients did improve over time on Fugl-Meyer test and Wolf motor function test in both the control and the experimental group . A significant improvement on the Frenchay arm test was found after training ( which was maintained at 12-month follow-up ) only in the experimental group . However , no difference in training effects between groups was demonstrated . CONCLUSIONS Training effects were demonstrated after MP training in patients with subacute stroke . However , the results of this study do not corroborate the hypothesis that the use of MP in addition to therapy as usual in patients with subacute stroke has an additional effect over neurodevelopmental therapy in addition to therapy as usual Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended , which makes outcome measures difficult to interpret . The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care . The intervention in each of six experimental wards comprised  training sessions in ' snoezelen for caregivers '  , evaluated using a question naire . To study experience with implementation , the follow-up and general meetings ( 20 in total ) were attended and semi-structured interviews ( six in total ) were conducted . The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care . The nursing assistants also experienced changes at the resident level and organisational changes . However , the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards Objective : To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke . Design : Two-centre , observer-blinded , stratified , block-r and omized controlled trial . Setting : General community . Patients : Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003 . Interventions : The experimental intervention involved practice of functional , unilateral and bilateral tasks that were design ed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks . Members in both groups participated in three sessions a week for six weeks . Main outcome measure(s ) : The primary test of arm function was the Box and Block Test . Secondary tests included the Nine-Hole Peg Test , maximal grip strength , the Test d'Evaluation des Membres supé rieurs des Personnes Agées ( TEMPA ) and the Stroke Rehabilitation Assessment of Movement . Results : Results are for the more affected arm . Baseline performance on the Box and Block Test was an average of 26 blocks ( st and ard deviation ( SD=16 ) in the experimental group ( n=47 ) and 26 blocks ( Sd=18 ) in the control group ( n=44 ) . These values represent approximately 40 % of age-predicted values . Values for the postintervention evaluation were an average of 28 ( SD=17 ) and 28 ( SD=19 ) blocks for the experimental and control group respectively . No meaningful change on other measures of arm function was observed . Conclusions : A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke Background Early rehabilitation after stroke is essential to help reduce disability . Purpose To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke . Data Sources English- language search es of multiple electronic data bases from April 2009 through July 2018 ; targeted search es to December 2018 for studies of selective serotonin reuptake inhibitors ( SSRIs ) or serotonin-norepinephrine reuptake inhibitors . Study Selection 19 systematic review s and 37 r and omized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke . Data Extraction One investigator abstract ed the data , and quality and GRADE assessment were checked by a second investigator . Data Synthesis Most interventions ( for example , SSRIs , mental practice , mirror therapy ) did not improve motor function . High- quality evidence did not support use of fluoxetine to improve motor function . Moderate- quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living ( ADLs ) . Low- quality evidence supported use of robotic arm training to improve ADLs . Low- quality evidence indicated that antidepressants may reduce depression , whereas the frequency and severity of antidepressant-related adverse effects was unclear . Low- quality evidence suggested that cognitive behavioral therapy and exercise , including mind-body exercise , may reduce symptoms of depression and anxiety . Limitation Studies were of poor quality , interventions and comparators were heterogeneous , and evidence on harms was scarce . Conclusion Cardiorespiratory training , repetitive task training , and transcranial direct current stimulation may improve ADLs in adults with stroke .  Cognitive behavioral therapy , exercise , and SSRIs may reduce symptoms of poststroke depression , but use of SSRIs to prevent depression or improve motor function was not supported . Primary Funding Source U.S. Department of Veterans Affairs , Veterans Health Administration [ Purpose ] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity , balance and walking endurance could be clinical ly applied to subacute stroke inpatient group therapy . [ Subjects and Methods ] Twenty subacute stroke patients were r and omly assigned to the intervention group ( n=10 ) or the control group ( n=10 ) . The intervention consisted of a structured , progressive , inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes , 5 days a week for 4 weeks . The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes , 5 days a week for 4 weeks . Outcome measures were lower-extremity motor control , balance , gait endurance and activities of daily living before and after 4 weeks . [ Results ] There were no significant differences at baseline between the two groups . After 4 weeks , both groups showed significant improvements in all outcome measures , but there were no significant differences between the two groups during the invention period . [ Conclusion ] In spite of the small sample size , these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity , balance and walking endurance of subacute stroke patients Background . Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery . Objective . To compare the effect of SMART Arm training , with or without outcome -triggered electrical stimulation to usual therapy , on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation . Methods . A prospect i ve , multicenter , r and omized controlled trial was conducted with 3 parallel groups , concealed allocation , assessor blinding and intention-to-treat analysis . Fifty in patients within 4 months of stroke with severe upper limb disability were r and omly allocated to 60 min/d , 5 days a week for 4 weeks of ( 1 ) SMART Arm with outcome -triggered electrical stimulation and usual therapy , ( 2 ) SMART Arm alone and usual therapy , or ( 3 ) usual therapy . Assessment occurred at baseline ( 0 weeks ) , posttraining ( 4 weeks ) , and follow-up ( 26 and 52 weeks ) . The primary outcome measure was Motor Assessment Scale item 6 ( MAS6 ) at posttraining . Results . All groups demonstrated a statistically ( P < .001 ) and clinical ly significant improvement in arm function at posttraining ( MAS6 change ≥1 point ) and at 52 weeks ( MAS6 change ≥2 points ) . There were no differences in improvement in arm function between groups ( P = .367 ) . There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining ( SMART Arm stimulation generalized odds ratio [ GenOR ] = 1.47 , 95%CI = 1.23 - 1.71 ) and at 26 weeks ( SMART Arm alone GenOR = 1.31 , 95 % CI = 1.05 - 1.57 ) . Conclusion . SMART Arm training supported a clinical ly significant improvement in arm function , which was similar to usual therapy . All groups maintained gains at 12 months In the recent Helsingborg declaration , acute organized stroke unit care was described as the backbone of the chain of care for all European stroke victims . Access to stroke units is , however , still limited . To improve the availability and the quality of affordable stroke care , the European Stroke Organisation ( ESO ) has appointed an ESO Stroke Unit Certification Committee to define the requirements and criteria for official certification as ESO Stroke Units and ESO Stroke Centres based on scientific evidence from r and omized controlled trials , clinical practice guidelines , and expert consensus . Important features of modern stroke care include the presence of a dedicated stroke unit ward , a multiprofessional team approach , a comprehensive stroke unit organization , including emergency room organization , adherence to diagnostic and therapeutic time-windows , early swallowing diagnostics and therapy , intravenous thrombolytic therapy , periods of automated monitoring , access to decrompressive craniectomy and intraarterial thrombolysis , early mobilization and rehabilitation , supported discharge and basic aftercare with treatment of risk factors and poststroke prevention . The Committee defined the target population , the necessary infrastructure , technical equipment , diagnostic pathways , therapeutic interventions , nursing care , and multiprofessional rehabilitation . The definitions also cover the hospital environment characteristics and the stroke unit ’s interactions with other departments . Quality indicators for benchmarking are presented . Although the ESO Stroke Unit ’s requirements are largely evidence -based , expert consensus is also included where evidence was unavailable . These recommendations of the ESO task force should stimulate hospitals in Europe to apply for ESO certification . Fulfilling of the criteria will be checked by on-site visits Background Stroke is one of the major causes of loss of independence , decreased quality of life and mortality among elderly people . About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke , which can lead to difficulties in picking up and managing their social life . The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients . Methods A two group multicentre r and omised controlled trial is used to evaluate the effects of the rehabilitation programme . The programme consists of three care modules : 1 ) neurorehabilitation treatment for elderly stroke patients ; 2 ) empowerment training for patient and informal caregiver ; and 3 ) stroke education for patient and informal caregiver . The total programme has a duration of between two and six months , depending on the individual problems of the patient and informal caregiver . The control group receives usual care in the nursing home and after discharge .  Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge . Data are gathered by face-to-face interviews , self-administered question naires , focus groups and registration forms . Primary outcomes for patients are activity level after stroke , functional dependence , perceived quality of life and social participation . Outcomes for informal caregivers are perceived care burden , objective care burden , quality of life and perceived health . Outcome measures of the process evaluation are implementation fidelity , programme deliverance and the opinion of the stroke professionals , patients and informal caregivers about the programme . Outcome measures of the economic evaluation are the healthcare utilisation and associated costs . Data are collected at baseline , and after six and 12 months . The first results of the study will be expected in 2014.Trial registration International St and ard R and omised Controlled Trial Register Number IS RCT N62286281 , The Dutch Trial Register Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Background Although task-oriented training has been shown to improve walking outcomes after stroke , it is not yet clear whether one task-oriented approach is superior to another . The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program ( MLWP ) , a varied overground walking task program consistent with key motor learning principles , to body-weight-supported treadmill training ( BWSTT ) in community-dwelling , ambulatory , adults within 1 year of stroke . Methods / Design A parallel , r and omized controlled trial with stratification by baseline gait speed will be conducted . Allocation will be controlled by a central r and omization service and participants will be allocated to the two active intervention groups ( 1:1 ) using a permuted block r and omization process . Seventy participants will be assigned to one of two 15-session training programs . In MLWP , one physiotherapist will supervise practice of various overground walking tasks . Instructions , feedback , and guidance will be provided in a manner that facilitates self-evaluation and problem solving . In BWSTT , training will emphasize repetition of the normal gait cycle while supported over a treadmill , assisted by up to three physiotherapists . Outcomes will be assessed by a blinded assessor at baseline , post-intervention and at 2-month follow-up . The primary outcome will be post-intervention comfortable gait speed . Secondary outcomes include fast gait speed , walking endurance , balance self-efficacy , participation in community mobility , health-related quality of life , and goal attainment . Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate . Intention-to-treat analysis will be used . Discussion In order to direct clinicians , patients , and other health decision-makers , there is a need for a head-to-head comparison of different approaches to active , task-related walking training after stroke . We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice , guidance and feedback . Trial Registration Clinical Trials.gov # Background Cardiovascular disease is the leading cause of death for adults in Australia . In recent years there has been a shift in health service delivery from institutional to community‐based care for chronic conditions , including cardiovascular disease . The general practice setting is seen to offer greater flexibility , higher levels of efficiency and more client focused healthcare delivery than is possible in the acute care sector . It has been suggested that practice nurses represent a useful adjunct to current models of cardiovascular disease management . To date , significant descriptive research has been conducted exploring the demographics , roles , educational needs and issues facing practice nurses . However , there is a need to evaluate the effectiveness of practice nurse interventions in terms of patient outcomes , clinician satisfaction and cost‐effectiveness . Objectives This review seeks to present the best available evidence regarding the efficacy of general practice nurse interventions for cardiac risk factor reduction in healthy adults , as well as those with established cardiovascular disease or known cardiac risk factors . Search Strategy A systematic literature search was performed using Medline ( 1966 ‐ 2005 ) , CINAHL ( 1982 −2005 ) , Cochrane Controlled Trials Register ( Issue 4 , 2005 ) and the Joanna Briggs Institute Evidence Library . In addition , the reference lists of retrieved papers , conference proceedings and the Internet , were scrutinised for additional trials . Selection Criteria This review considered any English language r and omised trials that investigated interventions conducted by the practice nurse for cardiovascular disease management or reduction of cardiac risk factors . Interventions conducted by specialist cardiac nurses in general practice were excluded . Outcomes measured included blood pressure , smoking cessation , total cholesterol , exercise , body weight/body mass index and cost‐effectiveness . Results Eighteen trials , reported in 33 papers , were included in the review . Ten trials investigated multifaceted interventions , while the remaining eight trials reported targeted interventions . Of the trials that reported multifaceted interventions , three trials investigated risk reduction in those with established cardiovascular disease , four trials focused on those with known cardiovascular disease risk factors and three trials included the general community . The eight trials which examined the efficacy of targeted interventions focused upon dietary intake ( two trials ) , smoking cessation ( three trials ) , weight reduction ( one trial ) and physical activity ( two trials ) . The effect of both the multifaceted and targeted interventions on patient outcomes was variable . However , both the multifaceted and targeted interventions demonstrated similar outcome trends for specific variables . Improvements were demonstrated by most studies in blood pressure , cholesterol level , dietary intake and physical activity . The variation in outcome measures and contradictory findings between some studies makes it difficult to draw definitive conclusions . Conclusions While interventions to reduce cardiovascular disease risk factors have produced variable results , they offer significant potential to assist patients in modifying their personal risk profile and should be developed . The public health importance of these changes is dependant upon the sustainability of the change and its effect on the health outcomes of these individuals . Further well‐ design ed research is required to establish the effectiveness of practice nurse interventions for cardiovascular disease management and risk factor reduction in terms of patient outcomes and cost‐effectiveness Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities OBJECTIVE To evaluate the outcome of stroke stratified according to both initial stroke severity and initial level of disability . DESIGN Prospect i ve , consecutive , and community based . SETTING A stroke unit of a hospital in Denmark . This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the City of Copenhagen .  Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age , stroke severity , and premorbid condition . PATIENTS 1197 patients with acute stroke . MAIN OUTCOME MEASURES Primary outcome was measured as death , discharge to nursing home , or to own home . Secondary outcome was measured as neurological deficits and functional disabilities after completed rehabilitation and again 6 months after stroke onset , using the Sc and inavian Neurological Stroke Scale and the Barthel Index . RESULTS Stroke was initially very severe in 223 ( 19 % ) of the patients , severe in 171 ( 14 % ) , moderate in 316 ( 26 % ) , and mild in 487 ( 41 % ) patients . Two hundred and fifty ( 21 % ) patients died during hospital stay , 177 ( 15 % ) were discharged to nursing home , and 770 ( 64 % ) patients were discharged to their own home . After completed rehabilitation , 11 % of survivors still had severe or very severe neurological deficits , 11 % had moderate deficits , and 78 % had no or only mild deficits ; 20 % were severely or very severely disabled , 8 % were moderately disabled , 26 % were mildly disabled , and 46 % had no disability in activities of daily living . Detailed information on outcome stratified according to initial stroke severity/disability also is presented . CONCLUSIONS This study provides a thorough description of the needs for stroke rehabilitation in the community and the amount of postrehabilitation disability in stroke survivors . For outcome prediction , the results can be used as a reliable tool for prognostication of the chances ( or risks ) of various outcomes in patients characterized by initial degree of stroke severity and /or functional disability using simple , reliable scores in the acute phase of stroke . However , the results should not be used as a guideline for selecting patients for rehabilitation in the acute phase because even the most severe cases regularly experience meaningful improvement during rehabilitation CONTEXT Stroke is a leading cause of death and disability worldwide , being the third leading cause of death in the United States and the second and third most common causes of death in Chinese cities and rural areas , respectively . Evaluation of different rehabilitative modalities appears necessary to optimize treatment . OBJECTIVES To compare acupuncture and physiotherapy for effectiveness and reliability in treating hemiplegic patients after stroke . DESIGN The research team design ed a multicentered , three-arm , r and omized controlled trial . Power calculations revealed a targeted sample size of 310 participants . SETTING The study took place at seven in-patient hospitals in China . PARTICIPANTS The research team screened a total of 310 patients . Of that number , 274 completed the study , 15 did not meet the inclusion /exclusion criteria , and 21 dropped out . Adverse events were rare ( less than 1 % ) , mild , and temporary . INTERVENTION The research team r and omly divided participants into three groups that all received conventional care as needed-including psychological counseling , st and ard nursing care , and daily medical evaluation plus ( 1 ) acupuncture , ( 2 ) physiotherapy , or ( 3 ) acupuncture plus physiotherapy . The participants received treatments once a day , 6 days a week for 4 weeks . OUTCOME MEASURES The research team evaluated all patients at baseline , after 2 weeks , and after 4 weeks using the Fugl-Meyer Assessment of Physical Performance ( FMA ) , a modified Barthel Index ( BI ) , and the Neurologic Defect Scale ( NDS ) . RESULTS No significant differences existed between the three groups at baseline . Compared to baseline , participants in all groups improved their FMA , BI , and NDS scores by the end of week 2 ( P≤.05 ) and further improved by the end of week 4 ( P≤.05 ) The study found no statistically significant differences in outcomes between the three groups after treatment ( P>.05 ) . CONCLUSION Acupuncture plus conventional care was similar in effectiveness to physiotherapy treatment plus conventional care for poststroke rehabilitation . The study found no synergistic effects for the combination of acupuncture and physiotherapy in addition to conventional care ; that combination of treatments was no more effective than either treatment by itself . The effectiveness and lack of adverse events associated with acupuncture in this study suggest that it may represent an additional treatment option for stroke patients Objective : To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center ( WC ) and to examine the correlation of the nursing time with nursing workload ( NW ) scores and with clinical severity and dependency.¶ Setting : Four-bed WC of a pulmonary rehabilitation department.¶Intervention : None.¶ Design and measurement : Prospect i ve , observational study of 46 consecutive patients admitted to a long-term WC .  Time required by  items of the Time Oriented Score System ( TOSS )  and other tasks specific to respiratory intermediate intensive care units were evaluated for all the activities performed on each patient in the first 2 days after admission . Patient dependency and level of nursing care at admission were measured using the Dependence Nursing Scale ( DNS ) and the Intermediate Therapeutic Intervention Score System ( TISS-int ) . The Acute Physiology and Chronic Health Evaluation ( APACHE ) II score was also recorded at admission.¶ Results : On the first day each patient needed 45 ± 15 % ( 63 ± 23 % , 45 ± 22 % , and 29 ± 14 % for the three nursing shifts ) of allocated single  nursing time  . On the TOSS on the first day patients required a daily mean 28 ± 10 % of total available nursing time ; on the second day the results did not change . Time of care in the first 24 h was only weakly related to DNS , APACHE II score , and TISS-int ; only DNS was able ( although weakly ; r = 0.45 ) to predict minutes of nursing care.¶ Conclusions : In difficult-to-wean patients from mechanical ventilation  the nursing time in the first 2 days after admission is high . The use of TOSS may underestimate NW by about 38 % . Although only DNS showed the ability to predict minutes of care , the weak relationship limits its value in clinical practice OBJECTIVE Rehabilitation strategies have been developed to improve functional state in stroke patients . The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses , on the functional recovery of basic and social activities in stroke patients compared with conventional care . DESIGN A r and omised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security ( IMSS ) in Mexico City between April 2003-May 2004 . PARTICIPANTS Stroke patients . METHODS Two rehabilitation strategies provided by nurses for stroke patients were compared : physiotherapy plus caregiver education in rehabilitation ( strategy 1 , S1 ) vs. education alone ( strategy 2 , S2 ) . The main outcome variables were the basic ( Barthel index ) and social ( Frenchay activities index ) activities of daily living , of each patient . Age , sex , morbidity , stroke symptoms , complications , neurological damage ( Canadian Scale ) , cognitive state ( mini-mental state examination question naire ) and duration of hospitalisation were defined as the control variables . Patients were evaluated at baseline and months one , three and six thereafter . RESULTS One hundred and ten patients with ischaemic stroke were enrolled and r and omised ; 59 were assigned to S1 and 51 to S2 . Comparison of the outcome variables showed that patients improved significantly over time , but no differences were observed between groups . We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living . RELEVANCE TO CLINICAL PRACTICE Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone . Those countries that do not have integral rehabilitation programmes for stroke patients should underst and their importance and budget re sources for them . Meanwhile , both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients [ Purpose ] The purpose of this study was to analyze the effects of task-oriented circuit training on the balance ability and gait endurance of chronic stroke in patients . [ Subjects and Methods ] The participants were 30 patients who had stroke > 6 months previously , result ing in a disability such as hemiparesis . The participants were r and omly divided into the group task-oriented circuit training group and the individual task-oriented circuit-training group . They performed eight types of modified task-oriented training .  Balance ability and gait endurance were measured by using the Berg balance scale question naire and the 6-min walk test , respectively , before and after the experiment . [ Results ] Significant differences were observed between before and after the intervention in all variables . There was a significant difference between groups in Berg balance scale scores ; however , no significant differences were seen in the timed up and go test and the 6-min walk test . [ Conclusion ] The results of this study indicated that group exercise can better improve the balance ability of chronic stroke in patients after stroke than can individualized exercise intervention Introduction Home-based self-rehabilitation programmes combined with botulinum toxin injections ( BTIs ) appear to be a relevant approach to increase the recommended intensive rehabilitation of patients with spasticity following a stroke . The literature highlights a lack of evidence of beneficial effects of this adjuvant therapy to reduce limitations of patients with stroke . The aim of this study is to assess the effects of a 6-month self-rehabilitation programme in adjunction to BTI , in comparison with BTI alone , to reduce limitations of patients with spasticity following a stroke . Methods and analysis 220 chronic patients will participate to this multicentre , prospect i ve , r and omised , controlled , assessor blinded study . All patients will benefit from two successive BTI ( 3 months apart ) , and patients r and omised in the self-rehabilitation group will perform in adjunction 6 months of self-rehabilitation at home . All patients continue their conventional physiotherapy . The main outcome is the primary treatment goal ( PTG ) , which will be determined jointly by the patient and the medical doctor using Goal Attainment Scaling . Impairments and functions , quality of life , mood and fatigue will be assessed . Botulinum toxin will be injected into the relevant muscles according to the PTG . Patients in the self-rehab group will be taught the self-rehabilitation programme involving respectively 10 min of stretching , 10 min of strengthening and 10 min of task-oriented exercises , corresponding to their PTG . Compliance to the self-rehabilitation programme will be monitored . Ethics and dissemination Patients will sign written informed consent . Ethical approval was obtained from ethics committee . The results will be disseminated in a peer- review ed journal and presented at international congresses . The results will also be disseminated to patients . Trial registration number NCT02944929 Background Across the developed world , we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision . Integrated care pathways ( ICPs ) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration . ICPs map out a patient 's journey , providing coordination of services for users . They aim to have : ' the right people , doing the right things , in the right order , at the right time , in the right place , with the right outcome ' . The value for ICPs in supporting the delivery of care across organisational boundaries , providing greater consistency in practice , improving service continuity and increasing collaboration has been advocated by many . However , there is little evidence to support their use , and the need for systematic evaluations in order to measure their effectiveness has been widely identified . A recent Cochrane review assessed the effects of ICPs on functional outcome , process of care , quality of life and hospitalisation costs of in patients with acute stroke , but did not specifically focus on service integration or its derivatives . To the best of our knowledge , no such systematic review of the literature exists . Objectives To systematic ally review all high‐ quality studies which have evaluated the impact of care pathway technologies on ' service integration ' and its derivatives in stroke care To examine how elements of service integration are defined in such studies To examine the type of evidence utilised to measure service integration To analyse the weight of evidence used to support cl aims about the effectiveness of ICPs on improving service integration To produce recommendations for ICP developers , users and evaluators . Inclusion criteria Types of participants The review focused on the care of adult patients who had suffered a stroke . It included the full spectrum of services ‐ acute care , rehabilitation and long‐term support ‐ in hospital and community setting s. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest , defined for the purpose of this review as ' a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and st and ardise the outcome orientated care ' . Here ' multidisciplinary ' is taken to refer to the involvement of two or more disciplines . Types of outcomes Service integration ' was the outcome of interest however , this was defined and measured in the selected studies . Types of studies This review was concerned with how ' service integration ' was defined in evaluations of ICPs ; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on ' service integration ' . Studies that made an explicit link between ICPs and service integration were included in the review . Evidence generated from r and omised controlled trials , quasi‐experimental , qualitative and health economics research was sought . The search was limited to publications after 1980 , coinciding with the emergence of ICPs in the healthcare context . Assessment for inclusion of foreign papers was based on the English‐ language abstract , where available . These were included only if an English translation was available . Exclusion criteria This review excluded studies that : focused only on a single aspect of stroke care ( e.g. dysphasia ) evaluated ICPs as part of a wider program of service development did not make an explicit link between ICPs and service integration did not meet the definition of ICP utilised for the purpose s of the review focused exclusively on the outcomes of variance analysis Search strategy In order to avoid replication , the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Data base and the Cochrane Library were search ed to establish that no systematic review s existed and none were in progress . A three‐stage search strategy was then used to identify both published and unpublished studies ( see Appendix III ) . Data collection Our search strategy located 2123 papers , of which 39 were retrieved for further evaluation . We critically appraised seven papers , representing five studies . These were all evaluation studies and , as is typical in this field , comprised a range of study design s and data collection methods . Owing to the diversity of the study types included in the review , we developed a single‐ appraisal checklist and data ‐ extraction tool which could be applied to all research design s.32 The tool drew on the Joanna Briggs Institute ( JBI ) appraisal checklists for experimental studies and interpretive and critical research , and also incorporated specific information and issues which were relevant for our purpose s ( see Appendix VI ) . This extends the thinking outlined in Lyne et al.31 in which , drawing on Campbell and Stanley 's classic paper , the case is made for developing an appraisal tool which is applicable to all types of evaluation , irrespective of study design . In assessing the quality of the papers , we were sympathetic to the method ological challenges of evaluating complex interventions such as ICPs . We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare context s. In accordance with the aims of this particular review , we have included studies , which are method ologically weaker than is typical of many systematic review s because , in our view , in the absence of stronger evidence , they yield useful information . Data synthesis Given the heterogeneity of the included studies , meta‐ analysis and /or qualitative synthesis was not possible . A narrative summary of the study findings is presented . Results ICPs can be effective in ensuring that patients receive relevant clinical interventions and /or assessment s in a timely manner , although these improvements may reflect better documentation rather than actual changes in practice . ICPs can be effective in improving the documentation of rehabilitation goals , documentation of communication with patients , carers ( diagnosis , prognosis and follow‐up arrangements ) and documentation of notification of primary care physicians of discharge . However , this can create additional burdens of work for staff . Early studies of  ICP‐managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination , morbidity or mortality . These effects do not reach statistical significance , however , and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay . While later studies in the acute and rehabilitation context s do not reveal any significant reduction in length of stay , they do report greater documented use of certain clinical interventions and assessment s , suggesting that ICPs can be effective in mobilising hospital re sources around the patient . ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections , although we do not know whether this can be attributed to improved service integration . ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher‐level functioning and carer needs influencing perceptions of quality of life . ICP management may assist in clarifying role boundaries and a shared underst and ing of the work , but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation . There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement , but in situations in which multidisciplinary working is effective , their positive effects may be limited . Furthermore , it is far from clear what the active ingredients of ICPs actually are . Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.20 None of the studies assessed the balance of costs and benefits of ICP use . Therefore , we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits . Conclusions Implication s for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care . This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of re sources around the patient without incurring additional increases in length of stay . ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable . Their value in the context of rehabilitation setting s in which recovery pathways are more variable is less clear . There is some evidence that ICPs may be effective in bringing about behavioural changes in context s where deficiencies in service provision have been identified . Their value in context s where inter‐professional working is well established is less clear . While earlier before and after studies show a reduction in length of stay in ICP‐managed care , this may reflect wider healthcare trends , and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced . There is some evidence to suggest that ICPs bring about improvements in documentation , but we do not know how far documented practice reflects actual practice . It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use . As none of the studies review ed included an economic evaluation , moreover , it remains unclear whether the benefits of ICPs UNLABELLED EXECUTIVE SUMMARY : BACKGROUND Across the developed world , we are witnessing an increasing emphasis on the need for more closely coordinated forms of health and social care provision . Integrated care pathways ( ICPs ) have emerged as a response to this aspiration and are believed by many to address the factors which contribute to service integration . ICPs map out a patient 's journey , providing coordination of services for users . They aim to have : ' the right people , doing the right things , in the right order , at the right time , in the right place , with the right outcome ' . The value for ICPs in supporting the delivery of care across organisational boundaries , providing greater consistency in practice , improving service continuity and increasing collaboration has been advocated by many . However , there is little evidence to support their use , and the need for systematic evaluations in order to measure their effectiveness has been widely identified . A recent Cochrane review assessed the effects of ICPs on functional outcome , process of care , quality of life and hospitalisation costs of in patients with acute stroke , but did not specifically focus on service integration or its derivatives . To the best of our knowledge , no such systematic review of the literature exists . OBJECTIVES • To systematic ally review all high- quality studies which have evaluated the impact of care pathway technologies on ' service integration ' and its derivatives in stroke care • To examine how elements of service integration are defined in such studies • To examine the type of evidence utilised to measure service integration • To analyse the weight of evidence used to support cl aims about the effectiveness of ICPs on improving service integration • To produce recommendations for ICP developers , users and evaluators . INCLUSION CRITERIA Types of participants The review focused on the care of adult patients who had suffered a stroke . It included the full spectrum of services - acute care , rehabilitation and long-term support - in hospital and community setting s. Types of intervention(s)/phenomena of interest Integrated care pathways were the intervention of interest , defined for the purpose of this review as ' a multidisciplinary tool to improve the quality and efficiency of evidence based care and is used as a communication tool between professionals to manage and st and ardise the outcome orientated care ' Here ' multidisciplinary ' is taken to refer to the involvement of two or more disciplines . Types of outcomes ' Service integration ' was the outcome of interest however , this was defined and measured in the selected studies . Types of studies This review was concerned with how ' service integration ' was defined in evaluations of ICPs ; the type of evidence utilised in measuring the impact of the intervention and the weight of evidence to support the effectiveness of care pathway technologies on ' service integration ' . Studies that made an explicit link between ICPs and service integration were included in the review . Evidence generated from r and omised controlled trials , quasi-experimental , qualitative and health economics research was sought . The search was limited to publications after 1980 , coinciding with the emergence of ICPs in the healthcare context . Assessment for inclusion of foreign papers was based on the English- language abstract , where available . These were included only if an English translation was available . EXCLUSION CRITERIA This review excluded studies that : • focused only on a single aspect of stroke care ( e.g. dysphasia ) • evaluated ICPs as part of a wider program of service development • did not make an explicit link between ICPs and service integration • did not meet the definition of ICP utilised for the purpose s of the review • focused exclusively on the outcomes of variance analysis SEARCH STRATEGY In order to avoid replication , the Joanna Briggs Institute for Evidence Based Nursing and Midwifery Data base and the Cochrane Library were search ed to establish that no systematic review s existed and none were in progress . A three-stage search strategy was then used to identify both published and unpublished studies ( see Appendix III ) . DATA COLLECTION Our search strategy located 2123 papers , of which 39 were retrieved for further evaluation . We critically appraised seven papers , representing five studies . These were all evaluation studies and , as is typical in this field , comprised a range of study design s and data collection methods . Owing to the diversity of the study types included in the review , we developed a single- appraisal checklist and data - extraction tool which could be applied to all research design s.(32 ) The tool drew on the Joanna Briggs Institute ( JBI ) appraisal checklists for experimental studies and interpretive and critical research , and also incorporated specific information and issues which were relevant for our purpose s ( see Appendix VI ) . This extends the thinking outlined in Lyne et al.(31 ) in which , drawing on Campbell and Stanley 's classic paper , the case is made for developing an appraisal tool which is applicable to all types of evaluation , irrespective of study design . In assessing the quality of the papers , we were sympathetic to the method ological challenges of evaluating complex interventions such as ICPs . We were also cognisant of the very real constraints in which service evaluations are frequently undertaken in healthcare context s. In accordance with the aims of this particular review , we have included studies , which are method ologically weaker than is typical of many systematic review s because , in our view , in the absence of stronger evidence , they yield useful information . DATA SYNTHESIS Given the heterogeneity of the included studies , meta- analysis and /or qualitative synthesis was not possible . A narrative summary of the study findings is presented . RESULTS 1 ICPs can be effective in ensuring that patients receive relevant clinical interventions and /or assessment s in a timely manner , although these improvements may reflect better documentation rather than actual changes in practice . 2 ICPs can be effective in improving the documentation of rehabilitation goals , documentation of communication with patients , carers ( diagnosis , prognosis and follow-up arrangements ) and documentation of notification of primary care physicians of discharge . However , this can create additional burdens of work for staff . 3 Early studies of ICP-managed care in the acute stroke context have demonstrated reduced length of stay without any associated adverse effects on discharge destination , morbidity or mortality . These effects do not reach statistical significance , however , and may reflect wider changes in service provision and a general trend towards reduced length of hospital stay . While later studies in the acute and rehabilitation context s do not reveal any significant reduction in length of stay , they do report greater documented use of certain clinical interventions and assessment s , suggesting that ICPs can be effective in mobilising hospital re sources around the patient . 4 ICPs implemented in the context of acute stroke care can be effective in reducing the occurrence of urinary tract infections , although we do not know whether this can be attributed to improved service integration . 5 ICP management in stroke rehabilitation may not be flexible enough to meet diverse patient needs and can result in insufficient attention to higher-level functioning and carer needs influencing perceptions of quality of life . 6 ICP management may assist in clarifying role boundaries and a shared underst and ing of the work , but this can result in some members of the disciplinary team perceiving that their contribution is not appropriately reflected in the documentation . 7 There is some evidence that ICPs may be effective in changing professional behaviours in the desired direction where there is scope for improvement , but in situations in which multidisciplinary working is effective , their positive effects may be limited . Furthermore , it is far from clear what the active ingredients of ICPs actually are . Kwan et al. suggest that it was the process of ICP development that had most impact on behaviours rather than the use of the artefact per se.(20 ) 8 None of the studies assessed the balance of costs and benefits of ICP  use . Therefore , we do not know whether the costs of ICP development and implementation are justified by any of the reported benefits . CONCLUSIONS Implication s for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care . This seems to be as a result of their ability to support the timely implementation of clinical interventions and the mobilisation of re sources around the patient without incurring additional increases in length of stay .  ICPs appear to be most successful in improving service coordination in the acute stroke context where patient care trajectories are predictable . Their value in the context of rehabilitation setting s in which recovery pathways are more variable is less clear . There is some evidence that ICPs may be effective in bringing about behavioural changes in context s where deficiencies in service provision have been identified . Their value in context s where inter-professional working is well established is less clear . While earlier before and after studies show a reduction in length of stay in ICP-managed care , this may reflect wider healthcare trends , and the failure of later studies to demonstrate further reductions suggests that there may be limits as to how far this can continue to be reduced . There is some evidence to suggest that ICPs bring about improvements in documentation , but we do not know how far documented practice reflects actual practice . It is unclear how ICPs have their effects and the relative importance of the process of development and the artefact in use . ( ABSTRACT TRUNCATED [ Purpose ] The purpose of this study was to determine the effects of task-oriented training with whole body vibration ( WBV ) on the sitting balance of stroke patients . [ Subjects ] The subjects were 30 stroke patients who were r and omly divided into experimental ( n1=15 ) and control ( n2=15 ) groups . [ Methods ] Subjects in both groups received general training five times per week . Subjects in the experimental group practice d an additional task-oriented training program with WBV , which was performed for 15 minutes , five times per week , for four weeks . The center of pressure ( COP ) path length and average velocity were used to assess subjects static sitting balance , and the Modified Functional Reach Test ( MFRT ) was used to assess their dynamic sitting balance . The paired t-test was performed to test the significance of differences between before and after the intervention . The independent t-test was conducted to test the significance of differences between the groups . [ Results ] Following the intervention , the experimental group showed a significant change in MFRT . [ Conclusion ] The results of this study suggest that task-oriented training with WBV is feasible and efficacious for stroke patients BACKGROUND AND PURPOSE Establishing evidence of content validity and satisfaction is an integral part of intervention research . The purpose of this article is to describe content validity and satisfaction relative to the Telephone Assessment and Skill-Building Kit ( TASK ) , an 8-week follow-up program based on individualized assessment of stroke caregiver needs . DESIGN AND METHODS The TASK intervention enables caregivers to develop skills based on assessment of their own needs . During the development of the TASK program , 10 experts rated the validity of the TASK intervention components for accuracy , feasibility , acceptability , and problem relevance . After incorporating feedback from the experts , a r and omized controlled clinical trial was instituted using a convenience sample of 40 stroke caregivers to determine satisfaction ( usefulness , ease of use , and acceptability ) with the TASK intervention ( n=21 ) compared with an attention control group ( n=19 ) . Data collection occurred between March 2005 and June 2006 . Data were analyzed using descriptive statistics , independent sample t tests , and content analysis . FINDINGS Expert ratings on a 1 to 5 scale , with 5 being strongly agree , provided evidence of content validity ( accuracy 4.71 , feasibility 4.46 , acceptability 4.40 , problem relevance 4.67 ) . Caregivers in the TASK group scored significantly higher than the attention control group on all satisfaction measures ( usefulness p=.02 ; ease of use p=.02 ; acceptability p=.05 ) . Qualitative comments from caregivers provided further evidence of satisfaction . CONCLUSIONS Evidence of content validity and user satisfaction for the TASK intervention relative to an attention control group was found . CLINICAL RELEVANCE The TASK program may be a viable telephone-based program that can be implemented by nurses to support family caregivers during the first few months after stroke survivors are discharged home Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US . Learning based rehabilitation training enables independent mobility in the majority of patients post stroke , however , restoration of fine manipulation , motor function and task specific functions of the hemiplegic arm and h and is noted in fewer than 15 % of the stroke patients . Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs ' manipulation . The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system ( EXO-UL7 ) using three different modalities : bilateral mirror image with symmetric movements of both arms , unilateral movement of the affected arm and st and ard care .  Five hemiparetic subjects were r and omly assigned to each therapy modality . An upper limb exoskeleton was used to provide bilateral and unilateral treatments . St and ard care was provided by a licensed physical therapist . Subjects were evaluated before and after the interventions using 13 different clinical measures . Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities . Subjects exhibited significant improvements in range of motion of the shoulder , and improved muscle strength for bilateral training and st and ard care , but not for unilateral training . In conclusion , a synergetic approach in which robotic treatments ( unilateral and bilateral depending on the level of the motor control ) are supplemented by the st and ard of care may maximize the outcome of the motor control recover following stroke Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities AIM This paper reports an evaluation of a range-of-motion exercise programme aim ed at improving joint flexibility , activity function , perception of pain , and depressive symptoms in a sample of stroke survivors in long-term care facilities . BACKGROUND The benefits of physical rehabilitation for stroke survivors have been well established . There is , however , little empirical data on the effects of a simple nurse-led range-of-motion exercise programme in improving function for these people . METHOD A r and omized controlled trial was conducted in 1999 with 59 bedridden older stroke survivors in residential care . Participants were r and omly assigned to usual care or one of two intervention groups . The 4-week , twice-per-day , 6 days-per-week range-of-motion exercise protocol s were similar in both intervention groups , and consisted of full range-of-motion exercises of the upper and lower extremities . To test the effect of different degrees of staff involvement , in intervention group I , a Registered Nurse was present to supervise participants performing the exercises , while intervention group II involved a Registered Nurse physically assisting participants to achieve maximum range-of-motion within or beyond their present abilities . RESULTS Both intervention groups had statistically significant improvement in joint angles , activity function , perception of pain and depressive symptoms compared with the usual care group ( P < 0.05 ) . Post hoc comparison revealed that the joint angles in intervention group II were statistically significantly wider than in both the other groups ( P < 0.01 ) . CONCLUSIONS A simple nurse-led range-of-motion exercise programme can generate positive effects in enhancing physical and psychological function of bedridden older people with stroke . Further studies are needed to investigate the long-term effects of the programme in maximizing function , reducing care utilization and enhancing quality of life for this population Aim . This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practice s for stroke rehabilitation . Background . The experience of stroke can have a negative impact on both psychological and physical health and on quality of life . Yoga and relevant practice s are promising therapies that have been used with patients with a variety of conditions . In order to draw conclusions on effectiveness for stroke patients , the evidence requires systematic assessment . Methods . A comprehensive search of major biomedical and complementary medicine data bases was conducted . Relevant research was categorized by study type and appraised according to study design . Results . Five r and omized controlled clinical trials and four single case studies were found . Additionally , one qualitative research study was identified . Studies reported positive results , including improvements in cognition , mood , and balance and reductions in stress . Modifications to different yoga practice s make comparison between studies difficult , and a lack of controlled studies precludes any firm conclusions on efficacy . Conclusion . Yoga and mindfulness could be clinical ly valuable self-administered intervention options for stroke rehabilitation . Further research is needed to evaluate these specific practice s and their suitability in stroke rehabilitation
RESULTS Studies of task-related training showed benefits for functional outcome compared with traditional therapies .
Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life .
CONCLUSION Generally , task-oriented rehabilitation proved to be more effective .
Many interventions are feasible for nurses and can be performed in a ward or at home .
AIM This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice .
BACKGROUND Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world .
The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes .
Nurses are therefore exploring other forms of rehabilitation intervention , including task-oriented rehabilitation .
Despite the growing number of studies showing evidence on task-oriented interventions , recommendations for daily nursing practice are lacking .