Courtney Pollock

Purpose: To co-create an exposure-based approach to post-stroke rehabilitation with treating physiotherapists. Additionally, we aimed to explore patient perspectives surrounding the implementation of the novel approach. Methods: Four physiotherapists (PTs) (practicing clinicians) working with stroke patients in a rehabilitation setting (two PTs working in in-patient units, one physiotherapist working in the intensive day rehabilitation program, and one PT working in the out-patient program), alongside clinical researchers in physiotherapy and psychology, were members of the co-creation team. All physiotherapists completed exposure-based cognitive behavioural techniques (EB-CBT) training and provided feedback regarding training components and implementation of the new approach through a series of co-creator meetings, as well as one on one discussions with the lead (clinical physiotherapist/researcher). The two out-patient PTs recruited a total of 6 patients undergoing stroke rehabilitation to participate in the study, and the two in-patient PTs remained as co-creators in this project. At discharge (from rehabilitation) and one-month post discharge, patients participated in semi-structured interviews and responded to Likert statements. Inductive content and thematic analyses were carried out on physiotherapist and patient semi-structured interviews, respectively, to assess perspectives on the integration and implementation of an exposure-based approach to the rehabilitation of walking function post-stroke. Intervention components consisted of education; goal setting; Exposure Hierarchies; homework; and graded exposure informed by the Rate of Perceived Stability (RPS) Scale. Results: We successfully co-created EB-CBT components to the physiotherapy rehabilitation of walking post-stroke in an out-patient setting. In addition, we explored patient perspectives surrounding the integrated approach and found that patients reported positive perspectives surrounding the integrated approach and reported that their PTs were able to help motivate and further challenge/progress patients and one-month after being discharged from their physiotherapy rehabilitation, walking and balance function was improving and patients were able to return to meaningful activities and transition to day-to-day life. Conclusion: Patients perceived the integrated EB-CBT approach to be beneficial to enhancing rehabilitation outcomes and facilitating self-progression. Future research is necessary in order to further modify/refine intervention parameters and to assess potential feasibility, as well as efficacy.

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This study explores reliability, validity, and feasibility of conducting clinical assessments of balance and walking ability for people post-stroke via videoconferencing.Twenty-eight people with chronic stroke who completed the in-person Six-minute Walk Test and Community Balance and Mobility Scale were recruited. Five clinical measures were modified as virtual assessments: Five-times Sit-to-Stand (5-times STS), Functional Reach Test (FRT), tandem stance (TS), Timed Up and Go test (TUG), and Thirty-seconds Sit-to-Stand (30-sec STS). Sessions were conducted over video-conferencing platform. Test-retest reliability was examined by Intra-class correlations (ICC) and the standard error of measurement (SEM) to evaluate the reliability and agreement between two testing days. The magnitude of associations among in-person and virtual assessments were used to examine convergent validity using Spearman rank correlation. Feasibility was evaluated by task completion rate, adverse events, and experienced technical difficulties.Twenty-one participants (52% female) participated both in-person and virtual assessments. There were no adverse events. Challenges of Internet connection or navigating the platform were experienced by 38% participants. The TUG, 30-sec STS, 5-times STS had good-to-excellent test-retest reliability (ICCs=0.97, 0.90, and 0.77 respectively). FRT and TS had moderate test-retest reliability (ICCs=0.54 and 0.50). The TUG, 5-times STS, and 30-sec STS had moderate-to-excellent relationships with in-person assessment (ρ= -0.55 to -0.85, P0.001). FRT and TS showed no significant relationships with in-person assessments.The good-to-excellent test-retest reliability of remotely conducting 5-times STS, TUG, and 30-sec STS for people with stroke, together with strong convergent validity of the measures compared to in-person 6MWT is promising. Measurement of walking and balance function in ambulatory people post-stroke over video-conferencing is feasible; however, technical challenges were experienced.

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