An Intensive Upper Extremity Program Coupled With A Wearable Device for Poststroke Rehabilitation: A Qualitative Study of the Perspectives of People With Stroke.

Objective: The Virtual Arm Boot Camp program (V-ABC) was one of the first virtually-delivered upper extremity exercise programs coupled with a novel wearable device that provided reach-to-grasp feedback for individuals with stroke. Understanding the experience of participants is critical to improve the implementation of rehabilitation interventions that embed biosensor technology within rehabilitation.

Design: A qualitative study embedded within a multi-center randomized controlled trial conducted on the CanStroke Recovery Trials Platform was used to investigate the experiences of participants poststroke with the V-ABC program.

A Randomized Control Trial of a Virtually Delivered Program for Increasing Upper Limb Activity After Stroke.

BackgroundUpper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke.MethodsThis was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022.

Societal implications of the Dobbs v Jackson Women's Health Organization decision.

On June 24, 2022, the US Supreme Court's decision in Dobbs v Jackson Women's Health Organization marked the removal of the constitutional right to abortion in the USA, introducing a complex ethical and legal landscape for patients and providers. This shift has had immediate health and equity repercussions, but it is also crucial to examine the broader impacts on states, health-care systems, and society as a whole. Restrictions on abortion access extend beyond immediate reproductive care concerns, necessitating a comprehensive understanding of the ruling's consequences across micro and macro levels.

Health-care workforce implications of the Dobbs v Jackson Women's Health Organization decision.

The Dobbs v Jackson Women's Health Organization Supreme Court decision, which revoked the constitutional right to abortion in the USA, has impacted the national medical workforce. Impacts vary across states, but providers in states with restrictive abortion laws now must contend with evolving legal and ethical challenges that have the potential to affect workforce safety, mental health, education, and training opportunities, in addition to having serious impacts on patient health and far-reaching societal consequences. Moreover, Dobbs has consequences on almost every facet of the medical workforce, including on physicians, nurses, pharmacists, and others who work within the health-care system.

Scaling Family Voices and Engagement to Measure and Improve Systems Performance and Whole Child Health: Progress and Lessons from the Child and Adolescent Health Measurement Initiative.

Background: The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes.

Methods: Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies.

The relationship between Rating of Everyday Arm-use in the Community and Home (REACH) scale affected arm-use assessment, activity and participation after stroke.

Background And Objectives: While arm function has been traditionally used as a primary goal for upper extremity rehabilitation post-stroke, we propose a simple measure of arm use, which may translate into better activities and participation. The aim was to determine the relationship between arm use and measures of activity and participation.

Methods: This was a cross-sectional study with evaluative components involving community-dwelling individuals with chronic stroke.

A Pilot Study for Remote Evaluation of Upper Extremity Motor Function After Stroke: The Arm Capacity and Movement Test (ArmCAM).

Importance: A simple measure that can be administered remotely by means of videoconferencing is needed for telerehabilitation.

Objective: To develop a valid and reliable measure, the Arm Capacity and Movement Test (ArmCAM), that can be administered remotely by means of videoconferencing to evaluate upper extremity motor function poststroke.

Design: Cross-sectional.

Responsiveness and trajectory of changes in the rating of everyday arm-use in the community and home (REACH) scale over the first-year post-stroke.

Objective: To examine the trajectory of the Rating of Everyday Arm-use in the Community and Home (REACH) scores over the first-year post-stroke, determine if REACH scores are modified by baseline impairment level and explore the responsiveness of the REACH scale through hypothesis testing.

Design: Consecutive sample longitudinal study.

Setting: Participants were recruited from an acute stroke unit and followed up at three, six, and 12 months post-stroke.

Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device.

Background: Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19.

Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home.

Objective: The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization.

Methods: In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively.

Real-World Functional Grasping Activity in Individuals With Stroke and Healthy Controls Using a Novel Wearable Wrist Sensor.

. While wrist-worn accelerometers have been used to measure upper extremity use in the past, they primarily measure arm motion and lack the ability to capture functional hand opening and grasping activities which are essential for activities of daily living. .

Clinicians' perceptions of a potential wearable device for capturing upper limb activity post-stroke: a qualitative focus group study.

Background: There is growing interest in the use of wearable devices that track upper limb activity after stroke to help determine and motivate the optimal dose of upper limb practice. The purpose of this study was to explore clinicians' perceptions of a prospective wearable device that captures upper limb activity to assist in the design of devices for use in rehabilitation practice.

Methods: Four focus groups with 18 clinicians (occupational and physical therapists with stroke practice experience from a hospital or private practice setting) were conducted.

Challenges of Estimating Accurate Prevalence of Arm Weakness Early After Stroke.

. Recent studies have reported lower statistics of upper limb (UL) weakness (48-57%) compared to widely cited values collected over 2 decades ago (70-80%). .

Governance and funding best practices for embedded research programs.

Health systems are increasingly embracing embedded research (ER) program models that allow researchers to integrate into operational and clinical practices. Successful ER programs rely on unique funding streams and bidirectional relationships with health system operational and executive leaders. This commentary summarizes current practices and recommendations for funding and governing ER programs.

Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships.

The benefits of supporting experiential learning for improved health and societal outcomes have been recognized in many countries. A number of funding organizations have developed competitive funding opportunities to support experiential learning in health system organizations outside of the traditional university setting. AcademyHealth in the US is an early innovator that pioneered the Delivery System Science Fellowship (DSSF) and inspired Canada's creation of the Health System Impact (HSI) Fellowship program.

Preliminary Examination of the Ability of a New Wearable Device to Capture Functional Hand Activity After Stroke.

Background and Purpose- A reliable measure of movement repetitions is required to assist in determining the optimal dose for maximizing upper limb recovery after stroke. This study investigated the ability of a new wearable device to capture reach-to-grasp repetitions in individuals with stroke. Methods- Eight individuals with stroke wore an instrumented wrist bracelet while completing 12 upper limb activities.

Healthcare utilization after stroke in Canada- a population based study.

Background: More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke.

Methods: This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey.

Show Me the Money! Trends in Funding for Health Services Research.

This paper presents longitudinal data representing federal funding for health services research and discusses the observed trends in the larger context of overall funding for research and development in the United States. By putting into context public and private funding trends, the authors examine how these trends effect the supply and demand of the health services research workforce.

Understanding the Current Health Services Research Workforce and Maximizing its Future.

In 2016, AcademyHealth continued its longstanding efforts to understand the health services research (HSR) workforce, to inform its changing needs through the commissioning of several papers and an invitational conference. This paper serves to summarize the commissioned studies that appear in the current issue of this journal.