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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Yu S, Guo X, Li G, Yang H, Sun G, Zheng L, Sun Y. Gender discrepancy of incidence and risk factors of metabolic syndrome among rural Chinese from 2012-2013 to 2015-2017. Diabetol Metab Syndr 2020; 12:48. [PMID: 32514317 PMCID: PMC7268361 DOI: 10.1186/s13098-020-00542-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/15/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We reported a relatively high rate of MetS in rural Northeast residents in 2012-2013. Many strategies like health knowledge propagation and lifestyle modification have been taken to help rural residents decrease metabolic disorders. Hence, we held the present follow-up study in order to figure the changes of metabolic parameters and the possible reasons together with the evaluation of MetS incidence and associated risk factors. METHODS A population-based sample of 8147 rural Northeast Chinese residents aged ≥ 35 years at baseline were followed up from 2012-2013 to 2015-2017. MetS was diagnosed following the unify criteria in 2009 using the Asian specific criteria. RESULTS Among residents with MetS at baseline, value of systolic, diastolic blood pressure, total cholesterol, HDL-C decreased while waist circumference increased in both genders in follow-up. Discrepancy of trend in body mass index, LDL-C and estimated GFR existed between male and female. Besides, triglyceride increased, and fast glucose decreased in female only. The alterations of dietary pattern might be accountable for those changes. Among residents without MetS at baseline, the cumulative incidence of newly diagnosed MetS was 24.0% (25.8% for male; 22.3% for female). As the number of metabolic disorders increased at baseline, the incidence of MetS also increased (zero metabolic disorder: 8.3%; one metabolic disorder: 17.1%; two metabolic disorders: 35.4%). In male residents, bad living habits like smoking and drinking were associated with increasing risk of Mets while in female, higher risk of MetS was more likely relevant to dietary pattern. CONCLUSION Metabolic parameters changes during the past years and seem to be associated with alteration of diet pattern. Incidence of MetS still high among rural Northeast Chinese. The risk factors of higher incidence of MetS show gender discrepancy which make the prophylaxis and control of MetS more effective and directive in rural residents.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, 110001 China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, 110001 China
| | - GuangXiao Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, First Hospital of China Medical University, Shenyang, 110001 China
| | - Hongmei Yang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, 110001 China
| | - Guozhe Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, 110001 China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004 China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, 110001 China
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Smyth B, Haber A, Trongtrakul K, Hawley C, Perkovic V, Woodward M, Jardine M. Representativeness of Randomized Clinical Trial Cohorts in End-stage Kidney Disease: A Meta-analysis. JAMA Intern Med 2019; 179:1316-1324. [PMID: 31282924 PMCID: PMC6618769 DOI: 10.1001/jamainternmed.2019.1501] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Systematic differences between patients included in randomized clinical trials (RCTs) and the general patient population may influence the generalizability of RCT findings. Comprehensive national registries of patients with end-stage kidney disease who are undergoing dialysis provide a unique opportunity to compare trial and real-world patient cohorts. OBJECTIVE To determine if participants in large, multicenter dialysis trials were similar to the general population undergoing dialysis in terms of age, comorbidities, and mortality rate. DATA SOURCES MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were systematically searched on January 6, 2017, for studies published from January 1, 2007, to December 31, 2016. Data sources were published manuscripts, supplementary material, and trial registration information. Data on the general population undergoing dialysis were derived from the US Renal Data System (USRDS). Data were analyzed from March 17 to July 22, 2018. STUDY SELECTION Randomized clinical trials enrolling only participants undergoing dialysis for end-stage kidney disease with 100 or more adult participants from 2 or more sites. DATA EXTRACTION AND SYNTHESIS Abstract screening and data extraction were performed independently by 2 researchers. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was difference in mean age between the RCT and USRDS populations. Secondary outcomes included differences in mortality rate and comorbidities. RESULTS The search identified 186 RCTs, enrolling 79 104 participants. Compared with the 2011 USRDS population, RCT participants were younger (mean age, 58.9 years; 95% CI, 58.3-59.5 years vs 61.2 years; P < .001), more likely to be male (58.9%; 95% CI, 57.6%-60.1% vs 55.7%; P < .001), and have coronary artery disease (26.9%; 95% CI, 22.2%-31.7% vs 17.7%; P < .001) and less likely to have diabetes (40.2%; 95% CI, 36.7%-43.6% vs 44.2%; P = .03) or heart failure (19.6%; 95% CI, 15.1%-24.0% vs 29.8%; P < .001). The mortality rate per 100 patient-years during trial participation was less than half that of the USRDS population (8.9; 95% CI, 7.8-10.0 vs 18.6; P < .001). The differences in age, mortality, and coronary artery disease remained when studies recruiting only from the United States were considered. Diabetes was more common in RCT participants from the United States than in the registry population. CONCLUSIONS AND RELEVANCE Participants in large, multicenter RCTs of patients with end-stage kidney disease undergoing dialysis are younger, have a different pattern of comorbidities, and have a lower mortality rate than the general population of patients undergoing dialysis. This finding has implications for the generalization of trial results to the broader patient population and for future trial design.
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Affiliation(s)
- Brendan Smyth
- The George Institute for Global Health and University of New South Wales, Sydney, Australia.,Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Anna Haber
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Konlawij Trongtrakul
- Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Vlado Perkovic
- The George Institute for Global Health and University of New South Wales, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health and University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Meg Jardine
- The George Institute for Global Health and University of New South Wales, Sydney, Australia.,Renal Unit, Concord Repatriation General Hospital, Sydney, Australia
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Leira EC, Viscoli CM, Polgreen LA, Gorman M, Kernan WN. Distance from Home to Research Center: A Barrier to In-Person Visits but Not Treatment Adherence in a Stroke Trial. Neuroepidemiology 2018; 50:137-143. [PMID: 29587267 DOI: 10.1159/000486315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Clinical trials often seek to enroll patients from both urban and rural areas to safeguard the generalizability of results. However, maintaining contact with patients who live away from a recruitment site, including rural areas, can be challenging. In this research we examine the effect of distance between patient and study centers on treatment adherence and retention. METHODS Secondary analysis of 2,466 participants in the Insulin Resistance Intervention after Stroke trial who were enrolled from research sites in the United States. Driving distance between the zipcodes of patient's reported place of residence and the study center was calculated. Outcome measures were loss to follow-up, completion of annual in-person visits, adherence to preventive therapy, and adherence to study drug in the first 3 years of participation. Logistic regression models were used to adjust for confounders. RESULTS Distance from residence to research center was not associated with loss to follow-up, adherence to study drug, or adherence to preventive therapy (p > 0.05 for each). However, patients who lived farther from the research center (>120 miles), compared to patients who lived closer (<60 miles), were less likely to complete the second annual in-person visit (62 vs. 81%; adjusted OR 0.48; 95% CI 0.31-0.75) and third visit (53 vs. 75%; adjusted OR 0.44; 95% CI 0.29-0.67). CONCLUSIONS Distance between patient and study center was an independent predictor of missed in-person visits but not with adherence to study treatment or preventive care.
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Affiliation(s)
- Enrique C Leira
- Colleges of Medicine, Iowa City, Iowa, USA.,Public Health, Iowa City, Iowa, USA
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Purvis T, Hill K, Kilkenny M, Andrew N, Cadilhac D. Improved in-hospital outcomes and care for patients in stroke research: An observational study. Neurology 2016; 87:206-13. [PMID: 27306625 DOI: 10.1212/wnl.0000000000002834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe stroke research activity in Australian acute public hospitals and determine if participation in research provides better quality of care and outcomes for patients with stroke. METHODS This was an observational study using data from hospitals that participated in the National Stroke Foundation (Australia) acute services audit program in 2009, 2011, and 2013. This included self-reported organizational features and a retrospective clinical audit of up to 40 medical records of patients with stroke from each hospital. Multilevel random effects logistic regression with level defined as hospital and adjustments for hospital, demographic, clinical, and stroke severity factors were undertaken. RESULTS A total of 240 hospitals submitted organizational data. Hospitals with a stroke unit (70% vs 7%, p < 0.001) and >200 stroke admissions per year (80% vs 17%, p < 0.001) reported greater involvement in research studies. Of 9,537 patients audited at 129 hospitals, 469 (5%) consented to participate in research. Patients who participated in research compared to nonparticipants were likely to be younger (median age 73 years; 25th percentile [Q1]: 63, 75th percentile [Q3]: 80, vs median age 76 years Q1: 64, Q3: 83; p < 0.001) and receive important clinical practices such as a swallow screen/assessment prior to oral intake (62% vs 56%; p < 0.01). An independent association with reduced in-hospital mortality (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.76) was evident if participating in research regardless of access to stroke unit care. CONCLUSIONS Patients who participate in stroke research receive better in-hospital care and are more likely to survive compared to nonresearch participants. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with stroke who participate in research receive better quality of care and have reduced in-hospital mortality.
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Affiliation(s)
- Tara Purvis
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia.
| | - Kelvin Hill
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Monique Kilkenny
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Nadine Andrew
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
| | - Dominique Cadilhac
- From Stroke and Ageing Research (T.P., M.K., N.A., D.C.), School of Clinical Sciences at Monash Health, Monash University; Stroke Division (T.P., M.K., D.C.), Florey Institute of Neuroscience and Mental Health; and National Stroke Foundation (K.H.), Melbourne, Australia
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Patterson KK, Gallant N, Ormiston T, Patience C, Whitechurch M, Mansfield A, Brown J. Development of a Questionnaire to Investigate Study Design Factors Influencing Participation in Gait Rehabilitation Research by People with Stroke: A Brief Report. Physiother Can 2016; 67:240-4. [PMID: 26839450 DOI: 10.3138/ptc.2014-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The main objective of this study was to evaluate the feasibility of a newly developed questionnaire to assess the influence of study design on participation in gait rehabilitation research in a pilot test with individuals with stroke. A secondary objective was to investigate the relationship between participation in gait rehabilitation research and social and clinical factors of interest after stroke. METHODS A questionnaire was developed with expert opinion and guidance from related previous research. The questionnaire was pilot tested in a group of 21 people with stroke, and social and clinical factors (including gait function) were collected. Gait function was assessed using a pressure-sensitive mat; social and clinical characteristics were extracted from patient charts. Correlations were performed to investigate relationships between questionnaire responses and gait function, motor impairment, and chronicity; t-tests were used to examine response differences between people with a caregiver at home and those without. RESULTS A total of 21 people with stroke completed the questionnaire without difficulty; mean completion time was 7.2 (SD 3.5) minutes, with a range of responses across participants. Borderline significant associations were found between gait function and the number of studies in which a person would participate and between stroke chronicity and the location of studies in which a person would participate. CONCLUSIONS A questionnaire to investigate the influence of study design factors on participation in rehabilitation research is feasible for administration in the post-stroke population and has potential to inform the design of future studies.
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Affiliation(s)
- Kara K Patterson
- Department of Physical Therapy, Faculty of Medicine, University of Toronto; Toronto Rehabilitation Institute, University Health Network, Toronto; School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont
| | - Nicole Gallant
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont
| | - Tracey Ormiston
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont
| | - Chad Patience
- Department of Physical Therapy, Faculty of Medicine, University of Toronto
| | - Mandy Whitechurch
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto
| | - Janet Brown
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont
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Prevalence of Dementia and Cognitive Complaints in the Context of High Cognitive Reserve: A Population-Based Study. PLoS One 2015; 10:e0138818. [PMID: 26390288 PMCID: PMC4577122 DOI: 10.1371/journal.pone.0138818] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/03/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study aimed to assess the prevalence of dementia and cognitive complaints in a cross-sectional sample of Luxembourg seniors, and to discuss the results in the societal context of high cognitive reserve resulting from multilingualism. METHODS A population sample of 1,377 people representative of Luxembourg residents aged over 64 years was initially identified via the national social insurance register. There were three different levels of contribution: full participation in the study, partial participation, and non-participation. We examined the profiles of these three different samples so that we could infer the prevalence estimates in the Luxembourgish senior population as a whole using the prevalence estimates obtained in this study. RESULTS After careful attention to the potential bias and of the possibility of underestimation, we considered the obtained prevalence estimates of 3.8% for dementia (with corresponding 95% confidence limits (CL) of 2.8% and 4.8%) and 26.1% for cognitive complaints (CL = [17.8-34.3]) as trustworthy. CONCLUSION Based on these findings, we postulate that high cognitive reserve may result in surprisingly low prevalence estimates of cognitive complaints and dementia in adults over the age of 64 years, which thereby corroborates the longer disability-free life expectancy observed in the Luxembourg population. To the best of our knowledge, this study is the first to report such Luxembourgish public health data.
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Bernhardt J, Raffelt A, Churilov L, Lindley RI, Speare S, Ancliffe J, Katijjahbe MA, Hameed S, Lennon S, McRae A, Tan D, Quiney J, Williamson HC, Collier J, Dewey HM, Donnan GA, Langhorne P, Thrift AG. Exploring threats to generalisability in a large international rehabilitation trial (AVERT). BMJ Open 2015; 5:e008378. [PMID: 26283667 PMCID: PMC4550737 DOI: 10.1136/bmjopen-2015-008378] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to examine potential threats to generalisability of the results of a multicentre randomised controlled trial using data from A Very Early Rehabilitation Trial (AVERT). DESIGN AVERT is a prospective, parallel group, assessor-blinded randomised clinical trial. This paper presents data assessing the generalisability of AVERT. SETTING Acute stroke units at 44 hospitals in 8 countries. PARTICIPANTS The first 20,000 patients screened for AVERT, of whom 1158 were recruited and randomised. MODEL We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalisability. As well as comparing the recruited patients with the target population, we also performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment. RESULTS The demographics and stroke characteristics of the included patients in the trial were broadly similar to population-based norms, with the exception that AVERT had a greater proportion of men. The most common reason for non-recruitment was late arrival to hospital (ie, >24 h). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95% CI 9.27 to 11.65). CONCLUSIONS A model which explores person, place, and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12606000185561) and Clinicaltrials.gov (NCT01846247).
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Affiliation(s)
- Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Audrey Raffelt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Richard I Lindley
- Westmead Clinical School and The George Institute for Global Health, Westmead Hospital C24, Sydney, New South Wales, Australia
| | - Sally Speare
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | | | - Md Ali Katijjahbe
- Physiotherapy Unit, Medical Rehabilitation Services Department, UKM Medical Centre, Kuala Lumpur, Malaysia
| | | | - Sheila Lennon
- School of Health Sciences, Flinders University, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Anna McRae
- Community and Long Term Conditions Directorate, Auckland District Health Board, Auckland City Hospital, Auckland, New Zealand
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Jan Quiney
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Hannah C Williamson
- Department of Physiotherapy, Austin Health, Austin Hospital, Heidelberg, Victoria, Australia
| | - Janice Collier
- Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Helen M Dewey
- Florey Institute of Neuroscience and Mental Health, and Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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