The British Society of Physical & Rehabilitation Medicine (BSPRM), representing over 450 members, hosted its annual scientific meeting on 29 to 30 September 2025 in Nottingham, UK. The conference, a key event for professionals in the field of physical and rehabilitation medicine, featured a diverse range of sessions, workshops and networking opportunities. All submitted abstracts underwent a rigorous peer-review process before being considered for oral or poster presentations. Following this review, 16 abstracts were selected for oral presentation and publication in this supplement. The selection process was conducted by a panel of experts from the meeting’s abstract adjudication committee and scientific committee.
BSPRM Email: admin@bsprm.org.uk.
Implementing Fragility Fracture Risk Assessment into Routine Clinical Practice After Major Lower Limb Amputation[Awarded Best Oral Presentation]
Carla Swanson-Low1, Shigong Guo1
1.Bristol Centre for Enablement, Bristol, United Kingdom
Background: Fragility-fracture risk assessment (FRAX) has been implemented in clinical practice for patients in the primary amputation clinic at Bristol Centre for Enablement since July 2023.
Aim: Review FRAX screening outcomes for new patients following major lower-limb amputation (MLLA), August 2023-August 2024.
Methods: Retrospective case notes review of all patients with MLLA within the FRAX validity age range (40-90 years).
Results: 171 MLLA cases of which 158 were eligible for FRAX assessment: 140 (88.6%) new amputation, 18 (11.4%) transfers from other regions. Average age 63.2 years; 127 (80.4%) male, 31 (19.6%) female; 30.3% current smokers, 9.1% alcohol use ⩾3 units/day. Outcomes were 89.2% for limb-wearer pathway. 12% died within 1 year of assessment. Of 158 eligible patients, 103 (65.2%) had FRAX screen completed. All cases were deemed to have “secondary risk” for Osteoporosis on FRAX assessment due to “prolonged immobility”, WHO Osteoporosis technical report criterion1. FRAX outcomes were: 51 (49.5%) low risk patients (lifestyle advice), 41(39.8%) intermediate referred for DEXA, 6 (5.8%), high-risk patients referred to GP for consideration of treatment, 5 (4.9%) very high risk referred to Speciality Bone Health services.
Conclusion: FRAX is a simple tool to add into clinical practice for primary prevention of fracture. Work is ongoing to follow up DEXA referral outcomes. Future research will need to assess the prevalence of FRAX variables against incident fractures. Of note our population has high mortality – FRAX usage will be an estimate of lifetime fracture risk for those patients who survive <10 years and may influence treatment decisions.
Reference
1. WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. (WHO technical report series: 921.) Geneva, Switzerland: WHO; 2003.
The Effects of Inspiratory Muscle Training on Diaphragm Thickness, Respiratory Muscle Strength, Balance, and Core Stability in Professional Dancers: A Randomized Controlled Trial
Hakan Aksu1, Suat Morkuzu2,3, Sergen Devran2, Bulent Bayraktar2
1Dynamiclinics, Mugla, Turkey.
2Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
3Department of Family Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Background: Inspiratory Muscle Training (IMT) significantly improves core stabilization muscle activity, pulmonary function, functional balance, and inspiratory muscle strength and endurance
Aim: This study aimed to investigate the effects of progressive resistance IMT on diaphragm muscle thickness, inspiratory muscle strength, balance, and isometric endurance of the hip-back extensor muscles in professional dancers.
Methods: Thirty-six professional dancers were randomly assigned to either a training group or a control group. Both groups performed IMT for 8 weeks, with the training group using progressive resistance and the control group using minimal resistance. Diaphragm thickness, respiratory muscle strength (maximal inspiratory pressure, MIP; and maximal expiratory pressure, MEP), balance (Y-balance Test), hip and back extensor muscle endurance (Biering-Sorenson Test), and the Oswestry Disability Index (ODI) were assessed before and after the intervention.
Results: At baseline, there were no significant differences between groups in demographic characteristics, dance experience, or training regimen (p>0.05). After 8 weeks of IMT, the training group showed significant improvements in MIP, MEP, diaphragm thickness at total lung capacity (TLC), hip-back extensor muscle endurance, balance, and ODI scores (p<0.01). The improvements in the training group were significantly higher than those in the control group for MIP, MEP, TLC, diaphragm thickness ratio (DTR), hip-back extensor muscle endurance, balance, and ODI scores (p<0.01).
Conclusion: Progressive resistance IMT effectively improves respiratory muscle strength, diaphragm thickness, balance, hip-back extensor muscle endurance, and reduces disability scores in professional dancers.
Evaluation of a Balance Intervention Focused on Abdominal Muscle Strengthening Using a Powered Exoskeleton for Individuals Living with Multiple Sclerosis (Rapper IV)
Mohamed Sakel1, Karen Saunders2, Paul A Bassett3, Lu Bai4, David Wilkinson5
1East Kent Hospitals University Foundation NHS Trust, Kent, UK
2University of Kent, Canterbury, UK
3StatsConsultancy Ltd., Buckinghamshire, UK
4Queen’s University Belfast, Belfast, UK
5University of Kent, Canterbury, UK
Background: Multiple Sclerosis (MS) causes balance impairment over time for most people diagnosed, which is a falls risk.
Aims: Evaluate the feasibility and effectiveness of an exercise intervention focused on balance improvement using an exoskeleton device.
Methods: 12 female and 8 male participants with Expanded Status Disability Scores of 4–6 were enrolled. The intervention comprised five exercise sessions of 1–2 hours, performed weekly for five weeks, focused on abdominal muscle strengthening using a Rex exoskeleton. Primary outcomes: completion of transfer into device, sit to stand inside device, one exercise session, and adverse events. Secondary outcomes: balance, risk of falls, spasticity, joint range of movement, mobility, pain, impact of MS and spasticity on Quality of Life (QoL). Participants also identified 2–3 individual goals that they wished to achieve. A follow up appointment re-assessed balance, impact of spasticity on QoL and goal achievement. NCT06429085
Results: Except for one, all participants completed a transfer into the device, sit-to-stand inside the device and performed at least one assisted exercise session safely. One minor and one moderate adverse event were recorded. Improvements were observed between pre- and post-intervention in balance confidence, perceived risk of falls, pain, MS Impact Scale and Impact of Spasticity on QoL (p>0.05). At follow-up, the reduced impact of spasticity on QoL was sustained. Some participants achieved the individual goals set at the start.
Conclusion: This study shows exoskeleton-based balance interventions are potentially effective in improving QoL, pain, balance confidence, and reducing fear of falls in people with MS.
SCI Care Starts Early: A Learning Programme to Optimise Outcomes in the Acute Setting
Ahmad Saif1, Jennifer Burrows1, Alison Gowdy2, Kavita Biggin1, Rosie Powell Davies3, Laura Bochkoltz4
1Oxford Centre for Enablement, Oxford, UK
2Health Innovation Oxford, Oxford, UK
3Oxford University Hospitals NHS Foundation Trust, Oxford, UK
4National Spinal Injuries Centre, Aylesbury, UK
Background: Not all patients with spinal cord injury (SCI) are accepted to specialist centres, with only 53% in our trust receiving such care. Many are managed in acute hospitals, where specialist expertise may be limited. To address this, alongside having an SCI inreach team, we developed a Major Trauma Centre (MTC)-led SCI learning programme accessible to regional staff across disciplines and settings, aiming to proactively upskill teams.
Aims: To improve staff confidence and knowledge in SCI management across the region and evaluate the impact on patient care and outcomes.
Methods: Following a baseline staff learning needs audit (n=76), we implemented monthly 1-hour hybrid SCI education sessions. A retrospective audit of pre-programme SCI patients (n=34) evaluated bowel/bladder management plans, ISNCSCI documentation, discharge destination and length of stay. Programme impact was assessed through pre/post-session confidence surveys (n=20), feedback, and post-programme audit (n=134 patients), including SCIM scores.
Results: Staff confidence significantly improved across all topics (p<0.05), with 88.9% reporting positive impact on practice. Cumulative attendance was 203 across 9 sessions. Staff reported improvements particularly in bladder/bowel management (81.3%). Post-programme audits showed an increase in patients discharged directly home (29.1% vs 22.9%) and a reduction in median length of stay (28 to 22 days). ISNCSCI documentation improved, and SCIM admission vs discharge scores showed a significant median improvement of 17 points (p<0.01), especially in respiratory and sphincter domains.
Conclusion: A consistent, accessible MTC-led SCI learning programme improves staff confidence and may contribute to improved patient outcomes in acute settings.
Acceptability and Efficacy of Ischaemic Preconditioning in Spinal Cord Injury: Preliminary Results from the SCIPC Study
Natasha Mehta1, Rohit Bhide2, Jakob Skarabot1, Christof Leicht1
1Loughborough University, Loughborough, UK
2Northern General Hospital, Sheffield Teaching Hospitals Trust, Sheffield, UK
Background: Ischaemic preconditioning (IPC) has gained popularity as an ergogenic aid in healthy adults. However, limited data exists on use of IPC in individuals with spinal cord injury (SCI). Understanding the intervention acceptability and effect of IPC on upper body strength and endurance is of clinical significance in this population.
Aim: Assess acceptability of IPC in SCI and its effect on triceps brachii maximal voluntary contraction (MVC) and time to exhaustion (TTE).
Methods: Twenty-eight individuals with SCI (with ⩾4/5 triceps strength) were randomised to receive four 5-minute cycles of either IPC (200mmHg) or sham (diastolic blood pressure 30 mmHg) intervention on both arms. Triceps brachii MVCs and rhythmic TTE tests (3s at 60% MVC, 2s recovery) were performed using an isometric testing rig before and after receiving the intervention. Acceptability and pain ratings were recorded immediately after the IPC/sham intervention.
Results: IPC prevented the significant decline in MVC that was seen with the sham intervention (IPC: pre 264±106 N, post 260±87 N, p(time)=0.588; Sham: pre 266±96 N, post 245±79 N, p(time)=0.02). TTE performance did not differ significantly between groups (IPC: pre 3±2 min, post 3±3 min; Sham: pre 3±2 min, post 3±2 min, p⩾0.617). All participants, irrespective of group, were ‘very willing’ or ‘willing’ to receive the intervention again in the future. There were no adverse events due to the IPC intervention.
Conclusion: IPC is an acceptable and well tolerated intervention in people with SCI. Treatment with IPC prevented the decline in the maximal strength of the triceps brachii.
Beyond the Initial Stroke: How Impairments, Activity Limitations, and Participation Restrictions Shape Quality of Life in Survivors
Yee Sien Ng1,2, Ren Hui Ng3, Wan Ying Tan4
1Singapore General Hospital, Singapore
2Duke-NUS Medical School, Singapore
3N/A, Singapore
4SingHealth Community Hospitals, Singapore
Background: Understanding the determinants of Health-Related Quality of Life (HRQoL) can guide stroke rehabilitation towards meaningful, person-centered goals.
Aims: Using the WHO-ICF Framework, we systematically categorized these determinants to evaluate their impact on HRQoL.
Methods: In this cross-sectional study, stroke survivors more than one-year post-event were prospectively recruited at an outpatient rehabilitation clinic. A comprehensive, tailored assessment measured impairments with the NIH Stroke Scale (NIHSS), activity limitations with the Modified Barthel Index (MBI), and participation restrictions with the Community Integration Questionnaire (CIQ) Total Score. The primary HRQoL outcome was the locally-weighted index value from the three-level EuroQol five-dimensional questionnaire (EQ5D-3L-IV).
Results: A total of 191 stroke survivors were included (64% male, 69.5% married), with a mean age of 63.1 years (SD=12.3) and an average of 9.2 years (SD=4.1) post-stroke. The cohort mean EQ5D-3L index value was 0.5 (SD=0.45). All three key measures—NIHSS (r=−0.74), MBI (r=0.75), and CIQ (r=0.71)—showed strong, significant correlations with EQ5D-3L-IV (p<0.01). On multiple regression, each remained a significant independent predictor of HRQoL (p<0.05), with low collinearity (tolerance 0.31–0.54) between these 3 measures. Age and gender were not associated with EQ5D-3L-IV.
Conclusion: Distinctive rehabilitation programs that target any of the key ICF domains—impairment, activity, or participation—are likely to enhance HRQoL in stroke survivors. Rehabilitation approaches that foster community participation, such as return-to-work or strengthening social networks, merit specific emphasis alongside traditional impairment- or activity-focused interventions.
Evaluating a New Multidisciplinary Inpatient Shoulder Pain Ward Round for the Neurological Patients with Upper Limb Unilateral or Bilateral Weakness
Benjamin Beare1, Rachel Higgins2, Jen Parker2, Kelly Orr2, Conor Carville2, Emma McGaffney1, Emilly Lonsway1, Celine Lakra2
1Brunel University, London, UK
2University College London Hospital Trust, London, UK
Background: Shoulder pain is common following upper limb weakness due to neurology and can significantly impact rehabilitation. A level-one neurological rehabilitation unit established a weekly multidisciplinary shoulder ward round, based on our published pathway1, aiming to establish a shoulder diagnosis and treatment plan based on clinical assessments and ultrasound as required.
Aim: Evaluate pain, passive range, and activity level outcomes in neurological patients with unilateral or bilateral shoulder pain.
Methods: Retrospective analysis of shoulder round data, January 2021 and December 2024: Subjective pain from the ‘Shoulder Questionnaire’, passive shoulder ranges from standardised goniometry assessments, and activity level changes from the ‘dressing upper body’ therapist-rated subsection of the Functional Independence Measure and Functional Assessment Measure (FIM&FAM).
Results: 157 patients attended the service within the evaluation period; mean age 51.8 (SD 15.0) years, average stay 102 days. 116 patients received a diagnosis of shoulder pain, 7 had bilateral pain. Predominant neurology was ischaemic stroke (34%) and haemorrhagic stroke (25%). Shoulder diagnoses were: 31% Mixed (⩾2 shoulder diagnoses), 32% Subacromial Pain Syndrome (SAPS), 19% Frozen Shoulder, 9% Hypotonia with subluxation, 6% Other, and 3% Spasticity. By discharge, pain on movement and at night significantly decreased (mean 2.02 and 3.35 points respectively, p<0.001), passive shoulder abduction and external rotation significantly improved (mean 17.3 and 15.1 degrees respectively, p<0.001), and upper body dressing scores (FIM+FAM) improved (mean 1.45 points, p<0.001).
Conclusion: Targeted and individualised approaches to shoulder pain in the neurological patient can be effective at improving impairment and activity level changes.
Reference
1. Lakra C, Higgins R, Beare B, et al. Managing painful shoulder after neurological injury. Practical Neurology 2023;23:229-238.
Daycase Intrathecal Baclofen Trials: Safe, Cost-Effective, and Preferred by Patients
Heesook Lee1, Elizabeth Keenan1, Nicola Betteridge1, Shaneeka Holness1, Emma Bretherton1, Katrina Buchanan1, Gerry Christofi1, William Goodison1, Sara Simeoni1,2, Rachel Farrell1,3, Valerie Stevenson1
1University College Hospitals NHS Foundation Trust, London, UK
2University College London institute of Neurology - Brain Repair and Rehabilitation, London, UK
3University College London Institute of Neurology - Neuroinflammation, London, UK
Background: Performing a lumbar puncture trial of intrathecal baclofen (ITB) prior to pump implantation is essential for appropriate patient selection when considering ITB therapy. Prior to March 2024 patients were electively admitted to an acute hospital bed for spasticity assessment and trial over multiple days.
Aim: To determine whether daycase ITB trials are safe, acceptable to patients, and reduce bed days used.
Methods: Retrospective comparative cohort analysis of all patients admitted for ITB trial over two years at a tertiary hospital pre- and post- introduction of daycase trials in March 2024. Complications, length of stay (LOS) and patient experience outcomes were collected.
Results: Pre-cohort: April 2023-March 2024, 26 patients underwent ITB trials; 1 (4%) was managed as a daycase. Post-cohort: April 2024-March 2025, 29 underwent ITB trials, 12 (41%) were managed as day cases. 3 were admitted as day cases but stayed 1 night (2 due to urinary retention; 1 required an increased dose trial next day). Mean LOS reduced from 3.6 days in 2023-2024 to 1.7 days in 2024-2025 (53% reduction or 47.5 saved bed days/year). Of the 13 day cases, 2 patients developed transient side effects following trial (1 headache; 1 vomited). Feedback from daycase patients was positive. The main theme of feedback collected was ‘avoidance of overnight stay in hospital’.
Conclusion: Daycase ITB trials are safe, and patients found this new pathway satisfactory. Importantly, it reduces hospital bed use, easing clinical and financial pressures on acute services.
Expansion of Undergraduate Medical Education into Rehabilitation Medicine Clinical Blocks – Are Student Expectations Met?
Uday Bhaskar Reddipalli1, Alison Hunter1
1Astley Ainslie Hospital, Edinburgh, United Kingdom
Background: Proposed increased UK medical students(1,2) and clinical placements offer undergraduate curricular opportunities and address World Health Organisation efforts to strengthen and integrate Rehabilitation medicine(RM) into all levels of health care(3).
Aim: Evaluate 4th year University of Edinburgh (UoE) medical student expectations of RM clinical blocks, identify strengths and weaknesses, and establish changes to RM comprehension with exposure.
Methods: Twenty-four medical students completed 5-week clinical rotations. Pre- and post-block, students were asked to identify three priority areas and confidence achieving them, “What RM means to you?”, and “What three things peers should know about RM blocks?”. Thematic analysis was used to identify trends.
Results: Twenty-two students identified 66 priority areas. Pre-block achievement confidence was 87% (>6/10). Six students reported low pre-block confidence (<5/10) in achieving 8 focused priorities. Of those, 5/8 priorities exceeded expectations by 14 points. Thirteen students’ expectations were incompletely met in 24% (16/66) of priorities. Procedural skills (7/16) and OSCE exam preparation (2/16) were common unmet needs; 76% of student expectations were met or exceeded. Comprehension of RM expanded with recognition of psychological and social dimensions, patient-centeredness, and holistic breadth. Peer recommendations highlighted opportunities to improve communication skill, history-taking, exposure to neurological conditions and clinical examination. Staff engagement and multidisciplinary teamworking was notable.
Conclusion: Student confidence regarding expansion into RM was high, and expectations were exceeded for the majority. Focused placement could address unmet procedural skills. Improved undergraduate RM understanding may strengthen rehabilitation in health systems and address profound unmet rehabilitation need worldwide.
References
1. NHS England (2025) NHS Long Term Workforce Plan. https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/
2. The Scottish Government (2017) National health and social care workforce plan: part one. https://www.gov.scot/publications/national-health-social-care-workforce-plan-part-1-framework-improving/
3. World Health Organisation (2017) Rehabilitation 2030 Initiative. https://www.who.int/initiatives/rehabilitation-2030
Electronic Oxford Cognitive Screen from Paper to Digital: Equiveillance Testing in UK, Swedish, and Italian Stroke Survivors and Healthy Adults
Mauro Mancuso1, Benedetta Basagni2, Kyra Hamilton3, Marika Möller4,5, Eleonor Krohn4, Helena Fordell6,7
Consulted by Sam S Webb8 and Nele Demeyere8
1Physical and Rehabilitative Medicine Unit, South-East Tuscany Regional Health Service, Italy
2Clinica di Riabilitazione Toscana (CRT), Montevarchi, Arezzo, Italy
3St George’s Hospital, St George’s Hospitals NHS Foundation Trust, London, UK
4Danderyd University Hospital, Stockholm, Sweden
5Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
6Neurosciences, Umeå University, Umeå, Sweden
7Brain Stimulation AB, Tvistevagen 47, Umeå, Sweden
8Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Background: Digital health technologies can improve efficiency and accuracy, and reduce demand of clinical resources, aligning with the WSO and NHS plan and recommendations. The Oxford Cognitive Screen (OCS) is a first-line cognitive screen for stroke, administered using a pen and paper, it requires a test booklet and response sheets. We developed and validated a CE-marked digital medical device version of the OCS on tablet for international use
Aim: Evaluate the equivalence between the conventional OCS and digital OCS across clinical and normative populations in the UK, Italy, and Sweden.
Methods: 151 subacute in-patient stroke survivors were assessed using the paper OCS and digital OCS on pen-on-tablet, across three countries. Normative data were collected from 280 healthy adults. Performance, normative cut-offs, and incidence of impairment were compared across both versions and analysed using equiveillance t-tests where appropriate to assess consistency.
Results: Scores on both versions were broadly equivalent, with minor deviations attributable to the shift in response modality. Internal consistency: α=0.88 (SD=0.17). The digital OCS was quicker to administer (p<0.05) than the paper OCS, and feasible in sub-acute stroke. The shift did not alter normative data cut-offs nor classification of cognitive impairment across countries.
Conclusion: The digital OCS demonstrates equivalence to the paper-based OCS, supporting its use in clinical and research settings. It saves time and clinical resources and provides continuous access to instructions and quick access to current and previous test performance. The digital OCS provides an easy-to-use, resource-efficient alternative for routine cognitive screening post-stroke.
Patient and Therapist Characteristics Associated with Vocational Rehabilitation Intervention Fidelity in the ROWTATE (Return to Work after Trauma) Randomised Controlled Trial
Jonathan Ritter1, Jain Holmes1, Rebecca Lindley1, Kate Radford1, Wright-Hughes1, Roshan das Nair1, Blerina Kellezi1, Denise Kendrick1
1University of Nottingham, Nottingham, UK
Background: Vocational rehabilitation (VR) supports people to remain in or return to work. The ROWTATE Randomised Control Trial (RCT) tests clinical effectiveness of VR in patients with moderate/severe trauma. The VR is delivered by specially trained occupational therapists (OTs) and clinical psychologists (CPs), provided with monthly mentoring from experienced OTs/CPs. Intervention fidelity (extent to which an intervention adheres to the protocol(1))is key in determining whether an intervention is effective(2). Our RCT of VR for stroke patients (RETAKE) found more mentoring was associated with greater fidelity and fidelity was positively associated with return to work(3).
Aim: Explore relationships between patient/therapist characteristics and fidelity in the ROWTATE trial.
Methods: Intervention fidelity was assessed using one randomly selected patient per therapist. Fidelity checklists were completed from intervention records. Patient/therapist characteristics were collected by self-completed questionnaires. Therapist competence was assessed using a Team Objective Structured Clinical Examination. Mentoring attendance was recorded. Regression analysis explored associations between patient/therapist characteristics and fidelity.
Results: Fidelity checklists were completed for 49 therapist-patient dyads. Fidelity scores were high; OTs=91%, CPs=94%. Greater therapist competence was associated with higher fidelity (β=1.73 (0.48, 2.98); p=0.008) as was increasing patient age (β=0.25 (0.06, 0.45); p=0.01). The number of mentoring sessions was of borderline significance on univariable analysis (β=0.81, 95%CI -0.06, 1.68; p=0.07) but wasn’t significant on multivariable analysis.
Conclusion: Greater therapist competence and increasing patient age are associated with greater fidelity. Further studies are required to improve understanding of factors associated with fidelity of VR interventions.
References
1. Carol T. Mowbray MCH, Gregory B. Teague, Deborah Bybee. Fidelity Criteria: Development, Measurement, and Validation. American Journal of Evaluation. 2003;24(3):315-40.
2. Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity in public health clinical trials. Journal of Public Health Dentistry. 2011;71(s1):S52-S63.
3. Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. Int J Environ Res Public Health. 2023;20(6).
Stakeholder Views on Facilitators and Barriers to Implementation of a Vocational Rehabilitation Intervention: An Interview Study
Claire Mann1, Kathryn Radford1, Denise Kendrick1, Stephen Timmons1, Rebecca Lindley1
1University of Nottingham, Nottingham, UK
Background: We developed a vocational rehabilitation intervention (ROWTATE) for seriously injured patients, delivered by occupational therapists (OTs) and clinical psychologists (CPs), currently being tested in a UK trial1.
Aim: To explore stakeholder perspectives to identify key facilitators and barriers to implementing ROWTATE.
Methods: This qualitative study conducted semi-structured interviews with stakeholders, including intervention deliverers (therapists, mentors), recipients (patients, employers, carers), and externals (commissioners, health professionals). Key stakeholders (therapists, mentors, patients) were interviewed at two time points—early and later in their engagement with ROWTATE—to capture evolving perspectives on implementation. Others were interviewed once. Data were coded using NVivo 13, with iterative discussion with a team of researchers to enhance rigour. Analysis was guided by the Consolidated Framework for Implementation Research (CFIR)2, identifying cross-cutting barriers and facilitators spanning all implementation domains.
Results: A total of 76 interviews were conducted. The key cross-cutting themes that emerged as facilitators and/or barriers to implementation of the ROWTATE intervention included: the variety of patient needs and outcomes, therapist mentoring, joint working, remote working, and engagement with employers. Data illustrates how stakeholders perceived these themes as influencing implementation3.
Conclusion: Understanding stakeholder perspectives highlighted critical factors influencing the implementation of the ROWTATE intervention. Addressing identified barriers—such as variability in patient needs and challenges with remote delivery—while strengthening facilitators like therapist mentoring and collaborative working, will be essential for successful adoption and scalability of the intervention in real-world settings.
References
1. Kettlewell, J., Radford, K., Kendrick, D., et al. (2022). Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway. BMJ Open, 12(3), e060294. DOI: 10.1136/bmjopen-2021-060294.
2. Damschroder, L. J., Reardon, C. M., Widerquist, M. A. O., et al. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, 75. DOI: 10.1186/s13012-022-01245-0.
3. Boulton, R., Semkina, A., Jones, F., & Sevdalis, N. (2025). Expanding the pragmatic lens in implementation science: why stakeholder perspectives matter. Implementation Science Communications, 6, 48. DOI: 10.1186/s43058-025-00730-z.
Use of Parenteral Nutrition for Patients with Spinal Cord Injury in the South-East of England – A Quality Improvement Initiative to Reduce Adverse Effects Associated with Parenteral Nutrition
Nilshana Jayamaha1, Shyam Swarna1, Samford Wong1, Shashi Hirani2, Alastair Forbes3, Vicky Blackwell1, Natasha Hamilton1, Ajmal Daulatzai1, Clare Hillier1, Marie Woodley1
1National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
2City St George’s University of London, London, UK
3Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
Background: After spinal cord injury (SCI), patients with SCI (PWSCI) will require additional protein for pressure ulcer healing and/or pre- and post- operatively1 . Depending on the site of pressure ulcers, increased provision of enteral nutrition could mean an increase in faecal output, leading to increased risk of faecal contamination. Enteral tube (ET) feeding is sometimes insufficient or unavailable2.
Aim: Report the use of PN in a UK national spinal injury centre covering patients in the South-East of England, and the occurrence of metabolic and catheter related blood stream infections (CRBSI).
Methods: A retrospective study was conducted during January 2018 to December 2024. We defined CRBSI as the presence of bacteraemia from a peripheral vein and from the intravenous catheter3.
Results: 2,002 adults with SCI were admitted during the study period. 38 of these patients received PN support. PN was used for a median of 35 days. PN use increased significantly over time (2019: n=3, 2020: n=4, 2021: n=2, 2022: n=12, 2023: n=8, 2024: n=9). Metabolic complications occurred in 95.2% of PWSCI on PN. The top 5 complications were hyponatraemia (63.9%), abnormal liver functions tests (61.1%), hyperglycaemia (61.1%); hypomagnesaemia (58.3%), and hypophosphatemia (44.4%). There were 9 confirmed CRBSIs.
Conclusion: This study suggests an increase in the use of PN in PWSCI over time. It also strengthens the case for review of Nutrition Team provision in SCI centres. Routine monitoring, management, and treatment of metabolic complications in PWSCI on PN should be considered2.
References
1. Consortium for Spinal Cord Medicine (2014) Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice guideline for Health-Care Professionals. 2nd Edition. Paralyzed Veterans of America, Washington DC.
2. National Institute for Health and Clinical Excellence (NICE): Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: NICE 2006. Available from https://www.nice.org.uk/guidance/cg32 (accessed 24 January 2023).
3. Lai S, Chadwick P, Nightingale J, BIFA Committee. Recommendations for catheter related blood stream infections (CRBSI) diagnosis. British Association of Parenteral and Enteral Nutrition / Intestinal Failure Alliance 2018. https://www.bapen.org.uk/pdfs/bifa/recommendations-for-crbsi-diagnosis.pdf (accessed 1st February 2023)
Provision of Inpatient Intensive Neurorehabilitation and Early Supported Discharge for Children and Young People – Learning Ten Years On
Denise Crozier1, Rachel Keetley1, Emily Bennett1, Melanie Dean1, Claire Pointer-Gleadhill1, Jane Williams1
1Nottingham Children’s Hospital, Nottingham, UK
Background: The BRILL Children’s Neurorehabilitation service launched in 2014 after receiving pump-priming funding from NHS England, with the aim of reducing length of stay (LOS) and improving quality of inpatient intensive neurorehabilitation and early supported discharge, for children and young people (CYP) with acquired brain and spinal injuries admitted to a regional specialist centre. The service received permanent funding in 2016 having demonstrated a reduced LOS, improved quality of provision and patient and family satisfaction.
Aim: To analyse routinely collected data and identify trends in referrals, length of stay, and service provision to inform service delivery and development.
Methods: A Plan Do Study Act cycle was used. Routinely collected data: referral information, demographic patient information, length of stay, discharge destination and follow up data was analysed descriptively.
Results: Referrals increased from 41 to 135-143 per year since 2014. Median LOS maintained around 10 days since the service was launched. Increase in inpatient referrals and complexity resulted in demand outstripping team capacity, a reduction in provision of the early supported discharge element of the service and increased demand for longer-term follow-up. Outpatient clinics waitlist was at 67 weeks; therefore, a multi-disciplinary clinic was established to double capacity, resulting in the wait reducing to 41 weeks.
Conclusion: Increased referrals, complexity, and demand on service has been observed. The need for long-term follow-up has been identified with CYP presenting with lifelong needs which requires transition to appropriate adult services.
References
1. Keetley R, Radford K, Manning JC. A scoping review of the needs of children and young people with acquired brain injuries and their families. Brain Inj 2019;33:1117–28.
2. Keetley R, Bennett E, Williams J, et al. Outcomes for children with acquired brain injury (ABI) admitted to acute neurorehabilitation. Developmental Medicine & Child Neurology. 2021;63:824-830. doi:DOI:10.1111/dmcn.14846
3. Wales L, Davis K, Kelly G, Lynott H. Long term participation outcomes for severe acquired brain injury in childhood - an expanded scoping review. Developmental Neurorehabilitation. 2021;24(6):379-387. doi:10.1080/175184423.2021.1886191
Functional Outcomes and Rehabilitation Processes in National Datasets – A Long Way to Go?
Tom Palser1, Shaikashraf Binshaikismail1, Ozlem Erol Durgan1, Javvad Haider1, Manoj Sivan1,2
1National Rehabilitation Centre, Nottingham, UK
2University of Leeds, Leeds, UK
Background: Together with mortality and morbidity, function has been proposed by the World Health Organisation (WHO) as the “third indicator of health”. In 2023 The World Health Assembly (WHA) adopted the global resolution of strengthening rehabilitation in health systems for all health conditions. National audits and datasets in the UK play a pivotal role in systematically measuring healthcare outcomes. However, the degree to which they currently measure functional outcomes and rehabilitation processes is unknown.
Aim: A cross-sectional evaluation of all English government-funded national clinical audits, registries and datasets to assess whether they include rehabilitation therapies or outcomes that assess function.
Methods: Datasets were examined by two researchers to identify if they reported 1) functional outcomes (defined as capturing the WHO ICF activity or participation domain), and 2) rehabilitation process indicators. Any discrepancies were resolved through discussion with a third reviewer.
Results: 49 national audits, registries, or datasets for a cross-section of health conditions were included. 41 (83.7%) reported no functional outcomes whatsoever. Four (8.2%) reported rehabilitation process indicators (such as therapy delivery). In particular, none of the eleven cancer datasets reported any outcomes related to function.
Conclusion: Despite the increasing recognition of the importance of function and rehabilitation in individual and societal health, functional outcomes and rehabilitation processes remain very poorly represented in national datasets. It is essential that datasets for all conditions urgently start including metrics on functional outcomes and the rehabilitation process to improve patients’ function.
References
1. Functioning: the third health indicator in the health system and the key indicator for rehabilitation. Stucki G, Bickenbach J. EJPRM 2017; 53(1)
2. The human functioning revolution: implications for health systems and sciences. Bickenbach J, Rubinelli S, Baffone C, Stucki G. Front Sci (2023) 1:1118512.
3. Black N. (2013). High-quality clinical databases: breaking down barriers. The Lancet, 382(9900), 1075–1076. doi:10.1016/S0140-6736(13)62011-6
4. Healthcare Quality Improvement Partnership (HQIP). (2020). National Clinical Audit and Patient Outcomes Programme: How national clinical audit contributes to quality improvement. https://www.hqip.org.uk
The Effect of Lesion Localisation on Analgesic Use in Acquired Brain Injury
Nina Dalton1, Lloyd Bradley1
1Royal Hospital for Neurodisability, London, UK
Background: Pain following acquired brain injury (ABI) arises through multifactorial mechanisms with potential to negatively impact quality of life and engagement with rehabilitation. Assessment and management of pain is reliant on patient feedback. This may be challenging following ABI, where particular locations of injury result in specific cognitive and/or communication impairments.
Aims: To compare regular and as-required analgesia requirements between cohorts of patients with ABI secondary to different anatomical lesions within an inpatient neuro-rehabilitation setting.
Methods: A retrospective cohort analysis of analgesia prescriptions for patients with ABI admitted for inpatient rehabilitation over four years. The cohort was divided into anatomical groups (left hemisphere, right hemisphere, global/bilateral, brainstem/cerebellum). For each patient, medical notes and prescribing charts were reviewed to determine admission and discharge prescriptions for analgesics (non-opiate, opiate and neuropathic) and use of as-required analgesia per week of inpatient admission.
Results: There were 478 patients admitted, of whom 204 were excluded (200 PDOC, 4 non-specific localisation). There was no difference between groups in the number of analgesics prescriptions at admission and discharge. Patients with right hemisphere lesions (n=63) used significantly more as-required analgesia (mean 51.65 doses/week) than those with left hemisphere (n=65) (31.56/week), global/bilateral (n=99) (39.8/week), and brainstem/cerebellum (n=47) (22.9/week) lesions during their admission.
Conclusion: The higher as-required analgesia requirements for individuals with right hemisphere lesions compared with other localisations may relate to the attention and sensory-processing issues associated with non-dominant hemisphere injuries. Further individualised evaluation of patient impairments is required.
References
1. Neumann, D., Parrott, D., Lumley, M. A., Williams, M. W., Qureshi, F., & Hammond, F. M. (2024). Emotional awareness and expression difficulties in relation to pain experiences in people with brain injury and chronic pain: preliminary investigation. Brain Injury, 39(2), 145–153. https://doi.org/10.1080/02699052.2024.2413628
2. Roza C, Martinez-Padilla A. Asymmetric Lateralization during Pain Processing. Symmetry. 2021; 13(12):2416. https://doi.org/10.3390/sym13122416
3. Ji G, Neugebauer V. Hemispheric lateralization of pain processing by amygdala neurons. J Neurophysiol. 2009 Oct;102(4):2253-64. doi: 10.1152/jn.00166.2009. Epub 2009 Jul 22. PMID: 19625541; PMCID: PMC2776996.
