Stroke rehabilitation for people living in the community is commonly delivered either in a centre, outpatient or day hospital setting. More recently, services may be offered in the actual home of the person as home-based or domiciliary rehabilitation. There are differing reports of the benefits and barriers of home-based vs. centre-based community rehabilitation. This systematic review sought to pool data from all retrieved studies that compared the functional benefits of home-based vs. centre for community-dwelling people with stroke. A comprehensive search strategy was implemented in all major databases (Cochrane library, Medline, AMED, Embase, Ageline, Cinahl, PEDro) for randomised controlled trials investigating this question in relation to functional benefits as a primary outcome and carer, cost or other benefits as secondary outcomes. There were no language or date limits. Eleven trials were found and results pooled for the Barthel Index, the measure of functional independence used consistently across the majority of retrieved studies. There was a significant effect in favour of home-based rehabilitation at 6 weeks (P=0.03) and 3-6 months (P=0.01). The effects were less clear at 6 months, although this was using the less sensitive version of the Barthel Index (P=0.27 or adjusted P=0.04). Individual studies reported cost benefits and increased carer satisfaction in favour of home-based rehabilitation. The provision of rehabilitation for people living in the community should trend towards home-based. Further research is required into adverse events and the experiences of all stakeholders.

BackgroundApproximately two out of three people with stroke experience gait problems. Trunk movement control and symmetry is an important prerequisite for functional walking gait. Movement control, measured objectively as kinematics during walking gait, is rarely investigated.ObjectiveTo describe the three-dimensional (3D) kinematics of the trunk during gait in people with stroke, including key spatiotemporal characteristics.MethodologyA total of 17 adults with stroke who met the inclusion criteria were selected to participate in this cross-sectional pilot study. An eight-camera T-10 Vicon system with Nexus 1.8 software (Vicon Motion System Limited, Oxford, UK) was used to analyse the 3D kinematics of the trunk during self-selected walking speed. Trunk kinematics throughout the gait cycle and spatiotemporal parameters were extracted using custom-built scripts in MATLAB used at the Stellenbosch University Movement Analysis Laboratory. Stata Version 12.1 software was used to assess differences in trunk kinematics between the affected and unaffected sides during gait using the Sign test (statistical significance level p < 0.05).ResultsParticipants achieved functional gait speeds although they presented with asymmetrical trunk kinematics. During the full gait cycle, there were statistically significant differences of trunk motion between the affected and unaffected sides in the coronal plane (p < 0.001). There were statistically significant differences in the trunk kinematics between the affected side and unaffected sides at initial contact (p < 0.001) and foot off (p < 0.049) in the coronal plane as well as at initial contact (p < 0.000) and foot off (p < 0.013) in the transverse plane.ConclusionThis pilot study found significant asymmetry in trunk motion between the affected and unaffected sides that varied across the gait cycle. This suggests the trunk may need to be targeted in clinical gait retraining post-stroke.

TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the ‘1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

Background: Health related quality of life (HRQoL) is a determinant of physical, social and emotional well-being post-stroke.Objectives: This study aimed to correlate self-reported HRQoL with activities of daily living (ADL) and stroke severity.Method: A longitudinal observational study was conducted at a rehabilitation centre in the Western Cape, South Africa. Stroke inpatients were sampled over 6 months. The Euro-QoL Five Dimensions instrument (EQ5D-3L) for self-reported HRQoL, Barthel Index (BI) for function and independence in ADL, and modified Rankin Scale (mRS) for stroke severity were administered on admission and discharge. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.Results: Of the 54 potential participants, 49 met inclusion criteria and 41 completed reassessments (median age 48 years [interquartile range {IQR} 39–60]; median length of stay 53 days [IQR 46–60]). Most participants had infarctions (89.90%); with hypertension or diabetes risk factors (73.47% and 28.57%, respectively). The BI and mRS scores improved significantly (p 0.001) with very strong correlation between scores (rs = -0.874, p 0.001); indicating a trend of decreased stroke severity as function improved. The EQ5D Visual Analog Scale (VAS) scores (p 0.001) and domains mobility, self-care, usual activities (p 0.001) and pain/discomfort (p = 0.034) improved significantly. The anxiety/depression domain showed a non-significant change (p = 0.378). A weak negative significant correlation existed between EQ5D VAS and mRS scores (rs = -0.362; p = 0.02); indicating a trend that HRQoL was not improving to the degree stroke severity decreased. A weak positive significant correlation was seen between EQ5D VAS and BI scores (rs = 0.329; p = 0.036).Conclusion: Although an improvement was noted in HRQoL, EQ5D VAS scores tended not to improve as strongly, despite significant improvements in function and stroke severity. These findings demonstrate the need for psychological support and pain management interventions for adjustment post-stroke.

BackgroundLow-level laser therapy is one of the adjunct treatments of choice with exercise therapy for shoulder rehabilitation in physiotherapy clinical practices. Although previous reviews have found little use of low-level laser therapy, there are recent trials whose findings are yet to be systematically reviewed.MethodsWe plan to do a systematic review to assess the effects of low-level laser therapy with exercise and exercise alone in participants who are 18 years and above, with a clinical or radiological diagnosis of various shoulder pathologies. We will search CENTRAL, MEDLINE, CINAHL, PEDro, Science Direct, Scopus and Physiotherapy Choices regardless of publication status. We will hand search for subject-specific journals (PhotoMedicine and Laser Surgery, Lasers in Surgery and Medicine and Journals of Lasers in Medical Science) and conference proceedings of World Association for Laser Therapy. Two review authors will independently screen, select studies, extract data and assess the risk of bias based on a priori criteria. Disagreements between review authors will be resolved either through discussion or consultation with a third review author. If there are at least two clinically homogeneous studies, we will perform meta-analysis.DiscussionThe findings will shed more light on the benefit of low-level laser therapy as an adjunct treatment to exercise in the management of shoulder disorders. The findings may also inform decision makers in the review and development of guidelines for shoulder rehabilitation in physiotherapy practices.Systematic review registrationPROSPERO CRD42014013691Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0050-2) contains supplementary material, which is available to authorized users.