As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of “clinimetric” analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.

This paper reports the results of a scoping study that reviewed research about child abuse, child protection and disabled children published in academic journals between 1996 and 2009. The review was conducted using a five stage method for scoping studies. Several studies have revealed a strong association between disability and child maltreatment, indicating that disabled children are significantly more likely to experience abuse than their non-disabled peers. Those with particular impairments are at increased risk. There is evidence that the interaction of age, gender and/or socio-cultural factors with impairment results in different patterns of abuse to those found among non-disabled children although the reasons for this require further examination. It appears that therapeutic services and criminal justice systems often fail to take account of disabled children's needs and heightened vulnerability. In Britain, little is known about what happens to disabled children who have been abused and how well safeguarding services address their needs. Very few studies have sought disabled children's own accounts of abuse or safeguarding. Considerable development is required, at both policy and practice level, to ensure that disabled children's right to protection is upheld. The paper concludes by identifying a number of aspects of the topic requiring further investigation.

AimsThe purpose of this study was to test the feasibility of a randomised controlled trial comparing six weeks of humanistic school-based counselling versus waiting list in the reduction of emotional distress in young people, and to obtain initial indications of efficacy.MethodsFollowing a screening procedure, young people (13 - 15 years old) who experienced emotional distress were randomised to either humanistic counselling or waiting list in this multi-site study. Outcomes were assessed using a range of self-report mental health measures, with the emotional symptoms subscale of the Strengths and Difficulties Questionnaire (SDQ) acting as the primary outcome indicator.ResultsRecruitment procedures were successful, with 32 young people consenting to participate in the trial and 27 completing endpoint measures. Trial procedures were acceptable to all involved in the research. No significant differences were found between the counselling and waiting list groups in reductions in levels of emotional symptoms (Hedges' g = 0.03), but clients allocated to counselling showed significantly greater improvement in prosocial behaviour (g = 0.89) with an average effect size (g) across the nine outcome measures of 0.25. Participants with higher levels of depressive symptoms showed significantly greater change.ConclusionThis study suggested that a randomised controlled trial of counselling in schools is acceptable and feasible, although initial indications of efficacy are mixed.Trial registrationCurrent Controlled Trials ISRCTN68290510.

Prospective and retrospective studies have examined traumatic injuries within competitive and recreational surfers worldwide using online surveys and health care facility (HCF; e.g., hospital, emergency department, medical record) data. However, few studies have provided a synthesis of all available literature. The purpose of this study was to obtain, critique and synthesise all literature specific to acute surfing injuries, and evaluate differences in injury type, mechanism and location between HCF and survey data. A systematic literature review design was used to identify relevant articles from three major databases. Peer-reviewed epidemiological studies of musculoskeletal surfing injuries were included. A modified AXIS tool was used for critical appraisal, and objective data was extracted and synthesized by lead researchers. Overall frequencies for injury location, type and mechanism were calculated from raw injury data. A total of 19 cross-sectional articles of fair to good quality (Modified AXIS 54.2–83.3%) were included in this study; 17 were National Health and Medical Research Council (NHMRC) level III-2 (retrospective) and two were level II (prospective). Articles examined competitive, recreational and combined populations. Injury data from Australia, Brazil, UK, USA, Portugal, Japan, Norway, and worldwide were represented. Skin (46.0%; HCF 50.1%, survey 43.8%) and being struck by own surfboard (38.6%; HCF 73.4%, survey 36.7%) were the most common injury type and mechanism. Head, face and neck injuries were most common in HCF (43.1%) versus lower limb injuries (36.4%) in survey data. Incidence proportion was highest in aerialists (0.48). Incidence rate (number of injuries per 1000 h) ranged from 0.74 in Australian surfers (Melbourne) to 6.6 in international contest surfers from medical record data. This review highlights the prevalence of skin, board-related, head, face and neck, and lower limb surfing injuries across available literature. Proposed use of protective equipment and foam-based surfboards in dangerous or crowded surf locations may reduce injury risk.

School-based humanistic counseling (SBHC) is a widely delivered intervention for psychological distress in young people, particularly in the UK. This study piloted a set of procedures for evaluating SBHC and obtaining indications of effect. Psychologically distressed young people (aged 13-16) were randomized to either 12 weeks of SBHC or a waiting list control. The primary outcome was psychological distress at the 12-week endpoint, as measured by the Young Person's CORE. Those allocated to counseling (n=16) showed significantly greater reductions in psychological distress than participants in the control group (n=17), with an effect size (ES) (g) of 1.14 on the primary outcome and a mean ES across all four outcome measures of 0.73 at endpoint. The findings indicate that SBHC may be an effective means of reducing psychological distress in young people.

Aims: To explore the feasibility and cost effectiveness of screening and delivery of a brief intervention for hazardous drinking employees.Methods: A pilot randomised controlled trial of a brief intervention delivered by an Occupational Health nurse versus no delivery of brief intervention (control group) conducted in a Local Authority Council (LCA) in the United Kingdom. Changes in quality of life and economic indicators were measured by the EQ-5D.Results: 627 employees were screened of whom 163 (26.01%) fulfilled the inclusion criteria with a total of 57 (35%) agreeing to participate. No significant differences were found between the groups for baseline demographics or levels/patterns of alcohol consumption. A statistically significant effect was found in the mean AUDIT scores over time (F = 8.96, p = 0.004) but not for group (F = 0.017, p = 0.896), and no significant interaction was found (F = 0.148, p = 0.702). The cost of each intervention was calculated at £12.48, the difference in service costs was calculated at £344.50 per person; that is there was a net saving of health and other care costs in the intervention group compared to the control group. The QALYs fell in both intervention and control groups, the difference -0.002 -(-0.010) yields a net advantage of the intervention of 0.008 QALYs. Conclusion:The main results from this pilot study suggest that alcohol brief interventions delivered in the workplace may offer the potential to reduce alcohol-related harm and save public sector resources. A fully powered multi-centre trial is warranted to contribute to the current evidence base and explore further the potential of alcohol brief interventions in the workplace. In a full trial the recruitment method may need to be re-considered.2

Background: Levels of goal agreement between therapists and adult clients have been shown to relate to therapeutic outcomes. Understanding clients' goals for therapy, therefore, is an important area of study. Aims: The purpose of this study was to investigate the therapeutic goals that young people have in school-based counselling, and the extent to which different types of goals are achieved. Method: The study is a post-hoc analysis of data collected from two pilot randomised controlled trials (RCT) using the Goal Based Outcome (GBO) tool, in which 73 participants were allocated to either a counselling group or a waitlist control group. Thematic analysis was used to identify the main types of goals young people had; with descriptive quantitative analysis to identify the prevalence of these goals, and multi-level analysis to identify whether some goals were attained to a greater extent than others. Results: The most frequent type of goals identified by young people related to increasing self-confidence and self-acceptance, followed by controlling or reducing anger, improving relationships with family, and increasing feelings of happiness. No significant relationship was found between the type of goal and the extent to which they were attained in counselling. Conclusion: Young people in counselling are particularly concerned with improving their self-confidence, and this suggests a somewhat different focus to the counselling work than that which emerges from counsellors' reports of presenting and predominant issues. This suggests that school-based counsellors should be mindful of clients' particular therapeutic goals

Background Recent research has indicated that school‐based humanistic counselling (SBHC) is effective for young people in reducing psychological distress and facilitating achievement of personal goals. However, the processes by which this form of counselling brings about change are not yet understood. Aim This study aims to clarify the dynamic processes of change that young people go through when they attend SBHC, in order inform school counselling practice, training and further research. Method This is a qualitative interview study with 14 participants who had recently completed between two and nine sessions of SBHC as part of a randomised controlled trial (RCT). Interviews were transcribed and analysed using a grounded theory approach resulting in the development of five change process models. Results Multiple change processes were evident for individual clients; and were labelled relief, increasing self‐worth, developing insight, enhancing coping strategies and improving relational skills. Implications The data indicate that multiple pathways of change are possible, and that change processes associated with different theories of personality change are not mutually exclusive. The study is limited by a small, selective sample and low testimonial validity, and further qualitative research is needed to understand change processes in SBHC more fully.