Rehabilitation and education are underutilized for mild stroke and TIA sufferers.

PURPOSE: Transient ischemic attack (TIA) and mild stroke represent a large proportion of cerebrovascular events, at high risk of being followed by recurrent, serious events. The importance of early education addressing risk management, secondary prevention and lifestyle modifications is the centerpiece of further stroke prevention. However, delivering education and rehabilitation to this population can be complex and challenging. METHODS: Via synthesis of a narrative review and clinical experience, we explore the unique and inherent complexities of rehabilitation management and education provision for patients following mild stroke and TIA. RESULTS: A considerable proportion of TIA/mild stroke survivors have ongoing rehabilitation needs that are poorly addressed. The need for rehabilitation in these patients is often overlooked, and available assessment tools lack the sensitivity to identify common subtle impairments in cognition, mood, language and fatigue. Active and accessible education interventions need to be initiated early after the event, and integrated with ongoing rehabilitation management. Priority areas in need of future development in this field are highlighted and discussed. Implications for rehabilitation Survivors of mild stroke and TIA have ongoing unmet rehabilitation needs and require a unique approach to rehabilitation and education. Rehabilitation needs are difficult to assess and poorly addressed in this cohort, where available assessment tools lack the sensitivity required to identify subtle impairments. Education needs to be initiated early after the event and involve active engagement of the patient in order to improve stroke knowledge, mood and motivate adherence to lifestyle modifications and secondary prevention. Rehabilitation physicians are currently an underutilized resource, who should be more involved in the management of all patients following TIA or mild stroke.

An initial loading-dose vitamin D versus placebo after hip fracture surgery: baseline characteristics of a randomized controlled trial (REVITAHIP).

BACKGROUND: Hypovitaminosis D is particularly common among older people with a proximal femoral (hip) fracture. There are currently no agreed strategies for vitamin D replenishment after hip fracture surgery. The REVITAHIP Study is a multisite, double-blinded randomized-controlled trial investigating the effects of an oral vitamin D loading dose on gait velocity after hip fracture surgery. We describe the baseline characteristics of participants, aiming to document hypovitaminosis D and its associations after hip fracture. METHODS: Participants, over 65, recruited within 7 days following hip fracture surgery from 3 Australia hospitals, were randomly allocated to receive a loading dose of vitamin D3 (250,000IU) or placebo, followed by oral maintenance vitamin D3/calcium (800 IU/500 mg) and the usual hip fracture rehabilitation pathway. Demographic and clinical data were collected, including surgical procedure, pre-fracture functional status, Mini Mental State Examination (MMSE) score, serum 25-hydroxyvitamin D (25-OHD), Verbal Rating Scale (VRS) for pain, grip strength and gait velocity. The associations of baseline 25-OHD levels with demographic and clinical data were assessed using Pearson's correlation, ANOVA and regression analyses. RESULTS: Two-hundred-and-eighteen people with hip fracture participated in the study. Mean age was 83.9+/-7.2 years, 77% were women and 82% lived in private homes. Fifty-six percent had a subcapital fracture. Mean comorbidity count was 3.13+/-2.0. Mean MMSE was 26.1+/-3.9. Forty-seven percent of participants had hypovitaminosis D (<50 nmol/L). Multivariate regression models demonstrated higher baseline vitamin D levels were significantly associated with higher premorbid Barthel index scores, lower post-operative VRS pain levels and use of vitamin D. CONCLUSION: This study cohort shared similar demographic characteristics and comorbidities with other cohorts of people with hip fracture, with the probable exception of less cognitive impairment. Hypovitaminosis D was not as prevalent as previously documented. Patients taking vitamin D supplements and with higher premorbid Barthel index, reflecting greater independence and activity, tended to have higher 25-OHD levels at baseline. Further, lower VRS pain ratings following surgery were associated with higher vitamin D levels. Such associations will need further investigation to determine causation. (ANZCTR number, ACTRN12610000392066). TRIAL REGISTRATION: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ANZCTRN ACTRN12610000392066.

An explanatory model of peer education within a complex medicines information exchange setting.

Studies of the effectiveness and value of peer education abound, yet there is little theoretical understanding of what lay educators actually do to help their peers. Although different theories have been proposed to explain components of peer education, a more complete explanatory model has not been established empirically that encompasses the many aspects of peer education and how these may operate together. The Australian Seniors Quality Use of Medicines Peer Education Program was developed, in conjunction with community partners, to improve understanding and management of medicines among older people - an Australian and international priority. This research investigated how peer educators facilitated learning about quality use of medicines among older Australians. Participatory action research was undertaken with volunteer peer educators, using a multi-site case study design within eight geographically-defined locations. Qualitative data from 27 participatory meetings with peer educators included transcribed audio recordings and detailed observational and interpretive notes, which were analysed using a grounded theory approach. An explanatory model arising from the data grouped facilitation of peer learning into four broad mechanisms: using educator skills; offering a safe place to learn; pushing for change; and reflecting on self. Peer educators' life experience as older people who have taken medicines was identified as an overarching contributor to peer learning. As lay persons, peer educators understood the potential disempowerment felt when seeking medicines information from health professionals and so were able to provide unique learning experiences that encouraged others to be 'active partners' in their own medicines management. These timely findings are linked to existing education and behaviour change theories, but move beyond these by demonstrating how the different elements of what peer educators do fit together. In-depth examination of peer educators' practice in this context offers potential insights into the practice of lay workers in other related complex health promotion programs.