The Oxford Participation and Activities Questionnaire was developed for generic use in the assessment of participation and activity levels. However, it is not available in Chinese and has not been tested in the stroke population. The Oxford Participation and Activities Questionnaire was translated into Chinese and culturally adapted. Its psychometric properties were examined in 100 people with stroke. The participation and activity levels of people with stroke and healthy people were also compared. Content validity and internal consistency (Cronbach’s α = 0.86–0.91) were excellent. The test–retest reliability (intraclass correlation coefficient = 0.91–0.94) was also satisfactory. The standard error of the measurement was 4.10–5.31, and the minimal detectable change was 11.37–14.71. Convergent and divergent validity were supported by hypothesis testing. The instrument had a five-factor structure without a ceiling effect. Its routine activity and social engagement scores discriminated people with stroke from healthy people. In conclusion, the Chinese version of the Oxford Participation and Activities Questionnaire is reliable and valid for assessing participation and activity levels in the stroke population.

Objective: To examine the contribution of perceived upper limb function to participation and activity among community-dwelling people with chronic stroke.Methods: A cross-sectional study was conducted with eighty-one people with stroke aged ≥50 years. The outcome measures included the Oxford Participation and Activities Questionnaire (Ox-PAQ), Arm Activity Measure (ArmA), Wolf Motor Function Test (WMFT), Timed Up and Go Test (TUG), and Geriatric Depression Scale (GDS).Results: Correlation analyses revealed that perceived upper limb function, as measured using the ArmA, had the strongest and most significant correlations with the levels of participation and activity, as measured using the Ox-PAQ, among all of the tested variables (rs=0.35–0.59, p<0.01). Multiple linear regression analyses also showed that perceived upper limb function significantly associated the levels of participation and activity, accounting for 2.0% to 9.0% of the variance in the Ox-PAQ scores. The final model, which included TUG time, the GDS score, the WMFT score, and the ArmA score, could explain 54% and 28% of the variance in the routine activities and social engagement subscales of the Ox-PAQ, respectively. The model including the GDS score, the WMFT score, and the ArmA score explains 32% of the variance in the emotional well-being subscale of the Ox-PAQ. Conclusion: Perceived upper limb function is a crucial determinant of participation and activity among community-dwelling people with chronic stroke. It could thus be a target component of stroke rehabilitation interventions to facilitate participation and activity after stroke.

Transcutaneous electrical nerve stimulation, including transcutaneous vagus nerve stimulation (tVNS) and transcutaneous spinal cord stimulation (tSCS), is potential interventions that can alleviate cognitive decline and promote motor recovery by modulating neurotransmitter systems, but current evidence in people with stroke remains inconclusive. This study investigated the effects of tVNS and tSCS and compared their efficacy in improving cognitive function and upper limb motor function after stroke. In this randomized controlled trial, 90 people with chronic stroke (mean ± standard deviation: 65.12 ± 5.85 years of age) were randomly assigned to receive 18 sessions of either tVNS, tSCS, or sham stimulation, each delivered concurrently with upper limb exercises for 45 min, three times per week, for 6 weeks. The primary outcomes were the Montreal Cognitive Assessment (MoCA) and the Fugl-Meyer Assessment for Upper Extremity (FMAUE). Outcomes were measured at baseline, after 9 and 18 sessions, and at 1 month after the intervention. The tVNS and tSCS groups demonstrated significantly greater improvements than did the sham group in MoCA (mean differences, 2.37 and 1.77, respectively; p < 0.001) and FMAUE scores (mean differences, 3.37 and 2.10, respectively; p < 0.001 and p = 0.007, respectively) after the intervention. Improvements in cognition persisted for 1 month in both groups, as indicated by non-significant within-group changes from post-intervention to follow-up assessments, whereas motor improvements were sustained only in the tVNS group. Both tVNS and tSCS may be potential interventions to combine with exercise for improving cognitive and upper limb function after stroke. ClinicalTrials.gov: NCT05615610.

Introduction: Cognitive impairment and upper limb impairment are common complications following stroke, but rehabilitation interventions targeting post-stroke cognitive and upper limb motor deficits remain understudied. Transcutaneous electrical nerve stimulation, including transcutaneous vagus nerve stimulation (tVNS) and transcutaneous spinal cord stimulation (tSCS), can potentially alleviate cognitive impairment and promote motor recovery. Although tVNS and tSCS may facilitate neuroplasticity following stroke, their effects on cognitive and upper limb motor outcomes have not been sufficiently studied. Therefore, the proposed clinical trial will investigate the effects of tVNS and tSCS on cognitive function and upper limb motor function in people with chronic stroke. Methods and analysis: A three-arm sham-controlled single-blind parallel-group randomised controlled trial will be performed with people with chronic stroke. All participants (n=90) will be randomly allocated to receive 18 sessions of intervention with different stimulation protocols (tVNS, tSCS and sham stimulation) at a 1:1:1 ratio. All participants will receive upper limb exercises concurrent with the corresponding stimulation protocols for 45 min in each session, three sessions per week, for 6 weeks. The primary outcomes will be the Montreal Cognitive Assessment and Fugl-Meyer Assessment for Upper Extremity. The secondary outcomes will be the Rivermead Behavioural Memory Test, Digit Span Test, Trail Making Test, Wolf Motor Function Test, maximum isometric voluntary contraction of the elbow, muscle stiffness of the elbow extensor and flexor, Arm Activity Measure, Oxford Participation and Activity Questionnaire and 12-item Short-Form Survey. All outcomes will be assessed at baseline, after 9 and 18 sessions of the intervention, and 1 month after the cessation of the intervention. Ethics and dissemination: Ethical approval has been obtained from the Human Subjects Ethics Committee of The Hong Kong Polytechnic University (HSEARS20221011002). The results yielded from this study will be submitted for publication in peer-reviewed journals and at international conferences. Trial registration number: NCT05615610 .