This paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement. We sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review. The stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups. We involved a stakeholder group in the update of a Cochrane systematic review, using clearly described structured methods to reach consensus decisions. The involvement of stakeholders impacted substantially on the review, with the inclusion of international studies, and changes to classification of treatments, comparisons and subgroup comparisons explored within the meta-analysis. We argue that the structured approach which we adopted has implications for other systematic reviews.

Background: Bilateral training (BT) of the upper limb (UL) might enhance recovery of arm function after stroke. To better understand the therapeutic potential of BT, this study aimed to determine the correlation between arm motor behavior and brain structure/function as a result of bilateral arm training poststroke.Methods: A systematic review of quantitative studies of BT evaluating both UL motor behavior and neuroplasticity was conducted. Eleven electronic databases were searched. Two reviewers independently selected studies, extracted data and assessed methodological quality, using the Effective Public Health Practice Project (EPHPP) tool.Results: Eight studies comprising 164 participants met the inclusion criteria. Only two studies rated “strong” on the EPHPP tool. Considerable heterogeneity of participants, BT modes, comparator interventions and measures contraindicated pooled outcome analysis. Modes of BT included: in‐phase and anti‐phase; functional movements involving objects; and movements only. Movements were mechanically coupled, free, auditory‐cued, or self‐paced. The Fugl‐Meyer Assessment (UL section) was used in six of eight studies, however, different subsections were used by different studies. Neural correlates were measured using fMRI and TMS in three and five studies, respectively, using a wide variety of variables. Associations between changes in UL function and neural plasticity were inconsistent and only two studies reported a statistical correlation following BT.Conclusions: No clear pattern of association between UL motor and neural response to BT was apparent from this review, indicating that the neural correlates of motor behavior response to BT after stroke remain unknown. To understand the full therapeutic potential of BT and its different modes, further investigation is required.

Post-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalised and community-dwelling stroke survivors view their social relationships differently. To i) examine social networks of stroke survivors and any influencing sociodemographic factors, as well as to ii) compare differences between institutionalised and community-dwelling stroke survivors. Stroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels. 160 stroke survivors completed the study. Stroke survivors reported a mean (SD) of 53.7(17.2) on the SSNS total score. Institutionalised stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U = 1856.5, z=-4.234, p < .001). Nearly a third (30.6%, n = 49) of the stroke survivors reported feeling lonely. Only 28.1% (n = 45) stroke survivors reported being ‘Very Satisfied’ with their overall social network. Compared to community-dwelling stroke survivors, institutionalised stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social network with all p < .05. A moderate correlation was found between SSNS ‘Satisfaction’ subdomain score and MSBS total score, r=-.401, p < .001. Stroke survivors had poor functioning social relationships. This study found that the perceived social support of institutionalised stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.

Background: Post-stroke social networks are associated with functional recovery. However, there is little information on the social networks of stroke survivors and whether institutionalized and community-dwelling stroke survivors view their social relationships differently. Purpose: To i) understand social networks of stroke survivors and any influencing sociodemographic factors, as well as to iii) compare differences between institutionalized and community-dwelling stroke survivors. Methods: Stroke survivors were recruited from eight healthcare institutions in Singapore. Stroke Social Network Scale (SSNS) was administered to assess the social network functioning. Multidimensional State Boredom Scale (MSBS) was used to evaluate state boredom levels. Results: 160 stroke survivors completed the study. Stroke survivors reported a mean(SD) of 53.7(17.2) on the SSNS total score. Institutionalized stroke survivors reported significantly lower SSNS scores than community-dwelling stroke survivors, (U=1856.5, z=-4.234, p<.001). Nearly a third (30.6%, n=45) of the stroke survivors reported feeling lonely. Only 28.1% (n=45) stroke survivors reported being ‘Very Satisfied’ with their overall social network. Compared to community-dwelling stroke survivors, institutionalized stroke survivors felt more lonely (40.7%) and only 25% were very satisfied with their social networks with all p<.05. Conclusions: Stroke survivors had poor functioning social relationships. This study identified that the perceived social support of institutionalized stroke survivors was poorer than community dwelling stroke survivors. A large proportion of stroke survivors reported feeling lonely and were not satisfied with their social networks. Identifying those at risk may be a means to prevent loneliness, increase social network satisfaction to improve well-being and quality of life.