Objective:To identify the barriers and facilitators to goal-setting during rehabilitation for stroke and other acquired brain injuries.Data sources:AMED, Proquest, CINAHL and MEDLINE.Review methods:Two reviewers independently screened, extracted data and assessed study quality using the Mixed Methods Appraisal Tool and undertook thematic content analysis for papers examining the barriers and facilitators to goal-setting during stroke/neurological rehabilitation (any design). Last searches were completed in May 2016.Results:Nine qualitative papers were selected, involving 202 participants in total: 88 patients, 89 health care professionals and 25 relatives of participating patients. Main barriers were: Differences in staff and patients perspectives of goal-setting; patient-related barriers; staff-related barriers, and organisational level barriers. Main facilitators were: individually tailored goal-setting processes, strategies to promote communication and understanding, and strategies to avoid disappointment and unrealistic goals. In addition, patients’ and staff’s knowledge, experience, skill, and engagement with goal-setting could be either a barrier (if these aspects were absent) or a facilitator (if they were present).Conclusion:The main barriers and facilitators to goal-setting during stroke rehabilitation have been identified. They suggest that current methods of goal-setting during inpatient/early stage stroke or neurological rehabilitation are not fit for purpose.

Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care.Design Cluster randomised controlled trial with one year follow-up.Setting 41 low level dependency residential care homes in New Zealand.Participants 682 people aged 65 years or over.Interventions 330 residents were offered a goal setting and individualised activities of daily living activity programme by a gerontology nurse, reinforced by usual healthcare assistants; 352 residents received social visits.Main outcome measures Function (late life function and disability instruments, elderly mobility scale, FICSIT-4 balance test, timed up and go test), quality of life (life satisfaction index, EuroQol), and falls (time to fall over 12 months). Secondary outcomes were depressive symptoms and hospital admissions.

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PURPOSE We wanted to assess the effectiveness of a home-based physical activity program, the Depression in Late Life Intervention Trial of Exercise (DeLLITE), in improving function, quality of life, and mood in older people with depressive symptoms. METHODSWe undertook a randomized controlled trial involving 193 people aged 75 years and older with depressive symptoms at enrollment who were recruited from primary health care practices in Auckland, New Zealand. Participants received either an individualized physical activity program or social visits to control for the contact time of the activity intervention delivered over 6 months. Primary outcome measures were function, a short physical performance battery comprising balance and mobility, and the Nottingham Extended Activities of Daily Living scale. Secondary outcome measures were quality of life, the Medical Outcomes Study 36-item short form, mood, Geriatric Depression Scale (GDS-15), physical activity, Auckland Heart Study Physical Activity Questionnaire, and self-report of falls. Repeated measures analyses tested the differential impact on outcomes over 12 months' follow-up. RESULTSThe mean age of the participants was 81 years, and 59% were women. All participants scored in the at-risk category on the depression screen, 53% had a Diagnostic and Statistical Manual of Mental Disorders or International Classifi cation of Diseases, Tenth Revision diagnosis of major depression or scored more than 4 on the GDS-15 at baseline, indicating moderate or severe depression. Almost all participants, 187 (97%), completed the trial. Overall there were no differences in the impact of the 2 interventions on outcomes. Mood and mental health related quality of life improved for both groups. CONCLUSIONThe DeLLITE activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. Future social and activity interventions should be tested against a true usual care control. 2010;8:214-223. doi:10.1370/afm.1093. Ann Fam Med INTRODUCTIONL ow mood in community-dwelling older people is common and is associated with poor physical function.1 Poor physical function predicts development of depression, 2 disability, health service use, and institutionalization, 3 and disability in turn predicts development of depression.2 Physical activity has the potential to interrupt the development of disability from both depression 4 and poor physical function. 5Even small gains in physical performance and mood may result in signifi cant benefi ts in functional status (ability to perform activities of daily living) and quality of life. 6 Physical activity programs improve physical performance, 7 and there are several established ways of promoting physical activity to older people, such as physician advice with community folNgaire Kerse, PhD, MBChB Karen J. Hayman, RN 215 AC T IV I T Y PRO GR A M A ND DEPR ES SED EL DER LYlow-up, 8 supervised group activity programs, and wider community level intervention. 7,9 The most frail may...

Objectives to determine whether a repetitive activities of daily living (ADL) activity programme improves health status, life satisfaction and mobility for older people living in residential care. Design cluster randomised controlled trial. Setting five low-level dependency residential care homes in Auckland, New Zealand. Participants one hundred and forty-nine older residents (mean age 84.7 years). Intervention trained research staff worked with residents in intervention wards to set a goal and complete a functional assessment for each resident. They then designed an individualised activity programme based on ADL and worked with residential care home staff to implement the programme into daily activities of residents. Measurements mobility: timed-up-and-go (TUG); life satisfaction: late life satisfaction index (LSI-Z); and health status: SF-36 were assessed at baseline, 3-and 6-months follow-up. Results in the intervention group the SF-36 total physical component summary (PCS) score improved at 3 months in comparison with the control group. There was no difference between groups on mobility measures at any time, nor any measures at 6-months follow-up. Significant contamination is likely to have affected the 6-month follow-up measures. Conclusions a repetitive ADL exercise programme may improve health status in the short term in a group of frail older people living in residential care. Further research is needed to establish sustainability of change.