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Objective To assess the effectiveness of enhanced communication therapy in the first four months after stroke compared with an attention control (unstructured social contact).Design Externally randomised, pragmatic, parallel, superiority trial with blinded outcome assessment.Setting Twelve UK hospital and community stroke services.Participants 170 adults (mean age 70 years) randomised within two weeks of admission to hospital with stroke (December 2006 to January 2010) whom speech and language therapists deemed eligible, and 135 carers.Interventions Enhanced, agreed best practice, communication therapy specific to aphasia or dysarthria, offered by speech and language therapists according to participants' needs for up to four months, with continuity from hospital to community. Comparison was with similarly resourced social contact (without communication therapy) from employed visitors.Outcome measures Primary outcome was blinded, functional communicative ability at six months on the Therapy Outcome Measure (TOM) activity subscale. Secondary outcomes (unblinded, six months): participants' perceptions on the Communication Outcomes After Stroke scale (COAST); carers' perceptions of participants from part of the Carer COAST; carers' wellbeing on Carers of Older People in Europe Index and quality of life items from Carer COAST; and serious adverse events.Results Therapist and visitor contact both had good uptake from service users. An average 22 contacts (intervention or control) over 13 weeks were accepted by users. Impairment focused therapy was the approach most often used by the speech and language therapists. Visitors most often provided general conversation. In total, 81/85 of the intervention group and 72/85 of the control group completed the primary outcome measure. Both groups improved on the TOM activity subscale. The estimated six months group difference was not statistically significant, with 0.25 (95% CI -0.19 to 0.69) points in favour of therapy. Sensitivity analyses that adjusted for chance baseline imbalance further reduced this difference. Per protocol analyses rejected a possible dilution of treatment effect from controls declining their allocation and receiving usual care. There was no added benefit of therapy on secondary outcome measures, subgroup analyses (such as aphasia), or serious adverse events, although the latter were less common after intervention (odds ratio 0.42 (95% CI 0.16 to 1.1)).Conclusions Communication therapy had no added benefit beyond that from everyday communication in the first four months after stroke. Future research should evaluate reorganised services that support functional communication practice early in the stroke pathway. Trial registration ISRCTN78617680 IntroductionThe UK National Audit Office recently estimated that the direct care cost for people with stroke was "at least £3 billion annually," with around a third of stroke survivors experiencing lifelong disabilities. 1 Randomised controlled trials and systematic reviews have shown the effectiveness of s...

Exercise intolerance and impaired quality of life (QoL) are characteristic of lung transplant candidates and recipients. This review investigated the effects of exercise training on exercise capacity, QoL and clinical outcomes in pre- and post-operative lung transplant patients.A systematic literature search of PubMed, Nursing and Allied Health, Cochrane (CENTRAL), Scopus and CINAHL databases was conducted from inception until February, 2020. The inclusion criteria were assessment of the impact of exercise training before or after lung transplantation on exercise capacity, QoL or clinical outcomes.21 studies met the inclusion criteria, comprising 1488 lung transplant candidates and 1108 recipients. Studies consisted of five RCTs, two quasi-experimental and 14 single-arm cohort or pilot studies. Exercise training improved or at least maintained exercise capacity and QoL before and after lung transplantation. The impact on clinical outcomes was less clear but suggested a survival benefit. The quality of evidence ranged from fair to excellent.Exercise training appears to be beneficial for patients before and after lung transplantation; however, the evidence for direct causation is limited by the lack of controlled trials. Well-designed RCTs are needed, as well as further research into the effect of exercise training on important post-transplant clinical outcomes, such as time to discharge, rejection, infection, survival and re-hospitalisation.

Purpose:We examined the validity and reproducibility of a squash-specific test designed to assess change-of-direction speed. Methods: 10 male squash and 10 male association-football and rugby-union players completed the Illinois agility run (IAR) and a squash change-of-direction-speed test (SCODS) on separate days. Tests were repeated after 24 h to assess reproducibility. The best time from three attempts was recorded in each trial. Results: Performance times on the IAR (TE 0.27 s, 1.8%, 90% CI 0.21 to 0.37 s; LOA −0.12 s ± 0.74; LPR slope 1, intercept −2.8) and SCODS (TE 0.18 s, 1.5%, 90% CI 0.14 to 0.24 s; LOA 0.05 s ± 0.49; LPR slope 0.95, intercept 0.5) were reproducible. There were no statistically significant differences in performance time between squash (14.75 ± 0.66 s) and nonsquash players (14.79 ± 0.41 s) on the IAR. Squash players (10.90 ± 0.44 s) outperformed nonsquash players (12.20 ± 0.34 s) on the SCODS (P < .01). Squash player rank significantly correlated with SCODS performance time (Spearman's  = 0.77, P < .01), but not IAR performance time (Spearman's  = 0.43, P = .21). Conclusions: The results suggest that the SCODS test is a better measure of sport-specific capability than an equivalent nonspecific field test and that it is a valid and reliable tool for talent identification and athlete tracking.