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BackgroundSelf-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients’ ability to participate in self-management.PurposeTo examine the effects of the empowerment intervention on stroke patients’ self-efficacy, self-management behavior, and functional recovery.MethodsThis is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups.ResultsA total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%.ConclusionPatient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Value streams for collected post-consumer textiles continue be analyzed within the global challenge to develop and employ commercially viable, yet ethical and sustainable strategies within the fashion industry. Upcycling is an existing strategy applicable to fashion production, with discarded materials used to design and create higher value products, keeping them in productive use for longer. A number of very small, niche upcycling enterprises have emerged in the UK. These brands have succeeded in creating stylistically relevant and commercially successful fashion styles utilizing waste textile materials. The advantages of scaling these enterprises up are not only environmental, but also economic and social, thereby creating a sustainable and innovative business model for UK led fashion production. Due to high levels of three key metrics of carbon, water and waste, UK government agency WRAP (Waste & Resources Action Programme) has identified textile products as priority materials for reuse and recycling. Upcycling enables a sustainable design option for reuse techniques to be employed for greatest economic and environmental benefit, in which used clothing and textiles are sourced for the production of newly designed fashion products. This paper identifies the key differences between standard fashion design and production processes and upcycled fashion design and production processes, in order to aid the development of large-scale fashion upcycling in the UK, and contribute to a circular economy.

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