What shapes local health system actors' thinking and action on social inequalities in health? A meta-ethnography.

Unlabelled: Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems.

Framing action to reduce health inequalities: what is argued for through use of the 'upstream-downstream' metaphor?

Background: Public health insights struggle to compete with dominant ideas which frame health inequalities as a problem of individual behaviour. There is consequently a need to critically reflect upon and question the effectiveness of different strategies for framing and communicating key insights. Taking the example of the 'upstream-downstream' metaphor, this literature review contributes to a necessary first step by asking what exactly is being argued for through its use.

Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines.

Background and Purpose- Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques.

Etiologic workup in cases of cryptogenic stroke: protocol for a systematic review and comparison of international clinical practice guidelines.

Background: Stroke is a leading cause of death and disability worldwide. Identifying the aetiology of ischaemic stroke is essential in order to initiate appropriate and timely secondary prevention measures to reduce the risk of recurrence. For the majority of ischaemic strokes, the aetiology can be readily identified, but in at least 30% of cases, the exact aetiology cannot be determined using existing investigative protocols.

Repetitive task training for improving functional ability after stroke.

Background: Repetitive task training (RTT) involves the active practice of task-specific motor activities and is a component of current therapy approaches in stroke rehabilitation.

Objectives: Primary objective: To determine if RTT improves upper limb function/reach and lower limb function/balance in adults after stroke. Secondary objectives: 1) To determine the effect of RTT on secondary outcome measures including activities of daily living, global motor function, quality of life/health status and adverse events.

Mechanisms of action of an implementation intervention in stroke rehabilitation: a qualitative interview study.

Background: Despite best evidence demonstrating the effectiveness of increased intensity of exercise after stroke, current levels of therapy continue to be below those required to optimise motor recovery. We developed and tested an implementation intervention that aims to increase arm exercise in stroke rehabilitation. The aim of this study was to illustrate the use of a behaviour change framework, the Behaviour Change Wheel, to identify the mechanisms of action that explain how the intervention produced change.

Case Series of a Knowledge Translation Intervention to Increase Upper Limb Exercise in Stroke Rehabilitation.

Background And Purpose: Current approaches to upper limb rehabilitation are not sufficient to drive neural reorganization and maximize recovery after stroke. To address this evidence-practice gap, a knowledge translation intervention using the Behaviour Change Wheel was developed. The intervention involves collaboratively working with stroke therapy teams to change their practice and increase therapy intensity by therapists prescribing supplementary self-directed arm exercise.

Mechanisms of change of a novel weight loss programme provided by a third sector organisation: a qualitative interview study.

Background: There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants.

Activities to support the implementation of complex interventions as part of routine care: a review of the quality of reporting in cluster randomised controlled trials.

Objective: To review a sample of cluster randomised controlled trials and explore the quality of reporting of (1) enabling or support activities provided to the staff during the trial, (2) strategies used to monitor fidelity throughout the trial and (3) the extent to which the intervention being tested was delivered as planned.

Design: A descriptive review.

Data Sources And Study Selection: We searched MEDLINE for trial reports published between 2008 and 2014 with combinations of the search terms 'randomised', 'cluster', 'trial', 'study', 'intervention' and 'implement*'.

Development of a behaviour change intervention to increase upper limb exercise in stroke rehabilitation.

Background: Two thirds of survivors will achieve independent ambulation after a stroke, but less than half will recover upper limb function. There is strong evidence to support intensive repetitive task-oriented training for recovery after stroke. The number of repetitions needed is suggested to be in the order of hundreds, but this is not currently being achieved in clinical practice.

A formative evaluation of the implementation of an upper limb stroke rehabilitation intervention in clinical practice: a qualitative interview study.

Background: The Graded Repetitive Arm Supplementary Program (GRASP) is a hand and arm exercise programme designed to increase the intensity of exercise achieved in inpatient stroke rehabilitation. GRASP was shown to be effective in a randomised controlled trial in 2009 and has since experienced unusually rapid uptake into clinical practice. The aim of this study was to conduct a formative evaluation of the implementation of GRASP to inform the development and implementation of a similar intervention in the United Kingdom.

Investigating measures of intensity during a structured upper limb exercise program in stroke rehabilitation: an exploratory study.

Objectives: To use 3 measures of intensity—time, observed repetitions, and wrist accelerometer activity counts—to describe the intensity of exercise carried out when completing a structured upper limb exercise program, and to explore whether a relationship exists between wrist accelerometer activity counts and observed repetitions.

Design: Observational study design.

Setting: Rehabilitation center research laboratory.

Therapists' use of the Graded Repetitive Arm Supplementary Program (GRASP) intervention: a practice implementation survey study.

Background: Only a small percentage of research is ever successfully translated into practice. The Graded Repetitive Arm Supplementary Program (GRASP) is a stroke rehabilitation intervention that anecdotally has had rapid translation from research to clinical practice. This study was conducted to explore the characteristics of this practice implementation.

Prescribing upper limb exercises after stroke: a survey of current UK therapy practice.

Objective: To investigate the current practice of physiotherapists and occupational therapists in prescribing upper limb exercises to people after stroke and to explore differences between professions and work settings.

Design: A cross-sectional survey design.

Participants: Occupational therapists and physiotherapists working in UK stroke rehabilitation.

Stroke survivors' experiences of somatosensory impairment after stroke: An Interpretative Phenomenological Analysis.

Background: Somatosensory ability is commonly impaired after stroke. Despite the growing recognition for the need to understand service users' experiences and perspectives in health services provision, the experiences of stroke survivors' living with somatosensory impairment have yet to be reported.

Objective: To gain an insight into how stroke survivors experience somatosensory impairment after stroke.