Stuti Chakraborty(she/her/hers)

Importance. Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important.

Objective. To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions.

Design. Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study.

Setting. Community.

Participants. Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr).

Intervention. Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth.

Outcomes and Measures. Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs.

Results.. Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers.

Conclusions and Relevance. Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions.

Plain-Language Summary. This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

Background. Healthcare Information for All (HIFA) is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of health care information in low- and middle-income countries (LMICs). During the COVID-19 pandemic, online HIFA forums saw a tremendous amount of discussion regarding the lack of information about COVID-19, the spread of misinformation, and the pandemic’s impact on different communities.

Objective. This study aims to analyze the themes and perspectives shared in the COVID-19 discussion on English HIFA forums.

Methods. Over a period of 8 months, a qualitative thematic content analysis of the COVID-19 discussion on English HIFA forums was conducted. In total, 865 posts between January 24 and October 31, 2020, from 246 unique study participants were included and analyzed.

Results. In total, 6 major themes were identified: infodemic, health system, digital health literacy, economic consequences, marginalized peoples, and mental health. The geographical distribution of study participants involved in the discussion spanned across 46 different countries in every continent except Antarctica. Study participants’ professions included public health workers, health care providers, and researchers, among others. Study participants’ affiliation included nongovernment organizations (NGOs), commercial organizations, academic institutions, the United Nations (UN), the World Health Organization (WHO), and others.

Conclusions. The themes that emerged from this analysis highlight personal recounts, reflections, suggestions, and evidence around addressing COVID-19 related misinformation and might also help to understand the timeline of information evolution, focus, and needs surrounding the COVID-19 pandemic.

Keywords. infodemic; infodemiology; COVID-19; pandemic; misinformation; health information; theme; public health; qualitative study; global health

The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I². Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14–182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4–34.4%)], followed by fatigue [24.4% (17.5–32.9%)], objective cognitive impairment [20.2% (10.3–35.7%)], anxiety [19.1% (13.3–26.8%)] and post-traumatic stress [15.7% (9.9–24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I² = 79.6–98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.

Keywords. COVID-19, neuropsychiatry, Long COVID, post-acute sequelae of COVID-19, chronic COVID syndrome

Background and Aims. People with neurological dysfunction have been significantly impacted in receiving adequate, quality rehabilitation services due to the ongoing COVID-19 pandemic. In addition, there have been several reports of cerebrovascular accident (CVA) or stroke as a serious complication of COVID-19. At present, clear guidelines for acute in-hospital rehabilitation during the pandemic, especially in low- and middle-income countries remain yet to be established. This study aimed to develop guidelines to cover a spectrum of neurological disorders. For the purpose of this abstract, results specific to the subsection on stroke are being presented.

Methods. Experts in stroke rehabilitation, consisting of neurologists, physical therapists and occupational therapists were identified to form the core group. A six-stage scoping review was conducted using a comprehensive search strategy with relevant MeSH terms. Specific statements with level 2b evidence from studies identified, were developed and circulated to 13 experts for consensus. The statements receiving  ≥ 80% agreement were grouped into relevant themes to develop recommendations.

Results. The search yielded 14 studies addressing acute stroke rehabilitation. Majority of the studies (9 out of 14) provided recommendations specific to inpatient settings. 72 statements in total received consensus from 13 experts. Stroke rehabilitation specific recommendations emphasised on the uninterrupted continuation of services through virtual home visits/rounds and speech, occupational and physical therapy management.

Conclusions. This consensus statement is of significance to stroke rehabilitation service providers and people living with stroke-related disability. Stakeholders involved in upholding standards for stroke rehabilitation practices in low- and middle-income countries must consider conversion of the consensus statement to minimum requirements within the context of the pandemic and in future.

Patients suffering from body integrity dysphoria (BID) desire to become disabled, arising from a mismatch between the desired body and the physical body. We focus here on the most common variant, characterized by the desire for amputation of a healthy limb. In most reported cases, amputation of the rejected limb entirely alleviates the distress of the condition and engenders substantial improvement in quality of life. Since BID can lead to life-long suffering, it is essential to identify an effective form of treatment that causes the least amount of alteration to the person’s anatomical structure and functionality. Treatment methods involving medications, psychotherapy, and vestibular stimulation have proven largely ineffective. In this hypothesis article, we briefly discuss the characteristics, etiology, and current treatment options available for BID before highlighting the need for new, theory driven approaches. Drawing on recent findings relating to functional and structural brain correlates of BID, we introduce the idea of brain–computer interface (BCI)/neurofeedback approaches to target altered patterns of brain activity, promote re-ownership of the limb, and/or attenuate stress and negativity associated with the altered body representation.

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.

We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.

13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.

Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Background. People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence.

Methods. A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed.

Results. 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators.

Conclusions. The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

Keywords. COVID-19, Pandemic, Neurorehabilitation, Guidelines, Consensus, Health Systems

Non–communicable diseases (NCDs) is an umbrella term used to describe a cluster of diseases constituting of Cardiovascular and Chronic Respiratory complications, Cancer, Diabetes and Mental Health conditions. The World Health Organisation (WHO) estimates that nearly 71% of all deaths worldwide (41 million people) can be attributed to inadequate and untimely intervention for Non–communicable diseases. Out of the 41 million people affected, the most vulnerable groups placed at the epicentre to face the repercussions of the growing impacts of NCDs are children, young people, people of lower socio-economic status (SES) and those belonging to lower and lower-middle income countries (LMICs). We call for policies to be more youth-inclusive and suggest further recommendations to incorporate youth voices and interventions to combat the global burden of NCDs as young people constitute of a major demographic widely affected by NCDs yet remain underrepresented in their say on tackling NCDs across local, regional, national and global levels.

The recent outbreak of COVID-19, declared a pandemic, has affected medical education globally. The scenario is no different for medical students in India as they find themselves at a crossroads in their careers, with clinical and elective postings called off. Missing out on the opportunity to learn from “first-hand” clinical observation stands to threaten the quality of medical education and learning procured by Indian medical students which is extremely essential to deal with the vast patient load that awaits them in their impending future as healthcare professionals. Is the Indian medical education system being able to cope with the challenges imposed by the increasing burden of COVID-19? The authors propose few administrative and on-ground interventions that must seek to work collectively with all government and private medical institutions in order to help students/interns and residents in coping with stress, anxiety or academic losses incurred due to the pandemic.

Keywords. Education, medical, undergraduate, graduate, pandemic, COVID-19

Occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. It is not always limited to just paid employment. Occupations of the global population have been adversely affected in one way or the other because of this COVID-19 pandemic. Four different key sects of occupations were majorly affected. These are the occupations of those who are or were COVID-positive, occupations of healthy individuals affected by COVID-19/lockdown, occupations of the population highly susceptible and vulnerable of contracting COVID-19 and occupations having a direct impact on global market, supply chain or economy. These occupations were locked up due to the pandemic lockdown. Occupational therapists can scientifically analyse occupations and help formulate exit strategies for the lockdown. They are experts who understand and study the different ways of measuring participation in occupation to develop innovative strategies and therapeutic interventions to facilitate individuals’ engagement in occupations. They can unravel the pragmatic strategies for preventing transmission (physical distancing, hand hygiene, personal protective equipment usage and decontamination) despite engaging in occupations safely and effectively. Nourishing this niche and essential science is pertinent, not just in this pandemic context but also against a backdrop of health and social care research, policy, practice and education for the future.

Keywords. Occupational Science, Occupational Therapy, Covid-19, Pandemic, Lockdown Coronavirus, Activity Analysis, Occupations

Assistive technologies are used to enhance the day-to-day functionality of people with disabilities by improving their quality of life and by reducing the impact of disability in their lives. Various socio-economic, cultural, contextual, medical, personal, and family-related factors determine the feasibility and outcomes of using assistive technologies. While various forms of assistive technologies are being widely used for rehabilitation, recreational, or personal purposes around the world many still remain inaccessible and vastly unaffordable in countries around the world. Literature suggests that, when comparing high income countries with low and lower-middle income countries, differences among the longevity, availability, ease of users, affordability and, most importantly, the recognition of the need for an assistive technology, are common, with those measures lagging in low and lower-middle income countries. Certain targeted interventions have been suggested to provide insight into how discrepancies in promoting the use of assistive technologies between developed and developing nations can be minimised with the goal of reducing the global impacts of disability.