Background
The likelihood of regaining independent walking after stroke is important to patients and their families and influences rehabilitation and discharge planning.

Objective
The aim of this study was to develop a tool that can be used early after stroke to predict whether and when a patient will regain the ability to walk independently.

Methods
Adults with stroke who had new lower limb weakness and were unable to walk independently were recruited from 2 large hospitals in Aotearoa. Clinical assessments and transcranial magnetic stimulation were completed 1-week post-stroke. Participants with a motor-evoked potential (MEP) in the tibialis anterior muscle were classified as MEP+. The primary outcome was time post-stroke by which independent walking (Functional Ambulation Category score ≥ 4) was achieved. Cox hazard regression identified predictors for achieving walking by 4, 6, 9, 16 or 26 weeks post-stroke. Predictors were assigned a weighted score and summed to form the TWIST score. MEP status and clinical predictors were combined in binary logistic regression analyses at each timepoint to identify whether MEP status adds value to clinical predictors.

Results
We included 93 patients (median age 71 years). Age < 80 years, knee extension strength ≥ 3/5, and Berg balance test score < 6, 6 – 15, or ≥ 16 were combined to form the TWIST prediction tool. The TWIST tool was at least 83% accurate for each timepoint. MEP status at 1-week post-stroke did not survive analyses when combined with clinical measures.

Conclusions
The TWIST tool accurately predicts whether and when a patient will achieve independent walking after stroke using simple bedside measures one-week post-stroke. Transcranial magnetic stimulation to determine MEP status is not needed for walking prediction.

Implications
Once validated, the TWIST tool will be an important addition to the physiotherapy toolbox that can advance stroke practice.

Background:
Constraint-induced movement therapy (CIMT) is recommended in the Australian and New Zealand Clinical Guidelines for Stroke Management, however only 11% of eligible stroke survivors receive CIMT. Difficulties attending face-to-face therapy is a key barrier to accessing CIMT for stroke survivors. The remote constraint induced therapy of the upper extremity (ReCITE) study explored the feasibility and acceptability of delivering CIMT via telehealth (TeleCIMT).

Purpose:
To explore the experiences of stroke survivors who have completed a three-week TeleCIMT program.

Methods:
Qualitative design using semi-structured interviews. Stroke survivors who had completed a three-week TeleCIMT program as part of usual rehabilitation were interviewed individually one month post program completion. Interviews were conducted by an independent researcher. Interviews were audio-recorded, transcribed and imported into Nvivo for thematic analysis using inductive coding.

Results:
Sixteen participants agreed to be interviewed following their TeleCIMT program. Whilst participants reported seeing improvements in their arm function from TeleCIMT, there were several challenges to program adherence. Challenges to the program included the reduced level of direct therapist input and the use of technology when conducting a program online. Participants also reported a high time burden for program preparation and recording of practice as well as challenges tolerating six hours of mitt wear per day within the home. Most participants completed their programs without a supporter, however reported having a support person would have been beneficial for program adherence, assisting with paperwork and to provide encouragement. The program was acceptable to stroke survivors with all participants stating they would recommend the program to others.

Conclusion:
Stroke survivors describe TeleCIMT as an acceptable intervention. Additional support is required for technology use and recording practice.

Implications:
CIMT delivery via telehealth creates an opportunity to reduce inequity in healthcare access and enhance delivery of stroke services within Aotearoa for stroke survivors.