Background

Degenerative cervical myelopathy (DCM) has a prevalence of 2.3% amongst adults, however this figure is thought to be underreported due to missed diagnosis. Current cervical screening guidelines, which have a strong emphasis on recognising vascular risk, overshadows the equally significant consideration of recognizing spinal cord dysfunction, as seen with DCM. Considering the patho-mechanics of DCM, and the potential for progressive neurofunctional decline, an understanding DCM and concomitant prevalence in common patient populations, such as lower back pain, is important when considering utilising cervical mobilisation and manipulation.



Purpose

This study aims to report on the prevalence of incidentally-identified community-dwelling DCM cases, emphasising the potential that DCM has an underreported prevalence, warranting clinical consideration.



Methods

A retrospective audit was conducted at a secondary care spine centre from January 2022 to December 2023. The study included consecutive patients over the age of 45 years, referred for lumbar spine-related issues as a convenient patient subset. All patients were screened for signs and symptoms of DCM by an orthopaedic-triage physiotherapist, and DCM was diagnosed upon the presence of at least one DCM symptom and one clinical sign coupled with MRI-confirmation.



Results

Out of 388 screened patients, 16 (4.1%) were diagnosed with DCM with an average age of 62.8 years; 11 of these patients were male. Ten out of 16 diagnosed patients were scheduled for surgical decompression.


Conclusion
This audit highlights the underrecognized prevalence of DCM in community-dwelling individuals. Further research to understand key at-risk patient populations will help identify relevant clinical populations where cervical manual therapy techniques may be contraindicated or reconsidered.
 
Implications
Despite the lack of recommendations for DCM screening in international pre-manipulative guidelines, the authors suggest considering screening patients over the age of 45 years for DCM prior to considering cervical spinal manipulation and high grade mobilisations.

Background: The significant and growing impact of stroke disability has prompted researchers and clinicians to re-think the core components of rehabilitation. While the concept of “task challenge” is often described as influencing individual’s experiences and outcomes of stroke rehabilitation, it is poorly understood. Challenge holds various meanings, including overlap with descriptions of task difficulty, physiological intensity, cognitive load and perceived effort, which can lead to suboptimal implementation of challenge in clinical practice.

Purpose: To explore how challenge is conceptualised in stroke rehabilitation from the perspectives of people with stroke, physiotherapists, occupational therapists and speech-language therapists.

Methods: Principle-based concept analysis was used to explore challenge within the stroke rehabilitation literature. A systematic search and screening process was used to select literature with high informational value. Included papers were analysed to elicit understandings of the range of purposes, meanings and uses of challenge, within and across rehabilitation perspectives.

Results: A total of 42 papers were included. Challenge appeared to be a multidimensional and dynamic concept which was understood through three facets: nominal, functional and perceived challenge. Nominal challenge was understood as the task difficulty based solely on characteristics of the task. Functional challenge was defined as an interaction between the task difficulty and the person’s ability. Perceived challenge emerged as the person’s subjective experience of challenge. In practice, functional and perceived challenge were predominantly used to create optimal challenge.

Conclusions: Challenge is an important concept which, when carefully optimised to the person’s ability and perception, may positively influence their engagement with and outcomes from stroke rehabilitation.

Implications: Challenge involves a multifaceted, multidimensional and dynamic interaction between the task, the person’s ability and their subjective experience. Therapists should consider both functional and perceived approaches to the operationalisation of optimal challenge with the person.

Background:
Informal carers play a significant role in stroke recovery, but care provision can be challenging, including emotional distress, anxiety, and social isolation. With the abruptness of stroke presentation and the psychological stress of suddenly supporting a person with stroke, interventions that enhance carers’ ability to cope with and build resilience are required.

Purpose:
To report the feasibility and benefits of a strengths-based resilience intervention (SBRI) for carers of stroke survivors.

Methods:
Based on systematic review and qualitative findings along with experts’ advice, a recognised strengths-based resilience intervention was modified and evaluated using a randomised controlled trial comparing SBRI with usual care. SBRI was group delivered once a week for 8 weeks by a researcher with a psychology background and a trained Stroke Foundation advisor. SBRI focused on resilience skills, growth, flexible thinking, and identifying and cultivating character strengths. Qualitative interviews explored benefits, acceptability and sought improvement suggestions. Data were analysed with the General Inductive Approach. Quantitative measures (Connor–Davidson Resilience Scale (CD-RISC) and Psychological General Well-Being Index (PGWBI) scores were compared between groups using Cohen’s d.

Results:
Of 27 participants (NZ European=23, Māori=2, Asian=2, male carer =1, age mean(SD) 61(7), range 52-77 years), 13 were randomised to the SBRI group. SBRI was feasible to deliver, acceptable and potentially beneficial, but more suitable to carers two years post-stroke. A significant between group difference were found for CD-RISC (p = 0.01, d = 1.01) post-intervention.

Conclusions:
SBRI was found potentially beneficial and acceptable, and worthy of further investigation. Additional input is required for new carers. Future trials must broaden recruitment diversity.

Implications:
Interventions focusing on carers’ resilience should be integrated into stroke rehabilitation to ensure sustainability of care provided to stroke survivors, thus enhancing stroke recovery. Physiotherapists can be trained to deliver SBRI to develop their role of supporting carers.