The National Clinical Programme for Rheumatology pilot project Work-Able Solutions is an integrated care occupational therapy vocational rehabilitation service for people with musculoskeletal disorders and arthritis. Funded by the Sláintecare Integration Innovation Fund (2022) this pilot is delivering services across Dublin South, Wicklow, Kildare, and Waterford until December 2024. Two sites are based in the acute hospital setting (St Vincent’s University Hospital and Naas General Hospital) and delivering service outward into primary care; the third site is in primary care (Waterford Primary Care) with inward links to the rheumatology service in University Hospital Waterford. Referrals are accepted from primary care and hospital rheumatology multidisciplinary team members.

Work-Able Solutions services deliver early access to individualised, flexible and tailored evidence-based interventions to people with musculoskeletal disorders and arthritis who require additional help to remain in or return to work. The service implements a ‘stepped-care approach’ starting with simple, low-intensity, low-cost interventions and with in-built mechanisms for progressively more intensive and structured interventions where required. This ‘stepped-care approach’ is aligned with established recommendations internationally and is associated with positive work outcomes including return to work rates, decreased absenteeism, increased productivity and self-management. Co-design of the service pathway, content, and modes for evaluation was completed by the National Clinical Programme team informed by the rheumatology programme of work and priorities, existing research and clinical practice, and included collaboration with the Department for Social Protection.

Vocational rehabilitation in community settings is increasingly common practice internationally however, this service is unique in the Irish context and implementation of the Work-Able Solutions services aligns Irish management of this work-based need with international practice. Furthermore, the project incorporates the Sláintecare implementation strategy (2018) goals and actions which focus on integrated care with specialist acute care providers delivering timely interventions in tertiary services.

Work-Able Solutions services have been fully operational since September 2023 with more than one hundred individuals seen to date. Monthly reporting to the funders is being completed to monitor how the service is supporting individuals to retain their work role or return to work after absences. In addition, a quasi-experimental study using a before and after design with a three-month follow up is being conducted to examine the effectiveness of the project. A detailed report to the funders will be completed at the end of pilot and formal research findings will be disseminated nationally and internationally. Findings will guide and influence the future development and national roll out of this service improvement initiative and improve access to timely work supports for this population. Furthermore, results will enable increased understanding of the influence of this type of service pathway and intervention in supporting a reduction in work absenteeism, improving work productivity, work presenteeism, work self-efficacy and health-related quality of life.

Introduction:
Access to rehabilitation is a basic human right yet often, accessing services is a challenge, especially in remote areas. Rehabilitation reduces disability, improves quality of life and saves money. Technology has the potential to transform rehabilitation by revolutionising service delivery.
Healthcare systems globally face combined challenges of limited resources and increasing demand for rehabilitation and healthcare services. Remote and isolated areas face increased challenges, where the proportion of older people is higher and distances for accessing healthcare services greater.
The ROSIA pre-commercial procurement project is creating a co-produced Innovation Ecosystem to pave the way for an extensive deployment of the self-care model for long-term conditions and disabilities, by generating a scalable model of Integrated care, organised around tele-rehabilitation and supported self-management of care.
The project is funded by the EU H2020 research and innovation programme. The 12 ROSIA healthcare partners include 3 procurers from Ireland, Spain, and Portugal.
Methodology:
In PCP, public procurers buy R&D from several competing suppliers in parallel to compare alternative solution approaches and identify the best value for money solutions that the market can deliver to address their needs. R&D is split into phases (solution design, prototyping, original development and validation/testing of a limited set of products) with the number of competing R&D providers being reduced after each R&D phase.

The preparatory phase included:

• A state-of-the-Art (SotA) analysis: the SCaling IntegRated Care in COntext (SCIROCCO) Self-assessment Tool for Integrated Care, Literature Reviews, Telehealth Capacity and Readiness Assessments, Stakeholder Needs Analysis and an Open Market Consultation.

The ROSIA design process includes:
Phase 1 - Design of ROSIA’s model based on evidence informed iterative work of co-creation with patients, clinicians and technical partners
Phase 2 - Prototype Development of three proposed solutions selected from Phase 1.
Phase 3 - Development and testing of the completed solution.

Results to date:
Through an Open Tender process, successful bidders were selected, leading to a first step in the design of a cutting-edge digital solution to support community integrated care.
The ROSIA Innovation Ecosystem comprises three elements:
- Development of an Open Platform to host shared services.
- Developers Tools.
- ROSIA Catalogue of certified ICT and telehealth solutions.
Applications and devices will connect to an open platform with integration of community supported self-care into patients’ care plans.
Phase 2: Functional demonstrations of each contractor's prototypes have been organised online providing clinicians and patients with the opportunity to engage with the contractors in a dynamic interaction and provide feedback for further prototypes development.

Next steps:
Phase 3, commencing February 2024 for 14 months, involves developing and testing the completed solution for clinical effectiveness, economic analysis and patients’ personal experience.

ROSIA provides interoperable solutions validated by end users across all three ‘procurer’ countries. Innovation procurement will provide valuable learning for an international audience.
Conclusion:
ROSIA will allow a model shift from hospital-based rehabilitation to tele-rehabilitation under follow-up of clinicians and self-management at home, optimising quality of care, patient experience and the use of clinical resources helping achieve the quintuple aim.

INTRODUCTION

Physical inactivity is a leading contributor of global disability-adjusted life-years (DALYs), incurring significant costs to patients and providers. Singapore recently announced Healthier SG, a nationwide initiative emphasising preventive health, including strategies to boost activity. The Singapore Physical Activity Guidelines are also regularly updated to encourage movement. Despite ongoing efforts, the proportion of residents achieving sufficient physical activity has declined. This paper presents the strategic integrative plan of Singapore’s National Healthcare Group, a sub-national public healthcare provider group, to create an active lifestyle ecosystem for sarcopaenia, exercise medicine, and musculoskeletal and joint health.

LIFE COURSE APPROACH

People begin life in good health, but suffer chronic diseases like osteosarcopaenia as they age, increasing risk of frailty and functional deterioration. Using a physical travelator analogy and a Life Course approach highlights opportunities for stakeholders to intervene with primary, secondary, and tertiary prevention strategies.

We established a multidisciplinary Steering Committee in 2020 to gather experts to develop clinical strategies, service development plans and integrate care across these fields to help residents increase years of healthy life.

CURRENT GAPS

Through comprehensive literature review and consulting internal and external experts, the committee identified five key gaps:

1) Residents are not exercising enough, increasing physical inactivity and associated comorbidities.
2) Physical Activity Vital Signs and other measures like gait speed are not routinely captured, reducing valuable information to help professionals manage residents.
3) Widespread use of safe exercise guidelines for population subgroups (e.g. those with disabilities or comorbidities) is lacking, thereby reducing physical activity.
4) Integrated pathways linking residents in primary or tertiary care back to community care are lacking, overburdening these services.
5) There are insufficient services and manpower in primary and preventive care, so residents may not receive prompt treatment, increasing disease chronicity and morbidity.

STRATEGIC THRUSTS

To bridge these gaps, the committee developed a vision for an active lifestyle ecosystem, anchored on three strategic thrusts: collective learning, care integration, and health and ecosystem mapping.

First, education, community engagement, and collaborative learning will reinforce the importance and adoption of physical activity. Second, care integration and information sharing improve outcomes with equivalent manpower. Third, mapping residents’ physical activity along standardised measures will enable data analytics to tailor precision population interventions.

DESIRED OUTCOMES AND FUTURE STATE

Our Physical Health programmes have shown initial success. The Collaborative Model of Care Between Orthopaedics and Allied Health Professional for Knee Osteoarthritis (CONNACT Plus) shifted osteoarthritis care from a hospital-centric episodic model to a community-centric chronic care model. Patients showed improved knee function and pain scores, with reduced healthcare costs. Other successful programmes include shared care models for non-surgical musculoskeletal care, and early community-based screening and intervention for frailty.

Outcomes align with national Healthier SG efforts, including physical activity levels, reduced emergency department attendance, and DALYs. Ecosystem-wide collection and review of physical activity measures are another success indicator.

The desired future is an active lifestyle ecosystem leveraging physical health measures, where individual ownership of one’s health naturally leads to adopting an active lifestyle, unconstrained by health status, disability, or age.

Patient and family caregiver experience is pivotal for integrated care, providing guidance for care coordination, decision-making, quality improvement, communication, and cultural transformation. By actively obtaining and responding to feedback, healthcare systems can enhance the effectiveness and responsiveness of integrated care, ultimately leading to improved outcomes and satisfaction for patients and their family caregivers. However, there is a notable gap in research addressing the effective utilization of diverse methods for collecting patient experience data to drive healthcare improvements. The aim of this scoping review was to address that gap by exploring the literature to examine the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in post-acute rehabilitation settings.
The review followed the JBI guidelines and Arksey & O’Malley methodological framework. A comprehensive search was performed across four databases (OVID MEDLINE; CINAHL; APA PsycINFO; COCHRANE) to capture the extent of the literature on this topic relevant to rehabilitation. Qualitative and quantitative studies (2012-2023) describing collection of patient experience data with the intent of using it for healthcare improvement in post-acute rehabilitation settings were included. After screening and data extraction, qualitative content analysis and thematic mapping were utilised to explore the selected studies.
Of 3570 initial records, 160 full texts were screened, and 30 were included in the final analysis. Majority of included studies were conducted among hospital patients, during admission (43.3%) or within three weeks post-discharge (13.3%). Caregiver experiences were gathered in conjunction with patient data in 40% of the studies. Most studies (70%) employed qualitative data collection methods, using semi-structured interviews or focus groups to elicit patient experience data, which indicates the need to speak directly with people regarding their care experience. On four occasions (13.3%), a mixed-methods approach was used, with a questionnaire administered alongside qualitative methods. In six (66.6%) of the quantitative studies, self-developed questionnaires were used rather than validated instruments. This may suggest that the routinely collected patient data are infrequently used for quality improvement initiatives within rehabilitation settings.
This evidence synthesis highlights the diverse methods used and contexts in which patient and family caregiver experience has been gathered in post-acute rehabilitation settings. Several papers mentioned quality improvement based on collected patient experience data but did not provide details of quality improvement activities or their corresponding impact. Few papers offered recommendations for policy or practice changes. Studies utilizing patient experience data reported a diverse array of small improvements to specific aspects of care (e.g., changes to discharge process or hospital documentation), or the development of educational materials or toolkits for patient use. This indicates there is underutilized potential for using patient experience data to improve rehabilitation care and services.
This scoping review provides a better understanding of how patient experience is being utilised in post-acute settings. However, it demonstrates the need for methodological rigor and transparency in future research when reporting how patient and family caregiver data is used for improving healthcare quality and integration. Future research should clearly articulate Patient and Public Involvement (PPI) in the research process, including implementation and evaluation.

Introduction
The National Clinical Guideline for Stroke charts the patient journey through hospital, rehabilitation, vocational rehabilitation & secondary prevention.
However of 238 pages, <2 pages deal with ‘Social integration & participation’, <1 page addresses ‘Long-term support services’, yet someone with a stroke may live for another 40 –50 years.
Method
The National Clinical Guideline for Stroke (2023) & related Acquired Brain Injury Guidelines were reviewed through the lens of United Nations Convention on the Rights of Persons with Disability (UNCRPD).
Results
Guidelines are largely based on models of service delivery, professional practices, expert opinion, available research, input from professional bodies & third sector organisations.
The UNCRPD definition of rehabilitation appears in in the current stroke guideline but reference to the human and disability rights of patients is not particularly visible.
Evidence Based Practice is not enough
Evidence Based Practice Clinical Stroke Guidelines are largely aimed at Health & Social Care services & professionals, yet:
• Patients & their families feel abandoned on completion of their care;
• Clinicians report their patients “are going home to nothing. Absolutely nothing!”, and;
• The disability that patients & their families experience for the rest of their lives is largely caused by the attitudes & barriers they encounter in society.
Human Rights Based Guidelines
Human Rights Based Stroke Guidelines should be developed which encompass Evidence Based Practice as well as the duties and responsibilities of states who have signed up to the UNCRPD.
Guidelines should identify actions within government departments of: Culture, Media, Sport, Education, Housing, Work, Environment & Transport which would significantly improve the lives of people living with Stroke and their families.
This is a societal model of rehabilitation, or reverse engineered rehabilitation.
The knowledge, skill, background and experience of Health & Social Care professionals is key in identifying the “attitudinal & environmental barriers that hinders the full & effective participation of their patients in society” as well as coming up with solutions on a population basis.
Human Rights Based Practice in The Arts & Sport
At Brain Injury Matters (NI) we model & deliver long-term rehabilitation based on the UNCRPD.
We showcase mainstream participation in The Arts & Sports “on an equal basis as others”.
Our Creatives & Sports people (formerly know as patients / clients) demonstrate that people with significant Physical, Cognitive, Behavioural & Emotional impairments can take part in mainstream Arts exhibitions, festivals & Sports events “on an equal basis as others”.
The Arts & Sports rehabilitation should be a key section in stroke guidelines as described in the UNCRPD “Article 30 –Participation in cultural life, recreation, leisure and sport.”
Conclusion
• This UNCRPD Human Rights Based model of rehabilitation aims to eradicate exclusion, challenge societal norms & change expectations.
• Human Rights Based Stroke Guidelines would promote the principles of the Charter of the United Nations (1946) of human dignity, worth & rights.
• Allied Health Professionals and the wider multidisciplinary team have a key role in Human Rights Based Practice, particularly in The Arts & Sports.

Introduction
Pedal Power is a Physiotherapist led, evidence based intervention, allowing people with acquired brain injury (ABI) to have regular social interaction, to be physically active, to cycle, attain cycling qualifications and to be skilled and equipped. This programme is delivered in partnership with Sustrans (NI) at their Active Travel Hub, at CS Lewis Square, Belfast.
Method
Adapted trikes, helmets, cycling shoes and jerseys are provided as part of this adapted cycling programme, 'Pedal Power'. Participants cycle weekly around miles of traffic free paths in their community. It is known people with ABI and disabilities have much lower levels of physical fitness and physical activity. The medical, physical, psychological, cognitive and social benefits of cycling and exercise has been well established. A key influence for 'Pedal Power' was Dr Dave Saunders, University of Edinburgh, lead author of the Cochrane review ‘Physical fitness training for stroke’ (an ABI). More recent research has demonstrated that one of the most important factors in ensuring that people stay engaged in sport and physical activity in the long-term, is social support. Some of this research was carried out 20 years ago, so this adapted cycling programme is about putting that research into practice. Additionally, 'Pedal Power' seeks to reflect the UN Convention on the Rights of People with Disabilities, particularly articles 8 (awareness raising) and article 30 (participation in cultural life, recreation, leisure and sport).
Results
Participants with a wide range of clinical needs report enhanced understanding of their ABI as well as improved mood, self-efficacy and social integration. Participants also feel supported across the lifespan and self-report developing new interests and skills. One person who suffered an ABI as a teenager, self-referred 20 years after injury, hoping: “…Just to have a purpose. Meet people with brain injury so I don’t feel alone.”
Conclusion
Pedal Power supports the World Health Organisation's definition of rehabilitation i.e., "appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.” This innovative programme shows promise in providing long term community support and rehabilitation to those impacted by ABI, and ultimately offers invaluable support and friendship.