An interpretative phenomenological analysis of delusions in people with Parkinson's disease

Purpose: The purpose of this study was to examine the feasibility and effects of an upper extremity gaming system on impairments, activity and participation restrictions in persons with chronic stroke. Method: Nine participants with chronic (5.4 SD 3 years after stroke) upper extremity impairment due to stroke completed 18 sessions over 6 weeks with the Hand Dance Pro? gaming system that included trunk restraint. Measures collected at pretest and posttest included three-dimensional motion analysis of paretic upper extremity reaching, Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS). Data were analyzed across time, with effect sizes (Cohen’s d), and by categorizing participants with Fugl-Meyer Upper Extremity Motor Assessment scores (mild >50/66, moderate 26–50/66 and severe <26/66). Results: Statistically, significant improvements and medium-to-large effect sizes from pretest to posttest were found with ipsilateral reaching kinematic outcomes of movement duration, mean velocity and elbow excursion (p < 0.05). Participants with mild impairment demonstrated the greatest change in elbow excursion. No significant differences and small effect sizes were found for the WMFT and SIS. Conclusion: The gaming intervention with high repetitions of reaching to targets and trunk restraint was feasible and led to improvements in upper extremity movement kinematics in this group of participants with chronic stroke.

Implications for Rehabilitation

• Persons with chronic stroke can tolerate a high number of repetitions (between 800 and 2000) of reaching for targets during 30 minutes of playing a video game.

• Gaming systems that incorporate multiple repetitions of reaching for targets with trunk restraint can improve movement patterns in the paretic upper extremity of persons with chronic stroke.

     

An augmented reality system for upper-limb post-stroke motor rehabilitation: a feasibility study

Purpose: To determine the clinical feasibility of a system based on augmented reality for upper-limb (UL) motor rehabilitation of stroke participants. Method: A physiotherapist instructed the participants to accomplish tasks in augmented reality environment, where they could see themselves and their surroundings, as in a mirror. Two case studies were conducted. Participants were evaluated pre- and post-intervention. The first study evaluated the UL motor function using Fugl-Meyer scale. Data were compared using non-parametric sign tests and effect size. The second study used the gain of motion range of shoulder flexion and abduction assessed by computerized biophotogrammetry. Results: At a significance level of 5%, Fugl-Meyer scores suggested a trend for greater UL motor improvement in the augmented reality group than in the other. Moreover, effect size value 0.86 suggested high practical significance for UL motor rehabilitation using the augmented reality system. Conclusion: System provided promising results for UL motor rehabilitation, since enhancements have been observed in the shoulder range of motion and speed.

• Implications for Rehabilitation

• Gain of range of motion of flexion and abduction of the shoulder of post-stroke patients can be achieved through an augmented reality system containing exercises to promote the mental practice.

• NeuroR system provides a mental practice method combined with visual feedback for motor rehabilitation of chronic stroke patients, giving the illusion of injured upper-limb (UL) movements while the affected UL is resting. Its application is feasible and safe.

• This system can be used to improve UL rehabilitation, an additional treatment past the traditional period of the stroke patient hospitalization and rehabilitation

     

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients after stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test–retest reliability. Method: TIS was translated according to international guidelines. The validity study was performed on data from 201 patients with acute stroke. Fifty patients with stroke and acquired brain injury were recruited to examine intertester and test–retest reliability. Construct validity was analyzed with exploratory and confirmatory factor analysis and item response theory, internal consistency with Cronbach’s alpha test, and intertester and test–retest reliability with kappa and intraclass correlation coefficient tests.Results: The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed. By combining items from the subscales Dynamic sitting balance and Coordination, six ordinal superitems (testlets) were constructed. The TIS-NV was renamed the modified TIS-NV (TIS-modNV). After modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. It demonstrated good construct validity, excellent internal consistency, and high intertester and test–retest reliability for the total score.Conclusions: This study supports that the TIS-modNV is a valid and reliable scale for use in clinical practice and research.

Implications for Rehabilitation

• Trunk control is an essential part of balance and postural control, thereby an important prerequisite for daily activities and function

• Impairments of trunk control is a common problem in stroke

• The TIS-modNV is a valid and reliable measure to evaluate impairments in trunk control

• The TIS-modNV containing ordinal superitems is recommended for use in clinical practice and research

     

Walking with robot assistance: the influence of body weight support on the trunk and pelvis kinematics

Purpose: The goal was to assess in healthy participants the three-dimensional kinematics of the pelvis and the trunk during robot-assisted treadmill walking (RATW) at 0%, 30% and 50% body weight support (BWS), compared with treadmill walking (TW). Methods: 18 healthy participants walked (2?kmph) on a treadmill with and without robot assistance (Lokomat; 60% guidance force; 0%, 30% and 50% BWS). After an acclimatisation period (four minutes), trunk and pelvis kinematics were registered in each condition (Polhemus Liberty? [240?Hz]). The results were analysed using a repeated measures analysis of variance with Bonferroni correction, with the level of suspension as within-subject factor. Results: During RATW with BWS, there were significantly (1) smaller antero-posterior and lateral translations of the trunk and the pelvis; (2) smaller antero-posterior flexion and axial rotation of the trunk; (3) larger lateral flexion of the trunk; and (4) larger antero-posterior tilting of the pelvis compared with TW. Conclusions: There are significant differences in trunk and pelvis kinematics in healthy persons during TW with and without robot assistance. These data are relevant in gait rehabilitation, relating to normal balance regulation. Additional research is recommended to further assess the influence of robot assistance on human gait.

• Implications for Rehabilitation

• The trunk and pelvis moves in a different way during walking with robot assistance.

• The data suggest that the change in movement is due to the robot device and the harness of the suspension system more than due to the level of suspension itself.

     

Effects of electromyography-driven robot-aided hand training with neuromuscular electrical stimulation on hand control performance after chronic stroke

Purpose: An electromyography-driven robot system integrated with neuromuscular electrical stimulation (NMES) was developed to investigate its effectiveness on post-stroke rehabilitation. Methods: The performance of this system in assisting finger flexion/extension with different assistance combinations was evaluated in five stroke subjects. Then, a pilot study with 20-sessions training was conducted to evaluate the training’s effectiveness. Results: The results showed that combined assistance from the NMES–robot could improve finger movement accuracy, encourage muscle activation of the finger muscles and suppress excessive muscular activities in the elbow joint. When assistances from both NMES and the robot were 50% of their maximum assistances, finger-tracking performance had the best results, with the lowest root mean square error, greater range of motion, higher voluntary muscle activations of the finger joints and lower muscle co-contraction in the finger and elbow joints. Upper limb function improved after the 20-session training, indicated by the increased clinical scores of Fugl-Meyer Assessment, Action Research Arm Test and Wolf Motor Function Test. Muscle co-contraction was reduced in the finger and elbow joints reflected by the Modified Ashworth Scale. Conclusions: The findings demonstrated that an electromyography-driven NMES–robot used for chronic stroke improved hand function and tracking performance. Further research is warranted to validate the method on a larger scale.

• Implications for Rehabilitation

• The hand robotics and neuromuscular electrical stimulation (NMES) techniques are still separate systems in current post-stroke hand rehabilitation. This is the first study to investigate the combined effects of the NMES and robot on hand rehabilitation.

• The finger tracking performance was improved with the combined assistance from the EMG-driven NMES–robot hand system. The assistance from the robot could improve the finger movement accuracy and the assistance from the NMES could reduce the muscle co-contraction on finger and elbow joints.

• The upper limb functions were improved on chronic stroke patients after the pilot study of 20-session hand training with the combined assistance from the EMG-driven NMES–robot. The muscle spasticity on finger and elbow joints was reduced after the training.

     

Understanding nursing practice in stroke units: a Q-methodological study

Abstract

Purpose: Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses’ involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses’ practice in stroke rehabilitation. Method: Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Results: Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. Conclusions: The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills.

• Implications for Rehabilitation

• Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care.

• Views of stroke unit team members on nurses’ involvement in rehabilitation have not been reported previously.

• Nurses can routinely incorporate rehabilitation principles in their care.

• Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.

     

Elbow flexion contractures in brachial plexus birth injury: function and appearance related factors

Abstract

Purpose: The purpose of this study was to identify the functional and aesthetic factors associated with an elbow flexion contracture in children with a brachial plexus birth injury who identified their elbow flexion contracture as a problem.

Materials and methods: A retrospective cross-sectional study of children with brachial plexus birth injury between 7 and 18 years was conducted to compare the characteristics of children who had treatment for an elbow flexion contracture with those who did not.

Results: Fifty of the 200 children included in the study had treatment (one surgical release, 49 serial casting/splinting) for the elbow flexion contracture. Children who had treatment were an average 12.4 years of age, which was significantly older than those who did not have treatment. Elbow extension passive range of motion was an average ?40.6° prior to treatment. Stepwise logistical regression model indicated that children who had treatment had greater severity in elbow contracture, higher Brachial Plexus Outcome Measure Activity scores, and lower Brachial Plexus Outcome Measure Self-Evaluation Appearance scores.

Conclusions: In addition to severity of contracture and function, perceived appearance of the limb is important factor to evaluate in the management of elbow flexion contractures.

• Implications for rehabilitation

• Priority is often given to evaluate the functional implications of elbow flexion contractures in brachial plexus birth injury to determine recommendations for rehabilitation interventions such as serial casting and splinting.

• Findings in this study indicate that severity of contracture, upper extremity activity function, and perceived upper extremity appearance are important factors in the management of elbow contractures.

• In addition to upper extremity function, routine evaluation of perceived upper extremity appearance in children and adolescents is important in the management of elbow flexion contractures.

     

Navigating stroke care: the experiences of younger stroke survivors

Abstract

Purpose: Although stroke is associated with ageing, a significant proportion of strokes occur in younger people. Younger stroke survivors have experienced care available as inappropriate to their needs. However, insufficient attention has been paid to how the social context shapes their experiences of care. We investigated this question with younger stroke survivors in Greater London, UK. Method: We conducted in-depth interviews with individuals aged between 24 and 62 years. Interviews were analysed thematically, with interpretation informed by Bourdieu’s concepts of field, capital and habitus. Results: In the acute care setting it was implicit for participants that expertise and guidance was to be prioritised and largely this was reported as what was received. Individuals’ cultural capital shaped expectations to access information, but health care professionals’ symbolic capital meant they controlled its provision. After discharge, professional guidance was still looked for, but many felt it was limited or unavailable. It was here that participants’ social, cultural and economic capital became more important in experiences of care. Conclusions: The field of stroke shaped younger stroke survivors’ experiences of care. Navigating stroke care was contingent on accessing different forms of capital. Differences in access to these resources influenced longer term adjustment after stroke.

• Implications for Rehabilitation

• Stroke care can be conceptualised as a temporal field of social activity and relationships which shapes variations in experiences of care among younger stroke survivors, and differences in expectations of support at different time points after stroke.

• On entering the field of stroke participants reported needing health care professional guidance and expertise to manage the acute event, yet difficulties accessing information in hospital limited the agency of some individuals wanting to take an active role in their recovery.

• After discharge from hospital variations in experiences of care among participants were more evident, with a number still seeking professional guidance, and requiring the capital and agency to navigate the field of stroke.

• Despite international efforts to improve the quality of acute care, effective models of community stroke care still need to be developed.

     

Facilitating mathematics learning for students with upper extremity disabilities using touch-input system

Purpose: To investigate the feasibility of using tablet device as user interface for students with upper extremity disabilities to input mathematics efficiently into computer. Methods: A touch-input system using tablet device as user interface was proposed to assist these students to write mathematics. User-switchable and context-specific keyboard layouts were designed to streamline the input process. The system could be integrated with conventional computer systems only with minor software setup. A two-week pre–post test study involving five participants was conducted to evaluate the performance of the system and collect user feedback. Results: The mathematics input efficiency of the participants was found to improve during the experiment sessions. In particular, their performance in entering trigonometric expressions by using the touch-input system was significantly better than that by using conventional mathematics editing software with keyboard and mouse. The participants rated the touch-input system positively and were confident that they could operate at ease with more practice. Conclusions: The proposed touch-input system provides a convenient way for the students with hand impairment to write mathematics and has the potential to facilitate their mathematics learning.

• Implications for Rehabilitation

• Students with upper extremity disabilities often face barriers to learning mathematics which is largely based on handwriting.

• Conventional computer user interfaces are inefficient for them to input mathematics into computer.

• A touch-input system with context-specific and user-switchable keyboard layouts was designed to improve the efficiency of mathematics input.

• Experimental results and user feedback suggested that the system has the potential to facilitate mathematics learning for the students.

     

Feasibility of a home-based program to improve handwriting after stroke: a pilot study

Purpose: To test the feasibility of a handwriting retraining program with adults after stroke; specifically the feasibility of: (i) recruiting people with stroke to the study, (ii) delivering the handwriting retraining program and (iii) outcome measures of handwriting performance. Method: A quasi-experimental pre-test post-test design was used. A four-week, home-based handwriting retraining program was delivered by an occupational therapist using task-specific practice. Legibility, speed, pen control and self-perception of handwriting were measured at baseline and completion of the program. Legibility was scored by a blinded rater. Results: Seven adults with stroke were recruited (eligibility fraction 43% of those screened, and enrolment fraction 78% of those eligible). There were no dropouts. Although, recruitment was slow the intervention was feasible and acceptable to adults with stroke. No statistically or clinically significant changes in legibility were reported in this small sample, but a ceiling effect was evident for some outcome measures. The study was not powered to determine efficacy. Conclusions: Delivery of a four-week handwriting intervention with eight supervised sessions in the community was feasible; however, recruitment of an adequate sample size would require greater investment than the single site used in this pilot.

• Implications for Rehabilitation

• Handwriting difficulty is common following hemiparesis after stroke, however research addressing handwriting retraining for adults with stroke is lacking.

• A four-week home-based handwriting program using task-specific practice and feedback was feasible to deliver and appropriate for adults with stroke.

• Improving handwriting legibility and neatness across a range of tasks were important goals for adults with handwriting impairment.

     

Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke

Purpose: To explore the nature and impact of foot and ankle impairments on mobility and balance in community-dwelling, chronic stroke survivors. Methods: A qualitative research design using face to face semi-structured, audio recorded interviews. Thirteen community-dwelling stroke survivors, all of whom had self-reported foot and ankle impairments, were interviewed (female n?=?6, mean age?=?67 years, SD?=?12 years, mean time since stroke?=?4 years, SD?=?6 years, right stroke n?=?7, left stroke n?=?6). A framework analysis approach was used to analyse and interpret transcribed interviews. Results: Three themes emerged: (1) Impact. The influence of foot and ankle impairments on mobility and balance. (2) Standing out. How participants felt they “stood out” because of their impairments and wanted to be normal. (3) Help. The specific help and advice participants received in managing their problems. Conclusions: Foot and ankle impairments such as pain, altered somatosensory input and weakness significantly contribute to problems with community ambulation, balance and fear of falling in people with chronic stroke. Specific foot and ankle impairments may also negatively contribute to perceptions of physical appearance and self-esteem. Therapeutic management approaches within clinical practice appear to focus mostly on the gross performance of the lower limb with little emphasis on the specific assessment or treatment of the foot or ankle.

• Implications for Rehabilitation

• Foot pain, sensory impairments and muscle weakness in the foot and ankle can impact on community ambulation, balance and fear of falling following stroke.

• Foot and ankle function post-stroke should be routinely assessed and monitored.

• Clinicians should be aware of the potentially distressing negative perceptions associated with altered gait patterns, footwear and orthotic use.

     

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

     

Survivors of chronic stroke – participant evaluations of commercial gaming for rehabilitation

Purpose: There has been an increase in research on the effect that virtual reality (VR) can have on physical rehabilitation following stroke. However, research exploring participant perceptions of VR for post-stroke rehabilitation has been limited.

Method: Semi-structured interviews were conducted with 10 chronic stroke participants (10 males, mean age?=?72.1, mean time since injury?=?38.6 mos.) who had recently completed an upper extremity VR stroke rehabilitation programme.

Results: Four main themes emerged: ‘the VR experience,’ ‘functional outcomes,’ ‘instruction,’ and the ‘future of VR in stroke rehabilitation,’ along with nine sub-themes. Participants illustrated the positive impact that VR training had on their functional abilities as well as their confidence towards completing activities of daily living (ADL). Participants also expressed the need for increased rehabilitation opportunities within the community.

Conclusion: Overall, participants were optimistic about their experience with VR training and all reported that they had perceived functional gain. VR is an enjoyable rehabilitation tool that can increase a stroke survivor’s confidence towards completing ADL.

• Implications for Rehabilitation

• Although there is an increase in rehabilitation programmes geared towards those with chronic stroke, we must also consider the participants’ perception of those programmes.

• Incorporating participant feedback may increase enjoyment and adherence to the rehabilitation programmes.

• The VR experience, as well as provision of feedback and instruction, are important aspects to consider when developing a VR programme for stroke survivors.

• VR for rehabilitation may be a feasible tool for increasing the survivors’ confidence in completing ADL post-stroke.

     

Rhythmic auditory cueing to improve walking in patients with neurological conditions other than Parkinson’s disease – what is the evidence?

Purpose: To investigate whether synchronising over-ground walking to rhythmic auditory cues improves temporal and spatial gait measures in adults with neurological clinical conditions other than Parkinson’s disease. Method: A search was performed in June 2011 using the computerised databases AGELINE, AMED, AMI, CINAHL, Current Contents, EMBASE, MEDLINE, PsycINFO and PUBMED, and extended using hand-searching of relevant journals and article reference lists. Methodological quality was independently assessed by two reviewers. A best evidence synthesis was applied to rate levels of evidence. Results: Fourteen studies, four of which were randomized controlled trials (RCTs), met the inclusion criteria. Patient groups included those with stroke (six studies); Huntington’s disease and spinal cord injury (two studies each); traumatic brain injury, dementia, multiple sclerosis and normal pressure hydrocephalus (one study each). The best evidence synthesis found moderate evidence of improved velocity and stride length of people with stroke following gait training with rhythmic music. Insufficient evidence was found for other included neurological disorders due to low study numbers and poor methodological quality of some studies. Conclusion: Synchronising walking to rhythmic auditory cues can result in short-term improvement in gait measures of people with stroke. Further high quality studies are needed before recommendations for clinical practice can be made.

Implications for Rehabilitation

• Gait training using synchronisation of walking to rhythmic auditory cues may improve stride length and velocity in people with stroke.

• Further research is needed before recommendations regarding the use of rhythmic auditory cueing for patients with neurological disorders other than Parkinson’s disease can be made.

     

Design,testing and evaluation of angle-adjustable backrest hardware

Purpose: The purpose of this study was to design and evaluate a final design prototype of angle-adjustable backrest hardware. Methods: A traditional iterative design development protocol was undertaken and completed. Before evaluation by a focus group, testing of the prototype was performed in strict accordance with ISO standards. Focus group participants were between 18 and 80 years of age, used a manual wheelchair as their primary means of mobility, and transferred independently. Individuals with pressure sores or who required of the use of specialized or custom seating for trunk support were excluded from the study. A questionnaire was administered to elicit participants’ opinions on the adjustability, function and appearance of the angle-adjustable backrest device. Results: The prototype successfully met the ISO testing standards. Wheelchair users (n?=?8) who evaluated the device in a focus group had an overall positive response. Things they most liked about the prototype were comfort, support (function/activities) and adjustability, while things they most disliked about the prototype were problems with string and reaching back position to adjust. Conclusions: The prototype had a positive impression from participants, however, improvements on the operation method and usability were suggested.

• Implications for Rehabilitation

• The adjustable backrest is in need of development to provide function, comfort and support for manual wheelchair users.

• Manual wheelchair users will benefit by using the angle adjustment as they maintain their active lifestyles.

• Balance control while performing pressure relief in a wheelchair would be increased.

     

A real time biofeedback using Kinect and Wii to improve gait for post-total knee replacement rehabilitation: a case study report

Purpose: This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group. Method: The biofeedback system consisted of Microsoft Kinect^TM and Nintendo Wii balance board with a dedicated software. A six-week inpatient rehabilitation program was augmented by biofeedback and tested in a single patient following TKR. Three patients underwent a six weeks standard rehabilitation with no biofeedback and served as a control group. Gait, function and pain were assessed and compared before and after the rehabilitation. Results: The biofeedback software incorporated real time visual feedback to correct limb alignment, movement pattern and weight distribution. Improvements in pain, function and quality of life were observed in both groups. The strong improvement in the knee moment pattern demonstrated in the case study indicates feasibility of the biofeedback-augmented intervention. Conclusion: This novel biofeedback software has used simple commercially accessible equipment that can be feasibly incorporated to augment a post-TKR rehabilitation program. Our preliminary results indicate the potential of this biofeedback-assisted rehabilitation to improve knee function during gait. Research is required to test this hypothesis.

• Implications for Rehabilitation

• The real-time biofeedback system developed integrated custom-made software and simple low-cost commercially accessible equipment such as Kinect and Wii board to provide augmented information during rehabilitation following TKR.

• The software incorporated key rehabilitation principles and visual feedback to correct alignment of the lower legs, pelvic and trunk as well as providing feedback on limbs weight distribution.

• The case study patient demonstrated greater improvement in their knee function where a more normal biphasic knee moment was achieved following the six-week biofeedback intervention.

     

Attendance at a psychological support group for people with multiple sclerosis and low mood

Purpose: A cognitive behavioural group promoting psychological adjustment for people with multiple sclerosis (MS) was found to reduce psychological distress. Not all those offered treatment attended the group sessions. The aims were to examine the rates of attendance and to evaluate feedback from participants. Method: Participants with MS and low mood were recruited to a randomized trial comparing attendance at a psychological support group with a usual care control group. The attendance at each session was determined and those who attended were compared with those who failed to attend using a Mann–Whitney U-test or chi-squared. A sample of participants completed a telephone feedback questionnaire to determine their views of the group. Results: The 44 participants who attended four or more sessions were not significantly different from the 28 who attended fewer than four sessions on demographic variables, disability, self-efficacy or quality of life, but significantly fewer men attended than women (p?=?0.03). Participants’ feedback from the group was mainly positive, and no factors were identified associated with non-attendance. Conclusions: Men were less likely to attend group treatment sessions than women, but no other variables were associated with non-attendance. Attendance rates influence the effectiveness of interventions and reasons for non-attendance need to be determined.

Implications for Rehabilitation

• Not all people with multiple sclerosis (MS) and low mood offered psychological support will attend group sessions.

• Women are more likely to attend psychological support groups for people with MS than men.

• In clinical practice it may be possible to adjust the membership of groups to increase attendance more than in randomized trials.