A considerable number of patients present with an upper limb impairment after stroke, which has a significant impact on daily life activities and quality of life. Currently, based on a Cochrane review, there is no high-quality evidence for any of the upper limb interventions used in routine practice. Therefore, the Jessa Hospital developed an additional arm-hand boost programme (AHA-BOOST), a novel, stratified intervention that integrates neurophysiological knowledge with an early start to optimise poststroke upper limb recovery.

This multicentre randomised controlled trial with parallel design compares AHA-BOOST with a dose-matched programme for the lower limbs. Both interventions are in addition to usual care and consist of a combination of group sessions (1 hour per day, 5 times per week) and individualised therapy (two 30 min sessions per week) provided over 4 weeks. In total, 80 subacute stroke patients will be recruited from five rehabilitation centres in Belgium and randomised to one of both interventions. Patients will be followed up until 12 months post stroke to support a cost-utility analysis and assess long-term clinical effects of the programme. Various outcomes are collected at different time points: preintervention, immediately post intervention, 3 months post intervention, 6 months post stroke and 12 months post stroke. The Action Research Arm Test is the clinical primary outcome. The secondary outcomes are: Fugl-Meyer assessment—upper extremity, Stroke Upper Limb Capacity Scale, Barthel Index, modified Rankin Scale, Stroke Impact Scale and EuroQoL 5D-5L (EQ-5D-5L). The clinical analysis includes a multivariate analysis of variance (MANOVA) analysis for comparing clinical changes between both groups and a subgroup analysis to explore the effects in different types of stroke survivors. Additionally, a process evaluation, guided by the Medical Research Council Framework, will assess key aspects of the implementation, including delivery (structures and resources), dose, reach, fidelity, adaptations, quality, mechanisms of change and the context. Both quantitative and qualitative data will be collected using the following tools during the intervention: therapy diaries for each session; video recordings of AHA-BOOST group sessions and after the intervention using: interviews with patients, therapists and management. The qualitative data will be assessed using content and thematic analysis and the quantitative data with descriptive statistics. Ultimately, in addition to the EQ-5D-5L, direct and indirect healthcare costs are collected for the health economic evaluation. A cost-utility analysis will be performed with a time horizon of 12 months post stroke comparing both therapies, and a Markov model will assess the cost-effectiveness of AHA-BOOST on a lifetime horizon. To test the robustness of the results, sensitivity and scenario analysis will be performed.

Ethical approval has been obtained by different ethical committees (UZ/KU Leuven (central committee), UZ Gent, Gasthuiszusters Antwerpen and Maria Middelares). The study will be performed in accordance with the protocol, current International Council for Harmonisation (ICH) and Good Clinical Practice (ICH-GCP) guidelines, and applicable regulatory requirements. The current approved protocol is version 5, dated 7 May 2025. Protocol amendments will be submitted to all involved ethical committees. The study results will be disseminated through peer-reviewed publications, conference presentations and stakeholder reports.

NCT06517251.

Frequent use of emergency departments (EDs) places a considerable burden on healthcare systems. Although frequent attenders are known to have complex physical, mental health and social needs, national-level evidence on their characteristics and patterns of attendance remains limited. This study aimed to provide a comprehensive, population-level description of frequent ED attendance in England, with a focus on age-based subgroups.

Retrospective cohort study.

EDs in England via the Hospital Episode Statistics and the Emergency Care Dataset data linked with primary care prescribing and mortality data, between March 2016 and March 2021.

The dataset received from National Health Service Digital contained approximately 150 million ED attendances by 30 million adult (>18 years) patients over the time period April 2016 to March 2021. A random sample of 5 million people was used for this analysis.

The primary outcome was the number of attendances in each financial year by frequent attenders compared with the remaining patients, split by age bands. Patients were classified as frequent attenders if they had ≥5 or ≥10 ED attendances within a rolling 12-month period. Secondary outcomes included demographic, diagnostic and prescribing characteristics, as well as the number of different ED sites visited.

A Gaussian mixture model was used to identify age-based subgroups. Descriptive statistics were used to summarise key features; 95% CIs were reported where applicable. Among 3.91 million unique adult ED attenders, there were 8.7 million attendances. Of these, 222 160 individuals (5.7%) had ≥5 attendances in a year, accounting for 12.6% of total attendances. A trimodal age distribution was identified, with three distinct peaks corresponding to ages 18–34, 35–64 and 65+. Frequent attenders were more likely to live in deprived areas and have a history of psychotropic or analgesic prescribing. Mental health diagnoses and polypharmacy were particularly common in the younger and middle-aged groups. Multisite attendance was uncommon, with over 80% of frequent attenders using only one ED site annually.

This national analysis reveals a trimodal age pattern among frequent ED attenders, with differing clinical and socio-demographic profiles across age groups. These findings highlight the need for age-tailored approaches to managing high-intensity ED use and inform targeted service development.