Clinical correlates of global functioning in obese treatment seeking persons with binge eating disorder

BACKGROUND

In recent years, research has called for an increased emphasis on clinical outcomes that are meaningful to patients with binge eating disorder (BED). This cross-sectional study examined the Global Assessment of Functioning (GAF) and its relation to clinical and demographic factors in BED patients.

SUBJECTS AND METHODS

Thirty-two patients (28 women and 4 men) with BED (age = 41.1 ± 10.7; body mass index = 38.9 ± 5.8) seeking treatment to a weekly multidisciplinary programme at the UPC KU Leuven, Campus Kortenberg in Belgium, were asked to participate at intake. All participants were assessed with the GAF scale, completed the Eating Disorder Inventory (EDI), the Body Attitude Test (BAT), the Symptoms Checklist-90, the Baecke Physical Activity Questionnaire (BPAQ), and performed a 6 minute walk test.

RESULTS

The GAF-score (55.9 ± 13.9) was only significantly associated with the BPAQ score (7.0 ± 1.4) (r = 0.383, p = 0.03) and the BAT score (63.9 ± 16.1) (r=-0.443, p = 0.011). The regression model including both of these variables explained 25.3% of the variability in the GAF-score.

CONCLUSIONS

This study highlights the value of clinicians assessing physical activity and body image in patients with BED. Research is needed to elucidate whether incorporating body image treatments and physical activity in the care of patients with BED can promote global functioning.

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

PURPOSE

The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity.

METHODS

Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented.

RESULTS

The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1 ± 75.8 m versus 682.7 ± 98.4, p < 0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p < 0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED.

CONCLUSION

Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.

IMPLICATIONS FOR REHABILITATION

Rehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment. Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers. Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.

What are the factors that influence physical activity participation in adults with knee and hip osteoarthritis? A systematic review of physical activity correlates

Objective:

To determine the factors associated with physical activity participation in adults with hip or knee osteoarthritis.

Methods:

A systematic review was conducted including searches of AMED, PsycINFO, CINAHL, MEDLINE, EMBASE, PubMed and the Cochrane Library from inception until October 2013. Studies presenting quantitative correlates of physical activity in adults with hip and/or knee osteoarthritis were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment. Correlates were analysed using the summary code approach within the socio-ecological model.

Results:

A total of 170 correlates were identified from 29 publications analysing 8076 individual people with hip or knee osteoarthritis. Methodological quality was generally good. For knee osteoarthritis, factors consistently negatively associated with physical activity (reported more than four studies) were increasing age (number of participants in studies supporting association = 4558), non-white ethnicity ( n = 3232), increased osteoarthritis symptoms ( n = 2374) and female gender ( n = 4816). Greater lower limb function ( n = 1671) and faster gait speed were ( n = 4098) positively associated with physical activity. Social (e.g. support from spouse ( n = 141)) and environment (outdoor temperature ( n = 38)) factors were identified as possible factors that influence physical activity. For hip osteoarthritis, higher body mass index ( n = 99), increased comorbidities ( n = 1021), lower mental health ( n = 189) and unemployment ( n = 65) were negatively associated with physical activity; while better social functioning ( n = 1055) and health-related quality of life were positively associated with physical activity ( n = 34).

Conclusion:

Demographic, physical, social, psychological and environmental factors are all important correlates for physical activity for people with knee or hip osteoarthritis. Clinicians should consider these in clinical practice.

Pain is associated with recurrent falls in community-dwelling older adults: evidence from a systematic review and meta-analysis

BACKGROUND

Pain and recurrent falls are highly problematic in community-dwelling older adults, yet the association remains elusive.

OBJECTIVE

The objective of this study was to investigate the association between pain and recurrent falls in community-dwelling older adults.

DESIGN

Two independent reviewers conducted searches of major electronic databases, completed methodological assessment, and extracted the data of all included articles. Articles that were included are those that (1) involved community-dwelling older adults; (2) recorded recurrent falls; and (3) assessed pain. Articles that were excluded are those that included participants with dementia, any neurological conditions, or those with orthopedic trauma/surgery in the past 6 months.

RESULTS

Out of a potential of 71 articles, 11 met the inclusion criteria and 7 (N = 9,581) were eligible for the meta-analysis. The annual prevalence of recurrent falls in those reporting pain (12.9%) was higher than the pain-free control group (7.2%, P < 0.001). A global meta-analysis established that pain was associated with recurrent falls (odds ratio [OR]: 2.04, confidence interval [CI]: 1.75-2.39; N = 3,950 with pain and N = 5,631 controls), and this was decreased in a subgroup meta-analysis utilizing prospective studies only (OR: 1.79, CI: 1.44-2.21, P < 0.001, I2  = 0%; N = 3, N = 2,646). A subgroup analysis comparing recurrent fallers vs. non-fallers only (OR: 2.18, CI: 1.82-2.60, N = 6,320, I2  = 0%) established the odds were particularly higher than single fallers vs. non-fallers (OR:1.44, CI: 1.26-1.64, N = 6,903, (I2)  = 0%).

CONCLUSION

Older adults with pain are at particularly increased risk of recurrent falls. Clinicians working with recurrent fallers should routinely assess pain while pain specialists should inquire about older adults' falls history.

Barriers to and facilitators of physical activity among persons with schizophrenia: a survey of physical therapists

OBJECTIVE

This study examined the experience, perceptions, and knowledge of physical therapists who work within mental health services regarding barriers to and facilitators of physical activity among people with schizophrenia.

METHODS

A total of 151 physical therapists, members of the International Organization of Physical Therapists in Mental Health, completed an online survey. Data-driven and concept driven content analysis was conducted with the responses.

RESULTS

The most frequently cited barriers were patients' lack of motivation (45% of respondents) and a lack of priority given to physical activity by other health care professionals (28%). The most frequently cited facilitators included the provision of esteem support by health care professionals (28%) and the promotion of enjoyment and autonomy for the patient (25%).

CONCLUSIONS

When promoting physical activity among individuals with schizophrenia, health care professionals who work in mental health settings should provide an individual approach, taking into account patient related and situational factors.

Selection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis

This research provides a critical consideration of the outcome measures used to assess physical activity in individuals with severe mental illness. A narrative synthesis was utilised to provide a simple juxtapose of the current research. A sensitive topic-based search strategy was conducted in order to identify studies that met the eligibility criteria. Fifty two studies met the inclusion criteria and 5 were identified specially as validation studies. The current research identified several methodological shortcomings. The justification and choice of outcome measure used is often weak and only five studies have validated a specific outcome measure of physical activity. Within these validation studies, the validation process often lacked a consideration of agreement between measures. Accelerometers have been most frequently used as a criterion measure, notably the RT3 tri-axial accelerometer. Objective based measures may be best placed to consider physical activity levels, although, methodological considerations for the utilization of such tools is required. Self-report questionnaires have benefits for use in this population but require further validation. Researchers and clinicians need to carefully consider what outcome measure they are using and be aware of the development, scope and purpose of that measure.

Associations between expiratory spirometry parameters and limitations in daily life activities in patients with schizophrenia

OBJECTIVE

This cross-sectional study considered whether variability in respiratory functioning could explain the variability in walking ability of individuals with schizophrenia taking into account variability in body mass index (BMI), lifestyle factors, psychiatric symptoms, antipsychotic medication use and muscular fitness.

METHOD

Eighty patients with schizophrenia and 40 age-, gender- and BMI-matched controls underwent a spirometry and the 6-min walk test (6 MWT) and completed the International Physical Activity Questionnaire. Patients were additionally screened for psychiatric symptoms.

RESULTS

Compared to health controls, patients with schizophrenia achieved a lower distance on the 6 MWT (583.6 ± 109.7 m versus 710.6 ± 108.4 m, P<.001) and had a lower forced vital capacity (3.7 ± 1.1 L versus 4.3 ± 0.9 L, P<.001) and forced expiratory volume in 1 s (FEV1) (3.0 ± 1.0 L versus 3.6 ± 0.7 L, P<.001). In multiple regression analysis, 68.1% of the variance in walking distance was explained by FEV1, BMI, muscular fitness and total energy expenditure.

CONCLUSION

The respiratory health of patients with schizophrenia should be of concern for clinicians. In addition, future research interventions should seek to investigate the impact of an impaired respiratory health upon individuals with schizophrenia.

The patient's experience of the psychosocial process that influences identity following stroke rehabilitation: a metaethnography

BACKGROUND AND PURPOSE

Patient experience is increasingly being recognised as a key health outcome due to its positive correlation with quality of life and treatment compliance. The aim of this study was to create a model of how patient's experiences of rehabilitation after stroke influence their outcome.

METHODS

A metaethnography of qualitative articles published since 2000 was undertaken. A systematic search of four databases using the keywords was competed. Original studies were included if at least 50% of their data from results was focused on stroke survivors experiences and if they reflected an overarching experience of stroke rehabilitation. Relevant papers were appraised for quality using the COREQ tool. Pata analysis as undertaken using traditional processes of extracting, interpreting, translating, and synthesizing the included studies.

RESULTS

Thirteen studies were included. Two themes (1) evolution of identity and (2) psychosocial constructs that influence experience were identified. A model of recovery was generated.

CONCLUSION

The synthesis model conceptualizes how the recovery of stroke survivors' sense of identity changes during rehabilitation illustrating changes and evolution over time. Positive experiences are shaped by key psychosocial concepts such as hope, social support, and rely on good self-efficacy which is influenced by both clinical staff and external support.

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

PURPOSE

To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults.

METHODS

A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two.

RESULTS

Of a potential 892 articles, 12 met the eligibility criteria (n=3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample.

CONCLUSION

This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults. Implications for Rehabilitation Pain is a common and pervasive problem in community dwelling older adults and can affect an individual's mobility, levels of physical activity and increase their falls risk. Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review. This review provides provisional evidence that pain may increase older adult's risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy. In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

Neurobiological effects of physical exercise in schizophrenia: a systematic review

PURPOSE

The aim of the present systematic review was to provide a summary of neurobiological effects of physical exercise for people with schizophrenia.

METHODS

A systematic review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Searches were conducted up to April 2013 across three databases: Medline, PsycINFO, and Embase. A methodological quality assessment using the Downs and Black Quality Index was carried out with all of the included studies.

RESULTS

Of the 654 initial data search results, two studies reported in 3 articles including 48 patients (six women) with schizophrenia, met the eligibility criteria. The methodological quality of each study was high. Data on hippocampal volume changes following physical exercise were conflicting while physical exercise-induced changes in other brain areas were absent. Increases in hippocampal volume following physical exercise were correlated with improvements in aerobic fitness and short-term memory.

CONCLUSIONS

Future research is needed to investigate whether brain health in people with schizophrenia is activity-dependent. Additionally, research that considers the neurobiological mechanisms and associated functional outcomes of physical exercise in individuals with schizophrenia is required.

IMPLICATIONS FOR REHABILITATION

Understanding the neurobiological effects of physical exercise in patients with schizophrenia may contribute to the development of new rehabilitation strategies. There is currently insufficient evidence to determine if physical exercise has a beneficial influence on the brain health of people with schizophrenia.

Physiotherapy students' experiences of bullying on clinical internships: an exploratory study

OBJECTIVES

To consider the prevalence and type of bullying behaviours experienced whilst on clinical placement in a cohort of final-year BSc undergraduate students.

DESIGN

Cross-sectional survey.

SETTING

University in the West Midlands, UK.

PARTICIPANTS

Fifty-two final-year undergraduate students.

MAIN OUTCOME

Prevalence of incivility and bullying behaviours.

RESULTS

Twenty-five percent of students reported at least one incident of bullying behaviour. The perpetrator of the bullying behaviour was most often the clinical educator (8/13, 62%). Despite the negative effects caused, the majority of students (11/13, 84%) did not report this experience to the university.

CONCLUSION

Bullying behaviour may take many forms and can have a negative effect on the well-being of students. It should be addressed by all stakeholders including universities, National Health Service trusts and researchers. Possible strategies to move forwards and better protect the future of the physiotherapy profession are briefly considered.