The effect of rebound exercise on cognition and balance of females with overweight and obesity

Balance issues have been reported to be common among females with overweight or obesity with associated fall risks. Despite the increasing reports of the negative impacts of obesity on balance and cognition, there is a scarcity of research aimed at evaluating effective interventions. To examine the effects of rebound exercises on cognition and balance among females with overweight and obesity. This Quasi-experimental study used the purposive sampling method to recruit 20 female students (aged 17-35 years) with overweight and obese at the Evangel University Akaeze, Ebonyi State Nigeria. Rebound exercise intervention was administered to all participants at the gym for 30 minutes in each session, three times a week for six weeks, while their cognitive performances, stationary balance, and dynamic balance were measured pre-and post-trial using Trail Marking Test Apparatuses, Unilateral Pedal Tests, and Meter Backward Walk Test respectively. There was a significant (p < 0.001) difference in the participants' cognition values across weeks 1, 3, and 6 with a progressive improvement over time. There was also a significant (p < 0.05) difference in the participants' static and dynamic balance values across weeks 1, 3, and 6 with a progressive improvement in balance performance over time. Rebound exercise significantly improved the cognition and balance of females with overweight or obese. This finding suggests a promising intervention to improve balance and cognitive-related problems in this population. Registered retrospectively in the Pan African Clinical Trial Registry, identification number for the registry is PACTR202405746557031. Dated 2 May 2024.

Siblings of Persons with Disabilities: A Systematic Integrative Review of the Empirical Literature

The systematic review aimed to systematize the empirical literature on the psychological impact of disability on the siblings of persons with disabilities, to inform research and provide clinical recommendations. Two research questions addressed the review: (1) What are the main psychological constructs investigated in siblings of persons with disability? (2) What is the main role of each psychological construct in siblings of persons with disability experience? The electronic search was conducted in 7 databases and the PRISMA diagram was used. The inclusion criteria were: Papers published in English and in peer-reviewed journals; papers published between January 2014 and June 2024; qualitative, quantitative, and mixed studies; and papers on the psychological impact of disabilities and/or chronic illnesses on the experience of siblings of persons with disabilities. The standardized Mixed Method Appraisal Tool protocol was used to appraise the methodological quality of the studies. To summarize the findings, a narrative approach was adopted. A total of 60 studies have been reviewed. According to the methodological quality appraisal of studies, most of them reported a high (n = 45) and medium (n = 15) quality. They involved 10,146 participants. Findings revealed that sibling relationships, sibling-focused parentification, and emotional/behavioral adjustment are the main psychological constructs investigated by existing literature. Few studies focused on siblings' well-being. Studies exploring more than a psychological construct were included as a hybrid. Only one study examined the siblings' psychological experience during the COVID-19 pandemic. The quality of the sibling relationship ranged from good to poor; the caregiver is the main role played by siblings of persons with disabilities; anxiety, depression, and aggressive behaviors are the main emotional/behavioral symptoms revealed. Most studies (n = 39) recruited participants with brothers or sisters with mental disorders. The findings of this systematic review may play a role in the clinical field, as they might help to design gender- and age-specific intervention programs.

High Intensity Interval Training POst-STroke (HIIT-POST): Perspectives of People Living With Stroke and Health Professionals

BACKGROUND

High intensity interval training (HIIT) is a mode of aerobic exercise that can increase neurotrophin concentration, improve cardiovascular health, and enhance recovery post-stroke. However, HIIT is not commonly prescribed in stroke rehabilitation. Exploring the clinical utility of, and barriers and facilitators to, HIIT is necessary to optimize clinical use.

OBJECTIVE

To identify perceptions of HIIT from people with stroke and health professionals working in stroke rehabilitation.

METHODS

People with stroke and health professionals in Australia were invited to participate in an online questionnaire. Participants were further invited to complete a one-on-one semi-structured interview. A Framework Analysis approach was applied to identify key themes.

RESULTS

Twenty-six people with stroke (mean ± standard deviation = 49.2 ± 60.6 months post-stroke, 57.7% female) and 37 health professionals (2 medical and 35 allied health) completed questionnaires. Ten people with stroke (5 female) and 8 allied health professionals completed an interview. Aerobic exercise was not considered a priority after stroke, though participants were interested in HIIT. People with stroke reported a lack of understanding of the benefits of HIIT and use of the term "high intensity" as barriers to participation. Facilitators included education about safety of HIIT and referral to health professionals. Health professionals reported a lack of knowledge of HIIT prescription parameters and participant motivation as barriers to prescription. Facilitators included education of HIIT prescription and benefits and appropriate screening prior to commencement.

CONCLUSIONS

People with stroke and health professionals are interested in HIIT after stroke. Increasing knowledge and confidence to participate in, and prescribe HIIT, may increase clinical use.

Effect of arm ergometer versus stabilization exercises on trunk control and pper extremity functions in children with diplegia: a randomized controlled trial

BACKGROUND

One of the most prevalent clinical subtypes of cerebral palsy (CP) is diplegia. Most children with diplegia have weakness in axial muscles and spasticity in extremities which have adverse impacts on trunk control and manual coordination of upper extremities.

AIM

To examine and compare between the effects of arm ergometer and stabilization exercises applied for duration of 12 weeks on upper extremity functioning, trunk control, and hand grip strength (HGS) in children with spastic diplegia.

METHODS

Forty-two children with spastic diplegia aged from 6 to 10 years were randomly assigned to either group A or B, (n = 21 each). Children in group A received a designed arm ergometer exercises for 30 min while those in group B received trunk stabilization exercises for 30 min. As well, children in both groups received 30 min of a designed physical training for 30 min. Treatment was delivered three times a week for 12 weeks in succession. The quality of upper extremity skill test (QUEST), hand held dynamometer (HHD) and Trunk control measuring scale (TCMS) were used to assess upper extremity functions, HGS and trunk control respectively before and after suggested treatment duration.

RESULTS

In terms of all indicators measured at baseline, study groups were comparable (P > 0.05). Significant improvements in all outcome indicators were recorded in within-group comparison (P < 0.05). Further, between groups comparison showed significant higher improvements in upper extremity functions and HGS in favor of group A while trunk control scores showed no significant difference between the two groups (P > 0.05).

CONCLUSION

Arm ergometer exercises have the capability to enhance upper extremity functions, HGS and trunk control. It is therefore beneficial for physical rehabilitation specialists to incorporate the arm ergometer exercises into the intervention plans for children with spastic diplegia.

Strength and dexterity of less affected hand of children with unilateral cerebral palsy: a comparison study with normal peers

BACKGROUND/AIM

A key aspect of hand function is dexterity, which is described as fine voluntary movements used to manipulate small objects during a specific task. The contralateral hand in children with unilateral cerebral palsy (U-CP); is commonly referred to as a "good" and "unimpaired" hand, while others have noted that it has subtle limitations. Therefore, this study aimed to assess and compare between the strength and dexterity of less-affected hand of children with U-CP and the dominant hand of normal peers.

METHODS

A sample of 120 volunteer children from both sexes and age ranged from 6 to 10 years participated in this study. Out of the 120 children, sixty were normal typically developing (TD) and sixty children with U-CP. Assessment of fine motor dexterity and grip and pinch strength were carried out by the Functional dexterity test (FDT) and Pneumatic squeeze Blub Dynamometer respectively.

RESULTS

The results showed that there was a significant lower in pinch and grip strength (p < 0.01) and significant higher FDT scores of children with U-CP compared with that of TD children (p = 0.001). Moreover, there was a significant higher functional levels in TD children compared with that of children with U-CP (p < 0.001) with no significant difference between groups in penalty distribution (p > 0.05).

CONCLUSION

Children with U-CP underperformed with their less-affected hand than the dominant hand of TD age matched peers. Future researches on bilateral hand function may be used to determine the best rehabilitation interventions.

Adaptation and Psychometric Properties of the Behavioral Regulation in Exercise Questionnaire (BREQ-3) for Motivation Towards Incidental Physical Activity

This study aimed to adapt and analyze the psychometric properties of the Exercise Behavior Regulation Questionnaire (BREQ-3) for assessing motivation towards incidental physical activity. An instrumental study in a sample of 346 university students (21.1 ± 2.6 years, and 61.3% women) from various universities in Chile was undertaken. An adaptation of the BREQ-3 was applied, and a confirmatory factor analysis was performed using a robust weighted least squares estimator to assess the construct validity of the scale. Also, the convergent validity was evaluated using the average variance extracted, the discriminant validity using composite reliability, and the internal consistency using Cronbach's alpha (α) and McDonald's omega (ω) coefficients. The six-factor structure of intrinsic motivation (α = 0.96, ω = 0.96), integrated regulation (α = 0.95, ω = 0.95), identified regulation (α = 0.89, ω = 0.90), introjected regulation (α = 0.75, ω = 0.77), external regulation (α = 0.80, ω = 0.83), and amotivation (α = 0.75, ω = 0.79), with acceptable fit indices after eliminating items 8 and 11, was confirmed-χ2/df: 2.196, CFI: 0.99, TLI: 0.99, RMSEA: 0.059 (90% CI; 0.051-0.067). Adaptation of the BREQ-3 appears to be a reliable measure for assessing motivation in the context of incidental physical activity. Its use will contribute to understanding the explanatory mechanisms underlying this behavior.

Stroke survivors with limited walking ability have unique barriers and facilitators to physical activity

PURPOSE

Stroke is a leading cause of morbidity and mortality in Canada. Approximately 73% of stroke survivors experience limited walking ability, requiring a gait aid or assistance. Physical activity is important for secondary stroke prevention, in addition to its benefits for physical and mental health. Little is known about the barriers and facilitators to physical activity in stroke survivors with limited walking ability.

METHODS

This qualitative study used inductive thematic analysis of structured interviews to explore the barriers and facilitators to physical activity in stroke survivors with limited walking ability.

RESULTS

Perceived barriers to physical activity included scarcity of services, societal views, changes in ability, and inclement weather. Perceived facilitators included the desired benefits of physical activity, multidisciplinary rehabilitation services, durable medical equipment, encouragement, positive mindset, and self-efficacy.

CONCLUSIONS

Improving access to rehabilitation services in the chronic phase of stroke and increasing the availability of structured exercise programmes are important strategies to address barriers to physical activity in this population. Supporting self-efficacy, addressing disability stigma, and policy changes are also needed to facilitate participation.

Do People With Stroke Meet Aerobic and Muscle-Strengthening Activity Guidelines? Data From the Canadian Longitudinal Study on Aging

BACKGROUND AND PURPOSE

It is unclear to what extent Canadians with stroke engage in moderate-vigorous physical activity (MVPA) and muscle-strengthening activities (MSA). The purpose of this study was to describe overall physical activity, aerobic MVPA, and MSA participation in Canadians with stroke; determine the functioning, disability, and health classes that best characterize this population; and examine the relationship between-class membership and physical activity participation.

METHODS

Activity levels were quantified using the Physical Activity Scale for the Elderly in 2094 adults with stroke or transient ischemic attack (mean age 67.9 years, 9.5 years poststroke) from the CLSA. Means and percentages were used to characterize participation. Latent class analysis was used to create health and disability classes, and activity levels were compared between classes.

RESULTS

Only 6.2% (95% confidence interval [CI], 4.8%-8.0%) met both MVPA and MSA guidelines. Most (88.2%, 95% CI, 85.0%-88.9%) engaged in MVPA <3 times/wk and 76.7% (95% CI, 73.7%-79.1%) never engaged in MSA. In latent class analyses, 2 classes for males and females were characterized by high-positive or low-negative levels of intrinsic capacity (eg, grip strength), functional mobility (eg, walking speed), and environment (eg, social support). Those in the low-negative classes had the lowest Physical Activity Scale for the Elderly scores and aerobic MVPA levels compared to the high-positive (healthiest) classes. MSA participation was not different between classes.

DISCUSSION AND CONCLUSIONS

Canadians with stroke are not engaging in sufficient physical activity. Clinicians should encourage regular participation in physical activity, especially among those with lower levels of intrinsic capacity, functional mobility, and environmental support.

Video Abstract available for more insights from the authors (see Supplementary Digital Content 3 available at: http://links.lww.com/JNPT/A494).

Knowledge, Perceptions and Attitudes among Sharia Practitioners in Palestine Regarding Halal Pharmaceuticals: An Exploratory Study

The purpose of this questionnaire-based cross-sectional study was to investigate the knowledge, perceptions, and attitudes regarding halal pharmaceuticals among sharia practitioners in Palestine. A total of 420 sharia practitioners with different educational levels were included. This was a cross-sectional study conducted between March and July 2021 with the use of a standardized, self-administered questionnaire. Volunteers were selected throughout Palestine using a systematic random selection approach. The data were summarized using descriptive statistics (mean, standard deviation, frequency, percentage, median, and interquartile range). The Chi-square and Fisher's exact tests were used to examine the relationship between demographic factors and the knowledge, attitude, and perception scores, respectively. The results revealed that sharia practitioners have relatively good and positive knowledge toward halal pharmaceuticals. The main knowledge of most halal pharmaceuticals was about 50.2%, yet there is still significant latitude in their knowledge of a few issues. The main attitude and perception score was about 96.4%. The results showed a positive and fair correlation between knowledge and attitude (r = 0.153, P < 0.001) and also between knowledge and perception (r = 0.341, P < 0.001). In addition, there is a good correlation between attitude and perception (r = 0.681, P < 0.001). The study concluded that better knowledge of halal pharmaceuticals is associated with positive perceptions and behaviors. The government, pharmaceutical manufacturers, religious scholars, and health care professionals should collaborate to achieve the goal of using halal medications.

Video Game-Based Trunk Exercises for Rehabilitation in Chronic Stroke Survivors: A Mixed-Methods Feasibility Study

Aim: To assess the feasibility of video game-based trunk exercises using the Valedo® system in a chronic stroke population. Method: Ten chronic stroke survivors (eight males and two females, mean age 63 ± 15 years) were asked to complete 18 intervention sessions, each lasting 45 min., over 6-8 weeks. Feasibility was evaluated quantitatively using the Psychosocial Impact of Assistive Devices Scale (PIADS) as well as through recruitment, retention, adherence, and safety measures. Qualitative data on feasibility were collected through post-intervention semi-structured interviews. Descriptive analysis was used to summarize participant characteristics, recruitment, retention, and adherence. Qualitative data were analyzed using thematic analysis of the interviews. Results: Twelve stroke survivors were recruited from Southampton (United Kingdom) and Riyadh (Kingdom of Saudi Arabia), with two participants dropping out after the baseline assessment session. The remaining ten participants completed the study with a mean adherence of 96.11% to the planned sessions. No serious adverse effects were reported, however, four participants did experience trunk muscle tightness and fatigue. Post-intervention interviews revealed that participants encountered some physical and cognitive challenges while playing the Valedo video games. However, they felt that the implementation of trunk exercises using video games was safe, as the exercises were performed in a secure environment and in safe positions. Conclusions: The findings suggest that the Valedo system is feasible for delivering trunk exercises to chronic stroke survivors. Several factors should be considered when implementing this type of intervention in the future.

Meta-prospective memory accuracy in young adults with and without depressive symptoms

Prospective memory (PM) is the ability to remember an intention in the future. Individuals with depression are candidates for PM failures, resulting in detrimental consequences, such as forgetting to take a medication or implement therapeutic techniques; inaccurate assessments of one's PM abilities can exacerbate these issues. The current study examined if appraisals about one's prospective memory (meta-PM) performance differs between healthy and depressed adults. Data were gathered from 137 adults and included self-reported depression, PM beliefs, objective PM, and assessment of executive functions (EFs). Participants were separated into depressed/healthy categories based on a self-report measure. There was a non-significant correlation between self-reported PM and objective PM for both depressed (r = .06, p = .61) and healthy (r = .08, p = .52) groups, suggesting both groups had inaccurate meta-PM. There were non-significant differences in meta-PM between these groups (Fisher's Z = -0.09, p = .93), but exploratory gender analyses revealed women's meta-PM was significantly less accurate than men's. Women had higher reports of depression and PM complaints compared to men. This study lends evidence that depression is not necessarily related to worse meta-PM accuracy, despite depression's association with memory complaints, and that women are at greater risk for inaccurate meta-PM.

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study

OBJECTIVE

To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery.

DESIGN

Qualitative focus group-based study.

SETTING

Acute and community national health service trusts.

PARTICIPANTS

Stroke and cardiac rehabilitation team members.

INTERVENTION

Adapted cardiac rehabilitation.

MAIN MEASURES

Focus groups. Thematic analysis was applied to the transcribed data.

RESULTS

Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles.

CONCLUSIONS

Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed.

REGISTRATION

ISRCTN65957980.

The Effect of 12 Weeks of Rebound Therapy Exercise Training on Walking Ability of Spinal Cord Injury Patients

Background

Walking ability is a crucial factor for recovery and rehabilitation of spinal cord injury (SCI) patients.

Objectives

The aim of this study was to investigate the effect of 12 weeks of rebound therapy on walking parameters in SCI patients.

Methods

Thirty members of Isfahan Spinal Cord Injury Association participated in this experimental study using a convenience sampling method. This study was approved by the ethics committee of the University of Isfahan (IR.UI.REC.1400.118). The participants were randomly assigned to control and rebound groups using a matched randomization method. Data were collected before and after 12 weeks of rebound therapy exercise (three sessions per week) in the walking laboratory, using a seven-camera 3D motion capturing system (Qualisys motion analysis). The final data were analyzed using repeated measures ANOVA in SPSS software (significance level p < .05).

Results

Rebound therapy training significantly improved all dependent variables (p < .05) except hip rotation, indicating its effectiveness for enhancing walking ability.

Conclusion

Given the importance of walking function, we recommend the use of rebound therapy training as an exercise rehabilitation method for spinal cord injury patients.

Barriers to self-administered home-based task-oriented practice post-stroke: development and content validity of a new instrument

PURPOSE

To develop a new instrument to identify barriers to self-administered home-based task-oriented practice post-stroke and test its content validity.

MATERIALS AND METHODS

The sample consisted of individuals with stroke and neurological rehabilitation professionals. The study consisted of two steps: (1) Instrument development, involving three processes; a data search in the literature, interviews with the target population and an open questionnaire (online) sent to professionals; and (2) Testing the content validity of the instrument by asking individuals with stroke and professionals about the comprehensiveness and relevance of the items and additionally asking individuals with stroke about the comprehensibility of the items. For each item in the instrument, the threshold validity scores were ≥0.80 in the Content Validity Index and ≥0.75 for the Kappa agreement.

RESULTS

The preliminary version was developed with 46 items. The content validation was performed in three rounds. The last version of the instrument Barriers to self-administered home-based task-oriented practice post-stroke (BASH-TOP-Stroke) contained 34 items in five response categories, in which the higher the value presented, the greater the number of barriers. The content validity for the items was excellent.

CONCLUSIONS

The study provides a new instrument to help identify barriers to self-administered home-based task-oriented practice post-stroke.

Implementing circuit class training can increase therapy time and functional independence in people with stroke receiving inpatient rehabilitation: findings from a retrospective observational clinical audit

BACKGROUND

Increased therapy time and task-specific practice can improve functional recovery post stroke. This observational study aimed to determine whether the clinical implementation of circuit training increases therapy time and improves function in stroke rehabilitation.

METHODS

In a retrospective clinical audit, medical records of 110 people (mean age 78.7, standard deviation 13.0, 49.1% male, 57.3% severe stroke) admitted to a stroke inpatient rehabilitation ward were evaluated to determine the differences between pre (Individual Therapy (IT), n = 55) and post (Circuit Class Therapy (CCT), n = 55) service change implementation. The primary outcome was the amount of time spent in physiotherapy daily (minutes). Secondary outcomes included the Functional Independence Measure (FIM) score and length of stay (LOS).

RESULTS

The CCT Group spent significantly more time in physiotherapy daily during their rehabilitation LOS compared to the IT Group (mean difference 8.45 (95% CI 5.99 to 10.90) mins, p < 0.001). No significant between-group differences were observed for FIM scores or LOS (p ≥ 0.066).

CONCLUSION

This study suggests that the clinical implementation of CCT can significantly increase therapy time by close to 9 minutes per session, with functional gains that are equivalent to usual care. This was achieved with a patient-to-staff ratio of 3:1, compared to the 1:1 ratio in IT, concurring with existing evidence in support of CCT as an alternative service delivery model for inpatient stroke rehabilitation.

Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'

BACKGROUND AND INTRODUCTION

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles.

PURPOSE

The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists.

METHODS

This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken.

RESULTS

Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories.

CONCLUSION

This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.

Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy

OBJECTIVE

This study aimed to compare the effect of core stabilization exercises and rebound therapy on balance in children with hemiplegic cerebral palsy (CP).

METHODS

Fifty- two children of spastic hemiplegic CP aged 5 up to 8 years from both genders were assigned randomly into two groups: core stability and rebound therapy groups. Both groups received 3 sessions/week, 1.5-h training per session, for 12 successive weeks. The measurement was performed at baseline and post-treatment. Balance as a primary outcome for this study was measured by a Biodex Balance System (BBS), and knee extensor strength and functional capacity as secondary outcomes were assessed using a hand-held dynamometer, and a six-minute walk test (6MWT), respectively.

RESULTS

All variables showed a significant improvement after intervention in each group (p < 0.0001), with significant improvement in all stability indices (overall, anteroposterior, and mediolateral) in core stability group when compared to rebound therapy group.

CONCLUSION

Core stability exercises and rebound therapy are recommended in the rehabilitation of children with hemiplegic CP. Core stability exercises were more effective than rebound therapy for balance improvement.

TRIAL REGISTRATION NUMBER

NCT05739396.

The value of headphone accommodations in Apple Airpods Pro for managing speech-in-noise hearing difficulties of individuals with normal audiograms

OBJECTIVE

To investigate the extent to which Headphone Accommodations in Apple AirPods Pro attend to the hearing needs of individuals with normal audiograms who experience hearing difficulties in noisy environments.

DESIGN

Single-arm interventional study using acoustic measures, speech-in-noise laboratory testing, and real-world measures via questionnaires and ecological momentary assessment.

STUDY SAMPLE

Seventeen normal-hearing individuals (9 female, 21-59 years) with self-reported hearing-in-noise difficulties.

RESULTS

Acoustic measures showed that, relative to unaided, AirPods Pro provided a SNR advantage of +5.4 dB. Speech intelligibility performance in laboratory testing increased 11.8% with AirPods Pro, relative to unaided. On average, participants trialling AirPods Pro in real-world noisy venues reported that their overall hearing experience was a bit better than without them. Five participants (29%) reported that they would continue using AirPods Pro in the future. The most relevant barriers that would discourage their future use were limited hearing benefit, discomfort, and stigma.

CONCLUSIONS

Occasional use of AirPods Pro may help some individuals with normal audiograms ameliorate their speech-in-noise hearing difficulties. The identified barriers may inspire the development of new technological solutions aimed at providing an optimal management strategy for the hearing difficulties of this segment of the population.

Perspectives of children with physical disabilities, parents and physiotherapists on use of walkers and their potential to increase physical activity. A qualitative exploration

Children with physical disabilities are less physically active than children with typical development. How children's experiences of using walkers relates to their physical activity has not been studied previously. This study aimed to explore perspectives of walker use and their potential to increase physical activity. Four focus groups were conducted with children aged 7-10 (n = 3; 12.5%), aged 9-12 (n = 4; 16.7%), parents (n = 7; 29.2%) and paediatric physiotherapists (n = 10; 41.7%). Groups were audio recorded and transcribed. Data were analysed using framework analysis. An overarching concept of walkers needing flexibility to accommodate individual, interpersonal and environmental variability was underpinned by three themes: (a) contrasting drivers for use/non-use of walkers, (b) trade-offs, (c) acceptance of technology within walkers to increase physical activity. Participants were motivated by differing drivers: social for children, emotional for parents and professional for physiotherapists. These contrasting drivers create trade-offs, for example between quality of movement and independence. To maximise physical activity, walker prescribers and designers should prioritise drivers that motivate children and parents, ensuring goal setting is family-centred and participation orientated. Involving families in co-designing walkers is therefore important. Individual clinical assessment allows for identification of children's specific needs and how a child's, parent's and physiotherapist's goals may differ.

Physiotherapy services during the COVID-19 pandemic: A mediated model of physiotherapists' self-efficacy, tele-physiotherapy role stressors, and motivation to provide tele-physiotherapy

BACKGROUND

Occupational self-efficacy is a stable predictor for professionals' motivation to engage with new methods and tasks. Yet, the delivery of tele-physiotherapy (Tele-PT) by physiotherapists (PTs) during the coronavirus disease of 2019 (COVID-19) outbreak without advance training may have had the potential to increase work stress and damage their motivation, regardless of their occupational self-efficacy.

OBJECTIVES

The present study examined whether the relations between PTs' overall occupational self-efficacy and motivation to provide Tele-PT was mediated by role stress (i.e. role conflict and ambiguity).

DESIGN AND METHOD

Between February 4 and April 23, 2021, 150 Israeli PTs completed an online survey that measured their overall occupational self-efficacy, their role stress induced by the provision of Tele-PT, their motivation to provide Tele-PT, and their demographic characteristics.

RESULTS

PTs' overall occupational self-efficacy was positively associated with PTs' motivation to provide Tele-PT (r= 0.328, p < .01) and fully mediated by role conflict (0.1757, 95% CI = [0.0231, 0.3797]) and by role ambiguity (0.1845, 95% CI = [0.0196, 0.4184]) (components of role stress) caused by the provision of Tele-PT.

CONCLUSIONS

It is important to investigate the predictors and mediators of the motivation to provide Tele-PT because in the post-COVID-19 era health organizations are likely to adopt many tele-medicine services, and they need to find ways to mitigate perceived challenges.

Short-Term Effects of Vestibular Training on Gross Motor Function in Children and Youth with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

AIMS

To review the literature on the effects of vestibular training on motor function and balance in children and youth with cerebral palsy.

METHODS

Eight databases (MEDLINE-PubMed, PEDro, Cochrane Library, OTSeeker, Web of Science, Scopus Database, CINAHL and SPORTDiscus.) were searched up to May 15th, 2023. Studies comparing vestibular training with other types of interventions. The DerSimonian and Laird method was employed using random effects models to calculate the pooled estimate of the effect size with confidence intervals of 95%. The risk of bias was assessed with the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation approach was used to judge the certainty of the evidence for all outcomes.

RESULTS

Eight studies were included comprising 226 participants with cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of vestibular training program compared to other technique(s) for Gross Motor Function Measure (-0.471; 95% confidence intervals: -0.919 to -0.023) and balance (-0.546; 95% confidence intervals: -0.916 to -0.176).

CONCLUSIONS

Vestibular training has potential benefits in the short-term as a therapeutic approach for improving gross motor function and the balance in children and youth with cerebral palsy, but further research is needed.

Diagnosis and referrals to physical therapy among caregivers of children with genetic disorders: a qualitative inquiry

PURPOSE

Genetic disorders are common in Saudi Arabia. Impaired motor development is one of the major characteristics associated with genetic disorders. Early identifications and referrals are key to receiving physical therapy. This study aims to explore caregivers of children with genetic disorders' experience with early identification and referrals to physical therapy.

MATERIALS AND METHODS

An inductive qualitative design of 16 caregivers of children with genetic disorders was done to investigate the identification and referral process to physical therapy. A thematic analysis was used to analyze the data and multiple coders coded the data to increase the trustworthiness of the analysis.

RESULTS

The analysis led to emergence of four main themes. Caregivers revealed their struggle with the detection process. They struggled with the vague information related to their children's condition. They also expressed a desperate need for guidance to clarify the process for genetic testing, counseling, and rehabilitation. Although their overall experience with physical therapy was satisfactory, they encountered a number of issues related to scheduling appointments, delayed referrals, and unconfirmed diagnoses.

CONCLUSION

The results of this study could indicate that more efforts are required to expedite and elucidate the identification and referral of children with genetic disorders in Saudi Arabia.

Patients' expectations of physiotherapists before and after an intensive chronic low back pain rehabilitation programme: a qualitative study based on semi-structured interviews and observations

PURPOSE

To investigate the expectations regarding physiotherapists of patients attending an interdisciplinary CLBP rehabilitation programme and the response to these expectations.

MATERIALS AND METHODS

A thematic analysis was conducted, based on interviews of working-age patients with CLBP and without significant comorbidities.

RESULTS

Twenty patients participated (9 male, 11 female, aged 21-58 years; symptoms duration 4.3 ± 3.0 years; pain VAS 53 ± 21 mm). Patients expected to learn pain and activity management. Expected outcomes were a reduction of pain, increased well-being and a return to normality. A collaborative approach involving therapeutic and relational adaptation was expected. Despite divergences concerning emotional aspects, patients expected a large range of applied psychosocial skills.The programme met the expectations of most patients, especially when its goals matched those reported by the individuals. For most participants, the pain relief was below expectations. Active therapies were valued. After the programme, patients felt more ready to take responsibility for their back.

CONCLUSION

The expectation of developing self-management skills was prevalent. Expected treatments were mostly compatible with recommendations. Expectations to resume activities and decrease pain were in line with the rehabilitation goals, although the expected reduction in pain was overestimated. Relational expectations converged towards patient-centred care.

Combating With COPD by QiGong Physical and Mental Exercise

Physical activity levels of patients with chronic obstructive pulmonary disease (COPD) are low due to the symptoms of COPD. The patients diagnosed with COPD are headed for complementary and alternative treatments to reduce the COPD symptoms, facilitate the treatment, and increase their physical activity. One of these treatments is QiGong, which is not yet common in our country. QiGong is a type of exercise based on ancient Chinese medicine, and mainly consists of active and passive exercises. These exercises open energy channels in the body, and thus prevent and/or heal diseases by establishing energy balance in the body through meditation, breath control, and bodily exercises. According to a literature review abroad, there are a small number of scientific studies related the therapeutic effect of QiGong exercises on symptom control, anxiety, reduction of stress and depression, increase in physical activity and quality of life, and the development of lung function of patients with COPD. By considering the educative role of nurses, it is important that the nurse has adequate knowledge of the treatment and care of patients with COPD. Therefore, this review is compiled to be informative about the effects of QiGong in the treatment of COPD, and assistance to subsequent studies.

Supportive mobility devices across the lifespan in Cerebral Palsy: a modified Delphi study to establish stakeholder research priorities

PURPOSE

The aim of this study was to co-develop research priorities and identify meaningful research questions with a diverse group of stakeholders representing the CP community for implementation in subsequent research activities. The overarching aim of this research was to 1) Understand the mobility experiences, supported mobility device (SMD) use, and desired participation outcomes of people with cerebral palsy (CP) across the lifespan; and 2) Describe how perspectives of rehabilitation care and professional resources may influence mobility decision-making processes and outcomes.

MATERIALS AND METHODS

A three-round modified Delphi consensus study was conducted with a stakeholder advisory panel consisting of three adults with CP, two parents of children with CP, and four SMD providers.

RESULTS

The advisory panel identified 11 unique topical categories focused on SMD selection and use, stratified by age group and stakeholder role. Questions or statements within each category were ranked, and top consensus and concordance statements were retained, reviewed, and refined for use in a co-developed focus group guide. Priorities were identified in three main groupings: (1) Age/GMFCS level/Environment-related; (2) Individual with CP/Caregiver need-related; and (3) Clinician/provider partnership-related.

DISCUSSION

A modified Delphi process was a useful tool for stakeholders in co-developing research priorities related to SMD use across the lifespan. Drawing on the lived expertise of stakeholders is important in facilitating improved research translation in the CP community.

Development of consensus on essential virtues for ethics and research integrity training using a modified Delphi approach

Most ethics and research integrity (ERI) training approaches are based on teaching moral rules, duties or responsibilities, often not sufficiently addressing virtue-based ethics. This study aimed to obtain a consensus among relevant experts on the importance of essential virtues for ERI training and their acquisitions. A modified Delphi consensus process was conducted in three rounds; 31 ERI experts participated in Round 1 and 23 in Round 2 and Round 3. Based on findings generated from qualitative data in Round 1, a structured questionnaire with 90 different statements grouped under five domains was developed for Round 2 and Round 3. After the final round, a consensus was achieved on two-thirds of statements included in this study. The experts agreed that virtues are based on learned and reflected attitudes and that the appropriate direction to acquire research virtues is through continuing education using case studies and discussions based on real-life scenarios. Furthermore, the consensus was obtained on 35 scientific virtues that should be stimulated in ERI training, prioritizing honesty, integrity, accountability, criticism and fairness as the most essential scientific virtues for good research practice. These results should be considered in developing or adjusting the ERI training program and materials.

Effects of robotic rehabilitation using the Erigo® device on patients with neurological injury: a systematic review and meta-analysis of randomized clinical trials

OBJECTIVE

To systematically review the effects of robotic rehabilitation with the Erigo® device on patients with neurological injury on safety, spasticity, muscle strength, functionality, gait/balance, and changes in the level of consciousness.

METHODS

MEDLINE, SciELO, EMBASE, The Cochrane Library - CENTRAL and PEDro databases were consulted without the restriction of date and language. Randomized controlled trials that evaluated the robotic rehabilitation and compared it to conventional or placebo therapy, isolated or in association with other therapy, were selected. Studies in which the treatment time was less than 10 sessions were excluded. The risk of bias was assessed with the use of the RoB 2.0 tool.

RESULTS

Nine studies were included, totaling 347 patients. The robotic rehabilitation performed by the Erigo® device proved to be safe for neurological patients. The meta-analysis showed an improvement for spasticity (MD = 0.29; 95% CI = -0.49 to -0.08; I2 = 0%), but there was no significant increase in muscle strength in patients with stroke (MD = 0.25; CI 95% = -0.22 to -0,71; I2 = 0%). Erigo® showed inconclusive effects on functionality, gait/balance and level of consciousness in patients with severe acquired brain injury and vegetative or minimally conscious state. All studies present some concerns for the risk of bias.

CONCLUSION

Erigo® as a robotic rehabilitation strategy is safe for patients with acquired brain injury and appears to reduce spasticity in patients with stroke. The effects on muscle strength, functionality, gait and balance and level of consciousness remain uncertain and the methodological quality of the clinical trials included in this review is limited.

Short-term effects of air pollution and weather on physical activity in patients with chronic obstructive pulmonary disease (COPD)

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) accumulate low levels of physical activity. How environmental factors affect their physical activity in the short-term is uncertain.

AIM

to assess the short-term effects of air pollution and weather on physical activity levels in COPD patients.

METHODS

This multi-center panel study assessed 408 COPD patients from Catalonia (Spain). Daily physical activity (i.e., steps, time in moderate-to-vigorous physical activity (MVPA), locomotion intensity, and sedentary time) was recorded in two 7-day periods, one year apart, using the Dynaport MoveMonitor. Air pollution (nitrogen dioxide (NO2), particulate matter below 10 μm (PM10) and a marker of black carbon (absorbance of PM2.5: PM2.5ABS), and weather (average and maximum temperature, and rainfall) were estimated the same day (lag zero) and up to 5 days prior to each assessment (lags 1-5). Mixed-effect distributed lag linear regression models were adjusted for age, sex, weekday, public holidays, greenness, season, and social class, with patient and city as random effects.

RESULTS

Patients (85% male) were on average (mean ± SD) 68 ± 9 years old with a post-bronchodilator forced expiratory volume in 1 s (FEV1) of 57 ± 18% predicted. Higher NO2, PM10 and PM2.5ABS levels at lag four were associated with fewer steps, less time in MVPA, reduced locomotion intensity, and longer sedentary time (e.g., coefficient (95% CI) of -60 (-105, -15) steps per 10 μg/m3 increase in NO2). Higher average and maximum temperatures at lag zero were related to more steps and time in MVPA, and less sedentary time (e.g., +85 (15, 154) steps per degree Celsius). Higher rainfall at lag zero was related to fewer steps and more sedentary time.

CONCLUSION

Air pollution affects the amount and intensity of physical activity performed on the following days in COPD patients, whereas weather affects the amount of physical activity performed on the same day.

Does the Canadian Occupational Performance Measure (COPM) Capture the Complex Experiences of Cancer Survivors? A Mixed Methods Approach

Occupational therapy practitioners are uniquely positioned to address the needs of cancer survivors. This study aimed to understand the complex needs of survivors using The Canadian Occupational Performance Measure and in-depth interviewing. A convergent, mixed methods approach was utilized with a purposive sample of 30 cancer survivors. The results indicate that while the COPM can be a practical tool to address basic occupational performance problems, the in-depth interviews exposed these challenges are intricately connected to identity, relationships, and roles. Implications for occupational therapy practitioners include a critical approach to evaluation and interventions to capture the complex needs of survivors.

Possibilities of intelligent textiles in AAC - perspectives of speech and language therapists

PURPOSE

The growth of new high-technology devices in the field of augmentative and alternative communication (AAC) has been rapid. However, a vast number of individuals with complex communication needs are left without functional means to communicate in their lives. Intelligent textiles are one of the growing industries in health technologies yet to be explored for the possibility of implementation as an AAC solution. This study aimed to investigate the potential of intelligent textiles and their functions in daily life perceived by experienced speech and language therapists and to obtain data, which will offer direction on how to proceed with prototype development.

MATERIALS AND METHODS

Focus group discussions were conducted remotely within two groups of experienced speech and language therapists (n = 12). The data obtained from the discussions were analysed thematically.

RESULTS AND CONCLUSION

According to the stakeholders in question, intelligent textiles were perceived most useful for individuals with motor disabilities and those with severe intellectual disabilities. The most prominent themes for the purpose of using the intelligent textiles were social interaction and accessing meaningful activities independently. The participants also described how this technology could be used in terms of the textile, the input needed and the output the technology provides. The versatile results are discussed along with directions for future research.

The Effect of ICF-Core Set-Based Occupational Therapy Interventions on the Function and Satisfaction of Individuals with Chronic Stroke: A Randomized Clinical Trial

Stroke can affect all aspects of a person's health and functioning. Therefore, it is important occupational therapists, have a comprehensive understanding of various levels of function and the factors affecting function. The ICF (International Classification of Functioning, Disability, and Health) and the selections of ICF categories or Core Sets relevant for people with a specific health condition, offer a model for intervention. This study aimed to investigate the effect of ICF-CS-based occupational therapy interventions on the function and satisfaction of individuals with chronic stroke. This study was designed as a randomized, single-blind, parallel-group clinical trial. Twenty-five patients with stroke were randomly assigned to the control group (which received traditional occupational therapy) or the treatment group (Stroke ICF-CS based occupational therapy). Patients were evaluated before and after the intervention (two months, three sessions per week, 45 minutes each session), as well as two weeks after the end of the intervention, using Fugl-Meyer and COPM (Canadian Occupational Performance Measure) tools. The independent T-test, Chi-square, and ANOVA with repeated measures were used to analyze the data. The results showed that the interaction effect of time and group was not significant in none of the Fugl-Meyer test sections (p > 0. 05), but it was significant in the performance and satisfaction of COPM (p < 0.05). The results suggest that ICF-CS-based occupational therapy interventions may assist persons with chronic stroke improve their functional level and satisfaction.

Physiotherapists' perceptions of their role in treating and managing people with depression and anxiety disorders: A systematic review

BACKGROUND

Despite the prevalence of mental health disorders rising worldwide, physio-therapists' perceptions of their role and ability to holistically treat people with anxiety and depression remain unclear.

PURPOSE

This research aimed to understand the physiotherapists' perception of their role in treating and managing people with anxiety and depression while revealing barriers and facilitators in practice.

METHODS

PubMed, PsycInfo, CINAHL, EMBASE, Web of Science, and Google Scholar were searched systematically for mixed-method, quantitative, or qualitative designs. Using the Joanna Briggs Institute (JBI) Methodology for Systematic Reviews, data was extracted, critically appraised, assigned quality grades, and synthesized through meta-aggregation.

RESULTS

A total of 2991 records were initially sourced, with eleven studies included in the systematic review. The studies were published worldwide between 2016 and 2021, with the majority (n = 8) published in 2020-2021. Participating physiotherapists most frequently had a Bachelor's degree (35.7-62.6%), followed by a Master's degree (28.4-37.4%). Meta-aggregation revealed the synthesized finding that physiotherapists perceived their role to include treating people with anxiety and depression despite feeling underprepared. Physiotherapists perceive many barriers and facilitators, such as education, when treating people with anxiety and depression.

CONCLUSION

Physiotherapists have positive perceptions toward anxiety and depression, despite feeling underprepared in their ability to implement psychosocial strategies.

Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and metasynthesis of qualitative research

PURPOSE

Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military.

METHODS

A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss.

RESULTS

Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond.

CONCLUSIONS

Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.

A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults

PURPOSE

This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language.

METHOD

A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols.

RESULTS

Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale.

CONCLUSION

The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.

Family Environment, Loneliness, Hope, and Subjective Well-Being of Asian Older Adults

The current study examined the interactions between family environment, hope, and loneliness, and their subsequent influence on the subjective well-being (SWB) of 345 noninstitutionalized older adults (aged 60 years and above) in Singapore. Door-to-door surveys information was collected on family environment (cohesiveness, relationship closeness, and support), hope, loneliness, and SWB (life satisfaction, happiness, and absence of negative affect). Structural equation modelling was conducted to test competing hypotheses derived from life stress and integrated resource theories. The results revealed that family environment influenced SWB both directly and indirectly. Family environment decreased loneliness and increased SWB. Additionally, family environment influenced SWB by offering increased hope. Family environment sets the context for the SWB of older adults in Singapore. Families should therefore be targeted for interventions to reduce loneliness, increase psychological resources, and raise SWB during old age.

Deep Diaphragmatic Breathing-Anatomical and Biomechanical Consideration

Background: Deep diaphragmatic breathing (DDB) involves slow and fully contraction of the diaphragm with expansion of the belly during inhalation, and slow and fully contraction of the abdominal muscles with reduction of the belly during exhalation. It is the key component of the holistic mind-body exercises commonly used for patients with multimorbidity. Purpose: The purpose of this study was to re-visit and address the fundamental anatomical and biomechanical consideration of the DDB with the relevant literature. Method: Peer-reviewed publications from last the 15 years were retrieved, reviewed, and analyzed. Findings: In this article, we described the updated morphological and anatomical characteristics of the diaphragm. Then, we elucidated in a biomechanical approach how and why the DDB can work on the gastrointestinal, cardiopulmonary, and nervous systems as well as on regulating the intra-abdominopelvic pressure and mind-body interaction to coordinate the diaphragm-pelvic floor-abdominal complex for a variety of physical and physiological activities. Conclusion: Understanding of this updated DDB knowledge may help holistic healthcare professionals including holistic nurses provide better patient education and care management during the DDB or DDB-based mind-body intervention time.

The Physical Abilities and Mobility Scale as a New Measure of Functional Progress in the PICU

Assessing functional motor changes and their relationship to discharge needs in the pediatric intensive care unit (PICU) population is difficult given challenges quantifying small functional gains with current tools. Therefore, we compared the Physical Abilities and Mobility Scale (PAMS) to the Functional Status Scale (FSS) in PICU patients to assess correlation and differences and association with discharge needs. This study was a retrospective chart review of all patients (2-18 years old) admitted to the PICU and cardiac PICU for over 9 months who received early mobility services, including PAMS and FSS scoring. Correlation between scales, relationship of scores to disposition, and logistic regression model of changes in PAMS in relation to disposition were determined. Data were obtained for 122 patients. PAMS and FSS scores strongly negatively correlated (Spearman's ρ  =  - 0.85), but with a nonlinear relationship, as the PAMS more readily differentiated among patients with higher functional status. The median FSS at discharge was 12.5 for those recommended an inpatient rehabilitation facility (IRF) ( n  = 24), versus 9 for those recommended discharge home ( n  = 83, Δ 3.5, 95% confidence interval [CI]: 1-6, around one-tenth of FSS scale). The corresponding median PAMS were 42 and 66 (Δ 24, 95% CI: 10-30, one-fourth of PAMS scale). Although not statistically significant, a logistic regression model was consistent with patients who showed modest change in PAMS across hospitalization but persistent deficits (PAMS < 60) were more likely to be recommended an IRF. The PAMS correlates to the FSS, but appears more sensitive to small functional changes, especially in higher functioning patients. It may be useful in prognosticating discharge needs.

Perseverance with home-based upper limb practice after stroke: perspectives of stroke survivors and their significant others

PURPOSE

The aim of this study was to explore factors that influence stroke survivors' ability to persevere with home-based upper limb practice.

METHODS

A qualitative descriptive study embedded within a theoretical framework was conducted. Data were collected through semi-structured focus group, dyadic, and individual interviews. The Theoretical Domains Framework and Capability, Opportunity, Motivation - Behaviour (COM-B) model guided data collection and directed content analysis.

FINDINGS

Participants were 31 adult stroke survivors with upper limb impairment, with 13 significant other/s, who were living at home in Queensland, Australia. Three central tenants aligned with the COM-B and six themes were identified. Stroke survivors' capability to persevere was influenced by being physically able to practice and being able to understand, monitor and modify practice, their opportunity to persevere was influenced by accessing therapy and equipment required for practice and fitting practice into everyday life, and their motivation to persevere was influenced by having goals and experiencing meaningful outcomes and having support and being accountable.

CONCLUSION

Persevering with practice is multifaceted for stroke survivors. All facets need to be addressed in the design of strategies to enhance stroke survivors' ability to persevere and in turn, enhance their potential for continued upper limb recovery.IMPLICATIONS FOR REHABILITATIONMany stroke survivors do not persevere with long-term home-based upper limb practice despite the belief that high dose practice will promote continued recovery.Therapists need to support stroke survivors to setup individualised goal-based home programs that they can complete independently, or with support, within their everyday life.Stroke survivors need coaching to monitor and modify their practice and map their progress, so that they can recognise and experience meaningful recovery.To optimise upper limb recovery after stroke, strategies to enhance stroke survivors' capability, opportunity, and motivation to persevere across the continuum of recovery, need to be co-designed by stroke survivors, therapists and researchers.

An evaluation of an open group for depressed mood on a stroke rehabilitation ward: three years of clinical data

PURPOSE

An open group intervention for stroke inpatients, based on Acceptance and Commitment Therapy, is evaluated using retrospective clinical service data.

MATERIALS AND METHODS

Participants were included unless severely unwell or unable to provide informed consent. 117 participants attended at least two sessions in a non-controlled, repeated measures design. Two session protocols were delivered on alternating weeks by an Assistant Psychologist and Trainee Psychologist, covering values, committed action, and acceptance. Participants rated their mood each session using the Depression Intensity Scale Circles (DISCs).

RESULTS

Attended sessions ranged from 1 to 11 (Md: 2). Significant reductions in DISCs scores with medium effect sizes were found among those scoring above the cut-off for depression at baseline, Χ2(3) = 20.87, p < .001. The likelihood of scoring below the cut-off for depression did not change between participants' first and last sessions, X2(1, N = 117) = 1.36, p = .24. The number of sessions attended did not predict outcome, rs(117) = .09, p = .33.

CONCLUSIONS

Design limitations prevented inferences of clinical effectiveness, but the group met several clinical utility criteria by providing a flexible intervention on a rehabilitation ward with competing demands. We highlight the importance of contrasting findings of clinical trials with data from clinical services.

Barriers and facilitators to physical activity participation among community-dwelling physically inactive individuals after stroke: a qualitative exploratory study

Physical activity has been shown to reduce the risk for first-ever stroke as well as recurrent stroke with positive effects on almost all known modifiable risk factors. However, the perceived barriers and facilitators for engaging in physical activity have been insufficiently studied and may differ between cultures. Therefore, the aim of this study was to explore the perceptions of community-dwelling physically inactive individuals with stroke about barriers and facilitators to their participation in physical activity. This qualitative study included two focus groups of ten individuals with stroke classified as physically inactive based on accelerometer recordings. A semi-structured set of questions was posed in each focus group session and the transcripts were analysed using thematic analysis. The results revealed three main themes and subthemes: individual factors (physical impairments, psychological factors, spirituality), interaction with the family (attitudes of family members/close community) and social and environmental factors (hobbies, lack of or presence of facilities, the use of orthosis). We conclude that physical activity participation is affected by a multitude of factors as well as cultural differences. Thus, interventions aimed at increasing participation in physical activity after stroke should not only be planned according to individual clinical characteristics but also take into account a range of personal-to-social factors, including cultural differences.

Unpacking the black box of voice therapy: A clinical application and revision of the Motor Learning Classification Framework (MLCF)

PURPOSE

Voice therapy is a complex behavioural intervention. Understanding its components is integral for continued advancement of voice therapy research, translation of evidence into the clinical setting and improved client care. The Motor Learning Classification Framework (MLCF) offers an excellent opportunity for increasing such knowledge, specifically in relation to identifying variables that affect motor learning (ML), an important mechanism hypothesised to bring about voice change during voice therapy. The MLCF has shown promising results in identifying speech-language pathologists' (SLPs) use of ML variables during experimentally controlled voice therapy contexts. The purpose of this study was to test the feasibility of applying the framework in the clinical context of everyday voice therapy practice.

METHOD

Data consisted of two video-recorded voice therapy sessions representing usual voice therapy care. Classification of ML variables used by SLPs during the recorded sessions was attempted based on the MLCF.

RESULT

Several problematic features of the framework were identified. Based on deliberations between the authors of the current paper, the MLCF was revised using an iterative process. This resulted in the construction of an updated version of the framework (MLCF-V2). The MLCF-V2 organises ML strategies into two broad categories: directly observable behaviours and learning processes. The framework incorporates greater consideration of theory and empirical evidence supporting motivational, attentional focus and subjective error estimation influences on ML. Several examples of each ML variable are included as well as an attempt to provide clearer classification instruction.

CONCLUSION

It is anticipated that the MLCF-V2 will provide a more useful and reliable classification for use in future investigations of SLPs' use of ML variables during usual voice therapy practice.

Patient- and proxy-perceptions on functioning after stroke rehabilitation using the 12-item WHODAS 2.0: a longitudinal cohort study

PURPOSE

To analyse longitudinally patient- and proxy-perceptions on stroke survivors'(SSs') functioning using the 12-item WHO Disability Assessment Schedule 2.0 (WHODAS) after subacute inpatient stroke rehabilitation.

METHODS

Sixty-five SSs and their significant others(proxies) responded to WHODAS questionnaire at discharge and 9 to 50 months later. Self-WHODAS ratings were compared with corresponding proxy-perceptions and informal ratings on self-reported functional recovery.

RESULTS

On average, SSs' functioning improved after discharge, except according to self-WHODAS ratings of those with severe stroke. Individual changes were, however, notable. Association between time and change was statistically insignificant. SSs perceived greatest improvements in walking, household tasks, community life and working ability. The only items showing slight deterioration were emotions and relationships. In parallel, proxies rated all items except emotions and relationships improved. At discharge, proxies rated SSs' functioning more impaired than SSs themselves, mostly regarding those with severe stroke. Still, inter-rater reliability was very strong and increased significantly with time (ICC 0.799 vs. 0.979 at follow-up). Ninety percent of SSs with improved functioning according to self-WHODAS reported better functioning also in the informal questionnaire.

CONCLUSION

WHODAS showed improvements in SSs' functioning 9-50 months after discharge from subacute stroke rehabilitation. Improvements were in line with proxy-perception and self-reported functional recovery.IMPLICATIONS FOR REHABILITATIONStroke survivors' functioning improved significantly during the 9-50 months follow-up after subacute inpatient stroke rehabilitation.Stroke survivors perceived slightly less difficulties in their functioning compared to evaluations by proxies.Strong correlation between patient- and proxy-perceptions on stroke survivors' functioning strengthened from subacute to chronic phase of stroke recovery.The 12-item WHODAS 2.0 seems to be a valuable patient- and proxy-reported outcome measure to assess longitudinal changes in stroke survivors' functioning after stroke.

The Hausa Northwick Park Neck Pain Questionnaire: translation, cross-cultural adaptation and psychometric assessment in patients with non-specific neck pain

PURPOSE

To translate and cross-culturally adapt the Northwick Park Neck Pain Questionnaire (NPQ) into Hausa and assess its psychometric properties.

MATERIALS AND METHODS

The NPQ was translated and cross-culturally adapted into Hausa using recommended guidelines. A consecutive sample of 92 Hausa-speaking patients with non-specific neck pain recruited from three tertiary hospitals in north-western Nigeria, completed the questionnaire to assess factorial validity (using confirmatory factor analysis), convergent validity (by correlating the Hausa-NPQ with the Numerical Pain Rating Scale [NPRS]), and internal consistency (using Cronbach's α). A subsample of 50 patients completed the questionnaire again 3 days after the first administration to assess relative reliability using intraclass correlation coefficients (ICC) and absolute reliability using standard error of measurement (SEM), smallest detectable change (SDC), and 95% limits of agreement (LOA).

RESULTS

The factor analysis confirmed a single-factor structure with excellent internal consistency (α = 0.94). The questionnaire showed a strong positive correlation with the NPRS (rho = 0.68). The ICC was 0.86, with SEM and SDC of 6.32 and 17.5, respectively. The LOA was - 29.3 to + 37.1 with no evidence of proportional bias.

CONCLUSIONS

The Hausa-NPQ is a valid and reliable measure of disability due to neck pain.

Factors guiding therapist decision making in the rehabilitation of physical function after severely disabling stroke - an ethnographic study

PURPOSE

Whilst strong evidence supports rehabilitation to improve outcomes post-stroke, there is limited evidence to guide rehabilitation in the most severely disabled group. In an era of evidence-based practice, the aim of the study was to understand what factors guide physiotherapists (PTs) and occupational therapists (OTs) to select particular interventions in the rehabilitation of physical function after severely disabling stroke.

MATERIAL AND METHODS

An ethnographic study was undertaken over an 18-month period involving five London, UK stroke services. Seventy-nine primary participants (30 PTs, 22 OTs, and 27 stroke survivors) were recruited to the study. Over 400 h of observation, 52 semi-structured interviews were conducted. Study data were analysed through thematic analysis.

RESULTS

Key factors guiding therapist decision making were clinical expertise, professional role, stroke survivors' clinical presentation, therapist perspectives about stroke recovery, and clinical guidelines. Research evidence, stroke survivors' treatment preferences, organisational type, and pathway design were less influential factors. Therapy practice did not always address the physical needs of severely disabled stroke survivors.

CONCLUSIONS

Multiple factors guided therapist decision making after severely disabling stroke. Alternative ways of therapist working should be considered to address the physical needs of severely disabled stroke survivors more fully.Implications for rehabilitationMultiple factors guide therapist decision making after severely disabling stroke, some of which result in the use of interventions that do not fully address stroke survivors' clinical needs.Therapists should critically reflect upon their personal beliefs and attitudes about severely disabling stroke to reduce potential sources of bias on decision making.Therapists should consider the timing and intensity of therapy delivery as well as their treatment approach to optimise outcomes after severely disabling stroke.

Is early initiated cardiorespiratory fitness training within a model of stroke-integrated cardiac rehabilitation safe and feasible?

OBJECTIVE

To investigate the safety and feasibility of an early initiated stroke-integrated Cardiac Rehabilitation program.

METHODS

People with acute first or recurrent ischaemic stroke, admitted to Epworth HealthCare were screened for eligibility and invited to participate. In addition to usual care neurorehabilitation, participants performed 1) cardiorespiratory fitness training 3-days/week during inpatient rehabilitation (Phase 1), and/or 2) 2-days/week centre-based cardiorespiratory fitness training plus education and 1-day/week home-based cardiorespiratory fitness training for 6-weeks during outpatient rehabilitation (Phase 2). Safety was determined by the number of adverse and serious adverse events. Feasibility was determined by participant recruitment, retention, and attendance rates, adherence to exercise recommendations, and participant satisfaction.

RESULTS

There were no study-related adverse or serious adverse events. Of 117 eligible stroke admissions, 62 (53%) were recruited, while 10 (16.1%) participants withdrew. Participants attended 189 of 201 (94%) scheduled cardiorespiratory fitness training sessions in Phase 1 and 341/381 (89.5%) scheduled sessions in Phase 2. Only 220/381 (58%) scheduled education sessions were attended. The minimum recommended cardiorespiratory fitness training intensity (40% heart rate reserve) and duration (20 minutes) was achieved by 57% and 55% of participants respectively during Phase 1, and 60% and 92% respectively during Phase 2. All respondents strongly agreed (69%) or agreed (31%) they would recommend the stroke-integrated Cardiac Rehabilitation program to other people with stroke.

CONCLUSION

Cardiorespiratory fitness training in line with multiple clinical practice guidelines included within a model of stroke-integrated Cardiac Rehabilitation appears to be safe and feasible in the early subacute phase post-stroke.

The effects of Pilates training on respiratory muscle strength in patients with ankylosing spondylitis

BACKGROUND

Reduction in flexibility and mobility are important factors that lead to impairments in quality of life, reduction of exercise tolerance, and a decreased pulmonary capacity with the progression of Ankylosing Spondylitis (AS).

AIM

The purpose of this study was to investigate the effects of Pilates exercises on mobility, quality of life, and respiratory muscle strength in patients with AS.

METHODS

Forty patients with AS were randomly divided into two groups as Pilates group and the control group. The Pilates group performed Pilates exercises in supervised group sessions and the control group performed conventional exercises at home three days a week for eight weeks. The main outcome measure was respiratory muscle strength. Secondary outcome measures were forced vital capacity (FVC), forced expiratory volume in one second (FEV1) FEV1/FVC ratio, chest expansion, Bath indices (BASDAI, BASMI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and six-minute walk test (6MWT). All participants were assessed by a blind assessor at baseline and the end of eight weeks.

RESULTS

Thirty-six AS patients (n = 19 in the Pilates group, n = 17 in the control group) completed the study. Respiratory muscle strength, FEV1/FVC, chest expansion, BASDAI, BASMI, ASQoL, and 6MWT significantly improved at the 8th week (p < .05) in the Pilates group, while inspiratory muscle strength, FEV1/FVC, chest expansion, and 6MWT showed significant improvements in the control group at 8th week compared to baseline (p < .05). No significant between-group differences were observed when the change over time values were compared (Δ).

CONCLUSION

Both Pilates and home exercises seem to be effective for improving respiratory parameters and functional status in patients with AS. Pilates exercises without using any equipment and additional exercises is found to be useful for improving respiratory functions and disease-related symptoms.

Effectiveness of structured physiotherapy in constipation in children with neurodevelopmental disorders-a randomized trial

INTRODUCTION

Constipation is one of the major issues faced by children with neuro-developmental disorder (NDD). The aims of the study were to: 1) examine the effectiveness of a structured physiotherapy program on constipation in children with NDD; and 2) compare if conventional physiotherapy along with structured physiotherapy intervention has any combined effect on constipation in children with NDD.

METHOD

Thirty-five children with neurodevelopmental disorder were assessed and randomly allotted into two groups. Twenty-two completed the intervention for 2 weeks and were statistically analyzed at baseline and post 4 weeks at a single tertiary center. The outcome measures used were Pediatric quality of life inventory (PedsQL), Peds QL Gastrointestinal symptoms scale, Bristol stool form scale, and defecation frequency. Group A received the conventional treatment, whereas group B received structured physiotherapy along with the conventional treatment.

RESULTS

Group A had no significant outcomes, whereas in group B there were statistically significant differences for all outcome measures. Comparatively, a statistically significant change was noted for PedsQL GI symptoms scale (p = .045) and its constipation sub-scale (p = .002) in group B along with change in the Bristol stool form.

CONCLUSION

Combined effect of structured along with conventional physiotherapy was better in terms of form of stool, constipation, and its associated quality of life factors as compared to conventional physiotherapy alone.

Experiences of participating in a vocational rehabilitation program in Singapore

PURPOSE

The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process.

MATERIALS AND METHODS

This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively.

RESULTS

Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants' experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants.

CONCLUSION

The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants' return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work.Implications for rehabilitationMulti- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients.VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work processVR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goalsVR service providers should address concurrent or future concerns that could impact on their clients' ability to return to or remain at work.

Changes in Patterns of Referral for Inpatient Rehabilitation Cancer Patients Due to COVID-19: A Retrospective Study

ABSTRACT

There is a paucity of literature on the effect of COVID-19 on hospital processes. We hypothesized that COVID-19 was associated with decreased cancer physiatry referrals in 2020. This is a retrospective cohort study of consecutive patients from April to July 2019 and 2020 admitted at an academic quaternary cancer center. The main outcomes were number of hospital admissions, rate, and characteristics of inpatient rehabilitation admissions and change in percentage of physiatry referrals as the primary endpoint. Results showed that in 2019, there were 387 referrals from 10,274 inpatient admissions (3.8%; 95% confidence interval, 2.4-4.2), compared with 337 referrals from 7051 admissions in 2020 (4.8%; 95% confidence interval, 4.3-5.3, P = 0.001). Hematology services referred more patients than neurosurgery in 2020 (20.4% vs. 31.4%; 48.2% vs. 26.5%, P = 0.01). Discharge disposition reflected an increased frequency of return to acute care service in 2020 (10.2% vs. 21.8%, P = 0.03). In conclusion, there was an increase in the rate of physiatry referrals despite a decrease in hospital admissions. There was an increase in referrals by hematology, likely due to emphasis on safe discharge and the populations hospitalized.

Mapping wheelchair functions and their associated functional elements for stair climbing accessibility: a systematic review

PURPOSE

Wheelchair (WC) design elements are subjected to the accessibility and assistive needs of a person with locomotor disability. In order to pursue a holistic design for a stairclimbing WC, there is a need for literature review on WC functions reported for both stair climbing and plane surface movement.

METHODS

A total of 112 Research articles are reviewed for the purpose of extracting the relationship between WC design elements and the functions associated with them. Stairclimbing technologies are reviewed for their technological assessment in terms of functional elements associated with stairclimbing. Cross-functional mapping between functional elements and their dominant function is performed. Heat map for primary user needs and associated design elements is generated from cross mapping.

CONCLUSIONS

A design gap for user's functional needs is indicated from the review of literature on prototypes and products of WC. The literature in stairclimbing technology is primarily focussed on stair climbing capability and not on the other functional needs, such as safety, ride comfort, seat comfort, manoeuvrability, etc.Implications for rehabilitationFor attaining the goal of an effective rehabilitation, it is important to design and develop an assistive technology that can provide maximum accessibility and functioning for a person with disability. In case of locomotor disability, wheelchair (WC) is the most empowering tool that can assist people in both accessibility and activities of daily living. This review of literature was conducted to draw out the functions fulfilled by a WC, such as safety, comfort, propulsion for its users and the associated WC elements like seat, wheels, backrest, etc., that are required to fulfil those functions.WC being the most important technological intervention in the life of a person who cannot walk should be designed with the highest level of empathy. Therefore, each and every aspect of the user's physical and emotional needs should be catered up to the limits of engineering design. The research on stair climbing technologies has also grown exponentially, fuelled by technological growth in engineering mechanisms, ambient awareness sensors, actuators, etc. The review attempts to envelop such technologies and consolidate them on the basis of their capabilities and efficacies.The virtue of stair climbing has been realized through some novel and innovative mechanisms reviewed in this article that can be integrated with the research in field of functional elements required to carry out primary functions of a disabled person, such as safety, comfort, intuitiveness, etc. This review can help in coupling both of them in a more rational way where a designer who is designing the technology is more empathetic towards the design for accessibility. It can also help user in becoming more confident towards adapting a new assistive technology.