A weighted blanket increases pre-sleep salivary concentrations of melatonin in young, healthy adults

Weighted blankets have emerged as a potential non-pharmacological intervention to ease conditions such as insomnia and anxiety. Despite a lack of experimental evidence, these alleged effects are frequently attributed to a reduced activity of the endogenous stress systems and an increased release of hormones such as oxytocin and melatonin. Thus, the aim of the present in-laboratory crossover study (26 young and healthy participants, including 15 men and 11 women) was to investigate if using a weighted blanket (~12% of body weight) at bedtime resulted in higher salivary concentrations of melatonin and oxytocin compared with a light blanket (~2.4% of body weight). We also examined possible differences in salivary concentrations of the stress hormone cortisol, salivary alpha-amylase activity (as an indicative metric of sympathetic nervous system activity), subjective sleepiness, and sleep duration. When using a weighted blanket, the 1 hour increase of salivary melatonin from baseline (i.e., 22:00) to lights off (i.e., 23:00) was about 32% higher (p = 0.011). No other significant differences were found between the blanket conditions, including subjective sleepiness and total sleep duration. Our study is the first to suggest that using a weighted blanket may result in a more significant release of melatonin at bedtime. Future studies should investigate whether the stimulatory effect on melatonin secretion is observed on a nightly basis when frequently using a weighted blanket over weeks to months. It remains to be determined whether the observed increase in melatonin may be therapeutically relevant for the previously described effects of the weighted blanket on insomnia and anxiety.

The Original and Short Versions of the Activities-Specific Balance Confidence (ABC) Scale in Community-Dwelling Older Adults: Clinical Implications Based on Scale Agreement, Internal Consistencies, and Associations With Self-Rated Health

BACKGROUND AND PURPOSE

Balance confidence assessment in older adults has implications for falls prevention and quality of life. It remains unclear whether the original Activities-specific Balance Confidence Scale (ABC-16) or the shortened 6-item scale (ABC-6) is recommended clinically. This study examined ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) in community-dwelling older adults.

METHODS

Secondary analysis of an existing dataset (N = 77) was performed. Scale association and agreement were assessed with a Spearman ρ correlation (rs), intraclass correlation coefficient, 95% limits of agreement (LoA), and Bland-Altman plot. Cronbach α values were calculated to determine internal consistencies. Separate multiple linear regression models with SRH as the outcome and ABC-6 and ABC-16 scores as primary predictors were estimated and subsequently used to conduct Hotelling t test.

RESULTS AND DISCUSSION

Participants were primarily female (80.5%) with a median age of 68 years living in the metro Detroit area. The ABC-6 and ABC-16 were closely associated [rs = 0.97, P < .001; intraclass correlation coefficient (2,1) = 0.80] but demonstrated discrepancy (95% LoA range of -3.9 to +18.2; mean difference = 7.2 points in the direction of the ABC-16). Cronbach α values were 0.95 (ABC-16) and 0.89 (ABC-6). Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2 = 0.36) in SRH compared with model 2 (ABC-16 = primary predictor; R2 = 0.29). Hotelling t test [t(74) = 2.4, P = .008] found that the predicted values from the ABC-6 model were significantly more highly correlated with SRH than those from the ABC-16 model.

CONCLUSIONS

Despite a high correlation between the ABC-16 and ABC-6, the 2 scales showed limited agreement and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 may be preferable to the ABC-16 for balance confidence assessment in older adults living in cold weather, urban, or well-resourced areas.

Enhancing speech-language pathology head and neck cancer service provision in rural Australia: Using a plan, do, study, act approach

PURPOSE

People with head and neck cancer (HNC) require ongoing speech-language pathology (SLP) services into the post-acute recovery phase of care. However, there are recognised service inequities/barriers for people from rural areas who are unable to access SLP services locally, necessitating travel to metropolitan centres. This study implemented strategies to assist rural speech-language pathologists to work to full scope of practice and support post-acute rehabilitation services for people with HNC.

METHOD

The study involved five SLP departments within a rural health referral network (one tertiary cancer centre, four rural sites). It involved a Plan-Do-Study-Act (PDSA) method, across two six month cycles, to achieve implementation of a model to support local SLP delivery of HNC care. Data collected included service activity, consumer feedback from people accessing local care, staff perceptions of the model and changes to local SLP service capabilities.

RESULT

Staff identified four objectives for change across the two PDSA cycles including resource development, upskilling/training and improving communication, and handover processes. In cycle 1, multiple resources were developed such as an eLearning program for training and skill development. In cycle 2, a pilot trial of a shared-care model was implemented, which successfully supported a transfer of care to local services for eight people with HNC. The majority of consumers accessing HNC care locally were satisfied with the service and would recommend future people with HNC receive similar care.

CONCLUSION

The PDSA process supported development and implementation of a model enabling local speech-language pathologists to offer post-acute care for people with HNC. This model helps rural people with HNC to access care closer to home by supporting rural clinicians to work to full scope of practice.

Qualitative Research and Cancer Nursing: A Guide for Novice Researchers

OBJECTIVE

To introduce the cancer nurse to qualitative research.

DATA SOURCES

A search of published literature including articles and books was conducted to inform the article using University libraries (University of Galway and University of Glasgow) and CINAHL, Medline, and Google Scholar databases using broad terms, including qualitative research, qualitative methods, paradigm, qualitative, and cancer nursing.

CONCLUSION

It is important for cancer nurses wishing to read, critically appraise, or undertake qualitative research to understand the origins and different methods employed in qualitative research.

IMPLICATIONS FOR NURSING PRACTICE

The article is of relevance for cancer nurses globally who wish to read, critique, or undertake qualitative research.

Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020

Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.

Prevalence of dietary supplement use and knowledge, attitudes, practice (KAP) and associated factors in student population: A cross-sectional study

Dietary supplements (DSs) intake has been increasing worldwide despite no consensus evidence for the efficacy and safety of disease prevention, control, or treatment in nutrient-replete populations. This study aimed to determine the prevalence of DSs use, knowledge, attitude, and practice (KAP) and associated factors among university students in Jordan. A national cross-sectional study was carried over across universities in Jordan. Participants completed a valid and reliable online questionnaire (Cronbach's alpha = 0.802 and correlation coefficients between 0.72 and 0.26). Univariate analyses were used to determine the relationship between variables. Multivariable regression was carried out to identify significant factors contributing DSs usage. A total of 448 university students completed the study (73.7% females). More than half of the students used DSs (60.9%), with single-nutrient ingredient supplements being the most commonly used type. The primary motivators were maintaining health and most students reported no side effects associated with consumption. The results revealed poor knowledge, a negative attitude towards DSs usage among all participants, even non-users, and high-risk practices among the DSs users. Normal weight and overweight individuals were more likely to use DSs (OR:2.88, 95%CI:1.61-5.16, OR:1.95, 95%CI:1.01-3.79, respectively). Low and medium-family income categories were more likely to use DSs than those in the high-income category (OR: 0.04, 95%CI: 0.02-0.07, OR: 0.06, 95CI:0.03-0.11, respectively). Undergraduate students were more likely to use DSs than postgraduate students (OR:5.56, 95%CI:3.19-9.69). In this study, a high prevalence of DSs use was highlighted. The results suggest that nutrition education is required to improve awareness of DSs and to promote safe practices.

Feasibility of a theoretically grounded, multicomponent, physiotherapy intervention aiming to promote autonomous motivation to adopt and maintain physical activity in patients with lower-limb osteoarthritis: protocol for a single-arm trial

BACKGROUND

Lower-limb osteoarthritis (OA) causes high levels of pain and disability in adults over 45 years of age. Adopting and maintaining appropriate levels of physical activity (PA) can help patients with lower-limb OA self-manage their symptoms and reduce the likelihood of developing secondary noncommunicable diseases. However, patients with lower-limb OA are less active than people without musculoskeletal pain. This single-arm feasibility trial seeks to determine the feasibility and acceptability of a complex multicomponent physiotherapy behaviour change intervention that aims to aid patients with lower-limb OA to adopt and maintain optimal levels of PA.

METHODS

This trial will be conducted at one site in a National Health Service physiotherapy outpatient setting in the West Midlands of England. Up to thirty-five participants with lower-limb OA will be recruited to receive a physiotherapy intervention of six sessions that aims to optimise their PA levels during phases of behavioural change: adoption, routine formation and maintenance. The intervention is underpinned by self-determination theory (and other motivational frameworks) and seeks to foster a motivationally optimal (empowering) treatment environment and implement behaviour change techniques (BCTs) that target PA behaviours across the three phases of the intervention. Physiotherapists (n = 5-6) will receive training in the why and how of developing a more empowering motivational environment and the delivery of the intervention BCTs. Participants will complete patient-reported and performance-based outcome measures at baseline and 3-month (to reflect behavioural adoption) and 6-month (maintenance) post-baseline. Feasibility and acceptability will be primarily assessed through semi-structured interviews (purposively recruiting participants) and focus groups (inviting all physiotherapists and research staff). Further evaluation will include descriptive analysis of recruitment rates, loss of follow-up and intervention fidelity.

DISCUSSION

A novel complex, multicomponent theoretical physiotherapy behaviour change intervention that aims to create a more empowering motivational treatment environment to assist patients with lower-limb OA to adopt and maintain optimal PA levels has been developed. Testing the feasibility and acceptability of the intervention and its associated physiotherapist training and related trial procedures is required to determine whether a full-scale parallel group (1:1) randomised controlled trial to evaluate the interventions effectiveness in clinical practice is indicated.

TRIAL REGISTRATION

Trial register: International Standard Randomised Controlled Trial identification number: ISRCTN12002764 . Date of registration: 15 February 2022.

Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study

INTRODUCTION

Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV.

METHODS AND ANALYSIS

We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques.

ETHICS AND DISSEMINATION

Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05006391.

A relational perspective of schizophrenia at work

Purpose

Despite a plethora of research on diversity and inclusion, workplace-related issues pertaining to individuals with schizophrenia (SCZ) remain grossly underexplored. This paper seeks to develop a relational, multilevel perspective of issues and challenges faced by individuals with SCZ in the work and career.

Design/methodology/approach

The research draws on the findings from in-depth, qualitative interviews with schizophrenic individuals, individuals’ family members, healthcare professionals and nongovernmental organization (NGO) representatives.

Findings

The findings highlight the interconnected nature of multilevel issues faced by schizophrenic individuals and indicate that at the societal level, social stigma, economic conditions and inadequate government policies are the key challenges faced by them. At the organizational level workplace support and job suitability and design affect individuals’ employment. At the individual level, self-stigma affects the employability in a negative way whereas personal motivation and resilience, family and social support and realization of illness are the facilitating factors.

Originality/value

The study adds to disability and diversity literature by developing a relational perspective that holistically captures the issues faced by schizophrenic individuals and suggests that the work and employment-related issues may be simultaneously addressed at multiple levels.

Expert Consensus on the Resource Needs of Autistic Children and Young People in Ireland During the Early Months of the COVID-19 Pandemic

The COVID-19 pandemic has brought significant changes across society. This Delphi study aimed to gain expert consensus on challenges faced and resource needs for autistic children during the COVID-19 pandemic. Round 1 of the Delphi method employed semi-structured interviews with experts (N = 24) which were thematically analysed in order to identify needs, resource targets and resource development. In a follow-up Round 2 survey participants rated emergent need and resource in order of priority. Round 2 provided consensus on challenges faced with anxiety, routine and wellbeing ranked most important. Direction on resource design was also obtained. Consensus on the challenges and resources was achieved and is being integrated into a needs-based transition resources toolkit. Future studies could make use of the Delphi method to quickly gain consensus on focus of needs in other contexts and communities.

Developing a conceptual model of post-disaster damage and loss assessment program in the Iranian health sector: a qualitative study protocol

INTRODUCTION

Annual natural and man-made disasters in Iran eventually lead to casualties and considerable financial loss. The success of a reconstruction programme depends on accurate postdisaster damage and loss assessment. Based on these assessments, the goals, priorities and approaches required for reconstruction are prepared and formulated. To effectively implement a reconstruction and rehabilitation programme in the country's health sector, it is necessary to prepare and compile a postdisaster damage and loss assessment programme.

METHODS AND ANALYSIS

This qualitative study will be conducted to develop a conceptual model of a postdisaster damage and loss assessment programme in Iran's health sector. First, a scoping review method will be conducted to identify the entities and components of the postdisaster damage and loss assessment programme. Then, using semistructured interviews, the opinions of university professors and disaster damage and loss assessors in the health sector will be obtained. Next, by conducting a focus group discussion, the initial programme of disaster damage and loss assessment in the Iranian health sector will be developed and then, the modified Delphi method will be used to validate it.

ETHICS AND DISSEMINATION

Ethical approval for this study was obtained from the research ethics committee of Isfahan University of Medical Sciences (IR.MUI.NUREMA.REC.1400.171). The study results will be disseminated to stakeholders, published in peer-reviewed journals and presented at conferences.

Test-Retest Reliability of a Passive Joint Position Sense Test After ACL Reconstruction: Influence of Direction, Target Angle, Limb, and Outcome Measures

Background:

The joint position sense (JPS) is an element of proprioception and defined as an individual’s ability to recognize joint position in space. The JPS is assessed by measuring the acuity of reproducing a predetermined target angle. The quality of psychometric properties of knee JPS tests after anterior cruciate ligament reconstruction (ACLR) is uncertain.

Purpose/Hypothesis:

The purpose of this study was to evaluate the test-retest reliability of a passive knee JPS test in patients who underwent ACLR. We hypothesized that the passive JPS test would produce reliable absolute error, constant error, and variable error estimates after ACLR.

Study Design:

Descriptive laboratory study.

Methods:

Nineteen male participants (mean age, 26.3 ± 4.4 years) who had undergone unilateral ACLR within the previous 12 months completed 2 sessions of bilateral passive knee JPS evaluation. JPS testing was conducted in both the flexion (starting angle, 0°) and the extension (starting angle, 90°) directions in the sitting position. The absolute error, constant error, and variable error of the JPS test in both directions were calculated at 2 target angles (30° and 60° of flexion) by using the angle reproduction method for the ipsilateral knee. The standard error of measurement (SEM), smallest real difference (SRD), and intraclass correlation coefficients (ICCs) with 95% Cis were calculated.

Results:

ICCs were higher for the JPS constant error (operated and nonoperated knee, 0.43-0.86 and 0.32-0.91, respectively) compared with the absolute error (0.18-0.59 and 0.09-0.86, respectively) and the variable error (0.07-0.63 and 0.09-0.73, respectively). The constant error of the 90°-60° extension test showed moderate to excellent reliability for the operated knee (ICC, 0.86 [95% CI, 0.64-0.94]; SEM, 1.63°; SRD, 4.53°), and good to excellent reliability for the nonoperated knee (ICC, 0.91 [95% CI, 0.76-0.96]; SEM, 1.53°; SRD, 4.24°).

Conclusion:

The test-retest reliability of the passive knee JPS tests after ACLR varied depending on the test angle, direction, and outcome measure (absolute error, constant error, or variable error). The constant error appeared to be a more reliable outcome measure than the absolute error and the variable error, mainly during the 90°-60° extension test.

Clinical Relevance:

As constant errors have been found reliable during the 90°-60° extension test, investigating these errors—in addition to absolute and variable errors—to reflect bias in passive JPS scores after ACLR is warranted.

Understanding Older Adults' Experiences With Technologies for Health Self-management: Interview Study

BACKGROUND

Many older adults now use technologies such as wearable devices and telehealth services to support their health and well-being while living independently at home. However, older adults vary in how they use these technologies, and there is a lack of knowledge regarding the motivations that influence their acceptance and use of health-related technologies in home environments.

OBJECTIVE

This study aimed to understand the types of technologies that older adults use to support their health and the factors that motivate them to use their chosen technologies to support their health. In addition, we aimed to understand the factors that enable the effective use of technologies for health self-management and to identify the barriers that can negatively affect the adoption of technologies.

METHODS

A total of 22 older adults participated in semistructured interviews regarding their experiences of using technologies for health self-management. Interview transcripts were analyzed through an in-depth thematic analysis.

RESULTS

The interviews revealed that a range of technologies, such as videoconferencing software, fitness trackers, and other devices, were being used by older adults to support their health. Interviews showed that participants were motivated to use technologies to monitor health issues, to stay active and connected, and to record and change their behavior in the light of foreseen risks related to their future health status. Enablers that facilitated the effective use of technologies include social and organizational influence, convenient access to health care and safety provided by the technology, and easy setup and low cost of the technology. Barriers include information overload and a sense of futility about future health decline; telehealth being an inadequate substitute for in-person consultation; concerns about trust related to privacy and accuracy; and technologies being stigmatizing, uncomfortable to use, expensive, and unfamiliar.

CONCLUSIONS

This study suggested that older adults were using a variety of technologies to prevent or prepare for future health decline, evidencing a resilient attitude toward health and aging. In addition, older adults were willing to continue using the technology when there was a perceived need. The enabler mentioned by most participants was the social and organizational influence that included health care staff, family, friends, and organizations. This analysis provides a better understanding of how older adults use technologies to support their health and can guide the provision of appropriate health technologies for them.

Influence of the constraint-induced method of constraint-induced movement therapy on improving lower limb outcomes after stroke: A meta-analysis review

Background

Constraint-induced movement therapy (CIMT) targeting the lower limb function uses various methods. The influence of CIMT methods on lower limb outcomes after stroke has rarely been examined.

Objectives

This study aimed to examine CIMT effects on lower limb outcomes and explore the influence of CIMT methods on treatment effects after stroke, with other potential factors considered as covariates.

Methods

PubMed, Web of Science, Cochrane Library, Academic Search Premier via EBSCOHost, and PEDro databases were searched until September 2022. We included randomized control trials with CIMT targeting the lower limb function and dosage-matched active control. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of each study. Hedges' g was used to quantify the effect size of CIMT on outcomes compared to the active control. Meta-analyses were conducted across all studies. A mixed-variable meta-regression analysis was used to investigate the influence of CIMT methods on treatment effects after stroke, with other potential factors considered as covariates.

Results

Twelve eligible randomized controlled trials with CIMT were included in the meta-analysis, where 10 trials were with a low risk of bias. A total of 341 participants with stroke were involved. For the treatment effects on the lower limb function, CIMT showed a moderate short-term effect size [Hedges' g = 0.567; P &gt; 0.05; 95% confidence interval (CI): 0.203–0.931], but a small and insignificant long-term effect size (Hedges' g = 0.470; P &gt; 0.05; 95%CI: −0.173 to 1.112), compared with conventional treatment. The CIMT method of using a weight strapped around the non-paretic leg and the ICF outcome category of the movement function were identified as significant factors contributing to the heterogeneity of short-term effect sizes across studies (β = −0.854 and 1.064, respectively, R2 = 98%, P &gt; 0.05). Additionally, using a weight strapped around the non-paretic leg had a significant contribution to the heterogeneity of long-term effect sizes across studies as well (β = −1.000, R2 = 77%, P &gt; 0.05).

Conclusion

Constraint-induced movement therapy is superior to conventional treatment for improvement of lower limb function in the short-term but not in the long-term. The CIMT method of using a weight strapped around a non-paretic leg contributed negatively to the treatment effect, and therefore might not be recommended.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021268681.

Timing and Dose of Constraint-Induced Movement Therapy after Stroke: A Systematic Review and Meta-Regression

The aim of this study is to investigate the effects of constraint-induced movement therapy on stroke patients who had intact cognition and some voluntary finger extension and to identify optimal protocols to apply this therapy method. We searched PubMed, Cochrane Library, and Embase for randomized controlled trials conducted prior to January 2022. The outcomes included the Motor Activity Log, Fugl-Meyer Assessment, and Wolf Motor Function Test. The inverse variance method fixed-effect model as well as the DerSimonian and Laird estimator random-effects model were applied, and the mean difference was calculated with 95% confidence interval to measure continuous outcomes. Six randomized controlled trials involving a total of 169 patients with stroke were enrolled. Compared with conventional rehabilitation methods, there was no significant effect of constraint-induced movement therapy when evaluated by the Motor Activity Log, including the amount of use (random-effect, standardized mean difference 0.65; 95%, confidence interval: −0.23–1.52) and quality of movement (random-effect, standardized mean difference 0.60; 95% confidence interval: −0.19–1.39). However, among patients with chronic stroke symptoms, meta-regression analyses showed better performance with a constraint time of at least 6 h per day and 6 h training per week when assessing the amount of use (p = 0.0035) and quality of movement (p = 0.0031). Daily intervention time did not lead to a significant difference in functional upper limb performance. An efficient protocol of constraint-induced movement therapy designed as 6 h of training per week with 6 h constraint per day could bring significant stroke symptom improvement to patients with chronic stroke.

The impact of childhood acquired brain injury on siblings: a scoping review

OBJECTIVE

(a) To analyze the extent and nature of research on the impact of childhood acquired brain injury (ABI) on siblings, (b) to synthetize in a descriptive way the results of these studies and propose perspectives of care/support.

METHOD

A literature search of 3 databases was performed up to August 2022. Studies addressing issues around siblings of children with ABI were included in the scoping review.

RESULTS

25 articles were identified and analyzed. Results indicate that there is a paucity of research on this issue. However, interest in the subject has increased over past decades. Despite variable results, the current literature highlights the negative impact of ABI on family functioning and relationships. The trajectory and quality of life of siblings of children with ABI are modified. ABI causes intense and mixed emotions, psychological distress, behavioral difficulties and social stigma. Siblings have varied ways of coping with ABI and express particular needs that must be addressed.

CONCLUSION

There is a significant impact of childhood ABI on siblings' subsequent life. Existing studies on this subject are few, heterogeneous, and sometimes contradictory. Further studies on this theme therefore appear necessary in order to propose appropriate support for patients' siblings according to their age and situation.

Functional and Cognitive Occupational Therapy (FaCoT) Improves Self-Efficacy and Behavioral-Emotional Status of Individuals with Mild Stroke; Analysis of Secondary Outcomes

BACKGROUND

Mild stroke is characterized by subtle impairments, such as low self-efficacy and emotional and behavioral symptoms, which restrict daily living. Functional and Cognitive Occupational Therapy (FaC_oT) is a novel intervention, developed for individuals with mild stroke.

OBJECTIVES

To examine the effectiveness of FaC_oT compared to a control group to improve self-efficacy, behavior, and emotional status (secondary outcome measures).

MATERIAL AND METHODS

Community-dwelling individuals with mild stroke participated in a single-blind randomized controlled trial with assessments at pre, post, and 3-month follow-up. FaC_oT included 10 weekly individual sessions practicing cognitive and behavioral strategies. The control group received standard care. The New General Self-Efficacy Scale assessed self-efficacy; the Geriatric Depression Scale assessed depressive symptoms; the Dysexecutive Questionnaire assessed behavior and emotional status; and the 'perception of self' subscale from the Reintegration to Normal Living Index assessed participation.

RESULTS

Sixty-six participants were randomized to FaC_oT (n = 33, mean (SD) age 64.6 (8.2)) and to the control (n = 33, age 64.4 (10.8)). Self-efficacy, depression, behavior, and emotional status improved significantly over time in the FaC_oT group compared with the control, with small to large effect size values.

CONCLUSION

The efficacy of FaC_oT was established. FaC_oT should be considered for community-dwelling individuals with mild stroke.

Interventions to Increase Physical Activity in Community-Dwelling Older Adults in Regional and Rural Areas: A Realist Synthesis Review Protocol

The importance of physical activity (PA) for the health and wellbeing of older adults is well documented, yet many older adults are insufficiently active. This issue is more salient in regional and rural areas, where evidence of the most critical components of interventions that explain PA participation and maintenance in older populations is sparse. This realist review will (1) systematically identify and synthesise literature on PA interventions in community-dwelling older adults in regional and rural areas, and (2) explore how and why those interventions increase PA in that population. Using a realist synthesis framework and the behaviour change wheel (BCW), context-mechanism-outcome (C-M-O) patterns of PA interventions for older adults in regional and rural areas will be synthesised. Thematic analysis will be employed to compare, contrast, and refine emerging C-M-O patterns to understand how contextual factors trigger mechanisms that influence regional and rural community-dwelling older adults' participation in PA interventions. This realist review will be the first to adopt a BCW analysis and a realist synthesis framework to explore PA interventions in community-dwelling older adults in regional and rural areas. This review will provide recommendations for evidence-based interventions to improve PA participation and adherence by revealing the important mechanisms apparent in this context. Systematic review registration: (PROSPERO CRD42023402499).

The biopsychosocial impact of hypermobility spectrum disorders in adults: a scoping review

Joint hypermobility affects approximately 30% of the United Kingdom (UK) population, characterised by the ability to move joints beyond the physiological limits. Associated conditions include Ehlers-Danlos syndrome and hypermobility spectrum disorders, affecting individuals across physical, psychological and social levels detrimentally impacting their health and wellbeing. The scoping review aims to describe the known biopsychosocial impact of joint hypermobility conditions in adults over the last decade. Additional objectives include to (1) identify the types of studies that address these factors, (2) to understand how the impact of the condition is measured and managed and (3) what healthcare professionals (HCPs) are involved. The scoping review was conducted using the five-stage framework by Arksey and O'Malley. The search strategy related to two main keywords, "hypermobility" and, "biopsychosocial" across a number of electronic databases. A pilot search was conducted to determine the suitability of the databases and terms. Following the search, the data was extracted and charted, summarised and narratively reported. 32 studies met the inclusion criteria. The majority were conducted in either the UK or United States of America and case-control in design. The biopsychosocial impact was wide-ranging including, but not limited to, musculoskeletal system and dermatology, gastroenterology, mood and anxiety disorders, education and employments. This review is the first of its kind to summarise all reported symptoms and impact of joint hypermobility conditions in adults, highlighting a clear need to promote a multidisciplinary and holistic approach in raising awareness of these conditions and improving their management.

Summary of best evidence for prevention and control of pressure ulcer on support surfaces

The aim of this study was to summarise the best evidence for the prevention and control of pressure ulcer at the support surface based on the site and stage of the pressure ulcer in order to reduce the incidence of pressure ulcer and improve the quality of care. In accordance with the top-down principle of the 6 S model of evidence-based resources, evidence from domestic and international databases and websites on the prevention and control of pressure ulcer on support surfaces, including randomised controlled trials, systematic reviews, evidence-based guidelines, and evidence summaries, was systematically searched for the period from January 2000 to July 2022. Evidence grading based on the Joanna Briggs Institute Evidence-Based Health Care Centre Evidence Pre-grading System (2014 version), Australia. The outcomes mainly embraced 12 papers, including three randomised controlled trials, three systematic reviews, three evidence-based guidelines, and three evidence summaries. The best evidence summarised included a total of 19 recommendations in three areas: type of support surface selection assessment, use of support surfaces, and team management and quality control.

Linear Mixed-Model Analysis Better Captures Subcomponents of Attention in a Small Sample Size of Persons With Aphasia

PURPOSE

Although there are several reports of attention deficits in aphasia, studies are typically limited to a single component within this complex domain. Furthermore, interpretation of results is affected by small sample size, intraindividual variability, task complexity, or nonparametric statistical models of performance comparison. The purpose of this study is to explore multiple subcomponents of attention in persons with aphasia (PWA) and compare findings and implications from various statistical methods-nonparametric, mixed analysis of variance (ANOVA), and linear mixed-effects model (LMEM)-when applied to a small sample size.

METHOD

Eleven PWA and nine age- and education-matched healthy controls (HCs) completed the computer-based Attention Network Test (ANT). ANT examines the effects of four types of warning cues (no, double, central, spatial) and two flanker conditions (congruent, incongruent) to provide an efficient way to assess the three subcomponents of attention (alerting, orienting, and executive control). Individual response time and accuracy data from each participant are considered for data analysis.

RESULTS

Nonparametric analyses showed no significant differences between the groups on the three subcomponents of attention. Both mixed ANOVA and LMEM showed statistical significance on alerting effect in HCs, orienting effect in PWA, and executive control effect in both PWA and HCs. However, LMEM analyses additionally highlighted significant differences between the groups (PWA vs. HCs) for executive control effect, which were not evident on either ANOVA or nonparametric tests.

CONCLUSIONS

By considering the random effect of participant ID, LMEM was able to show deficits in alerting and executive control ability in PWA when compared to HCs. LMEM accounts for the intraindividual variability based on individual response time performances instead of relying on measures of central tendencies.

What are tutors' perceptions of an online tutoring project-Digital Learning Companion-During the COVID-19 pandemic? A case study in Taiwan

The COVID-19 outbreak has had serious impact on remote education and service-learning implementation in Taiwan. To alleviate these impacts, the Digital Learning Companion, an online tutoring project, was proposed to bridge the digital divide and learning gap among remote children, while offering university students an online service-learning environment. This project recruited international students as tutors for local children. To explore tutors' perceptions of this project during the COVID-19 pandemic, qualitative research, particularly a case study, was conducted. Adopting purposive sampling, 15 participants were chosen for interviews at the end of the project, and 10 reflective videos were used to reveal further information to supplement the interview results. Content analysis was employed to analyse the data. The findings implied that using JoinNet and tutoring journals significantly facilitated the tutoring process, which led to tutors' remarkable development in skills, social relationships, multicultural experience, altruism, social responsibility, self-efficacy, and affective values. However, they encountered some challenges, such as technical problems, communication barrier, lack of tutee information, and short tutoring duration. The solutions to these challenges and insightful suggestions for the project development are pointed out. The results of this study contribute to tutors' cognitive, social, and motivational development, and support the online service-learning-integrated curriculum, which can become a reference for further studies regarding online service-learning implementation to bridge the research gap.

Graphical abstract

Impact of a specific consultation for patients with progressive forms of multiple sclerosis on the response to their unmet care needs: a cross-sectional study

BACKGROUND

As their disease evolves, most patients with progressive forms of multiple sclerosis (MS) develop particular healthcare needs that are not always addressed with usual follow-up. To adapt neurological care to these patients, we created a specific consultation for patients with progressive MS in our centre in 2019.

OBJECTIVES

To explore the main unmet care needs of patients with progressive MS in our setting, and to establish the usefulness of the specific consultation to address them.

METHODS

Literature review and interviews with patients and healthcare professionals were conducted to identify the main unmet needs in routine follow-up. Two questionnaires were developed, assessing the importance of the unmet needs identified and the usefulness of the consultation to meet them, for patients under follow-up in the specific consultation and their informal caregivers.

RESULTS

Forty-one patients and nineteen informal caregivers participated. The most important unmet needs were the information about the disease, access to social services and coordination between specialists. A positive correlation was found between the importance of these unmet needs and the responsiveness to each of them in the specific consultation.

CONCLUSIONS

The creation of a specific consultation may improve attention to the healthcare needs of patients with progressive MS.

A realist evaluation of the feasibility of a randomised controlled trial of a digital music and movement intervention for older people living in care homes

BACKGROUND

Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective.

METHODS

Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite.

CONCLUSION

This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed.

TRIAL REGISTRATION

Retrospectively registered at ClinicalTrials.gov NCT05559203.

A stroke rehabilitation training program for community-based primary health care, South Africa

Background

With an increasing burden of stroke and a lack of access to rehabilitation services in rural South African settings, stroke survivors rely on untrained family caregivers for support and care. Community health workers (CHWs) support these families but have no stroke-specific training.

Objectives

To describe the development of a contextually appropriate stroke training program for CHWs in the Cape Winelands District, South Africa.

Method

Twenty-six health professionals and CHWs from the local primary healthcare services participated in action research over a 15-month period from September 2014 to December 2015. The groups participated in two parallel cooperative inquiry (CI) groups. The inquiry followed the cyclical steps of planning, action, observation and reflection. In this article, the planning step and how the CI groups used the first three steps of the analyse, design, develop, implement, evaluate (ADDIE) instructional design model are described.

Results

The CHWs' scope of practice, learning needs, competencies and characteristics, as well as the needs of the caregivers and stroke survivors, were identified in the analysis step. The program design consisted of 16 sessions to be delivered over 20 h. Program resources were developed with appropriate technology, language and instructional methodology.

Conclusion

The program aims to equip CHWs to support family caregivers and stroke survivors in their homes as part of their generalist scope of practice. The implementation and initial evaluation will be described in a future article.

Contribution

The study developed a unique training program for CHWs to support caregivers and stroke survivors in a resource-constrained, rural, middle-income country setting.

Interprofessional teamwork before and after organizational change in a tertiary emergency department: An observational study

In healthcare settings, suboptimal interprofessional teamwork and communication contribute to unsafe care and avoidable harm. Interprofessional teamwork is essential in high-risk clinical areas such as the emergency department (ED). The aims of this study were to describe interprofessional teamwork in a hospital ED and to evaluate factors influencing interprofessional communication before and after implementation of a department-wide multifaceted intervention. Structured observations were undertaken during 2015/16 and 2019. Differences in interprofessional communication practices, teamwork, and sources of interruptions were compared before and after the intervention. The following domains were surveilled: (a) healthcare professionals (HCPs) communication initiatives, (b) HCPs' contribution to patient assessment, (c) interprofessional communication processes, and (d) team interruptions. The intervention included strategies to enable use of communication tools, changes to team structures, changes in work environment, ethical principles, and establishment of a code of professional conduct during interprofessional communication. Team interruptions significantly decreased post-intervention, and our findings suggest that organizational changes affect domains of teamwork. Statistically significant differences were observed in the initiated communication pre-intervention and contribution to patient assessment significantly increased post-intervention. Multifaceted organizational interventions can positively affect interprofessional team communication and work-flow in the ED, thus patient safety and quality of care can be improved.

Muscle energy technique for chronic obstructive pulmonary disease: a feasibility study

OBJECTIVE

This study aimed to investigate the feasibility of implementing a manual therapy technique (muscle energy technique, MET) protocol in a hospital pulmonary rehabilitation (PR) program for patients with moderate to severe chronic obstructive pulmonary disease (COPD).

METHODS

Participants aged 40 years and over, with moderate to severe COPD, were recruited into this 12-week study. The primary outcome measures were feasibility (acceptability of the intervention and attendance/adherence to the trial) and safety (adverse events, AEs). All participants received the MET and PR therapies. Participants and assessors were unblinded. Semi-standardized MET was delivered on 6 occasions (a maximum of once per week) at the hospital directly before a PR session. Participants undertook PR sessions as per the hospital program at a frequency of two days per week for 8 weeks. Participants were contacted 4 weeks after their final MET treatment via a telephone call to assess acceptability of the intervention.

RESULTS

Thirty-three participants were enrolled, with a median age of 74 years (range 45-89 years). The median number of MET sessions that participants attended was 5 (range 0-6) out of a possible 6 sessions (83% attendance). At follow-up, participants overwhelmingly enjoyed the MET treatment with some subjectively reporting improved breathing. There were no major AEs related to the intervention, with the majority of AEs classified as expected events related to COPD exacerbations.

CONCLUSION

It is feasible to implement a manual therapy protocol using MET as an adjunct to PR in a hospital setting. Recruitment rates were satisfactory and there were no AEs related to the MET component of the intervention.

Self-advocates with Down syndrome research the lived experiences of COVID-19 lockdowns in Aotearoa New Zealand

BACKGROUND

Individuals with Down syndrome are particularly vulnerable to COVID-19 because they are recognised as significantly immunocompromised. Yet their voices regarding their lived experiences of pandemic lockdowns have not been sought or heard.

AIM

This study aims to describe the lived experiences of people with Down syndrome during the pandemic lockdowns in Aotearoa New Zealand to add evidence in order to inform systemic advocacy.

METHOD

A mixed-methods approach positioned within an inclusive research paradigm was used, in which a group of self-advocates with Down syndrome co-designed a structured interview schedule and conducted 40 face-to-face interviews. Key themes were identified by using content analysis.

RESULTS

Despite the difficulties associated with lockdowns and participants not receiving their usual supports and having to make significant adjustments, they remained positive, adapted well, and demonstrated a high level of resilience and adaptability.

CONCLUSIONS

The findings add to the limited research on the lived experiences of people with Down syndrome during pandemic lockdowns. This research has given them a voice to contribute to policy, government initiatives, and service providers; particularly on issues around support during lockdown and staying connected with others.

The AERO study: A feasibility randomised controlled trial of individually tailored exercise adherence strategies based on a brief behavioural assessment for older people with musculoskeletal conditions

INTRODUCTION

Exercise is a widely used treatment modality for older people with musculoskeletal conditions. The effectiveness of exercise programmes is limited by adherence. The aims of this study were to examine the acceptability and feasibility of the AERO intervention in facilitating exercise adherence in older people with musculoskeletal conditions, and to inform the design of a future randomised controlled trial.

METHODS

A two arm feasibility randomised controlled trial with an embedded qualitative study conducted at one orthopaedic hospital in the South of England. Older adults referred to physiotherapy with musculoskeletal conditions were randomised to receive either usual care consisting of standard physiotherapy only, or the AERO intervention, consisting of usual care with the addition of tailored exercise adherence approaches based on a brief behavioural assessment. Feasibility outcomes included recruitment, randomisation, retention, acceptability, and fidelity to trial protocol. Secondary outcomes included exercise adherence, physical activity, and behavioural regulation.

RESULTS

48 participants were recruited to the study with 27 randomised to usual care and 21 to AERO and usual care. On the basis of recruitment, retention, the acceptability to participants and physiotherapists and fidelity, the AERO intervention was determined to be feasible.

CONCLUSION

The AERO intervention in which participants received tailored adherence strategies based on a behavioural assessment plus standard physiotherapy is feasible and acceptable. It is now ready to be tested in an adequately powered randomised controlled trial.

CONTRIBUTION OF THE PAPER

CLINICAL TRIAL REGISTRATION NUMBER: This study was registered at clinicaltrials.gov REF: NCT03643432.

Expert Consensus on the Characteristics of Patients with Epstein-Barr Virus-Positive Post-Transplant Lymphoproliferative Disease (EBV+ PTLD) for Whom Standard-Dose Chemotherapy May be Inappropriate: A Modified Delphi Study

INTRODUCTION

Following hematopoietic stem cell transplantation or solid organ transplantation, patients are at risk of developing Epstein-Barr virus-positive post-transplant lymphoproliferative disease (EBV⁺ PTLD), which is an ultra-rare and potentially lethal hematologic malignancy. Common treatments for EBV⁺ PTLD include rituximab alone or combined with chemotherapy. Given specific considerations for this population, including severity of the underlying condition requiring transplant, the rigors of the transplant procedure, as well as risks to the transplanted organ, there is a group of patients with EBV⁺ PTLD for whom chemotherapy may be inappropriate; however, there is limited information characterizing these patients. This study aimed to reach expert consensus on the key characteristics of patients for whom chemotherapy may be inappropriate in a real-world setting.

METHODS

A two-round modified Delphi study was conducted to reach consensus among clinicians with expertise treating EBV⁺ PTLD. Articles identified in a targeted literature review guided the development of round 1 and 2 topics and related statements. The consensus threshold for round 1 statements was 75.0%. If consensus was achieved in round 1, the statement was not discussed further in round 2. The consensus thresholds for round 2 were moderate (62.5-75.0%), strong (87.5%), or complete (100.0%).

RESULTS

The panel was composed of a total of eight clinicians (seven hematologists/hemato-oncologists) from six European countries. The panel generated a final list of 43 consensus recommendations on the following topics: terminology used to describe patients for whom chemotherapy may be inappropriate; demographic characteristics; organ transplant characteristics; comorbidities that preclude the use of chemotherapy; EBV⁺ PTLD characteristics; and factors related to treatment-related mortality and morbidity.

CONCLUSIONS

This modified Delphi panel successfully achieved consensus on key topics and statements that characterized patients with EBV⁺ PTLD for whom chemotherapy may be inappropriate. These recommendations will inform clinicians and aid in the treatment of EBV⁺ PTLD.

A mixed methods evaluation of Multiple Mini Interviews for entry into the Bachelor of Midwifery

BACKGROUND

Multiple-mini interviews (MMI) are increasingly used as part of the admission process into healthcare degrees. Evaluations have found MMIs to be a fair assessment tool in terms of reliability and validity and viewed positively by those involved in the MMI process. The use of MMIs in midwifery is novel and evaluation is lacking.

AIM

To evaluate the use of MMIs as part of the admission process for the Bachelor of Midwifery in one Australian university.

METHODS

A basic convergent mixed methods study design was utilised. Data included linked data sets, Likert scale responses to survey questions, focus groups and open-ended survey questions. Integration took place at the interpretation and reporting stage.

FINDINGS

Participants viewed the MMI experience positively. The study confirmed the reliability of the MMIs as an assessment tool. Most variance in MMI scores was attributed to the candidate at 31.4 % with the interviewer and the interview station having less influence on the MMI score at 11 % and 6.4 % variance. Older applicants on average achieved higher MMI scores, and those who spoke a language other than English at home or were first in family to attend university had lower on average MMI scores. Being born overseas did not impact an applicant's MMI score. The overall experience was seen as fair, offering further opportunity to gain entry into the Bachelor of Midwifery.

CONCLUSION

MMIs were viewed positively and findings support the use of MMIs as part of an admissions process for the Bachelor of Midwifery.

A synthesis of qualitative research to understand the complexity behind treatment decision-making for osteoarthritis

Objective

Osteoarthritis is the most common joint disease with treatment involving a multidisciplinary approach with pharmacological, physical therapies and surgery as options. Qualitative research can help us to understand the complexity of managing health conditions and this understanding plays a role in good clinical practice. We aimed to systematically search for, identify, and synthesise qualitative research exploring the experience of living with osteoarthritis, including decision making about joint replacement.

Methods

We comprehensively searched 4 bibliographic databases and used the methods of meta-ethnography to synthesise qualitative research findings. We screened 10 ​123 titles, 548 abstracts, and 139 full texts. We included findings from 118 reports (105 unique samples) of at least 2534 adults living with osteoarthritis around the world.

Results

We developed 7 themes: Becoming your own expert can be hard work; Living has become a careful balancing act; Medication is a double-edged sword; I have other things in my life to consider; You have to weigh up the odds of surgery; Surgery is the only effective option; and Surgery will give me a chance to live now. These findings have been drawn into a conceptual model reflecting a complex balancing act with tensions underpinning treatment decision making.

Conclusions

Osteoarthritis is framed as a world where patients become their own expert about their management and healthcare choices. Our conceptual model highlights key tensions underpinning treatment decision-making. These findings provide clinicians with insight of the complex nature of these decisions and how they can help patients through shared decision making.

Acute passive stretching has no effect on gastrocnemius medialis stiffness in children with unilateral cerebral palsy

PURPOSE

The aim of this study was to investigate the effects of an acute high-intensity, long-duration passive stretching session of the plantar flexor muscles, on maximal dorsiflexion (DF) angle and passive stiffness at both ankle joint and gastrocnemius medialis (GM) muscle levels in children with unilateral cerebral palsy (CP).

METHODS

13 children [mean age: 10 years 6 months, gross motor function classification system (GMFCS): I] with unilateral CP underwent a 5 min passive stretching session at 80% of maximal DF angle. Changes in maximal DF angle, slack angle, passive ankle joint and GM muscle stiffness from PRE- to POST-intervention were determined during passive ankle mobilization performed on a dynamometer coupled with shear wave elastography measurements (i.e., ultrasound) of the GM muscle.

RESULTS

Maximal DF angle and maximal passive torque were increased by 6.3° (P < 0.001; + 50.4%; 95% CI 59.9, 49.9) and 4.2 Nm (P < 0.01; + 38.9%; 95% CI 47.7, 30.1), respectively. Passive ankle joint stiffness remained unchanged (P = 0.9; 0%; 95% CI 10.6, - 10.6). GM muscle shear modulus was unchanged at maximal DF angle (P = 0.1; + 34.5%; 95% CI 44.7, 24.7) and at maximal common torque (P = 0.5; - 4%; 95% CI - 3.7, - 4.3), while it was decreased at maximal common angle (P = 0.021; - 35%; 95% CI - 11.4, - 58.5). GM slack angle was shifted in a more dorsiflexed position (P = 0.02; + 20.3%; 95% CI 22.6, 18).

CONCLUSION

Increased maximal DF angle can be obtained in the paretic leg in children with unilateral CP after an acute bout of stretching using controlled parameters without changes in passive stiffness at joint and GM muscle levels.

CLINICAL TRIAL NUMBER

NCT03714269.

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation

OBJECTIVE(S)

To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics.

DESIGN

Direct non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively.

SETTING

6 UK Stroke Units PARTICIPANTS: 89 therapy sessions were observed, involving 55 clinicians and 57 patients.

RESULTS

Proportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1-8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset.

CONCLUSIONS

To optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov (NCT03792126). CONTRIBUTION OF THE PAPER.

Exploration of individuals perspectives of recovery following severe hand burn injuries

INTRODUCTION

Burns to one or both hands can impact how a person interacts with the world around them. Research regarding the specific impact of hand burn injuries and the experiences of individuals who have sustained hand burn injuries remains limited.

OBJECTIVE

The aim of this study was to explore the lived experiences of people with severe hand burn injuries, including their return to daily activities.

METHODS

This study used an interpretive description approach, incorporating 23 semi-structured interviews with people who had sustained severe hand burn injuries.

RESULTS

A major theme, "changes over time ", was identified and reflected the progressive nature of the experience over time. This was present in all three sub-themes: physical recovery, activities of daily living recovery, and psychosocial impact. Participants described a dual process of managing the recovery of the burn injury and burn rehabilitation interventions, whilst simultaneously learning to live with their injury and finding ways to engage in their occupations to the best of their abilities.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The findings of the study suggest that burns recovery could be described in terms of performance rather than impairment and needs to be continuously monitored overtime.

Benefits, Facilitators, and Barriers of Alternative Models of Cardiac Rehabilitation: A QUALITATIVE SYSTEMATIC REVIEW

PURPOSE

Cardiac rehabilitation (CR) improves health outcomes and quality of life for patients with cardiovascular disease, yet only a quarter of eligible patients enroll. A myriad of CR models that use either an alternative location (ie, home-based) and/or an alternative exercise have been developed to overcome known attendance and physical limitation barriers; however, patient experiences with these models have not been systematically reviewed. Our aim is to review patient experiences with these models of CR.

REVIEW METHODS

We conducted a systematic review and thematic analysis of qualitative studies published between 2009 and January of 2022 from CINAHL, PubMed, Web of Science, and PsycINFO.

SUMMARY

Twenty-five studies were included, representing the perspectives of 487 individuals who participated in an alternative model of CR. Exercises included walking, tai chi, yoga, aquatic exercise, exergaming, chair-based exercises, aerobics, physical activity trackers, and individualized exercise plans. Nineteen of 25 studies used home-based models and two used live video. Twelve studies included patients with heart failure. Patient perspectives comprised three central themes: exercise benefits, exercise facilitators, and participation barriers. Some thematic categories were reported variably by particular model/study design (eg, home-based) than by others. All alternative models of CR were found to be physically, psychologically, and/or socially beneficial to patients. Participants described facilitators and barriers that were influential in the decision to initiate or continue exercise. These patient insights are critical for innovative delivery of CR that is appealing, accommodates physical limitations, and broadens access to improve health equity.

Adding Cognitive Remediation to Employment Support Services: A Randomized Controlled Trial

OBJECTIVE

Individual placement and support (IPS) is an evidence-based strategy that helps individuals with mental illness obtain and maintain competitive employment. Despite the approach's overall success, almost half of IPS clients do not find work. Impairment in cognitive abilities may hamper employment and limit the benefits from rehabilitation services such as IPS. This randomized controlled trial aimed to assess the effects of adding cognitive remediation therapy (CRT) for IPS clients who had difficulties finding employment.

METHODS

At 14 mental health centers in Canada, 97 clients who had not found work after 3 months of receiving IPS services were recruited. Consenting clients were randomly assigned to either continue IPS alone or receive CRT added to IPS. The CRT used the Thinking Skills for Work protocol, a 12-week program that included computerized cognitive exercises along with coping strategies for managing cognitive challenges.

RESULTS

Participants completed on average 10 of 12 individual training sessions in coping strategies and 12 of 24 computerized training sessions. The addition of CRT to IPS resulted in significantly more participants working at the 3-month (odds ratio [OR]=2.83, 95% confidence interval [CI]=1.22-6.60) and 9-month follow-ups (OR=2.91, 95% CI=1.27-6.65). Participants who received CRT worked more hours and earned more in wages than those receiving IPS alone over the 9-month follow-up period. Both groups showed significantly improved cognitive outcomes at the 3-month follow-up, with no time × group interaction.

CONCLUSIONS

Cognitive remediation, especially skills training in coping and compensatory strategies, improves employment outcomes among individuals who do not show an early benefit of using IPS services.

Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units

PURPOSE

The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units.

METHOD

VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory.

RESULTS

The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement.

CONCLUSION

Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.

Rehabilitation outcomes based on service provision and geographical location for patients with multiple trauma: A mixed-method systematic review

INTRODUCTION

Previous research has highlighted the benefit of regionalised trauma networks in relation to decreased mortality. However, patients who now survive increasingly complex injuries continue to navigate the challenges of recovery, often with a poor view of their experiences of the rehabilitation journey. Geographical location, unclear rehabilitation outcomes and limited access to the provision of care are increasingly noted by patients as negatively influencing their view of recovery.

STUDY DESIGN

This mixed-methods systematic review included research that addresses the impact of service provision and geographical location of rehabilitation services for multiple trauma patients. The primary aim of the study was to analyse functional independence measure (FIM) outcomes. The secondary aim of the research was to examine the rehabilitation needs and experiences of multiple trauma patients by identifying themes around the barriers and challenges to rehabilitation provision. Finally, the study aimed to contribute to the gap in literature around the rehabilitation patient experience.

METHODS

An electronic search of seven databases was undertaken against pre-determined inclusion/exclusion criteria. The Mixed Methods Appraisal Tool was utilised for quality appraisal. Following data extraction, both quantitative and qualitative analysis methods were utilised. In total, 17,700 studies were identified and screened against the inclusion/exclusion criteria. Eleven studies met the inclusion criteria (five quantitative, four qualitative, two mixed method).

RESULTS

FIM scores showed no significant difference in all studies after long-term follow-up. However, statistically significantly less FIM improvement was noted in those with unmet needs. Patients with physiotherapist assessed unmet rehabilitation needs were statistically less likely to improve than patients whose needs were reportedly met. In contrast, there was a differing opinion regarding the success of structured therapy input, communication and coordination, long-term support and planning for home. Common qualitative themes revealed lack of rehabilitation post-discharge, often with long waiting times.

CONCLUSION

Stronger communication pathways and coordination within a trauma network, particularly when repatriating outside of a network catchment area is recommended. This review has exposed the many rehabilitation variations and complexities a patient may experience following trauma. Furthermore, this highlights the importance of arming clinicians with the tools and expertise to improve patient outcomes.

The nonverbal BriefScreen: A cognitive screening method for patients with limited language and motor abilities

Dementia and significant cognitive decline are frequent sequelae of stroke, but are difficult to evaluate when aphasia and/or motor impairment are present. The linguistic and motor requirements of commonly employed screening tests render them problematic for use post-stroke. The present study examines the validity of the Nonverbal BriefScreen, a brief screening method with limited verbal and motor requirements, in groups of patients with known cognitive impairment using the MMSE as a gold standard. Participants were 137 healthy middle aged and older community dwellers, 21 patients with MCI/early dementia and 35 patients with different types of dementia. The sensitivity and specificity of the Nonverbal BriefScreen were calculated for various cutoff scores, with the MMSE as comparison. The Nonverbal BriefScreen was effective in discriminating between healthy controls and patients with dementia, as well as between healthy controls and all patients, with areas under the ROC curve similar to that of the MMSE. ROC analyses with a smaller sample of 35 age-matched healthy controls showed adequate discriminant ability to detect cognitive impairment. The Nonverbal BriefScreen was shown to be a valid method for screening for cognitive impairment that could be employed as a screening method for patients with limited language.

The feasibility, safety, physiological and clinical effects of high-intensity interval training for people with Parkinson's: a systematic review and meta-analysis

BACKGROUND

Exercise is important for people with Parkinson's (PwP), with high-intensity interval training (HIIT) proposed as a feasible and effective exercise modality. However, no literature synthesis for PwP has been undertaken.

OBJECTIVES

To evaluate the feasibility, safety, physiological and clinical effects of HIIT for PwP.

METHODS

Systematic searches of Medline, Embase, CINAHL, Web of Science, and Google Scholar were undertaken. Studies that included ≥ 2 weeks of HIIT for PwP and reported sufficient detail for full quality assessment were eligible. Quality was assessed with the TESTEX scale or the Downs and Black tool according to study design. Feasibility and safety data, physiological and clinical outcomes were extracted. Meta-analyses explored the pooled effects of HIIT on VO_2peak/max compared to moderate-intensity continuous exercise (MICE) and usual care.

RESULTS

Eleven articles were identified (seven controlled/comparator studies and four single group) including 117 HIIT participants predominantly of mild-to-moderate disease severity. HIIT programmes were professionally supervised and between 6 weeks and 24 months. Overall, study quality was deemed to be moderate to good. Following screening, nine studies reported 90-100% programme completion; however, only one was > 12 weeks in duration. Adverse events were uncommon. HIIT improved VO_2peak/max compared to usual care, but not to MICE. Increased brain-derived neurotrophic factor (BDNF) and improved motor symptoms were also reported.

CONCLUSION

Up to 12 weeks of supervised HIIT appears to be feasible and safe for some people with mild-to-moderate disease severity. HIIT improves cardiorespiratory fitness and may increase BDNF and improve motor symptoms in PwP. Future studies should explore safe ways to facilitate access and long-term adherence.

Evidence of validity based on the relation to other variables and inter-rater reliability of the Cognitive Screening (TRIACOG) for adults with cerebrovascular diseases

This study presents evidence of validity and reliability of the results obtained with the Cognitive Screening (TRIACOG) to evaluate post-stroke adults. The TRIACOG assesses orientation memory, language, arithmetic, praxis, information processing speed, and executive functions. A total of 126 post-stroke adults (M = 63.50; SD = 13.28 years old) and 126 neurologically healthy adults (M = 61.97; SD = 11.48 years old) participated in the study. Performance on the TRIACOG was positively correlated with scores on the Montreal Cognitive Assessment-Basic (MoCA-B), schooling, and reading and writing habits, and negatively correlated with the NIHSS and Rankin scales. Post-stroke adults scored lower and took longer to complete the instrument than neurologically healthy adults. Inter-rater agreement was achieved in scoring the TRIACOG. The TRIACOG presents evidence of validity based on its relationships to other variables (criterion and convergent) and on response processes, in addition to presenting reliability evidence established by inter-rater agreement. We expect that the TRIACOG will be employed by health workers in hospital settings, health units, and medical offices.

Pain coping tools for children and young adults with a neurodevelopmental disability: A systematic review of measurement properties

AIM

To systematically identify and evaluate the measurement properties of patient-reported outcome measures (PROMs) and observer-reported outcome measures (parent proxy report) of pain coping tools that have been used with children and young adults (aged 0-24 years) with a neurodevelopmental disability.

METHOD

A two-stage search using MEDLINE, Embase, CINAHL, Web of Science, and PsycInfo was conducted. Search 1 in August 2021 identified pain coping tools used in neurodevelopmental disability and search 2 in September 2021 located additional studies evaluating the measurement properties of these tools. Methodological quality was assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines (PROSPERO protocol registration no. CRD42021273031).

RESULTS

Sixteen studies identified seven pain coping tools, all PROMs and observer-reported outcome measures (parent proxy report) versions. The measurement properties of the seven tools were appraised in 44 studies. No tool had high-quality evidence for any measurement property or evidence for all nine measurement properties as outlined by COSMIN. Only one tool had content validity for individuals with neurodevelopmental disability: the Cerebral Palsy Quality of Life tool.

INTERPRETATION

Pain coping assessment tools with self-report and parent proxy versions are available; however, measurement invariance has not been tested in young adults with a neurodevelopmental disability. This is an area for future research.

A multidisciplinary-led early arthritis service to manage client-identified participation restrictions in early inflammatory arthritis: A qualitative study of service user and staff perspectives

BACKGROUND

The impact of inflammatory arthritis (IA) on occupational performance and on participation in meaningful life roles is recognised. However, limited research has explored how clinical services support broader life impact and participation restrictions associated with early disease as part of routine healthcare. This exploratory study was undertaken to describe how a novel multidisciplinary-led early arthritis service approach addresses client-identified participation restrictions in early IA.

METHODS

Qualitative Description (QD) approaches were used to explore perspectives of staff and clients of these multidisciplinary-led early arthritis services in Ireland. Data were gathered using focus groups with staff, and individual semi-structured interviews with clients. Transcripts were analysed using thematic analysis.

RESULTS

Fifteen staff working in these services participated in the focus groups and 43 clients with IA participated in interviews (female n = 31); diagnosis duration ranged from 5 to 24 months. Participants described how the multidisciplinary-led service had a clear remit to address participation alongside traditional symptom management and provided automatic, immediate access to interventions focussed on identification and management of participation restrictions experienced in early disease. The service model utilised a delivery approach that allowed for ease of early access to a full multidisciplinary team and prolonged support. The most significant feature of the service approach was 'the centrality of the client' which influenced a person-centred approach to identification of needs and priorities for interventions.

CONCLUSION

Findings indicate the role and value of this innovative multidisciplinary approach in addressing client-identified participation restrictions in routine clinical practice that is positively regarded by clients and staff.

Determinants of antimicrobial resistance occurrence in animal-based food, perceived by livestock farmers: A qualitative phenomenological study

Background and Purpose of the Study

The determinants of antimicrobial resistance in human medicine have been copiously explored. On the other hand, the existing research in veterinary medicine and animal husbandry is in its infancy. The present qualitative study used the one-health approach to explore farmers' attitudes toward antimicrobial use and antimicrobial stewardship.

Methodology

The present qualitative study was phenomenological in type. It was conducted in 2022 in the two cities of Kerman and Bandar Abbas in Iran. The data were collected through in-depth interviews by semistructured interviews with 17 livestock, poultry, and aquatic animal breeders selected through purposive sampling. The interviews lasted between 35 and 65 min in the Farsi language. The data were analyzed using conventional qualitative content analysis and Colaizzi's seven-step analysis technique.

Results

The open coding was done in MAXQDA 10 and the results of data analysis were classified into five main themes and 17 subthemes subcategories. The main categories include personal determinants, contextual determinants, legal and regulatory determinants, social determinants, and economic determinants.

Conclusion

Considering the increasing use of antibiotics among livestock farmers and breeders of animals used as human food, different measures such as educational, regulatory, social, and even cultural interventions may be able to control and prevent antimicrobial resistance.

How human anatomy is being taught in entry-level occupational therapy programs in the United States

There has been a lack of empirical information regarding anatomy education for occupational therapists (OTs). Insufficient anatomy education can result in underprepared entry-level OTs, who may then produce increased practice errors and reduced patient care. The objective of this study was to investigate how human gross anatomy was taught in entry-level occupational therapy programs throughout the United States and evaluate faculty perspectives on its teaching. A mixed-methods survey was sent to the directors of entry-level occupational therapy programs in the United States. Survey responses were compiled to best represent the current occupational therapy education environment. Ten of sixty-eight participating programs did not teach anatomy as a part of their standard occupational therapy curriculum. Of the programs that featured entry-level occupational therapy anatomy courses, the majority were taught by either a non-clinician anatomist or an OT without specialized anatomy training in a region-based, standalone anatomy course during the first semester. In most programs, anatomy was taught to only occupational therapy students using lecture, models/plastination, and/or prosection. Teaching tools, methods, faculty, and programmatic factors were perceived as contributing to program strengths. The design, resources, and faculty involved in the occupational therapy anatomy course may negatively impact the perceived quality of an occupational therapy anatomy program and its students. Participants identified several consequences of insufficient anatomy preparedness, including academic, clinical reasoning, treatment skills, patient care, and professional identity concerns. Occupational therapy educators may want to be aware of the current climate of occupational therapy anatomy education in the United States when designing entry-level occupational therapy anatomy curricula.

Radiographic technique modification and evidence-based practice: A qualitative study

INTRODUCTION

Evidence-based practice in radiography is an emerging practice, due to a lack of evidence. Beyond the diagnostic requirements of the examination, imaging technique decisions are guided by the radiographer's tertiary education and clinical experience. Imaging technique decisions should include all aspects of evidence-based practice: research-based evidence, patient circumstances and clinical experience. Previous research suggests radiographers do to not fully engage with the latter, which may jeopardise progress in the field and lead to outdated practices and suboptimal outcomes for patients. This study aimed to examine the motivators and influences involved in radiographers' decision-making when modifying imaging acquisition techniques.

METHODS

An exploratory descriptive, inductive qualitative interview-based design was used with a convenience sample of radiographers from three public hospital sites in Queensland. Twelve one-on-one semi-structured interviews were performed via video conference, the data were analysed through thematic analysis.

RESULTS

Five themes emerged from the data: advancement of technology; experience rather than evidence; radiology's influence on radiographic practice; information sources; and image quality. The pursuit of image quality was the key motivator and criterion that influenced radiographers' choices in imaging technique modification. Interviewees did not engage routinely with research-based evidence, preferring to rely on empirical observations and professional experience.

CONCLUSION

The exclusion of research-based evidence can lead to outdated and ineffective clinical decisions. Further work is needed to promote more research in the field of radiography and increase the willingness and capacity of radiographers to follow the principles of evidence-based practice.

Public sector physiotherapists’ organisation and profile: Implications for intensive care service

Background

Physiotherapists are essential in the management of hospitalised patients. The way in which a physiotherapy service is offered in intensive care units (ICUs) can affect ICU patient outcomes.

Objectives

To provide a clear picture of the organisation and structure of physiotherapy departments, the number and types of ICUs requiring physiotherapy services and the profile of physiotherapists working in South African public-sector central, regional and tertiary hospitals that house Level I-IV ICUs.

Method

Cross-sectional survey design using SurveyMonkey, analysed descriptively.

Results

One hundred and seventy units (the majority Level I, functioning as mixed [37%, n = 58] and neonatal [22%, n = 37] units) are serviced by 66 physiotherapy departments. The majority of physiotherapists (61.5%, n = 265) were younger than 30 years, had a bachelor's degree (95.1%, n = 408) and were employed in production Level I and community service posts (51%, n = 217) with a physiotherapy-to-hospital-bed ratio of 1:69.

Conclusion

Insight into the organisational structure of physiotherapy departments and physiotherapists working in public-sector hospitals with ICU facilities in South Africa was provided. It is evident that physiotherapists employed within this sector are young and early in their career development. The large number of ICUs functioning within these hospitals and high bed-to-physiotherapist ratio is concerning, highlighting the high burden of care within this sector and the possible effect on physiotherapy services in the ICUs.

Clinical implications

A high burden of care is placed on public-sector hospital-based physiotherapists. The number of senior-level posts within this sector raises concern. It is not clear how the current staffing levels, physiotherapist profile and structure of hospital-based physiotherapy departments affect patient outcomes.

Initial Development of a Patient-Reported Experience Measure for Older Adults Attending the Emergency Department: Part II-Focus Groups with Professional Caregivers

A wide range of healthcare professionals provide care for patients in the emergency department (ED). This study forms part of a wider exploration of the determinants of patient experience for older adults in the ED, to assist the development of a new patient-reported experience measure (PREM). Inter-professional focus groups aimed to build on findings from earlier interviews with patients conducted in the ED, by exploring professional perspectives on caring for older people in this setting. A total of thirty-seven clinicians, comprising nurses, physicians and support staff, participated in seven focus groups across three EDs in the United Kingdom (UK). The findings reinforced that meeting patients' communication, care, waiting, physical, and environmental needs are all central to the delivery of an optimal experience. Meeting older patients' basic needs, such as access to hydration and toileting, is a priority often shared by all ED team members, irrespective of their professional role or seniority. However, due to issues including ED crowding, a gap exists between the desirable and actual standards of care delivered to older adults. This may contrast with the experience of other vulnerable ED user groups such as children, where the provision of separate facilities and bespoke services is commonplace. Therefore, in addition to providing original insights into professional perspectives of delivering care to older adults in the ED, this study demonstrates that the delivery of suboptimal care to older adults may be a significant source of moral distress for ED staff. Findings from this study, earlier interviews, and the literature will be triangulated to formulate a comprehensive list of candidate items for inclusion in a newly developed PREM, for patients aged 65 years and older.