The Mealtime Behavior Problems of Children with Developmental Disabilities and the Teacher’s Stress in Inclusive Preschools

With an increasing number of children with developmental disabilities entering inclusive preschools, preschool teachers face more behavioral problems in class. Preschool teachers typically attempt to address mealtime behavior problems of children with and without developmental disabilities simultaneously in class. This study used qualitative research to identify the stress triggers of preschool teachers addressing the mealtime behavior problems of children with developmental disabilities. Five preschool teachers attended semi-structured interviews. The results indicated that most children with developmental disabilities had problems with eating only preferred foods, using eating utensils appropriately during mealtime, becoming distracted from eating, and becoming frustrated with the classroom routine. Although solving these problems triggered stress in the preschool teachers, their stress was mainly in response to the children’s parents, other children’s imitation of inappropriate mealtime behaviors, and classroom schedule time management. Most of the preschool teachers stated that they had insufficient support. Preschool teachers require specialized information and strategies for improving the mealtime behaviors of children with developmental disabilities.

Prevalence of physical health conditions and health risk behaviours in people with severe mental illness in South Asia: multi-country cross-sectional survey

BACKGROUND

People with severe mental illness (SMI) die earlier than the general population, primarily because of physical disorders.

AIMS

We estimated the prevalence of physical health conditions, health risk behaviours, access to healthcare and health risk modification advice in people with SMI in Bangladesh, India and Pakistan, and compared results with the general population.

METHOD

We conducted a cross-sectional survey in adults with SMI attending mental hospitals in Bangladesh, India and Pakistan. Data were collected on non-communicable diseases, their risk factors, health risk behaviours, treatments, health risk modification advice, common mental disorders, health-related quality of life and infectious diseases. We performed a descriptive analysis and compared our findings with the general population in the World Health Organization (WHO) 'STEPwise Approach to Surveillance of NCDs' reports.

RESULTS

We recruited 3989 participants with SMI, of which 11% had diabetes, 23.3% had hypertension or high blood pressure and 46.3% had overweight or obesity. We found that 70.8% of participants with diabetes, high blood pressure and hypercholesterolemia were previously undiagnosed; of those diagnosed, only around half were receiving treatment. A total of 47% of men and 14% of women used tobacco; 45.6% and 89.1% of participants did not meet WHO recommendations for physical activity and fruit and vegetable intake, respectively. Compared with the general population, people with SMI were more likely to have diabetes, hypercholesterolemia and overweight or obesity, and less likely to receive tobacco cessation and weight management advice.

CONCLUSIONS

We found significant gaps in detection, prevention and treatment of non-communicable diseases and their risk factors in people with SMI.

Impairment-based assessments for patients with lateral ankle sprain: A systematic review of measurement properties

STUDY DESIGN

Systematic review.

BACKGROUND AND OBJECTIVE

The International Ankle Consortium developed a core outcome set for the assessment of impairments in patients with lateral ankle sprain (LAS) without consideration of measurement properties (MP). Therefore, the aim of this study is to investigate MPs of assessments for the evaluation of individuals with a history of LAS.

METHODS

This systematic review of measurement properties follows PRISMA and COSMIN guidelines. Databases Pubmed, CINAHL, Embase, Web of Science, Cochrane Library and SPORTDiscus were searched for eligible studies (last search: July 2022). Studies on MP of specific tests and patient-reported outcome measurements (PROMs) in patients with acute and history of LAS (>4 weeks post injury) were deemed eligible.

RESULTS

Ten studies of acute LAS and 39 studies of history of LAS patients with a total of 3313 participants met the inclusion criteria. Anterior Drawer Test (ADT) in supine position five days post injury and Reverse Anterolateral Drawer Test are recommended in acute settings in single studies. In the history of LAS patients, Cumberland Ankle Instability Tool (CAIT) (4 studies) as a PROM, Multiple Hop (3 studies) and Star Excursion Balance Tests (SEBT) (3 studies) for dynamic postural balance testing showed good MPs. No studies investigated pain, physical activity level and gait. Only single studies reported on swelling, range of motion, strength, arthrokinematics, and static postural balance. Limited data existed on responsiveness of the tests in both subgroups.

CONCLUSION

There was good evidence to support the use of CAIT as PROM, Multiple Hop, and SEBT for dynamic postural balance testing. Insufficient evidence exists in relation to test responsiveness, especially in the acute situation. Future research should assess MPs of assessments of other impairments associated with LAS.

Combining robot-assisted therapy with virtual reality or using it alone? A systematic review on health-related quality of life in neurological patients

BACKGROUND

In the field of neurorehabilitation, robot-assisted therapy (RAT) and virtual reality (VR) have so far shown promising evidence on multiple motor and functional outcomes. The related effectiveness on patients' health-related quality of life (HRQoL) has been investigated across neurological populations but still remains unclear. The present study aimed to systematically review the studies investigating the effects of RAT alone and with VR on HRQoL in patients with different neurological diseases.

METHODS

A systematic review of the studies evaluating the impact of RAT alone and combined with VR on HRQoL in patients affected by neurological diseases (i.e., stroke, multiple sclerosis, spinal cord injury, Parkinson's Disease) was conducted according to PRISMA guidelines. Electronic searches of PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsychINFO (2000-2022) were performed. Risk of bias was evaluated through the National Institute of Health Quality Assessment Tool. Descriptive data regarding the study design, participants, intervention, rehabilitation outcomes, robotic device typology, HRQoL measures, non-motor factors concurrently investigated, and main results were extracted and meta-synthetized.

RESULTS

The searches identified 3025 studies, of which 70 met the inclusion criteria. An overall heterogeneous configuration was found regarding the study design adopted, intervention procedures and technological devices implemented, rehabilitation outcomes (i.e., related to both upper and lower limb impairment), HRQoL measures administered, and main evidence. Most of the studies reported significant effects of both RAT and RAT plus VR on patients HRQoL, whether they adopted generic or disease-specific HRQoL measures. Significant post-intervention within-group changes were mainly found across neurological populations, while fewer studies reported significant between-group comparisons, and then, mostly in patients with stroke. Longitudinal investigations were also observed (up to 36 months), but significant longitudinal effects were exclusively found in patients with stroke or multiple sclerosis. Finally, concurrent evaluations on non-motor outcomes beside HRQoL included cognitive (i.e., memory, attention, executive functions) and psychological (i.e., mood, satisfaction with the treatment, device usability, fear of falling, motivation, self-efficacy, coping, and well-being) variables.

CONCLUSIONS

Despite the heterogeneity observed among the studies included, promising evidence was found on the effectiveness of RAT and RAT plus VR on HRQoL. However, further targeted short- and long-term investigations, are strongly recommended for specific HRQoL subcomponents and neurological populations, through the adoption of defined intervention procedures and disease-specific assessment methodology.

"I loved it, absolutely loved it" a qualitative study exploring what student podiatrists learn volunteering as part of an interprofessional medical team at a marathon

BACKGROUND

Final year podiatry students volunteer annually as part of the wider interprofessional medical team at both the Brighton and London Marathon race events, supervised by qualified podiatrists, allied health professionals and physicians. Volunteering has been reported to be a positive experience for all participants and a way of developing a range of professional, transferable, and where appropriate, clinical skills. We sought to explore the lived experience of 25 students who volunteered at one of these events and aimed to: i) examine the experiential learning reported by students while volunteering in a dynamic and demanding clinical field environment; ii) determine whether there were elements of learning that could be translated to the traditional teaching environment in a pre-registration podiatry course.

METHODS

A qualitative design framework informed by the principles of interpretative phenomenological analysis, was adopted to explore this topic. We used IPA principles to enable analysis of four focus groups over a two-year period to generate findings. Focus group conversations were led by an external researcher, recorded, independently transcribed verbatim and anonymised prior to analysis by two different researchers. To enhance credibility, data analysis was followed by independent verification of themes, in addition to respondent validation.

RESULTS

In total, five themes were identified: i) a new inter-professional working environment, ii) identification of unexpected psychosocial challenges, iii) the rigors of a non-clinical environment, iv) clinical skill development, and v) learning in an interprofessional team. Throughout the focus group conversations, a range of positive and negative experiences were reported by the students. This volunteering opportunity fills a gap in learning as perceived by students, particularly around developing clinical skills and interprofessional working. However, the sometimes-frantic nature of a Marathon race event can both facilitate and impede learning. To maximize learning opportunities, particularly in the interprofessional environment, preparing students for new or different clinical settings remains a considerable challenge.

Profiling health professionals' personality traits, behaviour styles and emotional intelligence: a systematic review

BACKGROUND

Non-cognitive traits have been theorised to predict characteristics, career choice and outcomes of health professionals and could represent a homogenous group. This study aims to profile and compare personality traits, behaviour styles and emotional intelligence of health practitioners across a variety of professions.

METHODS

Empirical literature was systematically reviewed. A two-concept search strategy was applied to four databases (CINAHL, PubMed, Embase, ProQuest). Title/abstract and full text articles were screened against inclusion and exclusion criteria. Methodological quality was assessed using Mixed Methods Appraisal Tool. Data was synthesised narratively and meta-aggregated where feasible.

RESULTS

Three hundred twenty-one studies representing 153 assessment tools of personality (n = 83 studies), behaviour (n = 8), and emotional intelligence (n = 62) were included. Most studies (n = 171) explored personality (medicine, nursing, nursing assistants, dentistry, allied health, paramedics), revealing variation in traits across professions. Behaviour styles were least measured with only ten studies exploring these across four health professions (nursing, medicine, occupational therapy, psychology). Emotional intelligence (n = 146 studies) varied amongst professions (medicine, nursing, dentistry, occupational therapy, physiotherapy, radiology) with all exhibiting average to above-average scores.

CONCLUSION

Personality traits, behaviour styles and emotional intelligence are all key characteristics of health professionals reported in the literature. There is both heterogeneity and homogeneity within and between professional groups. The characterisation and understanding of these non-cognitive traits will aid health professionals to understand their own non-cognitive features and how these might be useful in predicting performance with potential to adapt these to enhance success within their chosen profession.

Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review

Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.

Dancing for Parkinson's Disease Online: Clinical Trial Process Evaluation

Background: Dancing is an engaging physical activity for people living with Parkinson's disease (PD). We conducted a process evaluation for a PD trial on online dancing. Methods: "ParkinDANCE Online" was co-produced by people with PD, healthcare professionals, dance instructors, and a PD organisation. The evaluation mapped the following inputs: (i) stakeholder steering group to oversee program design, processes, and outcomes; (ii) co-design of online classes, based on a research evidence synthesis, expert advice, and stakeholder recommendations; (iii) trial fidelity. The key activities were (i) the co-design of classes and instruction manuals, (ii) the education of dance teachers, (iii) fidelity checking, (iv) online surveys, (v) and post-trial focus groups and interviews with participants. The outputs pertained to: (i) recruitment, (ii) retention, (iii) adverse events, (iv) fidelity, (v) protocol variations, and (vi) participant feedback. Results: Twelve people with PD, four dance instructors and two physiotherapists, participated in a 6-week online dance program. There was no attrition, nor were there any adverse events. Program fidelity was strong with few protocol variations. Classes were delivered as planned, with 100% attendance. Dancers valued skills mastery. Dance teachers found digital delivery to be engaging and practical. The safety of online testing was facilitated by careful screening and a home safety checklist. Conclusions: It is feasible to deliver online dancing to people with early PD.

Use of Delphi in health sciences research: A narrative review

The use of the Delphi technique is prevalent across health sciences research, and it is used to identify priorities, reach consensus on issues of importance and establish clinical guidelines. Thus, as a form of expert opinion research, it can address fundamental questions present in healthcare. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Advantages of the use of Delphi include anonymity, controlled feedback, flexibility for the choice of statistical analysis, and the ability to gather participants from geographically diverse areas. Areas of methodological uncertainty worthy of further discussion broadly include experts and data management. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. For data management, there are issues with data collection, defining consensus and methods of data analysis, such as percent agreement, central tendency, measures of dispersion, and inferential statistics. Overall, the use of Delphi addresses important issues present in health sciences research, but methodological issues remain. It is likely that the aggregation of future Delphi studies will eventually pave the way for more comprehensive reporting guidelines and subsequent methodological clarity.

Patient and Clinician Perspectives of Physical Therapy for Walking Difficulties in Multiple Sclerosis

Gait speed is frequently the primary efficacy endpoint in clinical trials of interventions targeting mobility in people with multiple sclerosis (MS). However, it is unclear whether increased gait speed is a meaningful outcome for people living with MS. The purpose of this study was to identify the most important aspects of mobility for people with MS and physical therapists and to explore how patients and clinicians perceive whether physical therapy has been effective. Forty-six people with MS and 23 physical therapy clinicians participated in a focus group, one-on-one interview, or electronic survey. The focus group and interview data were transcribed and coded to identify themes. Free-text survey responses were also coded, and multiple-choice options were analyzed for frequency. Among people with MS, falls and difficulties getting out into the community were identified as highly important mobility limitations. Clinicians also identified falls and safety as a priority. Walking speed was infrequently described as a problem, and although gait speed is often measured by clinicians, improving gait speed is rarely a treatment goal. Despite their emphasis on safety, clinicians lacked certainty about how to objectively measure improvements in safety. People with MS evaluated physical therapy effectiveness based on the ease by which they can do things and acknowledged that "not getting worse" is a positive outcome. Clinicians evaluated effectiveness based on the amount of change in objective outcome measures and by patient and caregiver reports of improved function. These findings indicate that gait speed is not of major importance to people with MS or physical therapy clinicians. People with MS want to be able to walk further and without an assistive device, and they want to avoid falls. Clinicians want to maximize safety while improving functional ability. Clinicians and patients may differ in their expected outcomes from physical therapy.

Measuring mealtime performance in older adults with suspected oropharyngeal dysphagia: an updated systematic review of psychometric properties

PURPOSE

To update a previous review of psychometric properties of performance-based outcome measurement instruments (PerFOMs) for task performance in the context of meal activity of older adults (≥65 years) with suspected oropharyngeal dysphagia (OD).

MATERIALS AND METHODS

Systematic searches were conducted in PubMed, CINAHL, EMBASE, SCOPUS, and Web of Science. Studies on PerFOMs that covers items reflecting skills in the pre-oral, oral, and pharyngeal stages of ingestion during meals were included. Two review authors independently screened, extracted, and evaluated the methodological rigour and quality of the reported psychometric properties in the included studies using the guidelines of the COnsensus-based Standards for the Selection of health Measurement INstruments (COSMIN).

RESULTS

Twenty-three articles featuring nine original PerFOMs and five translated versions were included. PerFOM development and content validity were rated with inadequate or doubtful methodological quality across all studies. The quality of the evidence across the additional psychometric properties of the PerFOMs was very low for two, ranged from very low to moderate for six, and from very low to high for five.

CONCLUSIONS

There is limited evidence of the psychometric properties of available PerFOMs for measuring task performance during meals in older adults with OD, and further validation is warranted.Implication for rehabilitationAssessing the mealtime performance of older adults with oropharyngeal dysphagia (OD) provides important information.Performance-based outcome measurement instruments (PerFOMs) need to be valid and reliable.Clinicians need to be careful when choosing PerFOMs to assess the mealtime performance of older adults with OD as there is insufficient evidence on the quality of available instruments.Established guidelines and standards should be used when developing and investigating psychometric properties of PerFOMs assessing mealtime performance of older adults with OD.

Barriers and facilitators to the adoption of digital health interventions for COPD management: A scoping review

BACKGROUND

Knowledge of the barriers and facilitators in the adoption of digital health interventions (DHI) is sparse yet crucial to facilitate chronic obstructive pulmonary disease (COPD) management.

OBJECTIVES

This scoping review aimed to summarize patient- and healthcare provider-level barriers and facilitators in the adoption of DHIs for COPD management.

METHODS

Nine electronic databases were searched from inception up till October 2022 for English language evidence. Inductive content analysis was used.

RESULTS

This review included 27 papers. Frequent patient-level barriers were poor digital literacy (n = 6), impersonal care delivery (n = 4), and fear of being controlled by telemonitoring data (n = 4). Frequent patient-level facilitators were improved disease understanding and management (n = 17), bi-directional communication and contact with healthcare providers (n = 15), and remote monitoring and feedback (n = 14). Frequent healthcare provider-level barriers were increased workload (n = 5), lack of technology interoperability with existing health systems (n = 4), lack of funding (n = 4), and lack of dedicated and trained manpower (n = 4). Frequent healthcare provider-level facilitators were improved efficiency of care delivery (n = 6) and DHI training programmes (n = 5).

CONCLUSION

DHIs have the potential to facilitate COPD self-management and improve efficiency of care delivery. However, several barriers challenge its successful adoption. Attaining organizational support in developing user centric DHIs that can be integrated and are interoperable with existing health systems is crucial if we are to witness tangible return on investments at the patient-, healthcare provider- and healthcare system-level.

Effects of moderate-intensity aerobic exercise on serum BDNF and motor learning in the upper-limb in patients after chronic-stroke: A randomized, controlled feasibility study with embedded health economic evaluation

BACKGROUND

Brain-derived neurotrophic factor (BDNF) promotes activity-dependent neuroplasticity and is released following aerobic-exercise.

OBJECTIVE

Feasibility and efficacy of 1.Moderate-Intensity Cycle-Ergometer-Training (MI-ET) and 2.Low-Intensity Circuit-Training (LI-CT) on BDNF-serum-concentration in chronic-stroke and consequently efficacy of motor-learning in varying BDNF-concentrations (neuroplasticity being the substrate for motor-learning) via upper-limb robotic-training (RT) in both groups.

METHODS

Randomised-control feasibility-study. 12-week, 3x/week intervention, 17 chronic-stroke-survivors randomized into: (1) MI-ET&RT or (2) LI-CT&RT. Both groups completed 40 mins MI-ET or LI-CT followed by 40 mins RT. Feasibility outcomes: (1) screening and enrollment-rates, (2) retention-rates, (3) adherence: (i) attendance-rates, (ii) training-duration, (4) adverse events. Primary clinical outcomes: 1. serum-BDNF changes pre-post training (immediate) and pre-training basal-levels over 12-weeks (long-term). 2.upper-limb performance with Action-Research-Arm-Test (ARAT). Additionally, feasibility of an embedded health economic evaluation (HEE) to evaluate health-costs and cost-effectiveness.

OUTCOMES

cost-questionnaire return-rates, cost-of-illness (COI) and Health-Utitility-Index (HUI).

RESULTS

21.5% of eligible and contactable enrolled. 10 randomized to MI-ET and 7 to LI-CT. 85% of training-sessions were completed in MI-ET (306/360) and 76.3% in LI-CT-group (165/216). 12-weeks: Drop-outs MI-ET-10%, LI-CT-43%.

CLINICAL OUTCOMES

No significant changes in immediate or long-term serum-BDNF in either group. Moderate-intensity aerobic-training did not increase serum-BDNF post-stroke. Individual but no group clinically-relevant changes in ARAT-scores. HEE outcomes at 12-weeks: 100% cost-questionnaires returned. Group-costs baseline and after treatment, consistently favouring MI-ET group. COI: (1-year-time-frame): MI-ET 67382 SD (43107) Swiss-Francs and LI-CT 95701(29473) Swiss-Francs.

CONCLUSION

The study is feasible with modifications. Future studies should compare high-intensity versus moderate-intensity aerobic-exercise combined with higher dosage arm-training.

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke

OBJECTIVE

Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals.

METHOD

A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis.

RESULTS

Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD.

CONCLUSION

The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

The effectiveness of a mobile application-based programme for rehabilitation after total hip or knee arthroplasty: A randomised controlled trial

BACKGROUND

Total hip arthroplasty and total knee arthroplasty are widely performed worldwide. Patients undergoing total hip or knee arthroplasty are often discharged after a short hospital stay. Using information and communication technologies, such as mobile applications, to provide rehabilitation services remotely may be a strategy to support patients' postoperative recovery.

OBJECTIVE

This study aimed to evaluate the effectiveness of a rehabilitation programme delivered via a mobile application among Chinese patients after total hip or knee arthroplasty.

DESIGN

Randomised controlled trial.

SETTING

A teaching hospital in Shanghai, China.

PARTICIPANTS

Eighty-six patients who received a unilateral primary total hip or knee arthroplasty.

METHODS

The participants were recruited in the hospital and randomised into either the experimental or control group. Once discharged from the hospital, the control group (n = 43) received usual care, and the experimental group (n = 43) received usual care plus a 6-week mobile rehabilitation programme. Outcomes were assessed three times: the day before hospital discharge and 6 and 10 weeks after discharge. Primary outcomes were the changes in scores of self-efficacy and patient-reported physical function from baseline to 6 weeks post-discharge. Secondary outcomes included changes in scores of pain, depression, anxiety, and health-related quality of life. Data were analysed using generalised estimating equations.

RESULTS

At 6 weeks after hospital discharge, the experimental group showed statistically significant improvements compared to the control in scores of self-efficacy (adjusted mean difference = 0.72, 95% CI 0.31 to 1.14, P < .001) and patient-reported physical function (adjusted mean difference = 4.57, 95% CI 1.24 to 7.90, P = .007). The between-group difference in self-efficacy probably reached clinical significance. At week-10 follow-up, the experimental group had statistically significant improvements in scores of self-efficacy (adjusted mean difference = 0.64, 95% CI 0.33 to 0.95, P < .001), health-related quality of life (adjusted mean difference = 0.06, 95% CI 0.01 to 0.10, P = .018), anxiety (adjusted mean difference = -0.51, 95% CI -0.91 to -0.10, P = .015), and depression (adjusted mean difference = -0.37, 95% CI -0.66 to -0.08, P = .012). The between-group difference in self-efficacy and health-related quality of life may be clinically significant.

CONCLUSION

Mobile application-based rehabilitation demonstrated potentially positive effects on patients' self-efficacy, patient-reported physical function, health-related quality of life, and levels of anxiety and depression.

TRIAL REGISTRATION

Registered with the Australian New Zealand Clinical Trials Registry on 6 July 2021 (ACTRN12621000867897).

Numerical simulation of pneumatic throttle check valve using computational fluid dynamics (CFD)

The article presents a numerical CFD simulation of a throttle-check valve used in an innovative control system for two pneumatic drives. This type of control is used in an innovative rehabilitation device for lower limbs. In order to determine the boundary conditions, experimental tests were carried out. The throttle valves on the test stand were scaled and the air flow rate values were read for different valve opening heights. The purpose of this article is to present a CFD simulation of a pre-adjusted check valve throttle. Numerical simulation (CFD) makes it possible to study the flow phenomena inside a pneumatic throttle-check valve, with different sizes of flow gaps. The obtained results made it possible to determine the distribution of physical quantities of static pressure, the velocity of the medium flowing through the valve, or the vector velocity distribution. The throttle valve assembly has been scaled for a suitable degree of synchronization of the movement of the piston actuators independently of the different external loads acting on each of them. The authors investigated airflow phenomena for different valve opening heights. The simulation provided information on the occurrence of supersonic and subsonic flow velocities at specific valve opening heights.

Systematic review of candidate prognostic factors for falling in older adults identified from motion analysis of challenging walking tasks

The objective of this systematic review is to identify motion analysis parameters measured during challenging walking tasks which can predict fall risk in the older population. Numerous studies have attempted to predict fall risk from the motion analysis of standing balance or steady walking. However, most falls do not occur during steady gait but occur due to challenging centre of mass displacements or environmental hazards resulting in slipping, tripping or falls on stairs. We conducted a systematic review of motion analysis parameters during stair climbing, perturbed walking and obstacle crossing, predictive of fall risk in healthy older adults. We searched the databases of Pubmed, Scopus and IEEEexplore.A total of 78 articles were included, of which 62 simply compared a group of younger to a group of older adults. Importantly, the differences found between younger and older adults did not match those found between older adults at higher and lower risk of falls. Two prospective and six retrospective fall history studies were included. The other eight studies compared two groups of older adults with higher or lower risk based on mental or physical performance, functional decline, unsteadiness complaints or task performance. A wide range of parameters were reported, including outcomes related to success, timing, foot and step, centre of mass, force plates, dynamic stability, joints and segments. Due to the large variety in parameter assessment methods, a meta-analysis was not possible. Despite the range of parameters assessed, only a few candidate prognostic factors could be identified: older adults with a retrospective fall history demonstrated a significant larger step length variability, larger step time variability, and prolonged anticipatory postural adjustments in obstacle crossing compared to older adults without a fall history. Older adults who fell during a tripping perturbation had a larger angular momentum than those who did not fall. Lastly, in an obstacle course, reduced gait flexibility (i.e., change in stepping pattern relative to unobstructed walking) was a prognostic factor for falling in daily life. We provided recommendations for future fall risk assessment in terms of study design.In conclusion, studies comparing older to younger adults cannot be used to explore relationships between fall risk and motion analysis parameters. Even when comparing two older adult populations, it is necessary to measure fall history to identify fall risk prognostic factors.

Introducing a Clinical Practice Guideline in Physiotherapy to Address Sexuality in Adults with a Neuromuscular Disorder

Purpose:

We present the development and the key elements of a clinical practice guideline (CPG) in physiotherapy aiming to address sexuality, more specifically impairments and limitations that can interfere with sexual activity in adults with a neuromuscular disorder (NMD).

Method:

The CPG was based on the Rare Knowledge Mining Methodological Framework (RKMMF) and included a literature review, consultation with physiotherapists, and validation by an interdisciplinary team. The EX-PLISSIT (extended, permission, limited information, specific suggestions, intensive therapy) model and the Competency Profile for physiotherapists in Canada were also used as frameworks to divide the CPG into sections. Here, we present the methodology for the CPG development and key elements related to physiotherapy assessment and treatment related to sexual activity in people with NMDs.

Results:

An extensive CPG was developed through a literature review, consultations, and a validation process. A total of 75 articles were included in the review. Twelve physiotherapists and four health professionals reviewed the CPG. Physiotherapists should address the following in their assessment: relationships; assistance required during sexual activity; urinary, vaginal, or anorectal symptoms; erectile dysfunction; pain; fatigue; and the impact of the NMD on sexuality. Interventions can target physical activity, positioning, muscle weakness, fatigue, decreased range of motion, erectile dysfunction, sensitivity disorders, lubrication, pain, incontinence, and cardiorespiratory implications.

Conclusions:

The CPG promotes the importance of addressing sexuality and proposes different interventions that physiotherapists should integrate into their practice.

Advanced practice physiotherapy care in emergency departments for patients with musculoskeletal disorders: a pragmatic cluster randomized controlled trial and cost analysis

BACKGROUND

Advanced practice physiotherapy (APP) models of care where physiotherapists are primary contact emergency department (ED) providers are promising models of care to improve access, alleviate physicians' burden, and offer efficient centered patient care for patients with minor musculoskeletal disorders (MSKD).

OBJECTIVES

To compare the effectiveness of an advanced practice physiotherapist (APPT)-led model of care with usual ED physician care for persons presenting with a minor MSKD, in terms of patient-related outcomes, health care resources utilization, and health care costs.

METHODS

This trial is a multicenter stepped-wedge cluster randomized controlled trial (RCT) with a cost analysis. Six Canadian EDs (clusters) will be randomized to a treatment sequence where patients will either be managed by an ED APPT or receive usual ED physician care. Seven hundred forty-four adults with a minor MSKD will be recruited. The main outcome measure will be the Brief Pain Inventory Questionnaire. Secondary measures will include validated self-reported disability questionnaires, the EQ-5D-5L, and other health care utilization outcomes such as prescription of imaging tests and medication. Adverse events and re-visits to the ED for the same complaint will also be monitored. Health care costs will be measured from the perspective of the public health care system using time-driven activity-based costing. Outcomes will be collected at inclusion, at ED discharge, and at 4, 12, and 26 weeks following the initial ED visit. Per-protocol and intention-to-treat analyses will be performed using linear mixed models with a random effect for cluster and fixed effect for time.

DISCUSSION

MSKD have a significant impact on health care systems. By providing innovative efficient pathways to access care, APP models of care could help relieve pressure in EDs while providing efficient care for adults with MSKD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05545917 . Registered on September 19, 2022.

Motivation, Physical Activity, and Affect in Community-Dwelling Stroke Survivors: An Ambulatory Assessment Approach

BACKGROUND

Motivation is a frequently reported but far less studied driver for post-stroke physical activity participation. Motivation and physical activity may be important contributors to the prevention management and alleviation of affective symptoms among stroke survivors.

PURPOSE

To investigate the real-time associations between motivation, physical activity, and affect in the daily lives of community-dwelling stroke survivors using ecological momentary assessment (EMA) and accelerometry.

METHODS

Forty community-dwelling stroke survivors wore an accelerometer on the thigh and completed EMA surveys assessing motivation (autonomous motivation, controlled motivation) and affect (negative affect, positive affect) eight times daily for 7 days. Multivariate regression analysis and multilevel modeling investigated the associations between motivation, physical activity, and affect.

RESULTS

Greater autonomous motivation for physical activity was associated with less sedentary behavior (β = -0.40, p = .049) and more moderate-to-vigorous physical activity (β = 0.45, p = .020) participation in daily life. Greater autonomous motivation was momentarily associated with less depressed affect (β = -0.05, p < .001) and greater positive affect (β = 0.13, p < .001). Moreover, greater controlled motivation was momentarily associated with greater depressed affect (β = 0.06, p < .001). More intense physical activity was momentarily associated with greater positive affect (β = 0.13, p = .016). No moderating effect of motivation on the association between physical activity and affect was found.

CONCLUSIONS

Motivation and physical activity are momentarily associated with affect among stroke survivors. Assessing and fostering autonomous motivation may be beneficial for promoting physical activity and managing positive and depressed affect as stroke survivors return to the community.

Effects of Popping For Parkinson’s dance class on the mood of people with Parkinson’s disease

Background/Aims

Depression, low mood and apathy can affect people with Parkinson’s disease, impacting on their quality of life. The aim of this study was to investigate the effects of one Popping For Parkinson’s dance session on the mood of people with Parkinson’s disease.

Methods

A total of 33 people with Parkinson’s disease, with a mean age of 67.5 years (standard deviation 10.3 years), mean Parkinson’s level of 1.8 (standard deviation 1.6), took part in one Popping For Parkinson's dance class at four different locations: London (UK), Hatfield (UK), New York City (USA) and Turin (Italy). Participants’ mood was measured with the Profile of Mood States questionnaire at four time points: immediately before the dance class, immediately after the dance class, 24 hours after the dance class and 1 week after the dance class.

Results

Participants’ total mood score and the subscale score of vigour increased, while the subscales of tension, depression, and confusion decreased on the Profile of Mood States, significantly immediately after the dance intervention. However, at 24 hours and 1 week after the dance class, mood scores did not differ significantly compared with baseline measurements. The improvements in mood immediately after the dance class did not differ depending on sex, age, previous dance experience, the location of the dance class, stage of Parkinson’s disease, presence of tremor and deep brain stimulation treatment.

Conclusions

Participating in a Popping For Parkinson’s dance class boosts mood in the short term, and this improvement lasts less than 24 hours. This finding has implications for the provision of dance classes, suggesting that regular attendance may be necessary for sustained improvements. Further studies are needed to determine whether attending a series of Popping for Parkinson’s classes may have longer-term effects.

The influence of 15-weeks climbing program on the static and dynamic balance of young adults with mild and moderate intellectual disabilities

BACKGROUND

The aim of the study was to assess the effect of climbing on static and dynamic balance and to determine the usefulness of such training in supporting the fitness of young adults with mild and moderate intellectual disabilities.

METHOD

The study involved 47 men and 21 women aged 18-25 years. The experimental group participated in classes on an artificial climbing wall for 15 weeks. At that time, the control group did not participate in any organised sports activities. The balance was assessed twice using tests: a bench walk, a functional reach, a single leg stance with the eyes open and closed, and a BTS P-WALK baroresistive platform.

RESULTS

In the experimental group there were improvements in functional reach test by 7.79 cm (p < .001), balance walk test by 0.47 pts (p = .003), improvements in frontal and sagittal plane stability, and tilting area in the closed eyes test. The changes that were observed in the control group were not statistically significant.

CONCLUSIONS

Climbing activities can be part of a rehabilitation program to improve balance.

COPD: Providing the right treatment for the right patient at the right time

Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.

Extending the High-Frequency Bandwidth and Predicting Speech-in-Noise Recognition: Building on the Work of Pat Stelmachowicz

Recent work has demonstrated that high-frequency (>6 kHz) and extended high-frequency (EHF; >8 kHz) hearing is valuable for speech-in-noise recognition. Several studies also indicate that EHF pure-tone thresholds predict speech-in-noise performance. These findings contradict the broadly accepted "speech bandwidth" that has historically been limited to below 8 kHz. This growing body of work is a tribute to the work of Pat Stelmachowicz, whose research was instrumental in revealing the limitations of the prior speech bandwidth work, particularly for female talkers and child listeners. Here, we provide a historical review that demonstrates how the work of Stelmachowicz and her colleagues paved the way for subsequent research to measure effects of extended bandwidths and EHF hearing. We also present a reanalysis of previous data collected in our lab, the results of which suggest that 16-kHz pure-tone thresholds are consistent predictors of speech-in-noise performance, regardless of whether EHF cues are present in the speech signal. Based on the work of Stelmachowicz, her colleagues, and those who have come afterward, we argue that it is time to retire the notion of a limited speech bandwidth for speech perception for both children and adults.

We want more! Examining the perceived training and information needs of health and fitness practitioners about disability and physical activity

A lack of disability-specific knowledge among practitioners poses a significant barrier to physical activity (PA) participation for persons with physical disabilities (PWPDs). This study aimed to identify perceived training needs of health and fitness practitioners to support PA for PWPDs. Canadian health and fitness practitioners (n = 115; 81% female) completed an online survey. More specialized training and access to information about PA for PWPDs are needed. In-person training, webinars, and lived experiences of PWPDs are recommended.

Validity and reliability of a questionnaire measuring EBDPs among registered dietitian nutritionist

BACKGROUND

There is a lack of a valid and reliable instrument that measures objective and subjective knowledge of evidence-based dietetic practices (EBDP) among registered dietitian nutritionists (RDNs). The present study aimed to develop and assess the validity and reliability of an EBDP Questionnaire (EBDPQ) with objective knowledge items (i.e., quiz items) among RDNs in the USA.

METHODS

Subscales from four existing evidence-based practice (EBP) instruments were combined and modified for dietetics. Content and face validity and internal consistency were used to assess the full survey. Survey responsiveness and test-retest reliability were evaluated within the objective knowledge subscale. Content experts (n = 11) and nutrition professionals (n = 16) completed validation reviews. Doctoral students enrolled in a research course (n = 12) were used to analyse survey responsiveness. Internal and test-retest relability analyses utilised RDN participants (time point 1, n = 482; time point 2, n = 335).

RESULTS

Content validation resulted in a 38-item questionnaire. Average percent agreement among face validity reviewers was 95.1%. Only the pre-validation version of the objective knowledge subscale resulted in significantly higher post-course scores (Mdn = 11.50) compared to the pre-course (Mdn = 9.75, p = 0.05). The validated instrument had excellent internal consistency (Cronbach's α = 0.91); however, the objective knowledge subscale was low (Cronbach's α = 0.41). A good degree of reliability was found between the two time points (intraclass correlation coefficient = 0.71).

CONCLUSIONS

The EBDPQ demonstrated adequate validity and reliability among RDNs. Future research should assess construct validity, with the responsiveness and objective knowledge subscale requiring additional evaluation through an EBDP course.

Knee extensor force control as a predictor of dynamic balance in healthy adults

BACKGROUND

Previous research has demonstrated that force control in various muscles of the lower limb (measured according to the magnitude of force fluctuations) explains significant variance in static balance. Given the dynamic nature of many functional activities and sports, assessment of balance and its determinants under dynamic conditions is of importance.

RESEARCH QUESTION

Does muscle force control explain significant variance in dynamic balance, as measured using the Y balance test (YBT)?

METHODS

YBT performance and knee extensor muscle force control were measured in 28 healthy participants. The YBT involved stance on the right leg and attempting maximal reach with the left leg in the anterior, posteromedial, and posterolateral directions. Force control was assessed during isometric knee extension contractions of the right leg at 10%, 20% and 40% maximal voluntary contraction (MVC) and was quantified according to the magnitude (using the coefficient of variation [CV]), and the temporal structure (using sample entropy, SampEn; and detrended fluctuation analysis α), of force fluctuations.

RESULTS

Significant correlations were observed for YBT anterior reach and muscle force CV (r = -0.44, P = 0.02) and SampEn (r = 0.47, P = 0.012) during contractions at 40% MVC. A subsequent regression model demonstrated that muscle force CV and SampEn at 40% MVC significantly explained 54% of variance in YBT anterior reach. Significant correlations were also observed for YBT posteromedial reach and MVC (r = 0.39, P = 0.043) and muscle force CV during contractions at 40% MVC (r = -0.51, P = 0.006). The regression model demonstrated that MVC and muscle force CV at 40% MVC significantly explained 53.9% of variance in YBT posteromedial reach.

SIGNIFICANCE

These results are the first to indicate that a moderate amount of variance in dynamic balance can be explained by measures of isometric force control.

The psychometric properties of a novel task-based dance self-efficacy measure for older adult dance program participants

BACKGROUND

Self-efficacy for dance may reflect individual differences in factors likely to influence dance program participation. This study investigated the psychometric properties of six novel task-based dance self-efficacy (t-bDSE) questions for older adults participating in two large-scale dance intervention trials (N₁ = 530; N₂ = 131).

METHODOLOGY

Internal consistency of t-bDSE was assessed and items validated according to age, gender, physical ability, cognitive status, psychosocial wellbeing, dance experience and exercise behaviour. Responsiveness of t-bDSE was investigated by comparing dance program participants to control groups.

RESULTS

Internal consistency was high (Cronbach's α = .88). Dance self-efficacy was weaker in participantswith less dance experience, poorer mental health, poorer cognitive and physical abilities, and insufficiently active. t-bDSE scores improved in aged-care trial participants (ηp² = .05, a moderate effect).

CONCLUSIONS

The dance self-efficacy measure demonstrated good criterion and construct validity and can be included in future dance interventions to improve understanding of outcome variability and inform program evaluation.

Occupational intervention in mental health hospitals: Study of contextual impact

BACKGROUND

Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion.

AIMS

To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings.

MATERIALS AND METHODS

Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity.

RESULTS

Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8<t < 4.32, p < 0.05) with no improvement in the participation dimensions (-1.36<t < 1.36, p > 0.05) or reduction (-2.25<t < 3.74, p < 0.05). The pattern of change in primary and secondary outcomes in a new context was distinct from previous reports on OC effectiveness.

CONCLUSIONS AND SIGNIFICANCE

These findings suggest the impact of contextual factors on OC effectiveness. Personal participants' factors, institutional features, clinician characteristics, and intervention qualities should be considered in the process of the OC further development, evidence building, and clinical implementation to ensure optimal intervention results.

The theatre as therapy for military veterans? Exploring the mechanisms which impact psychosocial well-being and social connections during theatre-based programmes

BACKGROUND

In many countries, performing arts and theatre practices are being employed with Armed Forces Communities. However, very little evidence exists outlining the psychosocial benefits of this practice. Therefore, this study aims to explore the perceived impact of theatre-based programmes on psychosocial well-being, and social connections, of U.K. Military Veterans.

METHODS

This qualitative study carried out semi-structured interviews with six military veterans who had participated in at least one theatre-based programme.

RESULTS

Four themes were generated from this study; providing a purpose, therapeutic storytelling, social connection, and the impact of the programme ending.

CONCLUSIONS

This study provided unique insight into the benefits of theatre-based programmes on the psychosocial well-being of U.K. military veterans. The programmes were perceived as being beneficial for future employment opportunities, but the ending of these programmes was difficult for some and must be considered alongside provision.

An exploratory study of exercise behaviours and barriers to participation in people with Charcot-Marie-Tooth disease: a focus on resistance training

The aim of this study was to explore and describe the exercise behaviours and barriers in people with Charcot-Marie-Tooth disease (CMT), with a particular focus on resistance training (RT). Ninety-four Australian adults with a diagnosis of CMT completed an online survey. Fifty-seven percent of respondents reported performing some form of RT each week. Those performing RT engaged in more aerobic activity (P≤0.01) and were involved in longer periods of structured exercise (P<0.01) compared to those not performing RT. The RT group was more likely to perceive their exercise levels as acceptable (P<0.01), that following a program was important (P=0.02), and that exercise is beneficial (P=0.04). The RT group were more likely to have been advised to exercise (P=0.02). Common barriers to exercise were fatigue (64.9%), pain (57.4%), motivation (51.1%), and time (46.8%). RT status did not influence the type of barriers experienced. Weekly RT time was positively associated with exercise satisfaction (r=0.43, P<0.01) and walking distance prior to resting (r=0.29, P=0.04). The findings suggest that positive exercise experiences, advice, assistance from a trainer, and potentially greater resources may influence participation in RT for people with CMT.

'The key to this is not so much the technology. It's the individual who is using the technology': Perspectives on telehealth delivery for autistic adults during the COVID-19 pandemic

LAY ABSTRACT

The COVID-19 pandemic meant that a lot of healthcare services had to move online, such as to video-calls, or to telephone. However, not many studies have looked at how autistic adults feel about this kind of service delivery. It is important to know this, as autistic people may have poorer health than non-autistic people, and they may also struggle to access services more than non-autistic people. This study asked 11 autistic adults (aged 27-67 years), seven family members/carers (aged 44-75) reporting about autistic adults and six service providers about their experiences of accessing or providing a telehealth service. These experiences were collected through interviews, which were then analysed through thematic analysis. Two main themes were: technology aids communication and access - except when it doesn't, and in/flexibility. The themes pointed out some positive aspects of telehealth delivery, including improved communication and decreased stress. The themes also pointed out negative aspects of telehealth, such as increased rigidity of the healthcare system, amplifying pre-existing barriers. Because autistic people have many barriers to accessing healthcare, this study encourages researchers and healthcare providers to think about how such barriers could be addressed through telehealth, and about the possible limitations of telehealth for some autistic people.

Wellness of patients with chronic pain is not only about pain intensity

OBJECTIVE

Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients.

DESIGN

A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T₀ ), six (T₆ ), and twelve (T₁₂ ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively.

RESULTS

Participants included 510 patients. All variables were significantly improved from T₀ to T₆ and T₁₂ . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T₀ , T₆ , and T₁₂ (related conditions: β₀  = 0.55, p < 0.001; β₆  = 0.54, p < 0.001; and β₁₂  = 0.51, p < 0.001; pain: β₀  = 0.42, p < 0.001; β₆  = 0.18, p < 0.001; and β₁₂  = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness.

CONCLUSION

Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.

The hidden benefits of patient encounters

BACKGROUND

Whilst it is widely acknowledged that health care professionals (HCPs) learn from patient encounters, research exploring what HCPs learn from their meetings with patients is relatively sparse, particularly in the context of postgraduate training. Moreover, there are few research studies that examine the contribution of patient encounters to HCP education from both HCP and patient perspectives. This study set out to explore HCPs learning from patient encounters from both HCP and patient perspectives.

METHODS

Qualitative descriptive design was used to conduct this study. Using purposive sampling, we recruited participants from three different groups in a single department of paediatrics in a teaching hospital. Data was collected through interviews, which were transcribed and analysed for key themes.

FINDINGS

Patients felt that they played a central role in clinical education and highlighted their ability to educate postgraduate HCPs about their lived experiences of disease. HCPs highlighted the unique insight into a chronic illness gained from patient accounts, essential to developing patient and family orientated approaches to care. HCPs reported that they developed professionally, learning to adapt their negotiation and educational strategies.

CONCLUSIONS

This study highlights the importance of patient encounters as critical contributors to HCPs understanding of the lived experiences of patients with chronic disease, and offers insights into how parents view their contribution to clinical education. Much of this learning is embedded and implicit, which suggests that HCP trainees need to develop better in the moment awareness of what they are learning from their meetings with patients and their families.

Extension, austerity, and emergence: Themes identified from a global scoping review of non-urban occupational therapy services

INTRODUCTION

Rural communities contribute to national wellbeing, identities, economies, and social fabrics yet experience increased risk of mortality, morbidity, and disability, coupled with lower levels of income, formal education, and employment than urban citizens. Despite higher need, occupational therapy services are maldistributed to urban locations. Publications about non-urban services discuss predominantly outreach-based, individualist, rehabilitation for specified diagnoses/age groups. However, given this population level inequity, it is unclear why individualist focussed services are more commonly discussed. Understanding intentions expressed in publications about non-urban service design may identify assumptions/limitations to current approaches and contribute to improved future services.

METHODS

Each of 117 publications identified in a scoping review was read by two reviewers to independently identify themes. Provisional themes were discussed and modified in an iterative process to develop final themes/subthemes. The first author reinterrogated the publications and coded data to identify relevant examples to support the identified themes.

RESULTS

Three key themes and nine subthemes were identified. Hegemonic perspectives were found in the themes (i) Extension of urban practice and (ii) Austerity, particularly in the Global North. Non-urban services were typically extended to non-urban contexts underpinned by austerity and neoliberal values such that non-urban persons and their context were problematised rather than service or funding design. A counter-hegemonic perspective was found in the theme (iii) Responses to situational realities more commonly in Global South publications, which valued non-urban contexts, and focussed on developing non-urban communities and promoting justice.

CONCLUSION

The hegemonic paradigm links occupational therapy services with neoliberal notions of individualism, private provision of care, and efficiency/market value, rather than the occupational therapy values for justice. The profession must consider our role in perpetuating injustice for non-urban people and consider if and how more contextually tailored counter hegemonic place-based paradigms can be developed from and with regional, rural, and remote practice.

Normalising interdisciplinary role-based goal setting in inpatient brain injury rehabilitation: reflections and recommendations of clinicians

PURPOSE

Person-centred goal setting with people with brain injury, by interdisciplinary teams has benefits including improved communication between patients, families and clinicians, person-centred care, and improved engagement in rehabilitation. Exploring the experiences of team members who have adopted interdisciplinary, person-centred goal setting may assist in understanding what is needed to implement this complex, core component of rehabilitation practice. This study explored experiences of clinicians working in an extended inpatient brain injury rehabilitation unit about implementing a role-based goal planning approach within an interdisciplinary team.

MATERIALS AND METHODS

Semi-structured interviews with 13 clinicians working at the rehabilitation unit explored their experiences about the cognitive participation and collective actions required to carry out the practice, with data analysed using inductive content analysis guided by Normalisation Process Theory.

RESULTS

Three primary themes were identified: putting the person at the centre, accepting the mind-shift to participation focused goals and working collaboratively.

CONCLUSIONS

This study has elucidated some key processes that occurred and were necessary to carry out goal setting. A mind-shift towards holistic, participation-focussed goal setting was described as "unlearning" discipline-specific goal setting. Development and ownership by the team, acceptance of team members and willingness to share, and structured processes and resources were necessary.IMPLICATIONS FOR REHABILITATIONNormalising interdisciplinary role-based goal setting in multi-professional teams requires a mind-shift away from traditional, discipline-specific goal setting.Implementation of interdisciplinary, collaborative team goal setting within health service settings requires collective actions including collaborative working by team members, structured processes including organised time for collaborative team and family meetings, practical resources and training to support processes.Clinicians perceived the goal setting approach to put the person at the centre resulting in a deep understanding of the person, shared understanding, and motivation for rehabilitation.

Psychometric properties of questionnaires to assess evidence-based practice among occupational, physical and speech therapists: A systematic review

INTRODUCTION

Evidence-based practice (EBP) is an important aspect of healthcare work, but the clinical implementation is complex. To be able to facilitate EBP implementation, valid measurement of the "EBP status quo" is essential. Therefore, we aimed to identify valid tools for EBP status assessment among occupational, physical and speech therapists in Germany.

METHODS

The databases PubMed, Cochrane Library, PsycINFO, and CINAHL were systematically searched from August 2011 until July 2022. Methodological quality and evidence level were scored by two independent raters via: i) the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, ii) updated criteria for good measurement properties, and iii) modified GRADE criteria.

RESULTS

Overall, 57 reports describing the development or validation of 31 EBP questionnaires were included. Six questionnaires showed "sufficient" evidence for content validity, three questionnaires showed "sufficient" evidence for reliability, two questionnaires showed "sufficient" evidence for structural validity as well as internal consistency, and nine questionnaires showed "sufficient" evidence for construct validity. Most questionnaires demonstrated moderate or low-quality evidence for the psychometric properties tested.

DISCUSSION

Overall, the present review found a lack of sufficient evidence on the psychometric properties of most questionnaires. The Evidence-Based Practice Inventory (EBPI), the Evidence-based Practice Confidence (EPIC) scale and the Health Sciences-Evidence-Based Practice (HS-EBP) questionnaire were the only questionnaires with "sufficient" content validity and, in addition, "sufficient" reliability or "sufficient" internal consistency.

CONCLUSION

Although a lack of high-quality psychometric properties of EBP tools became apparent, the EBPI, the EPIC scale and the HS-EBP questionnaire currently appear to be the best validated tools to assess EBP behavior/attitude and implementation in occupational, physical and speech therapists.

Interventions promoting cognitive function in patients experiencing cancer related cognitive impairment: A systematic review

OBJECTIVE

To examine the effect of interventions used to enhance cognitive function in patients experiencing cancer-related cognitive impairment.

METHODS

Studies including adults with a non-metastatic cancer who have received chemotherapy as part of their treatment and who have undergone interventions targeting cancer-related cognitive impairment were included. Studies involving patients with metastatic cancer and pre-existing cognitive deficits were excluded. Academic Search Complete, CINAHL Plus with full text, MEDLINE, Education Full Text, PsycARTICLES, PsycINFO, and ERIC were searched for studies published between January 2011 and September 2022. Data extraction and quality appraisal were conducted by two authors and cross-checked by the review team. Quality appraisal was conducted using 12 items from the Mixed Methods Appraisal Tool. Findings were presented narratively without meta-analysis.

RESULTS

Thirty-one studies were included. Interventions were categorised as integrative/complementary, cognitive behavioural therapy and compensatory strategies, exercise, psychoeducational/psychosocial, brain-training, and pharmacological. Over 100 instruments were identified, including the Functional Assessment of Cancer Therapy-Cognitive, Trail Making Tests-A and B, and instruments measuring secondary outcomes, including depression. Instruments often measured attention and concentration, language, memory, executive function, and/or patient-reported outcomes. Improvements were reported, with most studies measuring some or various aspects of cognitive functioning and very few studies measuring all domains of cognitive functioning, making it difficult to draw definitive conclusions about effectiveness.

CONCLUSIONS

Various interventions are available to treat cancer-related cognitive impairment. Outcome measurement was inconsistent and future research should prioritise using standardised measures. Current evidence, whilst not being definitive, suggests that certain interventions show greater promise than others, including cognitive behavioural therapy and brain training.

Community Pharmacists' Views on the Early Stages of Implementation of a National Pilot Independent Prescribing Service in Wales: A Qualitative Study

Background

A pilot Independent Prescribers' Service (IPS) was introduced in 13 community pharmacies across Wales in June 2020. Independent Pharmacist Prescribers (IPPs) could prescribe in the areas of management of acute conditions, contraception, or opioid withdrawal, as agreed with local commissioners. Access to the patients' medical records was provided via Choose Pharmacy, the national community pharmacy IT platform.

Objective

To explore the experiences of IPPs delivering the service and commissioners responsible for financial resources regarding the IPS in Wales.

Methods

A qualitative methodology was employed, with purposive sampling, semi-structured interviews, and inductive thematic analysis.

Results

Five themes were constructed from 13 interviews (n=9 IPPs; n=4 commissioners): (i) patient experience and safety; (ii) professional enablement and rebalancing workload of GPs; (iii) role and limitations of remote consultations; (iv) funding and business model; (v) functionality on Choose Pharmacy to support patient care. The design of the service allowed pharmacists to determine how best to deliver the IPS, maximizing access for patients and promoting a sense of professional value amongst pharmacists.

Conclusion

This study builds on the body of evidence on enhanced patient experience with prescribing services in the community, reinforcing that IPPs have a key role in rebalancing management of common conditions from GP surgeries to community pharmacies. Several considerations need to be addressed to ensure future success of the service implementation, delivery and enhanced sustainability, such as formal referral pathways and access to medical records. These can be used by other commissioning bodies in the UK and internationally to build a network of suitably supported IPPs, confident to appropriately deal with uncomplicated acute and chronic conditions; and liaise with primary and/or secondary care when referrals are needed.

The effects of short foot exercises to treat flat foot deformity: A systematic review

BACKGROUND

Studies on the effects of performing short foot exercises (SFEs) on the medial longitudinal arch (MLA) have been inconclusive.

OBJECTIVE

This study aimed to conduct a systematic review of the effects of SFEs.

METHODS

'SFE' and 'intrinsic foot muscle' were keywords used to search for randomized controlled trials. One researcher screened relevant articles based on their titles and abstracts, and two independent researchers closely read the texts, accepting nine studies for inclusion. Outcomes, intervention duration, frequency, and the number of interventions were investigated.

RESULTS

Of 299 potential studies identified, the titles and abstracts of 211 studies were reviewed, and 192 were excluded. The full texts of 21 studies were obtained and evaluated according to inclusion and exclusion criteria. Nine studies met the inclusion criteria. Six studies concerning the MLA were identified, with four reporting MLA improvement. There was no consensus concerning the number and frequency of SFEs performed, and the mechanism of MLA improvement was unclear. MLA improvement was observed in participants who undertook ⩾ 5 weeks of interventions.

CONCLUSIONS

The results suggest that performing SFEs for ⩾ 5 weeks is effective in improving the MLA. Randomized controlled trials with details concerning the number and frequency of treatments are required.

Pet cat personality linked to owner-reported predation frequency

The domestic cat, Felis catus, is one of the most popular and widespread domestic animals. Because domestic cats can reach high population densities and retain at least some tendency to hunt, their overall impact on wildlife can be severe. Domestic cats have highly variable predation rates depending on the availability of prey in their environment, their owners' practices, and individual cat characteristics. Among these characteristics, cat personality has recently been hypothesized to be an important factor contributing to variations in the hunting activity of cats. In this study, we surveyed 2508 cat owners living in France about their cats' personalities, using the Feline Five personality framework, and the frequency with which cats bring home prey. Personality traits were analyzed using factor analysis and related to predation frequency using cumulative logit models. For both birds and small mammals, cats with high levels of extraversion or low levels of neuroticism had significantly higher frequencies of prey return. Owners whose cats had low levels of agreeableness or high levels of dominance reported a significantly lower frequency of bird return. Personality differences therefore seem to contribute to the high variability in predation rates among domestic cats. We also found that the owner-reported prey return frequencies were significantly higher for cats spending more time outdoors, for non-pedigree cats, and for owners living in rural or suburban areas as opposed to urban areas. By contrast, we did not detect an effect of cat sex or age on their reported prey return rates.

Neurofeedback Treatment Affects Affective Symptoms, But Not Perceived Cognitive Impairment in Cancer Patients: Results of an Explorative Randomized Controlled Trial

BACKGROUND

EEG biofeedback (NF) is an established therapy to enable individuals to influence their own cognitive-emotional state by addressing changes in brainwaves. Psycho-oncological approaches of NF in cancer patients are rare and effects are hardly studied.

OBJECTIVE

The aim of this explorative, randomized controlled trial was to test the effectiveness of an alpha and theta NF training protocol, compared to mindfulness based therapy as an established psycho-oncological treatment.

METHODS

Of initially 62 screened patients, 56 were included (inclusion criteria were cancer independent of tumor stage, age >18 years, German speaking; exclusion criteria suicidal ideation, brain tumor). Randomization and stratification (tumor stage) was conducted by a computer system. Participants got 10 sessions over 5 weeks, in (a) an NF intervention (n = 21; 13 female, 8 male; MAge = 52.95(10 519); range = 31 to 73 years)) or (b) a mindfulness group therapy as control condition (CG; n = 21; ie, 15 female, 6 male; MAge = 50.33(8708); range = 32 to 67 years)). Outcome parameters included self-reported cognitive impairment (PCI) as primary outcome, and secondary outcomes of emotional distress (DT, PHQ-8, GAD-7), fatigue (MFI-20), rumination (RSQ), quality of life (QoL, EORTC-30 QoL), self-efficacy (GSE), and changes in EEG alpha, and theta-beta band performance in the NF condition.

RESULTS

No changes in cognitive impairment were found (P = .079), neither in NF nor CG. High affective distress was evident, with 70.7% showing elevated distress and 34.1% showing severe depressive symptoms. Affective symptoms of distress (P ≤ .01), depression (P ≤ .05) and generalized anxiety (P ≤ .05) decreased significantly over time. No differences between NF and CG were found. There was a significant increase of the alpha band (P ≤ .05; N = 15) over the NF sessions. Self-efficacy predicted QoL increase in NF with P ≤ .001 and an explained variance of 48.2%.

CONCLUSION

This is the first study to investigate NF technique with regard to basic mechanisms of effectiveness in a sample of cancer patients, compared to an established psycho-oncological intervention in this field. Though there were no changes in cognitive impairment, present data show that NF improves affective symptoms comparably to mindfulness-based therapy and even more pronounced in QoL and self-efficacy.Trial registration: ID: DRKS00015773.

Challenging Future Generations: A Qualitative Study of Students' Attitudes toward the Transition to Animal-Free Innovations in Education and Research

In 2016, the Dutch government declared its commitment to phasing out animal experiments by 2025. Although a high number of animal experiments are still performed and the 2025 target will not be met, the commitment remains. Efforts are being made to identify levers that might foster the transition to animal-free science. Education has been found to play a key role in the future of animal-free science and young generations are increasingly seen as key stakeholders. However, their attitudes toward the transition to animal-free innovations have not been investigated. The present article focuses on the values and beliefs held by students, who in 2022, participated in the course 'Replacing Animal Testing' (RAT) Challenge, organized by a consortium of Dutch universities. Contextually, students' motivations to follow the course were investigated. The research was based on a qualitative study, including semi-structured interviews and a literature review. Our analysis of the findings revealed that students feel aligned with the social, ethical, and scientific reasons that support the transition to animal-free innovations. Moreover, the participants identified a series of regulatory, educational, cultural, and political obstacles to the transition that align with those identified in recent literature. From the discussion of these findings, we extrapolated six fundamental challenges that need to be addressed to foster the transition to animal-free science in an acceptable and responsible way.

Lost in Transition – Eine explorative qualitative Studie zur Transition von Jugendlichen aus der pädiatrischen Physiotherapie in die Erwachsenenphysiotherapie

Hintergrund In der Kinderphysiotherapie werden Kinder mit komplexer Beeinträchtigung oder chronischer Erkrankung und ihre Familien über Jahre begleitet. Während der Transition eines Jugendlichen in das Erwachsenenleben stellt sich oft die Frage: Wie kann sichergestellt werden, dass die Transition eines Jugendlichen von der pädiatrischen Physiotherapie in die Erwachsenenphysiotherapie als fließender Prozess ablaufen kann?

Ziel Evaluation von fördernden und hemmenden Faktoren für eine fließende Transition in der Physiotherapie sowie das Erstellen eines Leitfadens, um den Transitionsprozess fließender zu gestalten.

Methode In der qualitativen Studie wurden Beteiligte (Jugendliche, Eltern, Physiotherapeut*innen) mit leitfadengestützten Interviews befragt. Die Interviews wurden mittels der inhaltlich strukturierenden Inhaltsanalyse analysiert. Fördernde und hemmende Faktoren wurden abgeleitet.

Ergebnisse Es wurden 3 Hauptkategorien mit je 2 Subkategorien herausgearbeitet: 1. Eine vertrauensvolle und langjährige Beziehung zwischen allen Beteiligten spielt eine zentrale Rolle, 2. Um die Besonderheiten von Jugendlichen aufzuzeigen, sind medizinische und persönliche Informationen unerlässlich, 3. Das fachliche Wissen der Physiotherapeut*innen kann auf Erfahrung beruhen, aber genauso wichtig sind die Freude und das Interesse, sich weiterzubilden. Allen Beteiligten ist klar, dass eine optimale Übergabe eine zeitaufwändige und intensive Arbeit ist. Die Beziehung zwischen den verschiedenen Personen ist dabei das Kernelement.

Schlussfolgerung Für den Übergang von einer kindzentrierten zu einer erwachsenenorientierten Physiotherapie ist es wichtig, alle Beteiligten für das Thema zu sensibilisieren und alle wichtigen Teilschritte, die dieser Prozess beinhaltet, zu berücksichtigen. Ein Leitfaden zur Transition sollte den Prozess erleichtern.

Online neuropilates classes in chronic stroke patients: Protocol for a randomised controlled feasibility study

Introduction

Stroke survivors often demonstrate low physical activity levels and experience barriers to physical exercise including embarrassment, low self-efficacy and a shortage of tailored community exercise programmes. Access to physical activity programmes for stroke survivors could be improved by providing tailored, online programmes, although little is known about the safety and feasibility of online exercise classes for stroke survivors. One such programme of exercise which has received little attention in the literature is neuropilates. Neuropilates is the practice of a modified pilates programme in those with neurological conditions and is theorised to have beneficial effects on strength, balance and proprioception in stroke survivors. No previous study has been conducted to investigate online, remotely supervised neuropilates exercise classes in the stroke survivors.

Method and Analysis

This single assessor blinded randomised controlled feasibility study will compare a 6-week online, remotely instructed neuropilates programme to a 6-week online, remotely instructed generalised exercise programme and a 6-week unsupervised generalised home exercise programme in chronic stroke patients. Twenty adults, at least 6 months post stroke, and finished their formal rehabilitation will be recruited to the study. Primary feasibility outcome measures will include patient tolerance of the programme, adherence rates, adverse events, recruitment and retention. Secondary clinical outcomes will include; balance, gait, tone and quality of life. Assessments will be completed at baseline, on programme completion and 3 months post completion by a Physiotherapist blinded to the group allocation.

Ethics and dissemination

This study has received ethical approval from the Sligo University Hospital Ethics committee and ATU ethics board. Results will be published in peer-reviewed journals and presented at national and international conferences.The trial has been registered on clinicaltrials.gov (Identifier: NCT04491279).