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Feng G, Posa S, Sureshkumar A, Simpson S, Bruno T, Morrow SA, Donkers S, Knox K, Feinstein A, Bayley M, Munce S, Simpson R. Experiences of people with multiple sclerosis and clinicians in using cognitive behavioural therapies for hidden symptoms: a systematic review and meta-aggregation. J Neurol 2024; 271:1084-1107. [PMID: 38219252 DOI: 10.1007/s00415-023-12116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Cognitive behavioural therapies (CBTs) are a standard of care for treatment of many 'hidden symptoms' in people with MS (PwMS), such as stress, depression, and fatigue. However, these interventions can vary widely in formatting and may not be tailored for PwMS. To optimize CBTs for MS, understanding the experiences of PwMS and clinicians is essential. This systematic review and meta-aggregation synthesizes existing qualitative data on stakeholder perspectives of CBTs for PwMS. METHODS Systematic searches across five major electronic databases were conducted. Studies reporting qualitative data were identified. Two reviewers performed screening, quality assessment, data extraction, and certainty of evidence assessments. Meta-aggregation was performed as per the Joanna Briggs Institute approach, entailing qualitative data extraction, developing categories, and synthesizing overall findings. RESULTS Twenty-eight studies were included in this review, comprising data from 653 PwMS and 47 clinicians. In the meta-aggregation, 122 qualitative results were extracted and grouped into nine categories. Categories were then combined into six synthesized findings: (1) setting the context-life with MS, (2) reasons for participating in CBTs, (3) acceptability of and experiences with participating in CBTs, (4) perceived benefits of CBTs, (5) perceived challenges with CBTs, and (6) suggestions to improve CBTs for PwMS. CONCLUSIONS A range of benefits including psychological, social, and lifestyle improvements were reported, but varied based on the design of the CBT intervention. Future CBT interventions should be tailored to participant needs, delivered in group settings, offer online options, and be delivered by a trained facilitator familiar with MS. Further exploration of the ideal CBT design for PwMS, as well as engagement with caregivers and clinicians treating MS, is warranted.
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Affiliation(s)
- Gregory Feng
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Stephanie Posa
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Sharon Simpson
- Forest Hill Centre for Cognitive Behavioural Therapy, Toronto, Canada
| | - Tania Bruno
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah A Morrow
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Sarah Donkers
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Katherine Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robert Simpson
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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Nieste I, Franssen WMA, Duvivier BMFM, Spaas J, Savelberg HHCM, Eijnde BO. Replacing sitting with light-intensity physical activity throughout the day versus 1 bout of vigorous-intensity exercise: similar cardiometabolic health effects in multiple sclerosis. A randomised cross-over study. Disabil Rehabil 2023; 45:3293-3302. [PMID: 36190113 DOI: 10.1080/09638288.2022.2122601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Persons with Multiple Sclerosis (PwMS) are physically inactive and spend more time in sedentary behaviours than healthy persons, which increases the risk of developing cardiometabolic diseases. In this randomised crossover study, the cardiometabolic health effects of replacing sitting with light-intensity physical activity (LIPA) and exercise (EX) were investigated. MATERIALS AND METHODS Twenty-eight mildly disabled PwMS performed four 4-day activity regimens in free-living conditions; CONTROL (habitual activity), SIT, LIPA, and EX. Plasma glucose and insulin (oral glucose tolerance test), plasma lipids, inflammation, resting heart rate, blood pressure, body weight, and perceived exertion were measured (clinical-trials.gov: NCT03919058). RESULTS CONTROL: 9.7 h sitting/day, SIT: 13.3 h sitting/day, LIPA: 8.3 h sitting, 4.7 h standing, and 2.7 h light-intensity walking/day, and EX: 11.6 h sitting/day with 1.3 h vigorous-intensity cycling. Compared to SIT, improvements (p < 0.001) after LIPA and EX were found for insulin total area under the curve (-17 019 ± 5708 and -23 303 ± 7953 pmol/L*min), insulin sensitivity (Matsuda index +1.8 ± 0.3 and +1.9 ± 0.4) and blood lipids (triglycerides: -0.4 ± 0.1 and -0.5 ± 0.1 mmol/L; non-high-density lipoprotein cholesterol: -0.3 ± 0.1 and -0.5 ± 0.1 mmol/L), with no difference between LIPA and EX. Perceived exertion was higher after EX compared to LIPA (Borg score [6-20]: +2.6 ± 3.3, p = 0.002). CONCLUSION Replacing sitting with LIPA throughout the day exerts similar cardiometabolic health effects as a vigorous-intensity exercise in PwMS.IMPLICATIONS FOR REHABILITATIONIncreasing light-intensity physical activity (LIPA) throughout the day improves cardiometabolic health to the same extent as one vigorous-intensity exercise sessionIncreasing LIPA induces less exertion than performing a vigorous-intensity exercise.
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Affiliation(s)
- Ine Nieste
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
| | - Wouter M A Franssen
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | | | - Jan Spaas
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Faculty of Health, Medicine and Life Sciences, NUTRIM, School for Nutrition and Translation Research Maastricht, Maastricht University, Maastricht, Netherlands
| | - Bert O Eijnde
- Faculty of Medicine and Life Sciences, Sports Medicine Research Center, SMRC, BIOMED, Biomedical Research Institute, Hasselt University, Hasselt, Belgium
- University MS Center (UMSC) Hasselt-Pelt, Hasselt, Belgium
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Fortune J, Burke J, Dillon C, Dillon S, O’Toole S, Enright A, Flynn A, Manikandan M, Kroll T, Lavelle G, Ryan JM. Co-designing resources to support the transition from child to adult health services for young people with cerebral palsy: A design thinking approach. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:976580. [PMID: 36589713 PMCID: PMC9800984 DOI: 10.3389/fresc.2022.976580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022]
Abstract
Introduction Design thinking is a human-centred process that aims to identify the needs of end-users and iteratively develop solutions. Involving end-users in the development and design of solutions may enhance effectiveness by increasing focus on the needs of the target population. This paper describes the process of co-designing resources to support the transition from child-centred to adult-orientated health services using a design thinking approach. Methods Five co-design workshops were conducted remotely with a young person advisory group and parent advisory group. A design thinking process guided by the Stanford D.School approach was used to understand the transition needs of young people and their parents and iteratively develop solutions to improve end-user experience. Results Eight resource prototypes were generated: (1) designated transition coordinator, (2) digital stories of transition experience (3) written informational support (4) transition website, (5) transition checklists and worksheets (6) transition app, (7) transition programme or course and (8) educational programme for health professionals. Conclusion Design thinking is a feasible approach to identify, characterise and prioritise resources collaboratively with end-user partners.
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Affiliation(s)
- Jennifer Fortune
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland,Correspondence: Jennifer Fortune
| | | | | | | | | | | | | | - Manjula Manikandan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Thilo Kroll
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jennifer M. Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Polhemus A, Haag C, Sieber C, Sylvester R, Kool J, Gonzenbach R, von Wyl V. Methodological heterogeneity biases physical activity metrics derived from the Actigraph GT3X in multiple sclerosis: A rapid review and comparative study. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:989658. [PMID: 36518351 PMCID: PMC9742246 DOI: 10.3389/fresc.2022.989658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2023]
Abstract
BACKGROUND Physical activity (PA) is reduced in persons with multiple sclerosis (MS), though it is known to aid in symptom and fatigue management. Methods for measuring PA are diverse and the impact of this heterogeneity on study outcomes is unclear. We aimed to clarify this impact by comparing common methods for deriving PA metrics in MS populations. METHODS First, a rapid review of existing literature identified methods for calculating PA in studies which used the Actigraph GT3X in populations with MS. We then compared methods in a prospective study on 42 persons with MS [EDSS 4.5 (3.5-6)] during a voluntary course of inpatient neurorehabilitation. Mixed-effects linear regression identified methodological factors which influenced PA measurements. Non-parametric hypothesis tests, correlations, and agreement statistics assessed overall and pairwise differences between methods. RESULTS In the rapid review, searches identified 421 unique records. Sixty-nine records representing 51 eligible studies exhibited substantial heterogeneity in methodology and reporting practices. In a subsequent comparative study, multiple methods for deriving six PA metrics (step count, activity counts, total time in PA, sedentary time, time in light PA, time in moderate to vigorous PA), were identified and directly compared. All metrics were sensitive to methodological factors such as the selected preprocessing filter, data source (vertical vs. vector magnitude counts), and cutpoint. Additionally, sedentary time was sensitive to wear time definitions. Pairwise correlation and agreement between methods varied from weak (minimum correlation: 0.15, minimum agreement: 0.03) to perfect (maximum correlation: 1.00, maximum agreement: 1.00). Methodological factors biased both point estimates of PA and correlations between PA and clinical assessments. CONCLUSIONS Methodological heterogeneity of existing literature is high, and this heterogeneity may confound studies which use the Actigraph GT3X. Step counts were highly sensitive to the filter used to process raw accelerometer data. Sedentary time was particularly sensitive to methodology, and we recommend using total time in PA instead. Several, though not all, methods for deriving light PA and moderate to vigorous PA yielded nearly identical results. PA metrics based on vertical axis counts tended to outperform those based on vector magnitude counts. Additional research is needed to establish the relative validity of existing methods.
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Affiliation(s)
- Ashley Polhemus
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Christina Haag
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Chloé Sieber
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
| | - Ramona Sylvester
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Jan Kool
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Roman Gonzenbach
- Research Department Physiotherapy, Rehabilitation Centre, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology and Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
- Institute for Implementation Science in Health Care, University of Zürich, Zürich, Switzerland
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Huynh TLT, Silveira SL, Motl RW. Systematic review of participant characteristics in theory-based behavior change interventions for physical activity in multiple sclerosis: are we missing those with the greatest potential for lifelong benefits? Disabil Rehabil 2022; 44:5784-5803. [PMID: 34334057 DOI: 10.1080/09638288.2021.1954705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined participant characteristics, particularly disease duration, in theory-based physical activity behavior change trials in multiple sclerosis (MS) and summarized theoretical frameworks and changes in physical activity outcomes. MATERIALS AND METHODS PubMed, CINAHL, Embase, and Scopus were searched to identify potential trials. One reviewer screened titles and abstracts, and two reviewers then independently screened full-text articles based on predetermined eligibility criteria. Data were extracted by one reviewer and checked by a second reviewer. RESULTS Among 33 trials reviewed, only one trial reported a mean disease duration of less than five years (i.e., 4.5 years) for the sample. The remaining trials included samples with a mean disease duration of 6.7 years or longer. The most common theories used were Social Cognitive Theory, Trans-theoretical Model, and Motivational Interviewing. The effects on physical activity were heterogeneous; device-measured outcomes increased in 41.4% of studies, self-reported outcomes improved in 72.4%. Adherence (≥80%) was reported in 34.5% of studies. CONCLUSIONS There is little focus on persons with MS in the early disease course in physical activity behavior change interventions. Future research should include comprehensive theoretical approaches for more homogeneous effects across outcome measures when targeting those in the early stage and all MS populations.IMPLICATIONS FOR REHABILITATIONTheory-based physical activity behavior change interventions have not included persons with multiple sclerosis (MS) in the early disease course (<5 years since diagnosis).Disease duration has not been a criterion used to include or exclude participants in the reviewed theory-based behavior change interventions for physical activity in people with MS.The theory-based behavior change interventions in this review positively affected short-term physical activity levels in people with MS.
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Affiliation(s)
- Trinh L T Huynh
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert W Motl
- Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Larsen RT, Wagner V, Korfitsen CB, Keller C, Juhl CB, Langberg H, Christensen J. Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376:e068047. [PMID: 35082116 PMCID: PMC8791066 DOI: 10.1136/bmj-2021-068047] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION PROSPERO CRD42018102719.
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Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Brain Injury Rehabilitation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christoffer Bruun Korfitsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
- Danish Health Authority, Copenhagen, Denmark
| | - Camilla Keller
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
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Fortune J, Norris M, Stennett A, Kilbride C, Lavelle G, Hendrie W, DeSouza L, Victor C, Ryan JM. Correlates of Objectively Measured Physical Activity Among People With Multiple Sclerosis: A Cross-Sectional Study. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726436. [PMID: 36188781 PMCID: PMC9397718 DOI: 10.3389/fresc.2021.726436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022]
Abstract
Background: Identifying correlates of physical activity (PA) for people with multiple sclerosis (MS) is essential to design effective PA interventions.Methods: Participants completed a battery of questionnaires and wore an ActiGraph accelerometer. Light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) (min/day) were calculated. Associations were examined using multiple linear regression adjusted for demographic and clinical confounders.Results: Fifty-eight adults with MS participated (mean ± SD age: 56.8 ± 9.2 yr; 67% women). MS type was associated with time in LPA. Participants with secondary progressive MS (B = −54.0, 95% CI −84.7 to −23.3) and primary progressive MS (B = −42.9, 95% CI −77.5 to −8.3) spent less time in LPA than those with relapsing remitting MS. Walking capacity, assessed using the 12-item MS walking scale (MSWS-12), was associated with time in MVPA (B = −0.36, 95% CI −0.72 to −0.01).Conclusion: This work identifies walking capacity and type of MS as correlates of PA, which may indicate development of interventions to promote PA.
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Affiliation(s)
- Jennifer Fortune
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Meriel Norris
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
- *Correspondence: Meriel Norris
| | - Andrea Stennett
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Cherry Kilbride
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Grace Lavelle
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Wendy Hendrie
- Multiple Sclerosis (MS) Therapy Centre, Norwich, United Kingdom
| | - Lorraine DeSouza
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Christina Victor
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
| | - Jennifer Mary Ryan
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, United Kingdom
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Louie J, Baquie K, Offerman J, Granger CL, Khan F, Bower KJ. Maximising Abilities, Negotiating and Generating Exercise options (MANAGE) in people with multiple sclerosis: A feasibility randomised controlled trial. Clin Rehabil 2021; 36:498-510. [PMID: 34881669 DOI: 10.1177/02692155211064949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. DESIGN Feasibility randomised controlled trial. SETTING Outpatient rehabilitation facility. SUBJECTS Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. INTERVENTIONS The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. MAIN MEASURES Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. RESULTS Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. CONCLUSIONS The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance.
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Affiliation(s)
- Julie Louie
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Katherine Baquie
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Justin Offerman
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Catherine L Granger
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia.,2281The University of Melbourne, Melbourne, VIC, Australia
| | - Fary Khan
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia.,6451Department of Rehabilitation Medicine, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kelly J Bower
- Department of Physiotherapy, 90134Royal Melbourne Hospital, Melbourne, VIC, Australia.,2281The University of Melbourne, Melbourne, VIC, Australia
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Fortune J, Norris M, Stennett A, Kilbride C, Lavelle G, Hendrie W, Victor C, Ryan JM. Patterns and correlates of sedentary behaviour among people with multiple sclerosis: a cross-sectional study. Sci Rep 2021; 11:20346. [PMID: 34645876 PMCID: PMC8514488 DOI: 10.1038/s41598-021-99631-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022] Open
Abstract
High levels of sedentary behaviour are associated with poor health outcomes in people with multiple sclerosis (MS). Identifying modifiable correlates of sedentary behaviour for people with MS is essential to design effective intervention strategies to minimise sedentary time. This study aimed to quantify patterns and identify correlates of sedentary behaviour among adults with MS. Fatigue, self-efficacy, walking capability, the physical and psychological impact of MS, health-related quality of life, and participation and autonomy were assessed by questionnaire. Participants wore an activPAL monitor. Total (min/day), prolonged bouts (≥ 30 min) and breaks in sedentary time were calculated. Associations were examined using regression analysis adjusted for demographic and clinical confounders. Fifty-six adults with MS participated (mean ± SD age: 57.0 ± 9.25 years; 66% female). Self-efficacy for control over MS was associated with sedentary time (β = 0.16, 95% CI 0.01, 0.30). Self-efficacy in function maintenance (β = 0.02, 95% CI 0.00, 0.04), health-related quality of life (EuroQol-5D) (β = 31.60, 95% CI 7.25, 55.96), and the autonomy indoors subscale of the Impact on Participation and Autonomy Questionnaire (β = − 5.11, 95% CI − 9.74, − 0.485) were associated with breaks in sedentary time. Future studies should consider self-efficacy, health-related quality of life and participation and autonomy as potential components of interventions to reduce sedentary behaviour.
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Affiliation(s)
- Jennifer Fortune
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Meriel Norris
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK.
| | - Andrea Stennett
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK.,Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Cherry Kilbride
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Grace Lavelle
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Christina Victor
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Jennifer Mary Ryan
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University London, London, UK
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Stennett AM, De Souza LH, Norris M. Flipping the ICF: Exploring the Interplay of Theory and the Lived Experience to Reconsider Physical Activity in Community-Dwelling People With Multiple Sclerosis. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:710618. [PMID: 36188838 PMCID: PMC9397990 DOI: 10.3389/fresc.2021.710618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022]
Abstract
People with multiple sclerosis (MS) report lower physical activity levels and are at a risk of becoming sedentary. As such, they are at an increased risk of developing secondary health conditions associated with inactivity. This is of major public health concern. Attempts to improve the physical activity levels in people with MS remain a challenge for health professionals. One key reason might be the lack of understanding about the meanings people with MS ascribe to exercise and physical activity. This paper draws on the key findings of a three-phased interconnected mixed methods sequential explanatory study to examine the meanings of exercise and physical activity from the perspectives of people with MS and health professionals. Phase 1 used a four-round Delphi questionnaire to scope and determine the consensus of priorities for exercise and physical activity and the reasons why people with MS (N = 101) engaged in these activities. Phase 2 used face-to-face semistructured interviews of people with MS (N = 16) to explore the meanings ascribed to exercise and physical activity. Phase 3 explored the perceptions of physiotherapists (N = 14) about exercise and physical activity using three focus groups. Using the International Classification of Functioning, Disability, and Health as a theoretical framework to underpin this study, the authors discuss the key factors, for example, emphasis on the contextual factors, that drive decision making around exercise and physical activity participation in people with MS and explore the clinical implications to health professionals.
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Affiliation(s)
- Andrea Marjorie Stennett
- Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, United Kingdom
- Department of Health Sciences, Brunel University London, London, United Kingdom
- *Correspondence: Andrea Marjorie Stennett
| | | | - Meriel Norris
- Department of Health Sciences, Brunel University London, London, United Kingdom
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Mehrabani G, Aminian S, Norton S, Motl RW, Manns PJ. Preliminary efficacy of the "SitLess with MS" intervention for changing sedentary behaviour, symptoms, and physical performance in multiple sclerosis. Disabil Rehabil 2021; 44:6374-6381. [PMID: 34433359 DOI: 10.1080/09638288.2021.1966520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE People with multiple sclerosis (MS) sit (i.e., are sedentary) more than peers. We examined the preliminary efficacy of an internet-based intervention that focuses on sitting less and moving more for changing sedentary behaviour outcomes, symptoms, QOL, and physical performance in adults with MS. METHODS Persons with mild-to-moderate disability from MS took part in a 15-week pre-post trial. Outcomes including sedentary behaviour, representative symptoms (e.g., fatigue, pain), QOL and physical performance measures (e.g., walking speed) were measured at three time points: pre-post intervention and at follow-up. An unstructured linear mixed-effects model was used to determine change over time per outcome. RESULTS Forty-one persons with MS participated (age 50 ± 10.3 years). There were significant reductions in total sedentary time (d = 0.34) and the number of long (≥30 min) bouts of sedentary time (d = 0.39) post-intervention. All symptoms and physical performance measures were significantly improved following the intervention, with effects sizes greatest for fatigue (d = 0.61) and depression (d = 0.79). Changes were maintained during the 7-week follow-up, except for all sedentary behaviour outcomes and sleep quality. Cognition did not change. CONCLUSIONS This study provides preliminary support for the efficacy of an intervention focused on sitting less and moving more for improving symptoms in adults with MS.IMPLICATIONS FOR REHABILITATIONThis research provides preliminary evidence that an intervention aimed at reducing sedentary behaviour and increasing light intensity activity throughout the day can have an impact.Fatigue, depression and anxiety, symptoms frequently encountered by people with MS, showed the greatest improvement following the intervention.Weekly coaching sessions including discussions about results from activity monitoring provided motivation for participants. TRIAL REGISTRATION The "SitLess with MS" feasibility study was registered at ClinicalTrials.gov Trial Registration Number: NCT03136744. Date of registration was 2 May 2017. Find at https://clinicaltrials.gov/ct2/show/NCT03136744.
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Affiliation(s)
- Golnoush Mehrabani
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Saeideh Aminian
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Sarah Norton
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama, Birmingham, AL, USA
| | - Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Manns PJ, Mehrabani G, Norton S, Aminian S, Motl RW. The SitLess With MS Program: Intervention Feasibility and Change in Sedentary Behavior. Arch Rehabil Res Clin Transl 2021; 2:100083. [PMID: 33543106 PMCID: PMC7853339 DOI: 10.1016/j.arrct.2020.100083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objectives This study reports on the feasibility of the SitLess with MS trial, an intervention targeting sedentary behavior in individuals with multiple sclerosis (MS). Design Single group, pre-post intervention design. Setting Community. Participants Participants (N=41) with mild to moderate disability from MS. Intervention The intervention was 15 weeks, with a 7-week follow-up, and included 2 stages: SitLess and MoveMore. During the SitLess stage, participants were encouraged to break up prolonged sitting bouts over a 7-week period, whereas the MoveMore stage promoted increased steps per day and interrupting sitting over a 7-week period. The intervention was delivered through weekly one-on-one coaching sessions via telerehabilitation and an accompanying newsletter based on social-cognitive theory. Activity was monitored throughout the program using a Fitbit. Main Outcome Measures Process (eg, recruitment) and resource and management (eg, personnel requirements) metrics were assessed, along with efficacy outcomes (eg, effect). Progression criteria were set a priori and were related to safety, fatigue, satisfaction, and attrition. Sedentary behavior, measured using the ActivPal, was reported pre- and postintervention, as well as 7 weeks postintervention. Effect sizes (pre to post, pre to 7 weeks post) were calculated for the sedentary behavior outcomes (eg, time sitting, transitions from sitting to standing, number of long sitting bouts). Experiences with the intervention were explored through an online survey. Results Forty-one participants enrolled, 39 of whom completed the intervention. All participants but 1 were satisfied with the experience. Pre-post intervention effect sizes for change in total sedentary time, number of transitions from sit to stand, and number of long (>30 min) sedentary bouts were 0.34, 0.02, and 0.39 respectively. All a priori progression criteria were met. Conclusions The SitLess with MS program, a novel intervention that emphasized and facilitated sitting less and moving more, was feasible and resulted in small changes in sedentary behavior in individuals with MS.
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Affiliation(s)
- Patricia J Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Golnoush Mehrabani
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Norton
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Saeideh Aminian
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Urbana, AL
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Silveira SL, Huynh T, Kidwell A, Sadeghi-Bahmani D, Motl RW. Behavior Change Techniques in Physical Activity Interventions for Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102:1788-1800. [PMID: 33549545 DOI: 10.1016/j.apmr.2021.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify and summarize the behavior change techniques (BCTs) included in behavior change interventions for promoting physical activity in persons with multiple sclerosis (MS). DATA SOURCES PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Complete, Scopus, and Embase were initially searched in November 2019, and data extraction began in June 2020. STUDY SELECTION The inclusion criteria for studies were: adults older than 18 years with diagnosed MS, English language, clinical trial designs (ie, pre-post or randomized controlled trials), group or individual interventions, and home or community-based settings wherein physical activity was defined as a primary or secondary outcome. Exclusion criteria for studies included protocol manuscripts pending results, case studies, studies focused on populations with multiple chronic diseases, and interventions targeting multiple behaviors. Two researchers completed screening for study selection, and a third researcher served as a referee. Of the initially identified 8681 studies, 54 studies met selection criteria. DATA EXTRACTION Data extraction was completed by 3 researchers. Each article was coded by 2 of the 3 researchers, and a fourth researcher resolved discrepancies. Data extracted from each paper included study title, authors, country, year, sample size, study design, intervention details, physical activity outcomes, and BCTs. DATA SYNTHESIS Thirty-eight unique behavior change interventions were identified, and 53 of the 93 possible BCTs were included across the studies. The mean number of BCTs per study was 15, and studies and effect sizes across studies ranged from 0.04-1.49. CONCLUSIONS This review provides a comprehensive overview of BCTs as the active ingredients in behavior change interventions targeting physical activity in MS. Results from this study provide a compendium for future intervention development for increasing physical activity and improving overall health in MS.
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Affiliation(s)
- Stephanie L Silveira
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL.
| | - Trinh Huynh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Ariel Kidwell
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Dena Sadeghi-Bahmani
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
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Fortune J, Norris M, Stennett A, Kilbride C, Lavelle G, Victor C, De Souza L, Hendrie W, Ryan J. Pedometers, the frustrating motivators: a qualitative investigation of users' experiences of the Yamax SW-200 among people with multiple sclerosis. Disabil Rehabil 2020; 44:436-442. [PMID: 32515233 DOI: 10.1080/09638288.2020.1770344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Self-monitoring may represent a mechanism to enhance physical activity among people with multiple sclerosis. To optimise activity monitoring as a behavioural tool to increase physical activity, user experience must be understood. This study evaluated user experience of the Yamax SW-200 Digi-walker pedometer in a group of people with MS.Methods: Semi-structured interviews were conducted with 15 adults who participated in a 12-week pedometer-supported behavioural change intervention, the iStep-MS trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the Framework Method.Results: An overarching theme Pedometers, the frustrating motivators captures the complex and often contradictory experience of the pedometer. Sub-themes include: Increasing activity awareness, which describes the pedometer's utility in raising activity consciousness; Numeric motivation provides insight into dual motivating and demotivating experiences of using an objective feedback device; (Un) usability focuses on practical concerns encountered in the day-to-day use of the monitor.Conclusion: The Yamax SW-200 Digi-walker raised awareness and enhanced participant motivation to engage in physical activity. Accuracy and usability concerns highlighted warrant consideration in the selection of this pedometer within a population with multiple sclerosis. Trial registration: Changing physical activity behaviour in people with MS: the iStep-MS trial; ISRCTN15343862; https://doi.org/10.1186/ISRCTN15343862Implications for rehabilitationUse of self-monitoring tools such as pedometers can enhance physical activity awareness.Objective, numeric step count feedback is an effective motivational tool for physical activity.Accuracy and usability concerns may limit the value of the Yamax SW-200 Digiwalker for people with MS.Identification of individualised, reliable, usable and acceptable tools is important to ensure engagement with self-monitoring.
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Affiliation(s)
- Jennifer Fortune
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Meriel Norris
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Andrea Stennett
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Cherry Kilbride
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Grace Lavelle
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Christina Victor
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | - Lorraine De Souza
- Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
| | | | - Jennifer Ryan
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,Ageing Studies Theme, Institute of Environment, Health and Societies, Brunel University, London, UK
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