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Alsbury-Nealy K, Scodras S, Colquhoun H, Jaglal SB, Munce S, Salbach NM. Exploring the role of healthcare partners in referrals to a community-based exercise program with a healthcare-community partnership designed for people with balance and mobility limitations. Disabil Rehabil 2024:1-9. [PMID: 39154242 DOI: 10.1080/09638288.2024.2390045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 06/24/2024] [Accepted: 08/04/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To explore how healthcare partners in community-based exercise programs for people with balance and mobility limitations perceive and enact referral in the context of their role. MATERIALS AND METHODS We conducted a descriptive, qualitative study involving semi-structured interviews and reflexive thematic analysis. RESULTS Twelve healthcare partners from the Together In Movement and Exercise (TIMETM) program completed interviews. Seven (58%) participants were clinicians and 5 (42%) held non-clinical roles. The most common professional background of participants was physical therapy (n = 9, 75%). Clinicians made direct referrals while non-clinical participants facilitated referral by promoting the program. The main theme was healthcare partners perceive their role in referrals as secondary to their role as educators and trainers. Subthemes were: (1) healthcare partners fulfill educator and trainer roles when conducting formal training of instructors, educating instructors during program visits, and fielding questions; (2) almost all healthcare partners facilitate referral by sharing program information formally and informally; and (3) healthcare partners in clinical practice make direct referrals depending on the clientele. CONCLUSIONS Healthcare partners perceive their roles as educators and trainers as taking precedence over their role in referrals. Findings can be used to guide selection and training of healthcare partners, design of clinical education programs, and research on competencies.
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Affiliation(s)
- K Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - H Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - S B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
| | - S Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - N M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- The KITE Research Institute, University Health Network, Toronto, Canada
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Uchiyama Y, Takebayashi T, Takahashi K, Amano S, Gosho M, Sakai M, Hashimoto K, Hachisuka K, Domen K. Estimating the minimal clinically important difference of upper extremity outcome measures in chronic stroke patients with moderate to severe impairment: a cross-sectional study. Top Stroke Rehabil 2024; 31:409-417. [PMID: 37742304 DOI: 10.1080/10749357.2023.2259649] [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: 05/18/2023] [Accepted: 09/09/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Approximately 70% of chronic stroke patients experience upper extremity (UE) functional impairments, and UE outcome measures are often used as quality-of-life indicators. OBJECTIVE The purpose of this study was to estimate minimal clinically important difference (MCID) values for UE outcome measures in chronic stroke patients with moderate to severe UE hemiplegia. METHODS This study was a cross-sectional study, conducted as a secondary analysis of data from the ReoGo-J study, a multicenter, prospective, randomized, parallel-group trial of robot-assisted self-training for UE hemiplegia in chronic stroke. The patients were randomized to 1 of 3 treatment groups. Treatment was provided 3 times a week for 10 weeks, and UE outcome measures were evaluated before and after treatment. The anchor-based method was used to estimate MCID values for UE outcome measures, with Stroke Impact Scale (SIS) subscales as anchors. MCID values were estimated by identifying cutoff values in a receiver operating characteristic (ROC) curve. RESULTS Between-group comparisons of UE outcome measures, based on the clinically important difference (CID) values of SIS subscales, revealed significant differences in both the Amount of Use (AOU) and Quality of Movement (QOM) components of the Motor Activity Log (MAL)-14. The estimated MCID values were 0.89 for the AOU component and 0.77 for the QOM component. CONCLUSIONS The estimated MCID values for the MAL-14 not only add information regarding the clinical characteristics of the MAL-14 but also facilitate interpretations of changing scores in chronic stroke patients with moderate to severe UE hemiplegia undergoing rehabilitation therapy. STUDY REGISTRATION https://www.umin.ac.jp/ctr/index.htm (UMIN000022509; 1 July 2016).
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Affiliation(s)
- Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Hyogo, Japan
| | - Takashi Takebayashi
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Satoru Amano
- Department of Occupational Therapy, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Sakai
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | - Koichi Hashimoto
- Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Hyogo, Japan
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Hildebrand MW, Geller D, Proffitt R. Occupational Therapy Practice Guidelines for Adults With Stroke. Am J Occup Ther 2023; 77:7705397010. [PMID: 37862268 DOI: 10.5014/ajot.2023.077501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
IMPORTANCE Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and their caregivers. OBJECTIVE These Practice Guidelines are meant to support occupational therapy practitioners' clinical decision making when working with people after stroke and their caregivers. METHOD Clinical recommendations were reviewed from three systematic review questions on interventions to improve performance and participation in daily activities and occupations and from one question on maintaining the caregiving role for caregivers of people after stroke. RESULTS The systematic reviews included 168 studies, 24 Level 1a, 90 Level 1b, and 54 Level 2b. These studies were used as the basis for the clinical recommendations in these Practice Guidelines and have strong or moderate supporting evidence. CONCLUSIONS AND RECOMMENDATIONS Interventions with strong strength of evidence for improving performance in activities of daily living and functional mobility include mirror therapy, task-oriented training, mental imagery, balance training, self-management strategies, and a multidisciplinary three-stages-of-care rehabilitation program. Constraint-induced therapy has strong strength of evidence for improving performance of instrumental activities of daily living. Moderate strength of evidence supported cognitive-behavioral therapy (CBT) to address balance self-efficacy, long-term group intervention to improve mobility in the community, and a wearable upper extremity sensory device paired with training games in inpatient rehabilitation to improve social participation. Practitioners should incorporate problem-solving therapy in combination with CBT or with education and a family support organizer program. What This Article Adds: These Practice Guidelines provide a summary of strong and moderate evidence for effective interventions for people with stroke and for their caregivers.
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Affiliation(s)
- Mary W Hildebrand
- Mary W. Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA
| | - Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor of Rehabilitation and Regenerative Medicine, Programs in Occupational Therapy, Columbia University, New York, NY
| | - Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia
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Aravind G, Bashir K, Cameron JI, Bayley MT, Teasell RW, Howe JA, Tee A, Jaglal SB, Hunter S, Salbach NM. What matters to program partners when implementing a community-based exercise program for people post-stroke? A theory-based qualitative study and cost analysis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1064206. [PMID: 37645234 PMCID: PMC10461472 DOI: 10.3389/fresc.2023.1064206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
Background Community-based exercise programs integrating a healthcare-community partnership (CBEP-HCP) can facilitate lifelong exercise participation for people post-stroke. Understanding the process of implementation from multiple perspectives can inform strategies to promote program sustainability. Purpose To explore stakeholders' experiences with undertaking first-time implementation of a group, task-oriented CBEP-HCP for people post-stroke and describe associated personnel and travel costs. Methods We conducted a descriptive qualitative study within a pilot randomized controlled trial. In three cities, trained fitness instructors delivered a 12-week CBEP-HCP targeting balance and mobility limitations to people post-stroke at a recreation centre with support from a healthcare partner. Healthcare and recreation managers and personnel at each site participated in semi-structured interviews or focus groups by telephone post-intervention. Interviews and data analysis were guided by the Consolidated Framework of Implementation Research and Theoretical Domains Framework, for managers and program providers, respectively. We estimated personnel and travel costs associated with implementing the program. Results Twenty individuals from three sites (4 recreation and 3 healthcare managers, 7 fitness instructors, 3 healthcare partners, and 3 volunteers) participated. We identified two themes related to the decision to partner and implement the program: (1) Program quality and packaging, and cost-benefit comparisons influenced managers' decisions to partner and implement the CBEP-HCP, and (2) Previous experiences and beliefs about program benefits influenced staff decisions to become instructors. We identified two additional themes related to experiences with training and program delivery: (1) Program staff with previous experience and training faced initial role-based challenges that resolved with program delivery, and (2) Organizational capacity to manage program resource requirements influenced managers' decisions to continue the program. Participants identified recommendations related to partnership formation, staff/volunteer selection, training, and delivery of program activities. Costs (in CAD) for first-time program implementation were: healthcare partner ($680); fitness coordinators and instructors ($3,153); and participant transportation (personal vehicle: $283; public transit: $110). Conclusion During first-time implementation of a CBEP-HCP, healthcare and hospital managers focused on cost, resource requirements, and the added-value of the program, while instructors and healthcare partners focused on their preparedness for the role and their ability to manage individuals with balance and mobility limitations. Trial Registration: ClinicalTrials.gov, NCT03122626. Registered April 17, 2017-Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03122626.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Community Programs and After Stroke, March of Dimes Canada, Toronto, Ontario, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert W. Teasell
- Schulich School of Medicine and Dentistry, Western University, St. Joseph’s Healthcare London—Parkwood Institute, London, Ontario, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, Barrie, Ontario, Canada
| | - Susan B. Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Nancy M. Salbach
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- The KITE Research Institute, University Health Network, Toronto, Ontario, Canada
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Jiancaro T, Bayoumi AM, Ibáñez-Carrasco F, Torres B, McDuff K, Brown DA, Chan Carusone S, Tang A, Loutfy M, Cobbing S, O’Brien KK. Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1176960. [PMID: 37546578 PMCID: PMC10399961 DOI: 10.3389/fresc.2023.1176960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Introduction Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists. Methods We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis. Results Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics. Conclusion Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.
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Affiliation(s)
- T. Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A. M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - B. Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K. McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - D. A. Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - S. Chan Carusone
- McMasterCollaborative Centre for Health and Aging, McMaster University, Hamilton, ON, Canada
| | - A. Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - M. Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - S. Cobbing
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Institute of Education Research, University Health Network, Toronto, ON, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - K. K. O’Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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Turner JR, Chow J, Cheng J, Hassanali F, Sevigny H, Sperduti M, Chan Carusone S, Dagenais M, O'Brien KK. Wireless physical activity monitor use among adults living with HIV in a community-based exercise intervention study: a quantitative, longitudinal, observational study. BMJ Open 2023; 13:e068754. [PMID: 37019491 PMCID: PMC10083752 DOI: 10.1136/bmjopen-2022-068754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Our aim was to examine wireless physical activity monitor (WPAM) use and its associations with contextual factors (age, highest education level, social support and mental health) among adults living with HIV engaged in a community-based exercise (CBE) intervention. DESIGN Quantitative, longitudinal, observational study. SETTING Toronto YMCA, Ontario, Canada. PARTICIPANTS Eighty adults living with HIV who initiated the CBE intervention. INTERVENTION Participants received a WPAM to track physical activity during a 25-week CBE intervention involving thrice-weekly exercise, supervised weekly (phase 1) and a 32-week follow-up involving thrice-weekly exercise with no supervision (phase 2), completed in December 2018. OUTCOME MEASURES Uptake was measured as participants who consented to WPAM use at initation of the intervention. Usage was defined as the proportion of days each participant had greater than 0 steps out of the total number of days in the study. We measured contextual factors using a baseline demographic questionnaire (age, highest education level), and median scores from the bimonthly administered Medical Outcomes Study-Social Support Scale and Patient Health Questionnaire (mental health), where higher scores indicated greater social support and mental health concerns, respectively. We calculated Spearman correlations between WPAM usage and contextual factors. RESULTS Seventy-six of 80 participants (95%) consented to WPAM use. In phase 1, 66% of participants (n=76) and in phase 2, 61% of participants (n=64) used the WPAM at least 1 day. In phase 1, median WPAM usage was 50% (25th, 75th percentile: 0%, 87%; n=76) of days enrolled and in phase 2, 23% (0%, 76%; n=64) of days. Correlation coefficients with WPAM usage ranged from weak for age (ρ=0.26) and mental health scores (ρ=-0.25) to no correlation (highest education level, social support). CONCLUSIONS Most adults living with HIV consented to WPAM use, however, usage declined over time from phase 1 to phase 2. Future implementation of WPAMs should consider factors to promote sustained usage by adults living with HIV. TRIAL REGISTRATION NUMBER NCT02794415.
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Affiliation(s)
- Joshua R Turner
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Judy Chow
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Cheng
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farhanna Hassanali
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hayley Sevigny
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Sperduti
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Soo Chan Carusone
- Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Matthieu Dagenais
- Faculty of Applied Health Sciences, Brock University, Saint Catharines, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Aravind G, Graham ID, Cameron JI, Ploughman M, Salbach NM. Conditions and strategies influencing sustainability of a community-based exercise program incorporating a healthcare-community partnership for people with balance and mobility limitations in Canada: A collective case study of the Together in Movement and Exercise (TIME™) program. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1064266. [PMID: 36923967 PMCID: PMC10009252 DOI: 10.3389/fresc.2023.1064266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/25/2023] [Indexed: 03/02/2023]
Abstract
Background Community-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time. Purpose To identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers. Methods Using a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences. Results Twenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation. Conclusion Sustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Ian D. Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jill I. Cameron
- Department of Occupational Science and Occupational Therapy, Centre for Practice Changing Research, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Michelle Ploughman
- BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Nancy M. Salbach
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
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Wu JM, Chen HS, Chen HH, Cheng BW, Huang CW, Chung MH. Enhancing patient self-management after a first stroke: An application of the wearable devices and the health management platform. Disabil Health J 2023; 16:101392. [PMID: 36333265 DOI: 10.1016/j.dhjo.2022.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-stroke disability restricts a patient's physical activity, affects the patient's quality of life, and leads to higher medical costs. Therefore, it is essential to promote patients' continuous exercise during this period of recovery. OBJECTIVE This study aimed to verify the effectiveness of applying a health management platform combined with wearable devices to enhance stroke patients' self-management of recovery and to allow comparisons with active care intervention management. METHOD This quasi-experimental study aimed at examining those participants who had sustained a stroke for the first time. A 90-day experiment was implemented with the intervention of monitoring and active care from the researchers who also interviewed the selected participants at the end of the study. A total of 26 participants were examined (14 in the experimental group and 12 in the control group). RESULT The participants in the experimental group made significant progress between the pre- and post-tests. Firstly, their six-minute walking distance improved by 89.5 m (p < 0.001). Secondly, their sit-to-stand transfers in 60 s improved 2.85 times (p = 0.017), and their Berg balance test improved by 6.36 points (p = 0.003). Finally, the Partners in Health scale (PIH) scores also improved. According to the data collected in the interviews, the researchers' intervention improved the patients' self-management ability. CONCLUSION The short-term physical performance in the experimental group after the intervention was better than that in the control group. In clinical practice, it is suggested that continuous interaction between medical staff and patients be sustained while applying wearable devices to promote the patient's self-management ability.
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Affiliation(s)
- Jia-Min Wu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Hsin-Shui Chen
- PhD Program for Aging, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung City 406040, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC; School of Medicine, China Medical University, No. 91, Xueshi Rd, North District, Taichung City 404333, Taiwan, ROC.
| | - Hsin-Han Chen
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Chiu-Wen Huang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC
| | - Ming-Hung Chung
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC
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10
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Alatawi SF. A Comparison of Three Common Rehabilitation Interventions Used to Improve Cardiovascular Fitness after Stroke: An Overview of the Literature. BIOMED RESEARCH INTERNATIONAL 2023; 2023:4350851. [PMID: 37082188 PMCID: PMC10113054 DOI: 10.1155/2023/4350851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 04/22/2023]
Abstract
Background One of the most frequent consequences of stroke is a reduction in heart function. After a stroke, one of the main aims of physiotherapy practice is to improve cardiovascular fitness (CVF). This paper is aimed at identifying the best effective intervention of improving the cardiovascular fitness (CVF) after stroke while focusing on body weight-supported treadmill training (BWSTT), over gait training (OGT), and therapeutic exercise. Methods Different electronic databases were searched until July 2022. Controlled randomized trials examining the effects of BWSTT, OGT, and therapeutic exercise to improve CVF on an ambulatory person with stroke, written in English and reporting cardiovascular fitness or at least one of its indicators, such as peak oxygen consumption (VO2), gait speed, gait energy expenditure, and functional independence measure for locomotion (FIM-L), were included. The quality of the methodology was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Results The research yielded 3854 relevant studies, of which 22 met the eligibility criteria. The primary indicators of the CVF, VO2 and energy expenditure, were used to examine the CVF in only three studies, while the rest used other indicators of the CVF. There was a lack of sufficient evidence to establish the superiority of one intervention over another. However, it appears that utilizing BWSTT to improve the CVF after stroke is effective. Conclusion Physiotherapy has the potential to enhance the CVF of stroke patients. However, effective interventions and long-term effects remain debatable.
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Affiliation(s)
- Salem F. Alatawi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Saudi Arabia
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11
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Pérez-Rodríguez M, Gutiérrez-Suárez A, Arias JÁR, Andreu-Caravaca L, Pérez-Tejero J. Effects of Exercise Programs on Functional Capacity and Quality of Life in People With Acquired Brain Injury: A Systematic Review and Meta-Analysis. Phys Ther 2022; 103:pzac153. [PMID: 36336977 DOI: 10.1093/ptj/pzac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 05/14/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aims of this systematic review and meta-analyses were to evaluate the effects of exercise on the functional capacity and quality of life (QoL) of people with acquired brain injury (ABI) and to analyze the influence of training variables. METHODS Five electronic databases (MEDLINE, Cochrane Library, CINAHL, SportDiscus, and Web of Science) were searched until October 2021 for clinical trials or experimental studies examining the effects of exercise on the functional capacity and QoL in adults with ABI and comparing exercise interventions with non-exercise (usual care). RESULTS Thirty-eight studies were evaluated. A total sample of 2219 people with ABI (exercise, n = 1572; control, n = 647) were included in the quantitative analysis. A greater improvement was observed in walking endurance (z score = 2.84), gait speed (z score = 2.01), QoL physical subscale (z score = 3.42), and QoL mental subscale (z score = 3.00) was observed in the experimental group than in the control group. In addition, an improvement was also observed in the experimental group in the "Timed Up and Go" Test scores and balance without differences from the control group. Significant interactions were also observed between the rehabilitation phases, type, frequency and volume of training, and overall effects. CONCLUSION The results suggest that exercise improves functional capacity and QoL regardless of model training, highlighting the effectiveness of long-term exercise that includes short sessions with components such as strength, balance, and aerobic exercise. IMPACT The results shown in this systematic review with meta-analysis will allow physical therapists to better understand the effects of training on people with ABI.
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Affiliation(s)
- Marta Pérez-Rodríguez
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Andrea Gutiérrez-Suárez
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Universidad de A Coruña, A Coruña, Spain
| | - Jacobo Ángel Rubio Arias
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
- Health Research Centre, Department of Education, Faculty of Educational Sciences, University of Almería, Almería, Spain
| | - Luis Andreu-Caravaca
- International Chair of Sports Medicine, Faculty of Medicine, UCAM, Universidad Catolica de Murcia, Murcia, Spain
- Facultad de Deporte, UCAM, Universidad Católica de Murcia, Murcia, Spain
| | - Javier Pérez-Tejero
- Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
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12
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Alsbury-Nealy K, Scodras S, Munce S, Colquhoun H, Jaglal SB, Salbach NM. Models for establishing linkages between healthcare and community: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3904-e3920. [PMID: 36317803 DOI: 10.1111/hsc.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/22/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
Community-based programmes can support healthcare systems by delivering preventive services and health promotion. This study aimed to determine the nature, range, and extent of theoretical models that guide the development of linkages between healthcare settings and community programmes. A scoping review guided by the Joanna Briggs Institute methodology and the PRISMA-ScR was conducted. Four databases (MEDLINE, EMBASE, CINAHL and PsycINFO) were searched on August 8, 2020. Two reviewers independently screened articles by title and abstract and divided the remaining articles for full-text screening. Articles that described the development of a theoretical model to guide the establishment of linkages between healthcare settings and community programmes, were peer-reviewed, and in English, were included. Articles that solely applied linkage models were excluded. One reviewer extracted data on study and model characteristics (e.g. model purpose, model components and relationships between components from the included articles). Categorical data were summarised using frequencies and percentages. Conventional content analysis was used for variables that had lengthier descriptions and variable terminology. The search identified 8926 records. Six articles describing six unique models were included in the review. Of the four models that described intended users, three (75%) identified primary care. Healthcare settings were identified in all models, with three (50%) focusing on primary care. Models used two or more linkage strategies: (1) agreeing on sharing resources, staff, and information, (2) coordinating services and referral processes, (3) planning and evaluation, (4) leadership, policies, and funding, (5) boundary spanning and (6) brokering. All models used the linkage strategy of agreeing on sharing resources, staff, and information. Findings provide important considerations for healthcare and community programme providers planning linkages. Future research should investigate the role and characteristics of community programmes in linkages, and linkages with other types of healthcare settings.
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Affiliation(s)
- Kyla Alsbury-Nealy
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Scodras
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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13
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Proffitt R, Boone A, Hunter EG, Schaffer O, Strickland M, Wood L, Wolf TJ. Interventions to Improve Social Participation, Work, and Leisure Among Adults Poststroke: A Systematic Review. Am J Occup Ther 2022; 76:23881. [PMID: 35943845 DOI: 10.5014/ajot.2022.049305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address. OBJECTIVE To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke. DATA SOURCES MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. STUDY SELECTION AND DATA COLLECTION Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. CONCLUSIONS AND RELEVANCE Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Anna Boone
- Anna Boone, PhD, MOT, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Elizabeth G Hunter
- Elizabeth G. Hunter, PhD, OTR/L, is Assistant Professor, Graduate Center for Gerontology, University of Kentucky, Lexington
| | - Olivia Schaffer
- Olivia Schaffer, BHS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Madison Strickland
- Madison Strickland, BHS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Lea Wood
- Lea Wood, BS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Timothy J Wolf
- Timothy J. Wolf, PhD, OTD, MSCI, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, University of Missouri, Columbia
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14
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Itoh S, Ogino T, Kawakami K, Miyake K, Iyoda H, Imaizumi H, Nakajima M, Kitahara H, Sonoda S. Gait evaluation in stroke hemiplegic patients using short physical performance battery. J Stroke Cerebrovasc Dis 2022; 31:106704. [PMID: 36037677 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Falls can occur daily in stroke patients and appropriate independence assessments for fall prevention are required. Although previous studies evaluated the short physical performance battery (SPPB) in stroke patients, the relationship between SPPB and fall prediction and walking independence remains unclear. Therefore, we aimed to verify whether SPPB is a predictor of walking independence. MATERIALS AND METHODS The present study included 105 hemiplegic stroke patients who were admitted to the rehabilitation ward and gave consent to participate. Cross-sectional physical function and functional independence measure cognitive (FIM-C) evaluation were conducted in hemiplegic stroke patients. Logistic regression analysis using the increasing variable method (likelihood ratio) was performed to extract factors for walking independence. Cutoff values were calculated for the extracted items using the receiver operating-characteristic (ROC) curve. RESULTS Among 86 participants included in the final analysis, 36 were independent walkers and 50 were dependent walkers. In the logistic regression analysis, SPPB and FIM-C were extracted as factors for walking independence. The cutoff value was 7 [area under the curve (AUC), 0.94; sensitivity, 0.83; specificity, 0.73)] for SPPB and 32 (AUC, 0.83; sensitivity, 0.69; specificity, 0.57) for FIM-C in ROC analysis CONCLUSIONS: SPPB and FIM-C were extracted as factors for walking independence. Although SPPB alone cannot determine independent walking, combined assessment of SPPB with cognitive function may enable more accurate determination of walking independence.
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Affiliation(s)
- Shota Itoh
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan.
| | - Takahiro Ogino
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Kenji Kawakami
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Kosuke Miyake
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Honoka Iyoda
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Hidenori Imaizumi
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Misaki Nakajima
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Haruna Kitahara
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan; Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University Tsu, Mie, Japan
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15
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Proffitt R, Boone A, Schaffer O, Strickland M, Wood L, Wolf TJ. Impairment-Based Interventions to Improve Social Participation Outcomes for Adults Poststroke (January 1, 2009-December 31, 2019). Am J Occup Ther 2022; 76:23321. [PMID: 35789360 DOI: 10.5014/ajot.2022.050090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on stroke and impairment-based interventions to improve social participation for adults poststroke.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Anna Boone
- Anna Boone, PhD, MOT, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Olivia Schaffer
- Olivia Schaffer, BHS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Madison Strickland
- Madison Strickland, BHS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Lea Wood
- Lea Wood, BS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Timothy J Wolf
- Timothy J. Wolf, PhD, OTD, MSCI, OTR/L, FAOTA, is Associate Dean for Research and Department Chair, Department of Occupational Therapy, University of Missouri, Columbia
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16
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Sheill G, Hennessy M, Neill LO, Reynolds S, Towns J, Gill M, Guinan E. Exercise and chronic health conditions in the community: A qualitative Study of Patients and Fitness instructors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1025-1034. [PMID: 33704862 DOI: 10.1111/hsc.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 11/14/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
Further information is needed on how community exercise facilities can be effectively utilised to engage people living with chronic health conditions in exercise. The aim of this study was to identify the exercise barriers, facilitators and needs of patients with chronic disease in the community; and to provide recommendations to support the transition from hospital-based to community-based exercise. Using a qualitative approach, four focus groups were conducted with patients who had completed hospital-based exercise programmes (n = 11) and fitness instructors (n = 10). Data were audio recorded, member checked and transcribed verbatim for thematic analysis using NVivo. The side effects of chronic health conditions, the gym environment and a need for support when joining/attending a gym were perceived as barriers to exercising in the community. In contrast, the presence of supportive staff was perceived by patients as a facilitator to engaging in exercise in the community. A total of three themes emerged from participants views on exercise needs in the community; the referral and induction process in community gyms, fitness instructor training and experience and creating a supportive exercise environment. Themes informed eight key recommendations to support patients to exercise in the community, including supportive gym referral and induction processes for patients with chronic conditions, increased professional training for fitness instructors in the area of chronic disease management and exercise prescription, and exercise support at regular intervals for those with chronic conditions attending community gyms. This study found that there is potential for community gyms to play a key role in promoting health among people with chronic conditions. However, more can be done to foster an inclusive atmosphere in this space. Patients living with chronic conditions need information and advice on exercising in their communities. Community gyms require further support to ensure that facilities meet the exercise needs of people with chronic conditions.
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Affiliation(s)
- Gráinne Sheill
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
| | - Martina Hennessy
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Linda O Neill
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Jeremy Towns
- Wellcome HRB Clinical Research Facility, St James's Hospital, Dublin, Ireland
| | - Michael Gill
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry & Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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17
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Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud 2022; 8:88. [PMID: 35459194 PMCID: PMC9028093 DOI: 10.1186/s40814-022-01037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke. Methods We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function. Results Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1–2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health. Conclusion The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial. Trial registration ClinicalTrials.gov, NCT03122626. Registered April 21, 2017 — retrospectively registered.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada
| | - Robert W Teasell
- Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Joanne Zee
- Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
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18
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Lau B, Sharma I, Manku S, Kobylianski J, Wong LY, Ibáñez-Carrasco F, Carusone SC, O'Brien KK. Considerations for developing and implementing an online community-based exercise intervention with adults living with HIV: a qualitative study. BMJ Open 2022; 12:e059294. [PMID: 35428647 PMCID: PMC9014056 DOI: 10.1136/bmjopen-2021-059294] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To describe the need for, and utility of, online community-based exercise (CBE) interventions with adults living with HIV and identify factors to consider in developing and implementing an online CBE intervention with adults living with HIV. DESIGN Qualitative descriptive study using web-based semistructured interviews. PARTICIPANTS We recruited adults representing at least one of five stakeholder groups with experience in CBE and/or HIV: (1) adults living with HIV, (2) rehabilitation professionals, (3) fitness personnel, (4) educators with eLearning experience and (5) representatives from HIV community-based organisations (CBOs). DATA COLLECTION We asked participants to describe their experiences with online CBE, need and utility for online CBE and factors in developing and implementing online CBE interventions. We analysed data using a group-based thematic analytical approach. RESULTS Among the 11 participants, most had experience working with adults living with HIV (73%) or with telehealth/rehabilitation/coaching in HIV or other chronic conditions (91%). Participants (eight women; two men; one non-binary; median age: 49 years), identified the need and utility for online CBE interventions to increase accessibility and continuity of care with adults living with HIV. Six factors to consider in developing and implementing online CBE included: (1) person-specific considerations (episodic nature of HIV, stigma, HIV disclosure), (2) accessibility of programme (physical space to exercise, reliable internet, access to devices, digital literacy), (3) programme delivery and technology (live vs prerecorded online classes, multiple online platforms for delivery, physical activity tracking, troubleshooting technology), (4) attributes of programme personnel (working with CBOs, relatable instructors, diverse staff), (5) programme content and design (tailored exercise classes, educational sessions) and (6) building community (shared experiences, peer support, social opportunities). CONCLUSIONS There is a need and utility for online CBE in the context of HIV. Considerations for development and implementation span individual, structural and technical, and community dimensions. Results can inform the future development and implementation of online CBE with adults living with HIV and other chronic episodic conditions.
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Affiliation(s)
- Bernice Lau
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isha Sharma
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sukhbir Manku
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kobylianski
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lin Yin Wong
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
- Casey House, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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Mayer JF, Sandberg CW, Mozeiko J, Madden EB, Murray LL. Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:785312. [PMID: 36188840 PMCID: PMC9397720 DOI: 10.3389/fresc.2021.785312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.
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Affiliation(s)
- Jamie F. Mayer
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL, United States
- *Correspondence: Jamie F. Mayer
| | - Chaleece W. Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, CT, United States
| | - Elizabeth B. Madden
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Laura L. Murray
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
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20
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Choi KB, Cho SH. Are Physical Therapeutics Important for Stroke Patients to Recover Their Cardiorespiratory Fitness? Medicina (B Aires) 2021; 57:medicina57111182. [PMID: 34833400 PMCID: PMC8619703 DOI: 10.3390/medicina57111182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Aspects of improving cardiorespiratory fitness should be factored into therapeutics for recovery of movement in stroke patients. This study aimed to recommend optimized cardiorespiratory fitness therapeutics that can be prescribed to stroke patients based on a literature review and an expert-modified Delphi technique. Materials and Methods: we searched PubMed, Embase, CINAHL, and Cochrane databases and yielded 13,498 articles published from 2010 to 2019 to support the development of drafts. After applying the exclusion criteria, 29 documents were analyzed (drafts, 17 articles; modified Delphi techniques, 12 articles). This literature was reviewed in combination with the results of a modified Delphi technique presented to experts in the physical medicine and rehabilitation field. Analysis of the literature and survey results was conducted at the participating university hospital. Results: the results of this analysis were as follows: first, 12 intervention items derived through a researcher’s literature review and a Delphi technique questionnaire were constructed using the Likert scale; second, we asked the experts to create two modified Delphi techniques by reconstructing the items after statistical analysis for each order comprising five categories, and 15 items were finally confirmed. Conclusions: the recommendations in this study may lead to the development of a standard decision-making process for physiotherapists to improve their patients’ cardiorespiratory fitness. Moreover, the study results can help prescribers document patient care to reduce prescription errors and improve safety. In the future, multidisciplinary studies could potentially provide better therapeutics alternatives for cardiorespiratory fitness.
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Affiliation(s)
- Ki-Bok Choi
- Team of Rehabilitation Treatment, Chosun University Hospital, 365, Pilmun-daero, Dong-gu, Gwangju 61453, Korea;
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, 23 Cheomdan Jungang-ro, Gwangsan-gu, Gwangju 62271, Korea
- Correspondence: ; Tel.: +82-10-3060-1330
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21
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Solomon P, Chan Carusone S, Davis AM, Aubry R, O'Brien KK. A Qualitative Study of Fitness Coaches' Experiences in Community Based Exercise with People Living with HIV. J Int Assoc Provid AIDS Care 2021; 20:23259582211046762. [PMID: 34668422 PMCID: PMC8532256 DOI: 10.1177/23259582211046762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fitness coaches need to understand the needs of people living with HIV engaged in community-based exercise (CBE) to be competent in developing exercises programs with this population. Our aim was to understand coaches’ experiences engaging in a CBE intervention with PLWH in an urban center in Canada. As part of a broader study, coaches supervised weekly hour-long individualized exercise sessions with PLWH over a six-month period. Using qualitative longitudinal methods, we interviewed coaches up to three times over six months. Transcribed interviews were analyzed cross-sectionally and longitudinally. Seven coaches participated in 15 interviews. Developing confidence, improving health and experiencing a sense of community were viewed as key benefits to PLWH by the coaches. Challenges included accommodating the episodic nature of HIV and ensuring they felt prepared to work with PLWH. Understanding the experiences of coaches engaged in CBE can assist in tailoring exercise programs to meet the needs of PLWH.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, Canada.,Department of Health Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Aileen M Davis
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada.,7938Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,7938Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Rachel Aubry
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kelly K O'Brien
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada.,7938Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,7938Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
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22
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Solomon P, Carusone SC, Davis AM, Aubry R, O'Brien KK. Experiences of People Living With HIV in Community Based Exercise: A Qualitative Longitudinal Study. J Int Assoc Provid AIDS Care 2021; 20:2325958221995344. [PMID: 33611978 PMCID: PMC7903824 DOI: 10.1177/2325958221995344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This qualitative longitudinal study examined the experiences of people living with HIV who engaged in a structured community-based exercise (CBE) program under the supervision of a fitness coach. Twenty people living with HIV were invited to participate in 3 semi-structured interviews over time. Participants engaged in exercise 3 times per week for 6 months with one weekly session supervised by a coach. Interviews were audio-recorded, transcribed verbatim and underwent longitudinal thematic analyses. Eleven participants were included representing a total of 30 interviews. Participants valued their experiences with the CBE program, particularly the motivation provided by the coach. Concerns about the environment, stigma and episodic health challenges affected their overall experience. To foster independence and promote self-management, health providers should consider these findings when encouraging CBE with people living with HIV. It is important to understand their goals and offer a variety of exercise options to meet their needs.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, 3710McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- 169566Casey House, Toronto, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada
| | - Aileen M Davis
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Rachel Aubry
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada
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24
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Homayouni TS, Ruth A, Abbott-Tate Z, Burger H, Rahim S, Murray C, Wannamaker R, Chan Carusone S, O'Brien KK. Experiences engaging in a group-based physiotherapist-led exercise programme for adults living with HIV and complex multimorbidity: a qualitative study. BMJ Open 2021; 11:e045158. [PMID: 34315789 PMCID: PMC8317082 DOI: 10.1136/bmjopen-2020-045158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore experiences participating in a group-based physiotherapist (PT)-led exercise programme among people living with HIV and complex multimorbidity. DESIGN We conducted a qualitative descriptive study using semistructured interviews. RECRUITMENT AND SETTING We recruited community-dwelling adults living with HIV who engaged in a group-based PT-led exercise programme within an HIV-specialty hospital in Toronto, Canada. Interviews were conducted in-person or by telephone. PARTICIPANTS Eight men and two women with a median age of 58 years and median of six concurrent conditions in addition to HIV, who had attended ≥2 classes of the exercise programme. DATA COLLECTION Interviews explored (1) reasons for engaging in the programme, (2) experiences with exercise prior to and after joining the programme, (3) facilitators and barriers to engagement and (4) perceived impacts of participation on health and disability. We administered the HIV Disability Questionnaire and a demographic questionnaire. RESULTS Experiences spanned perspectives prior to, during and after the PT-led exercise programme. Reasons for engaging in the programme included addressing health-related goals. Participants identified accessibility, the flexible schedule, interprofessional staff and the HIV-specific, group-based environment as facilitators to engagement. Participants reported high attendance rates, but identified episodic health challenges and overcrowded space as potential barriers to attending exercise classes. Perceived impacts on health and disability outcomes included improved physical, mental, social and cognitive health, and activities of daily living. Anticipated or actual experiences transitioning to independent exercise included facilitators (supportive programme leaders) and barriers (challenges motivatiing self to exercise alone). CONCLUSIONS Features of the programme that facilitated engagement included the interprofessional, group-based environment that offered tailored exercise in an HIV-specific facility, whereby participants perceived benefits in domains of health and disability. However, challenges transitioning to independent exercise remain. Group-based PT-led exercise programmes may facilitate engagement in exercise among adults living with HIV and complex multimorbidity.
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Affiliation(s)
- Tina S Homayouni
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ruth
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Abbott-Tate
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Burger
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaera Rahim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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25
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Bohannon RW. Characterization of muscle strength using the strength domain of the stroke impact scale: An integrative review. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE: Muscle weakness is among the most common and obvious impairments in older adults and individuals with neurologic disorders. Although impairments in muscle strength are typically characterized using performance measures, the impairments have also been described using patient or observer-report. The objective of this review was to summarize literature describing use of a patient-report instrument, the Strength Domain (SD) of the Stroke Impact Scale (SIS), to grade strength impairments. METHODS: Peer-reviewed literature reporting SD scores for the SIS was identified using computerized searches of the CINAHL, PubMed, and Scopus databases followed by hand searches. Potentially relevant articles were then mined for data on the participants tested, the SIS version used, scores documented, and clinimetric properties reported. RESULTS: Sixty-five articles were judged appropriate based on inclusion and exclusion criteria. The articles involved more than 7000 residents of 22 countries. All articles focused on individuals with stroke (usually chronic), although one also included community-dwelling adults without stroke. The SIS version used was frequently unreported, but 3.0 was version most often specified. For articles reporting SD scale scores the mean ranged from 19.7 to 85.5. Construct (known groups, convergent, and discriminant) validity of the SD was supported by the literature as was its internal consistency and test-retest reliability. Responsiveness of the SD was evinced by numerous studies showing increases in SD scores with time or accompanying effective interventions. However, only one study indicated responsiveness using an anchor-based statistic. CONCLUSIONS: The SD of the SIS is a well-established and mostly clinimetrically sound patient-report measure of paretic limb strength among individuals with stroke. Its use with individuals with weakness accompanying aging or diagnoses other than stroke remains to be substantiated.
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Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series. Brain Sci 2020; 10:brainsci10080555. [PMID: 32824012 PMCID: PMC7464211 DOI: 10.3390/brainsci10080555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023] Open
Abstract
(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1-2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen's D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.
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Handlery R, Fulk G, Pellegrini C, Stewart JC, Monroe C, Fritz S. Stepping After Stroke: Walking Characteristics in People With Chronic Stroke Differ on the Basis of Walking Speed, Walking Endurance, and Daily Steps. Phys Ther 2020; 100:807-817. [PMID: 31995194 DOI: 10.1093/ptj/pzaa020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/01/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND What contributes to free-living walking after stroke is poorly understood. Studying the characteristics of walking may provide further details that guide interventions. OBJECTIVE The objectives of this study were to examine how the walking characteristics of bouts per day, median steps per bout, maximum steps per bout, and time spent walking differ in individuals with various walking speeds, walking endurance, and daily steps and to identify cutoffs for differentiating ambulators who were active versus inactive. DESIGN This study involved a cross-sectional analysis of data from the Locomotor Experience Applied Post-Stroke trial. METHODS Participants were categorized by walking speed, walking endurance (via the 6-minute walk test), and daily steps (via 2 consecutive days of objective activity monitoring). Differences in walking characteristics were assessed. Linear regression determined which characteristics predicted daily step counts. Receiver operating characteristic curves and areas under the curve were used to determine which variable was most accurate in classifying individuals who were active (≥5500 daily steps). RESULTS This study included 252 participants with chronic stroke. Regardless of categorization by walking speed, walking endurance, or daily steps, household ambulators had significantly fewer bouts per day, steps per bout, and maximum steps per bout and spent less time walking compared with community ambulators. The areas under the curve for maximum steps per bout and bouts per day were 0.91 (95% confidence interval = 0.88 to 0.95) and 0.83 (95% confidence interval = 0.78 to 0.88), respectively, with cutoffs of 648 steps and 53 bouts being used to differentiate active and inactive ambulation. LIMITATIONS Activity monitoring occurred for only 2 days. CONCLUSIONS Walking characteristics differed based on walking speed, walking endurance, and daily steps. Differences in daily steps between household and community ambulators were largely due to shorter and fewer walking bouts. Assessing and targeting walking bouts may prove useful for increasing stepping after stroke.
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Affiliation(s)
- Reed Handlery
- Department of Exercise Science, University of South Carolina, 1300 Wheat St, Columbia, SC 29208 (USA)
| | - George Fulk
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York
| | | | | | - Courtney Monroe
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Stacy Fritz
- Department of Exercise Science, University of South Carolina
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Effects of a Multicomponent Exercise Program in Older Adults with Non-Small-Cell Lung Cancer during Adjuvant/Palliative Treatment: An Intervention Study. J Clin Med 2020; 9:jcm9030862. [PMID: 32245169 PMCID: PMC7141539 DOI: 10.3390/jcm9030862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical intervention studies support the efficacy and safety of exercise programs as a treatment modality for non-small-cell lung cancer (NSCLC) during adjuvant/palliative treatment, but the effectiveness of real-world oncogeriatric services is yet to be established. We aimed to examine the effects of a 10-week structured and individualized multicomponent exercise program on physical/cognitive functioning and mental wellness in elderly patients with NSCLC under adjuvant therapy or palliative treatment. A non-randomized, opportunistic control, longitudinal-design trial was conducted on 26 patients with NSCLC stage I-IV. Of 34 eligible participants, 21 were allocated into two groups: (i) control group (n = 7) received usual medical care; and (ii) intervention group (n =19) received multicomponent program sessions, including endurance, strength, balance, coordination and stretching exercises. Tests included the Short Physical Performance Battery (SPPB), 5-m habitual Gait Velocity Test (GVT), Timed Up & Go Test (TUG), 6-Min Walk Test (6MWT), independence of activities in daily living (IADL), muscular performance, cognitive function, and quality of life, which were measured at baseline and after 10 weeks of the program. Results revealed a significant group×time interaction for SPPB (p = 0.004), 5-m GVT (p = 0.036), TUG (p = 0.007), and muscular performance (chest and leg power; p < 0.001). Similarly, significant changes were observed between groups for cognitive functioning (p = 0.021) and quality of life for EUROQoL 5D (p = 0.006). Our findings confirm that a multicomponent exercise program improves measures of physical/cognitive functioning and quality of life in the elderly with NSCLC under adjuvant therapy or palliative treatment. This is an interesting and important study that adds to our current body of knowledge on the safety of exercise interventions, especially in the elderly with solid tumors.
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Continual Long-Term Physiotherapy After Stroke: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-70. [PMID: 32194882 PMCID: PMC7077936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Stroke is a serious health issue in which an interruption in blood flow to any part of the brain damages brain cells. About 83% of people survive with substantial morbidity after their first stroke. We conducted a health technology assessment of continual long-term physiotherapy for people with a diagnosis of stroke, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding continual long-term physiotherapy for people with a diagnosis of stroke, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We also performed a systematic literature search of the economic evidence. We did not conduct a primary economic evaluation because there was insufficient clinical evidence. We also analyzed the budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario. To contextualize the potential value of continual long-term physiotherapy after stroke, we spoke with people who had been diagnosed with stroke, as well as their caregivers. RESULTS We did not find any published studies that met the specific clinical inclusion criteria. We did not identify any studies that compared the cost-effectiveness of continual long-term versus short-term physiotherapy after stroke. The budget impact of publicly funding continual long-term physiotherapy after stroke in Ontario over the next 5 years ranges from $445,000 in year 1 at an uptake rate of 8% to $888,000 in year 5 at an uptake rate of 16%. The people who had been diagnosed with stroke with whom we spoke reported that they had benefitted from continual long-term physiotherapy. CONCLUSIONS We did not identify studies that addressed the specific research question. Based on the clinical evidence review, we are unable to determine the benefits of continual long-term compared with short-term physiotherapy after stroke. The cost-effectiveness of continual long-term physiotherapy after stroke in Ontario is unknown. We estimate that publicly funding continual long-term physiotherapy after stroke in Ontario would result in additional costs of between $445,000 and $888,000 annually over the next 5 years. Patients and caregivers who we spoke with felt that patients who have experienced a stroke should be able to continue with physiotherapy.
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Loughney L, Cahill R, O’Malley K, McCaffrey N, Furlong B. Compliance, adherence and effectiveness of a community-based pre-operative exercise programme: a pilot study. Perioper Med (Lond) 2019; 8:17. [PMID: 31827773 PMCID: PMC6886214 DOI: 10.1186/s13741-019-0126-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pre-operative exercise training improves HR components of fitness and HRQoL following hospital-based programmes. OBJECTIVE To assess compliance and adherence of a pragmatic community-based preoperative exercise programme and its effect on health-related (HR) components of fitness and health-related quality of life (HRQoL). METHODS Thirty-two surgical oncological participants (15 prostate cancer and 17 colorectal cancer (CRC)) were recruited and assessed to measure HR components of fitness (strength and functional exercise capacity) and HRQoL. An exercise programme was prescribed in the time available prior to surgery with repeat assessments pre-operatively. RESULTS Twenty-four participants (14 prostate cancer and 10 CRC) completed the full study (75% compliance). Exercise training was delivered over a median interquartile range (IQR) of 4 (3-4) weeks and 2 (1-3) weeks for the prostate cancer and CRC participants, with > 80% adherence. From baseline to post-exercise intervention, there were significant improvements in lower body strength in the prostate cancer group (p = 0.045), the CRC group (p = 0.001), and in both groups overall (p = .001). Additionally, there were statistically significant improvements in HRQoL: global health status for CRC group (p = 0.025) and for both groups overall (p = 0.023); emotional health subscale for the prostate cancer group (p = 0.048) and for both groups overall (p = 0.027); nausea/vomiting/pain subscale for the CRC group (p = 0.005) and for both groups overall (p = 0.030); and for health scale status for the prostate cancer group (p = 0.019) and for both groups overall (p = 0.006). CONCLUSION This community-based pre-operative exercise programme showed acceptable compliance and adherence rates, and significantly increased upper and lower body strength and HRQoL. Pre-operative exercise training should be considered as early as possible in the surgical-oncology pathway and respected within patient scheduling.
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Affiliation(s)
- Lisa Loughney
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
| | - Ronan Cahill
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
- Section of Surgery and Surgical Science, University College Dublin, Dublin, Ireland
| | - Kiaran O’Malley
- Department of Urology Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Noel McCaffrey
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
| | - Brona Furlong
- MedEx Wellness, School of Health and Human Performance, Dublin City University, Glasnevin, Dublin, Ireland
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MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, Macko R, Nguyen E, Prior P, Suskin N, Tang A, Thornton M, Unsworth K. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Phys Ther 2019; 100:149-156. [PMID: 31596465 PMCID: PMC8204880 DOI: 10.1093/ptj/pzz153] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 09/18/2018] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
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Affiliation(s)
| | - Sandra A Billinger
- Physical Therapy and Rehab Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Dromerick
- Department of Neurology, Pasquerilla Healthcare Center, Washington, DC
| | | | - Charlene Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Macko
- Department Neurology, VA Maryland Health Care System, Baltimore, Maryland
| | | | - Peter Prior
- Department of Psychology, St. Joseph's Health Care London, London, Ontario, Canada
| | - Neville Suskin
- Department of Cardiology, Western University, London, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Unsworth
- Department of Cardiac Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada
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Scholten EWM, Hillebregt CF, Ketelaar M, Visser-Meily JMA, Post MWM. Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review. Disabil Rehabil 2019; 43:746-772. [PMID: 31366259 DOI: 10.1080/09638288.2019.1641847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE (1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies. MATERIALS AND METHODS Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies. RESULTS (1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire. CONCLUSIONS There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection. PROSPERO REGISTRATION CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.
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Affiliation(s)
- Eline W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chantal F Hillebregt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMCU Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Behavioural and social sciences to enhance the efficacy of health promotion interventions: redesigning the role of professionals and people. ACTA ACUST UNITED AC 2019. [DOI: 10.1017/bpp.2019.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractEvidence on the effectiveness of health promotion interventions is mixed, especially in terms of the magnitude of their impact and long-term adherence. This paper proposes a comprehensive approach informed by behavioural economics of developing behavioural change programmes, which is designed to educate, activate, engage and empower people by taking into consideration individual and social mechanisms. Three applied pilots and their results are presented in order to illustrate the approach using cognitive and social mechanisms to lead to better health outcomes, individually and community-wide. More research is needed to explore levers and barriers for the systemic adoption of this framework in implementing health promotion interventions.
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Stuart M, Dromerick AW, Macko R, Benvenuti F, Beamer B, Sorkin J, Chard S, Weinrich M. Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States. Neurorehabil Neural Repair 2019; 33:668-680. [PMID: 31296113 DOI: 10.1177/1545968319862562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility. Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States. Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors. Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion. Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.
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Affiliation(s)
- Mary Stuart
- 1 University of Maryland Baltimore County, Baltimore, MD, USA.,2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 VA Health System, Washington, DC, USA.,6 Medstar National Rehabilitation Hospital, Washington, DC, USA
| | - Richard Macko
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Brock Beamer
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Sarah Chard
- 1 University of Maryland Baltimore County, Baltimore, MD, USA
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Lee JM, Moon HH, Lee SK, Lee HL, Park YJ. The effects of a community-based walking program on walking ability and fall-related self-efficacy of chronic stroke patients. J Exerc Rehabil 2019; 15:20-25. [PMID: 30899731 PMCID: PMC6416491 DOI: 10.12965/jer.1836502.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/31/2018] [Indexed: 11/22/2022] Open
Abstract
The objectives of this study were to evaluate the effects of community-based walking training (CWT) on the walking ability and fall-related self-efficacy of chronic stroke patients and compare the effects of CWT to the conventional walking programs in stroke patients. Previous studies focused on walking speed, walking endurance, and balance. However, no studies have examined the changes in fall-related self-efficacy after CWT. In order to achieve purpose of this study, 45 chronic stroke patients, who were hospitalized at National Rehabilitation Center, were randomly divided into the CWT group (CWTG, n=15), the treadmill walking training group (TWTG, n=15), and the control group (CG, n=15). The treatment was conducted 3 times per week (30 min each) for 4 weeks. CWT was carried out by gradually increasing the difficulty level in various environments outside the hospital room. The results revealed that the CWTG was more effective in enhancing the walking ability and fall-related self-efficacy than the TWTG and the CG. These findings demonstrated that the CWTG increased the walking ability and fall-related self-efficacy of chronic stroke patients. Therefore, we suggest that adding CWT to standard rehabilitation might be an effective method for improving walking ability and fall-related self-efficacy in chronic stroke patients.
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Affiliation(s)
- Jun-Min Lee
- National Rehabilitation Center, Seoul, Korea
| | - Hyung-Hoon Moon
- Department of Sports Medicine, College of Health Sciences, CHA University, Pocheon, Korea
| | - Sung-Ki Lee
- Department of Sports Medicine, College of Health Sciences, CHA University, Pocheon, Korea
| | - Hae-Lim Lee
- School of Global Sport Studies, Korea University, Sejong, Korea
| | - Yun-Jin Park
- School of Global Sport Studies, Korea University, Sejong, Korea
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Skrastins O, Tsotsos S, Aqeel H, Qiang A, Renton J, Howe JA, Tee A, Moller J, Salbach NM. Fitness coordinators' and fitness instructors' perspectives on implementing a task-oriented community exercise program within a healthcare-recreation partnership for people with balance and mobility limitations: a qualitative study. Disabil Rehabil 2019; 42:2687-2695. [PMID: 30739500 DOI: 10.1080/09638288.2019.1570357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Healthcare organizations are partnering with recreation organizations to support the delivery of community-based exercise programs for people with balance and mobility limitations. The value and impact of support strategies provided by healthcare organizations, however, have not been examined.Objective: Study objectives were to explore fitness coordinators' and fitness instructors' experiences with implementing a task-oriented community-based exercise program for people with balance and mobility limitations within the context of a healthcare-recreation partnership.Methods: A qualitative descriptive study was conducted. Fitness coordinators and instructors involved with delivering a licensed, group, task-oriented community-based exercise program for people with balance and mobility limitations supported by a healthcare-recreation partnership were interviewed by telephone. Interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed.Results: Eight fitness coordinators and 8 fitness instructors from 14 recreation centres were interviewed. Findings showed that healthcare-recreation partnerships help to optimize exercise program quality and safety through multiple strategies. Fitness coordinators and instructors still face challenges with program implementation at start-up and over time. Recommendations to address these challenges included increased training content related to adjusting exercises to accommodate participant abilities, 1-2 visits from a healthcare professional each program after initial program implementation, suggestions to increase exercise variety, and ongoing education.Conclusions: Findings clarify the role of healthcare organizations, ongoing challenges, and directions for improvement in this program delivery model.Implications for rehabilitationCommunity recreation centres can provide task-oriented exercise programs to help people with balance and mobility limitations safely engage in regular exerciseHealthcare organizations should provide specific supports to help increase the safety and quality of task-oriented exercise programs in recreation centresSupports include providing clear exercise guidelines, and a healthcare professional who trains fitness instructors, visits the program, answers questions between visits, promotes collaboration and information exchange between recreation centres, and provides ongoing education.
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Affiliation(s)
- Olivia Skrastins
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Tsotsos
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hammad Aqeel
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anthony Qiang
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica Renton
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Alda Tee
- Royal Victoria Regional Health Centre, Ontario Central East Stroke Network, Barrie, ON, Canada
| | - Jason Moller
- British Columbia Fraser Health Authority, Chilliwack, BC, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
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Merali S, Cameron JI, Barclay R, Salbach NM. Experiences of people with stroke and multiple sclerosis and caregivers of a community exercise programme involving a healthcare-recreation partnership. Disabil Rehabil 2019; 42:1220-1226. [PMID: 30668173 DOI: 10.1080/09638288.2018.1519042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions of people with neurological conditions and their caregivers of the health benefits of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership.Materials and methods: Descriptive qualitative study. Individuals with balance and mobility deficits from a neurological condition, and their caregivers, were interviewed on completion of a group, task-oriented community-based exercise programme incorporating a healthcare-recreation partnership. A thematic analysis was performed.Results: Nine people post-stroke, and four people with multiple sclerosis (MS) (n = 13; 54% male) and 12 caregivers (83% spouses) participated. Two themes emerged. One theme indicated that the programme fosters diverse, interrelated health benefits. Participants described experiences of improved balance, strength, and confidence that translated to improved everyday functioning and social participation. Benefits were reinforced through repeated programme registration. A second theme indicated that caregivers experience challenges and diverse benefits related to the programme. Transportation and programme cost were primary challenges. Caregivers described emotional health benefits from assisting participants during classes and observing participants improvement over time.Conclusions: Group, task-oriented community-based exercise programmes incorporating a healthcare-recreation partnership may yield health benefits for exercise participants and caregivers. Results can guide programme evaluation, the nature and timing of education about such programmes, and efforts to address cost and transportation issues.Implications of rehabilitationStroke and multiple sclerosis commonly cause balance and mobility limitations that can result in physical inactivity and further deterioration in health.Group, task-oriented community-based exercise programmes in which rehabilitation professionals train and support fitness instructors to deliver the exercise programme in community centres may increase access to exercise participation for this group.Study results suggest by improving balance and mobility, these programmes help increase independence in activities of daily living and social and leisure participation, while improving caregiver mental health and decreasing the need for caregiver assistance.Rehabilitation professionals can use findings to inform patient education, and support programme implementation and referral.
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Affiliation(s)
- Saira Merali
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Ruth Barclay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Interdisciplinary Approaches to Facilitate Return to Driving and Return to Work in Mild Stroke: A Position Paper. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Engel-Yeger B, Tse T, Josman N, Baum C, Carey LM. Scoping Review: The Trajectory of Recovery of Participation Outcomes following Stroke. Behav Neurol 2018; 2018:5472018. [PMID: 30271506 PMCID: PMC6151208 DOI: 10.1155/2018/5472018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Participation is a central concept in health and well-being and healthcare, yet operationalizing this concept has been difficult. Its definition, uses in healthcare, and impacts on recovery require ongoing research. Our review question goes like this: from the longitudinal evidence investigating participation among stroke survivors, what are the patterns of participation recovery in stroke survivors over time, and what interventions are used to improve participation? To fully understand these questions, we also ask, how is participation defined in the stroke literature, and what are the measures of participation used in the stroke literature? A systematic scoping review was undertaken using the search terms "stroke," "longitudinal," "participation," and "outcome" in seven databases. Articles included were published until April 2017, written in English, and had at least two longitudinal assessments of participation. Fifty-nine articles met the inclusion criteria. The International Classification of Functioning, Disability and Health was the most frequent definition of participation used (34%). There were 22 different measures of participation. Eight of ten studies demonstrated significant improvements in participation up to 12 months poststroke. Efficacy of interventions and their impact on participation varied. The various definitions, measures, and intervention efficacies of participation highlight the need for further research worldwide into achieving meaningful participation and quality of life among stroke survivors. Future practice should include participation as a main outcome measure.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Leeanne M. Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Bui KD, Johnson MJ. Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke. J Neuroeng Rehabil 2018; 15:75. [PMID: 30107849 PMCID: PMC6092818 DOI: 10.1186/s12984-018-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.
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Affiliation(s)
- Kevin D. Bui
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
| | - Michelle J. Johnson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Salbach NM, Howe JA, Baldry D, Merali S, Munce SEP. Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation. BMC Res Notes 2018; 11:214. [PMID: 29609662 PMCID: PMC5879753 DOI: 10.1186/s13104-018-3313-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To increase access to safe and appropriate exercise for people with balance and mobility limitations, community organizations have partnered with healthcare providers to deliver an evidence-based, task-oriented group exercise program in community centers in Canada. We aimed to understand challenges and solutions to implementing this program model to inform plans for expansion. RESULTS At a 1-day meeting, 53 stakeholders (healthcare/recreation personnel, program participants/caregivers, researchers) identified challenges to program implementation that were captured by seven themes: Resources to deliver the exercise class (e.g., difficulty finding instructors with the skills to work with people with mobility limitations); Program marketing (e.g., to foster healthcare referrals); Transportation (e.g., particularly from rural areas); Program access (e.g., program full); Maintaining program integrity; Sustaining partnerships (i.e., with healthcare partners); and Funding (e.g., to deliver program or register). Stakeholders prioritized solutions to form an action plan. A survey of individuals supervising 28 programs revealed that people with stroke, acquired brain injury, multiple sclerosis, and Parkinson's disease register at 95-100% of centers. The most prevalent issues with program fidelity across centers were not requiring a minimum level of walking ability (32%), class sizes exceeding 12 (21%), and instructor-to-participant ratios exceeding 1:4 (19%). Findings provide considerations for program expansion.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Diem Baldry
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Saira Merali
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sarah E P Munce
- University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
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Condon M, Guidon M. A survey of exercise professionals' barriers and facilitators to working with stroke survivors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:250-258. [PMID: 29143386 DOI: 10.1111/hsc.12517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs' opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs' barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs' barriers, facilitators and skills along with access to suitable equipment.
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Affiliation(s)
- Marie Condon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Guidon
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
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43
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Effects of walking trainings on walking function among stroke survivors: a systematic review. Int J Rehabil Res 2018; 41:1-13. [DOI: 10.1097/mrr.0000000000000250] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Richardson J, Tang A, Guyatt G, Thabane L, Xie F, Sahlas D, Hart R, Fleck R, Hladysh G, Macrae L. FIT for FUNCTION: study protocol for a randomized controlled trial. Trials 2018; 19:39. [PMID: 29335013 PMCID: PMC5769391 DOI: 10.1186/s13063-017-2416-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/15/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The current state of evidence suggests that community-based exercise programs are beneficial in improving impairment, function, and health status, and are greatly needed for persons with stroke. However, limitations of these studies include risk of bias, feasibility, and cost issues. METHODS/DESIGN This single-blinded, randomized controlled trial (RCT) of 216 participants with stroke will compare the effectiveness of a 12-week YMCA community-based wellness program (FIT for FUNCTION) specifically designed for community-dwelling persons with stroke to persons who receive a standard YMCA membership. The primary outcome will be community reintegration using the Reintegration to Normal Living Index at 12 and 24 weeks. Secondary outcomes include measurement of physical activity level using the Rapid Assessment of Physical Activity and accelerometry; balance using the Berg Balance Scale; lower extremity function using the Short Physical Performance Battery; exercise capacity using the 6-min walk test; grip strength and isometric knee extension strength using hand held dynamometry; and health-related quality of life using the European Quality of Life 5-Dimension Questionnaire. We are also assessing cardiovascular health and lipids; glucose and inflammatory markers will be collected following 12-h fast for total cholesterol, insulin, glucose, and glycated hemoglobin. Self-efficacy for physical activity will be assessed with a single question and self-efficacy for managing chronic disease will be assessed using the Stanford 6-item Scale. The Patient Activation Measure will be used to assess the patient's level of knowledge, skill, and confidence for self-management. Healthcare utilization and costs will be evaluated. Group, time, and group × time interaction effects will be estimated using generalized linear models for continuous variables, including relevant baseline variables as covariates in the analysis that differ appreciably between groups at baseline. Cost data will be treated as non-parametric and analyzed using a Mann-Whitney U test. DISCUSSION This is a RCT with broad study eligibility criteria intended to recruit a wide spectrum of individuals living in the community with stroke. If positive benefits are demonstrated, results will provide strong research evidence to support the implementation of structured, community-based exercise and education/self-management programs for a broad range of people living in the community with stroke. TRIAL REGISTRATION ClinicalTrials.gov, NCT02703805 . Registered on 14 October 2014.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Centre for Evaluation of Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact and Department of Medicine, McMaster University, Hamilton, ON Canada
- Programs for Assessment of Technology in Health Research Institute, St. Joseph’s Healthcare Hamilton, Hamilton, ON Canada
| | - Demetrios Sahlas
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | - Robert Hart
- Department of Medicine, McMaster University, Hamilton, ON Canada
- Population Health Research Institute, Hamilton, ON Canada
| | - Rebecca Fleck
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
| | | | - Louise Macrae
- Central South Regional Stroke Centre, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON Canada
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Short Physical Performance Battery for cardiovascular disease inpatients: implications for critical factors and sarcopenia. Sci Rep 2017; 7:17425. [PMID: 29234165 PMCID: PMC5727140 DOI: 10.1038/s41598-017-17814-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/01/2017] [Indexed: 12/25/2022] Open
Abstract
We examined the relationship between Short Physical Performance Battery (SPPB) and clinical and laboratory factors and the effect of sarcopenia and sarcopenic obesity (SO) on clinical and laboratory factors for cardiovascular disease (CVD) inpatients. CVD male (n = 318) and female (n = 172) inpatients were recruited. A stepwise multiple-regression analysis was performed to predict total SPPB scores and assess clinical and laboratory factors (physical characteristics, functional and morphological assessments, etc.). Each test outcome were compared among sarcopenia, SO and non-sarcopenic groups. To predict total SPPB scores, the predicted handgrip, Controlling Nutritional Status score, % body fat, anterior mid-thigh muscle thickness, standing height and systolic blood pressure were calculated for males and anterior mid-thigh MTH, BMI, knee extension and fat mass were calculated for females. There were no differences in blood pressure, total SPPB scores and functional assessments between sarcopenia and SO groups for CVD male and female inpatients. In conclusion, the physical performance of CVD inpatients can be predicted by nutritional, functional, clinical and anthropometric variables, regardless the gender and the presence of sarcopenia. Furthermore, the presence of sarcopenia has a negative effect on the clinical and laboratory factors, but there is a difference in impact between sarcopenia and SO regardless the gender.
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46
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Yasuda T, Fukumura K, Nakajima T. Short physical performance battery for middle-aged and older adult cardiovascular disease patients: implication for strength tests and lower extremity morphological evaluation. J Phys Ther Sci 2017; 29:748-753. [PMID: 28533623 PMCID: PMC5430286 DOI: 10.1589/jpts.29.748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/18/2017] [Indexed: 12/22/2022] Open
Abstract
[Purpose] To examine if the SPPB is higher with healthy subjects than outpatients, which
was higher than inpatients and if the SPPB can be validated assessment tool for strength
tests and lower extremity morphological evaluation in cardiovascular disease patients.
[Subjects and Methods] Twenty-four middle aged and older adults with cardiovascular
disease were recruited from inpatient and outpatient facilities and assigned to separate
experimental groups. Twelve age-matched healthy volunteers were assigned to a control
group. SPPB test was used to assess balance and functional motilities. The test outcomes
were compared with level of care (inpatient vs. outpatient), physical characteristics,
strength and lower extremity morphology. [Results] Total SPPB scores, strength tests (knee
extensor muscle strength), and lower extremity morphological evaluation (muscle thickness
of anterior and posterior mid-thigh and posterior lower-leg) were greater in healthy
subjects and outpatients groups compared with inpatients. To predict total Short Physical
Performance Battery scores, the predicted knee extension and anterior mid-thigh muscle
thickness were calculated. [Conclusion] The SPPB is an effective tool as the strength
tests and lower extremity morphological evaluation for middle-aged and older adult
cardiovascular disease patients. Notably, high knee extensor muscle strength and
quadriceps femoris muscle thickness are positively associated with high SPPB scores.
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Affiliation(s)
- Tomohiro Yasuda
- Graduate School of Medicine, University of Tokyo, Japan.,School of Nursing, Seirei Christopher University, Japan.,Faculty of Medicine, Toho University, Japan
| | - Kazuya Fukumura
- Graduate School of Medicine, University of Tokyo, Japan.,Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Japan
| | - Toshiaki Nakajima
- Graduate School of Medicine, University of Tokyo, Japan.,Heart Center, Dokkyo Medical University Hospital, Japan
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47
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Montgomery CA, Henning KJ, Kantarzhi SR, Kideckel TB, Yang CFM, O'Brien KK. Experiences participating in a community-based exercise programme from the perspective of people living with HIV: a qualitative study. BMJ Open 2017; 7:e015861. [PMID: 28377397 PMCID: PMC5387963 DOI: 10.1136/bmjopen-2017-015861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Our aim was to explore the experiences of engaging in a community-based exercise programme (CBEP) from the perspective of people living with HIV (PLWH). DESIGN We conducted a descriptive qualitative study using semistructured interviews. SETTING We recruited adults living with HIV who participated in a 16-week CBEP in Toronto, Canada. PARTICIPANTS 11 participants, the majority men (64%), with a median age of 52 years, and living with a median of 5 concurrent health conditions in addition to HIV participated in the study. OUTCOME MEASURES We asked participants about their overall experiences: strengths, limitations and perceived benefits of the CBEP; factors influencing participation and current level of exercise after completion of the CBEP. We administered a self-reported demographic questionnaire followed by the Rapid Assessment of Physical Activity (RAPA) questionnaire. We analysed interview data using thematic analysis. RESULTS We developed a framework that describes the experiences before, during and after the CBEP; and the perceived impact of the CBEP on health, which influenced the intent to, engagement in and sustainability of exercise among PLWH. Participants described the positive impact of the CBEP on their physical, mental and social health. Interviews were completed at a median of 6 months after the CBEP, when 9 participants reported ongoing engagement in exercise, but to a lesser extent than during the CBEP. Intrinsic and extrinsic factors facilitated or hindered engagement in exercise throughout all phases of the CBEP. The episodic nature of HIV and multimorbidity influenced engagement in exercise and posed challenges to re-engagement after periods of inactivity. CONCLUSIONS CBEPs provide an opportunity to enhance physical activity, perceived health outcomes and knowledge about exercise for PLWH. Community-based exercise is a strategy that may be used by health providers to promote engagement in sustained physical activity for PLWH.
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Affiliation(s)
| | - Katherine J Henning
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah R Kantarzhi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tamar B Kideckel
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl F M Yang
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
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48
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Li A, McCabe T, Silverstein E, Dragan S, Salbach NM, Zobeiry M, Beldick S, Godi C, O'Brien KK. Community-Based Exercise in the Context of HIV: Factors to Consider when Developing and Implementing Community-Based Exercise Programs for People Living with HIV. J Int Assoc Provid AIDS Care 2017; 16:267-275. [PMID: 28074681 DOI: 10.1177/2325957416686836] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify factors to consider for developing and implementing a community-based exercise (CBE) program for people living with HIV (PLWH). METHODS We conducted a qualitative descriptive study using semi-structured interviews with PLWH, rehabilitation professionals, and recreation providers from Canada and the United Kingdom. We asked participants to describe their experience with exercise, facilitators, and barriers to accessing and participating in exercise, and factors to consider in developing a CBE program for PLWH. Interviews were analyzed using content analytical techniques. RESULTS We developed a Framework of CBE in the Context of HIV that describes (1) exercise experiences of PLWH (nature of exercise, motivators for initiating or sustaining exercise, perceived benefits, and barriers and facilitators to exercise) and (2) 11 factors to consider in developing and implementing a CBE program for PLWH. CONCLUSION Recommendations for the development and implementation of an accessible and feasible CBE program may enhance exercise participation among PLWH.
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Affiliation(s)
- Anna Li
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,2 Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Taylor McCabe
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Erin Silverstein
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Dragan
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,3 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Chris Godi
- 5 Toronto People With AIDS Foundation, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,3 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,6 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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49
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Merali S, Cameron JI, Barclay R, Salbach NM. Characterising community exercise programmes delivered by fitness instructors for people with neurological conditions: a scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:e101-e116. [PMID: 26445890 DOI: 10.1111/hsc.12282] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 06/05/2023]
Abstract
A scoping review was conducted to characterise evaluations of community-based exercise programmes (CBEPs) delivered by fitness instructors to people with neurological conditions. Literature published from 1946 to April 2014 in MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and the grey literature were searched. Search terms included community, programme, exercise, adult, brain disease and spinal cord disease. Two reviewers independently screened titles and abstracts for inclusion. One author reviewed full-text articles to evaluate eligibility. Studies were included if the study objective was to evaluate an exercise programme, the programme was community-based and delivered by fitness instructors, exercise participants were ≥18 years of age and had a neurological condition, and a full-text article was available and written in English. After reviewing 1785 titles and abstracts, 18 (1.01%) articles describing 15 studies were included in the review. One author completed data abstraction from the included studies. A second reviewer independently verified the extracted data for accuracy. Exercise programmes most commonly included people with stroke (47%) and Parkinson's disease (40%), incorporated a stand-alone (80%), multi-component (20%), group (67%), individual (20%) and combined format (13%), strength training (40%) and functional/task-oriented training (40%), reported a minimum walking requirement (67%), and involved a healthcare professional (HCP) with various roles (53%), including training (27%), advising and supporting (33%). The most commonly examined participant outcomes were health-related quality of life (60%) and functional balance (47%). More research is needed to develop CBEPs targeting individuals with low ambulatory function and multiple neurological conditions, to develop recommendations for the involvement of HCPs in CBEPs and document their involvement, and to evaluate system-level outcomes such as cost, healthcare utilisation and impact on caregivers. The findings support a number of considerations to guide future research into CBEPs delivered by fitness instructors for individuals with neurological conditions.
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Affiliation(s)
- Saira Merali
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Barclay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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50
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O'Brien KK, Bayoumi AM, Solomon P, Tang A, Murzin K, Chan Carusone S, Zobeiry M, Nayar A, Davis AM. Evaluating a community-based exercise intervention with adults living with HIV: protocol for an interrupted time series study. BMJ Open 2016; 6:e013618. [PMID: 27798038 PMCID: PMC5073553 DOI: 10.1136/bmjopen-2016-013618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). METHODS AND ANALYSIS We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0-8 months), participants will be monitored bimonthly. In the intervention phase (8-14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14-22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of presentations and publications in open access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02794415; Pre-results.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kate Murzin
- Realize (formally known as the Canadian Working Group on HIV and Rehabilitation (CWGHR)), Toronto, Ontario, Canada
| | | | - Mehdi Zobeiry
- Toronto Central Grosvenor Street YMCA, Toronto, Ontario, Canada
| | - Ayesha Nayar
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Health Care and Outcomes, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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