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Petrusevski C, MacDermid JC, Wilson MG, Richardson J. Framing Physical Literacy for Adults Through a Rehabilitation Lens: An Expert Consensus Study. J Aging Phys Act 2024; 32:488-495. [PMID: 38417423 DOI: 10.1123/japa.2023-0095] [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: 04/03/2023] [Revised: 11/29/2023] [Accepted: 01/13/2024] [Indexed: 03/01/2024]
Abstract
Research indicates a positive relationship between physical literacy and healthy aging; however, there is no consensus on the components required to become a physically literate adult. The objective of this study was to understand how physical literacy for adults with chronic conditions is characterized from the perspective of healthcare professionals. Physiotherapy leaders and physical literacy researchers within North America were invited to an online consensus panel and presented with questions related to physical literacy and rehabilitation. A nominal group technique was used for idea generation, clarification, and ranking. Confidence and safety with movements, motivation and commitment to physical activity, the ability to self-monitor changes in function, and understanding the benefits of physical activity were key components when defining physical literacy. There is a need to reconceptualize physical literacy to include the rehabilitation needs of adults living with chronic conditions, and to design programs that promote physical literacy to enhance function and mobility.
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Affiliation(s)
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
| | - Michael G Wilson
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
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Maseko L, Adams F, Myezwa H. Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district. BMC Health Serv Res 2024; 24:501. [PMID: 38649859 PMCID: PMC11035128 DOI: 10.1186/s12913-024-10965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Primary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals. METHODS A retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies. RESULTS The findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30-49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use. CONCLUSION This study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.
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Affiliation(s)
- Lebogang Maseko
- Occupational Therapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.
| | - Fasloen Adams
- Department of Health and Rehabilitation Sciences, Division of Occupational Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hellen Myezwa
- Physiotherapy Department, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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Re-braiding the Strands of Life through Community Rehabilitation, Home Care, and Informal Support: A Longitudinal Collective Case Study. Can J Aging 2023; 42:80-91. [PMID: 35815762 DOI: 10.1017/s0714980822000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Limited research exists on the experiences of older adults participating in community rehabilitation. Our longitudinal, collective case study explored older adults' experiences while they engaged in community rehabilitation and home care services, as well as family caregivers' concurrent experiences. Drawing on interpretive description, we inductively analysed interview data gathered at three points over 3-6 months from six family dyads. Questions focused on activities of daily living, instrumental activities of daily living and other meaningful activities affected by changes in the older adult's health. From our thematic analysis, three themes emerged: (a) Centring community rehabilitation and home care services around the older adult and family; (b) Understanding the intricate interface of formal and informal supports; and (c) Supporting the meaningful aspects of life. Our findings suggest a metaphor of re-braiding, a reconfiguration of activities that requires increased integration of formal and informal supports within home care and community rehabilitation.
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Abstract
AIM To examine and describe the current evidence about occupational therapy services in primary care. BACKGROUND Interprofessional primary care teams have been introduced to support the changing demographics and provide more comprehensive and coordinated care. Occupational therapists have the opportunity to play an important role in this expanding area of practice. To do so, occupational therapists must develop roles built on evidence and a clear understanding of the care delivery context. METHODS A scoping review was conducted based on the scientific and grey literature. Studies that described or examined the occupational therapy role with clients (individuals, groups, communities, populations) of all ages, conditions or occupational issues in a primary care context and that presented or referred to an occupational therapist working in a primary care setting were included. Studies were excluded if they were not in English or French. The Canadian Model of Occupational Performance and Engagement was used to chart the data. FINDINGS 129 articles were identified, with 62 non-research and 67 research-focussed articles. A total of 268 assessments and 868 interventions were identified. The top interventions offered by occupational therapists were referring to/advocating for/coordinating/linking to and navigating community services (n = 36 articles), chronic disease management (n = 34 articles)/self-management education (n = 28 articles), health promotion (n = 30 articles) and falls prevention (n = 27 articles). The predominant focus in the literature is on adult and older adult populations.
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A Comprehensive Assessment of The Eight Vital Signs. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.
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Smith-Turchyn J, McCowan ME, O'Loughlin E, Fong AJ, McDonough MH, Santa Mina D, Arbour-Nicitopoulos KP, Trinh L, Jones JM, Bender JL, Culos-Reed SN, Tomasone JR, Vani MF, Sabiston CM. Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial. BMC Sports Sci Med Rehabil 2021; 13:128. [PMID: 34649590 PMCID: PMC8515152 DOI: 10.1186/s13102-021-00341-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Peer-based exercise interventions that cultivate new opportunities for support with a fellow cancer survivor may result in increased exercise volume. It is not clear whether adding qualified exercise professional (QEP) support to peer-based interventions improves health outcomes. Therefore, the purpose of this study is to determine whether breast cancer survivor (BCS) dyads who receive 10 weekly sessions of virtually delivered QEP support have improved outcomes compared to BCS dyads who do not receive QEP support. METHODS Participants Adult BCS with medical clearance for exercise, who have an internet-connected device, and currently engage in < 150 min of moderate-intensity exercise per week. Intervention BCS will be matched using evidence-based criteria. The intervention group will receive dyadic exercise information sessions and a program tailored by a QEP for 10 weeks (intervention period) and have access to the QEP for an additional 4 weeks (tapering period). The control will not receive any QEP support. Outcomes The primary outcome is post-intervention self-reported exercise volume. Secondary outcomes include device-assessed exercise volume (i.e., Fitbit), social support, and health-related quality of life. Randomization 108 participants, matched in dyads, will be randomized 1:1 to the MatchQEP or Match groups using a web-based scheme. Statistical analysis Outcomes will be measured at baseline, post-intervention, post-tapering, and at 12 weeks post-intervention follow-up. DISCUSSION The findings from this RCT will determine if matched BCS dyads who receive 10 weeks of virtually delivered QEP support have higher levels of self-report and device-measured exercise, social support, and health related quality of life compared to matched dyads without QEP-delivered exercise guidance. To our knowledge this will be the first study to assess the combined effect of peer- and QEP support on exercise volume. Project findings will inform and optimize intervention methods aimed to increase exercise among BCS through accessible exercise supports. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov (study identifier: NCT04771975, protocol Version Number: 2, date: July 22, 2021).
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Affiliation(s)
- Jenna Smith-Turchyn
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.
| | - Michelle E McCowan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Erin O'Loughlin
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Angela J Fong
- Department of Kinesiology and Health, Rutgers University, New Brunswick, USA
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | | | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Jennifer M Jones
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jackie L Bender
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Madison F Vani
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Catherine M Sabiston
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada.
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey A, Lovell-Smith C, Gallanders J, Cooney JK, Williams N. 'Function First': how to promote physical activity and physical function in people with long-term conditions managed in primary care? A study combining realist and co-design methods. BMJ Open 2021; 11:e046751. [PMID: 34315792 PMCID: PMC8317101 DOI: 10.1136/bmjopen-2020-046751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory. DESIGN Realist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation. RESULTS A taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions. ABRIDGED REALIST PROGRAMME THEORY Routinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy. CO-DESIGN The programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change. CONCLUSIONS Previous physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | | | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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Napoleone JM, Boudreau RM, Lange-Maia BS, El Khoudary SR, Ylitalo KR, Kriska AM, Karvonen-Gutierrez CA, Strotmeyer ES. Metabolic Syndrome Trajectories and Objective Physical Performance in Mid-to-Early Late Life: The Study of Women's Health Across the Nation (SWAN). J Gerontol A Biol Sci Med Sci 2021; 77:e39-e47. [PMID: 34216218 PMCID: PMC8824556 DOI: 10.1093/gerona/glab188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Little is known about how adverse, midlife metabolic profiles affect future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multiethnic women. METHODS MetS status from 1996 to 2011 (8 visits) and objective physical performance in 2015/2016 (Short Physical Performance Battery [SPPB; 0-12], 40-foot walk [meter/second], 4-meter gait speed [meter/second], chair stands [seconds], stair climb [seconds]) were assessed in the Study of Women's Health Across the Nation (SWAN; n = 1722; age 65.4 ± 2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1 = low-MetS (28.7%), 2 = mid-MetS (30.9%), and ≥3 = high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes. RESULTS High-MetS versus none had higher body mass index, pain, financial strain, and lower physical activity and self-reported health (p < .0001). Compared with White, African American and Hispanic women were more likely to be in the high-MetS groups and had worse physical functioning along with Chinese women (SPPB, chair stand, stair climb, and gait speed-not Hispanic). After adjustments, high-MetS versus none demonstrated significantly worse 40-ft walk (β: -0.08; 95% CI: -0.13, -0.03), gait speed (β: -0.09; 95% CI: -0.15, -0.02), SPPB (β: -0.79; 95% CI: -1.15, -0.44), and chair stands (β: 0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. CONCLUSIONS Midlife MetS groups were related to poor physical performance in early old age multiethnic women. Midlife management of metabolic function may improve physical performance later in life.
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Affiliation(s)
- Jenna M Napoleone
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
- Address correspondence to: Jenna M. Napoleone, PhD, MPH, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA. E-mail:
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Brittney S Lange-Maia
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | - Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Andrea M Kriska
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
| | | | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA
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Ylitalo KR, Karvonen-Gutierrez CA, Sternfeld B, Pettee Gabriel K. Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women. J Aging Health 2021; 33:409-417. [PMID: 33517822 DOI: 10.1177/0898264320988405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: Physical activity (PA) may slow aging-related declines in physical functioning (PF), but the relationship of PA and falls is not well understood. This study examined the association of PA and PF with falls. Methods: The Study of Women's Health Across the Nation participants (n = 1597; age: 65.1 years ± 2.7) reported PF and PA in 2012-2013 and falls in 2016-2017. Four phenotypes were identified: high PA-high PF, high PA-low PF, low PA-high PF, and low PA-low PF. Results: One-third (29.3%) reported ≥1 fall. Women with low PA-low PF (RR = 1.32; 95% CI: 1.06, 1.66) and with high PA-low PF (RR = 1.37; 95% CI: 1.07, 1.74) were more likely to fall than high PA-high PF. Over time, women with worsening PF had increased fall risk (RR = 1.43; 95% CI: 1.17, 1.74), but women who increased PA did not. Discussion: Poor PF increases the risk of falls, regardless of PA. However, increasing PA does not necessarily increase fall risk, reinforcing the importance of PA engagement.
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11
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Functional Independence in the Community Dwelling Older People: a Scoping Review. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AbstractAgeing potentially poses a threat to independent functioning of older adults. Although clinicians commonly focus on physical factors limiting Functional Independence (FI), it is likely that personal and environmental interactions also seem important to maintain FI. Herewith, FI exceeds several professional borders and calls for a uniform, multidisciplinary interdisciplinary supported definition of FI. This study aims to provide such a definition of FI in community dwelling older people. A scoping review was performed. Pubmed/Medline, Psychinfo and CINAHL were searched for studies describing aspects of FI. A literature-based definition of FI was discussed by experts (n = 7), resulting in a formulated final definition of FI and insight into contributing factors to FI. A multidisciplinairy focusgroup a stakeholder consultation (n = 15) ensured clinical relevance for daily practice. Data from the focusgroup stakeholder consultation were analyzed by using Atlas.ti (version 8). Based on the literature search, 25 studies were included. FI was finally defined as “Functioning physically safely and independent from another person, within one’s own context”. The contributing factors of FI comprised physical capacity combined with coping, empowerment and health literacy. Moreover, the level of FI is influenced by someone’s own context. This study confirms the relevance of the physical aspect of FI, but additionally stresses the importance of psychological factors. In addition, this study shows that one’s context may affect the level of FI as well. This underlines the importance of a holistic view and calls for multidisciplinary interdisciplinary collaboration in community-dwelling older people.
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Mirza M, Gecht-Silver M, Keating E, Krischer A, Kim H, Kottorp A. Feasibility and Preliminary Efficacy of an Occupational Therapy Intervention for Older Adults With Chronic Conditions in a Primary Care Clinic. Am J Occup Ther 2020; 74:7405205030p1-7405205030p13. [PMID: 32804621 PMCID: PMC7430728 DOI: 10.5014/ajot.2020.039842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Occupational therapy can play a role in primary care management of chronic diseases among older adults. OBJECTIVE To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. DESIGN Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. SETTING Family medicine clinic serving an urban, low-income, working-class community. OUTCOMES AND MEASURES Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. PARTICIPANTS Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. INTERVENTION i-PROACTIF focuses on preserving functional independence, is based on the Person-Environment-Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. RESULTS Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. CONCLUSION AND RELEVANCE Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. WHAT THIS ARTICLE ADDS The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.
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Affiliation(s)
- Mansha Mirza
- Mansha Mirza, PhD, OTR/L, MSHSOR, is Associate Professor, Department of Occupational Therapy, University of Illinois at Chicago;
| | - Maureen Gecht-Silver
- Maureen Gecht-Silver, OTD, MPH, OTR/L, is Assistant Professor, Clinical Family Medicine and Clinical Occupational Therapy, and Associate Director, Medical Student Education, Department of Family Medicine, University of Illinois at Chicago
| | - Emily Keating
- Emily Keating, OTD, OTR/L, is Occupational Therapist, Chicago Public Schools, Chicago
| | - Amy Krischer
- Amy Krischer, OTD, OTR/L, is Occupational Therapist and Independent Early Intervention Contractor, Chicago
| | - Hajwa Kim
- Hajwa Kim, MS, is Associate Director, Biostatistics Core, Center for Clinical and Translational Science, University of Illinois at Chicago
| | - Anders Kottorp
- Anders Kottorp, PhD, OT Reg, is Professor and Dean, Health and Society, University of Malmö, Malmö, Sweden
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13
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Barnes N, Walsh B, Samuel D. Feasibility of Using Strength Measures, Including Peak Inspiratory Flow, for Routine Monitoring in Case Management Patients Aged 65 and Over. Geriatrics (Basel) 2020; 5:E59. [PMID: 32967375 PMCID: PMC7555426 DOI: 10.3390/geriatrics5030059] [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: 08/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
Peak inspiratory flow (PIF) is a portable, relatively new method for measuring respiratory function and indirect muscle strength; the feasibility of its routine clinical measurement is unknown. To investigate the acceptability, reliability and short-term stability of PIF, alongside the established measures of peak expiratory flow (PEF) and grip strength in community dwelling case management patients. Patients were tested in a sitting position, initially on two occasions, one week apart; seven patients having repeated measures taken on a further four occasions over a seven-week period. The best of three attempts for all measures were recorded. Reliability was tested using intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and Bland-Altman analysis. Eight patients aged 69-91 years (mean age 81.5 ± 7.7 years; 5 males) participated. For between-day reliability using the first two time points, one week apart the ICCs (3,1) were 0.97, 0.98 and 0.99 for PIF, PEF and grip strength respectively; using all five time points resulted in ICCs of 0.92, 0.99 and 0.99 respectively. Bland-Altman plots also illustrated a good level of agreement across days. Feedback on the acceptability of the measures was gathered from patients. PIF, PEF and grip strength showed excellent reliability and acceptability. Whilst excellent reliability was observed over the seven-week period, the occurrence of clinically significant symptoms and adverse events in the presence of unchanging PIF, PEF and grip strength, suggests that the measures may not be suitable to identify patients with multiple health conditions entering a period of acute decline.
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Affiliation(s)
| | | | - Dinesh Samuel
- Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK; (N.B.); (B.W.)
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14
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Richardson J. L’activité fonctionnelle, un indicateur central de l’état de santé : le rôle de la physiothérapie. Physiother Can 2020; 72:109-111. [PMID: 32494094 DOI: 10.3138/ptc-72-2-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Julie Richardson
- Institute of Applied Health Sciences, école de réadaptation et département de données probantes et d'incidence sur la santé, université McMaster, Hamilton (Ontario)
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15
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Richardson J. Functional Status as a Central Indicator of Health Status: The Role of Physiotherapy. Physiother Can 2020; 72:107-109. [PMID: 32494093 DOI: 10.3138/ptc-72-2-gee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Julie Richardson
- Institute of Applied Health Sciences, School of Rehabilitation and Department of Health Evidence and Impact, McMaster University, Hamilton, Ont
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16
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Al-Abbad H, Madi S. Perception of tertiary care clients toward the availability of physical therapy service at primary health care centers in Saudi Arabia: a cross-sectional survey. J Phys Ther Sci 2020; 32:323-331. [PMID: 32425349 PMCID: PMC7192735 DOI: 10.1589/jpts.32.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To explore the views of clients referred for physical therapy in a tertiary
care setting regarding the integration of physical therapy service at primary health care
centers. [Participants and Methods] A self-administered questionnaire was distributed to
eligible Saudi clients. The questionnaire consisted of three sections including
demographic information section; closed-ended section with 6 Likert scale items on the
perceptions of potential advantages of physical therapy service at the primary health care
level; and open-ended section on potential disadvantages and barriers of implementing
physical therapy service. The surveys were described and analyzed quantitatively and
qualitatively. [Results] A total of 412 participants were included in the analysis (56.8%
females). Participants’ mean age was 35.7 ± 21.9 years; 67.2% were Riyadh city residents;
and 38.1% had musculoskeletal conditions. Seventy-five percent responded in support for
the availability of physical therapy service at the primary health care level. Demographic
characteristics had no effect on the level of support to the service availability.
[Conclusion] The results of this survey demonstrated high positive support for the
integration of physical therapy service at primary health care centers in Saudi Arabia.
However, challenges and barriers identified by the study results require attention when
physical therapy services are to be established.
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Affiliation(s)
- Hani Al-Abbad
- Department of Physical Therapy, Rehabilitation Hospital, King Fahad Medical City: P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | - Sanaa Madi
- Department of Physical Therapy, Rehabilitation Hospital, King Fahad Medical City: P.O. Box 59046, Riyadh 11525, Saudi Arabia
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Law RJ, Williams L, Langley J, Burton C, Hall B, Hiscock J, Morrison V, Lemmey A, Partridge R, Lovell-Smith C, Gallanders J, Williams N. 'Function First-Be Active, Stay Independent'-promoting physical activity and physical function in people with long-term conditions by primary care: a protocol for a realist synthesis with embedded co-production and co-design. BMJ Open 2020; 10:e035686. [PMID: 32041865 PMCID: PMC7045082 DOI: 10.1136/bmjopen-2019-035686] [Citation(s) in RCA: 5] [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] [Received: 11/11/2019] [Revised: 12/11/2019] [Accepted: 12/18/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION People with long-term conditions typically have reduced physical functioning, are less physically active and therefore become less able to live independently and do the things they enjoy. However, assessment and promotion of physical function and physical activity is not part of routine management in primary care. This project aims to develop evidence-based recommendations about how primary care can best help people to become more physically active in order to maintain and improve their physical function, thus promoting independence. METHODS AND ANALYSIS This study takes a realist synthesis approach, following RAMESES guidance, with embedded co-production and co-design. Stage 1 will develop initial programme theories about physical activity and physical function for people with long-term conditions, based on a review of the scientific and grey literature, and two multisector stakeholder workshops using LEGO® SERIOUS PLAY®. Stage 2 will involve focused literature searching, data extraction and synthesis to provide evidence to support or refute the initial programme theories. Searches for evidence will focus on physical activity interventions involving the assessment of physical function which are relevant to primary care. We will describe 'what works', 'for whom' and 'in what circumstances' and develop conjectured programme theories using context, mechanism and outcome configurations. Stage 3 will test and refine these theories through individual stakeholder interviews. The resulting theory-driven recommendations will feed into Stage 4 which will involve three sequential co-design stakeholder workshops in which practical ideas for service innovation in primary care will be developed. ETHICS AND DISSEMINATION Healthcare and Medical Sciences Academic Ethics Committee (Reference 2018-16308) and NHS Wales Research Ethics Committee 5 approval (References 256 729 and 262726) have been obtained. A knowledge mobilisation event will address issues relevant to wider implementation of the intervention and study findings. Findings will be disseminated through peer-reviewed journal publications, conference presentations and formal and informal reports. PROSPERO REGISTRATION NUMBER CRD42018103027.
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Affiliation(s)
- Rebecca-Jane Law
- North Wales Centre for Primary Care Research, School of Health Sciences, Bangor University, Wrexham, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Joseph Langley
- Lab4Living, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Christopher Burton
- School of Allied Health Professions, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Beth Hall
- Library and Archives Service, Bangor University, Bangor, Gwynedd, UK
| | - Julia Hiscock
- North Wales Centre for Primary Care Research, School of Health Sciences, Bangor University, Wrexham, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, Gwynedd, UK
| | - Andrew Lemmey
- School of Sport, Health and Exercise Science, Bangor University, Bangor, Gwynedd, UK
| | - Rebecca Partridge
- Lab4Living, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | | | | | - Nefyn Williams
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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18
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Pape SB, Muir S. Primary Care Occupational Therapy: How Can We Get There? Remaining Challenges in Patient-Centered Medical Homes. Am J Occup Ther 2019; 73:7305090010p1-7305090010p6. [PMID: 31484018 DOI: 10.5014/ajot.2019.037200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Passage of the Patient Protection and Affordable Care Act in 2010 mandated reform of the United States' existing primary care system. As part of this reform, advanced practice models, including the Patient-Centered Medical Home model, expanded, with the goal of increasing the use of interprofessional teams. Integrating occupational therapy was promoted as an opportunity to enhance the value of care provided in these redesigned primary care practices. However, occupational therapy's presence in primary care is still extremely limited.
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Affiliation(s)
- Sharon B Pape
- Sharon B. Pape, MS, OTR, is Senior Lecturer, Department of Occupational Therapy, School of Health and Human Sciences, Indiana University, Indianapolis;
| | - Sherry Muir
- Sherry Muir, PhD, OTR/L, is Chair and Program Director, Occupational Therapy Program, University of Arkansas for Medical Sciences, Fayetteville
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19
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Putting function first: redesigning the primary care management of long-term conditions. Br J Gen Pract 2018; 68:388-389. [PMID: 30049775 DOI: 10.3399/bjgp18x698249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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20
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The Impact of Osteoarthritis on the Functioning and Health Status of a Low-Income Population. J Clin Rheumatol 2018; 24:57-64. [DOI: 10.1097/rhu.0000000000000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Donnelly C, O'Neill C, Bauer M, Letts L. Canadian Occupational Performance Measure (COPM) in Primary Care: A Profile of Practice. Am J Occup Ther 2018; 71:7106265010p1-7106265010p8. [PMID: 29135432 DOI: 10.5014/ajot.2017.020008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to understand how the Canadian Occupational Performance Measure (COPM) can be used as an outcome measure in primary care and to identify the occupational performance profiles in this setting. METHOD First, the COPM was administered to all eligible clients at two sites. Second, a focus group with participating occupational therapists explored the feasibility of using the COPM in primary care. RESULTS A total of 161 COPMs were initially administered. Self-care goals were identified most frequently (n = 248), followed by productivity (n = 229) and leisure (n = 179) goals (total goals = 656). Mean initial performance and satisfactions scores were 3.2 and 2.8, respectively. The average change (n = 22) scores were 2.1 and 2.6, respectively. CONCLUSION The COPM is an invaluable tool to guide initial assessments and offer an occupation-focused lens. Given the lifespan approach and an emphasis on screening and assessment, the challenge was finding the opportunity for readministration.
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Affiliation(s)
- Catherine Donnelly
- Catherine Donnelly, PhD, OT Reg (Ont.), is Associate Professor, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada;
| | - Colleen O'Neill
- Colleen O'Neill, BSc (OT), OT Reg (Ont.), is Occupational Therapist, McMaster Family Health Team, McMaster University, Hamilton, Ontario, Canada
| | - Martha Bauer
- Martha Bauer, BSc (OT), OT Reg (Ont.), is Occupational Therapist, McMaster Family Health Team, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- Lori Letts, PhD, OT Reg (Ont.), is Associate Dean, Occupational Therapy Program, and Professor, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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22
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Bakhru RN, Davidson JF, Bookstaver RE, Kenes MT, Welborn KG, Morris PE, Clark Files D. Physical function impairment in survivors of critical illness in an ICU Recovery Clinic. J Crit Care 2018; 45:163-169. [PMID: 29494941 DOI: 10.1016/j.jcrc.2018.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The aims were to 1) determine feasibility of measuring physical function in our ICU Recovery Clinic (RC), 2) determine if physical function was associated with 6-month re-hospitalization and 1-year mortality and 3) compare ICU survivors' physical function to other comorbid populations. MATERIALS AND METHODS We established the Wake Forest ICU RC. Patients were seen in clinic 1month following hospital discharge. Testing included the Short Form-36 questionnaire and Short Physical Performance Battery (SPPB). We related these measures to 6month re-hospitalizations and 1year mortality, and compared patients' functional performance with other comorbid populations. RESULTS Thirty-six patients were seen in clinic from July 2014 to June 2015; the median SPPB score was 5 (IQR 5). The median SF-36 physical component summary score was 21.8 (IQR 28.8). Mortality was 14% at 1year. Of those who did not die by 1year, 35% were readmitted to our hospital within 6months of hospital discharge. SPPB scores demonstrated a non-significant trend with both mortality (p=0.06) and readmissions (p=0.09). ICU survivors' SPPB scores were significantly lower than those of other chronically ill populations (p<0.001). CONCLUSIONS Physical function measurement in a recovery clinic is feasible and may inform subsequent morbidity and mortality.
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Affiliation(s)
- Rita N Bakhru
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Critical Illness Injury and Recovery Research Center, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - James F Davidson
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Rebecca E Bookstaver
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Kristin G Welborn
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Peter E Morris
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, 740 S. Limestone, Lexington, KY 40536, USA.
| | - D Clark Files
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Critical Illness Injury and Recovery Research Center, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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23
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Ylitalo KR, Karvonen-Gutierrez C, McClure C, El Khoudary SR, Jackson EA, Sternfeld B, Harlow SD. Is self-reported physical functioning associated with incident cardiometabolic abnormalities or the metabolic syndrome? Diabetes Metab Res Rev 2016; 32:413-20. [PMID: 26518120 PMCID: PMC4838533 DOI: 10.1002/dmrr.2765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/13/2015] [Accepted: 10/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Physical functioning may be an important pre-clinical marker of chronic disease, used as a tool to identify patients at risk for future cardiometabolic abnormalities. This study evaluated if self-reported physical functioning was associated with the development of cardiometabolic abnormalities or their clustering (metabolic syndrome) over time. METHODS Participants (n = 2,254) from the Study of Women's Health Across the Nation who reported physical functioning on the Short Form health survey and had a metabolic syndrome assessment (elevated fasting glucose, blood pressure, triglycerides and waist circumference; reduced HDL cholesterol) in 2000 were included. Discrete survival analysis was used to assess the 10-year risk of developing metabolic syndrome or a syndrome component through 2010. RESULTS At baseline, the prevalence of metabolic syndrome was 22.0%. Women with substantial limitations (OR = 1.60; 95% CI: 1.12, 2.29) in physical functioning were significantly more likely to develop the metabolic syndrome compared with women reporting no limitations. Self-reported physical functioning was significantly associated with incident hypertension and increased waist circumference. CONCLUSIONS Simple screening tools for cardiometabolic risk in clinical settings are needed. Self-reported physical functioning assessments are simple tools that may allow healthcare providers to more accurately predict the course of chronic conditions.
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Affiliation(s)
- Kelly R. Ylitalo
- School of Public Health, University of Michigan
- School of Medicine, University of Michigan
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24
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Donnelly CA, Leclair LL, Wener PF, Hand CL, Letts LJ. Occupational therapy in primary care: Results from a national survey: L'ergothérapie dans les soins primaires : Résultats d'un sondage national. The Canadian Journal of Occupational Therapy 2016; 83:135-142. [PMID: 27074910 DOI: 10.1177/0008417416637186] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. To support integration of occupational therapy in primary care and research in this area, it is critical to document examples of occupational therapy in primary care. PURPOSE. This study describes occupational therapy roles and models of practice used in primary care. METHOD. An electronic survey was sent to occupational therapists across Canada. Participants were identified using purposive and snowball sampling strategies. Descriptive statistics were used to analyze the data. FINDINGS. Respondents ( n = 52) were almost exclusively working on interprofessional teams. Intervention was provided most frequently to individual clients, and services were provided both within the home/community and in the clinic. Occupational therapists offered a range of health promotion and prevention services, predominantly to adults and older adults. A number of supports and barriers to the integration of occupational therapy were identified. IMPLICATIONS. A growing number of occupational therapists are working in primary care providing a broad range of services across the life span.
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26
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The Relationship Between the Physical Functioning of Older Adults and Their Use of a Personal Health Record: A Systematic Review. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ylitalo KR, McEwen LN, Karter AJ, Lee P, Herman WH. Self-reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD. J Diabetes Complications 2013; 27:565-9. [PMID: 23891274 PMCID: PMC4278639 DOI: 10.1016/j.jdiacomp.2013.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 01/22/2023]
Abstract
AIMS To examine the association between physical functioning and mortality in people with type 2 diabetes, and determine if this association differs by race/ethnicity in managed care. METHODS We studied 7894 type 2 diabetic patients in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Physical functioning was assessed with the Short Form Health Survey. The National Death Index was searched for deaths over 10years of follow-up (2000-2009). RESULTS At baseline, mean age was 61.7years, 50% were non-Hispanic White, 22% were Black, and 16% of participants reported good physical functioning. Over 10years, 28% of participants died; 39% due to cardiovascular disease. Relative to those reporting good functioning, those reporting poor physical functioning had a 39% higher all-cause death rate after adjusting for age, sex, race/ethnicity, education, income, body mass index, smoking, and comorbidities (Hazard Ratio=1.39; 95% Confidence Interval: 1.16, 1.67). Although Blacks were less likely than Whites to report good functioning (p<0.01), the association between functioning and mortality did not differ by race/ethnicity. CONCLUSIONS In this managed care population, self-reported physical functioning was a robust independent predictor of mortality and may be a useful benchmark for tailoring clinical care.
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Affiliation(s)
- Kelly R Ylitalo
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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