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Someeh N, Mirfeizi M, Asghari-Jafarabadi M, Alinia S, Farzipoor F, Shamshirgaran SM. Predicting mortality in brain stroke patients using neural networks: outcomes analysis in a longitudinal study. Sci Rep 2023; 13:18530. [PMID: 37898678 PMCID: PMC10613278 DOI: 10.1038/s41598-023-45877-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023] Open
Abstract
In this study, Neural Networks (NN) modelling has emerged as a promising tool for predicting outcomes in patients with Brain Stroke (BS) by identifying key risk factors. In this longitudinal study, we enrolled 332 patients form Imam hospital in Ardabil, Iran, with mean age: 77.4 (SD 10.4) years, and 50.6% were male. Diagnosis of BS was confirmed using both computerized tomography scan and magnetic resonance imaging, and risk factor and outcome data were collected from the hospital's BS registry, and by telephone follow-up over a period of 10 years, respectively. Using a multilayer perceptron NN approach, we analysed the impact of various risk factors on time to mortality and mortality from BS. A total of 100 NN classification algorithm were trained utilizing STATISTICA 13 software, and the optimal model was selected for further analysis based on their diagnostic performance. We also calculated Kaplan-Meier survival probabilities and conducted Log-rank tests. The five selected NN models exhibited impressive accuracy ranges of 81-85%. However, the optimal model stood out for its superior diagnostic indices. Mortality rate in the training and the validation data set was 7.9 (95% CI 5.7-11.0) per 1000 and 8.2 (7.1-9.6) per 1000, respectively (P = 0.925). The optimal model highlighted significant risk factors for BS mortality, including smoking, lower education, advanced age, lack of physical activity, a history of diabetes, all carrying substantial importance weights. Our study provides compelling evidence that the NN approach is highly effective in predicting mortality in patients with BS based on key risk factors, and has the potential to significantly enhance the accuracy of prediction. Moreover, our findings could inform more effective prevention strategies for BS, ultimately leading to better patient outcomes.
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Affiliation(s)
- Nasrin Someeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mani Mirfeizi
- Werribie Mercy West Hospital, Werribee, VIC, 3030, Australia
| | - Mohammad Asghari-Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
- School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia.
- Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia.
| | - Shayesteh Alinia
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Farshid Farzipoor
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Cowan S, Grassi A, Monahan Couch L, Jeanes Y, Lim S, Pirotta S, Harris J, McGirr C, Moran L. Evidence-Based Lifestyle Guidelines and Self-Management Strategies Utilized by Women with Polycystic Ovary Syndrome. Nutrients 2023; 15:nu15030589. [PMID: 36771296 PMCID: PMC9919009 DOI: 10.3390/nu15030589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/25/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 13% of reproductive-aged women. While lifestyle management is the first-line treatment for improving complications, women experience challenges with implementation. This cross-sectional study aims to identify the types and sources of dietary and physical activity (PA) interventions implemented by women with PCOS and understand how they use self-management strategies to support lifestyle change. An online questionnaire was disseminated via a consumer-based PCOS website (May 2015-2016). Women (n = 1167) were aged 18-45 years and primarily born within the United States (70%). A quarter or less of women (diet 25%, PA 14%) sought lifestyle advice from health professionals (medical clinicians or dietitians) compared to over half (diet 59%, PA 67%) using alternative sources, namely from online platforms. While only 33% and 16% of women reported following formal dietary or PA guidelines, respectively, 57% had implemented a 'special diet' to manage their condition, many of which were inconsistent with evidence-based practice in PCOS. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. These findings suggest that online information may promote inaccurate and ineffective lifestyle advice and emphasize the need to increase engagement with qualified health professionals.
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Affiliation(s)
- Stephanie Cowan
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia
| | - Angela Grassi
- Nutrition Department, West Chester University of Pennsylvania, West Chester, PA 19383, USA
| | - Lynn Monahan Couch
- Nutrition Department, West Chester University of Pennsylvania, West Chester, PA 19383, USA
| | - Yvonne Jeanes
- School of Life and Health Sciences, Department of Life Sciences, University of Roehampton, London SW15 5PH, UK
| | - Siew Lim
- Eastern Health Clinical School, Monash University, Box Hill, VIC 3128, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jeff Harris
- Nutrition Department, West Chester University of Pennsylvania, West Chester, PA 19383, USA
| | - Caroline McGirr
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia
- Correspondence:
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Guo Y, Liu Y, Yan X, Ding R, Tan H, Wang L. Factors affecting the adoption of health-promoting behaviours in patients with polycystic ovary syndrome: a cross-sectional study. BMJ Open 2022; 12:e056478. [PMID: 35354623 PMCID: PMC8968562 DOI: 10.1136/bmjopen-2021-056478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aimed to investigate health-promoting lifestyle status and associated risk factors in patients with polycystic ovary syndrome (PCOS). DESIGN Cross-sectional study. SETTING This study was conducted at a tertiary hospital in Guizhou, China from December 2020 to June 2021. PARTICIPANTS A total of 366 participants (18-45 years) diagnosed with PCOS were recruited from the outpatient departments. MEASURES Sociodemographic characteristics were collected, and health-promoting behaviours were measured using the Health-Promoting Lifestyle Profile scale. Anxiety status was measured using the Zung's Self-Rating Anxiety Scale, depression status using the Zung's Self-Rating Depression Scale and self-efficacy using the Managing Chronic Disease 6-Item Scale. Multiple stepwise linear regression was conducted to assess the risk factors associated with the health-promoting behaviours of the study participants. RESULTS The participants had a poor health-promoting behaviours (88.54±17.44). The highest score in all dimensions was spiritual growth (16.68±4.98), while physical activity (12.71±2.68) was the lowest. Multiple regression analysis revealed that the main factors influencing the development and maintenance of health-promoting behaviours among participants were education (B=10.788, p<0.001), depression (B=-0.377, p<0.001), anxiety (B=-0.333, p<0.001) and self-efficacy (B=0.938, p=0.002). The model showed 74.40% variance shared between the dependent and independent variables (R2=74.40, F=264.633, p<0.001). CONCLUSION Health-promoting behaviours are minimal among patients with PCOS, and improving negative emotions and enhancing behavioural awareness and self-efficacy are necessary to increase the adoption of health-promoting behaviours among patients with PCOS. TRIAL REGISTRATION NUMBER ChiCTR2000034572.
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Affiliation(s)
- Yunmei Guo
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Ying Liu
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Xing Yan
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Rui Ding
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Huiwen Tan
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
| | - Lianhong Wang
- Family Planning Department, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- Nursing Department, Zunyi Medical University, Zunyi, China
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Abaoğlu H, Doğu SE. Physical activity for a meaningful and purposeful life in typical adults: a cross-sectional study. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2022. [DOI: 10.1590/2526-8910.ctoao23783103] [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
Abstract Introduction Physical activity is a part of life and an essential element for health and well-being. Investigating the meaning and purpose that physical activity adds to life will guide occupation-based interventions. Objective This cross-sectional study aimed to examine the relationship between physical activity level and meaning and purpose in life in typical adults. Method The study included a total of 300 typical adults (181 female, 119 male). Demographic characteristics of the participants, such as age, gender, and educational status, were recorded. The International Physical Activity Questionnaire, the Life Attitude Profile-Revised, and the Purpose in Life Test were used as measurement tools. Spearman correlation coefficient was used to analyse the relationship between nonparametric variables. Results A weak positive correlation was found between the physical activity total scores, meaning in life sub-scores and total scores (r=0.25, p<0.01), and purpose in life total scores (r=0.16, p<0.01). Conclusion Our findings revealed that people engaging in more physical activity had a sense of meaning and purpose in life. Physical activity must take place in occupational therapy practices as an occupation that adds meaning and purpose to an individual's life. Further research is needed on this subject.
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Bailey RR, Ipsen M. Facilitators and barriers to performing dietary behaviors among chronic community-dwelling stroke survivors: A qualitative secondary analysis. Disabil Health J 2022; 15:101270. [DOI: 10.1016/j.dhjo.2022.101270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/03/2022]
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Pirotta S, Lim SS, Grassi A, Couch LM, Jeanes YM, Joham AJ, Teede H, Moran LJ. Relationships between self-management strategies and physical activity and diet quality in women with polycystic ovary syndrome. PATIENT EDUCATION AND COUNSELING 2022; 105:190-197. [PMID: 33966953 DOI: 10.1016/j.pec.2021.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/24/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine the relationships of self-management strategies and physical activity (PA) and diet quality in women with PCOS. METHODS An online cross-sectional study involving women (n = 501), 18-45 years in the general Australian community with a self-reported PCOS diagnosis. The self-management and lifestyle behaviour questionnaires were completed between August 2017 and March 2018. RESULTS Implementation of PA related self-management strategies increased the odds of meeting PA recommendations [Odds ratio (OR): 2.929 (95%CI: 2.172, 3.951), p < 0.001] but had no association with body mass index (BMI) [OR: 0.-0.984 (95%CI: -1.010, 0.959), p = 0.217] nor perception of self weight [OR: 1.382 (95% CI: 0.700, 2.725), p = 0.352]. Nutrition related self-management strategies were inversely associated with BMI [OR: - 0.115 (95%CI: -7.159, -0.980), p = 0.010] but had no association with diet quality [OR: 0.183 (95%CI: -2.328, 2.800), p = 0.855], energy intake [OR: - 0.092 (95%CI: -1204.443, 527.496) p = 0.438] or weight [OR: - 0.034 (95%CI: -4.020, 1.930), p = 0.491]. CONCLUSIONS PA self-management strategies were associated with meeting PA recommendations. Nutrition strategies were associated with lower BMI but not diet quality, energy intake or weight in women with PCOS. PRACTICE IMPLICATIONS Other behaviour change determinants (e.g. education, skills and self-efficacy) should be considered when designing a PCOS lifestyle programme in conjunction with self-management strategies.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, Monash University, Melbourne, Australia.
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia.
| | - Angela Grassi
- Nutrition Department, West Chester University of Pennsylvania, West Chester, PA, USA.
| | - Lynn Monahan Couch
- Nutrition Department, West Chester University of Pennsylvania, West Chester, PA, USA.
| | - Yvonne M Jeanes
- Department of Life Sciences, University of Roehampton, London, UK.
| | - Anju J Joham
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia; Department of Diabetes, Monash Health, Clayton, Australia.
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia.
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Someeh N, Asghari Jafarabadi M, Shamshirgaran SM, Farzipoor F. The outcome in patients with brain stroke: A deep learning neural network modeling. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:78. [PMID: 33088315 PMCID: PMC7554543 DOI: 10.4103/jrms.jrms_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/11/2020] [Accepted: 04/25/2020] [Indexed: 11/19/2022]
Abstract
Background: The artificial intelligence field is obtaining ever-increasing interests for enhancing the accuracy of diagnosis and the quality of patient care. Deep learning neural network (DLNN) approach was considered in patients with brain stroke (BS) to predict and classify the outcome by the risk factors. Materials and Methods: A total of 332 patients with BS (mean age: 77.4 [standard deviation: 10.4] years, 50.6% – male) from Imam Khomeini Hospital, Ardabil, Iran, during 2008–2018 participated in this prospective study. Data were gathered from the available documents of the BS registry. Furthermore, the diagnosis of BS was considered based on computerized tomography scans and magnetic resonance imaging. The DLNN strategy was applied to predict the effects of the main risk factors on mortality. The quality of the model was measured by diagnostic indices. Results: The finding of this study for 81 selected models demonstrated that ranges of accuracy, sensitivity, and specificity are 90.5%–99.7%, 83.8%–100%, and 89.8%–99.5%, respectively. Based on the optimal model (tangent hyperbolic activation function with the minimum–maximum hidden units of 10–20, max epochs of 400, momentum of 0.5, and learning rate of 0.1), the most important predictors for BS mortality were time interval after 10 years (accuracy = 92.2%), age category (75.6%), the history of hyperlipoproteinemia (66.9%), and education level (66.9%). The other independent variables are at moderate importance (66.6%) which include sex, employment status, residential place, smoking habits, history of heart disease, cerebrovascular accident type, blood pressure, diabetes, oral contraceptive pill use, and physical activity. Conclusion: The best means for dropping the BS load is effective BS prevention. DLNN strategy showed a surprising presentation in the prediction of BS mortality based on the main risk factors with an excellent diagnostic accuracy. Moreover, the time interval after 10 years, age, the history of hyperlipoproteinemia, and education level are the most important predictors for BS.
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Affiliation(s)
- Nasrin Someeh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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He J, Guo Z, Shao Z, Zhao J, Dan G. An LSTM-Based Prediction Method for Lower Limb Intention Perception by Integrative Analysis of Kinect Visual Signal. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:8024789. [PMID: 32774824 PMCID: PMC7396070 DOI: 10.1155/2020/8024789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
Recently, computer vision and deep learning technology has been applied in various gait rehabilitation researches. Considering the long short-term memory (LSTM) network has been proved an excellent performance in learn sequence feature representations, we proposed a lower limb joint trajectory prediction method based on LSTM for conducting active rehabilitation on a rehabilitation robotic system. Our approach based on synergy theory exploits that the follow-up lower limb joint trajectory, i.e. limb intention, could be generated by joint angles of the previous swing process of upper limb which were acquired from Kinect platform, an advanced computer vision platform for motion tracking. A customize Kinect-Treadmill data acquisition platform was built for this study. With this platform, data acquisition on ten healthy subjects is processed in four different walking speeds to acquire the joint angles calculated by Kinect visual signals of upper and lower limb swing. Then, the angles of hip and knee in one side which were presented as lower limb intentions are predicted by the fore angles of the elbow and shoulder on the opposite side via a trained LSTM model. The results indicate that the trained LSTM model has a better estimation of predicting the lower limb intentions, and the feasibility of Kinect visual signals has been validated as well.
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Affiliation(s)
- Jie He
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Zhexiao Guo
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Ziwei Shao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
| | - Junhao Zhao
- Zhejiang Provincial Hospital of Traditional Clinical Medical, Hangzhou 310006, China
| | - Guo Dan
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518056, China
- Shenzhen Institute of Neuroscience, Shenzhen 518060, China
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Sharma R, Molinares-Mejia D, Khanna A, Maltser S, Ruppert L, Wittry S, Murphy R, Ambrose AF, Silver JK. Training and Practice Patterns in Cancer Rehabilitation: A Survey of Physiatrists Specializing in Oncology Care. PM R 2019; 12:180-185. [PMID: 31140751 DOI: 10.1002/pmrj.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians. OBJECTIVES To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field. DESIGN Cross-sectional descriptive survey study. SETTING Online survey. PARTICIPANTS American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship-trained and not fellowship-trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking. METHODS All CRPC physicians were invited to complete a voluntary and anonymous 43-question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field. MAIN OUTCOME MEASUREMENTS Training, practice, opioid prescribing, and professional support. RESULTS Thirty-seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty-five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations. CONCLUSIONS Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors-often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Raman Sharma
- Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY
| | - Diana Molinares-Mejia
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish Khanna
- Department of Cancer Rehabilitation, Kessler Institute for Rehabilitation & ReVital Program, West Orange, NJ
| | - Susan Maltser
- Department of Cancer Rehabilitation, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Lisa Ruppert
- Department of Rehabilitation Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sarah Wittry
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Ryan Murphy
- Physical Medicine & Rehabilitation Services, Valley Hospital & Valley Medical Group, Ridgewood, NJ
| | - Anne Felicia Ambrose
- Department of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, Wang Q. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 63:59-68. [PMID: 31465865 DOI: 10.1016/j.rehab.2019.07.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking. OBJECTIVE This systematic review and meta-analysis aimed to investigate the effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors. METHODS We performed a systematic electronic search for articles in MedLine via PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and SPORTSDiscus up to April 1, 2019. Peak oxygen consumption (VO2peak), 6-min walk test (6MWT), fastest 10-m walk test (10MWT), and adverse events were assessed. The standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute the effect size, and subgroup analysis was conducted to test the consistency of results as well as sensitivity analysis to assess the robustness of the results. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS We included 17 studies (PEDro score≥4) in the meta-analysis. Post-intervention, high-intensity exercise had a significant effect on peak oxygen uptake (VO2peak; SMD=0.56, P<0.01, I2=8%; WMD=2.53mL/kg/min; high quality of evidence) and 6MWT (SMD=0.26, P<0.01, I2=40%; WMD=17.08m; moderate quality of evidence) but not fastest 10MWT (SMD=0.33, P=0.27, I2=77%; WMD=0.05m/s; low quality of evidence). Subgroup analysis showed better effects of higher-intensity treadmill training (≥70% heart rate reserve/VO2peak) for a longer duration (≥12 weeks) on VO2peak and 6MWT in sub-acute or chronic stroke survivors. The high-intensity exercise and control groups did not differ in adverse events including falls [odds ratio (OR) 1.40, P=0.35, I2=11%; low quality of evidence], pain (OR 3.34, P=0.09, I2=0%; moderate quality of evidence), or skin injuries (OR 1.08, P=0.90, I2=0%; low quality of evidence). CONCLUSIONS Our meta-analysis suggests that high-intensity exercise is beneficial for cardiorespiratory fitness in stroke survivors and might be safe as a novel intervention in cardiopulmonary rehabilitation after stroke.
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Affiliation(s)
- Lu Luo
- Department of Rehabilitation Medicine, Qingdao University, Qingdao, China; Department of Rehabilitation Medicine, Fudan University, Shanghai, China
| | - Haining Meng
- Department of Special Medicine, School of Basic Medical College, Qingdao University, Qingdao, China
| | - Ziwei Wang
- The Ohio State University, Columbus, OH, United States
| | - Shiqiang Zhu
- Department of Rehabilitation Medicine, Ningxia Medical University, Ningxia, China
| | - Song Yuan
- Department of Rehabilitation Medicine, Taihe Hospital, Hubei, China
| | - Yuyang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China
| | - Qiang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China.
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