Exploring the experiences of an exercise-based telerehabilitation program among Canadian community-dwelling adults with stroke

PURPOSE

Telerehabilitation is emerging as a means for delivering stroke rehabilitation to address unmet lower extremity rehabilitation needs. However, there is currently limited and low-quality evidence supporting the use telerehabilitation interventions for lower extremity recovery after stroke. Thus, we developed an exercise-based telerehabilitation program (TRAIL) for safe and effective promotion of lower extremity function after stroke. This study reports on the qualitative findings from the feasibility study of the TRAIL program.

METHODS

An interpretive description methodology and inductive thematic analysis approach were undertaken. One-on-one semi-structured interviews were conducted on a subset of participants who completed the TRAIL feasibility study. Participants were recruited via email and enrolled into the study based on pre-determined purposeful sampling strategies.

RESULTS

Ten participants (6 men, 4 women) completed a semi-structured interview. Two main themes emerged: (i) TRAIL ingredients for success and (ii) telerehabilitation is a viable option for stroke rehabilitation.

CONCLUSION

Exercise-based telerehabilitation appears to be well-received by men and women post-stroke when social support, professional guidance, and program resources are offered. TRAIL may also prolong the continuum of care that individuals receive once they are discharged back into the community, and contribute to improvements in mobility, lower extremity strength and balance.

Understanding Mobile Health and Youth Mental Health: Scoping Review

BACKGROUND

A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy.

OBJECTIVE

The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes.

METHODS

Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis.

RESULTS

The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results.

CONCLUSIONS

This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.

Clinical Measures of Balance and Walking Ability in People with Stroke for Assessment via Videoconferencing

Purpose:

This study modified established clinical balance and walking measures and estimated the reliability, validity, and feasibility of using these measures to assess people post-stroke via videoconferencing.

Method:

Twenty-eight people with chronic stroke were recruited and completed the in-person balance and mobility tests. Five clinical measures were modified as virtual assessments over videoconferencing. Feasibility was evaluated by task completion rate, occurrence of adverse events, and technical difficulties. Test–retest reliability and agreement were examined by intra-class correlations and standard error of measurement between two testing days. Convergent validity was examined by the magnitude of associations between in-person and virtual assessments using Pearson or Spearman rank correlation.

Results:

Twenty-one participants (52% female) participated in both in-person and virtual assessments. No adverse events occurred. Technical challenges were experienced by eight participants. Test–retest reliability for timed up and go test, 30-seconds sit-to-stand, five-times sit-to-stand, functional reach test, and tandem stance resulted in intra-class coefficients of 0.97, 0.90, 0.77, 0.54, and 0.50 respectively. The standard error of measurement was low across all virtual assessments. The timed up and go test, five-times sit-to-stand, and 30-seconds sit-to-stand showed relationship with in-person assessments ( r = −0.55 to −0.81).

Conclusion:

Virtual assessment of walking and balance function in ambulatory people post-stroke is feasible; however, technical challenges were experienced. The test–retest reliability of virtual assessments of timed up and go test and sit-to-stand tasks for people with stroke, together with strong convergent validity of the measures compared to in-person assessments is promising.

Does peak expiratory flow moderate trajectories of cognitive function among individuals with lung diseases? A longitudinal analysis of the National Health and Aging Trends Study

INTRODUCTION

Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases.

METHODS

This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles.

RESULTS

In females, interactions of time-by-PEF were found for both immediate (n = 489, t = 2.73, p<0.01) and delayed recall (n = 489, t = 3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n = 296, t = -3.08, p < 0.01; delayed recall: n = 292, t = -2.46, p = 0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n = 484, t = 0.25, p = 0.81; males: n = 291, t = -0.61, p = 0.55).

CONCLUSION

Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

Canadian Stroke Best Practice Recommendations: Virtual Stroke Rehabilitation Interim Consensus Statement 2022

ABSTRACT

The seventh edition of the Canadian Stroke Best Practice Recommendations for Rehabilitation and Recovery following Stroke includes a new section devoted to the provision of virtual stroke rehabilitation. This consensus statement uses Grading of Recommendations, Assessment, Development and Evaluations methodology and Appraisal of Guidelines for Research & Evaluation II principles. A literature search was conducted using PubMed, Embase, and Cochrane databases. An expert writing group reviewed all evidence and developed recommendations, as well as consensus-based clinical considerations where evidence was insufficient for a recommendation. All recommendations underwent internal and external review. These recommendations apply to hospital, ambulatory care, and community-based settings where virtual stroke rehabilitation is provided. This guidance is relevant to health professionals, people living with stroke, healthcare administrators, and funders. Recommendations address issues of access, eligibility, consent and privacy, technology and planning, training and competency (for healthcare providers, patients and their families), assessment, service delivery, and evaluation. Virtual stroke rehabilitation has been shown to safely and effectively increase access to rehabilitation therapies and care providers, and uptake of these recommendations should be a priority in rehabilitation settings. They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location and personal circumstances in Canada.

The Impact of COVID-19-Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study

BACKGROUND

The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people's daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults.

OBJECTIVE

We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions.

METHODS

This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC's Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants' sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants' COVID-19-related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses.

RESULTS

This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021.

CONCLUSIONS

Findings from our study will inform the development and recommendations of a new resource guide for the post-COVID-19 period and for future public health emergencies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28337.

Primary care of people with spinal cord injury: scoping review

OBJECTIVE

To perform a scoping review of the empirical evidence between 1980 and 2009 regarding primary care for adults with spinal cord injury (SCI).

DATA SOURCES

Peer-reviewed journals were searched from 1980 to 2009 using CINAHL, PubMed-MEDLINE, EMBASE, PsycINFO, Social Sciences Abstracts, and Social Work Abstracts.

STUDY SELECTION

The key word-driven electronic search identified 42 articles on primary care and SCI. Inclusion criteria narrowed the set to 21 articles that were published in English, that had a sample size of greater than 3, and that offered empirical analysis.

SYNTHESIS

Approximately 90% of people with SCI identify family physicians as their regular doctors; 63% have SCI specialists. People with long-term SCI develop complex rubrics for navigating their personal health care systems. There is conflicting evidence about the effectiveness of outreach programs for maintaining health and preventing complications following SCI. Regular follow-up by specialized teams and annual comprehensive health examination are supported by the evidence. The research shows a high level of consistency in identifying the most common issues raised by people with SCI in primary care, most of which are related to disability-specifically, secondary complications such as bowel or bladder dysfunction and pain. There is also good evidence that many general health issues require attention in this population, such as bone density problems, depression, and sexual and reproductive health issues. There is level 4 and 5 evidence for unmet health needs among individuals living with SCI in the community. Despite patients with SCI being high users of primary care and health services in general, the evidence suggests that the information needs of these patients in particular are poorly met.

CONCLUSION

A robust system of primary care is the best assurance of good health outcomes and reasonable health service use for people with SCI, including annual comprehensive examination, appropriate specialist use, and attention to accessibility and unmet needs.

Serum amyloid A, cytokines, and corticosterone responses in germfree and conventional mice after lipopolysaccharide injection

To determine why germfree mice are less susceptible to lipopolysaccharide (LPS) than conventional mice, we studied serum levels of serum amyloid A (SAA), tumor necrosis factor (TNF), interleukin 1 (IL-1), IL-6, and corticosterone in mice after treatment with LPS. A single injection of LPS caused an elevation of SAA, an acute-phase protein in the mouse, in both conventional and germfree IQI mice, and the response was significantly less in germfree mice. LPS-induced elevations of serum TNF, IL-1, and IL-6 levels were also significantly less in germfree mice, while serum corticosterone levels were greater in germfree mice than in conventional mice. These results suggest that the lower susceptibility to LPS and a smaller response of SAA elevation by LPS in germfree mice may result from less elevation in serum of these cytokines in these mice, which are known to mediate the acute phase response of SAA. High levels of serum corticosterone in germfree mice may be partly responsible for the lower responsiveness of these inflammatory cytokines to LPS in these mice.

Effect of vitamin B6 deficiency on the levels of several water-soluble vitamins in tissues of germ-free and conventional rats

The influence of vitamin B6 deficiency on the levels of several water-soluble vitamins and on acetyl-coenzyme A carboxylase activity was investigated using of germ-free and conventional rats. Judging from the vitamin B6 levels in tissues and the percent of decrease, the degree of vitamin B6 deficiency was more severe in the tissues of deficient germ-free rats than in deficient conventional rats. Nicotine acid, pantothenic acid and biotin levels per wet weight significantly decreased in the liver of vitaminB6-deficient germ-free rats, and nicotine acid levels per wet weight significant decreased in the liver of deficient conventional rats. In the kidney of vitamin B6-deficient germ-free rats, a significant decrease in riboflavin and biotin levels was observed, although there was no observable difference in riboflavin, nicotinic acid, biotin and patothenic acid levels in the kidney of deficient conventional rats. From an enzymatic standpoint, acetyl-coenzyme A carboxylase activity was especially significantly decreased in both germ-free and conventional rats fed a vitamin B6-deficient diet, and the percent od decrease was more in germ-free rats than in conventional ones. These findings suggest that vitamin B6 deficiency had stronger effects on the levels of water-soluble vitamins in germ-free rats compared with conventional rats.

The differences of the metabolism related to vitamin B6-dependent enzymes among vitamin B6-deficient germ-free and conventional rats

The differences of the metabolism related to vitamin B6-dependent enzymes were investigated using germ-free and conventional rats. There was a significant difference in the boyd weight gain between vitamin B6-deficient germ-free and conventional rats after about 30 days of the experiment, and the body weight gain was much less in the deficient germ-free rats than in the deficient conventional ones. Urinary excretion of xanthurenic acid was higher in the deficient germ-free rats than in the deficient conventional ones after 18 days. There was a significant difference in the activities of kynurenine aminotransferase in mitochondrial fractions of germ-free rats, but not in mitochondrial fractions of conventional ones. The activities of aspartate and alanine aminotransferases, with or without pyridoxal phosphate, significantly decreased in the deficient germ-free rats, but not in the deficient conventional ones. These findings indicate that the degree of vitamin B6 deficiency was more severe in the deficient germ-free rats than in the deficient conventional ones, and also suggest that intestinal microflora may have some effects on vitamin B6-deficient conventional rats.

Observations of the concentration of zinc and iron in tissues of vitamin B6-deficient germ-free rats

The transition of zinc and iron metabolism in vitamin B6 deficiency was investigated using germ-free and conventional rats. In contrast to previous reports, a decrease in zinc content was not observed in the liver, pancreas, kindney, spleen, lung or testes of vitamin B6-deficient conventional and germ-free rats, but we found an increase in zinc content in the kidney of conventional rats and in the liver and spleen of germ-free rats. Vitamin B6-deficient conventional and germ-free rats retained more iron in their tissues than the control animals did, except for the spleen of germ-free rats. The deposit of iron was more evident in vitamin B6-deficient germ-free rats than in vitamin B6-deficient conventional rats, and is possibly proportional to the degree of vitamin B6 deficiency. It is possible that the deposit of iron in the organs had some influence on metabolic disorders in vitamin B6-deficient rats.

Protective effect of hyperbaric oxygen for the temporary ischaemic myocardium. Macroscopic and histological data

A protective effect of hyperbaric oxygen immediately after reopening of occluded coronary blood flow for the temporary ischaemic myocardial muscle was studied. Thirty dogs were used in this study, and 20 dogs were sacrificed after 4 h and 10 dogs were sacrificed after 5 d. Temporary occlusion of coronary artery (from 30 min to 2 h) was produced by ligation. One group were controls and the other group were a hyperbaric group in which dogs breathed 100% oxygen at an absolute pressure of 2 atmospheres before and after release of coronary ligation. The macroscopic extent of ischaemic area was studied by using nitroblue tetrazolium and microscopic and ECG findings were examined. By breathing oxygen at high pressure immediately after reopening of occluded coronary blood flow, the ischaemic area was markedly reduced. In such cases, some myocardial muscles around the arterioles and sinusoids, even when these vessels existed in the ischaemic area, were kept in a viable state. The repair of necrotic myocardial muscles was promoted histologically. Serious arrhythmia, especially ventricular fibrillation, was also well suppressed, and the stable haemodynamic conditions were obtained during operative procedures. No harmful side effects of hyperbaric oxygen were observed. One of the most effective treatments of acute myocardial infarction involves reconstruction of the occluded coronary artery as soon as possible after the onset of myocardial infarction by using these advantages of hyperbaric oxygen.

Effect of myocardial revascularization on acute phase of myocardial infacrtion. Macroscopic, histological and electrocardiographic data

The purpose of this study was to investigate the time during which the emergency reconstruction of the occluded coronary artery is most effective. This problem was examined from the viewpoint of the extent of reversibility of the damage to ischemic myocardial muscle, by using forty nine mongrel dogs. The surgical reconstruction of the occluded coronary artery within 6 hours after the onset of myocardial infarction was most effective. In such cases, the extent of myocardial infarction remained small in size, and the healing of necrotic myocardial muscle was hastened. Thus, the development of cardiac failure was well protected.