'I can do this': a qualitative exploration of acceptability and experiences of a physical activity behaviour change intervention in people with multiple sclerosis in the UK

OBJECTIVES

The purpose of this study was to explore the experiences of people with multiple sclerosis (MS) who participated in iStep-MS, a feasibility randomised controlled trial of a behaviour change intervention that aimed to increase physical activity and reduce sedentary behaviour.

DESIGN

A qualitative approach was undertaken embedded in the feasibility randomised controlled trial. One-to-one semi-structured interviews were conducted and analysed using Framework analysis.

SETTING

Participants were recruited from a single MS therapy centre in the southeast of England, UK.

PARTICIPANTS

Sixty people with MS were randomly allocated in a 1:1 ratio to the intervention or usual care. Following a purposive sampling strategy, 15 participants from the intervention arm undertook 1:1 semi-structured interviews.

INTERVENTIONS

The iStep-MS intervention consisted of four therapist-led sessions over 12 weeks, supported by a handbook and pedometer.

RESULTS

Three themes were identified from the data. "I can do this": developing competence in physical activity highlights the enhanced physical activity confidence gained through goal setting and accomplishment. "I felt valued": the nurturing culture provides an overview of the supportive and non-judgemental environment created by the programme structure and therapeutic relationship. Finally, "What can I do?": empowered enactment describes the transition from the supported iStep-MS intervention to intrinsically motivated physical activity enactment.

CONCLUSIONS

Overall, this study supports the acceptability of the iStep-MS intervention and identified key areas that supported participants to be physically active.

TRIAL REGISTRATION NUMBER

ISRCTN15343862.

Optical and transport properties correlation driven by amorphous/crystalline disorder in InP nanowires

Indium phosphide nanowires with a single crystalline zinc-blend core and polycrystalline/amorphous shell were grown from a reliable route without the use of hazardous precursors. The nanowires are composed by a crystalline core covered by a polycrystalline shell, presenting typical lengths larger than 10 μm and diameters of 80-90 nm. Raman spectra taken from as-grown nanowires exhibited asymmetric line shapes with broadening towards higher wave numbers which can be attributed to phonon localization effects. It was found that optical phonons in the nanowires are localized in regions with average size of 3 nm, which seems to have the same order of magnitude of grain sizes in the polycrystalline shell. Regardless of the fact that the nanowires exhibit a crystalline core, any considerable degree of disorder can lead to a localized behaviour of carriers. In consequence, the variable range hopping was observed as the main transport instead of the usual thermal excitation mechanisms. Furthermore the hopping length was ten times smaller than nanowire cross-sections, confirming that the nanostructures do behave as a 3D system. Accordingly, the V-shape observed in PL spectra clearly demonstrates a very strong influence of the potential fluctuations on the exciton optical recombination. Such fluctuations can still be observed at low temperature regime, confirming that the amorphous/polycrystalline shell of the nanowires affects the exciton recombination in every laser power regime tested.

Electric-powered indoor/outdoor wheelchairs (EPIOCs): users' views of influence on family, friends and carers

PURPOSE

This study explored the effects of electric-powered indoor/outdoor wheelchair (EPIOC) provision to users on their family and carers.

METHOD

EPIOC users receiving their chairs between February and November 2002 (N = 74) were invited to participate in a telephone questionnaire/interview, and 64 agreed. This study examined the responses to the question 'Has the use of your EPIOC affected your family or friends in any way?' and related comments. Interviews were analysed using a qualitative framework approach to identify emergent themes. In addition, the proportion of individuals raising issues related to each theme was determined. Participants were interviewed 10-19 (mean = 14.3) months after chair delivery.

RESULTS

The following themes emerged: reduced physical burden on family/friends and increased independence and freedom. However, an EPIOC does not eliminate other practical problems particularly during transportation and negotiating kerbs and slopes. Users also reported anxiety/worry in relationship to EPIOC use, e.g., weather conditions, personal safety (muggings), use of ramps and kerbs.

CONCLUSION

There are considerable benefits to families and carers associated with powered wheelchair use. A reduction in the physical demand for pushing and increased freedom were identified. These benefits appear to outweigh the residual practical difficulties and worries.

Young people's experiences using electric powered indoor – outdoor wheelchairs (EPIOCs): Potential for enhancing users' development?

PURPOSE

To examine the experiences of severely physically disabled young people who use electric powered indoor - outdoor chairs (EPIOCs).

METHODS

A priori interview questions examined young people's functioning with EPIOCs, pain and discomfort with EPIOC use and accidents or injuries resulting from EPIOC use. Eighteen young people (13 males and five females) aged 10 - 18 (mean 15) years were interviewed by telephone using a qualitative framework approach. Participants were interviewed 10 - 19 (mean 14.5) months after delivery of the chair. Diagnoses included muscular dystrophy (n = 10), cerebral palsy (n = 5), and 'other' (n = 3).

RESULTS

Many children reported positive functioning following EPIOC use, including increased independence and social activities like wheelchair football. However, EPIOC use was also associated with pain and discomfort, as well as perceived lack of safety, and minor accidents. Most young people and their families were fairly satisfied with the service and provision of their wheelchairs.

CONCLUSIONS

The findings suggest that the development of disabled young people may benefit from the use of electric powered indoor/outdoor wheelchairs, although the advantages may come at certain costs to young people's perceived and real safety. Recommendations to powered wheelchair providers include the demonstrated need for additional driving training as these young people mature.

Dealing with chronic pain: giving voice to the experiences of mothers with chronic pain and their children

Despite the substantial monetary, personal, and social cost of chronic pain, research into the family life of sufferers is wanting. Parents dealing with chronic pain, as well as their children, have been particularly neglected. Using qualitative interview data from 16 mothers suffering from a variety of chronic pain conditions, and their 21 children, aged 6 to 12 years, we explored the impact of maternal chronic pain on mothers and children. Consistent with a gains-and-loss theory and the strengths perspective, the findings revealed both positive and challenging aspects of pain. Despite the presence of risks--including maternal stress, parenting difficulties, and children's distress--maternal chronic pain also provided opportunities for growth in many families. The findings suggest that maternal chronic pain can catalyze enhanced development as well as adversity. Researchers and clinicians should be aware of the pitfalls facing families dealing with chronic pain, while remaining open to the possibility that some families might flourish.

Older adults' use of, and satisfaction with, electric powered indoor/outdoor wheelchairs

BACKGROUND

Research documenting the experiences of electric powered indoor/outdoor wheelchair (EPIOC) users has generally failed to take into account the specific needs and concerns of older adults. This study sought to qualitatively examine the older EPIOC users' satisfaction with the chair and service providers.

METHOD

Eight women and nine men aged between 60 and 81 (mean 69) years were recruited through a specialist wheelchair service database. All had severe mobility disabilities. Analysis was performed using a qualitative framework approach.

RESULTS

Participants reported a variety of EPIOC uses, including shopping and some social contact. Moderate satisfaction with the chair was reported. Use was compromised by indoor and outdoor environmental barriers; and the chair not meeting users' needs. Accidents were rare, but many users still experienced insecurity in the chair. High levels of satisfaction with the service were reported, although concern was expressed over length of waiting times.

CONCLUSIONS

EPIOCs proved useful to most older people with disabilities. However, even those who were satisfied reported only moderate use of the chair outdoors. Limited use related to an infrequent need for outings, outdoor barriers, feelings of insecurity over chair safety and lengthy waiting times for chair delivery and required modifications. Service providers should be aware that older EPIOC users may require extra support and the provision of timely adjustments to increase chair use.