PREP Plus combined postrehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: protocol for a mixed-methods, cluster-assigned feasibility study

INTRODUCTION

Poor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead to upper limb recovery, often this is not maintained, with less than 50% of people regaining the ability to use their upper limb for independent function at 6 months. Upper limb recovery potential is reported for many years poststroke, yet current long-term provision is insufficient.

METHODS AND ANALYSIS

60 participants will be recruited into this feasibility study, with 30 allocated to a Post Rehabilitation Enablement Programme (PREP) alone and 30 allocated to a combined programme, PREP Plus, consisting of PREP and the Graded Repetitive Arm Supplementary Programme (GRASP). We will aim to complete four iterative waves. Within each wave, the intervention design will be refined, based on participant feedback. Within each wave, there will be one cluster unit (one intervention group ;PREP Plus) and one control group ;PREP alone)). A total of five PREP sites within Northern Ireland Health and Social Care Trusts will be used for this study. PREP Plus will have a home exercise component along with exercises logs and a behaviour contract. Qualitative and quantitative measures will evaluate the acceptability and feasibility to determine how feasible it is to embed the intervention into practice, as well as to determine the feasibility of a larger, mixed-methods, randomised controlled trial to assess intervention efficacy. Clinical endpoints will also be explored.

ETHICS AND DISSEMINATION

This study has been approved by the Health and Social Care Research Ethics Committee A, IRAS project ID (278620). Participants will provide informed consent prior to participating in the study. Information outlining the purpose of the study, what data will be collected and how the data will be managed will be provided. Results will be published in peer-reviewed journals and any published data will be available on the university data repository. The project management group will advise on different avenues for dissemination to ensure it reaches appropriate audiences.

TRIAL REGISTRATION NUMBER

NCT05090163.

Alpha-cells and therapy of diabetes: Inhibition, antagonism or death?

Absolute or relative hyperglucagonaemia is a characteristic of both Type 1 and Type 2 diabetes, resulting in fasting hyperglycaemia due in part to increased hepatic glucose production and lack of postprandial suppression of circulating glucagon concentrations. Consequently, therapeutics that target glucagon secretion or biological action may be effective antidiabetic agents. In this regard, specific glucagon receptor (GCGR) antagonists have been developed that exhibit impressive glucose-lowering actions, but unfortunately may cause off-target adverse effects in humans. Further to this, several currently approved antidiabetic agents, including GLP-1 mimetics, DPP-4 inhibitors, metformin, sulphonylureas and pramlintide likely exert part of their glucose homeostatic actions through direct or indirect inhibition of GCGR signalling. In addition to agents that inhibit the release of glucagon, compounds that enhance the transdifferentiation of glucagon secreting alpha-cells towards an insulin positive beta-cell phenotype could also help curb excess glucagon secretion in diabetes. Use of alpha-cell toxins represents another possible strategy to address hyperglucagonaemia in diabetes. In that respect, research from the 1920 s with diguanides such as synthalin A demonstrated effective glucose-lowering with alpha-cell ablation in both animal models and humans with diabetes. However, further clinical use of synthalin A was curtailed due its adverse effects and the increased availability of insulin. Overall, these observations with therapeutics that directly target alpha-cells, or GCGR signaling, highlight a largely untapped potential for diabetes therapy that merits further detailed consideration.

Changes in dietary fat intake and associations with mental health in a UK public sample during the COVID-19 pandemic

Background

Consumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic.

Methods

Data were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks’ Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models.

Results

Eight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health.

Conclusions

A higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.

The Effect of Chair-Based Exercise on Physical Function in Older Adults: A Systematic Review and Meta-Analysis

Physical activity is an important determinant of health in later life. The public health restrictions in response to COVID-19 have interrupted habitual physical activity behaviours in older adults. In response, numerous exercise programmes have been developed for older adults, many involving chair-based exercise. The aim of this systematic review was to synthesise the effects of chair-based exercise on the health of older adults. Ovid Medline, EMBASE, CINAHL, AMED, PyscInfo and SPORTDiscus databases were searched from inception to 1 April 2020. Chair-based exercise programmes in adults ≥50 years, lasting for at least 2 weeks and measuring the impact on physical function were included. Risk of bias of included studies were assessed using Cochrane risk of bias tool v2. Intervention content was described using TiDieR Criteria. Where sufficient studies (≥3 studies) reported data on an outcome, a random effects meta-analysis was performed. In total, 25 studies were included, with 19 studies in the meta-analyses. Seventeen studies had a low risk of bias and five had a high risk of bias. In this systematic review including 1388 participants, results demonstrated that chair-based exercise programmes improve upper extremity (handgrip strength: MD = 2.10; 95% CI = 0.76, 3.43 and 30 s arm curl test: MD = 2.82; 95% CI = 1.34, 4.31) and lower extremity function (30 s chair stand: MD 2.25; 95% CI = 0.64, 3.86). The findings suggest that chair-based exercises are effective and should be promoted as simple and easily implemented activities to maintain and develop strength for older adults.

A measure of family eating habits: initial psychometric properties using the profile pattern approach (PPA)

Although it seems likely that family characteristics and eating habits are a major factor in the development of eating behaviors, there are no self-report measures that examine how individuals view their family's eating habits. Seventy-one women ages 18-22 were recruited from a private university in a large northeastern city and asked to complete a short questionnaire packet consisting of demographic questions, the newly developed Family Eating Habits Questionnaire (FEHQ) and the Eating Inventory (EI). Internal consistency and test-retest reliability of the FEHQ was established. Significant associations were found between the FEHQ and the EI, indicating convergent validity for the FEHQ. Further validation was conducted using a novel statistical technique, the profile pattern approach (PPA). The results of the present study are limited by the restricted sample characteristic of a university setting. However, our findings show that the family eating habits' measure appears psychometrically sound. A future aim will be to continue validating this instrument in other samples, particularly to determine its predictive value.