Efficacy of an 8-hour education intervention on dementia knowledge, attitude and skills in healthcare professionals in regional hospitals: a nation-wide study from Uganda.

Introduction: dementia imposes an enormous burden, mainly in low-income countries (LICs). Due to lack of well-trained healthcare professionals, 70-90% of people with dementia do not receive adequate care in LICs. The aim of this study was to evaluate whether a one-day, 8-hour medical education intervention on dementia care improves the knowledge and attitude about and confidence in providing dementia care among healthcare professionals in 8 referral hospitals in UgandaMethods: in this pre-test/post-test study without a control group, participants completed the Alzheimer´s Disease Knowledge Scale (ADKS), Dementia Care Attitude Scale (DCAS), and 9 visual analogue scales (VAS) regarding confidence in specific dementia care skills pre- and post-medical education intervention. Results: in one hundred twelve healthcare professionals (age = 41.7±10.2 years; 54.5% women), the ADKS, DCAS, and VAS scores for recognizing and assessing core dementia symptoms, communicating effectively, providing psycho-education, activating patients mentally and physically, managing behavioral and psychological symptoms, and involving carers in the treatment improved significantly (P < 0.001) post-medical education intervention. Conclusion: our study demonstrates that brief educational interventions are efficacious in strengthening the dementia literacy among healthcare professionals in a low-income country. Future research should explore whether such brief educational interventions also result in implementation of efficacious dementia care into routine clinical practice and whether it ultimately may lead to improved health outcomes in patients and formal and informal caregivers.

A 10-hours workshop improves physical activity prescription for mental illness knowledge and confidence in health care professionals: a nation-wide multicentre study from Uganda.

PURPOSE: Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. MATERIAL AND METHODS: 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire - Health Professionals Version (EMIQ-HP) pre- and post-workshop. RESULTS: The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen's d = 1.28, 95% confidence interval, CI = 1.04-1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen's d = 1.14, 95% CI = 0.91-1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. CONCLUSIONS: Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals.IMPLICATIONS FOR REHABILITATIONThe majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs.Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care.Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs.Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.

Physical activity and physical fitness in community patients with alcohol use disorders versus matched healthy controls: cross-sectional data from Uganda.

In order to develop adequate public health interventions, there is a need to explore whether people with an alcohol use disorder (AUD) not requiring inpatient treatment do have compromised physical health and are consequently a population at risk. We cross-sectionally compared physical fitness and physical activity levels in community patients with an AUD with healthy matched controls in Uganda. Fifty community patients (42 men, median age=32.0 years, interquartile range=10.7 years) and 50 age-, gender- and body mass index-matched controls performed a 6-minute walk test (6MWT), and completed the Simple Physical Activity Questionnaire (SIMPAQ). Differences between groups were assessed with a t-test or Mann Whitney U test when appropriate. Community patients with AUD have significantly lower 6MWT [median=480.0 (interquartile range=109) versus 802.5 (121.2) m, P<0.001], SIMPAQ walking [0 (30.0) min/day versus 35.0 (17.4) min/day, P<0.001], SIMPAQ exercise [0 (1.5) min/day versus 0 (2.5) min/day, P<0.001], and SIMPAQ incidental physical activity [30.0 (50.0) min/day versus 300.0 (315.0) min/day, P<0.001]. A reduced physical fitness and physical inactivity should be considered and assessed in early interventions targeting community patients with AUDs. If left untreated, both might also emerge as important modifiable risk factors for somatic co-morbidity in this population-at-risk.

Physical activity, physical fitness and quality of life in outpatients with major depressive disorder versus matched healthy controls: Data from a low-income country.

BACKGROUND: There is an urgent need to increase awareness that people with major depressive disorder (MDD) in low-income countries do also have a compromised physical health. We compared physical fitness and physical activity levels in outpatients with MDD with healthy matched controls in Uganda and explored whether the variance in quality of life (QoL) can be explained by the variance in physical fitness and physical activity levels. METHODS: Fifty outpatients (35 men, median age = 29 years, interquartile range = 14 years) and 50 age, gender and body mass index matched controls performed a 6-minute walk test (6MWT), the World Health Organization Quality of Life short-version (WHOQoLBref), Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18). Differences between groups were assessed with a Mann Whitney U test and backward stepwise multivariable regression analysis was performed to evaluate independent variables explaining the variance in WHOQoLBref scores. RESULTS: Outpatients with MDD have significantly lower 6MWT, SIMPAQ walking, SIMPAQ incidental physical activity, physical and psychological WHOQoLBref scores, and significantly higher BSI-18 depression and anxiety scores. BSI-18 depression was the only significant independent predictor of the WHQoLBref physical score explaining 39.7% of the variance, while the 6MWT score remained the only significant independent predictor of the WHQoLBref psychological score explaining 31.7% of the variance. CONCLUSIONS: Our data demonstrate that outpatients with MDD in a low-income country are significantly less physically fit and less physically active than the general population. Lower physical fitness levels are also associated with lower QoL levels.

Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with alcohol use disorder.

We investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan outpatients with alcohol use disorder (AUD). We also explored practice effects, and assessed the minimal detectable change (MDC) and correlations with the 2MWT. Fifty outpatients [7 women; median age = 32.0 years] performed the 2MWT twice, the 6MWT once, and completed the Simple Physical Activity Questionnaire, Brief Symptoms Inventory-18 (BSI-18), and Alcohol Use Disorders Identification Test. The median (interquartile) 2MWT score on the first and second test were 162.0 (49.0) meters and 161.0 (58.0) meters, respectively, without significant difference between the two trials (p = 0.20). The intraclass correlation between the two 2MWTs was 0.96 (95% confidence interval = 0.94-0.98). The Spearman Rho correlation between the second 2MWT and the 6MWT was 0.91 (p < 0.001). The MDC for the 2MWT was 18 m. There was no evidence of a practice effect. Variance in BSI-18 depression and the presence of leg pain following the 2MWT explained 18.7% of 2MWT score variance. The 2MWT is a reliable and valid fitness test, which can be conducted without any special equipment or substantial time demands in outpatients with AUD.

Test-retest reliability, validity, and correlates of the 2-min walk test in outpatients with depression.

OBJECTIVES: A reason for the lack of interest in physical fitness testing in mental healthcare is limited time among existing staff. This cross-sectional study investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan patients with depression. We also explored practice effects and assessed the minimal detectable change (MDC) and clinical correlates with the 2MWT. METHODS: This is a cross-sectional study executed in Butabika National Referral Hospital in Kampala, Uganda. Fifty Ugandan patients with depression (15 women; median age = 29.0 years) performed twice a 2MWT, once a 6MWT, and completed the Simple Physical Activity Questionnaire (SIMPAQ), and Brief Symptoms Inventory-18 (BSI-18). RESULTS: The median (interquartile) 2MWT score on the first and second test were 125.5 (59.2) meters and 131.0 (57.0) meters (p = .28). The intraclass correlation was.96 (95% confidence interval [0.94, 0.98]). The MDC was 23.5 m for men and 23.4 m for women. There was no evidence of a practice effect. Scores on BSI-18 depression, SIMPAQ walking, and SIMPAQ incidental physical activity explained 66.3% of 2MWT score variance. CONCLUSION: The 2MWT is a reliable test, which can be conducted without any special equipment or substantial time demands, to provide a valid assessment of the functional exercise capacity in outpatients with depression.

Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with psychosis.

The aim of this study was to investigate the test-retest reliability of the 2-minute walk test (2MWT) and the concurrent validity with the 6-minute walk test (6MWT) in outpatients with psychosis. We also explored whether there was a practice effect, determined minimal detectable changes (MDC) and assessed which factors are associated with the 2MWT performance. Fifty outpatients [22 women; 33.5 (14.3) years] performed the 2MWT twice and the 6MWT once and completed the Simple Physical Activity Questionnaire (SIMPAQ) and Brief Symptoms Inventory -18. The median (interquartile) 2MWT score on the first and second test were 128.0 (44.0) meters and 128.0 (31.5) meters, without significant difference between the two trials. The intraclass coefficient was 0.94 (95% confidence interval=0.91-0.97). The significant Spearman Rho correlation between the second 2MWT and the 6MWT was 0.69. The MDC was 22 m for men and 21 m for women. There was no evidence for a practice effect. Variability in SIMPAQ sedentary, exercise, incidental physical activity and leg pain following the test explained 54.6% of the variance in 2MWT score. The current study demonstrates that the 2MWT is a reliable, valid and clinically feasible tool for assessing and evaluating the functional exercise capacity in outpatients with psychosis.