Health-promoting physical activities for refugees from Syria - physiotherapists' clinical reasoning.

BACKGROUND: Refugees from Syria face health challenges with psychosocial dimensions due to disrupted networks, uncertain life situations, and language barriers. Additionally, a sedentary lifestyle increases the risk of noncommunicable diseases, so health-promoting initiatives involving physical activities are essential. PURPOSE: To explore physiotherapists' clinical reasoning and collaboration with refugee families in developing group-based health-promoting physical exercising to increase participants' wellbeing, sense of togetherness, and self-efficacy. METHODS: The design was participating action research with 24 resettled refugees from Syria. Data consisted of field notes and three focus group interviews. Data gathering followed a phenomenological approach, and the four-step analysis was inspired by Giorgi. RESULTS: Based on clinical reasoning and collaboration with the participants and their wishes, the physiotherapists organized a physical exercise intervention integrating language learning. The physiotherapists based the intervention on social cognitive theory, focusing on the group's and the individual's capacity and working with the participants on exercise and organizational adaptations to the group and individual. The participants appreciated the joyful physical activities, body awareness, and a sense of togetherness. To accommodate that many suffered from musculoskeletal pain, the physiotherapists developed an intervention for therapeutic exercising that included individual assessment and pain management. CONCLUSION: The physiotherapists' clinical reasoning in working with refugees included the cultural, linguistic, and social context rooted in a salutogenic perspective. The participants' wellbeing and self-efficacy in adhering to exercise increased. They experienced pain relief and increased confidence in using the body.

Outpatients' perspectives of quality in rehabilitation - development and validation of a patient-reported experience measure (PREM).

PURPOSE: This study aimed to develop and validate a patient-reported experience measure (PREM) to examine the patients' perspectives on the quality of outpatient physiotherapy and occupational therapy rehabilitation. MATERIALS AND METHODS: A systematic literature search in PubMed, Embase, Scopus, and Cinahl was conducted to identify relevant themes for the questionnaire. Fourteen studies were analyzed through a systematic text condensation to identify quality aspects in the rehabilitation from patients' perspectives. Further, based on the analysis, 13 items with answers on a five-point Likert scale were developed. Face validity and content validity were established during interviewing 14 municipality outpatients. Finally, to determine the construct validity and internal consistency, the questionnaire was distributed to 385 patients with various diagnoses. RESULTS: The final questionnaire, Outpatients' Experience of quality in Rehabilitation (OPER), demonstrated good face and content validity and covered patients' experience of quality in municipal rehabilitation. Data from 307 respondents established construct validity and high internal consistency and showed, in general, a positive experience of outpatient rehabilitation. CONCLUSIONS: The OPER demonstrates satisfactory psychometric properties based on an extensive development and validation process. By assessing outpatients' experience of the rehabilitation process, OPER offers a measurement of the quality of therapists' practice of patient-centered rehabilitation.

Quality in outpatient rehabilitation should be measured with patient-reported experience measures (PREMs) that encompass patients' experience of the rehabilitation process.Based on analyses of the literature and a thorough validation process, the study developed a PREM for outpatient rehabilitation: OutPatients' Experience of quality in Rehabilitation (OPER).OPER demonstrates satisfying psychometric properties in an outpatient population with various diagnoses.OPER is based on patient-centeredness in meeting with physiotherapists and occupational therapists.

Making meaning of everyday life in the context of lung cancer treatment-a qualitative study of outpatients' perspectives.

BACKGROUND: The increasing survival after a lung cancer diagnosis implies that patients live longer with the disease, which means that symptoms and side effects of the treatment become part of everyday life. AIM: The study explored how older adults make meaning of everyday life when undergoing treatment for their lung cancer. MATERIAL AND METHODS: A qualitative study using semi-structured interviews was conducted with 12 older adults with lung cancer undergoing various treatments. The analysis followed Giorgi's phenomenologic five-step method. RESULTS: The analysis revealed three partly overlapping themes: meeting the health care system, losing identity, and struggling for meaning in everyday life. The patients appreciate clear and coherent communication at the oncology clinic. They had different needs for support from organised support groups, friends, communities, or relatives to make meaning of everyday life. CONCLUSION: Creating meaning in everyday life is essential despite the disease and the treatments' side effects. Interpersonal relationships create meaningfulness in everyday life through a salutogenic perspective that makes everyday life comprehensible and manageable. SIGNIFICANCE: The patients need an everyday life perspective on the disease and the side effects, which a salutogenic approach in the encounter with the health care system could support.

Health and wellbeing in refugee families from Syria resettled in Denmark.

Aims: The aim was to evaluate self-reported health status and wellbeing in a well-defined group of refugee families from Syria 2-4 years after resettlement in Denmark, and, where possible, compare it with a Danish reference population. The purpose was to determine the need for specialized health care to resettled refugees. Methods: This cross-sectional study involved 90 individuals from Syria aged 13-56 years. We used questionnaire survey to assess the general health and wellbeing in the study population in relation to a Danish reference population. Objective measurements of selected health indicators like overweight, hypertension and levels of cholesterol and blood glucose (HbA1c) were also determined for the study population. Results: Mean wellbeing scores and the proportion of study participants rating their health as good were lower among the study participants compared with the Danish population for all age groups. The proportion of participants who reported often being alone against their will was significantly higher than among Danes, as was the proportion who had nobody to talk to when having problems. A significantly higher proportion of participants experienced various forms of pain or discomfort than in the Danish population. Overall, 23.6% and 3.4% of participants had elevated cholesterol and HbA1c levels, respectively, and the prevalence of overweight (BMI ≥ 25) was 70%. Hypertension was more frequent (16.2%) than in another refugee population in Denmark (9%). Conclusions: The study demonstrated various mental and physical health challenges among the Syrian refugee families, and their health and wellbeing appeared to be substantially poorer as compared to the Danish reference population. The findings emphasize the need for systematic and specialized health care services at a municipality level to resettling refugees as a prerequisite for the refugees to become contributing citizens.

Internal consistency and construct validity of the Short Musculoskeletal Function Assessment (SMFA) in older adults.

OBJECTIVE: The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting. METHODS: This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: 'mobility', 'daily activities', 'emotional status', and 'function of the arm and hand'. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity. RESULTS: We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach's alpha values of 0.90-0.94 for the SMFA indices and 0.77-0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p < 0.05, SMFA-Bother r = 0.72, p < 0.05). Only fair correlations were found between SMFA index scores and clinical outcome measures. DISCUSSION: This study demonstrated that the SMFA has adequate internal consistency and construct validity for self-reported health status in older adults, especially when considering components covering physical health status. However, we only observed fair correlations between SMFA and clinical outcome measures, indicating that SMFA does not adequately capture muscle strength and functional capacity.

I'll be back - Predictive validity of adults' expectations for recovery after fractures - A longitudinal observational study.

PURPOSE: Recovery after fractures due to accidents relates to all aspects of the biopsychosocial model. Therefore, it is difficult for the patients to foresee the consequences of the fractures. This study aimed to examine 1) patients' expectations regarding the impact of the injury on everyday life, 2) predictive validity of their expectations after six months, and 3) factors that predict a return to work. PATIENTS AND METHODS: Patients were 18-64 years old and hospitalized with simple or compound/multiple fractures due to an accident. During admission, structured interviews were conducted with a questionnaire covering working conditions, expectations regarding recovery, sports, economy, family, household, and return to work. Additionally, mental and physical status were covered with Short Musculoskeletal Function Assessment questionnaire (SMFA) and Short Form 36, and working conditions were uncovered too. After six months, telephonic interviews were conducted with the 164 available patients to elucidate the impact of the fractures on everyday life, their health status, and sick leave. Likelihood ratios, post-test probabilities, and logistic regression analysis were performed to establish if patients' expectations predicted recovery, economy, sports, family, household, and return to work. RESULTS: Few patients' baseline expectations about everyday life were met. The likelihood ratios were small, and the post-test probabilities for expectations consistent with outcomes were between 18% and 68%, with recovery as the lowest and participation in sports as the highest. In the multivariate analysis, patients' expectations did not predict short-term (less than two months) or long-term sick leave (more than three months). Self-rated health and the bother index of SMFA were significant short-term and long-term predictors for sick leave. Additionally, vitality, pain, and decision latitude at work predicted sick leave of less than two months. CONCLUSION: A few days after the accident, patients' expectations about everyday life are not associated with outcomes six months later. Likelihood ratios indicate difficulties for the patients in predicting fractures' consequences on various aspects of everyday life. Return to work was associated with self-rated health and the bother index of SMFA. Future research should examine if fracture patients can benefit from comprehensive, individual counseling during admission to set appropriate expectations.

Six-months outcome after fracture for working-age persons analyzed using the International Classification of Functioning, Disability, and Health - a prospective cohort observational study.

BACKGROUND: Fractures following trauma affect physical and mental health for working-age persons, and the International Classification of Functioning, Disability, and Health (ICF) can help therapists understand the fractures' impact on daily lives. PURPOSE: To examine self-reported functioning and outcomes six months after upper and lower body fractures and compare limitations using the ICF. METHODS: Data were collected from 160 patients with fractures as part of a prospective cohort study. The primary outcome measure was the Short Musculoskeletal Function Assessment questionnaire that covers all domains of the ICF. Moreover, sick leave, sense of coherence, and physical activity were reported. RESULTS: Six months after the injury, function had improved significantly, but patients reported problems on all domains in the ICF with few differences between the upper and lower body groups. Leisure activities caused problems for 63 (38.8%) of the patients and bothered 86 (53.8%). Problems performing work bothered 63 (39.4%) with no significant difference between the groups, although a significantly higher proportion in the upper body group had returned to work within two months (p < .001). CONCLUSION: Six months after fractures, adults reported problems on all ICF domains, especially on the participation dimension, which therapists should address in the rehabilitation process.

Change in sense of coherence and health-related quality of life after injury - a prospective cohort study.

PURPOSE: To investigate how accidents leading to fracture affect sense of coherence and health-related quality of life 6 months later and the association between the two phenomena. MATERIALS AND METHODS: A cohort study including 201 patients admitted to hospital with fractures was conducted. Data were based on structured interviewing a few days after admission and 6 months later. Sense of coherence was evaluated with a nine-item scale and health-related quality of life was examined with the subscales of Short Form-36 (SF-36). RESULTS: Follow-up comprised 164 patients (81.6%), mean age 47 years. Sense of coherence changed to be either stronger (43%) or weaker (41%) and was stable for 15.9% of the participants. Health-related quality of life changed positively after 6 months but did not reach normative values. Strong sense of coherence was significantly associated with the SF-36 subscales emotional role functioning, social functioning, vitality, and mental health. CONCLUSIONS: Accidents leading to fracture can be stressful life events that could influence an individual's sense of coherence to be stronger or weaker. The association between sense of coherence and health-related quality of life emphasises the importance of therapists supporting the patients' personal resources and promote a salutogenic focus.IMPLICATIONS FOR REHABILITATIONAn injury may change an individual's sense of coherence to be stronger or weaker.For patients who sustain fracture, sense of coherence should be included in therapists' analysis of personal resources and support a salutogenic perspective.Health-related quality of life is especially for younger individuals affected by an accident and its consequences and need a guided and meticulous rehabilitation course.

Cross-cultural adaptation and validation of the Danish version of the Short Musculoskeletal Function Assessment questionnaire (SMFA).

PURPOSE: The aim of this study was to translate and culturally adapt the Short Musculoskeletal Function Assessment (SMFA) into Danish (SMFA-DK) and assess the psychometric properties. METHODS: SMFA was translated and cross-culturally adapted according to a standardized procedure. Minor changes in the wording in three items were made to adapt to Danish conditions. Acute patients (n = 201) and rehabilitation patients (n = 231) with musculoskeletal problems aged 18-87 years were included. The following analysis were made to evaluate psychometric quality of SMFA-DK: Reliability with Chronbach's alpha, content validity as coding according to the International Classification of Functioning, Disability and Health (ICF), floor/ceiling effects, construct validity as factor analysis, correlations between SMFA-DK and Short Form 36 and also known group method. Responsiveness and effect size were calculated. RESULTS: Cronbach's alpha values were between 0.79 and 0.94. SMFA-DK captured all components of the ICF, and there were no floor/ceiling effects. Factor analysis demonstrated four subscales. SMFA-DK correlated good with the SF-36 subscales for the rehabilitation patients and lower for the newly injured patients. Effect sizes were excellent and better for SMFA-DK than for SF-36. CONCLUSION: The study indicates that SMFA-DK can be a valid and responsive measure of outcome in rehabilitation settings.

Importance of a patient-centred approach in ensuring quality of post-fracture rehabilitation for working aged people: A qualitative study of therapists' and patients' perspectives.

BACKGROUND: Quality in rehabilitation is important for recovery and return to work for people at working age, who sustain fractures, but there is limited information about what constitutes quality in rehabilitation. OBJECTIVE: To identify factors that therapists and patients define as quality in the rehabilitation process for working population after simple or multiple fractures. METHODS: The study is a qualitative study based on grounded theory approach with semi-structured interviews conducted individually or in focus groups. Seven patients with fractures, 15 physiotherapists and eight occupational therapists from hospitals, municipalities and private practice were included in the study. Grounded theory was used to analyze data and develop a theory about quality in the rehabilitation process. RESULTS: Partnership was identified as the core category with continuity of rehabilitation and patient-centred approach as its dimensions. Themes in the patient-centred approach were Biopsychosocial understanding and Professionalism. The patient's perceived control enhanced when the therapist addressed the whole situation, especially return to work. Therapist's individual considerations and patient's involvement in decisions about the therapeutic methods had the same effect. CONCLUSION: Quality in rehabilitation was enhanced in all its dimensions namely structure, process and outcome when therapists used the patient-centred approach and addressed the patient's overall situation.

[Rehabilitation using telemedicine].

The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of dealing with the demographics changes of a growing elderly population and increasing number of patients with chronic conditions needing rehabilitation. Results from research indicate, that TR is equally as efficient as usual care. However, there is a need for more studies of high quality on the efficacy and cost-effectiveness of TR just as the long-term effects of TR have to be determined. In addition, there is a need for qualitative studies elucidating the patients' perspective of TR.

Quality in rehabilitation after a working age person has sustained a fracture: partnership contributes to continuity.

OBJECTIVE: Research in quality of rehabilitation has mostly concerned patients with chronic diseases, but the aim of the present study was to investigate what constitutes good quality in rehabilitation after a person has sustained a fracture at working age, from both patients' and therapists' perspectives. PARTICIPANTS: Seven patients with bone fracture, aged 32-60 years, and 23 occupational therapists and physiotherapists from hospitals, municipalities and private practices in Denmark. METHODS: Qualitative study with in-depth semi-structured interviews. Data were analyzed according to grounded theory method. RESULTS: Partnership was a central theme that was constituted by continuity of rehabilitation and therapists' use of a patient-centred approach. Patients' experiences of continuity of rehabilitation was supported, not only by organizational factors, but depended also on values constituting the patient-centred approach. Therapists used their professional network to refine the transition process from hospital into the community, but there was no co-operation between departments in the municipalities about patients' return to work. CONCLUSIONS: The study suggests that patients with acute injuries need partnership, respect, and understanding through the rehabilitation course. Personal relations were important for continuity of rehabilitation (i.e. that organizational quality depended more on therapists' efforts to promote continuity for the patient than organizational tools).

Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial.

OBJECTIVE: Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. METHODS: Court-ordered patients with substance abuse ( n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. RESULTS: Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. CONCLUSIONS: Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. CLINICAL IMPLICATIONS: The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.

Commitment to coercive care in relation to substance abuse reports to the social services. A 2-year follow-up.

BACKGROUND: In Sweden, a person with substance abuse can be reported to the social services for an investigation about commitment to coercive care. After a change in legislation, municipalities varied greatly in the ratio of commitments/reports compared with the period before the legislation was amended. AIMS: The primary aims of this study were first, to investigate whether subjects from municipalities with a high ratio of commitments/reports have a better outcome compared with subjects from municipalities with a low ratio and second, if a high ratio has an impact on mortality. METHODS: The study involved two municipalities with high ratio of commitments/reports with 56 cases reported for substance abuse including 31 committed cases (55%). It also included two municipalities with a low ratio, 50 reported cases including six committed cases (12%). Two social service inspectors at the country administrative board assessed the cases in terms of severity of addiction according to legal criteria (κ(s)=0.66), indicating good inter-rater agreement. A global index based on information about substance abuse, employment and housing was used as outcome measure at the 2-year follow-up. RESULTS: Global outcome did not differ between cases from high- and low-ratio municipalities. Seven subjects had deceased because of causes related to substance abuse. None of the deceased had been committed to coercive care. CONCLUSIONS AND CLINICAL IMPLICATIONS: In conclusion, the different ratios of commitments/reports did not influence global outcome. Commitment may reduce substance-related deaths.

ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial.

OBJECTIVES: To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity. DESIGN: Multicentre, multinational, randomised clinical trial with masked outcome assessment. SETTING: Stroke units in Denmark, China, Poland, and Estonia. PARTICIPANTS: 314 patients with ischaemic stroke aged >or=40 years who were able to walk-157 (mean age 69.7 years) randomised to the intervention, 157 (mean age 69.4 years) in the control group. INTERVENTIONS: Patients randomised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months. Control patients had follow-up visits with the same frequency but without instructions in physical activity. MAIN OUTCOME MEASURES: Physical activity assessed with the Physical Activity Scale for the Elderly (PASE) at each visit. Secondary outcomes were clinical events. RESULTS: The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group (difference 5.0 (95% confidence interval -5.8 to 15.9), P=0.36. The intervention had no significant effect on mortality, recurrent stroke, myocardial infarction, or falls and fractures. CONCLUSION: Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score. More intensive strategies seem to be needed to promote physical activity after ischaemic stroke. TRIAL REGISTRATION: Clinical Trials NCT00132483.

The ExStroke Pilot Trial: rationale, design, and baseline data of a randomized multicenter trial comparing physical training versus usual care after an ischemic stroke.

INTRODUCTION: A high level of physical activity is associated with a decreased risk of first stroke and physical activity modifies recognized stroke risk factors and is recommended for stroke survivors. Available research shows that stroke patients can increase their level of physical performance over a short period. When the intervention period is over, physical performance often declines towards baseline level. Currently, there is no evidence on the association between physical activity and the risk of recurrent stroke. The ExStroke Pilot Trial is a randomized clinical trial with the aim of increasing stroke patients' level of physical activity and secondarily to associate the level of physical activity to the risk of recurrent stroke, myocardial infarction, and all-cause mortality in the two groups. We describe the rationale, design, and baseline data of the ExStroke Pilot Trial. METHODS: Patients with ischemic stroke above 39 years were randomized to intervention or control group. The intervention group will, over a 2-year period, receive information on and verbal instruction to exercise by a physiotherapist or a physician. The control group will receive the department's usual care. Physical activity is assessed in both groups seven times during follow-up using the Physical Activity Scale for the Elderly (PASE) questionnaire, which quantifies the amount of physical activity done in the last seven days prior to interview. The PASE score constitutes the primary outcome measure. The secondary outcome is the time from randomization to recurrent stroke, myocardial infarction, or all-cause mortality. Further outcome measures include: time from randomization to recurrent stroke, myocardial infarction, and vascular death; recurrent stroke; modified Rankin Scale; quality of life; occurrence of falls and fractures. TRIAL STATUS: From 9 centers in 4 countries, 314 patients were included and follow-up is ongoing. Mean age and standard deviation (SD) of the study participants was 68.4 (11.9) years and 56.4% were male. Mean (SD) PASE score was 84.1 (55.9) and median (interquartile range) Scandinavian Stroke Scale score was 54 (51-58).

Level of physical activity in the week preceding an ischemic stroke.

BACKGROUND: Most observational studies investigating physical activity as a risk factor for stroke have concentrated on the years preceding a stroke event. In the present case control study we compared the reported level of physical activity performed during the week preceding an ischemic stroke with that of community controls. Furthermore we calculated the odds ratio for stroke based on the level of physical activity. SUBJECTS AND METHODS: Patients with an ischemic stroke were recruited consecutively from hospitals covering Copenhagen City. Community controls were recruited among participants of the Copenhagen City Heart Study and matched according to age and gender. The level of physical activity was assessed using The Physical Activity Scale for the Elderly (PASE), which quantifies the amount of physical activity done in the last 7 days. RESULTS: A total of 127 cases and 301 control subjects were included in the study. Mean (+/-SD) PASE scores for cases were 76.0 +/- 46.2 and 119.7 +/- 69.4 for controls (p < 0.001). For each 1-point increase in PASE score the odds ratio for ischemic stroke was 0.98 (0.98-0.99), equivalent to an odds ratio of 0.86 (95% CI: 0.82-0.90) for each 10-point increase. CONCLUSION: Stroke patients are less physically active in the week preceding an ischemic stroke when compared to age- and sex-matched controls. Increasing PASE score was inversely, log-linearly and significantly associated with odds ratio for ischemic stroke.