Between commitment and avoidance - working age stroke survivors' perceptions of physical activity and sedentary behaviour: a qualitative study.

BACKGROUND: It is critical for stroke survivors in working age to develop skills and confidence for long-term self-management of physical activity and exercise training to maintain a healthy lifestyle and decrease the risk of recurrent stroke and other cardiovascular diseases. Still, knowledge is scarce about concerns and experiences of physical activity and sedentary behaviour after stroke in working age, and further qualitative studies are required. The aim of this study was to explore and describe perceptions of physical activity and sedentary behaviour in stroke survivors under 65 years who are living with disability. METHODS: A qualitative design with individual semi-structured interviews was selected to generate rich data. Ten informants aged 36-61 years were interviewed 0.5-25 years after their stroke. The interviews were analysed with qualitative content analysis, with an inductive and interpretive approach. RESULTS: A two-sided contradictory relationship to physical activity and sedentary behaviour was identified. The overarching theme found was "Physical activity and sedentary behaviour - between commitment and avoidance", comprising three main themes; "Physical activity - medicine for body and mind", "Physical activity reminds of limitations", and "Sedentary behaviour - risk, rest, and alternative". The informants perceived physical activity as medicine, important for both physical and mental functioning, but also as a constant reminder of having a body that no longer functions as it used to. These mixed perceptions and feelings influenced the informants' behaviours related to physical activity and sedentary behaviour, and both commitment and avoidance were clear strategies. CONCLUSIONS: Working age stroke survivors expressed a clear positive perception of the importance of physical activity for health. However, physical activity was also described as a strong reminder of limitations which paradoxically could lead to sedentary behaviour. To support a physically active lifestyle post stroke, effective interventions as well as health promotion, counselling and patient education are imperative. These should be delivered by appropriately skilled health care professionals.

Organisation of services and systems of care in paediatric spinal cord injury rehabilitation in seven countries: a survey with a descriptive cross-sectional design.

STUDY DESIGN: International multicentre cross-sectional study. OBJECTIVES: To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. SETTING: Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. METHODS: An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. RESULTS: The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. CONCLUSIONS: As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study.

QUESTIONS: What is the 1-year incidence of falls and injurious falls in a representative cohort of community-dwelling ambulatory individuals with chronic spinal cord injury? What are the predictors of recurrent falls (more than two/year) and injurious falls in this population? DESIGN: One-year longitudinal observational multi-centre study. PARTICIPANTS: A representative sample of 68 (of 73 included) community-dwelling ambulatory individuals with traumatic SCI attending regular follow-up programs at rehabilitation centres. OUTCOME MEASURES: Primary outcome measures were incidence and predictors of recurrent falls (more than two/year) and injurious falls reported every 2 weeks for 1year. RESULTS: A total of 48% of participants reported recurrent falls. Of the 272 reported falls, 41% were injurious. Serious injuries were experienced by 4% of participants, all of whom were women. Multivariate logistic regression analysis showed that recurrent falls in the previous year (OR=111, 95% CI=8.6 to 1425), fear of falling (OR=6.1, 95% CI=1.43 to 26) and longer time taken to walk 10m (OR=1.3, 95% CI=1.0 to 1.7) were predictors of recurrent falls. Fear of falling (OR=4.3, 95% CI=1.3 to 14) and recurrent falls in the previous year (OR=4.2, 95% CI=1.2 to 14) were predictors of injurious falls. CONCLUSION: Ambulatory individuals have a high risk of falling and of fall-related injuries. Fall history, fear of falling and walking speed could predict recurrent falls and injurious falls. Further studies with larger samples are needed to validate these findings. [Jørgensen V, Butler Forslund E, Opheim A, Franzén E, Wahman K, Hultling C, Seiger Å, Ståhle A, Stanghelle JK, Roaldsen KS (2017) Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study. Journal of Physiotherapy 63: 108-113].