Mobilization and Exercise Intervention for Patients With Multiple Myeloma: Clinical Practice Guidelines Endorsed by the Canadian Physiotherapy Association.

OBJECTIVE: Individuals with multiple myeloma (MM) often have reduced functional performance due to the cancer itself or as a direct side effect of cancer treatments. Physical therapy is a part of cancer rehabilitation; however, no guidelines are available to provide information and direction for physical therapists managing patients with MM. The goal of this guideline is to provide recommendations based on a systematic review and consensus process that physical therapists can use to manage patients with MM. METHODS: A systematic review of the literature published until August 2018 was performed in 8 databases with 2 independent reviewers assessing quality. Seventeen articles were identified as relevant, and a draft guideline was developed in the form of action statements. A total of 10 physical therapists with hematology experience and 10 patients with MM were recruited for consensus process. A priori threshold of 80% agreement was used to establish a consensus for each statement. The draft guidelines were reviewed externally by 4 methodologists using the AGREE II tool and a stakeholder representing OH (Cancer Care Ontario) Program in Evidence Based Care, McMaster University. The final guideline was reviewed and officially endorsed by the Canadian Physiotherapy Association. RESULTS: A total of 30 action statements were developed that achieved consensus, indicating physical therapy recommendations based on physiological markers (ie, hemoglobin, platelet count), complete patient presentation, and the stage of medical treatment. CONCLUSION: These clinical practice guidelines were developed to aid physical therapists in implementing evidence-based and best-practice care for patients with MM to optimize rehabilitation outcomes. IMPACT: These guidelines fill an important knowledge gap and are the first to provide information specifically for physical therapist management of patients with MM.

Evidence-based guidelines for physiotherapy management of patients with multiple myeloma: study protocol.

BACKGROUND: Patients with multiple myeloma (MM) are often treated with chemotherapy, radiation, and, if indicated, autologous stem cell transplant. In addition to side effects of the treatment, patients with MM often have bone pain, pathological fractures, spinal cord compressions, fatigue, and muscle weakness, which negatively impact functional performance and quality of life. Currently, there are no related guidelines for safe and effective physiotherapy (PT) management. Accordingly, the aim of the present study is to develop guidelines for effective physiotherapy management of patients with MM by systematically reviewing and evaluating the available evidence followed by a consensus process to specifically describe the research questions as detailed below. METHODS/DESIGN: Physiotherapy management guidelines for patients with multiple myeloma will be developed based on the results of a systematic search of the following databases: US National Library of Medicine Database (PubMed), Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Elton B. Stephens Co. (EBSCO), Web of Science, Database of Abstracts of Reviews of Effects (DARE), Cochrane Database of Systematic Review, and Physiotherapy Evidence Database (PEDro). All articles will be screened for inclusion and exclusion criteria. Relevant potential articles will be identified and systematically reviewed for final phase of inclusion. Two independent reviewers will systematically review and analyze the quality of identified articles using standardized assessment tools. Scientific conclusions will be drawn and recommendations will be made based on a critical appraisal process. The guideline development will also be based on the team's judgment about the overall quality of the studies and a consensus process. DISCUSSION: Draft guidelines will be developed in the form of action statements based on the strength of evidence and grades of recommendations. The draft guidelines will be reviewed internally by two independent reviewers using AGREE II and externally by a methodological expert from Evidence-Based Care - Cancer Care Ontario and will be sent to the Canadian Physiotherapy Association (CPA) for feedback from physiotherapists. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017064056.

Body Image and Anti-Fat Attitudes: An Experimental Study Using a Haptic Virtual Reality Environment to Replicate Human Touch.

It is well documented that anti-fat attitudes influence the interactions individuals have with overweight people. However, testing attitudes through self-report measures is challenging. In the present study, we explore the use of a haptic virtual reality environment to physically interact with overweight virtual human (VH). We verify the hypothesis that duration and strength of virtual touch vary according to the characteristics of VH in ways similar to those encountered from interaction with real people in anti-fat attitude studies. A group of 61 participants were randomly assigned to one of the experimental conditions involving giving a virtual hug to a female or a male VH of either normal or overweight. We found significant associations between body image satisfaction and anti-fat attitudes and sex differences on these measures. We also found a significant interaction effect of the sex of the participants, sex of the VH, and the body size of the VH. Female participants hugged longer the overweight female VH than overweight male VH. Male participants hugged longer the normal-weight VH than the overweight VH. We conclude that virtual touch is a promising method of measuring attitudes, emotion and social interactions.

The development of a haptic virtual reality environment to study body image and affect.

We report the results of a preliminary study testing the effect of participants' mood rating on visual motor performance using a haptic device to manipulate a cartoonish human body. Our results suggest that moods involving high arousal (e.g. happiness) produce larger movements whereas mood involving low arousal (e.g. sadness) produce slower speed of performance. Our results are used for the development of a new haptic virtual reality application that we briefly present here. This application is intended to create a more interactive and motivational environment to treat body image issues and for emotional communication.

Perceptions of self in 3-5-year-old children: a preliminary investigation into the early emergence of body dissatisfaction.

The main objective of this study was to investigate normal weight and overweight preschool children's ability to understand conceptualizations of body image and their association with parental perceptions of their child's body. One hundred and forty-four children aged 3-5 years were interviewed (68 girls and 76 boys) regarding their body image and their satisfaction with such. Parents completed a questionnaire that probed socio-demographic characteristics as well as their perceptions of their child's body image. Results showed that (1) children's misperceptions corresponded to those held by their parents. Specifically, overweight children and their parents underestimated the child's body size. (2) Gender differences in body dissatisfaction were consistently observed and were similar to those seen in adolescents and adults. It was determined that children's inaccuracies were not a result of developmental limits, that is, the participants' inability to understand the concepts measured.

The prediction of preschool children's weight from family environment factors: gender-linked differences.

The main objective of this study was to test an explanatory model predicting preschool girls' and boys' body weight from certain child variables (food intake, sedentary behaviors, and eating habits), as well as family variables (interaction during mealtime and level of family financial resources allocated to meeting children's eating needs). A randomized stratified subsample of parents was selected from a larger study (Quebec Longitudinal Study of Child Development, QLSCD-1998-2002), with a breakdown of 581 girls and 611 boys of 4 years of age. Children's skin fold ratio, weight, height, and Body Mass Index (BMI) were recorded. Questionnaires were administered to parents (usually the mother). Using structural equation modeling (SEM) separately for girls and boys, the family environment model of healthy weight development was tested. Results yielded a good fit of the model for both genders. For boys, significant predictors of body weight in the model were family food insecurity and conflicts during mealtime. Healthy eating was predicted by food insecurity, mealtime conflicts, and sedentary behaviors. Mealtime conflicts predicted sedentary behaviors. For girls, none of the variables predicted body weight, however food insecurity predicted less healthy eating. These results outline the importance of prevention and intervention within families with young children.

Parental Influence on Young Children's Physical Activity.

Parents influence on their young children's physical activity (PA) behaviours was examined in a sample of 102 preschool-aged children (54 boys). Questionnaires regarding family sociodemographics and physical activity habits were completed. Results showed that children who received greater parental support for activity (B = .78, P < .10) and had parents who rated PA as highly enjoyable (B = .69, P < .05) were significantly more likely to engage in one hour or more of daily PA. Being an older child (B = -.08, P < .01), having older parents (B = -.26, P < .01), and watching more than one hour of television/videos per day (B = 1.55, P < .01) reduced the likelihood that a child would be rated as highly active. Children who received greater parental support for PA were 6.3 times more likely to be highly active than inactive (B = 1.44, P < .05). Thus, parents can promote PA among their preschoolers, not only by limiting TV time but also by being highly supportive of their children's active pursuits.

The influence of puberty onset, body mass index, and pressure to be thin on disordered eating behaviors in children and adolescents.

The main objective of this study is to verify the hypothesis that pubertal development, obesity, body satisfaction, as well as family and peer influences predict unhealthy eating habits in children and adolescents. A randomized stratified sample of young Quebecers aged 9, 13, and 16 years on March 31, 1999 [608 children aged of 9 years (325 girls and 283 boys) and 662 adolescents aged of 13 and 16 years (349 girls and 313 boys)] were used. Children's weight, height, and Body Mass Index (BMI) were recorded. Questionnaires were administered to children and a parent (usually the mother). Among 9-year-old children, this study found that weight loss or weight control behaviors were predicted mainly by the onset of puberty, lower maternal abusive control, and the level of peer pressure. Among adolescents, mother's BMI, income, peer pressure, and negative comments about the child's weight most strongly predicted behaviors to control weight, strategies to lose weight and the frequency of such behaviors. The findings suggest that both parents and children need to understand the impact of comments on a child's behavior.

Precocious puberty in adolescent girls: a biomarker of later psychosocial adjustment problems.

We have investigated the hypothesis that stress condition will accelerate pubertal maturation in adolescent girls and that faster maturing girls will display more behavioral problems than their on-time or late-maturing peers during pubertal development. Longitudinal data were collected yearly from 1986 to 1997. Parents of 1039 French-speaking Canadian girls completed a questionnaire about their characteristics as well as those of their family. To predict onset of puberty by time and cumulative risk factors, a Hierarchical Regression Analysis and a Survival Regression Analysis were conducted. Results revealed that: (1) anxiety at 8 years old, lower level of anxiety a year earlier and more adverse family condition predict a younger age at first menses; and (2) Body Mass Index, conflicts, and sleep disturbances significantly predict the onset of puberty. Complementary standard regression analyses demonstrated that situational stress mediated the effect of these variables. We concluded that precocious puberty could be an indicator of stress in a child, thus, allowing professionals to intervene early and to prevent later problems in psychosocial adjustment.