Feasibility of a Broad Test Battery to Assess Physical Functioning Limitations of People Experiencing Homelessness.

BACKGROUND: People who are homeless experience poor health. Reflective of overall health and factors such as acquired injuries, physical ability or functioning is often low among people who are homeless, but there is a lack of consistency of measures used to evaluate this construct. The aim of this study was to evaluate the feasibility of a broad test battery to evaluate limitations in physical functioning among people who are homeless. METHODS: This cross-sectional, observational study occurred in a hospital in Dublin, Ireland. We evaluated lower extremity physical function (Short Physical Performance Battery), falls risk (timed up and go), functional capacity (six-minute walk test), stair-climbing ability (stair climb test), frailty (Clinical Frailty Scale), grip strength (handgrip dynamometer) and muscular mass (calf circumference measurement) in a population of people experiencing homelessness admitted for acute medical care. The test completion rate was evaluated for feasibility. RESULTS: The completion rate varied: 65% (Short Physical Performance Battery), 55.4% (timed up and go), 38% (six-minute walk test), 31% (stair climb test), 97% (Clinical Frailty Scale), 75% (handgrip dynamometer), 74% (calf circumference measurement)). Collectively, the most common reasons for test non-participation were pain (24.1%, n = 40), not feeling well or able enough (20.1%, n = 33), and declined (11%, n = 18). CONCLUSION: The feasibility of the test battery was mixed as test participation rates varied from 31% to 97%. Physical functioning tests need to be carefully chosen for people who are homeless as many standard tests are unsuitable due to pain and poor physical ability.

Physical functioning limitations and physical activity of people experiencing homelessness: A scoping review.

Background: Adults who are experiencing homelessness suffer higher levels of premature mortality and age-related medical conditions compared to the general population, but little is known about physical factors that influence their health experience. This review aimed to evaluate what is known about physical functional limitations and physical activity levels, and how these constructs are measured in adults experiencing homelessness. Methods: This review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews. Suitable quantitative and qualitative articles were searched using PubMed, CINAHL, EMBASE, PsychInfo, Web of Science and SCOPUS databases using a combination of keywords and medical subject headings  and a grey literature search was also performed. Two reviewers independently screened articles for inclusion. Inclusion criteria were studies that examined physical functional limitations and/or physical activity among homeless adults (with/without co-occurring mental illness, infectious disease, substance use disorder), as a primary or secondary outcome measure. Results: We identified 15 studies for inclusion including 2,018 participants. Studies were primarily quantitative (n=11) and there were 4 qualitative studies. The following physical focused measures were evaluated across studies; mobility levels (n=2), frailty (n=1), flexibility (n=2), strength (n=1), physical symptom burden (n=3), physical activity levels (n=6) and exercise capacity (n=3). The majority of studies reported high levels of functional limitations among participants and low physical activity levels although a spectrum of abilities was noted. Conclusion: This review showed that many adults who are homeless appear to show a high burden of physical functional limitations and low physical activity levels but more objective and consistent measures should be applied to examine these factors in future studies. This will help address and plan future care, physical rehabilitation and housing needs for this vulnerable cohort. This scoping review will help direct research and future systematic reviews in this emerging area.

Addressing complex societal challenges in health education - A physiotherapy-led initiative embedding inclusion health in an undergraduate curriculum.

People who are socially excluded experience vastly poorer health outcomes compared to the general population. Inclusion Health seeks to directly address this health inequity. Despite the increased requirement for health care and the increased prevalence of complex health and social needs in socially excluded people, Inclusion Health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in Inclusion Health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within Physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of Inclusion Health. Secondly, we have also initiated a step-wise process of introducing the topic of Inclusion Health into the formal undergraduate curriculum. This letter demonstrates the need to implement strategies to incorporate Inclusion Health into the curriculum and the approaches described are applicable to diverse health professions and settings.