Effects of Real-Time Pressure Map Feedback on Confidence in Pressure Management in Wheelchair Users With Spinal Cord Injury: Pilot Intervention Study.

BACKGROUND: Wheelchair users with a spinal cord injury (SCI) are at a high risk for developing pressure injuries (PIs). Performing weight shifts is a primary method of pressure management for PI prevention; however, individuals with SCI may lack confidence in their abilities to perform adequate pressure relief due to their lack of sensation. Real-time seat interface pressure mapping feedback may provide partial substitution for sensory feedback such that an individual's confidence is improved. OBJECTIVE: We aim to examine how confidence for pressure management by wheelchair users with SCI was impacted by providing access to real-time, on-demand seat interface pressure mapping feedback. METHODS: Adults with SCI (N=23) completed self-efficacy questions addressing confidence around 4 factors related to performing weight shifts in this longitudinal, repeated-measures study. We evaluated the impact of providing standard PI prevention education and access to live pressure map feedback on confidence levels for performing weight shifts. RESULTS: Access to live pressure map feedback while learning how to perform weight shifts resulted in significantly higher confidence about moving far enough to relieve pressure at high-risk areas. Confidence for adhering to the recommended weight shift frequency and duration was not significantly impacted by in-clinic education or use of pressure map feedback. Confidence that performing weight shifts reduces PI risk increased most following education, with slight additional increase when pressure map feedback was added. CONCLUSIONS: Access to live pressure mapping feedback improves confidence about performing weight shifts that relieve pressure when provided in the clinical setting and demonstrates potential for the same in the home. This preliminary exploration of a smartphone-based pressure mapping intervention highlights the value of access to continuous pressure mapping feedback to improve awareness and confidence for managing pressure. TRIAL REGISTRATION: ClinicalTrials.gov NCT03987243; https://clinicaltrials.gov/study/NCT03987243.

Efficacy of a Forearm Rotation Orthosis for People With a Hemiparetic Arm.

IMPORTANCE: Insufficient voluntary forearm movements are associated with ineffective and inefficient functional performance among people poststroke. Although evidence supports the application of the occupational therapy task-oriented (OTTO) approach for this population, the training protocol does not explicitly address the role of forearm rotation movements. In addition, a need exists for theoretical support for orthotic interventions for people poststroke.  Objective: To examine the efficacy of (1) a forearm rotation orthosis, (2) the OTTO approach, and (3) the combination of the two with people poststroke with a hemiparetic arm. DESIGN: Stratified, randomized, two-group, single-blinded, repeated-measures design. SETTING: Rehabilitation clinic. PARTICIPANTS: Participants (N = 14) with a diagnosis of stroke and at least 10° of voluntary shoulder and elbow movement. INTERVENTION: Participants were stratified into three groups by motor function (mild, moderate, severe) and randomly assigned either to 6 wk of no treatment followed by 6 wk of OTTO or to 6 wk of orthotic intervention followed by 6 wk of orthosis plus OTTO. Outcomes and Measures: Primary outcome measures were the Canadian Occupational Performance Measure (COPM), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL), administered at baseline (Week 1), at the end of Phase 1 (Week 7), and at the end of Phase 2 (Week 15) by blinded evaluators. RESULTS: Both groups showed clinically important improvements on the COPM. No significant differences were found on the WMFT or MAL. CONCLUSIONS AND RELEVANCE: The OTTO intervention provides clinically important benefits in self-perceived functional performance to people poststroke. What This Article Adds: The OTTO approach is an occupation-focused intervention that aims at functional performance and emphasizes clients' active engagement throughout the process. The findings suggest that the protocol of the OTTO intervention and its efficacy are appropriate for clinical practice.

REFRESH protocol: a non-inferiority randomised clinical trial comparing internet and teleconference to in-person 'Managing Fatigue' interventions on the impact of fatigue among persons with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. It is considered a major cause of non-traumatic disability in young adults. One of the most common and disabling symptoms of MS is fatigue. MS fatigue can impact all aspects of quality of life, including physical, mental and social function. Fortunately, fatigue self-management interventions, such as 'Managing Fatigue: A 6 week energy conservation course', can decrease the impact of fatigue and improve health-related quality of life. The purpose of this study is to compare three modes of delivering the Managing Fatigue intervention-two remote delivery formats (teleconference and internet) and one in-person format-on perceptions of fatigue and its impact on physical, mental and social function. METHODS AND ANALYSIS: A non-inferiority randomised clinical trial is being conducted to compare the three delivery formats (1:1:1 allocation ratio) among 582 participants with MS living in the Midwestern and Northeastern United States. The hypothesis is that teleconference and internet versions of the intervention are non-inferior to the traditional mode of clinical service delivery (ie, one to one, in person) in terms of the primary outcome of self-reported fatigue impact (ie, Fatigue Impact Scale) and the secondary outcome of health-related quality of life (ie, Multiple Sclerosis Impact Scale). Outcomes are being measured at baseline, 2 months, 3 months and 6 months. The primary analysis tool will be linear mixed effects model. The prespecified inferiority margin for the primary outcome is 10 points. We will also examine whether baseline characteristics (eg, sociodemographic) moderate outcomes of the Managing Fatigue intervention and whether changes in self-efficacy and fatigue self-management behaviours mediate changes in outcomes. ETHICS AND DISSEMINATION: The protocol is approved centrally by the institutional review board at Case Western Reserve University. Eligible participants give consent before being enrolled and randomised into the study. The study results will be disseminated through relevant advocacy organisations, newsletters to participants, publication in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: NCT03550170; Pre-results.

Development, construct validity, and reproducibility of a mimetic sealed jar measuring the dynamics of opening.

Measurement of the dynamic kinetics involved in opening a jar may enable health care professionals to understand and train individuals in optimal hand/grip mechanics. This technical note details the design, validity, and reproducibility testing of a mimetic jar capable of measuring the forces and moments and isolated digital forces applied to the lid of the jar. An ecological jar instrument was designed with a torque limiter to provide a natural opening mechanism while a six-axis load cell and force sensing resistors recorded the way individuals applied force to the jar and lid during opening of a sealed container. A total of 115 volunteers participated in a validation of the device and an additional 36 participated in repeatability testing. Compared with prior instruments, this mimetic jar provides more force data and a simulated opening experience - making this jar instrument unique. Future studies utilizing the jar designed herein may allow health care professionals to evaluate patients suffering from debilitating osteoarthritis, fibromyalgia or other neuromuscular conditions and offer improvement strategies.

Effects of a One-to-One Fatigue Management Course for People With Chronic Conditions and Fatigue.

OBJECTIVE: We assessed the impact of a one-to-one fatigue management course on participants' fatigue, self-efficacy, quality of life, and energy conservation behaviors. METHOD: This observational study used a one-group, pretest-posttest, follow-up design. Forty-nine people with chronic conditions and fatigue participated in the one-to-one fatigue management course in outpatient and community-based settings. The Functional Assessment of Chronic Illness Therapy-Fatigue Scale was used to measure fatigue; the Functional Assessment of Cancer Therapy-General measured quality of life; and the Self-Efficacy for Performing Energy Conservation Strategies Assessment was used to measure self-efficacy. RESULTS: Participants showed significant reductions in fatigue and significant increases in self-efficacy and quality of life at posttest. These beneficial effects were maintained at follow-up. The Social Well-Being subscale was the only measure on which outcomes did not change significantly. CONCLUSION: The one-to-one fatigue management course is a beneficial intervention for people with chronic conditions and fatigue.

Efficacy of Occupational Therapy Task-oriented Approach in Upper Extremity Post-stroke Rehabilitation.

There is a need for more effective rehabilitation methods for individuals post-stroke. Occupational Therapy Task-Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more-affected Upper Extremity (UE) of persons post-stroke. A randomized single-blinded cross-over trial recruited 20 participants post-stroke (mean chronicity = 62 months) who demonstrated at least 10° active more-affected shoulder flexion and abduction and elbow flexion-extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no-intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post-stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.

One-year follow-up to a randomized controlled trial of an energy conservation course for persons with multiple sclerosis.

In this randomized controlled trial, 169 persons with multiple sclerosis were randomly assigned to an immediate intervention group or a delayed control group using a crossover design. The outcome measures (Fatigue Impact Scale and SF-36 Health Survey) were measured four times before and after courses. This study investigated whether the immediate benefits of a 6-week, community-based, energy conservation course for persons with multiple sclerosis were maintained at 1-year follow-up. We performed intent-to-treat and compliers-only analyses using mixed effects analysis of variance models. Results showed that the beneficial effects were maintained 1-year postcourse compared with immediate postcourse. In addition, there were significant improvements in all three subscales of the Fatigue Impact Scale and in four subscales of SF-36 Health Survey 1-year postcourse compared with precourse. Together, these results provide strong evidence that the beneficial effects of the energy conservation course taught by occupational therapists were maintained up to 1-year postcourse.

Randomized controlled trial of an energy conservation course for persons with multiple sclerosis.

OBJECTIVE: To assess the short-term efficacy and effectiveness of a six-week energy conservation course on fatigue impact, quality of life and self-efficacy for persons with multiple sclerosis (MS). METHODS: In this randomized controlled trial, we randomly assigned 169 persons with MS to an immediate intervention group or a delayed control group using a crossover design. The outcome measures: Fatigue Impact Scale, SF-36 Health Survey and Self-Efficacy for Performing Energy Conservation Strategies were measured before and after courses and no intervention control periods. We performed intent-to-treat analysis and compliers-only analyses using mixed effects analysis of variance models. RESULTS: Taking the energy conservation course had significant effects on reducing the physical and social subscales of Fatigue Impact Scale and on increasing the Vitality subscale of the SF-36 scores compared with not taking the course. Additional subscales were significant depending on methods of analyses. Self-Efficacy for Performing Energy Conservation Strategies Assessment increased significantly (P <0.05) postcourse compared to precourse. CONCLUSIONS: Results support the efficacy and effectiveness of the energy conservation course to decrease fatigue impact, and to increase self-efficacy and some aspects of quality of life.