Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups.

INTRODUCTION: For individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations provided outside of conventional rehabilitation services and strategies used to optimise equitable access and inclusivity in these programmes is lacking. We aim to characterise evaluations of virtual exercise programmes for adults with mobility limitations, and the nature of and extent to which equity, diversity and inclusion considerations are integrated in the research process. METHODS AND ANALYSIS: A scoping review following a six-stage methodological framework, including a consultation exercise, is proposed. A comprehensive strategy will be used to search Medline, Embase, PEDro, CINAHL and Scopus to identify peer-reviewed studies evaluating virtual exercise programmes for adults with mobility limitations living in the community. Three trained reviewers will select studies independently. Data (eg, study methodology, programme structure and content, participant characteristics) will be extracted using a standardised form, and collated and summarised using quantitative and qualitative methods. The PROGRESS-Plus and International Classification of Functioning, Disability and Health frameworks will be used to classify participant characteristics and study outcomes, respectively. During the consultation exercise, key knowledge users, including exercise participants, programme providers and coordinators, and members of community organisations for persons living with disabilities and under-represented groups, will be asked to provide insights regarding the applicability of review findings. A directed content analysis of data from the consultation exercise will be performed. ETHICS AND DISSEMINATION: The research ethics board at the University of Toronto approved the consultation exercise. Findings will be disseminated through peer-reviewed publications and conference presentations. Findings will enhance understanding of current research evaluating virtual exercise programmes and inform future research and strategies for promoting equitable access and outcomes for individuals with mobility limitations. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/X5JMA.

Distance-limited walk tests post-stroke: A systematic review of measurement properties.

BACKGROUND: Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE: To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS: Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS: Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS: The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.

A Qualitative study assessing organisational readiness to implement caregiver support programmes in Ontario, Canada.

OBJECTIVE: To qualitatively explore factors affecting implementation of caregiver support programmes in healthcare institutions in a regional stroke system. DESIGN: A qualitative descriptive study with the Ontario Stroke System (OSS) was conducted. Data were collected through focus groups and in-depth interviews. Transcripts were coded and analysed using inductive thematic analysis. SETTING: Regional Stroke System, Ontario, Canada. PARTICIPANTS: OSS stakeholders including medical directors, executives, programme directors, education coordinators, rehabilitation and community and long-term care specialists, primary care leaders and healthcare professionals. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data collection explored perceptions of the need for caregiver support programmes and factors that may affect their implementation. RESULTS: Four focus groups (n=43) and 29 interviews were completed. Analyses identified themes related to (1) evidence that a caregiver programme will improve health and health system outcomes, (2) personnel requirements, (3) barriers associated with current billing and referral processes and (4) integration with current practice and existing workflow processes. CONCLUSIONS: Implementation strategies to adopt caregiver programmes into clinical practice should incorporate evidence and consider personnel and existing workflow processes.

Evaluation of a Community-Based Self-Management Program to Increase Access to Rehabilitation for People Living with HIV.

We qualitatively evaluated a novel educational program to help people living with HIV understand the role of rehabilitation, facilitate access to rehabilitation, and promote self-management of chronic disease in Canada. The program incorporated components of self-efficacy, client-centered care, peer education, and problem-based learning. Delivery of the community-engaged program was viewed as feasible and acceptable; however, a flexible delivery model was deemed important. Perceived learning was related to rehabilitation, advocacy, and taking responsibility for one's health. A co-leader model and access to online resources were strengths. Future work should assess the ability to apply advocacy knowledge and skills to access rehabilitation services.

Partnering to increase access to community exercise programs for people with stroke, acquired brain injury, and multiple sclerosis.

BACKGROUND: The purpose of this article is to describe the development and evaluation of a task-oriented group exercise program, delivered through a municipal recreation program, for community-dwelling people with neurological conditions. METHODS: Physical therapists (PTs) at a rehabilitation hospital partnered with a municipal recreation provider to develop and evaluate a 12-week exercise program for people with stroke, acquired brain injury, and multiple sclerosis at 2 community centers. Fitness instructors who were trained and supported by PTs taught 1-hour exercise classes twice a week. In a program evaluation of the safety, feasibility and effects of the program, standardized measures of physical function were administered before and after the program. RESULTS: Fourteen individuals (mean age: 63 years) participated and attended 92% of exercise classes, on average. Two minor adverse events occurred during 293 attendances. Improvement in mean score on all measures was observed. In people with stroke, a statistically significant improvement in mean Berg Balance Scale (mean ± SD change = 3 ± 2 points, P = .016, n = 7) and 6-minute walk test scores (change = 26 ± 26 m, P = .017, n = 9) was observed. CONCLUSIONS: This model of exercise delivery provides people with neurological conditions with access to a safe, feasible and potentially beneficial exercise program in the community.

Further development of the response scales of the Acquired Brain Injury Challenge Assessment (ABI-CA).

PRIMARY OBJECTIVE: To revise the scaling of the response sets of the Acquired Brain Injury Challenge Assessment (ABI-CA) through expert input and determination of empirically based cut-points. RESEARCH DESIGN: A measurement development study with a content validity focus. METHODS: Response option wording was revised through consultation with six physiotherapists with paediatric ABI expertise. Twenty-nine typically-developing children performed the ABI-CA and empirically-based cut-points for item-specific response options were derived from their time/distance/repetition results (SD values) as benchmark values. Movement quality considerations (compensatory movements) were identified from expert consultation/ABI-CA video observation and built into revised response options. The revised ABI-CA was pilot-tested with four children with ABI, aged 7-15 years, for a feasibility check. RESULTS: Nineteen of the 23 items' response scales were revised based on experts' feedback and empirically-based cut-points replaced the previous arbitrarily-determined cut-points. Compensatory movement considerations were re-defined in nine items. The mean score of the refined ABI-CA was 70.0% (SD = 18.5) with four children with ABI. CONCLUSION: The new response options in the ABI-CA appeared suitable for testing high-functioning children with ABI and the mid-range mean score in this pilot sample indicates its potential to measure change. Recommendations are outlined for final ABI-CA amendments before large-scale validation.

Development of a challenge assessment tool for high-functioning children with an acquired brain injury.

PURPOSE: To develop a performance-based challenge assessment to evaluate gross motor abilities of high-functioning youth with an acquired brain injury (ABI). METHODS: Potential items were identified from the literature. A panel of 4 expert physical therapists selected items on the basis of 3 criteria: safety to test, feasibility to administer, and importance to perform. Item reduction was completed using ratings from a physical therapist web survey. The Acquired Brain Injury-Challenge Assessment (ABI-CA) was created and pilot tested with youth with an ABI. RESULTS: Seventy-eight items were identified and reduced to 47 items following expert panel discussion. Web-survey item reduction by 75 pediatric physical therapists yielded a 24-item ABI-CA that was administered to 6 youth with an ABI, aged 8 to 17 years. The ABI-CA mean score was 50.7/81.0 (SD = 17.4). CONCLUSION: The ABI-CA was feasible to administer and demonstrated gross motor activity challenges beyond the Gross Motor Function Measure. Response option refinement and measure validation are required prior to clinical/research use.