Long-term care residents' acceptance of a standing intervention: A qualitative intrinsic case study.

Older adults in long-term care are sedentary. Standing is recommended to reduce sedentary time, but there is limited research on long-term care residents' acceptability of standing interventions. The acceptability of the Stand If You Can (SIYC) randomized clinical trial among long-term care residents was explored using a single intrinsic qualitative case study design. The five month intervention consisted of supervised 100 min standing sessions per week. Participants completed post-intervention interviews, which were analyzed using the Thematic Framework Analysis through the lens of an acceptability framework. The 10 participants (7 female), age 73 to 102 years, stood a median of 53% of the intervention offered time (range 20%-94%). The participants reported acceptability in many aspects of the Theoretical Framework of Acceptability. Standing is a simple intervention to decrease sedentary time and seems to be accepted among long-term care residents when burden is not perceived as too high.

Reliability and Validity of a Novel Wearable Device for Measuring Elbow Strength.

Muscle strength is an important clinical outcome in rehabilitation and sport medicine, but options are limited to expensive but accurate isokinetic dynamometry (IKD) or inexpensive but less accurate hand-held dynamometers (HHD). A wearable, self-stabilizing, limb strength measurement device (LSMD) was developed to fill the current gap in portable strength measurement devices. The purpose of this study was to evaluate the reliability and validity of the LSMD in healthy adults. Twenty healthy adults were recruited to attend two strength testing sessions where elbow flexor and extensor strength was measured with the LSMD, with HHD and with IKD in random order, by two raters. Outcomes were intra-rater repeatability, inter-rater reproducibility and inter-session reproducibility using intra-class correlation coefficients (ICC). Limits of agreement and weighted least products regression were used to test the validity of the LSMD relative to the criterion standard (IKD), and calibration formulas derived to improve measurement fidelity. ICC values for the LSMD were >0.90 for all measures of reliability and for both muscle groups, but over-predicted extensor strength and under-predicted flexor strength. Validity was established by transforming the data with the criterion standard-based calibration. These data indicate that the LSMD is reliable and conditionally valid for quantifying strength of elbow flexors and extensors in a healthy adult population.

Predictive value of the pendulum test for assessing knee extensor spasticity.

BACKGROUND: The pendulum test is commonly used to quantify knee extensor spasticity, but it is currently unknown to what extent common pendulum test metrics can detect spasticity in patients with neurological injury or disease, and if the presence of flexor spasticity influences the test outcomes. METHODS: A retrospective analysis was conducted on 131 knees, from 93 patients, across four different patient cohorts. Clinical data included Modified Ashworth Scale (MAS) scores for knee extensors and flexors, and years since diagnosis. BioTone™ measures included extensor strength, passive and active range of motion, and pendulum tests of most affected or both knees. Pendulum test metrics included the relaxation index (RI), 1st flexion amplitude (F1amp) and plateau angle (Plat), where RI=F1amp/Plat. Two-way ANOVA tests were used to determine if pendulum test metrics were influenced by the degree of knee flexor spasticity graded by the MAS, and ANCOVA was used to test for confounding effects of age, years since injury, strength and range of motion (ROM). In order to identify the best pendulum test metrics, Receiver Operator Characteristic analysis and logistic regression (LR) analysis were used to classify knees by spasticity status (none or any) and severity (low/moderate or high/severe). RESULTS: Pendulum test metrics for knee extensors were not influenced by degree of flexor spasticity, age, years since injury, strength or ROM of the limb. RI, F1amp and Plat were > 70% accurate in classifying knees by presence of clinical spasticity (from the MAS), but were less accurate (< 70%) for grading spasticity level. The best classification accuracy was obtained using F1amp and Plat independently in the model rather than using RI alone. CONCLUSIONS: We conclude that the pendulum test has good predictive value for detecting the presence of extensor spasticity, independent of the existence of flexor spasticity. However, the ability to grade spasticity level as measured by MAS using the RI and/or F1amp may be limited. Further study is warranted to explore if the pendulum test is suitable for quantifying more severe spasticity.

Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial.

BACKGROUND: Although physical activity and exercise is known to benefit people with multiple sclerosis (MS), the ability of these individuals to participate in such interventions is difficult due to the mobility impairments caused by the disease. Keeogo is a lower-extremity powered exoskeleton that may be a potential solution for enabling people with MS to benefit from physical activity and exercise. METHODS: An open-label, randomized, cross-over trial was used to examine the immediate performance effects when using the device, and the potential benefits of using the device in a home setting for 2 weeks. Clinical performance tests with and without the device included the 6 min walk test, timed up and go test and the 10-step stair test (up and down). An activity monitor was also used to measure physical activity at home, and a patient-reported questionnaire was used to determine the amount and extent of home use. Generalized linear models were used to test for trial effects, and correlation analysis used to examine relationships between trial effects and usage. RESULTS: Twenty-nine patients with MS participated. All measures showed small decrements in performance while wearing the device compared to not wearing the device. However, significant improvements in unassisted (Rehab effect) performance were found after using the device at home for 2 weeks, compared to 2 weeks at home without the device, and participants improved their ability to use the device over the trial period (Training effect). Rehab and Training effects were related to the self-reported extent that participants used Keeogo at home. CONCLUSIONS: Keeogo appears to deliver an exercise-mediated benefit to individuals with MS that improved their unassisted gait endurance and stair climbing ability. Keeogo might be a useful tool for delivering physical activity interventions to individuals with mobility impairment due to MS. TRIAL REGISTRATION: ClinicalTrials.gov : NCT02904382 . Registered 19 September 2016 - Retrospectively registered.

Convergent Validity of a Wearable Sensor System for Measuring Sub-Task Performance during the Timed Up-and-Go Test.

BACKGROUND: The timed-up-and-go test (TUG) is one of the most commonly used tests of physical function in clinical practice and for research outcomes. Inertial sensors have been used to parse the TUG test into its composite phases (rising, walking, turning, etc.), but have not validated this approach against an optoelectronic gold-standard, and to our knowledge no studies have published the minimal detectable change of these measurements. METHODS: Eleven adults performed the TUG three times each under normal and slow walking conditions, and 3 m and 5 m walking distances, in a 12-camera motion analysis laboratory. An inertial measurement unit (IMU) with tri-axial accelerometers and gyroscopes was worn on the upper-torso. Motion analysis marker data and IMU signals were analyzed separately to identify the six main TUG phases: sit-to-stand, 1st walk, 1st turn, 2nd walk, 2nd turn, and stand-to-sit, and the absolute agreement between two systems analyzed using intra-class correlation (ICC, model 2) analysis. The minimal detectable change (MDC) within subjects was also calculated for each TUG phase. RESULTS: The overall difference between TUG sub-tasks determined using 3D motion capture data and the IMU sensor data was <0.5 s. For all TUG distances and speeds, the absolute agreement was high for total TUG time and walk times (ICC > 0.90), but less for chair activity (ICC range 0.5-0.9) and typically poor for the turn time (ICC < 0.4). MDC values for total TUG time ranged between 2-4 s or 12-22% of the TUG time measurement. MDC of the sub-task times were higher proportionally, being 20-60% of the sub-task duration. CONCLUSIONS: We conclude that a commercial IMU can be used for quantifying the TUG phases with accuracy sufficient for clinical applications; however, the MDC when using inertial sensors is not necessarily improved over less sophisticated measurement tools.

Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson's disease by facilitating progressive exercise intensity.

People with Parkinson's disease (PwPD) can benefit from progressive high-intensity exercise facilitated with a lower-extremity exoskeleton, but the mechanisms explaining these benefits are unknown. We explored the relationship between exercise intensity progression and memory and gait outcomes in PwPD who performed 8 weeks (2 × per week) of progressive exercise with and without a lower-extremity powered exoskeleton, as the planned exploratory endpoint analysis of an open-label, parallel, pilot randomized controlled trial. Adults 50-85 years old with a confirmed diagnosis of PD participated. Twenty-seven participants randomized to exercise with (Exo = 13) or without (Nxo = 14) the exoskeleton were included in this exploratory endpoint analysis. Detailed exercise logs were kept and actigraphy was used to measure activity count*min-1 (ACPM) during all exercise sessions. Only the Exo group were able to progressively increase their ACPM over the entire 8-week intervention, whereas the Nxo group plateaued after 4 weeks. Exercise intensity progression correlated with change in the memory sub-scale of the SCOPA-COG and change in gait endurance from the 6MWT, consistent with the prevailing hypotheses linking high-intensity interval exercise to improved muscle and brain function via angiogenic and neurotrophic mechanisms. Facilitating high-intensity exercise with advanced rehabilitation technology is warranted for improving memory and gait endurance in PwPD.Registration: ClinicalTrials.gov, NCT03583879 (7/10/2018).

Elbow spasticity during passive stretch-reflex: clinical evaluation using a wearable sensor system.

BACKGROUND: Spasticity is a prevalent chronic condition among persons with upper motor neuron syndrome that significantly impacts function and can be costly to treat. Clinical assessment is most often performed with passive stretch-reflex tests and graded on a scale, such as the Modified Ashworth Scale (MAS). However, these scales are limited in sensitivity and are highly subjective. This paper shows that a simple wearable sensor system (angle sensor and 2-channel EMG) worn during a stretch-reflex assessment can be used to more objectively quantify spasticity in a clinical setting. METHODS: A wearable sensor system consisting of a fibre-optic goniometer and 2-channel electromyography (EMG) was used to capture data during administration of the passive stretch-reflex test for elbow flexor and extensor spasticity. A kinematic model of unrestricted passive joint motion was used to extract metrics from the kinematic and EMG data to represent the intensity of the involuntary reflex. Relationships between the biometric results and clinical measures (MAS, isometric muscle strength and passive range of motion) were explored. RESULTS: Preliminary results based on nine patients with varying degrees of flexor and extensor spasticity showed that kinematic and EMG derived metrics were strongly correlated with one another, were correlated positively (and significantly) with clinical MAS, and negatively correlated (though mostly non-significant) with isometric muscle strength. CONCLUSIONS: We conclude that a wearable sensor system used in conjunction with a simple kinematic model can capture clinically relevant features of elbow spasticity during stretch-reflex testing in a clinical environment.

Correction to: Using gait robotics to improve symptoms of Parkinson's disease: an open-label, pilot randomized controlled trial.

This article was published in Volume 58, issue 5 of publishing year 2022, with a mistake in Figure 4. The correct Figure 4 is the one included in this erratum.

Evaluation of a novel real-time adaptive assist-as-needed controller for robot-assisted upper extremity rehabilitation following stroke.

Rehabilitation therapy plays an essential role in assisting people with stroke regain arm function. Upper extremity robot therapy offers a number of advantages over manual therapies, but can suffer from slacking behavior, where the user lets the robot guide their movements even when they are capable of doing so by themselves, representing a major barrier to reaching the full potential of robot-assist rehabilitation. This is a pilot clinical study that investigates the use of an electromyography-based adaptive assist-as-needed controller to avoid slacking behavior during robotic rehabilitation for people with stroke. The study involved a convenience sample of five individuals with chronic stroke who underwent a robot therapy program utilizing horizontal arm tasks. The Fugl-Meyer assessment (FM) was used to document motor impairment status at baseline. Velocity, time, and position were quantified as performance parameters during the training. Arm and shoulder surface electromyography (EMG) and electroencephalography (EEG) were used to assess the controller's performance. The cross-sectional results showed strong second-order relationships between FM score and outcome measures, where performance metrics (path length and accuracy) were sensitive to change in participants with lower functional status. In comparison, speed, EMG and EEG metrics were more sensitive to change in participants with higher functional status. EEG signal amplitude increased when the robot suggested that the robot was inducing a challenge during the training tasks. This study highlights the importance of multi-sensor integration to monitor and improve upper-extremity robotic therapy.

Effect of using of a lower-extremity exoskeleton on disability of people with multiple sclerosis.

BACKGROUND: Although ongoing exercise is known to reduce disability in people with multiple sclerosis (MS), participation in lower-extremity exercise programs can be limited by their existing mobility impairments. Lower-extremity exoskeletons could address this problem by facilitating home and community locomotion and enhancing exercise capability but little data is available on the potential of this technology for reducing disability of people with MS. METHODS: We evaluated the Keeogo™ exoskeleton for people with MS using an open-label randomised cross-over design. The trial design allowed us to quantify rehabilitation effects (tested without device) and training effects (tested with device) using functional outcomes: 6-minute walk test (6MWT), timed stair test (TST), and timed up-and-go (TUG). Baseline and post-study self-report instruments included Medical Outcomes Survey Short Form-36 (SF36), MS Walking Scale (MSWS), and others. Amount of home use was documented by daily activity log. Partial correlation analysis was used to explore the relationships between changes in functional outcomes and self-report disability, controlling for amount of home use of the device. RESULTS: Twenty-nine participants with MS completed the trial. Change scores for MSWS, SF36 physical function and SF36 emotional well-being correlated positively with changes in 6MWT which was explained by amount of home use. CONCLUSIONS: The benefits in physical functioning and emotional well-being from using the exoskeleton at home were linked to amount of device usage. Low-profile robotic exoskeletons could be used to deliver facilitated exercise while assisting with locomotor activities of daily living, such as walking and stair climbing in the home and community environment.IMPLICATIONS FOR REHABILITATIONExoskeletons for home use may have the potential to benefit people with MS in terms of physical functioning and emotional well-being.The benefits in physical functioning and emotional well-being appeared to be linked to amount of usage.Exoskeletons might be useful for delivering facilitated exercise while assisting with walking and stair climbing in the home.

The Effect of a Standing Intervention on Falls in Long Term Care: a Secondary Analysis of a Randomized Controlled Trial.

Background: Older adults in long term care (LTC) spend over 90% of their day engaging in sedentary behaviour. Sedentary behaviour may exacerbate functional decline and frailty, increasing the risk for falls. The purpose of this study is to explore the impact of a 22-week standing intervention on falls among LTC residents at 12-month follow-up. Methods: This was a planned secondary analysis of the Stand if You Can randomized controlled trial. The original trial randomized 95 participants (n = 47 control; n = 48 intervention) to either a sitting control or a supervised standing intervention group (100 minutes/week) for 22 weeks. Falls data were available to be collected over 12 months post-intervention for 89 participants. The primary outcome was a hazard of fall (Yes/No) during the 12-month follow-up period. Results: A total of 89 participants (average age 86 years ± 8.05; 71.9% female) were followed for 12-months post-intervention. Participants in the intervention group (n=44) had a significantly greater hazard ratio of falls (2.01; 95% CI = 1.11 to 3.63) than the control group (n=45) when accounting for the history of falls, frailty status, cognition level, and sex. Conclusion: Participants who received a standing intervention over 22 weeks were twice as likely to fall 12 months after the intervention compared with the control group. However, the prevalence of falls did not surpass what would be typically observed in LTC facilities. It is imperative that future studies describe in detail the context in which falls happen and collect more characteristics of participants in the follow-up period to truly understand the association between standing more and the risk of falls.

Tricompartment offloader knee brace reduces contact forces in adults with multicompartment knee osteoarthritis.

The levitation tricompartment offloader (TCO) brace is designed to unload all three knee compartments by reducing compressive forces caused by muscle contraction. This study aimed to determine the effect of the TCO on knee contact forces and quadriceps muscle activity in individuals with knee osteoarthritis. Lower limb kinematics, kinetics, and electromyography data were collected during a chair rise-and-lower task. A three-dimensional inverse dynamics model of the lower leg and foot was used with a sagittal plane knee model to compute knee joint forces. TCO brace use significantly decreased forces in the tibiofemoral [p = 0.001; mean difference, MD (97.5% confidence interval, CI) -0.62 (-0.91, -0.33) body weight (BW)] and patellofemoral [p = 0.001; MD (97.5% CI) -0.88 (-1.36, -0.39) BW] compartments in high-power mode. Significant reductions in quadriceps tendon force [p = 0.002; MD (97.5% CI) -0.53 (-0.83, -0.23) BW] and electromyography intensity of the vastus medialis [p = 0.018, MD (97.5% CI) -30.7 (-59.1, -2.3)] and vastus lateralis [p = 0.012, MD (97.5% CI) -26.2 (-48.5, -3.9)] were also observed. The TCO significantly reduced tibiofemoral and patellofemoral contact forces throughout chair lower, and when knee flexion was greater than 50° during chair rise in high power. These results demonstrate that the TCO reduces contact forces in the tibiofemoral and patellofemoral joint compartments and confirms that the TCO unloads the joint by reducing compressive forces caused by the quadriceps. Clinical significance: The magnitude of knee joint unloading provided by the TCO is similar to that achieved by clinically recommended levels of bodyweight loss and is therefore expected to result in clinical benefits for knee osteoarthritis patients.

Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture.

The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient's frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture. A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%. The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.

Comparison of strain-gage and fiber-optic goniometry for measuring knee kinematics during activities of daily living and exercise.

There is increasing interest in wearable sensor technology as a tool for rehabilitation applications in community or home environments. Recent studies have focused on evaluating inertial based sensing (accelerometers, gyroscopes, etc.) that provide only indirect measures of joint motion. Measurement of joint kinematics using flexible goniometry is more direct, and still popular in laboratory environments, but has received little attention as a potential tool for wearable systems. The aim of this study was to compare two goniometric devices: a traditional strain-gauge flexible goniometer, and a fiberoptic flexible goniometer, for measuring dynamic knee flexion/extension angles during activity of daily living: chair rise, and gait; and exercise: deep knee bends, against joint angles computed from a "gold standard" Vicon motion tracking system. Six young adults were recruited to perform the above activities in the lab while wearing a goniometer on each knee, and reflective markers for motion tracking. Kinematic data were collected simultaneously from the goniometers (one on each leg) and the motion tracking system (both legs). The results indicate that both goniometers were within 2-5 degrees of the Vicon angles for gait and chair rise. For some deep knee bend trials, disagreement with Vicon angles exceeded ten degrees for both devices. We conclude that both goniometers can record ADL knee movement faithfully and accurately, but should be carefully considered when high (>120 deg) knee flexion angles are required.

Using gait robotics to improve symptoms of Parkinson's disease: an open-label, pilot randomized controlled trial.

BACKGROUND: People with Parkinson's Disease (PD) have difficulty participating in exercise. AIM: The primary objective of this pilot randomized controlled trial (RCT) was to determine if 8 weeks (2x per week) of bilateral exoskeleton (Exo) exercise results in positive changes in cognition and participation in adults with PD compared to exercising without an exoskeleton (Nxo) or wait-list control (Con). DESIGN: Open-label, parallel, pilot randomized controlled trial. SETTING: Neurorehabilitation clinic in a large urban center. POPULATION: Adults 50-85 years old with a confirmed diagnosis of PD. METHODS: Eight weeks of twice-weekly combined aerobic, strength and mobility exercise or wait-list control. Participants were randomly assigned to exercise with no exoskeleton (Nxo), exercise with the exoskeleton (Exo), or waitlist control (Con). Primary endpoints were change in cognitive function (SCOPA-COG) and mood. Secondary endpoints were change in gait speed, six-minute walk test (6MWT), freezing of gait, balance, and PD-specific health and quality of life outcomes. Safety endpoint was analysis of adverse events (AE). RESULTS: Forty participated in the trial (Exo, N.=13; Nxo, N.=14; Con, N.=13). Significant improvement in the Memory & Learning domain of the SCOPA-COG (P=0.014) and 6MWT (P=0.008) were detected for the Exo group compared to the Nxo and/or Con group. No other statistically significant between-groups effects were found. There were no serious or unanticipated AE. CONCLUSIONS: Functional exercise with a low-profile overground exoskeleton showed promising results for improving memory and gait endurance in people with PD across HY stages I-IV. CLINICAL REHABILITATION IMPACT: Exoskeletons can improve participation in high-intensity exercise.

A Comparison of Force-Plate Based Center of Mass Estimation Algorithms.

Estimating horizontal center of mass (CoM) is an important process that is used in the control of self-paced treadmills, as well as in clinical and scientific biomechanical analysis. Many laboratories use motion-capture to estimate CoM, while others use force-plate based estimates, either because they cannot access motion-capture or they do not want to be taxed with post-processing optoelectronic data. Three force-plate derived center of mass estimation algorithms were compared against a benchmark motion-capture technique. Two of them have recently been reported in the literature, and both rely on numerical integration of 2nd-order differential equations. We propose a third technique that uses an algebraic equation to directly relate center of pressure to center of mass without numerical drift. Twenty-four healthy adults participated in a five-minute steady-state walking test to compare these algorithms. The sample-by-sample standard deviation of the three force-plate based algorithms from the motion-capture benchmark algorithm was evaluated. The algebraic technique provided less error than either of the two more common integration techniques (p<0.05). The results of this study support the viability of using only ground reaction forces for self-paced treadmills and also show that a simple algebraic model is preferred to integration approaches. The use of an algebraic estimation simplifies control implementation for self-paced treadmill applications and eliminates the need for event-based drift recalibration.

Evaluation of a lower-extremity robotic exoskeleton for people with knee osteoarthritis.

A multi-site study was conducted to evaluate the efficacy of the Keeogo™ exoskeleton as a mobility assist device for use in the clinic and at home in people with knee osteoarthritis (KOA). Twenty-four participants were randomized in a two-stage cross-over design that evaluated the immediate effects of using the exoskeleton in the clinic and the cumulative effects of training and home use. Immediate effects were quantified by comparing 1) physical performance with|without (W|WO) the device during a battery of mobility tests, and 2) physical activity levels at home (actigraphy) for one month, two weeks W|WO the device. Cumulative effects were quantified as change in physical performance W and WO over time. WOMAC and other self-report scales were measured and usability assessed. There were no immediate effects on physical performance or physical activity at home; however, there were cumulative effects as indicated by improved stair time (p = .001) as well as improved WOMAC pain (p = .004) and function (p = .003). There was a direct relationship between improved physical function and improved WOMAC pain (r = -.677, p < .001) and stiffness (r = .537, p = .007). Weight and battery life were identified as important to usability. A full-scale RCT with more participants, longer study period, and better usage monitoring is warranted.

Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia.

INTRODUCTION: Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health. METHODS AND ANALYSIS: The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up. ETHICS AND DISSEMINATION: Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER: NCT04997681, Pre-results.

Symptoms experienced by HIV-infected Individuals on antiretroviral therapy in KwaZulu-Natal, South Africa.

Symptom management in HIV/AIDS is a critical issue that influences the quality of life of those living with the disease. Although the goals of treating the numbers living with HIV/AIDS have not yet been achieved, availability of antiretroviral therapies (ARVs) has been expanded to many clinical settings in KwaZulu-Natal, the epicenter of HIV infection in South Africa. The South African Department of Health (2007) estimates indicate that 5.54 million South Africans are living with HIV/AIDS, whereas UNAIDS (2007) estimates suggest that 18.8% of the population in South Africa is affected. Because the symptom experience may influence adherence to ARVs and quality of life, this study focused on the prevalence of symptoms reported by patients (N = 149) diagnosed with HIV/AIDS and adherence to medications and appointments. Self-report data were obtained from this community-based sample of HIV-infected patients who received care in outpatient clinics in Durban, KwaZulu-Natal, South Africa. With an average of three side effects, the most frequently reported by the study participants were fatigue/tiredness (41%), rashes (40%), headaches (32%), insomnia (31%), sadness (24%), disturbing dreams (23%), numbness (22%), pain (22%), and self-appearance (20%). On a scale of 1 to 10 (10 being worst possible), those with symptoms reported an average intensity of 4.2 (SD = 2.0), and the degree to which symptoms affected activity levels was 3.2 (SD = 2.2). Although intensity of symptoms and effects on activity levels were strongly correlated (r = .78, p < .001), there were no significant relationships between adherence and the intensity of symptoms or the relationship of symptoms with activity levels. Logistic regression analyses indicate that the presence of a greater number of symptoms was not associated with greater adherence (odds ratio = 2.27, 95% confidence interval = 0.60-8.70, ns). However, those who reported higher adherence were 1.5 times more likely to report greater physical health than low adherers (p = .04). High adherers were also 1.6 times more likely to report greater psychological health than low adherers (p = .03). This suggests that further study is needed to investigate adherence motivations for those living with HIV/AIDS in South Africa because adherence seems not to be linked to the frequency of symptoms or limitations on activity related to symptoms.

Physiotherapists' Experiences Using the Ekso Bionic Exoskeleton with Patients in a Neurological Rehabilitation Hospital: A Qualitative Study.

Use of bionic overground exoskeletons to assist with neurological rehabilitation is becoming increasingly prevalent and has important implications for physiotherapists and their patients. Yet, there is a paucity of research about the impact of integrating this technology on physiotherapists' work. The purpose of this study was to explore how the training and implementation of using the Ekso robotic exoskeleton with patients affects physiotherapists' work. An exploratory qualitative study of three physiotherapists working at a neurological rehabilitation centre in Eastern Canada was conducted using one-on-one semistructured interviews in July 2017. Audio recordings were transcribed verbatim, and data was coded and analyzed using thematic analysis. Six themes emerged from the data: developing organizational capacity; ethical use of technology; benefits of the equipment; challenges of the equipment; cognitive workload; and the technological environment. The results suggest that the adoption and integration of bionic exoskeletons into rehabilitation practice is not as simple as training physiotherapists and giving them the device. More research is needed to understand the increased cognitive demands of working with patients using technologically advanced exoskeletons within a dynamic, technology-rich healthcare environment, while managing patient expectations and ethical use.