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OBJECTIVE: This study aimed to identify factors at hospital discharge that predict physical activity and walking outcomes in the first 6 months after stroke. DATA SOURCES: Searches were conducted in CINAHL (EBSCO), Web of Science, PubMed and Scopus from inception to 30 April 2024. Reference lists of included articles were manually screened to identify additional studies. REVIEW METHODS: Studies of adults with stroke reporting predictors at hospital discharge and outcomes of physical activity or walking across the first 6 months after hospital discharge were included. Two reviewers independently screened titles, abstracts and reviewed full texts. Quality of included studies was assessed with Quality in Prognostic Studies screening tool. A narrative synthesis was undertaken. RESULTS: The search strategy retrieved 7834 studies, from which 6 eligible studies were identified, including a total of 1433 participants. Overall, studies had a low risk of bias. Age, balance, walking speed and walking distance at hospital discharge predicted physical activity outcomes after stroke (n = 2 studies). Cognition, lower limb cycling rhythm and self-efficacy for walking at hospital discharge predicted walking outcomes after stroke (n = 4 studies). CONCLUSIONS: A range of factors predicted physical activity and walking outcomes 6 months after stroke. Physical capabilities at discharge appear to be a predictor of these outcomes; however, this needs to be interpreted with caution. Diverse measures and time points were used across studies to characterise physical activity and walking outcomes, highlighting the need for consistency in measurement and longitudinal studies in stroke research.
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BACKGROUND: Digital interventions in health services often fail due to an underappreciation of the complexity of the implementation. This study develops an approach to address complexity through an evidenced-based, theory-driven education and implementation program for an Electronic Medical Record (EMR) digital enhancement for acute stroke care. METHODS: An action research approach was used to design, develop, and execute the education and implementation program over several phases, with iterative changes over time. The study involved collaboration with multiple statewide and local key stakeholders and was conducted across two tertiary teaching hospitals and a regional hospital in Australia. RESULTS: Insights were gained over five phases. Phase 1 involved a review of evidence that supported blended learning strategies for the education and training of staff end-users. In Phase 2, contextual assessment was conducted via observation of study sites, providing awareness of local context variability and insight into key implementation considerations. The Non-adoption, Abandonment, Scale-Up, Spread and Sustainability (NASSS) framework assisted in Phase 3 to identify and manage the key domains of complexity. Phase 4 involved the design of the program which included group-based training and an e-learning package, endorsed and evaluated by key leaders. Throughout implementation in Phase 5, further barriers were identified, and iterative changes were tailored to each context. CONCLUSIONS: The NASSS framework, combined with a multi-phased approach employing blended learning techniques, context evaluations, and iterative modifications, can serve as a model for generating theory-driven and evidence-based education strategies that adresss the complexity of the implementation process and context.
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Registros Electrónicos de Salud , Aprendizaje , Humanos , AustraliaRESUMEN
Adherence to prescribed exercise poses significant challenges for older adults despite proven benefits. The aim of this exploratory descriptive qualitative study was to explore the perceived barriers to and facilitators of prescribed home exercise adherence in community-dwelling adults 65 years and older. Three focus groups with 17 older adults (Mage ± SD = 77 ± 5.12) living in Singapore were conducted. Inductive thematic analysis revealed that "the level of motivation" of individuals constantly influenced their exercise adherence (core theme). The level of motivation appeared to be a fluid concept and changed due to interactions with two subthemes: (a) individual factors (exercise needs to be tailored to the individual) and (b) environmental factors (i.e., support is essential). Hence, these factors must be considered when designing strategies to enhance exercise adherence in this vulnerable population. Strategies must be informed by the culturally unique context, in this case, a developed country with a multiethnic urban Asian population.
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Terapia por Ejercicio , Ejercicio Físico , Humanos , Anciano , Singapur , Investigación CualitativaRESUMEN
BACKGROUND: The first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility. METHODS: A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015-2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs. RESULTS: A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group. After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively. CONCLUSIONS: Implementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.
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Terapia Ocupacional , Adulto , Anciano , Australia , Estudios de Cohortes , Humanos , Pacientes Internos , Tiempo de Internación , Modalidades de Fisioterapia , Equilibrio Postural , Estudios Prospectivos , Estudios de Tiempo y MovimientoRESUMEN
There is little evidence of the concurrent validity of commercially available wrist-worn long battery life activity monitors to measure steps in older adults at slow speeds and with real-world challenges. Forty adults aged over 60 years performed a treadmill protocol at four speeds, a 50-m indoor circuit, and a 200-m outdoor circuit with environmental challenges while wearing a Garmin Vivofit®4, the activPAL3™, and a chest-worn camera angled at the feet. The Garmin Vivofit®4 showed high intraclass correlation coefficients2,1 (.98-.99) and low absolute percentage error rates (<2%) at the fastest treadmill speeds and the outdoor circuit. Step counts were underestimated at the slowest treadmill speed and the indoor circuit. The Garmin Vivofit®4 is accurate for older adults at higher walking speeds and during outdoor walking. However, it underestimates steps at slow speeds and when walking indoors with postural transitions.
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Monitores de Ejercicio , Monitoreo Ambulatorio , Anciano , Prueba de Esfuerzo/métodos , Humanos , Persona de Mediana Edad , Reproducibilidad de los Resultados , Caminata , Velocidad al CaminarRESUMEN
OBJECTIVES:: To explore the effect of environmental enrichment within an acute stroke unit on how and when patients undertake activities, and the amount of staff assistance provided, compared with a control environment (no enrichment). DESIGN:: This is a substudy of a controlled before-after observational study. SETTING:: The study was conducted in an Australian acute stroke unit. PARTICIPANTS:: The study included stroke patients admitted to (1) control and (2) environmental enrichment period. INTERVENTION:: The control group received standard therapy and nursing care, which was delivered one-on-one in the participants' bedroom or a communal gym. The enriched group received stimulating resources and communal areas for mealtimes, socializing and group activities. Furthermore, participants and families were encouraged to increase patient activity outside therapy hours. MAIN MEASURES:: Behavioral mapping was performed every 10 minutes between 7.30 a.m. and 7.30 p.m. on weekdays and weekends to estimate activity levels. We compared activity levels during specified time periods, nature of activities observed and amount of staff assistance provided during patient activities across both groups. RESULTS:: Higher activity levels in the enriched group ( n = 30, mean age 76.7 ± 12.1) occurred during periods of scheduled communal activity ( P < 0.001), weekday non-scheduled activity ( P = 0.007) and weekends ( P = 0.018) when compared to the control group ( n = 30, mean age 76.0 ± 12.8), but no differences were observed on weekdays after 5 p.m. ( P = 0.324). The enriched group spent more time on upper limb ( P < 0.001), communal socializing ( P < 0.001), listening ( P = 0.007) and iPad activities ( P = 0.002). No difference in total staff assistance during activities was observed ( P = 0.055). CONCLUSION:: Communal activities and environmental resources were important contributors to greater activity within the enriched acute stroke unit.
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Unidades Hospitalarias/organización & administración , Medio Social , Participación Social , Accidente Cerebrovascular/epidemiología , Anciano , Australia , Estudios Controlados Antes y Después , Femenino , Humanos , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: The level of physical activity undertaken by stroke survivors living in the community is generally low. The main objectives of the IMPACT trial are to determine, in individuals undergoing rehabilitation after stroke, if 8 weeks of high-intensity treadmill training embedded in self-management education (i) results in more physical activity than usual physiotherapy gait training and (ii) is more effective at increasing walking ability, cardiorespiratory fitness, self-efficacy, perception of physical activity, participation, and health-related quality of life as well as decreasing cardiovascular risk, and depression, at 8 and 26 weeks. METHODS: A prospective, two-arm, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis, will be conducted. 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and randomly allocated to either the experimental or control group, who will both undergo gait training for 30 min, three times a week for 8 weeks under the supervision of a physiotherapist. Outcomes will be measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). This study has obtained ethical approval from the relevant Human Research Ethics Committees. DISCUSSION: Improving stroke survivors' walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity. Furthermore, if education in self-management results in sustained high levels of physical activity, this should result in improved participation and quality of life. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July, 2013.
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Terapia por Ejercicio , Automanejo , Rehabilitación de Accidente Cerebrovascular/métodos , Australia , Capacidad Cardiovascular , Método Doble Ciego , Ejercicio Físico , Conductas Relacionadas con la Salud , Humanos , Educación del Paciente como Asunto , Estudios Prospectivos , Calidad de Vida , Proyectos de Investigación , Autoeficacia , CaminataRESUMEN
OBJECTIVES: To determine whether an enriched environment embedded in an acute stroke unit could increase activity levels in acute stroke patients and reduce adverse events. DESIGN: Controlled before-after pilot study. SETTING: An acute stroke unit in a regional Australian hospital. PARTICIPANTS: Acute stroke patients admitted during (a) initial usual care control period, (b) an enriched environment period and (c) a sustainability period. INTERVENTION: Usual care participants received usual one-on-one allied health intervention and nursing care. The enriched environment participants were provided stimulating resources, communal areas for eating and socializing and daily group activities. Change management strategies were used to implement an enriched environment within existing staffing levels. MAIN MEASURES: Behavioural mapping was used to estimate patient activity levels across groups. Participants were observed every 10 minutes between 7.30 am and 7.30 pm within the first 10 days after stroke. Adverse and serious adverse events were recorded using a clinical registry. RESULTS: The enriched environment group ( n = 30, mean age 76.7 ± 12.1) spent a significantly higher proportion of their day engaged in 'any' activity (71% vs. 58%, P = 0.005) compared to the usual care group ( n = 30, mean age 76.0 ± 12.8). They were more active in physical (33% vs. 22%, P < 0.001), social (40% vs. 29%, P = 0.007) and cognitive domains (59% vs. 45%, P = 0.002) and changes were sustained six months post implementation. The enriched group experienced significantly fewer adverse events (0.4 ± 0.7 vs.1.3 ± 1.6, P = 0.001), with no differences found in serious adverse events (0.5 ± 1.6 vs.1.0 ± 2.0, P = 0.309). CONCLUSIONS: Embedding an enriched environment in an acute stroke unit increased activity in stroke patients.
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Unidades Hospitalarias , Medio Social , Rehabilitación de Accidente Cerebrovascular/métodos , Anciano , Australia , Estudios Controlados Antes y Después , Femenino , Humanos , Masculino , Proyectos Piloto , Estudios ProspectivosRESUMEN
OBJECTIVE: To determine the effect of aerobic exercise on brain-derived neurotrophic factor (BDNF) levels in people with neurological disorders. DATA SOURCES: Six electronic databases (CINAHL, PubMed, Cochrane, PsycINFO, SportDiscus, and Web of Science) were searched until the end of December 2016. STUDY SELECTION: Experimental or observational studies of people with neurological disorders who undertook an exercise intervention with BDNF as an outcome measure. The search strategy yielded 984 articles. DATA EXTRACTION: Study data were independently extracted from each article. Methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. A meta-analysis was planned based on the assessment of predetermined criteria. DATA SYNTHESIS: Eleven articles were included. Studies employed either a program of aerobic exercise, a single bout of aerobic exercise, or both. A meta-analysis of studies comparing a program of aerobic exercise against usual care/nil therapy showed a large effect (SMD: 0.84, 95% CI 0.47-1.20, p < 0.001) in favour of aerobic exercise to increase levels of BDNF. Findings for a single bout of aerobic exercise were mixed. Quality of studies was low (PEDro average score 4.3/10). CONCLUSIONS: A program of aerobic exercise may contribute to increased levels of BDNF in neurological populations.
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Factor Neurotrófico Derivado del Encéfalo/metabolismo , Encéfalo/metabolismo , Terapia por Ejercicio , Ejercicio Físico/fisiología , Esclerosis Múltiple/terapia , Enfermedad de Parkinson/terapia , Accidente Cerebrovascular/terapia , Humanos , Esclerosis Múltiple/metabolismo , Enfermedad de Parkinson/metabolismo , Calidad de VidaRESUMEN
BACKGROUND: Therapy that combines repetitive training with non-invasive brain stimulation is a potential avenue to enhance upper limb recovery after stroke. This study aimed to investigate the feasibility of transcranial Random Noise Stimulation (tRNS), timed to coincide with the generation of voluntary motor commands, during reaching training. METHODS: A triple-blind pilot RCT was completed. Four stroke survivors with chronic (6-months to 5-years) and severe arm paresis, not taking any medications that had the potential to alter cortical excitability, and no contraindications to tRNS or MRI were recruited. Participants were randomly allocated to 12 sessions of reaching training over 4-weeks with active or sham tRNS delivered over the lesioned hemisphere motor representation. tRNS was triggered to coincide with a voluntary movement attempt, ceasing after 5-s. At this point, peripheral nerve stimulation enabled full range reaching. To determine feasibility, we considered adverse events, training outcomes, clinical outcomes, corticospinal tract (CST) structural integrity, and reflections on training through in-depth interviews from each individual case. RESULTS: Two participants received active and two sham tRNS. There were no adverse events. All training sessions were completed, repetitive practice performed and clinically relevant improvements across motor outcomes demonstrated. The amount of improvement varied across individuals and appeared to be independent of group allocation and CST integrity. CONCLUSION: Reaching training that includes tRNS timed to coincide with generation of voluntary motor commands is feasible. Clinical improvements were possible even in the most severely affected individuals as evidenced by CST integrity. TRIAL REGISTRATION: This study was registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) http://www.ANZCTR.org.au/ACTRN12614000952640.aspx . Registration date 4 September 2014, first participant date 9 September 2014.
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Terapia por Ejercicio/métodos , Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Estimulación Transcraneal de Corriente Directa/métodos , Adulto , Brazo/fisiología , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Recuperación de la Función/fisiología , Accidente Cerebrovascular/complicaciones , Sobrevivientes , Estimulación Eléctrica Transcutánea del Nervio , Extremidad SuperiorRESUMEN
OBJECTIVE: To characterize community ambulation and determine if it changes across the first 6 months after discharge from hospital after stroke. DESIGN: Prospective, observational study. SETTING: Community setting. PARTICIPANTS: Subacute stroke survivors with no cognitive impairment or conditions limiting mobility prior to stroke (N=34). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Community ambulation was measured by an accelerometer, Global Positioning System, and activity diary. Measures included the following: volume (step count; time spent in the community, lying/sitting, standing, and walking), frequency (number of community trips; number of and time in short-, medium-, long-duration bouts), intensity (number of and time at low-, moderate-, high-intensity bouts), and trip type at 1, 3, and 6 months after hospital discharge. RESULTS: At 1 month participants took on average 1 trip per day in the community, lasting 137±113 minutes. Overall, most community ambulation was spread across long-duration bouts (>300 steps) lasting 11.3 to 14.1min/d and moderate-intensity bouts (30-80 steps per minute). There was no change in community ambulation trip type (P<.302) or ambulation characteristics over time except for a greater number of and time spent in long ambulation bouts at 6 months only (P<.027). CONCLUSIONS: Total volume and intensity of community ambulation did not change over the first 6 months postdischarge after stroke. However, at 6 months, survivors spent more time in long-duration ambulation bouts. Review of stroke survivors at 6 months after hospital discharge is suggested because this is when changes in community ambulation may first be observed.
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Acelerometría , Sistemas de Información Geográfica , Características de la Residencia , Rehabilitación de Accidente Cerebrovascular/métodos , Caminata , Anciano , Anciano de 80 o más Años , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de TiempoRESUMEN
OBJECTIVES: To explore differences in gait endurance, speed, and standing balance in people with multiple sclerosis (MS) across the Disease Step Rating Scale, and to determine if differences are statistically significant and clinically meaningful. DESIGN: Observational study. SETTING: Community rehabilitation - primary health care center. PARTICIPANTS: Community-dwelling people with MS (N=222; mean age, 48±12y; 32% men). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were categorized using the Disease Step Rating Scale. Demographics and clinical measures of gait endurance (6-minute walk test [6MWT]), gait speed (10-m walk test [10MWT] and 25-foot walk test [25FWT]), and balance (Berg Balance Scale [BBS]) were recorded in 1 session. Differences in these parameters across categories of the Disease Step Rating Scale were explored, and clinically meaningful differences were identified. RESULTS: The 6MWT showed a greater number of significant differences across adjacent disease steps in those with less disability (P<.001), whereas the 10MWT and 25FWT demonstrated more significant changes in those with greater disability (P<.001). The BBS demonstrated significant differences across the span of the Disease Step Rating Scale categories (P<.001). Differences in gait and balance between adjacent Disease Step Rating Scale categories met most previously established levels of minimally detectable change and all minimally important change scores. CONCLUSIONS: Our findings support the Disease Step Rating Scale is an observational tool that can be used by health professionals to categorize people with MS, with the categories reflective of statistically significant and clinically meaningful differences in gait and balance performance.
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Evaluación de la Discapacidad , Marcha/fisiología , Esclerosis Múltiple/rehabilitación , Modalidades de Fisioterapia/normas , Equilibrio Postural/fisiología , Adulto , Estudios Transversales , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , CaminataRESUMEN
AIM: To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. METHODS: A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). RESULTS: Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1 minutes per session during physiotherapy and 11.2 minutes during occupational therapy, while another study reported 5.7 minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4 minutes per session (range 0.9 to 7.9, n = 4 studies) during physiotherapy and 17 minutes per session (range 9.3 to 28.9, n = 3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. CONCLUSION: The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.
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Brazo/fisiopatología , Terapia Ocupacional , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular , HumanosRESUMEN
INTRODUCTION: Studies of exercise in patients with myasthenia gravis (MG) are sparse. Balance strategy training (BST) multimodal exercise has proven efficacy in adults for enhancing balance and functional mobility. This prospective study aims to determine if BST improves functional ability and balance in people with MG. METHODS: Seven individuals with MG participated in a 16-session workstation intervention. Repeated measures (pre/post-intervention and 4-week follow-up) consisting of quantitative myasthenia gravis score (QMG), 6-minute walk test (6MWT), timed up and go (TUG) with dual task (TUG(manual) and TUG(cognitive)), and standing stability on foam with eyes closed (foamEC) were assessed. RESULTS: Most measurements showed sustained improvement at follow-up. QMG, TUG(cognitive), and foam EC achieved clinically significant improvements (>15%). No adverse effects were reported. CONCLUSIONS: BST was effective in improving balance and QMG scores in subjects with MG. A multimodal BST approach is thus suggested to target different aspects of balance and functional mobility.
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Terapia por Ejercicio/métodos , Miastenia Gravis/rehabilitación , Equilibrio Postural , Adulto , Anciano , Estudios de Cohortes , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To determine whether there were differences in characteristics and activity limitations relevant to physiotherapists among people receiving inpatient rehabilitation after stroke in 2001, 2005, and 2011. DESIGN: A multicenter observational study of 3 periods. SETTING: Inpatient rehabilitation units (N=15). PARTICIPANTS: Adult stroke survivors (N=738) admitted over 3 periods (2001, 2005, 2011). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Characteristics, hospital metrics, and Motor Assessment Scale (MAS) scores were recorded on admission and discharge. RESULTS: All 3 cohorts were similar in terms of sex, side affected by stroke, and length of time from stroke onset to rehabilitation admission. Stroke participants in the 2005 cohort were older than those in the 2011 and 2001 cohorts. Participants in the 2011 cohort had a longer inpatient rehabilitation length of stay, experienced lower average MAS gains per day (F>3.298, P<.038), and experienced more activity limitations in basic functional tasks involving bed mobility, standing up, and sitting balance on admission and discharge, and in walking and arm function at discharge only compared with earlier cohorts. CONCLUSIONS: In 2011, on average, people admitted for rehabilitation after stroke were approximately the same age as patients in 2005 and 2001 and it took approximately 2 weeks for all of these patients to be admitted to a rehabilitation unit, but patients in 2011 had a longer inpatient rehabilitation length of stay compared with patients in 2005 and 2001. In addition, activity limitations at inpatient rehabilitation admission and discharge appear to be worse, particularly for activities such as rolling, sitting up over the edge of the bed, and balanced sitting.
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Actividades Cotidianas , Evaluación de la Discapacidad , Movimiento/fisiología , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Centros de Rehabilitación , Accidente Cerebrovascular/fisiopatologíaRESUMEN
OBJECTIVE: To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery after stroke, defined using a measure of activity. DATA SOURCES: A search was conducted of Medline/Pubmed, CINAHL and Web of Science. REVIEW METHODS: Two reviewers independently assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale. RESULTS: Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function after stroke. CONCLUSION: This review provides limited evidence to support the supposition that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Further investigations are required to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.
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Actividades Cotidianas , Calidad de Vida , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Anciano , Bases de Datos Bibliográficas , Humanos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Rehabilitación/métodosRESUMEN
BACKGROUND: Concurrent validity and intra-rater reliability using a customized Android phone application to measure cervical-spine range-of-motion (ROM) has not been previously validated against a gold-standard three-dimensional motion analysis (3DMA) system. FINDINGS: Twenty-one healthy individuals (age:31 ± 9.1 years, male:11) participated, with 16 re-examined for intra-rater reliability 1-7 days later. An Android phone was fixed on a helmet, which was then securely fastened on the participant's head. Cervical-spine ROM in flexion, extension, lateral flexion and rotation were performed in sitting with concurrent measurements obtained from both a 3DMA system and the phone.The phone demonstrated moderate to excellent (ICC = 0.53-0.98, Spearman ρ = 0.52-0.98) concurrent validity for ROM measurements in cervical flexion, extension, lateral-flexion and rotation. However, cervical rotation demonstrated both proportional and fixed bias. Excellent intra-rater reliability was demonstrated for cervical flexion, extension and lateral flexion (ICC = 0.82-0.90), but poor for right- and left-rotation (ICC = 0.05-0.33) using the phone. Possible reasons for the outcome are that flexion, extension and lateral-flexion measurements are detected by gravity-dependent accelerometers while rotation measurements are detected by the magnetometer which can be adversely affected by surrounding magnetic fields. CONCLUSION: The results of this study demonstrate that the tested Android phone application is valid and reliable to measure ROM of the cervical-spine in flexion, extension and lateral-flexion but not in rotation likely due to magnetic interference. The clinical implication of this study is that therapists should be mindful of the plane of measurement when using the Android phone to measure ROM of the cervical-spine.
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Teléfono Celular , Aplicaciones Móviles , Cuello/fisiología , Rango del Movimiento Articular/fisiología , Adulto , Vértebras Cervicales/fisiología , Femenino , Humanos , Masculino , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Standardised patients are used in medical education to expose students to clinical contexts and facilitate transition to clinical practice, and this approach is gaining momentum in physiotherapy programs. Expense and availability of trained standardised patients are factors limiting widespread adoption, and accessing clinical visits with real patients can be challenging. This study addressed these issues by engaging senior students as standardised patients for junior students. It evaluated how this approach impacted self-reported constructs of both the junior and senior students. METHODS: Learning activities for undergraduate physiotherapy students were developed in five courses (Neurology, Cardiorespiratory and three Musculoskeletal courses) so that junior students (Year 2 and 3) could develop skills and confidence in patient interview, physical examination and patient management through their interaction with standardised patients played by senior students (Year 4). Surveys were administered before and after the interactions to record junior students' self-reported confidence, communication, preparedness for clinic, and insight into their abilities; and senior students' confidence and insight into what it is like to be a patient. Satisfaction regarding this learning approach was surveyed in both the junior and senior students. RESULTS: A total of 253 students completed the surveys (mean 92.5% response rate). Across all courses, junior students reported a significant (all P < 0.037) improvement following the standardised patient interaction in their: preparedness for clinic, communication with clients, confidence with practical skills, and understanding of their strengths and weaknesses in relation to the learning activities. Senior students demonstrated a significant improvement in their confidence in providing feedback and insight into their own learning (P < 0.001). All students reported high satisfaction with this learning experience (mean score 8.5/10). CONCLUSION: This new approach to peer-assisted learning using senior students as standardised patients resulted in positive experiences for both junior and senior students across a variety of physiotherapy areas, activities, and stages within a physiotherapy program. These findings support the engagement of senior students as standardised patients to enhance learning within physiotherapy programs, and may have application across other disciplines to address challenges associated with accessing real patients via clinical visits or utilising actors as standardised patients.
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Simulación de Paciente , Modalidades de Fisioterapia/educación , Autoeficacia , Estudiantes de Medicina , Competencia Clínica , Evaluación Educacional , Femenino , Humanos , Masculino , Enseñanza/métodos , Adulto JovenRESUMEN
PURPOSE: This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS: A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS: Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION: Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.
Asunto(s)
Hospitales de Rehabilitación , Pacientes Internos , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Estudios Prospectivos , Grupos FocalesRESUMEN
BACKGROUND: Physical activity levels are low in people with Parkinson's disease (PD) and have proved difficult to increase with exercise programs alone. Intervention approaches that address both the capacity to engage in physical activity and self-management strategies to change and maintain exercise behaviours are needed to address this intractable issue. METHODS: This will be an assessor-blinded, randomized controlled trial performed in Brisbane, Australia. Ninety-two people with mild-moderate PD will be randomly allocated to two groups: usual care, and a physiotherapy-led group exercise program combined with self-management strategies. In the intervention group, twelve, 80-min sessions will be conducted over 4 weeks in groups of up to 4 participants. The intervention will consist of circuit training including treadmill walking to target aerobic fitness, and activities targeting strength, balance, and gait performance. In addition, each session will also incorporate strategies focusing on self-management and behaviour change, augmented by the provision of a fitness activity tracker. Outcome measures will be collected at baseline (T1), immediately post intervention (T2) and at 6 months follow-up (T3). The primary outcome measure is free-living physical activity (average daily step count over 7 days) at pre (T1) and post (T2) intervention measured using an activPAL™ device. Secondary outcome measures captured at all time points include time spent walking, sedentary and in moderate intensity exercise over 7 days; spatiotemporal gait performance (step length, gait speed, endurance); health-related quality of life; and outcome expectations and self-efficacy for exercise. DISCUSSION: Sustainability of gains in physical activity following exercise interventions is a challenge for most populations. Our incorporation of a chronic disease self-management approach into the exercise program including fitness tracking extends previous trials and has potential to significantly improve free-living physical activity in people with PD. TRIAL REGISTRATION: This study has been prospectively registered in Australian and New Zealand Clinical Trial Registry (ACTRN12617001057370), registered on 19/07/2017. Available from www.anzctr.org.au/ACTRN12617001057370.aspx .