Aquatic Exercise Training Outcomes on Functional Capacity, Quality of Life, and Lower Limb Lymphedema: Pilot Study.

OBJECTIVE: To investigate whether patients with lower limb lymphedema (LLL) can benefit from water immersion exercise training to improve functional capacity, quality of life (QOL), and help control/diminish limb volume. DESIGN: A before-after trial. SETTING: A community University Sports Center. SUBJECTS: Eleven participants were recruited to participate and four declined to pursue the study for personal reasons. A convenient sample of seven female affected by either bilateral or unilateral LLL volunteered for this pilot study. Patients had primary or secondary lymphedema as complications of melanoma or gynecologic cancers. INTERVENTIONS: An aquatic training exercise intervention of moderate to vigorous intensity was conducted for a 6-week period (12 sessions of 45 min). This innovative circuit training program consisted of yoga exercises, aqua-jogging, pedaling on a water bike, and muscular training on an aquastep and a trampoline. OUTCOME MEASURES: The physical characteristics of water could be used to overcome the physical and medical limitations encountered on dry land for patients with LLL to exercise and reach training benefits. Outcome measures were the 6-min walk test (6MWT), handgrip strength test, QOL for limb lymphedema questionnaire (LYMQOL), bioelectrical impedance spectroscopy, and limb circumference. RESULTS: The distance covered in the 6MWT and the handgrip strength were significantly improved. A trend toward an increase in the overall QOL score was noticeable, whereas a significantly improved emotions score was observed with the LYMQOL questionnaire. Limb circumferential volume was significantly lower and impedance was increased, denoting a decrease in lymphatic fluid. CONCLUSIONS: Innovative aquatic exercise training program allows moderate and vigorous intensity activities for patients with LLL, increases functional capacity and QOL. Thus, immersion exercise does not appear to exacerbate LLL and a randomized clinical trial with larger numbers is essential to consolidate the results of this study.

Acute effects of water immersion on heart rate variability in participants with heart disease.

BACKGROUND: Water immersion and aquatic exercise can be an important therapeutic tool in patients suffering from heart disease (HD). However, the effects of water immersion on heart rate variability (HRV) in HD participants remain unknown. METHODS: Twenty-eight volunteers in sinus rhythm within the same age range took part in this study: 18 HD and ten healthy controls (HC). Heart rhythm was collected with a heart rate monitor (sampling rate 1000 Hz) for periods of 10 min at rest in the supine position on land, standing on land (STL) and standing in water (STW) to the xiphoid process. RESULTS: Heart disease participants had the same response as HC participants to the three experimental conditions (no significant between-group differences in all HRV variables). STW (immersion) caused in both groups to increase HRV when compared to supine and STL. CONCLUSION: Heart disease participants demonstrate similar beneficial adaptations as HC participants to the effects of immersion, reinforcing the concept that immersion can be a valuable aquatic cardiac rehabilitation tool to acutely increase HRV. Approaches that improve HRV in both healthy and cardiac patients may have a positive impact on the reduction of morbidity and mortality.

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

INTRODUCTION: Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). METHODS AND ANALYSIS: This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). ETHICS AND DISSEMINATION: This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. PROSPERO REGISTRATION NUMBER: CRD42015020558.

Improved cardiovascular prevention using best CME practices: a randomized trial.

INTRODUCTION: It was hypothesized that after a continuing medical education (CME) event, practice enablers and reinforcers addressing main clinical barriers to preventive care would be more effective in improving general practitioners' (GPs) adherence to cardiovascular guidelines than a CME event only. METHODS: A cluster-randomized trial was conducted on a convenience sample of 122 GPs who were randomly assigned to either CME only (control group) or CME with practice enablers and reinforcers (PER group). In the PER group, nurses visited GPs' offices once a month to implement the clinical intervention on patients > or = 55 years old with a scheduled visit in the month following the nurse visit: (1) screening medical records for potentially undermanaged high-risk patients; (2) prompting physicians to reassess preventive care in these patients; (3) enclosing a checklist reporting most recent information relevant to guidelines' implementation; and (4) enclosing a summary of experts' recommendations in the form of a follow-up and treatment algorithm. RESULTS: A retrospective chart audit of 2344 consenting patients, potentially undermanaged at baseline, demonstrated that the PER intervention following CME significantly improved adherence to guidelines compared to CME alone (OR: 1.78, 95% CI: 1.32-2.41). DISCUSSION: The intervention was designed for self-implementation in primary care practices that have their own nursing staff. PER GPs were highly satisfied with the intervention; the majority said that they would implement it in their practice if someone trained their nurse, thus suggesting support for development of a multiprofessional CME program to disseminate this clinical approach to primary care practice groups.