Concurrent Validity of the Garmin Vivofit®4 to Accurately Record Step Count in Older Adults in Challenging Environments.

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.

Are Changes in Gait and Balance Across the Disease Step Rating Scale in Multiple Sclerosis Statistically Significant and Clinically Meaningful?

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.

Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study.

PURPOSE: Physical activity is an important modifiable determinant of health. There has been a historical aversion to movement in people with myasthenia gravis (MG) due to the pathophysiology of the disease, however, research suggests engagement in physical activity is safe and does not exacerbate symptoms. There are currently no studies investigating the qualitative perspectives of people with MG on physical activity. The aim of this study was to explore perceptions of physical activity, barriers, enablers, and participants' experiences of physical activity advice from health professionals. MATERIALS AND METHODS: Semi-structured interviews were used, with verbatim transcripts analysed using content analysis. RESULTS: Ten adults (median age 64.5 years) living in Australia with generalised MG were interviewed. Key findings were identified: (1) Physical activity is perceived to be important for general health and for MG; (2) Medical management and social support are key enablers; (3) Fatigue and pain are potential barriers; and (4) Experiences with healthcare professionals were considered insufficient and failed to provide disease specific advice regarding MG and physical activity. CONCLUSION: People with MG have unique barriers and enablers to physical activity engagement that clinicians should consider when providing physical activity behaviour change support to this population.

Physical activity is perceived positively by people with myasthenia gravis, both due to the general benefits and disease-specific impacts, however unique barriers such as fatigue and pain can make physical activity engagement challenging.Tailored physical activity behaviour change support is recommended to consider these barriers on an individual level.Effective interprofessional collaboration is important in ensuring medical management is optimised to enable greater physical activity participation, and behaviour change techniques involving social supports may warrant consideration.Health professionals should seek to improve their understanding of myasthenia gravis to deliver evidence-based, person-centred approaches to physical activity promotion in this population.

Fragmented care and missed opportunities: the experiences of adults with myasthenia gravis in accessing and receiving allied health care in Australia.

PURPOSE: Although allied health services are important adjuncts to medical care for people with myasthenia gravis (MG), the underutilisation of these services is not well understood within the Australian context. It is critical to explore patients' perceptions to develop services that meet consumer needs. This study, therefore, sought to obtain insight into MG patients' perspectives and experiences, in addition to the outcomes, of accessing allied health services. MATERIALS AND METHODS: Thirteen Australian adults with MG participated in semi-structured interviews. Qualitative analysis was conducted inductively using thematic content analysis. RESULTS: Four themes were identified: (1) missed opportunities and unmet care needs were common, due to frequent patient-provider communication breakdowns and a lack of referral protocols, (2) personal factors - patient self-advocacy influenced their perceived need, with some lacking confidence to seek help, (3) perceived benefit and health provider capacities - most valued allied health despite differing perceptions of health professionals' attitudes, skills, and willingness to learn, and (4) a resultant fragmentation of care between services was universal. CONCLUSIONS: Findings highlighted a need for clear referral pathways, coordinated multidisciplinary care, improved access to community-based services and education for allied health professionals about MG.Implications for rehabilitationAdults with myasthenia gravis (MG) report a lack of referral pathways to allied health services, leading to unmet needs and fragmented care.Although there is a perceived benefit to allied health care, experiences are impacted by health provider capacity and attitudes.There needs to be an overall shift towards multidisciplinary care for people with MG, and the development of clear referral pathways.Specific education about MG should be available for allied health professionals to improve their knowledge and skills in treating this population.

Do people with Myasthenia Gravis need speech-language pathology services? A national survey of consumers' experiences and perspectives.

Purpose: This study explored experiences of bulbar (speech, voice and swallowing) symptoms in Australian adults with Myasthenia Gravis (MG), and the relationship between these symptoms and community participation and quality-of-life. Further, it examined access to and experiences with speech-language pathology (SLP) services, and awareness and perceptions of the SLP's role.Method: A cross-sectional mixed methods online survey collected data using researcher-designed questions and patient-reported outcome measures (PROMs) including the Dysarthria Impact Profile (DIP), Voice Handicap Index (VHI), Dysphagia Handicap Index (DHI), Community Integration Questionnaire-Revised (CIQ-R), and Myasthenia Gravis Quality of Life-Revised 15 (MG-QOL15r). Analyses included descriptive and non-parametric statistics, and content analysis.Result: Participants were 111 adults with MG living in Australia. 74% of respondents reported experiencing symptoms of speech difficulties but only 20% of those were referred to SLP services. Similarly, 85% of respondents reported experiencing swallowing difficulties, but only 26% were referred to SLP. Voice handicap (VHI) was strongly correlated with the psychosocial impact of dysarthria (DIP) and dysphagia handicap (DHI). Increased voice and dysphagia handicap were moderately correlated with worse quality-of-life. There was generally poor awareness of the SLP's role and many were reluctant to attend SLP appointments.Conclusion: These findings highlight unmet consumer needs for MG-related bulbar symptoms, and a lack of awareness of SLP services. It is suggested that, in addition to other strategies, consumer education and increased awareness are required to address these unmet needs.

Walking impairment in patients with multiple sclerosis: The impact of complex motor and non-motor symptoms across the disability spectrum.

BACKGROUND: Multiple sclerosis (MS) is a neurodegenerative pathology that affects young people in the prime of their lives, often having an impact on motor tasks such as walking, which subsequently affects participation in daily activities. The symptoms caused by MS are highly variable, and rehabilitation strategies, which often focus on movements and exercises to improve symptoms or function, are variable in success. OBJECTIVE: The aim of this article is to summarise how motor and non-motor symptoms have an impact on walking ability in people with MS, and how this impact may vary across disability levels. DISCUSSION: A variety of motor and non-motor symptoms are common in people with MS early after diagnosis, but they vary in their impact on walking, and this differs by disability level. A comprehensive assessment of all symptoms is required to understand contributors to walking disability and thus direct targeted non-pharmacological management options.

The Association between Hearing Impairment and Postural Stability in Older Adults: A Systematic Review and Meta-analysis.

There is growing evidence linking hearing impairment to higher falls risk through alterations in postural stability, with studies showing mixed results. The primary aim of this systematic review and meta-analysis was to determine the association between hearing impairment and postural instability in older adults, including differences based on severity of hearing impairment. This review was pre-registered in PROSPERO and performed in accordance with PRISMA guidelines across six databases. Primary research on adults aged 60 years and older with hearing loss and an objective measure of postural stability or gait were eligible for inclusion. Methodological quality was assessed using the modified Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Data were analysed using meta-analyses and a narrative synthesis. Inclusion in the meta-analyses required clearly defined audiometrically-assessed hearing impairment, and two subgroups of participants: mild (25-40 dB HL) and moderate to-severe (>40 dB HL) hearing impairment. Twenty-five eligible studies (n = 27,847) were included in the narrative synthesis, with quality ratings ranging from unsatisfactory to very good on the modified NOS. Eight studies were included in the meta-analysis which showed individuals with moderate to-severe hearing impairment were significantly slower on the 5 x sit-to-stand test (mean difference[95%CI] = 0.50 s [0.04, 0.97], p = .03), had a slower gait speed (mean difference[95%CI] = -0.11 s [-0.16, -0.05], p < .001) and had lower total Short Physical Performance Battery scores (mean difference[95%CI] = -0.79[-1.17, -0.41], p < .001) than those with normal hearing. This review provides evidence there is an inverse association between increasing severity of hearing impairment and poorer postural stability across both the meta-analysis and narrative synthesis.