Perspectives of choice and control in daily life for people following brain injury: A qualitative systematic review and meta-synthesis.

BACKGROUND AND OBJECTIVE: Acquired brain injury (ABI) can result in considerable life changes. Having choice and control over daily life is valued by people following ABI. This meta-synthesis will analyse and integrate international research exploring perspectives of choice and control in daily life following ABI. METHODS: Databases were searched from 1980 to 13 January 2022 for eligible qualitative studies. After duplicates were removed, 22,768 studies were screened by title and abstract, and 241 studies received full-text assessment with 56 studies included after pearling. Study characteristics and findings were extracted that related to personal perspectives on choice and control by people with an ABI (including author interpretation and quotes). Data from each study were coded and then segments of coded data across the studies were compared to create multiple broad categories. FINDINGS: Findings were then reduced from categories into 3 overarching themes with 12 subthemes. These themes were: (1) feeling like a second-class citizen; (2) reordering life and (3) choosing a path. Participants with an ABI tussled between their feelings of loss following brain injury and their thinking about how they start to regain control and become agents of their own choices. The themes describe their sense of self, their changed self and their empowered self in relation to 'choice and control'. CONCLUSIONS: Re-engaging with choice and control after ABI is dynamic and can be challenging. Health professionals and supporters need to facilitate a gradual and negotiated return to agency for people following ABI. A sensitive and person-centred approach is needed that considers the readiness of the person with ABI to reclaim choice and control at each stage of their recovery. Clear service or process indicators that are built on lived experience research are needed to facilitate changes in service delivery that are collaborative and inclusive. PATIENT OR PUBLIC CONTRIBUTION: This review included the voices of 765 people living with ABI and was conducted by a diverse team of allied health professionals with practice knowledge and research experience with people following ABI. Twenty-nine of the 56 included studies had participants contributing to their design or analysis.

Exercising Choice and Control: A Qualitative Meta-synthesis of Perspectives of People With a Spinal Cord Injury.

OBJECTIVE: To systematically search the literature and construct a meta-synthesis of how choice and control are perceived by people with spinal cord injury (SCI). DATA SOURCES: Medline, Academic Search Premier, CINAHL, Cochrane, EMBASE, HealthSource, ProQuest, PsychInfo, SAGE, and SCOPUS were searched from 1980 until September 2018 including all languages. Reference lists of selected studies were also reviewed. STUDY SELECTION: Eligible qualitative studies included perspectives about choice of control as reported by people with an SCI. Studies were excluded if they included perspectives from other stakeholder groups. A total of 6706 studies were screened for title and abstract and full text of 127 studies were reviewed resulting in a final selection of 29. DATA EXTRACTION: Characteristics of the studies were extracted along with any data (author interpretations and quotes) relating to perspectives on choice and control. DATA SYNTHESIS: First-order analysis involved coding the data in each study and second-order analysis involved translating each segment of coded data into broader categories with third-order analysis condensing categories to 2 broad overarching themes. These themes were experiencing vulnerability or security and adapting to bounded abilities. CONCLUSIONS: Perspectives of choice and control are influenced by interrelated environmental, interpersonal, and personal contexts. From a personal perspective, participants reported a readiness for adaptation that included turning points where emotional and cognitive capacity to make choices and take control changed. Health professionals need to be responsive to this readiness, promote empowerment and foster, rather than remove, hope.

It's not raining men: a mixed-methods study investigating methods of improving male recruitment to health behaviour research.

BACKGROUND: Although gender is an important determinant of health behaviour with males less likely to perform health-protective behaviours, samples in health behaviour research are heavily biased towards females. This study investigated the use of online social network, Facebook, to reach and recruit inactive males to a team-based, social, and gamified physical activity randomised controlled trial. METHODS: Methodological techniques included a narrative literature review, survey of inactive males (n = 34) who rated advertisement images and text captions on scales of 1-10, and trial Facebook-delivered recruitment campaigns. Advertisement effectiveness was measured by cost-per-click to the study website, number of expressions of interest, and study enrolments from males. RESULTS: Survey results showed that vibrant images of men exercising accompanied by concise captions (< 35 words) were most effective. An advertising campaign incorporating these components achieved a cost-per-click of $0.60, with 80% of n = 50 expressions of interest being from men, a marked improvement from baseline campaigns in which only 11% of expressions of interest were from men. Despite this, men who were recruited through the targeted campaign failed to enrol into the study, primarily due to reluctance to invite friends to join their team. An alternative strategy of encouraging females to invite men boosted male participation from 18% of the sample at baseline to 29% in the targeted recruitment phase. CONCLUSIONS: Evidence-based approaches can improve Facebook recruitment outcomes, however, there are complex barriers hindering male recruitment to health behaviour studies that may necessitate multi-faceted strategies including involvement of family and friends.

Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand.

BACKGROUND: Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels. METHODS: A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer's Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis. RESULTS: A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05). CONCLUSIONS: These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.

The comorbidity of low back pelvic pain and risk of depression and anxiety in pregnancy in primiparous women.

BACKGROUND: Approximately 50% of Australian women experience low back pain in pregnancy, with somewhere between 8 and 36% of women suffering from pregnancy related depression/anxiety. Both low back and pelvic pain and depression and anxiety are associated with poor maternal health outcomes, including increased sick leave, higher rates of functional disability, and increased access to healthcare. It also impacts upon time and mode of delivery with an increase in inductions and elective caesarean sections. For babies of women with depression and anxiety preterm birth, low birth weight and intrauterine growth restriction are all common complications. Given these poor health outcomes, it is important to determine the co-morbidity of low back and pelvic pain and depression/anxiety in pregnancy. METHODS: A cross sectional study of a hospital based sample of 96 nulliparous women were assessed at 28 weeks as part of their routine antenatal appointment. Data was collected via interview and clinical records and included the Edinburgh Depression Scale (EDS), the Numerical Rating Scale (NRS) and the Modified Oswestry Low Back Pain Disability Questionnaire (MODQ). Spearman's correlation co-efficients, prevalence ratios and ANOVA were used to determine comorbidity. RESULTS: 96 women consented to participation in the study. All study outcomes were moderately correlated. There were three main findings: One, there was a positive correlation between low back and pelvic girdle pain (LBPP) and depression/anxiety was rho = 0.39, p < 0.001, between LBPP and functional disability was rho = 0.51, p < 0.001 and between risk of depression/anxiety and functional disability was rho = 0.54, p < 0.001. Two, a woman with LBPP was 13 times more likely to have increased risk of depression/anxiety, whilst a woman with increased risk of depression/anxiety was 2.2 times more likely to have LBPP and finally three, amongst women who reported LBPP, the level of disability experienced was significantly higher in women who had concurrent increased risk of depression/anxiety (p = 0.003). This occurred even though the severity of pain did not differ between groups (NRS score mean p = 0.38). CONCLUSIONS: This study found a high level of co-occurrence of LBPP, functional disability and depression/anxiety in women in their third trimester of pregnancy. Importantly women who reported higher depression/anxiety symptoms appeared to experience higher levels of functional disability in relation to their LBPP, than women with lower depression/anxiety symptoms and LBPP.

Farmers' perceptions of health in the Riverland region of South Australia: 'If it's broke, fix it'.

OBJECTIVE: To explore perceptions of health among South Australian farmers. DESIGN: Descriptive qualitative study, using semi-structured interviews. SETTING: Two rural towns in the Riverland region of South Australia. PARTICIPANTS: Fifteen adults involved in farming within the Riverland region of South Australia, from a variety of farming industries; age range 23-70 years old; 53% male, 47% female. MAIN OUTCOME MEASURES: Perceptions and definitions of health. RESULTS: Participants described an ecological understanding of health across individual, farm, and community domains. Participants perceived health as being able to function and complete farm work. Participants reported that farm work helped to maintain fitness, but the multiple stress and hazards associated with farming had a significant influence on health. Participants described how health was influenced by community activities and social support from friends and families. Women were reported to take a lead role in health. CONCLUSIONS: Health providers can frame interventions to resonate with the perceptions of health held by people, shaped and formed by the context of farming. Further research is needed to explore farmers' perceptions of health in different locations, from different industries and from a range of age groups.

Strategies to enhance resilience post-natural disaster: a qualitative study of experiences with Australian floods and fires.

BACKGROUND: Disasters have a significant impact on mental health that may be mitigated by promoting resilience. This study explores the lay perspective on public health interventions that have the potential to facilitate resilience of adults who experience a natural disaster. METHODS: Semi-structured interviews were conducted 6 months post-disaster between June 2011 and January 2012 with 19 people who experienced the 2010/11 Victorian floods. Twenty lay witness statements from people who presented to the 2009 Victorian Bushfires Royal Commission were also selected for analysis. Transcripts were analysed using an interpretive and comparative content analysis to develop an understanding of disaster resilience interventions in an ecological framework. RESULTS: The participants identified resilience focused interventions such as information that help individuals manage emotions and make effective decisions and plans, or enable access to resources; face-to-face communication strategies such as public events that restore or create new social connections; rebuilding of community capacity through coordination of volunteers and donations and policies that manage disaster risk. CONCLUSIONS: Disaster recovery interventions designed within an ecological model can promote a comprehensive integrated systems approach to support resilience in affected populations.

An ethical approach to health promotion in physiotherapy practice.

ISSUE ADDRESSED: With increased emphasis on reducing the global burden of non-communicable disease, health professionals who traditionally focused on the individual are being encouraged to address population-level health problems. While physiotherapists are broadening their clinical role to include health promotion strategies in their clinical practice, the ethical foundations of this practice focus have received less attention. METHODS: We use a physiotherapy clinical scenario to highlight different physiotherapeutic approaches and to analyse underpinning ethical values and implications for practice. RESULTS: We suggest there are potential harms of incorporating health promotion into physiotherapy management of individuals if the population-based research does not resonate with an individual's particular circumstances, capacity to change or view of what counts as important and meaningful. We propose that critical reasoning and ethical judgment by the physiotherapist is required to determine how health promotion messages applied in primary care settings might work to benefit and enhance a client's well being rather than impose burdens or cause harm. CONCLUSION: We suggest four ethical reasoning strategies designed to assist physiotherapists to frame and understand fundamental ethical principles of beneficence, harm, autonomy and justice when implementing health promotion and self-management approaches in clinical practice.

Resilience in allied health undergraduate education: a scoping review.

PURPOSE: Students of allied health disciplines deal with daily challenges. Without methods to mitigate stress, a decline in academic and clinical performance may result. This scoping review aims to examine the current evidence for the efficacy of interventions for enhancing resilience for allied health students. MATERIALS AND METHODS: Medline, Emcare and Cochrane Library were systematically searched for literature published until October 2022. The search included Quantitative studies which employed a pre-post or controlled study design to evaluate an intervention to improve resilience for university students in medical radiation, pharmacy, optometry, physiotherapy and podiatry. Screening and data extraction was conducted independently by two reviewers. Critical appraisal was conducted using Joanna Briggs Institute (JBI) critical appraisal tools. Seven studies were included. RESULTS: A range of resilience interventions were discovered in terms of the frequency and duration, method of implementation including didactic and online learning. Statistically significant findings were found in most controlled trials and pre-post studies. Interventions to enhance resilience are effective within allied health curriculum. CONCLUSIONS: The evidence that resilience can be significantly influenced by an intervention suggests that stakeholders should spend more time on designing and piloting interventions within their context. Future research should look to assess longer term and clinical related outcomes.

Universities and healthcare organizations consider resilience to be a critical capability of graduates in many allied health professions.There are positive benefits regarding the perceptions and knowledge of allied health students who participate in resilience training.Interventions should be designed to relate closely to an articulated understanding of resilience and utilize measurement tools which possess all forms of validity.

The ability of older people to overcome adversity: a review of the resilience concept.

Resilience has been recognized as the ability to bounce back from adversity and regain health. This review seeks to explore the validity of the current understanding of resilience as it applies to older people and its application as guide for interventions. One mixed method, 19 qualitative and 22 quantitative papers were located through a systematic search of nine databases. Results confirmed a number of themes of personal resources. Older people who have the ability to use personal resources and see the world beyond their own concerns are more likely to be resilient. In addition a number of environmental factors were identified including social support from community, family and professionals as well as access to care, availability of resources and the influence of social policy and societal responses. Nurses can facilitate resilience of older people by maintaining or enhancing social support and facilitating access to care and resources.

Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve functional outcomes? A systematic review.

OBJECTIVE: A systematic review was undertaken to update the understanding of the available evidence for antenatal physical therapy interventions for low back or pelvic pain in pregnant women to improve functional outcomes when compared with other treatments or no treatment. DATA SOURCES: Seven electronic databases were systematically searched and supplemented by hand searching through reference lists. METHODS OF STUDY SELECTION: Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials using the Clinical Appraisal Skills Program tool. RESULTS: Four trials with 566 participants were identified that met the inclusion criteria. The validity of the trials was moderate. Exercise, pelvic support garments and acupuncture were found to improve functional outcomes in pregnant women with low back or pelvic pain. No meta-analysis was performed because of the heterogeneity of functional outcome measures. CONCLUSIONS: While there is some evidence that physical therapy using exercise, acupuncture and pelvic supports may be useful, further research needs to consider other treatment modalities used by physical therapists and establish an appropriate, reliable and valid functional outcome measure to assess low back and pelvic pain in pregnancy.

The Psychometric Properties of the Short Physical Performance Battery to Assess Physical Performance in Older Adults: A Systematic Review.

BACKGROUND AND PURPOSE: Maintaining physical performance in older age is critical. The Short Physical Performance Battery (SPPB) is one of many tools available to measure physical performance in older people. PURPOSE: Describe the psychometric properties of the SPPB. METHODS: Using a systematic review methodology, quantitative studies addressing the validity, reliability, and sensitivity of the SPPB in populations 60 years or older were included. We searched 8 databases: MEDLINE, CINAHL, Cochrane, Ageline, Amed, Embase, Scopus, and Emcare, as well as gray literature. Two researchers independently screened, appraised, and extracted data from the literature, following which a descriptive synthesis was undertaken. RESULTS: Twenty-eight studies with varying methodological quality were included. Floor and ceiling effects were reported in 4 studies, generally related to very high or very low functioning adults. Nineteen studies investigated validity with varying correlations between the SPPB and other physical performance assessment tools. Ten studies reported good to excellent reliability (intraclass correlation coefficient ranging 0.82-0.92). Minimum detectable change indicates low sensitivity (ranging 0.7-3.42). DISCUSSION: Evidence from the literature indicates that the SPPB is a reliable and valid measure of physical performance in adults older than 60 years. However, the SPPB has a narrow scope and is most appropriate for frail older adults who can ambulate and are cognitively able to follow instructions. It has limited applicability for specific populations such as people with dementia who have difficulty following instructions. Targeted training for users may improve its usability and success in clinical practice. CONCLUSIONS: Clinicians should be mindful that while the SPPB has good validity and reliability, it has limited applicability for people with dementia and is not particularly sensitive to change. In practice, this means that it provides a good snapshot of a client's physical performance compared with the rest of the older population; it is less useful for tracking changes to physical performance over time.

Occupational therapists and physiotherapists weighing up the dignity of risk for people living with a brain injury: grounded theory.

PURPOSE: Following a brain injury survivors may have physical, or cognitive changes or behaviours which bring safety risks into play when engaging in activities. Therapists experience tensions in enabling the dignity of participation in the context of managing risk. MATERIALS AND METHODS: Ten occupational therapists and seven physiotherapists participated in a grounded theory study utilising semi-structured in-depth interviews to explore the tensions between dignity and management of safety risks. Data were analysed using constant comparative method and a process of moving from open coding to categories to theory development. RESULTS: The process of weighing up was central to the therapists' approach to supporting dignity while managing risk. Respecting dignity itself is placed at risk when preventing harm is weighted higher than living a full life. Therapists who use weighing up as a process that respects dignity place greater value on the principles of respecting autonomy and promotion of justice for people with a brain injury. CONCLUSION: Rather than taking control and attempting to minimise risk therapists who privilege the perspective of the client, and provide opportunities for learning through failure or success, enable clients to live a full life.IMPLICATIONS FOR REHABILITATIONEnsuring that clients with brain injury are safe often requires therapists to exercise control and remove agency thus removing the rights of the client to the dignity of risk and living a full life.Providing opportunities within rehabilitation for clients to experience failure and success enables learning and thereby support dignity.Privileging the client perspective provides clients the dignity of living a normal life.

Variable levels of stress and anxiety reported by physiotherapy students during clinical placements: a cohort study.

OBJECTIVES: Healthcare students are at risk of high stress and anxiety, particularly during clinical placements. This study measured the stress and anxiety levels of physiotherapy students during clinical placements, how stress/anxiety changed over time, effect on academic performance, factors influencing stress/anxiety and coping strategies. DESIGN: A prospective cohort study using surveys collecting quantitative and qualitative data. SETTING: Three sites where physiotherapy students from one university undertook clinical placements. PARTICIPANTS: 109 students across 159 placements. MAIN OUTCOME MEASURES: The State-Trait Anxiety Inventory (STAI [Y2]) provided a baseline measure of general stress level and propensity for anxiety. Perceived stress and anxiety were measured using visual analogue scales (VASs) at baseline and weekly over the 5-weeks duration of placements. A questionnaire sought students' perceptions of factors affecting stress/anxiety and coping strategies. RESULTS: VAS stress/anxiety scores were highly variable between participants. Higher VAS scores were seen at Weeks 3 and 4 compared to Week 5 and placements earlier in the academic year. Baseline VAS scores were significantly associated with Weeks 1-5 VAS scores. Higher VAS scores were associated with poorer academic results. Stress/anxiety were affected by patient complexity, assessments, workload, poor health and family issues. Most participants felt supported by clinical educators/peers, and used coping strategies including exercise and taking breaks. CONCLUSIONS: Physiotherapy students demonstrated highly variable stress/anxiety levels during clinical placements, with higher levels negatively affecting academic performance. Baseline measures of perceived stress/anxiety could potentially highlight students at risk of high levels of stress/anxiety during clinical placements, allowing more targeted interventions. Australian New Zealand Clinical Trials Registry (ACTRN12618000302257).

An interactive teaching module for increasing undergraduate physiotherapy students' cultural competence: A quantitative survey.

OBJECTIVES: To provide safe and effective healthcare, physiotherapists must be aware of, and able to appropriately respond to, the individual needs of their clients. Cultural competence is an essential part of the curriculum to prepare physiotherapy students for their graduate practice. The primary aim of this study was to investigate the effectiveness of a 4-week educational intervention to increase the perceived cultural competence of undergraduate physiotherapy students and whether effectiveness changed as students progressed in their education. Secondary aims were to understand if a clinical placement prior to the course intervention, or the student's cultural background, influenced the effectiveness of the intervention. METHODS: A prospective cohort study was conducted with 73 students in their second year of an Australian Bachelor of Physiotherapy programme who participated in a 4-week tutorial module to develop their cultural competence. Perception of cultural competence was measured at three time points (pre, post, post 18 months) using the Cultural Intelligence Scale questionnaire which assesses metacognitive, cognitive, motivational and behavioural domains. Participant and their parents' country of birth data were collected. RESULTS: Cultural intelligence scores for the cohort significantly increased from pre- to post-intervention (mean change 0.4, p < 0.001). A 3-week clinical placement prior to the teaching intervention had no effect on the change in scores. Students who were not born in Australia, or who had a parent not born in Australia, demonstrated less change in overall cultural intelligence score than Australian-born participants. CONCLUSION: Undergraduate physiotherapy students at an Australian university can increase their perceived level of cultural competence by participating in a 4-week classroom-based tutorial module, and this effect can be sustained over an 18-month period. Exposure to cultural diversity is not sufficient by itself for a change in perceived cultural competence. However, classroom-based teaching needs to be responsive to the cultural characteristics of the students.

Physiotherapists' attitudes toward circuit class therapy and 7 day per week therapy is influenced by normative beliefs, past experience, and perceived control: A qualitative study.

INTRODUCTION: Attitudes are recognized as influencing research implementation. However, little is known about the process by which physiotherapists' attitudes and beliefs shape their use of 7-day per week therapy and circuit class therapy research findings. Understanding beliefs may assist in addressing barriers to research uptake. METHODS: Fifteen physiotherapists from six rehabilitation centers who ranged in seniority, experience, and education levels consented to be interviewed. The transcribed interviews were analyzed using a qualitative content analysis drawing on the Theory of Planned Behavior. FINDINGS: Participants felt that they had autonomy in adopting new approaches when the evidence was supported by social norms. Participants believed that 7-day per week therapy delivers a seamless service that increases physiotherapy time, which helps maintain patient improvement, but needs to accommodate patient choice and expectations. Circuit class therapy was viewed positively as it provides more physiotherapy time, increases patient social interaction, and motivation. However, this was qualified by a belief that patients would not receive individualized, quality of movement focused therapy, particularly for patients with limited capacities. CONCLUSION: Implementation of a new approach depends on the past experience, coherence with individual beliefs regarding important elements of therapy content, and opportunities to control barriers to implementation.

Accelerometry Shows Inpatients With Acute Medical or Surgical Conditions Spend Little Time Upright and Are Highly Sedentary: Systematic Review.

BACKGROUND: Physical inactivity and sedentary behaviors have significant and independent effects on health. The use of wearable monitors to measure these constructs in people who are hospitalized with an acute illness is rapidly expanding, but has not been systematically described. PURPOSE: The purpose of this study was to review the use of accelerometer monitoring with inpatients who are acutely ill, including what activity and sedentary behaviors have been measured and how active or sedentary inpatients are. DATA SOURCES: Databases used were MEDLINE, EMBASE, CINAHL, and Scopus. STUDY SELECTION: Quantitative studies of adults with an acute medical or surgical hospital admission, on whom an accelerometer was used to measure a physical activity or sedentary behavior, were selected. DATA EXTRACTION AND DATA SYNTHESIS: Procedures were completed independently by 2 reviewers, with differences resolved and cross-checked by a third reviewer. Forty-two studies were identified that recruited people who had medical diagnoses (n = 10), stroke (n = 5), critical illness (n = 3), acute exacerbations of lung disease (n = 7), cardiac conditions (n = 7), or who were postsurgery (n = 10). Physical activities or sedentary behaviors were reported in terms of time spent in a particular posture (lying/sitting, standing/stepping), active/inactive, or at a particular activity intensity. Physical activity was also reported as step count, number of episodes or postural transitions, and bouts. Inpatients spent 93% to 98.8% (range) of their hospital stay sedentary, and in most studies completed <1,000 steps/day despite up to 50 postural transitions/day. No study reported sedentary bouts. Many studies controlled for preadmission function as part of the recruitment strategy or analysis or both. LIMITATIONS: Heterogeneity in monitoring devices (17 models), protocols, and variable definitions limited comparability between studies and clinical groups to descriptive synthesis without meta-analysis. CONCLUSIONS: Hospitalized patients were highly inactive, especially those with medical admissions, based on time and step parameters. Accelerometer monitoring of sedentary behavior patterns was less reported and warrants further research.

A Qualitative Study to Examine Feasibility and Design of an Online Social Networking Intervention to Increase Physical Activity in Teenage Girls.

BACKGROUND: Online social networks present wide-reaching and flexible platforms through which to deliver health interventions to targeted populations. This study used a social marketing approach to explore teenage girls' perceptions of physical activity and the potential use of online social networks to receive a physical activity intervention. METHODS: Six focus groups were conducted with 19 Australian teenage girls (ages 13 to 18 years) with varying levels of physical activity and socioeconomic status. A semi-structured format was used, with groups discussion transcribed verbatim. Content analysis identified emergent themes, with triangulation and memos used to ensure accuracy. RESULTS: Physical activity was most appealing when it emphasised sport, exercise and fitness, along with opportunities for socialisation with friends and self-improvement. Participants were receptive to delivery of a physical activity intervention via online social networks, with Facebook the most widely reported site. Participants commonly accessed online social networks via mobile devices and particularly smartphones. Undesirable features included promotion of physical activity in terms of walking; use of cartoon imagery; use of humour; and promotion of the intervention via schools, each of which were considered "uncool". Participants noted that their parents were likely to be supportive of them using an online social networking physical activity intervention, particularly if not promoted as a weight loss intervention. CONCLUSION: This study identified key features likely to increase the feasibility and retention of an online social networking physical activity intervention for teenage girls. Guidelines for the design of interventions for teenage girls are provided for future applications.

Immediate blood pressure changes and aquatic physiotherapy.

OBJECTIVE: No studies to date have examined the effect on Blood pressure (BP) when pregnant women participate in aquatic physiotherapy (AP) classes; although, previous studies have indicated that there may be a detrimental outcome to the pregnant mother and fetus when there is a significant rise in the maternal BP. At least three components may contribute to BP changes: temperature, exercise, and immersion. This study examines BP changes in pregnant women attending AP classes. METHOD: An experimental same-subject, repeated measures design was employed. Forty-five sets of data were collected from pregnant women attending routine, existing, nonaerobic AP classes. Blood pressure measurements were taken preimmersion, 2-5 minutes after entering the pool, immediately following the 50 minute AP class (while immersed), and 8-12 minutes after exiting the water. RESULTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) data were analyzed using a repeated measures analysis of variance (ANOVA). For all sets of data a highly significant difference was observed (p = 0.0000). Post-hoc Tukey test results showed BP to decrease significantly on entering the water (MAP mean difference of 10.52 mm Hg, 95% CI 8.75 to 12.29), to remain at this low level postexercise while still immersed, and then return to preimmersion values 8-12 minutes after exiting the water. CONCLUSION: These results indicate that AP classes are safe for nonhypertensive pregnant women in their third trimester. The use of AP in the antenatal care of women with unstable BP or who are hypertensive needs further research.

Resilience-rhetoric to reality: a systematic review of intervention studies after disasters.

OBJECTIVE: This report aimed to examine the literature regarding evidence about community-based interventions that use the concept of resilience to increase positive health outcomes after disaster. METHODS: A search was conducted of databases; gray literature, public health journals, and available key journals focused on disaster, emergency, and trauma from inception to December 2013. Excluded were non-English publications, only about children or adolescents, or a commentary or theoretical discussion on resilience. RESULTS: From a total of 1880 records, excluding duplicates, 8 studies were found. Exclusions included participants younger than age 18 years (n=74), non-English (n=40), nonempirical (n=265), not referring to disaster (n=188), not a public health intervention (n=319), and not related to an intervention targeting resilience (n=890). CONCLUSIONS: This systematic review highlighted a gap in the evidence relating to interventions targeting the resilience of adults who have experienced a disaster. The results were mixed in relation to information provision but promising for strategies that promote social interactions or develop community competence. Future studies could explore the ability of interventions to build the intrinsic capacity of a system, community, or society at risk of a disaster to adapt and survive.