Characterizing variability in total mercury hair:blood ratio in the general Canadian population.

BACKGROUND/OBJECTIVES: The body burden of mercury in humans can be measured through hair or blood biomarkers. To compare results from different studies, it is often required to convert mercury in hair to an equivalent level in blood, using a default hair:blood ratio of 250:1 by the World Health Organization (WHO). However, the actual ratio may vary within and between populations. The objectives of this study were to analyze the hair:blood mercury ratio in the general Canadian population, explore factors associated with higher/lower ratios, and determine if the standard ratio of 250:1 is supported. METHODS: The Canadian Health Measures Survey (CHMS) Cycle 5 (2016-2017) measured total mercury (THg) in both hair and blood of 1168 participants 20-59 years of age. We calculated geometric mean (GM) concentrations of THg for this entire sample and subgroups. The subgroups included biological sex, women of childbearing age, race, hair treatments, categories of blood and hair selenium, urinary arsenobetaine/arsenocholine, categories of blood and hair mercury, and food consumption. We calculated a hair:blood ratio for each participant and determined population-level ratios from the GMs of the distributions. Differences by subgroups, and agreement with the WHO ratio of 250:1, were tested. The combined effect of factors on the THg hair:blood ratio was explored using staged regression analysis. RESULTS: For participants with paired hair and blood mercury measurements, the GM of the hair:blood THg ratio was 293 (95%CI:273-316), and significantly >250. In women of childbearing age, the ratio did not differ from 250. The GMs of the ratio were higher (i.e.>300) for second tertile blood selenium (365, 95%CI:307-433), third and fourth quartiles hair mercury (347, 95%CI:308-390 and 376, 95%CI:336-422), and consumers of shellfish (338, 95%CI:308-371). Shellfish consumption was the only statistically significant factor associated with the hair:blood ratio as identified in the regression model. CONCLUSIONS: The mean hair:blood THg ratio among Canadians generally exceeded the default ratio of 250:1. Higher ratios were observed in certain subgroups, such as seafood consumers, and shellfish consumption was the most important variable associated with the ratio. Our results suggest that population-specific hair:blood THg ratios be considered, if possible, when converting mercury levels from hair to blood to better characterize the variation around the conversion.

Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes.

This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.

Trainer-exerciser relationship: The congruency effect on exerciser psychological needs using response surface analysis.

Perceptions of fitness trainers' need-supportive and need-thwarting behaviors have been shown to impact exercisers' psychological need satisfaction and frustration. Currently, it is unknown whether an agreement or disagreement between exercisers' and fitness trainers' reported perceptions of these behaviors leads to the satisfaction and/or frustration of psychological needs. Based on self-determination theory, the present study examined the effect of congruency between fitness trainers' and exercisers' perceptions of need-supportive and need-thwarting interpersonal behaviors on basic psychological need satisfaction and frustration. A sample of 130 fitness trainers (43 females; Mage  = 31.58 ± 7.65) and a total of 640 gym exercisers (350 females; Mage  = 34.23 ± 11.59) participated in this study. Findings suggested that the majority of fitness trainers tended to over-report their use of need-supportive behavior and under-report their need-thwarting behaviors. Results showed that when there was congruency between fitness trainers' reported use and exercisers' perception of interpersonal behaviors, basic need satisfaction tended to increase. This effect was greater for exercisers that rated their respective fitness trainer high on relatedness support. Fitness trainers should be self-aware of their interpersonal behaviors when engaging with exercisers and interventions based on self-determination theory could serve as a promising avenue to improve the quality of exercisers' experience.

Planning and self-monitoring the quality and quantity of eating: How different styles of self-regulation strategies relate to healthy and unhealthy eating behaviors, bulimic symptoms, and BMI.

This research examined if planning and self-monitoring could be distinguished in terms of quality and quantity, and if differences in the uses of these strategies were associated with distinct eating outcomes. In Study 1 (n = 355), the structure of a new scale designed to measure planning and self-monitoring in terms of quality (i.e., nutrient intake) and quantity (i.e., calories and portion sizes) was examined through Confirmatory Factor Analysis. Structural equation models were also tested in which the relationships between the proposed strategies, healthy and unhealthy eating behaviors and bulimic symptoms, as well as BMI, were examined. The purpose of Study 2 (n = 318) was to replicate the results found in Study 1, using a different sample. Overall, a 6-factor structure was found for the scale and results revealed that strategies related to the quality of eating were more strongly and positively associated with healthy eating and more strongly and negatively associated with unhealthy eating behaviors, whereas strategies related to the quantity of eating were more strongly and positively associated with bulimic symptoms and BMI. Results are discussed in terms of implications for health professionals who wish to improve individuals' eating behaviors and/or weight.

Individuals with self-determined motivation for eating have better overall diet quality: Results from the PREDISE study.

The study aimed at documenting motivational orientations for the regulation of eating as defined by self-determination theory and their association with sociodemographic characteristics and overall diet quality. As part of the PREDISE study, French-speaking women (n = 550) and men (n = 547), aged 18-65 years, living in the Province of Québec, Canada, completed online validated questionnaires. The Regulation of Eating Behavior Scale, based on the self-determination theory, assessed self-determined and non-self-determined motivation to regulate one's eating behavior. Three web-based 24-h food recalls were completed and used to compute the Canadian Healthy Eating Index 2007 (C-HEI), an indicator of the overall adherence to Canadian guidelines for healthy eating. Multiple linear regressions were performed to assess how regulation styles are associated with the C-HEI. Model 1 included no covariate, model 2 included sociodemographic covariates, and fully adjusted model 3 included as covariates sociodemographic variables as well as variables that were previously associated with diet quality, namely nutrition knowledge and social support for healthy eating. Women (p < 0.0001), older individuals (p = 0.0002), those with a higher education level (p < 0.0001), and non-smokers (p < 0.0001) reported higher self-determined motivation score than their counterparts. Self-determined motivation was positively (model 1: B = 4.67, p < 0.0001; model 2: B = 3.82, p < 0.0001; model 3: B = 3.61, p < 0.0001) and non-self-determined motivation was negatively (model 1: B = -1.62, p = 0.0009; model 2: B = -1.63, p = 0.0006; model 2: B = -1.49, p = 0.0022) associated with C-HEI. The present study suggests that some subgroups of the general adult population show more self-determined motivation for eating, which is associated with a better diet quality independently of individual characteristics and other individual and social determinants of healthy eating. Strategies to help individuals internalize the regulation of eating should be further investigated.

A 1-Year Accredited Nurse Residency Program's Effect on Intent to Leave.

OBJECTIVE: This article describes the evaluation of a system-wide program to enhance new graduate nurse resident (NGNR) experience, enculturation, and commitment to the organization. BACKGROUND: Structured nurse residency programs support NGNR transition to the work environment and increase retention and organizational commitment. METHODS: The study used a descriptive, comparative design measuring NGNR perceptions of affective commitment, job satisfaction, job stress, and other variables over 3 times from baseline to 24 months. RESULTS: Findings demonstrated a reduction in affective commitment and an increase in nursing stress from baseline to 12 and 24 months of employment. The highest mean in intent to leave occurred at 12 months, highlighting the vulnerability of the NGNR at that time. CONCLUSIONS: Nurse leaders must consider resources supporting NGNRs beyond the traditional 12 months to ensure retention and organizational commitment, thereby decreasing intent to leave.

The validation of the Healthy and Unhealthy Eating Behavior Scale (HUEBS): Examining the interplay between stages of change and motivation and their association with healthy and unhealthy eating behaviors and physical health.

The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.

Psychometric Testing of a Patient Empowerment, Engagement, and Activation Survey.

BACKGROUND: Patient or person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Person-centered care has recently been conceptualized as patient empowerment, engagement, and activation with studies citing positive outcomes. PURPOSE: This study reports the psychometric properties of the Patient Empowerment, Engagement, and Activation Survey. METHODS: An instrument development and testing approach was used. RESULTS: A 21-item survey was developed demonstrating respectable Cronbach α coefficients for the total scale (α = 0.88) and for each subscale: Empowerment (α = 0.71), Engagement (α = 0.81), and Activation (α = 0.76). A regression analysis with 1 item, "I am ready to be discharged" as the dependent variable and all other items as independent variables explained 65% of the variance in readiness for discharge (P < .001). DISCUSSION: The Patient Empowerment, Engagement, and Activation Survey can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).

An Exploratory, Descriptive Study of Nurse Leaders' Personal and Work Experiences During Union Negotiations and Strike Events.

OBJECTIVE: This study explored the experiences, perceptions and emotional state of nurse leaders during union activities to understand the impact on their personal and professional lives. BACKGROUND: Other than anecdotal stories shared during union negotiations and strike preparations, very little evidence exists in nursing and healthcare literature about nursing unions and their impact on nurse leaders and their organizational priorities. METHODS: This study used an exploratory, descriptive design with a convenience and snowball sample of Association of California Nurse Leaders members. RESULTS: The findings indicate nurse leaders experience a range of emotional states in response to union activities with perceptions of increased workload, job stress, and constrained and deliberate communications with their staff. CONCLUSION: This study adds to the body of knowledge about nurse leader experiences and feelings during union activities.

Effectiveness of a Psychiatric-Mental Health Nurse Residency Program on Retention.

BACKGROUND: Nurse residency programs (NRPs) provide new graduate nurses (NGNs) with social support and experiential activities as a formal transition to clinical practice. AIMS: The study was conducted to answer the question: What is the effectiveness of an NRP in retaining NGNs in a psychiatric-mental health setting? METHOD: This study used a quantitative time-sequenced comparative study of multiple cohorts of NGNs hired into an NRP at a freestanding hospital in California. RESULTS: The study yielded a turnover rate of 11.7% in Year 1 (88.3% retention) and 2.9% in Year 2 (97.1% retention rate), which are lower than reported turnover rates (17.5% and 33.5%, respectively). Significant correlations are described in the workplace domains of knowledge and skills, social support, organizational citizenship behavior, civility, coping self-efficacy, organizational and occupational commitment, person-organizational fit, and burnout. CONCLUSIONS: NRPs are effective in attracting and retaining competent, confident NGNs in psychiatric-mental health nursing.

Starting Off on the Best Foot: A Review of Message Framing and Message Tailoring, and Recommendations for the Comprehensive Messaging Strategy for Sustained Behavior Change.

Health promotion programs represent a salient means through which physical activity promoters can cultivate positive health behavior change and maintenance. The messages communicated within these programs serve as an essential component as they are often used to convey valuable information, resources, or tools that facilitate health behavior initiation and sustained engagement. Identifying the most effective way to communicate health promotion information is, therefore, of considerable importance to ensuring that people not only attend to these messages, but also connect with and internalize the information conveyed within them. This paper was written to (1) summarize and evaluate the most prominent reviewed research approaches of message framing and tailoring to message design; and (2) offer a comprehensive messaging strategy to promote sustained health behavior change. A review of the literature demonstrated that a messaging strategy that has consistently led to healthy behavior change has yet to be identified. Furthermore, scholars have articulated that a multi-theoretical approach that places emphasis on facilitating motivation and healthy behavior change needs to be employed. Thus, this paper proposes and provides recommendations for employing the Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC), which advocates tailoring messages to peoples' stage of change and framing them to focus on self-determined motives and intrinsic goals.

When hunger does (or doesn't) increase unhealthy and healthy food consumption through food wanting: The distinctive role of impulsive approach tendencies toward healthy food.

OBJECTIVE: Hunger indirectly triggers unhealthy high-calorie food consumption through its positive effect on the incentive value (or "wanting") for food. Yet, not everyone consumes unhealthy food in excess, suggesting that some individuals react differently when they are exposed to unhealthy high-calorie food, even when they are hungry. The purpose of the present study was to investigate whether individual differences in impulsive approach tendencies toward food may explain how, and for whom, hunger will influence unhealthy food consumption through its effect on food wanting. A complementary goal was to explore whether these individual differences also influence healthy food consumption. METHODS: Students (N = 70) completed a questionnaire measuring their hunger and food wanting. Then, they performed a manikin task designed to evaluate their impulsive approach tendencies toward unhealthy food (IAUF) and healthy food (IAHF). The main outcomes variables were the amount of sweets (i.e., unhealthy food) and raisins (i.e., healthy food) consumed during a product-testing task. RESULTS: A moderated mediation analysis revealed that the indirect effect of hunger on unhealthy consumption through food wanting was moderated by IAHF. Specifically, hunger positively predicted sweets consumption through wanting for food among individuals with a low or moderate, but not high IAHF. The moderated mediation pattern was, however, not confirmed for IAUF. Finally, results revealed a direct and positive effect of IAHF on raisins consumption. CONCLUSION: These findings showed that IAHF play a protective role by preventing hunger to indirectly increase unhealthy food consumption through wanting for food. It confirms the importance of considering how individuals may differ in their impulsive approach tendencies toward food to better understand why some individuals will increase their unhealthy food intake when they are hungry, whereas other will not.

The Québec NTBC Study.

In this chapter we describe the current Quebec NTBC Study protocol. Quebec's unique characteristics have influenced the development of the protocol, including a high prevalence of hepatorenal tyrosinemia (HT1), universal newborn screening for HT1, availability of treatment with nitisinone (NTBC) and special diet, a large territory, where HT1 treatment is coordinated by a small number of centers. Screened newborns are seen within 3 weeks of birth. Patients with liver dysfunction (prolonged prothrombin time and/or international normalized ratio (INR) provide sensitive, rapidly available indicators) are treated by NTBC and special diet. The specific diagnosis is confirmed by diagnostic testing for succinylacetone (SA) in plasma and urine samples obtained before treatment. After an initial period of frequent surveillance, stable patients are followed every 3 months by assay of plasma amino acids and NTBC and plasma and urine SA. Abdominal ultrasound is done every 6 months. Patients have an annual visit to the coordinating center that includes multidisciplinary evaluations in metabolic genetics, hepatology, imaging (for abdominal ultrasound and magnetic resonance imaging) and other specialties as necessary. If hepatocellular carcinoma is suspected by imaging and/or because of progressive elevation of alphafetoprotein, liver transplantation is discussed. To date, no patient in whom treatment was started before 1 month of age has developed hepatocellular carcinoma, after surveillance for up to 20 years in some. This patient group is the largest in the world that has been treated rapidly following newborn screening. The protocol continues to evolve to adapt to the challenges of long term surveillance.

The Antecedents of Coaches' Interpersonal Behaviors: The Role of the Coaching Context, Coaches' Psychological Needs, and Coaches' Motivation.

This study explored how the coaching context influences coaches' psychological needs, motivation, and reported interpersonal behaviors, using self-determination theory. In Study 1, 56 coaches identified how contextual factors influence their coaching experience. Coaches identified administration, athlete motivation, colleagues, parents, professional development, time, and work-life as having the largest impact on them. In Study 2, 424 coaches reported on their perceptions of the factors identified in Study 1 and their psychological needs, motivation, and interpersonal behaviors. Structural equation modeling analyses suggested perceptions of the coaching context supported or thwarted their psychological needs, which positively or negatively predicted their autonomous and controlled motivation. Coaches' autonomous motivation predicted their reported supportive interpersonal behaviors and controlled motivation predicted thwarting behaviors. Overall, the results provided additional support for understanding how the coaching context, coaches' psychological needs, and their motivation for coaching relate to their coaching behaviors.

Patient-centered care and engagement: nurse leaders' imperative for health reform.

Although there is agreement about the importance of patient-centered care (PCC) to ensure optimal outcomes for patients, there is a lack of focused instruments to measure PCC. The aims of this article were to synthesize literature related to the concepts PCC and to provide concrete attributes, definitions, and a conceptual model for the concept of PCC.

Standardizing Nurse Transition to Practice: An Infrastructure to Support Nursing Excellence.

Nurse residency programs (NRPs) require effective structures and processes to ensure achievement of desired outcomes, including program accreditation, newly licensed nurse retention, and a healthy nursing workforce for the future. A healthcare system created strategic positions of director of nursing workforce transitions and nursing workforce professional development specialists to standardize an NRP across six hospitals and to achieve Practice Transition Accreditation Program accreditation. The positions provide a strong infrastructure to optimize nurse transition to practice.

Social desirability, dietary intakes, and variables related to attitudes and behaviours towards eating among French-speaking adults from Quebec, Canada: The PREDISE study.

The primary objective of this study was to examine how social desirability is associated with self-reported measures of dietary intakes and variables related to attitudes and behaviours towards eating. This analysis was conducted in 1083 adults (50.0% women) from the PREDISE study. Social desirability was assessed using the Balanced Inventory of Desirable Responding (BIDR) questionnaire, which includes two subscales: (1) self-deceptive enhancement (SDE), i.e., having an overly positive self-image and (2) impression management (IM), i.e., intentional response distortion to please. BIDR total score and IM subscore were positively associated with the Canadian Healthy Eating Index (C-HEI) (ß = 0.24 and ß = 0.50; p ≤ 0.0003), calculated using data from three self-administered 24 h food recalls. All BIDR scores were positively associated with self-determined motivation for eating regulation (0.03 ≤ ß ≤ 0.06; p < 0.0001), measured by the Regulation of Eating Behavior Scale, and with the intuitive eating score (0.02 ≤ ß ≤ 0.05; p < 0.0001). Also, all BIDR scores were negatively associated with hunger and disinhibition scores measured by the Three-Factor Eating Questionnaire (-0.17 ≤ ß ≤ -0.09; p < 0.0001). All these associations were adjusted for age, sex, BMI, and the education level. Furthermore, controlling for both dimensions of social desirability did not impact the magnitude of the association between self-determined motivation (the strongest predictor of healthy eating in the PREDISE study) and C-HEI. According to our results, associations are observed with diet quality, as well as with attitudes and behaviours towards eating; therefore, a measurement of social desirability responding would be pertinent in studies using those or related variables.

A physiotherapist's perception of their own behavior compared to the perception of their behavior by persons with TBI within the context of telerehabilitation: A self-determination theory perspective.

BACKGROUND: According to Self-Determination Theory, the fulfillment of basic psychological needs of autonomy, competence, and relatedness plays an important role in one's motivation, engagement, and well-being. How a therapist is perceived to support or thwart these needs can impact adherence to treatment, thus influencing the effectiveness of therapeutic interventions. OBJECTIVES: This alternating single-subject design explores how the physiotherapist self-reports interpersonal behaviors, how the person living with a disability (PwD) perceives the physiotherapist's supportive/thwarting interpersonal behaviors, and how the two align in the context of telerehabilitation. METHODS: Five PwD and their physiotherapist completed two telerehabilitation exercise programs. The PwD completed the Interpersonal Behavior Questionnaire (IBQ) to examine how they perceived the physiotherapist interpersonal behaviors. The physiotherapist completed the Interpersonal Behavior Questionnaire-Self (IBQ-Self) to document how they self-reported these same behaviors. Descriptive statistics were used to document self-reports and perceptions of behaviors. RESULTS: Each PwD perceived the physiotherapist as being more supportive than thwarting. The supportive/thwarting behaviors varied across relationships. Greater alignment of the perceptions of therapist and the PwD was observed at the end of the programme when compared to baseline. CONCLUSION: Assessing how therapist support/thwart psychological needs and how these behaviors are perceived by PwD is recommended as it may influence the therapist's behavior and the PwD's adherence to future telerehabilitation exercise programs.

Automaticity mediates the association between action planning and physical activity, especially when autonomous motivation is high.

OBJECTIVES: Action planning promotes physical activity (PA). However, mechanisms underlying this association are poorly understood, as are the variables that moderate this link remain unexplored. To fill these gaps, we investigated whether automaticity mediated the association between action planning and PA, and whether autonomous motivation moderated this mediation. METHODS AND MEASURES: PA was measured by accelerometry over seven days among a sample of 124 adults. Action planning, automaticity, and autonomous motivation were assessed by questionnaires. RESULTS: Structural equation models revealed that automaticity mediated the association between action planning and PA (total effect, ß = .29, p < .001) - action planning was associated with automaticity (a path, ß = .47, p < .001), which in turn related to PA (b path, ß = .33, p = .003). Autonomous motivation moderated the a path (ß = .16, p = .035) - action planning was more strongly associated with automaticity when autonomous motivation was high (+1 standard-deviation [SD]) (unstandardized b = 0.77, p < .001) versus low (-1 SD) (b = 0.35, p = .023). CONCLUSION: These findings not only support that action planning favors an automatic behavioral regulation, but also highlight that a high autonomous motivation toward PA may reinforce this mechanism.

The Impact of Two Telerehabilitation Supervision Schedules on Physical Activity, Mobility, and Balance Among People with Moderate to Severe Traumatic Brain Injury: A Mixed-Method Single-Subject Design.

Background: Many individuals who experience a moderate or severe traumatic brain injury (TBI) have long-term deficits in physical activity, balance, and mobility requiring specialized care. New delivery models are being investigated for interventions to address challenges caused by living in remote communities, difficulties with transportation, and/or physical distancing requirements. Determining the effectiveness of telerehabilitation is critical given the current movement toward remote health care delivery. Objective: We investigated the effectiveness of two teletherapy supervision schedules used to deliver a home-based, intensive exercise programme on 1) physical activity, mobility, balance, participation, and 2) concerns with falling, and satisfaction with life. Methods: A mixed methods approach with alternating single subject design (SSD) and interviews was used. Five individuals who experienced a moderate or severe TBI completed two intensive home-based telerehabilitation programmes. Programmes differed only by supervision schedule - daily or weekly. Impacts on objective and patient-reported outcomes were measured. Results: Four individuals demonstrated clinically significant improvements in physical activity level, balance, and mobility. One individual experienced less concerns with falling after both schedules, while two other individuals showed a trend in that direction after the weekly remote supervision. Important functional gains (i.e., improved balance and decreased fatigue) were also perceived and reported by family partners regardless of supervision schedule. Conclusion: Although the study has limitations, the findings indicate that exercise programmes delivered via telerehabilitation can improve balance and mobility as well as positively affect concerns with falling and physical activity levels for this population. No clear differences were seen between the two telerehabilitation supervision schedules.

Historique : de nombreuses personnes qui sont victimes d'un traumatisme crânien (TC) modéré ou grave ont des déficits à long terme en matière d'activité physique, d'équilibre et de mobilité et doivent recevoir des soins spécialisés. De nouveaux modèles de prestation sont en cours d'étude afin que les interventions relèvent les problèmes liés à la vie en région éloignée, au transport ou à la distanciation physique. Il est essentiel de déterminer l'efficacité de la téléréadaptation en raison du mouvement actuel vers la prestation des soins à distance. Objectif : examiner l'efficacité de deux horaires de supervision de la téléthérapie utilisés pour fournir un programme d'exercice intensif à domicile sur 1) l'activité physique, la mobilité, l'équilibre et la participation et 2) les craintes de chutes et la satisfaction de vivre. Méthodologie : méthodologie mixte faisant appel à une alternance entre la méthodologie individuelle et les entrevues. Cinq personnes qui avaient été victimes d'un TC modéré ou grave ont suivi deux programmes intensifs de téléréadaptation à domicile. Les programmes différaient seulement en fonction de l'horaire de supervision, qui était quotidien ou hebdomadaire. Les chercheurs ont mesuré les répercussions sur les résultats cliniques objectifs et déclarés par les patients. Résultats : quatre personnes ont démontré des améliorations cliniquement significatives au taux d'activité physique, à l'équilibre et à la mobilité. Une personne craignait moins les chutes après les deux programmes tandis que les deux autres ressentaient une tendance dans cette direction après la supervision hebdomadaire à distance. Des gains fonctionnels importants (amélioration de l'équilibre et diminution de la fatigue) étaient également perçus et déclarés par les partenaires familiaux, quel que soit l'horaire de supervision. Conclusion : même si l'étude comporte des limites, les observations indiquent que les programmes d'exercices donnés en téléréadaptation peuvent améliorer l'équilibre et la mobilité et avoir des effets positifs sur les craintes de tomber et les taux d'activité physique dans cette population. Il n'y avait pas de différences évidentes entre les deux horaires de supervision de la téléréadaptation.