A Range of Service Delivery Modes for Children With Developmental Coordination Disorder Are Effective: A Randomized Controlled Trial.

PURPOSE: To investigate whether the environment and personnel providing intervention to children with developmental coordination disorder make a difference in motor outcomes and perceived competency. METHODS: Ninety-three children (66 males), aged 5 years 1 month to 8 years 11 months, with developmental coordination disorder were randomized to receive a 13-week group-based task-oriented intervention, either at school by a school assistant or physical therapist, or in a health clinic by a physical therapist. The Movement Assessment Battery for Children (MABC) assessed motor skills pre- and postintervention. Self-perception and cost-effectiveness were also assessed. RESULTS: Participants demonstrated a significant improvement in motor skills following intervention for all modes of delivery up to 6 months postintervention, MABC mean difference 7.20 (95% confidence interval, 5.89-8.81), effect size = 0.98. CONCLUSION: Group intervention programs for developmental coordination disorder can be run by either a health professional or a school assistant (supported by physical therapist) in either the school or clinic environment and provide successful outcomes.

The impact of 10-minute activity breaks outside the classroom on male students' on-task behaviour and sustained attention: a randomised crossover design.

AIM: The aim was to evaluate the impact of a brief activity bout outside the classroom on boys' attention and on-task behaviour in the classroom setting. METHODS: Fifty-eight boys (mean age 11.2 ± 0.6 years) were recruited from a boys' elementary school in Adelaide, South Australia. Two year 5 and, similarly, two year 6 classes were assigned using a crossover design to either four weeks of a 10 minute Active Lesson Break followed by four weeks of a 10 minute Passive Lesson Break (reading) or visa versa. Attention was quantified using a computerised psychomotor vigilance task, and on-task behaviour by direct observation. RESULTS: Neither the Active Lesson nor the Passive Lesson condition significantly affected sustained attention or on-task behaviour, and there were no significant differences between conditions. CONCLUSION: There was no impact on participants' sustained attention or on-task behaviour after a short activity break between lessons. Brief activity breaks outside the classroom do not compromise participants' on-task behaviour or attention levels upon returning to the classroom, although improvement in these variables is not seen either. However, the results suggest that active breaks are effective for accruing moderate-to-vigorous physical activity without compromising classroom behaviours.

Can resistance training change the strength, body composition and self-concept of overweight and obese adolescent males? A randomised controlled trial.

BACKGROUND/AIM: Resistance training is an exercise modality at which overweight and obese adolescents can excel and which can therefore positively affect their psychological well-being. The aim of this study was to determine the effect of a 6-month resistance training intervention on the self-concept strength and body composition of overweight and obese adolescent males. METHODS: 56 overweight and obese males aged 13-17 years were randomly allocated to an Intervention (n=30) or Control (n=26) group. Primary (psychological) and secondary (strength and body composition) outcomes were assessed at baseline as well as at 3 (halfway through the intervention), 6 (immediately postintervention) and 12 months follow-up. Random effects mixed modelling was used to determine the effects of the intervention. RESULTS: Statistically significant differences between the Intervention and Control groups were observed at 3-month and 6-month assessments for exercise self-efficacy, resistance training confidence and self-esteem. Large increases in strength for the Intervention group, relative to Controls, were also observed with no substantial changes in body composition shown for either group. Values for all variables returned to baseline following completion of the programme. CONCLUSIONS: A 6-month resistance training intervention can positively affect the self-concept and strength of overweight and obese adolescent boys.

Randomized controlled trial of yoga for chronic poststroke hemiparesis: motor function, mental health, and quality of life outcomes.

PURPOSE: To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis. METHOD: Twenty-two individuals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11). RESULTS: The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety. CONCLUSIONS: Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.

Brief mindfulness-based therapy for chronic tension-type headache: a randomized controlled pilot study.

BACKGROUND: Mindfulness-based therapy (MBT) has been demonstrated to be effective for reducing chronic pain symptoms; however, the use of MBT for Chronic Tension-Type Headache (CTH) exclusively has to date not been examined. Typically, MBT for chronic pain has involved an 8-week program based on Mindfulness Based Stress Reduction. Recent research suggests briefer mindfulness-based treatments may be effective for chronic pain. AIMS: To conduct a pilot study into the efficacy of brief MBT for CTH. METHOD: We conducted a randomized controlled trial of a brief (6-session, 3-week) MBT for CTH. RESULTS: Results indicated a significant decrease in headache frequency and an increase in the mindfulness facet of Observe in the treatment but not wait-list control group. CONCLUSION: Brief MBT may be an effective intervention for CTH.

Clustering of attitudes towards obesity: a mixed methods study of Australian parents and children.

BACKGROUND: Current population-based anti-obesity campaigns often target individuals based on either weight or socio-demographic characteristics, and give a 'mass' message about personal responsibility. There is a recognition that attempts to influence attitudes and opinions may be more effective if they resonate with the beliefs that different groups have about the causes of, and solutions for, obesity. Limited research has explored how attitudinal factors may inform the development of both upstream and downstream social marketing initiatives. METHODS: Computer-assisted face-to-face interviews were conducted with 159 parents and 184 of their children (aged 9-18 years old) in two Australian states. A mixed methods approach was used to assess attitudes towards obesity, and elucidate why different groups held various attitudes towards obesity. Participants were quantitatively assessed on eight dimensions relating to the severity and extent, causes and responsibility, possible remedies, and messaging strategies. Cluster analysis was used to determine attitudinal clusters. Participants were also able to qualify each answer. Qualitative responses were analysed both within and across attitudinal clusters using a constant comparative method. RESULTS: Three clusters were identified. Concerned Internalisers (27% of the sample) judged that obesity was a serious health problem, that Australia had among the highest levels of obesity in the world and that prevalence was rapidly increasing. They situated the causes and remedies for the obesity crisis in individual choices. Concerned Externalisers (38% of the sample) held similar views about the severity and extent of the obesity crisis. However, they saw responsibility and remedies as a societal rather than an individual issue. The final cluster, the Moderates, which contained significantly more children and males, believed that obesity was not such an important public health issue, and judged the extent of obesity to be less extreme than the other clusters. CONCLUSION: Attitudinal clusters provide new information and insights which may be useful in tailoring anti-obesity social marketing initiatives.

Associations between parenting styles and nutrition knowledge and 2-5-year-old children's fruit, vegetable and non-core food consumption.

OBJECTIVE: During the early years, parents have a major influence on children's diets and developing food choices. We investigated parenting styles as predictors of 2­5-year-old children's diets and whether general nutrition knowledge (GNK) mediated these influences. DESIGN: Cross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment. SETTING: Questionnaires were completed by main caregivers at home. SUBJECTS: Parents of children aged 2­5 years (n 269). RESULTS: Higher child fruit/vegetable consumption was associated with lower overreactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P50?083) and 19% of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P = 0.043) and 28% of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = -0.005). CONCLUSIONS: These findings highlight that young children's diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practices v. laxness and longitudinal research.

Somatotyping using 3D anthropometry: a cluster analysis.

Somatotyping is the quantification of human body shape, independent of body size. Hitherto, somatotyping (including the most popular method, the Heath-Carter system) has been based on subjective visual ratings, sometimes supported by surface anthropometry. This study used data derived from three-dimensional (3D) whole-body scans as inputs for cluster analysis to objectively derive clusters of similar body shapes. Twenty-nine dimensions normalised for body size were measured on a purposive sample of 301 adults aged 17-56 years who had been scanned using a Vitus Smart laser scanner. K-means Cluster Analysis with v-fold cross-validation was used to determine shape clusters. Three male and three female clusters emerged, and were visualised using those scans closest to the cluster centroid and a caricature defined by doubling the difference between the average scan and the cluster centroid. The male clusters were decidedly endomorphic (high fatness), ectomorphic (high linearity), and endo-mesomorphic (a mixture of fatness and muscularity). The female clusters were clearly endomorphic, ectomorphic, and the ecto-mesomorphic (a mixture of linearity and muscularity). An objective shape quantification procedure combining 3D scanning and cluster analysis yielded shape clusters strikingly similar to traditional somatotyping.

Chronic condition management and self-management in Aboriginal communities in South Australia: outcomes of a longitudinal study.

OBJECTIVES: This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. METHODS: The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. RESULTS: Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. CONCLUSIONS: The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. WHAT IS KNOWN ABOUT THE TOPIC? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. WHAT DOES THIS PAPER ADD? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.

Effects of n-3 fatty acids, EPA v. DHA, on depressive symptoms, quality of life, memory and executive function in older adults with mild cognitive impairment: a 6-month randomised controlled trial.

Depressive symptoms may increase the risk of progressing from mild cognitive impairment (MCI) to dementia. Consumption of n-3 PUFA may alleviate both cognitive decline and depression. The aim of the present study was to investigate the benefits of supplementing a diet with n-3 PUFA, DHA and EPA, for depressive symptoms, quality of life (QOL) and cognition in elderly people with MCI. We conducted a 6-month double-blind, randomised controlled trial. A total of fifty people aged >65 years with MCI were allocated to receive a supplement rich in EPA (1·67 g EPA + 0·16 g DHA/d; n 17), DHA (1·55 g DHA + 0·40 g EPA/d; n 18) or the n-6 PUFA linoleic acid (LA; 2·2 g/d; n 15). Treatment allocation was by minimisation based on age, sex and depressive symptoms (Geriatric Depression Scale, GDS). Physiological and cognitive assessments, questionnaires and fatty acid composition of erythrocytes were obtained at baseline and 6 months (completers: n 40; EPA n 13, DHA n 16, LA n 11). Compared with the LA group, GDS scores improved in the EPA (P=0·04) and DHA (P=0·01) groups and verbal fluency (Initial Letter Fluency) in the DHA group (P=0·04). Improved GDS scores were correlated with increased DHA plus EPA (r 0·39, P=0·02). Improved self-reported physical health was associated with increased DHA. There were no treatment effects on other cognitive or QOL parameters. Increased intakes of DHA and EPA benefited mental health in older people with MCI. Increasing n-3 PUFA intakes may reduce depressive symptoms and the risk of progressing to dementia. This needs to be investigated in larger, depressed samples with MCI.

Parental nutrition knowledge and attitudes as predictors of 5-6-year-old children's healthy food knowledge.

OBJECTIVE: Young children's knowledge about healthy food may influence the formation of their eating behaviours, and parents have a major influence on the development of children's knowledge in the early years. DESIGN: We investigated the extent to which parental nutrition knowledge and attitudes around food predicted young children's knowledge of healthy foods, controlling for other influences such as socio-economic status (SES) and parent education levels in a cross-sectional research design. Children were given a healthy food knowledge activity and parents completed questionnaires. SETTING: Twenty primary schools in Adelaide, Australia, stratified by SES. SUBJECTS: We recruited 192 children aged 5-6 years and their parents. RESULTS: Structural equation modelling showed that parent nutrition knowledge predicted children's nutrition knowledge (r = 0·30, P < 0·001) independently of attitudes, SES and education level. CONCLUSIONS: Nutrition education for parents, targeted at low-SES areas at higher risk for obesity, may contribute to the development of healthy food knowledge in young children.

A reduction in the use of volunteered descriptors of air hunger is associated with increased walking distance in people with COPD.

BACKGROUND: This study investigated whether descriptors of breathlessness differed after participation in an 8 week pulmonary rehabilitation program and whether changes in sensory quality would be reflected in responsiveness to pulmonary rehabilitation. METHODS: People with COPD provided descriptors for their sensation of breathlessness before and after an 8 week pulmonary rehabilitation program. Primary outcomes for responsiveness to pulmonary rehabilitation were the 6 minute walk distance (6MWD) and the St George Respiratory questionnaire. Significant proportional shifts for sensory categories after rehabilitation were identified using the McNemar test. Random effects mixed modeling was used to determine significance of differences for primary outcomes between subjects modifying or not modifying descriptors of breathlessness. RESULTS: Of the 107 people referred to the pulmonary rehabilitation program, 94 met the spirometric criteria for COPD, with 58 having data for pre and post assessments (36 males, 71 ± 9 years old, percent of predicted FEV(1) 58 ± 24%). A significant proportion of subjects reduced descriptors of air hunger (P = .03, odds ratio 0.31, 95% CI 0.09-0.89) and depressed, regret, helpless (P = .04, odds ratio 0.36, 95% CI 0.10-1.05) following rehabilitation. Subjects reducing their use of descriptors of air hunger had greater improvements in the 6MWD after rehabilitation (P = .006, mean increase 46 m). CONCLUSIONS: The sensory quality of breathlessness was modified for approximately one third of subjects after pulmonary rehabilitation, with significant improvements in the 6MWD for subjects who reduced their use of descriptors of air hunger.

Anthropometric estimates of total and regional body fat in children aged 6-17 years.

AIM: To develop prediction equations for total and regional (trunk, abdominal, arms and legs) body fat using surface anthropometric measures in children aged 6-17 years. METHODS: This was a cross-sectional correlation study of 70 Caucasian children aged 6-17 years recruited from a larger randomly sampled population-based study. The independent variables included age, mass, height, body mass index, waist and hip girth, and skinfold thicknesses at eight sites. Subscapular/triceps skinfold ratio was also calculated and entered as an independent variable. The dependent variables were total body percentage fat, and fat mass for total body, trunk, abdominal region of interest, arms and legs measured using dual-energy X-ray absorptiometry (DXA). Partial least squares regression was used to determine the best predictive equation for fat percentage or fat mass in each body region in each sex. RESULTS: Sex-specific prediction equations were developed with high coefficients of determination (r(2)), ranging from 0.869 to 0.936 in boys and from 0.900 to 0.979 in girls, absolute bias was low, and limits of agreement were narrow. CONCLUSION: Equations were developed, which were able to predict total and regional body fat of Caucasian children aged 6-17 years using surface anthropometric measurements with high predictive accuracy.

Is three-dimensional anthropometric analysis as good as traditional anthropometric analysis in predicting junior rowing performance?

With the use of three-dimensional whole body scanning technology, this study compared the 'traditional' anthropometric model [one-dimensional (1D) measurements] to a 'new' model [1D, two-dimensional (2D), and three-dimensional (3D) measurements] to determine: (1) which model predicted more of the variance in self-reported best 2000-m ergometry rowing performance; and (2) what were the best anthropometric predictors of ergometry performance, for junior rowers competing at the 2007 and 2008 Australian Rowing Championships. Each rower (257 females, 16.3 ± 1.4 years and 243 males, 16.6 ± 1.5 years) completed a performance and demographic questionnaire, had their mass, standing and sitting height physically measured and were landmarked and scanned using the Vitus Smart® 3D whole body scanner. Absolute and proportional anthropometric measurements were extracted from the scan files. Partial least squares regression analysis, with anthropometric measurements and age as predictor variables and self-reported best 2000-m ergometer time as the response variable, was used to first compare the two models and then to determine the best performance predictors. The variance explained by each model was similar for both male [76.1% (new) vs. 73.5% (traditional)] and female [72.3% (new) vs. 68.6% (traditional)] rowers. Overall, absolute rather than proportional measurements, and 2D and 3D rather than 1D measurements, were the best predictors of rowing ergometry performance, with whole body volume and surface area, standing height, mass and leg length the strongest individual predictors.

Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts.

BACKGROUND: Training in the five steps of evidence-based practice (EBP) has been recommended for inclusion in entry-level health professional training. The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students. Few studies have investigated longitudinal changes in EBP attitudes and behaviours. This study aimed to assess the changes in EBP knowledge, attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce. METHODS: A prospective, observational, longitudinal design was used, with two cohorts. From 2008, 29 participants were tested in their final year in a physiotherapy program, and after the first and second workforce years. From 2009, 76 participants were tested in their final entry-level and first workforce years. Participants completed an Evidence-Based Practice Profile questionnaire (EBP2), which includes self-report EBP domains [Relevance, Terminology (knowledge of EBP concepts), Confidence, Practice (EBP implementation), Sympathy (disposition towards EBP)]. Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data. Effect sizes (ES) (95% CI) were calculated for all changes. RESULTS: Effect sizes of the changes in EBP domains were small (ES range 0.02 to 0.42). While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year (ES -0.42 to -0.29) followed by an improvement in the second year (ES +0.27). Scores in Terminology improved (ES +0.19 to +0.26) in each of the first two workforce years, while Practice scores declined (ES -0.23 to -0.19) in the first year and improved minimally in the second year (ES +0.04). Confidence scores improved during the second workforce year (ES +0.27). Scores for Sympathy showed little change. CONCLUSIONS: During the first two years in the workforce, there was a transitory decline in the self-reported practice and sense of relevance of EBP, despite increases in confidence and knowledge. The pattern of progression of EBP skills beyond these early professional working years is unknown.

The internal consistency and construct validity of the partners in health scale: validation of a patient rated chronic condition self-management measure.

PURPOSE: The purpose of this study was to test the internal consistency and construct validity of the revised 12-item self-rated Partners in Health (PIH) scale used to assess patients' chronic condition self-management knowledge and behaviours. METHODS: Baseline PIH data were collected for a total of 294 patients with a range of co-morbid chronic conditions including diabetes, cardiovascular disease and arthritis. Scale data for the initial sample of 176 patients were analysed for internal consistency and construct validity using Reliability Analysis and Factor Analysis. Construct validity was tested in a separate sample of 118 patients using confirmatory factor analysis and a structural equation model. RESULTS: Good internal consistency was indicated with a Cronbach's alpha coefficient of 0.82 in the initial sample. Factor analysis for this sample revealed four key factors (knowledge, coping, management of condition and adherence to treatment) across the twelve items of the scale. These four key factors were then confirmed by applying the exploratory structural equation model to the separate sample. CONCLUSION: The PIH scale exhibits construct validity and internal consistency. It therefore is both a generic self-rated clinical tool for assessing self-management in a range of chronic conditions as well as an outcome measure to compare populations and change in patient self-management knowledge and behaviour over time. The four domains of self-management provide a valid measure of patient competency in relation to the self-management of their chronic condition(s).

Alcohol, metabolic risk and elevated serum gamma-glutamyl transferase (GGT) in Indigenous Australians.

BACKGROUND: The interaction between overweight/obesity and alcohol intake on liver enzyme concentrations have been demonstrated. No studies have yet examined the interaction between metabolic syndrome or multiple metabolic risk factors and alcohol intake on liver enzymes. The aim of this study was to examine if alcohol consumption modifies the effect of metabolic risk on elevated serum GGT in Indigenous Australians. METHODS: Data were from N = 2609 Indigenous Australians who participated in a health screening program in rural far north Queensland in 1999-2000 (44.5% response rate). The individual and interactive effects of metabolic risk and alcohol drinking on elevated serum GGT concentrations (>or=50 U/L) were analyzed using logistic regression. RESULTS: Overall, 26% of the population had GGT>or=50 U/L. Elevated GGT was associated with alcohol drinking (moderate drinking: OR 2.3 [95%CI 1.6 - 3.2]; risky drinking: OR 6.0 [4.4 - 8.2]), and with abdominal obesity (OR 3.7 [2.5 - 5.6]), adverse metabolic risk cluster profile (OR 3.4 [2.6 - 4.3]) and metabolic syndrome (OR 2.7 [2.1 - 3.5]) after adjustment for age, sex, ethnicity, smoking, physical activity and BMI. The associations of obesity and metabolic syndrome with elevated GGT were similar across alcohol drinking strata, but the association of an adverse metabolic risk cluster profile with elevated GGT was larger in risky drinkers (OR 4.9 [3.7 - 6.7]) than in moderate drinkers (OR 2.8 [1.6 - 4.9]) and abstainers (OR 1.6 [0.9 - 2.8]). CONCLUSIONS: In this Indigenous population, an adverse metabolic profile conferred three times the risk of elevated GGT in risky drinkers compared with abstainers, independent of sex and ethnicity. Community interventions need to target both determinants of the population's metabolic status and alcohol consumption to reduce the risk of elevated GGT.

Quality of recalled dyspnoea is different from exercise-induced dyspnoea: an experimental study.

QUESTIONS: Are volunteered and endorsed descriptors of recalled breathlessness consistent with descriptors of exercise-induced breathlessness? Are volunteered and endorsed descriptors of exercise-induced breathlessness consistent? DESIGN: Within-participant, repeated measures, experimental study. PARTICIPANTS: 57 people with symptomatic chronic respiratory disease aged 71 years. INTERVENTION: There were three conditions. The first was recalled breathlessness. Two conditions of exercise-induced breathlessness were created by getting the participants to undertake the 6-min Walk Test twice (breathlessness 1 and 2). OUTCOME MEASURES: Descriptors of breathlessness were volunteered (where participants' used their own words) or endorsed (from a pre-existing list of 15 breathlessness statements). RESULTS: Emotive descriptors made up 65% of recalled descriptors compared with 11% of exercise-induced descriptors, whereas physical descriptors made up 35% of recalled descriptors compared with 89% of exercise-induced descriptors. Of the 237 potential language pairs volunteered to describe recalled and exercise-induced breathlessness 1, only 27 (11%) were identical whereas of the 171 potential language pairs endorsed as describing recalled and exercise-induced breathlessness 1, 66 (39%) were identical. Of the 175 potential language pairs of descriptors volunteered to describe exercise-induced breathlessness 1 and 2, 72 (41%) were identical whereas of the 153 potential language pairs endorsed as describing exercise-induced breathlessness 1 and 2, 71 (46%) were identical. CONCLUSION: The language used to describe exercise-induced breathlessness immediately after two walking challenges was similar. However, descriptions of recalled breathlessness did not consistently match descriptions of exercise-induced breathlessness, which may reflect the different contexts under which breathlessness was recalled and induced.

The language of breathlessness differentiates between patients with COPD and age-matched adults.

BACKGROUND: If descriptors of the sensation of breathlessness are able to differentiate between medical conditions, the language of breathlessness could potentially have a role in differential diagnosis. This study investigated whether the language used to describe the sensation of breathlessness accurately categorized older individuals with and without a prior diagnosis of COPD. METHODS: Using a parallel-group design, participants with and without a prior diagnosis of COPD volunteered words and phrases and endorsed up to three statements to describe their sensation of breathlessness. Cluster analysis (v-fold cross-validation) was applied, and subjects were clustered by their choice of words. Cluster membership was then compared to original group membership (COPD vs non-COPD), and predictive power was assessed. RESULTS: Groups were similar for age and gender (COPD, n = 94; 48 men; mean age, 70 +/- 10 years [+/- SD]; vs non-COPD, n = 55; 21 men; mean age, 69 +/- 13 years) but differed significantly in breathlessness-related impairment, intensity, and quality of life (p < 0.0001). Cluster membership corresponded accurately with original group classifications (volunteered, 85%; and up to three statements, 68% agreement). Classification based on a single best descriptor (volunteered [62%] or endorsed [55%]) was less accurate for group membership. CONCLUSIONS: Language used to describe the sensation of breathlessness differentiated people with and without a prior diagnosis of COPD when descriptors were not limited to a single best word or statement.

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes.

The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.