Counsellors' verbal behaviours and skills that elicit participants' change or sustain talk in virtual motivational interviewing for physical activity among older adults.

Exploring the influence of counsellors' verbal behaviours on participants' utterances in virtual motivational interviewing (MI) could broaden our understanding of how MI works. This study aims to determine counsellors' behaviours that are more or less likely than chance to elicit participants' change talk and sustain talk during a virtual MI intervention to promote physical activity among older adults. A sequential analysis was used to examine the transitional probability between the counsellors' and participants' behaviours. Thirty-five MI sessions were analysed from the virtual motivational interviewing (VIMINT) trial. MI-consistent behaviours (MICO) were significantly more likely than chance to be followed by change talk, sustain talk and follow/neutral talk. MI-inconsistent behaviours (MIIN) were more likely than chance to be followed by change talk, and 'other' counsellors' behaviours were more likely than chance to be followed by change talk and follow/neutral talk. In conclusion, all three types of counsellors' behaviours elicited change talk. This study re-emphasizes the link between MICO, change and sustain talk. The influence of MIIN and 'other' behaviours on change talk needs to be explored further. This study has implications for MI training and the need for counsellors to continuously develop skills or behaviours consistent with MI principles.

Determining Associations Among Health Orientation, Fitness Orientation, and Attitudes Toward Fatness in Physiotherapists and Physiotherapy Students Using Structural Equation Modeling.

Purpose: Research suggests physiotherapists hold negative attitudes and beliefs toward fatness and fat people. Physiotherapists are also health-conscious, and invested in healthy lifestyle behaviours including physical activity. Our purpose was to describe relationships between health orientation, fitness orientation, and fat attitudes. Methods: Physiotherapists (n = 187) and physiotherapy students (n = 34) completed an online survey (Health Orientation Scale, Multidimensional Body-Self Relations Questionnaire, Fat Attitudes Assessment Toolkit). Structural equation modeling estimated associations between fat attitudes (dependent variable) and health and fitness orientation (independent variables). Results: Participants scored high in orientation toward fitness and health. We found strong positive associations between fitness orientation and health orientation (p < 0.001). Health orientation was not significantly associated with fat attitudes (p = 0.075), whereas increased age was associated with more positive fat attitudes (p < 0.01). Although most participants acknowledged that factors outside an individual's control contribute to body weight, many also agreed with normative negative perspectives. Conclusions: Physiotherapists are highly oriented toward fitness and health. This may underlie beliefs in the controllability of body weight and contribute to negative attitudes toward fatness and fat people. Further research, with greater sample sizes is necessary to further investigate associations between health orientation and fat attitudes.

Objectif: selon les recherches, les physiothérapeutes ont des attitudes et croyances négatives à l'égard de l'obésité et des personnes obèses. Ils sont également soucieux de la santé et investis dans des comportements sains, y compris l'activité physique. Les chercheurs visaient à décrire la relation entre l'orientation vers la santé, l'orientation vers la forme physique et les attitudes vers l'obésité. Méthodologie: les physiothérapeutes (n = 187) et les étudiants en physiothérapie (n = 34) ont rempli un sondage en ligne (échelle d'orientation vers la santé, questionnaire multidimensionnel des relations entre le corps et soi, outil d'évaluation des attitudes envers l'obésité). Les chercheurs ont utilisé la modélisation des équations structurelles pour estimer les associations entre les attitudes envers l'obésité (variables dépendantes) et l'orientation vers la santé et la forme physique (variables indépendantes). Résultats: les participants ont obtenu un résultat élevé à l'égard de l'orientation vers la forme physique et vers la santé. Les chercheurs ont trouvé des associations positives vigoureuses entre l'orientation vers la forme physique et l'orientation vers la santé (p < 0,001). L'orientation vers la santé n'était pas associée de manière significative aux attitudes envers l'obésité (p = 0,075), mais un âge plus avancé était associé à des attitudes plus positives envers l'obésité (p < 0,01). Même si la plupart des participants reconnaissent que des facteurs hors du contrôle individuel contribuent au poids, bon nombre conviennent également avoir des points de vue négatifs normatifs. Conclusions: les physiothérapeutes sont fortement orientés vers la forme physique et la santé, ce qui peut sous-tendre des croyances à l'égard de la contrôlabilité du poids et contribuer à des attitudes négatives envers l'obésité et les personnes obèses. Il faudra réaliser des recherches plus approfondies auprès d'échantillons plus importants pour étudier les associations entre l'orientation vers la santé et les attitudes envers l'obésité de manière plus approfondie.

Virtual pulmonary rehabilitation approaches in patients with post COVID syndrome: a pilot study.

BACKGROUND: The characteristics of optimal virtual pulmonary rehabilitation (PR) for individuals with post-COVID syndrome (PCS) have not been identified. This study aimed to assess the feasibility, safety, and satisfaction associated with a virtual PR program with the exercise component delivered through group or self-directed sessions. METHODS: Adults with PCS-respiratory symptoms were randomly assigned to the video conference (PRVC) or self-directed (PRSD) group and completed an exercise program (aerobic, strengthening, and breathing exercises) three times/week for eight weeks. PRVC sessions were led by a physiotherapist via Zoom, whereas the PRSD group exercised individually following a pre-recorded video. Both groups received personalized exercise recommendations, education related to the condition, and a weekly follow up call. Satisfaction was assessed through a patient survey. Lung function, dyspnea, fatigue, sit-to-stand capacity, health-related quality of life, and participation were assessed pre- and post-PR. RESULTS: Fourteen PCS individuals (49 ± 9 years, 86% females) completed 83% of the sessions. All participants were satisfied with information provided by the therapist and frequency of data submission, whereas most were satisfied with the frequency and duration of exercise sessions (88% in PRVC and 83% in PRSD). A higher proportion of participants in the PRVC (88%) were satisfied with the level of difficulty of exercises compared with the PRSD (67%), and 84% of the sample reported a positive impact of the program on their health. No adverse events were reported. Significant changes in sit-to-stand capacity (p = 0.012, Cohen's r = 0.67) and questions related to fatigue (p = 0.027, Cohen's r = 0.58), neurocognitive (p = 0.045, Cohen's r = 0.53), and autonomic (p = 0.024, Cohen's r = 0.60) domains of the DePaul Symptom Questionnaire short-form were also found between groups. CONCLUSION: Virtual PR with exercises delivered via video conference or pre-recorded video were feasible, safe, and well-received by individuals with PCS. TRIAL REGISTRATION: NCT05003271 (first posted: 12/08/2021).

Self-reported factors associated with community ambulation after stroke: The Canadian Longitudinal Study on Aging.

Community ambulation is frequently limited for people with stroke. It is, however, considered important to people with stroke. The objectives were to identify factors associated with self-reported community ambulation in Canadians aged 45+ with stroke and to identify factors associated with community ambulation specific to Canadian males and to Canadian females with stroke. Data were utilized from the Canadian Longitudinal Study on Aging Tracking Cohort. Multivariate logistic regression models were developed for community ambulation. Mean age was 68 (SE 0.5) years (45% female). In the final community ambulation model (n = 855), factors associated with being less likely to 'walk outdoors sometimes or often' included difficulty or being unable to walk 2-3 blocks (decreased endurance) vs. no difficulty. Being more likely to walk outdoors was associated with 'better weather' months and being 55-64 years of age vs 75-85. Differences were noted between the models of only males and only females. Decreased walking endurance is associated with a decreased likelihood of walking in the community-a factor that can be addressed by rehabilitation professionals and in community based programs.

Virtual Motivational Interviewing (VIMINT) to support physical activity: Experiences of older adults and counsellors.

The aim of this study was to explore the experiences of older adults and counsellors involved in virtual motivational interviewing (MI). This study was part of the Virtual Motivational INTerviewing (VIMINT) feasibility trial of virtual MI for physical activity in older adults. A descriptive qualitative design utilized content analysis. Seven older adults and three counsellors were interviewed. Four categories were developed: (i) Benefits and limitations of using technology (ii) Relationships between older adults and counsellors (iii) MI skills and spirit and (iv) Effects of virtual MI. Older adults and counsellors reported that receiving/delivering MI virtually was convenient and flexible. They described reduced non-verbal communication in virtual MI. Virtual MI facilitates interpersonal relationships, and counsellors reported that MI skills and spirit can be applied virtually. This study showed that virtual MI offers potential benefits with some limitations. The findings could inform future research involving virtual delivery of MI.

Individual and environmental variables related to outdoor walking among older adults: Verifying a model to guide the design of interventions targeting outdoor walking.

OBJECTIVE: To estimate the relationships between individual and environmental variables and outdoor walking (OW) in older adults with OW limitations through verifying a conceptual model. METHODS: Baseline data from 205 older adults participating in a randomized trial of a park-based OW program were analyzed using structural equation modeling. We evaluated a three latent factor model: OW (accelerometry and self-report); individual factors (balance; leg strength; walking self-confidence, speed and endurance; mental health; education; income; car access); and environmental factors (neighbourhood walkability components). RESULTS: Mean age was 75 years; 73% were women. Individual factors was significantly associated with OW (ß = 0.39, p < .01). Environmental factors was not directly associated with OW but was indirectly linked to OW through its significant covariance with the individual factors (ß = 0.22, p < .01). The standardized factor loadings from the individual factors on walking self-confidence and walking capacity measures exceeded 0.65. CONCLUSIONS: Better walking capacity and more confidence in the ability to walk outdoors are associated with higher OW in older adults. Better neighbourhood walkability is indirectly associated with more OW. The conceptual model demonstrates an individual and environment association; if the capacity of the individual is increased (potentially through walking interventions), they may be able to better navigate environmental challenges.

Community ambulation in older adults and people with OA - a model verification using Canadian Longitudinal Study on Aging (CLSA) data.

BACKGROUND: There are health and well-being benefits of community ambulation; however, many older adults do not regularly walk outside of their home. Objectives were to estimate the associations between latent constructs related to community ambulation in older adults aged 65-85 (65+), and in adults with osteoarthritis (OA) aged 45-85. METHODS: Secondary data analysis of the comprehensive baseline and maintaining contact questionnaire data from the Canadian Longitudinal Study of Aging (CLSA) was completed. Based on a previous model of community ambulation post-stroke, structural equation modeling (SEM) was used to develop measurement and structural models for two groups: older adults 65+ and people with OA. Multi-group SEM was conducted to test measurement invariance across sex and age groups. Measurement models were developed for the following latent factors: ambulation (frequency of walking outside/week, hours walked/day, ability to walk without help, frequency and aids used in different settings); health perceptions (general health, pain frequency/intensity); timed functional mobility (gait speed, timed up-and-go, sit-to-stand, balance). Variables of depression, falls, age, sex, and fear of walking alone at night were covariates in the structural models. RESULTS: Data were used from 11,619 individuals in the 65+ group (mean age 73 years ±6, 49% female) and 5546 individuals in the OA group (mean age 67 ± 10, 60% female). The final 65+ model had a close fit with RMSEA (90% CI) = 0.018 (0.017, 0.019), CFI = 0.91, SRMR = 0.09. For the OA group, RMSEA (90% CI) = 0.021 (0.020, 0.023), CFI = 0.92, SRMR = 0.07. Health perceptions and timed functional mobility had a positive association with ambulation. Depression was associated with ambulation through negative associations with health perceptions and timed functional mobility. Multi-group SEM results reveal the measurement model was retained for males and females in the 65+ group, for males and females and for age groups (65+, < 65) in the OA group. CONCLUSIONS: The community ambulation model post-stroke was verified with adults aged 65+ and for those with OA. The models of community ambulation can be used to frame and conceptualize community ambulation research and clinical interventions.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial.

BACKGROUND: Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial. METHODS: GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG. RESULTS: All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG. CONCLUSIONS: This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Verification of a comprehensive framework for mobility using data from the Canadian Longitudinal Study on Aging: a structural equation modeling analysis.

BACKGROUND: Mobility within and between life spaces is fundamental for health and well-being. Our objective was to verify a comprehensive framework for mobility. METHODS: This was a cross-sectional study. We used structural equation modeling to estimate associations between latent factors with data from the Canadian Longitudinal Study on Aging for participants 65-85 years of age (65+, n = 11,667) and for adults with osteoarthritis (OA) aged 45-85 (n = 5,560). Latent factors included life space mobility, and physical, psychosocial, environmental, financial, and cognitive elements. Personal variables (age, sex, education) were covariates. RESULTS: The models demonstrated good fit (65+: CFI = 0.90, RMSEA (90% CI) = 0.025 (0.024, 0.026); OA: CFI = 0.90, RMSEA (90% CI) = 0.032 (0.031, 0.033)). In both models, better psychosocial and physical health, and being less afraid to walk after dark (observed environmental variable) were associated with greater life space mobility. Greater financial status was associated with better psychosocial and physical health. Higher education was related to better cognition and finances. Older age was associated with lower financial status, cognition, and physical health. Cognitive health was positively associated with greater mobility only in the 65 + model. Models generated were equivalent for males and females. CONCLUSIONS: Associations between determinants described in the mobility framework were verified with adults 65-85 years of age and in an OA group when all factors were considered together using SEM. These results have implications for clinicians and researchers in terms of important outcomes when assessing life space mobility; findings support interdisciplinary analyses that include evaluation of cognition, depression, anxiety, environmental factors, and community engagement, as well as physical and financial health. Public policies that influence older adults and their abilities to access communities beyond their homes need to reflect the complexity of factors that influence life space mobility at both individual and societal levels.

Components of a Behavior Change Model Drive Quality of Life in Community-Dwelling Older Persons.

This study aimed to inform a measurement approach for older persons who wish to engage in active living such as participating in a walking program. The Patient Generated Index, an individualized measurement approach, and directed and summative content analyses were carried out. A sample size of 204 participants (mean age 75 years; 62% women) was recruited; it generated 934 text threads mapped to 460 unique categories within 45 domains with similarities and differences for women and men. The Capability, Opportunity, Motivation, and Behaviors Model best linked the domains. The results suggest that older persons identify the need to overcome impaired capacity, low motivation, and barriers to engagement to live actively. These are all areas that active living programs could address. How to measure the outcomes of these programs remains elusive.

Physical Activity Intensity of Singles and Doubles Pickleball in Older Adults.

The purpose of this study was to measure heart rate, activity intensity, and steps in recreational singles and doubles pickleball players. We collected data in 22 singles and 31 doubles players (62.1 ± 9.7 years of age) using Garmin Fenix 5 watches (Garmin International, Inc.) and ActiGraph GT3X+ (ActiGraph LLC) accelerometers. Mean heart rates during singles and doubles were 111.6 ± 13.5 and 111.5 ± 16.2 beats/min (70.3% and 71.2% of predicted maximum heart rate), respectively. Over 70% of singles and doubles playing time was categorized in moderate to vigorous heart rate zones whereas 80.5% of singles time and 50.4% of doubles time were moderate based on Freedson accelerometer cut-points. Steps per hour were higher in singles versus doubles (3,322 ± 493 vs. 2,791 ± 359), t(51) = 4.540, p < .001. Singles and doubles pickleball are moderate- to vigorous-intensity activities that can contribute substantially toward older adults meeting physical activity guidelines.

Factors associated with social participation and community ambulation in people with osteoarthritis: Findings from the Canadian Longitudinal Study on Aging.

AIM: Walking in the community allows participation in meaningful activities which positively influences self-rated health and quality of life. Our objective was to identify factors associated with social participation and community ambulation in a representative sample of Canadian adults with osteoarthritis (OA). METHODS: Data were from >3800 participants in the Baseline Tracking Dataset of the Canadian Longitudinal Study on Aging with OA of the hip and/or knee. Outcomes included frequency of participation in 8 community-based activities (past year, social participation), and frequency walking outside the home (past 7 days, community ambulation). Explanatory variables (15 for social participation, 11 for community ambulation) established in previous literature were evaluated. Variables significant in univariate binary logistic regression models were entered into multivariable models. RESULTS: Frequency of social participation was greater for females, and individuals with higher levels of education. Those who were younger, dissatisfied with life, and had difficulty walking 2-3 blocks were less likely to participate. Having fewer chronic conditions, being younger, being single/widowed and being interviewed in spring/summer were associated with more frequent ambulation. Lower self-rated health, difficulty walking 2-3 blocks, pain and being female were associated with less frequent walking outside the home. CONCLUSION: Many factors influence frequency of social participation and community ambulation. The ability to walk short distances is positively associated with both outcomes. This important factor can and should be addressed clinically to improve health and quality of life in people with OA.

Effect of a Supervised Stretching Program on Neck, Shoulder, and Trunk Range of Motion in Older Women.

Upper body and neck range of motion (ROM) are important for safe walking and driving. The purpose of this study was to determine whether stretching would improve neck, trunk, and shoulder ROM. Forty-eight community-dwelling women (75 ± 3 years of age) were randomly allocated to intervention (upper body stretching, n = 15) and control conditions (lower body power training, n = 33). All participants exercised in supervised 45-minute sessions twice weekly for 12 weeks. Testing of upper body ROM included a cervical ROM, device-based measurement and field tests of the neck, trunk, and shoulder ranges. Shoulder ROM was the only movement that improved in the intervention group beyond levels seen in control participants (33% increase, p < 0.01). Neck and trunk ROM did not change in response to a specific stretching program. Older adults with ROM limitations may need to explore other exercise options or focus on compensatory strategies for safe community mobility.

Signs of Inequitable Access: Users of Private Physiotherapy Services Do Not Reflect the Urban Population in Winnipeg, Manitoba.

Purpose: Both private and public funding cover outpatient physiotherapy (PT) in Canada. Knowledge is lacking in who does and does not access PT services, which limits the ability to identify health/access inequities created by current financing structures. This study characterizes the individuals accessing private PT in Winnipeg to better understand whether inequities exist, given the very limited publicly financed PT. Methods: Patients attending PT in 32 private businesses, sampled for geographic variation, completed a survey online or on paper. We compared the sample's demographic characteristics with Winnipeg population data using chi-square goodness-of-fit tests. Results: In total, 665 adults accessing PT participated. Respondents were older and had higher levels of income and education compared to Winnipeg census data (p < 0.001). Our sample included higher proportions of female and White individuals, and lower proportions of Indigenous persons, newcomers, and people from visible minorities (p < 0.001). Conclusions: There are signs that inequities exist in access to PT in Winnipeg; the cohort who access private PT services does not reflect the wider population, which suggests that some segments of the population are not receiving care.

Objectif : un financement tant public que privé couvre les services ambulatoires de physiothérapie au Canada. On ne sait pas qui y a accès ou non, ce qui limite la possibilité de déterminer les iniquités en matière de santé et d'accès attribuables aux structures actuelles de financement. La présente étude caractérise les personnes qui accèdent à des services de physiothérapie privés à Winnipeg, afin de mieux comprendre s'il existe des iniquités, compte tenu des services de physiothérapie très limités qui sont financés par le secteur public. Méthodologie : des patients recevant des services de physiothérapie dans 32 entreprises privées, échantillonnées d'après leur variation géographique, ont rempli un sondage en ligne ou sur papier. Les chercheurs ont comparé les caractéristiques démographiques de l'échantillon aux données populationnelles de Winnipeg au moyen de tests du chi carré pour la qualité de l'ajustement. Résultats : au total, 665 adultes qui avaient accès à des services de physiothérapie ont participé. Ils étaient plus âgés et avaient un revenu et une scolarisation supérieurs aux données du recensement de Winnipeg (p < 0,001). L'échantillon contenait une plus forte proportion de femmes et de personnes blanches, et une plus faible proportion de personnes autochtones, de nouveaux arrivants et de membres des minorités visibles (p < 0,001). Conclusions : il y a des signes d'iniquité d'accès aux services de physiothérapie à Winnipeg. La cohorte qui a accès aux services de physiothérapie privés ne reflète pas l'ensemble de la population, ce qui indique que certains segments de la population ne reçoivent pas de soins.

"This program should come with a warning sign!": Mental wellness in occupational therapy and physical therapy students.

Objectives: To measure and compare distress in entry-level masters occupational therapy (OT) and physical therapy (PT) students; to evaluate distress levels relative to existing data; and to explore factors that cause stress, effects of stress, and coping strategies. Participants: Ninety-eight OT and PT students (75 females, 23 males) from two cohorts at a Canadian university. Methods: Sequential mixed-methods including questionnaires and inductive analysis of focus group discussions. Results: OT and PT students from one cohort reported higher levels of stress, anxiety and/or depression compared to the following academic year and compared to undergraduate and general population samples. The overall theme was the unrelenting tug of war between school and other aspects of students' lives. Factors related to academic workload negatively affected mental health. Coping strategies included physical activity, strategic selection of peers, and modifying expectations. Conclusions: Wellness in OT and PT students is an important concern that deserves attention.

Experiences of stroke survivors and measurement of post stroke participation and activity across seasons-A mixed methods approach.

Participation and activity post stroke can be limited due to adverse weather conditions. This study aimed to: Quantify and compare summer and winter participation and activity, and explore how community dwelling people with stroke describe their feelings about their level of participation and activity by season. This embedded mixed-methods observational study took place in a city with weather extremes. Community dwelling individuals at least one year post-stroke, able to walk ≥50 metres +/- a walking aide were included. Evaluations and interviews occurred at participants' homes in two seasons: Reintegration to Normal living Index (RNL), Activities-specific Balance Confidence (ABC) and descriptive outcomes. Participants wore activity monitors for one week each season. Analysis included descriptive statistics, non-parametric tests and an inductive approach to content analysis. Thirteen individuals participated in quantitative evaluation with eight interviewed. Mean age 61.5 years, 62% female and mean 6.2 years post-stroke. No differences between winter-summer values of RNL, ABC, or activity monitor outcomes. However, participants felt they could do more and were more independent in summer. The winter conditions such as ice, snow, cold and wind restricted participation and limited activities. Nonetheless, many participants were active and participated despite the winter challenges by finding other ways to be active, and relying on social supports and personal motivation. The qualitative findings explained unexpected quantitative results. Participants described many challenges with winter weather, but also ways they had discovered to participate and be active despite these challenges. Changes to future studies into seasonal differences are suggested.

Apparent Discordance Between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review.

OBJECTIVE: Many survivors of COVID-19 experience ongoing signs and symptoms affecting multiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages. METHODS: MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. Select questions from the Appraisal of Guidelines for Research and Evaluation instrument were used to evaluate the quality of consensus guidelines. RESULTS: Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, activities of daily living and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation. CONCLUSION: There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self-management and access to rehabilitation specialists in multidisciplinary teams. IMPACT: Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.

Validation of an Adapted Questionnaire for Outdoor Walking Among Older Adults: The CHAMPS-OUTDOORS.

The aim of this study was to examine the construct and known-groups validity of the total score of five items adapted from the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure outdoor walking (CHAMPS-OUTDOORS) in older adults. Data from the baseline assessment of the Getting Older Adult OUTdoors (GO-OUT) trial were used. Construct validity of the CHAMPS-OUTDOORS used objective measures of outdoor walking (accelerometry-GPS), Ambulatory Self-Confidence Questionnaire, RAND-36, 6-min walk test, 10-m walk test, and Mini-Balance Evaluation System Test. For known-groups validity, we compared the CHAMPS-OUTDOORS of those who walked < or ≥1.2 m/s. Sixty-five participants had an average age of 76.5 ± 7.8 years. The CHAMPS-OUTDOORS was moderately correlated with total outdoor walking time (r = .33) and outdoor steps (r = .33) per week measured by accelerometry-GPS, and weakly correlated with Mini-Balance Evaluation System Test score (r = .27). The CHAMPS-OUTDOORS did not distinguish known groups based on crosswalk speed (p = .33). The CHAMPS-OUTDOORS may be used to assess outdoor walking in the absence of accelerometry GPS. Further research examining reliability is needed.

Quality and content analysis of clinical practice guidelines which include nonpharmacological interventions for knee osteoarthritis.

RATIONALE, AIMS, AND OBJECTIVES: Clinical practice guidelines (CPGs) for knee osteoarthritis (OA) guide the provision of high-quality healthcare for people with knee OA, which may improve outcomes. Our aim was to evaluate the quality of and content within recently published CPGs for people with knee OA. METHODS: CPGs (2014-2019) that described recommendations for nonpharmacological interventions for knee OA were included in the analysis. Two pairs of evaluators used the Appraisal of Guidelines Research and Evaluation II instrument (AGREE II) to assess the quality of guideline development. CPG content was reviewed and summarized for comparison. RESULTS: Ten CPGs were identified for inclusion in the quality and content analysis (seven newly developed and three recently updated). Overall CPG scores ranged between 42% and 100%. Six CPGs were found to be high-quality. Exercise was the only intervention recommended by all CPGs that we appraised. Weight-management and education were the next most frequently recommended interventions. Inter-rater reliability scores were high in domain 1: scope and purpose, (P-value = .001, intraclass correlation coefficient [ICC] = 0.90, 95% confidence interval [CI] = 0.62-0.98), domain 3: rigor of development (P-value = .000, ICC = 0.95, 95% CI = 0.80-0.99) and domain 5: applicability (P-value = .001, ICC = 0.91, 95% CI = 0.64-0.98). CONCLUSION: Several CPGs have been developed or recently updated since 2014. Over half of the ten CPGs we appraised were deemed to be high-quality. Exercise, education, and weight-management advice are interventions that were most commonly recommended by CPGs.