Barriers and enablers of physical activity engagement for patients with COPD in primary care.

BACKGROUND: Given that physical activity (PA) has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory. METHODS: A purposive sample of 26 individuals with a range of COPD severity (age range: 50-89 years; males =15) were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs. RESULTS: Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather), psychological (embarrassment, fear, frustration/disappointment), attitudinal (feeling in control of their condition, PA perception, older age perception), and motivational. The main enabling factors were related to motivation (autonomous or controlled), attitudes, self-regulation, and performance accomplishments. CLINICAL IMPLICATIONS: When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning.

What are health professionals' intentions toward using research and products of research in clinical practice? A systematic review and narrative synthesis.

AIM: To explore health professionals' intentional behaviour and what determines their intention to use products of research in clinical practice. BACKGROUND: Trying to get research and products of research into clinical practice is an enduring problem. A clearer picture is emerging as to how individual practitioners respond toward practical problems of changing clinical practice, but this does not include health professionals' intentions to use products of research and what influences their intentions. DESIGN: Systematic Review and Narrative Synthesis. DATA SOURCES: Five databases were searched systematically. This included BNI, HMIC, Psych INFO, CINHAL and MEDLINE; articles published in the English language only were included. REVIEW METHODS: PRISMA guidelines were used as a framework for structuring the review and methods of narrative synthesis to analyse study outcomes. RESULTS: Eighteen studies matched the final inclusion criteria. All studies used questionnaires to measure intention. Most studies involved Nurses or Physicians. Nurses' intentions were mostly influenced by their perceived ability to use guidelines in their practice. Physicians' intentions were often influenced by their perceptions of the usefulness and relevance of the guideline and peer pressure amongst the professional group. Practice habits, when added to intentional models were also predictive of intentional behaviour. In studies that compared intentions with behaviour, the level of intention often did not match self-report or actual behaviour.

Is the practice of goal-setting for patients in acute stroke care patient-centred and what factors influence this? A qualitative study.

OBJECTIVE: To explore whether goal-setting for rehabilitation with acute stroke survivors is patient-centred and identify factors which influence the adoption of patient-centredness in goal-setting practice. SETTING: Acute stroke unit in a large teaching hospital in England. PARTICIPANTS: Patients with stroke who had no cognitive or significant communication problems and health care professionals who had a significant engagement with an individual patient were approached for participation. METHOD: Multiple qualitative methods were used. Perceptions and beliefs about patient-centredness, within the context of goal-setting, were collected from patients and corresponding professionals using qualitative semi-structured interviews. Adoption of patient-centred behaviour was triangulated using analysis of patient records and observation of team meetings related to participating patients. DATA ANALYSIS: Interview transcripts and field notes were coded, clustered under categories and descriptively summarised. Additionally, data from patients' documents were summarised. These summaries were then mapped on to an a-priori frame work of patient-centredness from which further interpretative themes were derived. RESULTS: Seven patients and seven health-care professionals participated. Goal-setting was not consistently patient-centred as evidenced by a) incongruities between patients and professionals in setting, communicating and prioritising of goals and b) dysfunctional therapeutic relationships. The factors that influenced patient-centred goal-setting were both professional and patient beliefs and attributes, work-culture, practice model, limitations in knowledge and systems that disempowered both professionals and patients. CONCLUSION: It may be possible to infer that current local practice of goal-setting was inadequately patient-centred. Further research is required to identify strategies to overcome these challenges and to develop patient-centred goal-setting methods.

THE PROBLEMATIC WORLD OF FOLLOWING A RENAL DIET OUTSIDE THE HOME.

BACKGROUND: Individuals on peritoneal dialysis are given dietary advice to help reduce disease morbidity and mortality. However, the experience of people who have been given this advice is not well researched. OBJECTIVE: To understand the experiences of individuals on peritoneal dialysis when following dietary advice. METHOD: A phenomenological approach, using semi-structured in-depth interviews was used to understand the experiences of ten service-users of the renal dietetic service. Data were analysed using Framework Analysis. FINDINGS: One theme emerged around difficulty when eating outside the home. Individuals experienced negative emotions when following advice. Individuals ate foods reluctantly, offered excuses as to why meals could not be eaten, or in extreme cases did not attend certain social gatherings in order to avoid the perceived attention and judgement from fellow guests related to their food choices. CONCLUSION: A renal diet for peritoneal dialysis may be difficult to follow outside the home. Further support around eating in social situations may need to be offered when giving dietary advice.

Investigating the benefits of sport participation for individuals with schizophrenia: a systematic review.

BACKGROUND: The purpose of this review was to consider the impact of being introduced to a sport and sport participation on (a) weight loss and psychiatric symptoms, (b) any other health benefits in people with schizophrenia, supported by quantitative and qualitative findings. SUBJECT AND METHODS: A systematic review in accordance with the PRISMA statement was conducted. Searches were undertaken in January 2014. Articles were eligible that (1) considered the effect (quantitative studies) and experience (qualitative and case studies) of either; being introduced to a 'sport' or undertaking a sport activity, (2) included >85% of patients diagnosed with schizophrenia or schizo-affective spectrum disorders according to recognised criteria. RESULTS: A total of 10 studies including 5 trials (2*pre-experimental, 2*controlled trials, 1*randomised control trial), 2 qualitative studies and 3 case studies were included (n=185). Two out of 3 studies that considered weight as an outcome measure reported significant reductions in weight and psychiatric symptoms following sports participation. The mean reduction in body mass index (BMI) ranged from -0.7kg.m2 (p<0.001) following 12 weeks of basketball to -1.33 kg.m2 (p<0.001) after 12-weeks of soccer. The mean reduction in the Positive and Negative Symptoms score ranged from 2.4 points (F=-19.0, p<0.001) following 12 weeks of basketball to 7.4 points (t=-5.0, p<0.001) following a 40 week programme of horse riding. A range of secondary health and wellbeing outcomes identified some significant results. Qualitative findings showed that participants had positive experiences from participating in sports. CONCLUSIONS: Sport participation may result in reduced BMI and psychiatric symptoms in patients with schizophrenia. Sport has the potential to improve an individual's quality of life through providing a meaningful normalizing activity that leads to achievement, success and satisfaction. Well-designed randomised controlled trials are required to fully determine the health effects of sports participation in schizophrenia.

Identifying the facilitators and processes which influence recovery in individuals with schizophrenia: a systematic review and thematic synthesis.

BACKGROUND: Research is required to better understand the psychosocial factors that influence the recovery of individuals with schizophrenia. OBJECTIVE: To conduct a systematic review and thematic synthesis and identify the factors which influence recovery. METHODS: Major electronic databases were searched from inception until February 2014. Qualitative articles were included that considered the concept of recovery from individuals with schizophrenia, their caregivers or health care professionals. Methodological quality was assessed and studies were thematically synthesised. RESULTS: Twenty articles involving 585 individuals with schizophrenia, 298 primary care givers or close sources of support and 47 health care professionals were included. The results identified and detailed the psychosocial factors and processes that influenced recovery. The factors which promoted recovery included: (1) adjustment, coping and reappraisal (2) responding to the illness (3) social support, close relationships and belonging. The factors which challenged recovery included: (1) negative interactions and isolation (2) internal barriers (3) uncertainty and hopelessness. CONCLUSION: Health care professionals and researchers will benefit from a greater understanding of the psychosocial factors which influence recovery for individuals with schizophrenia. Implications are discussed within the text.

The experience of Parkinson's disease: a systematic review and meta-ethnography.

There has been little attempt to summarise and synthesise qualitative studies concerning the experience and perception of living with Parkinson's disease. Bringing this information together would provide a background to understand the importance of an individual's social identity on their well-being and hope. Three primary aims were identified (a) understanding the importance of social identity and meaningful activities on individuals' well-being, (b) identifying factors and strategies that influence well-being and hope, and (c) establishing a model that relates to an individual's hope and well-being. Three stages were undertaken including a traditional electronic search, a critical appraisal of articles, and a synthesis of studies. Qualitative articles were included that considered the experience of living with Parkinson's disease. Thirty seven articles were located and included in the review. Five themes were identified and the themes were used to inform development of a new model of hope enablement. The current review furthered understanding of how physical symptoms and the experience of Parkinson's disease affect the individual's well-being and hope. Social identity was established as a key factor that influenced an individual's well-being. Being able to maintain, retain, or develop social identities was essential for the well-being and hope of individuals with Parkinson's disease. Understanding the factors which prevent or can facilitate this is essential.

Selection, use and psychometric properties of physical activity measures to assess individuals with severe mental illness: a narrative synthesis.

This research provides a critical consideration of the outcome measures used to assess physical activity in individuals with severe mental illness. A narrative synthesis was utilised to provide a simple juxtapose of the current research. A sensitive topic-based search strategy was conducted in order to identify studies that met the eligibility criteria. Fifty two studies met the inclusion criteria and 5 were identified specially as validation studies. The current research identified several methodological shortcomings. The justification and choice of outcome measure used is often weak and only five studies have validated a specific outcome measure of physical activity. Within these validation studies, the validation process often lacked a consideration of agreement between measures. Accelerometers have been most frequently used as a criterion measure, notably the RT3 tri-axial accelerometer. Objective based measures may be best placed to consider physical activity levels, although, methodological considerations for the utilization of such tools is required. Self-report questionnaires have benefits for use in this population but require further validation. Researchers and clinicians need to carefully consider what outcome measure they are using and be aware of the development, scope and purpose of that measure.

Identifying a Framework for Hope in Order to Establish the Importance of Generalised Hopes for Individuals Who Have Suffered a Stroke.

Hope and hopelessness are important psychological constructs that physiotherapists should consider when working with patients who have experienced a stroke. The view of hope in rehabilitation is often focused around the concept of goals and how hope works within this framework. However, the current paper proposes a broader framework for hope and the importance of a more generalised view of understanding why a certain hope exists or is identified by a patient. A narrative review using an a priori thematic analysis was undertaken to consider how more generalised hopes are expressed by individuals who have suffered a stroke. An electronic search of 4 databases from inception until April 2014 was undertaken. Qualitative articles were included if they considered the concept of hope for patients who had suffered a stroke. The results identified three themes which included (1) consideration of the patient's identity/identities, (2) meaningful activities, experiences, and interactions, and (3) the experience of suffering and need for relief. An awareness of patients' generalised hopes should be a priority for HCPs. Detailed implications for HCPs are identified within the discussion.

An exploration of the professional identity embedded within UK cardiorespiratory physiotherapy curricula.

OBJECTIVES: To explore whether consensus exists about content and professional identity represented within pre-registration cardiorespiratory physiotherapy (CPT) curricula, and to establish whether the curricula feature contemporary themes evident in policy and professional guidance in order to test whether CPT education is demonstrating responsiveness and relevance to practice. DESIGN: An exploratory qualitative case study design employing documentary analysis of curricula materials related to CPT. PARTICIPANTS: Fourteen UK higher education institutions offering undergraduate physiotherapy qualifying programmes agreed to participate. INTERVENTION: Relevant curriculum documentation was requested, such as student module guides, programme handbooks and institutional module descriptors, encompassing information including indicative content, teaching and learning methods, and modes of assessment. Document analysis combined deduction (through content analysis) and induction (through thematic analysis). RESULTS: Consensus was observed on core content, underpinning philosophy and professional identity across institutions. The projected identity appeared to be strongly biomedical in focus, and was less well influenced by some of the contemporary aspects promoted by the Chartered Society of Physiotherapy, such as promotion of a patient-centred model of practice and acknowledgement of the emotional challenges existing within this area of work. CONCLUSION: Continuing critical review of the content and approach promoted within curricula is needed to ensure that learning remains relevant and responsive to current agendas. This study supports the need for course teams to reconsider the emphasis within individual curricula to ensure that responsiveness and relevance to the practice setting are made explicit.

A systematic review and synthesis of the quantitative and qualitative evidence behind patient-centred goal setting in stroke rehabilitation.

OBJECTIVE: To map out from the literature the nature, extent and effects of application of patient-centred goal setting in stroke rehabilitation practice. DESIGN: Systematic review. DATA SOURCES: A search was conducted in the Cochrane (Wiley), AMED, Medline (EBSCO), Embase, Sports discuss, Medline (Ovid) and CINAHL databases. Secondary search based on references from the preliminary search was undertaken. REVIEW METHODS: Quantitative and qualitative studies that included aspects of patient-centredness and goal setting in stroke patients from 1980 to June 2010 were collected. Studies were scrutinized for relevance and quality based on published methodology. The findings were synthesized by aggregating the themes from the qualitative studies and relating them to relevant findings from the quantitative studies. RESULTS: Eighteen qualitative and eight quantitative and one mixed method study conducted in stroke rehabilitation services ranging from acute to community rehabilitation were included. Themes that emerged were related to perceptions of patients and professionals regarding patient-centredness, nominal adoption of this concept, consequences of discrepancies in the perceptions and practice, related ethical conflicts, challenges to application and strategies to improve its application. The effects of following patient-centred goal-setting practice have been studied mostly with weak methodologies and studies show some benefit with psychological outcomes. CONCLUSION: Patient-centred goal setting is minimally adopted in goal-setting practice due to various barriers. Since the effects of incorporating this concept have not been evaluated rigorously it is suggested that further research is essential to investigate its effect on patient outcomes.