Teachers' and students' perceptions on barriers and facilitators for eHealth education in the curriculum of functional exercise and physical therapy: a focus groups study.

BACKGROUND: Despite the growing importance of eHealth it is not consistently embedded in the curricula of functional exercise and physical therapy education. Insight in barriers and facilitators for embedding eHealth in education is required for the development of tailored strategies to implement eHealth in curricula. This study aims to identify barriers/facilitators perceived by teachers and students of functional exercise/physical therapy for uptake of eHealth in education. METHODS: A qualitative study including six focus groups (two with teachers/four with students) was conducted to identify barriers/facilitators. Focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were identified, grouped and classified using a generally accepted framework for implementation including the following categories: innovation, individual teacher/student, social context, organizational context and political and economic factors. RESULTS: Teachers (n = 11) and students (n = 24) of functional exercise/physical therapy faculties of two universities of applied sciences in the Netherlands participated in the focus groups. A total of 109 barriers/facilitators were identified during the focus groups. Most related to the Innovation category (n = 26), followed by the individual teacher (n = 22) and the organization (n = 20). Teachers and students identified similar barriers/facilitators for uptake of eHealth in curricula: e.g. unclear concept of eHealth, lack of quality and evidence for eHealth, (lack of) capabilities of students/teachers on how to use eHealth, negative/positive attitude of students/teachers towards eHealth. CONCLUSION: The successful uptake of eHealth in the curriculum of functional exercise/physical therapists needs a systematic multi-facetted approach considering the barriers and facilitators for uptake identified from the perspective of teachers and students. A relatively large amount of the identified barriers and facilitators were overlapping between teachers and students. Starting points for developing effective implementation strategies can potentially be found in those overlapping barriers and facilitators. REGISTRATION: The study protocol was a non-medical research and no registration was required. Participants gave written informed consent.

The effect of functional-task training on activities of daily living for people with Parkinson`s disease, a systematic review with meta-analysis.

OBJECTIVE: To evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson`s Disease. METHODS: We searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in a meta-analyses and heterogeneity was explored by meta-regression analysis. RESULTS: Out of 2546 identified studies, 69 full texts articles were checked for eligibility, of which ten were included in the systematic review. Moderate quality of evidence indicated that exercise interventions containing functional-task training had a positive effect on ADL performance scores on the Unified Parkinson's Disease Rating Scale (UPDRS) in people with Parkinson (pwp) directly after intervention (UPDRS=-2.62(-5.34;0.10)). This effect improved, in favor of functional-task interventions, at the first follow-up (UPDRS=-4.0(-7.56;-0.4)). A post-hoc meta-regression analysis yielded a significant relationship between intensity rate (minutes/week) and the size of the (average) effect on ADL score. CONCLUSION: Exercise interventions containing functional-task training have a clinically important positive effect on ADL performance in pwp directly after intervention and at first follow-up, compared to no intervention or placebo. The intensity rate of the functional-task training should be as intense as possible, within the capabilities of the person with PD. Future research is necessary to determine the exact amount of effect that can be contributed to functional-task training.

Occupational therapy for stroke patients not admitted to hospital: a randomised controlled trial.

BACKGROUND: Patients who have a stroke are not always admitted to hospital, and 22-60% remain in the community, frequently without coordinated rehabilitation. We aimed to assess the efficacy of an occupational therapy intervention for patients with stroke who were not admitted to hospital. METHODS: In this single-blind randomised controlled trial, consecutive stroke patients on a UK community register in Nottingham and Derbyshire were allocated randomly to up to 5 months of occupational therapy at home or to no intervention (control group) 1 month after their stroke. The aim of the occupational therapy was to encourage independence in personal and instrumental activities of daily living. Patients were assessed on outcome measures at baseline (before randomisation) and at 6 months. The primary outcome measure was the score on the extended activities of daily living (EADL) scale at 6 months. Other outcome measures included the Barthel index, the general health questionnaire 28, the carer strain index, and the London handicap scale. All assessments were done by an independent assessor who was unaware of treatment allocation. The analysis included only data from completed questionnaires. FINDINGS: 185 patients were included: 94 in the occupational therapy group and 91 in the control group. 22 patients were not assessed at 6 months. At follow-up, patients who had occupational therapy had significantly higher median scores than the controls on: the EADL scale (16 vs 12, p<0.01, estimated difference 3 [95% CI 1 to 4]); the Barthel index (20 vs 18, p<0.01, difference 1, [0-1]); the carer strain index (1 vs 3, p<0.05, difference 1 [0 to 2]); and the London handicap scale (76 vs 65, p<0.05, difference 7, [0.3 to 13.5]). There were no significant differences on the general health questionnaire between the patient or carer. INTERPRETATION: Occupational therapy significantly reduced disability and handicap in patients with stroke who were not admitted to hospital.

Practical guidelines for independent assessment in randomized controlled trials (RCTs) of rehabilitation.

OBJECTIVE: To provide guidelines for conducting independent assessments in randomized controlled trials (RCTs) of rehabilitation. The article aims to assist those who plan to put independent assessment into practice and to be an introduction for those who are new to independent assessment. ISSUES: Possible causes of unblinding to group allocation are discussed, such as unblinding by other people, the environment, patients and assessors themselves. Other issues discussed in this paper are bias during assessment and monitoring levels of unblinding. CONCLUSION: The importance of monitoring levels of unblinding is stressed. Although it may not be possible to always keep an assessor blind in RCTs of rehabilitation, we should strive for perfection. It is therefore advocated that levels of unblinding should be reported.