Benefits and harms of structured outdoor physical activity for people with somatic or mental diseases: A systematic review and meta-analysis.

OBJECTIVE: To examine the benefits and harms of structured outdoor physical activity (PA) for people living with one or more somatic or mental diseases. METHODS: We identified articles from inception until Marts 2023 in MEDLINE, EMBASE, CINAHL and CENTRAL and citation tracking in Web of Science. We included randomized controlled trials (RCTs) and observational studies examining structured outdoor PA reporting physical function, health-related quality of life (HRQOL), pain or mental outcomes. We used random-effect meta-analyses and investigated heterogeneity in subgroups, sensitivity and meta-regression analyses. Observational studies and studies with insufficient data were summarized narratively. Certainty of evidence was assessed with GRADE. RESULTS: From 4098 hits, 20 studies (19 RCTs and 1 cohort) were included (n: 1759 participants). Studies varied in type of disease and intervention. End of intervention results suggested a small effect on HRQOL (k = 10, SMD = 0.45, 95%CI: 0.19 to 0.71) and physical function (k = 14, SMD = 0.39, 95%CI: 0.13 to 0.64), while effects were moderate on mental outcomes (k = 13, SMD = -0.52, 95%CI: -0.82 to -0.23) favoring the outdoor intervention over comparators (no intervention, usual care, indoor PA or outdoor intervention without exercise). We were not able to conclude on outdoor interventions' effect on pain. Four studies reported adverse events including non-serious (pain, falls, fatigue) and serious (hospitalization, pneumonia). Certainty of evidence was overall very low. CONCLUSION: Structured outdoor PA may improve HRQOL and physical function, as well as mental health outcomes. The very low certainty of evidence calls for high quality RCTs to determine benefits and harms of structured outdoor PA.

Exercise-based rehabilitation in and with nature: a scoping review mapping available interventions.

INTRODUCTION: Exercise is an effective component in rehabilitation of a range of chronic conditions. There is a growing interest in the use of exercise-based nature interacted rehabilitation (EBNIR), but an overview of current evidence is missing. The objective of this scoping review was to map existing exercise-based rehabilitation interventions conducted with incidental or intentional nature interaction focusing on its populations, types of outcomes, and theoretical rationale for people with physical and mental disabilities. METHODS: This scoping review identified peer-reviewed publications, registered upcoming trials and grey literature. To map all available knowledge, a comprehensive search of selected databases (MEDLINE; EMBASE; CINAHL; Cochrane; Web of Science; Pedro) from inception to October 2022. Data were synthesized in a thematic presentation guided by TIDieR, supplemented by a checklist developed for this study accounting nature incidental or intentional interaction. RESULTS: Twelve studies including 856 participants met the inclusion criteria. Eleven were completed trials and one was registered in clinicaltrials.gov to be run in 2023. A total of 856 patients were enrolled in the 12 studies (range 18-262, median 50). The included studies had great variation. The incidental or intentional interacted exercise-based interventions consisted of outdoor walks, neck exercises and surfing interventions in patients with physical or mental health conditions. CONCLUSIONS: This scoping review presents an overview of limited and diverse evidence within the field of EBNIR, in patients with physical or mental health conditions. Our review provides an overview that will be helpful in the design of future EBNIR trials.

Inter-rater reliability and agreement of 6 Minute Walk Test and 10 Meter Walk Test at comfortable walk speed in patients with acute stroke.

PURPOSE: Remediation of gait problems is a key feature of neurological physiotherapy We aimed to investigate the inter-rater reliability and agreement of the Six Minute Walk Test (6MWT) and Ten Meter Walk Test (10MWT), at comfortable walking speed, in hospitalized acute ischemic stroke patients. METHOD: Forty acute first-time patients with brain stem or hemispheric ischemic stroke aged 67.4 ± 12.5 (SD), able to walk with or without an assistive device, were tested by one of three physiotherapists. Test-retest reliability was evaluated using a one-way random effects single measures model (1,1) absolute agreement-type Interclass Correlation Coefficient (ICC). Agreement was evaluated using the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). RESULTS: Both tests demonstrated good reliability; ICC1,1 0.83 (CI 95% 0.70-0.90) (6MWT) and 0.76 (CI 95% 0.59-0.87) (10MWT). The 6MWT-SEM was 27.2 m (m) and the SDC was 75.4 m. The 10MWT-SEM was 0.36 meters per second (m/s) and the SDC was 1.0 m/s. CONCLUSION: Both tests demonstrated good inter-rater reliability, confirming their discriminative ability on a group of hospitalized first-time acute ischemic stroke patients. However, the measurement error was large for both tests, which is likely due to spontaneous neurological recovery and stress in the acute phase severely affecting the individual-level agreement estimate.

Neuromuscular Electrical Stimulation Improves Activities of Daily Living Post Stroke: A Systematic Review and Meta-analysis.

Objectives: (1) To elucidate the effectiveness of neuromuscular electrical stimulation (NMES) toward improving activities of daily living (ADL) and functional motor ability post stroke and (2) to investigate the influence of paresis severity and the timing of treatment initiation for the effectiveness of NMES. Data Sources: PubMed, MEDLINE, Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Library searched for relevant articles from database inception to May 2020. Study Selection: The inclusion criteria were randomized controlled trials exploring the effect of NMES toward improving ADL or functional motor ability in survivors of stroke. The search identified 6064 potential articles with 20 being included. Data Extraction: Two independent reviewers conducted the data extraction. Methodological quality was assessed using the PEDro scale and the Cochrane Risk of Bias Tool. Data Synthesis: Data from 428 and 659 participants (mean age, 62.4 years; 54% male) for outcomes of ADL and functional motor ability, respectively, were pooled in a random-effect meta-analysis. The analysis revealed a significant positive effect of NMES toward ADL (standardized mean difference [SMD], 0.41; 95% CI, 0.14-0.67; P=.003), whereas no effect on functional motor ability was evident. Subgroup analyses showed that application of NMES in the subacute stage (SMD, 0.44; 95% CI, 0.09-0.78; P=.01) and in the upper extremity (SMD, 0.34; 95% CI, 0.04-0.64; P=.02) improved ADL, whereas a beneficial effect was observed for functional motor abilities in patients with severe paresis (SMD, 0.41; 95% CI, 0.12-0.70; P=.005). Conclusions: The results of the present meta-analysis are indicative of potential beneficial effects of NMES toward improving ADL post stroke, whereas the potential for improving functional motor ability appears less clear. Furthermore, subgroup analyses indicated that NMES application in the subacute stage and targeted at the upper extremity is efficacious for ADL rehabilitation and that functional motor abilities can be positively affected in patients with severe paresis.

On the frontline treating COVID-19: A pendulum experience-from meaningful to overwhelming-for Danish healthcare professionals.

OBJECTIVES: In the current study, we aimed to explore the experiences and attitudes among healthcare professionals as they transitioned from their familiar disciplines to respiratory medicine, intensive care or other departments during the first wave of the COVID-19 pandemic. BACKGROUND: In preparation for the increasing number of patients suspected of having or who would be severely ill from COVID-19, a major reconstruction of the Danish Healthcare System was initiated. The capacity of the healthcare system to respond to the unprecedented situation was dependent on healthcare professionals' willingness and ability to engage in these new circumstances. For some, this may have resulted in uncertainty, anxiety and fear. DESIGN: The study was a descriptive study using semi-structured focus group interviews. Healthcare professionals (n = 62) from seven departments were included, and 11 focus group interviews were conducted. The focus group interviews took place during June 2020. Analyses was conducted using thematic analysis. The current study was reported using the consolidated criteria for reporting Qualitative research (COREQ). RESULTS: Healthcare professionals experiences was described by five themes: 1) Voluntary involvement, 2) Changes within the organisation, 3) Risks, 4) Professional identity and 5) Personal investment. Common to all five themes was the feeling of being on a pendulum from a meaningful experience to an experience of mental overload, when situations and decisions no longer seemed to be worthwhile. CONCLUSIONS: Healthcare professionals experienced a pendulum between a meaningful experience and one of mental overload during the COVID-19 pandemic. The swinging was conditioned by the prevailing context and was unavoidable. RELEVANCE TO CLINICAL PRACTICE: To balance the continuous pendulum swing, leaders must consider involvement, and to be supportive and appreciative in their leader style. This is consistent with a person-centred leadership that facilitates a well-adjusted work-life balance and may help prevent mental overload developing into burnout.

Electrical Stimulation in Lower Limb During Exercise to Improve Gait Speed and Functional Motor Ability 6 Months Poststroke. A Review with Meta-Analysis.

INTRODUCTION: Stroke is the third most common cause of disability in adults over 65 years of age and there are 30.7 million survivors after stroke worldwide. Stroke survivors have the highest odds of reporting severe disability and the greatest variety of individual domains of disability compared to a range of other conditions. Electrical stimulation of peripheral sensory-motor systems increases voluntary movement and muscle strength and thereby raises the activities of daily living (ADL). Little is known about electrical stimulation during physical activity in rehabilitation; the objective of this review is therefore to investigate whether external electrical stimulation combined with activity improves functional motor ability and gait speed in patients who have experienced a stroke within the last 6 months. METHODS: A review and random effects meta-analysis of randomized controlled clinical trials on gait speed and functional motor ability measured with Barthel Index (BI) and Bergs Balance Scale (BBS). RESULTS: Eight trials were included (n = 191). Explorative meta-analysis was performed on gait speed (5 trials, n = 120), BI (3 trials, n = 74), and BBS (3 trial n = 79). A small, significant difference on gait speed 0.15 (95% confidence interval [CI]: 0.08-0.21) m/s, but no difference in BI 2.88 (95 % CI: -3.3 to 9.07) and BBS 1.73 (95% CI: -2.8 to 6.27). CONCLUSIONS: Sparse, low-quality evidence indicates that electrical stimulation combined with activity is a relevant intervention to improve ADL within 6 months poststroke.