Benefits and Barriers to Exercise among Individuals with Class III Obesity.

Objectives: In this paper, we describe the degree of exercise and sedentary behavior among individuals with class III obesity, identify perceived benefits and barriers to exercise, and discuss the association of exercise barriers with activity and sedentary behavior. Methods: This was a cross-sectional study at a tertiary care center. Adults with class III obesity referred to the Bariatric Program completed the exercise benefits/barriers scale, the International Physical Activity Questionnaire Short-Form, and the Sedentary Behavior Questionnaire. Participants were asked to list additional exercise barriers. Results: The 80 participants engaged in a median of 699.0 MET-minutes/week of physical activity, and were sedentary 10.4 ± 4.5 hours/day. The mean exercise benefits/barriers score was 126.3 ± 12.8 (barrier score = 31.6 ± 5.3, benefit score = 87.8 ± 9.4). Less than 60% identified exercise as enjoyable, or a form of social interaction. More than 60% identified exercise barriers related to physical exertion. Additional barriers included pain and musculoskeletal comorbidities (39.4%), psychological factors (14.7%), and weight (12.6%). There was no statistically significant association between exercise barriers and sedentary behavior (p = .69) or physical activity (p = .08). Conclusions: Participants reported low physical activity, with high sedentary behavior and exercise barriers. Physical exertion, pain and musculoskeletal comorbidities were common barriers, which highlights importance of thoughtful exercise with attention to exercise barriers in this population .

Optimising the mandatory reporting process for drivers admitted to an inpatient stroke rehabilitation unit.

Ontario physicians are legally obligated to report patients who may be medically unfit to drive to the Ministry of Transportation of Ontario (MTO). Currently at Toronto Rehabilitation Institute (TRI), there are no standardised processes for MTO reporting, resulting in inconsistent communication regarding driving with patients and between healthcare providers, redundant assessments and ultimately reduced patient satisfaction. TRI received 10 patient complaints regarding the driving reporting process in the 5 years prior to this project and a large number of patients were not being reported appropriately. The project aim was to use Lean Methods to achieve 100% reporting and optimise communication and education of drivers admitted to a 23-bed inpatient stroke rehabilitation unit. Interventions included process mapping, identification of wasteful steps and implementation of a standard work. Chart audits before and after implementation were performed. Value stream process mapping identified inconsistent reporting procedures and lack of use of the government-issued driver reporting form. Following implementation of standard work processes, use of the MTO Medical Conditions Report Form increased from 0% to 100%. Indication of whether drivers were reported to the MTO in Physical Medicine & Rehabilitation consultation notes increased from 50% to 91%. Identifying reported drivers in the discharge summary, of which patients receive a copy at the time of discharge, increased from 0% to 90%. Physician satisfaction with the new standard work process was qualitatively assessed to be high, with no negative impacts reported. Lean methodology was effective for increasing the usage of the MTO Medical Conditions Report Form, documenting driver status in the initial Physical Medicine & Rehabilitation consultation and indicating MTO reporting status in the discharge summary. Communication between healthcare providers regarding patients' driving status has been successfully standardised, resulting in improved coordination of care and a reduction in patient complaints to zero in the 14 months since implementation.