Preferences for an eHealth tool to support physical activity and exercise training in COPD: a qualitative study from the viewpoint of prospective users.

BACKGROUND: Despite well-known positive effects of pulmonary rehabilitation, access is limited. New strategies to improve access are advocated, including the use of eHealth tools. OBJECTIVES: The aim of this study was to explore prospective users' preferences for an eHealth tool to support the self-management of physical activity and exercise training in COPD. METHODS: A qualitative research design was applied. Data was collected in six, audio recorded, digital co-creation workshops, which were guided by a participatory and appreciative action and reflection approach. A total of 17 prospective users took part in the process, including people with COPD (n = 10), relatives (n = 2), health care givers (n = 4) and a patient organization representative (n = 1). During the workshops, pre-selected relevant topics to exploring end-users' preferences for eHealth support in self-management in COPD were discussed. The workshops were recorded and transcribed. Data was analysed using inductive qualitative content analysis. RESULTS: The overarching theme "fusing with, rather than replacing existing support structures" was uncovered when the two-sided relationship between positive expectations towards digital solutions and the fear of losing access to established rehabilitation systems, emerged in the discussions. Three categories were identified, focused on wishes for an evidence-based support platform of information about COPD, a well-designed eHealth tool including functionalities to motivate in the self-management of physical activity and exercise training, and requirements of various forms of support. Co-creators believed that there were clear benefits in combining the best of digital and existing support systems. CONCLUSIONS: Co-creators viewed an eHealth tool including support for physical activity and exercise training as a valuable digital complement to the now existing rehabilitation services. A future eHealth tool needs to focus on user-friendliness and prospective users's requests.

Clinical supervisors' experience of giving feedback to students during clinical integrated learning.

Background: For students within health-care education, clinical integrated learning has an important role in combining theory and practice. Constructive feedback is a cornerstone of effective clinical teaching, even though it can be a challenging task for both students and supervisors. There are limited studies on clinical physiotherapists' experience of giving feedback to students.Purpose: To explore clinical physiotherapy supervisors' experience of giving feedback to students during clinical integrated learning.Method: Twelve physiotherapists were interviewed in focus groups about their experiences of giving feedback to students. The interviews were analyzed using qualitative content analysis. Results: One latent, overarching theme was identified, which was continuous development and support within the social network at the workplace facilitates the work of giving feedback to students and three manifest main themes: (1) constructive dialog; (2) professionalism; and (3) enabling strategies.Conclusion: The current study focuses on supervisors' experiences of giving feedback to students in a clinical setting. The findings showed that giving feedback to students was a part of continuous development, facilitated by the social network at the workplace, and that the supervisors aimed to be professional while handling emotions in social interactions between supervisors and students.

Access to, use, knowledge, and preferences for information technology and technical equipment among people with chronic obstructive pulmonary disease (COPD) in Sweden. A cross-sectional survey study.

BACKGROUND: The use of information technology can make pulmonary rehabilitation interventions in people with chronic obstructive pulmonary disease (COPD) more flexible and thereby has the potential to reach a larger proportion of the population. However, the success of using information technology in pulmonary rehabilitation is dependent on the end-user's competence in information technology and access to the Internet. The aim was to describe the access to, and the use, knowledge, and preferences of information technology and technical equipment among people with COPD. METHODS: Telephone interviews were conducted using a standardised questionnaire on information technology and technical devises addressing the household, access to and usage of the Internet, contact with authorities, e-commerce, security, the workplace, digital competence, and disabilities. Questions were also posed regarding participants' views on a future eHealth tool for COPD, appropriate content, and the potential likelihood for them to use an eHealth tool for exercise training. RESULTS: In total 137 persons agreed to participate, 17 dropped out resulting in 120 included participants (response rate 88%). The participants (86 women) were aged 51 to 92 years (mean: 72.5), and all severity grades of COPD according to GOLD A-D were represented. Over 90% had access to the Internet. Smartphones were used by 81%, and over 90% used apps. Participants had high knowledge of how to use the Internet, 91% had used the Internet during the last 3 months, 85% almost every day. The most common requests for a future eHealth tool for COPD were evidence-based and trustworthy information on COPD, (including medication, exercise training, inhalation and breathing techniques), communication (chat) with others and with health carers. Access to individually adjusted exercise training, and support, (motivation via prompts, chat rooms, digital information board) was also desired. CONCLUSIONS: The present study showed that people with COPD in Sweden have high access and ability to use the Internet and information technology. They are frequent users and most of them take part in the digital society, even to a higher extent than the general population. The results show that the use of an eHealth tool could be a suitable strategy for people with COPD.

"Stay balanced" - effectiveness of evidence-based balance training for older adults transferred into a physical therapy primary care setting - a pilot study.

Purpose: To evaluate the effects of the Stay Balanced program when this is transferred into a clinical setting regarding balance, gait speed, leg muscle strength, concerns about falling, and physical activity.Method: Implementation pilot study with a pre-post intervention design. Fifteen older adults, 75-91 years of age, participated in a progressive balance training program with a focus on divided attention. The balance training was performed in group sessions twice a week for 10 weeks at a primary care physical therapy clinic. Training efficacy was evaluated after completion of training as well as after 3 months using the Mini-Balance Evaluation Systems Test (Mini-BESTest), 10-meter walk test, 30-s chair stand test, Fall Efficacy Scale-International (FES-I), and steps/day.Results: Significant improvements were shown at the 10-week follow up for balance, gait speed, leg muscle strength, and concerns about falling (p < 0.008). At the 3-month follow-up balance, leg muscle strength and concerns about falling showed persistent improvement compared to baseline (p < 0.045). No significant differences were found for physical activity.Conclusions: This study confirms the results of our previous randomized controlled trials (RCTs), and suggests that the Stay Balanced program can be transferred to clinical physiotherapy practice. The program was appreciated by the participants and proved to be safe, effective, and feasible in primary care.Implication for rehabilitationThe Stay Balance program can easily be transferred to clinical practice without losing the effectiveness of the intervention in older adults with balance problems.The program was appreciated by the participants and proved to be safe, effective, and feasible when executed in primary care.Stay Balance program is an individually adjusted and progressive group balance training including exercises with divided attention that can easily be transferred to tasks in daily life.

Reliability of the Swedish version of the Evidence-Based Practice Attitude Scale assessing physiotherapist's attitudes to implementation of evidence-based practice.

PURPOSE: To translate and apply a cross-cultural adaptation of the Evidence-Based Practice Attitude Scale (EBPAS) in Swedish and investigate its absolute and relative reliability. METHODS: The original EBPAS (a questionnaire assessing health professionals' attitudes to implementation of evidence-based practice) was translated into Swedish using a forward and backward procedure, including a group discussion and expert committee. To assess reliability, 55 physiotherapists (48 women) aged 23-64 years from different clinical settings in the Stockholm region answered the EBPAS by postal survey twice within an interval of 2 weeks. RESULTS: The Cronbach's alpha values for EBPAS were >0.721. The intraclass correlation (ICC) between test and retest (relative reliability) was moderate to good for the four subscales, with ICC(A.1) and ICC(C.1) values approximately equal and in the range 0.56-0.89. Values for the absolute reliability of the mean score were a standard error of measurement of about 7% and a smallest real difference of about 19%. CONCLUSION: The Swedish version of the EBPAS shows mainly good reliability.

Controlling the Uncontrollable: Perceptions of Balance in People With Parkinson Disease.

BACKGROUND: Exercise improves balance in Parkinson disease (PD), yet the majority of people with the diagnosis are physically inactive. Insights gained from understanding how people with PD (PwPD) make sense of their symptoms and their ability to control them may inform the communication strategies and motivational approaches adopted by physical therapists. To our knowledge, no previous study has qualitatively explored how PwPD perceive the concept of balance and the beliefs they hold concerning their ability to affect balance. OBJECTIVE: This study aimed to explore the meaning of balance for PwPD and the beliefs they hold regarding their ability to influence their balance in everyday life. DESIGN: The design was a qualitative study with an inductive approach. METHODS: In-depth interviews were conducted with 18 participants with PD (age range 46-83 years, Hoehn and Yahr range 1-4), and transcripts were analyzed using qualitative content analysis. RESULTS: Five main themes emerged from the analysis: remaining in control over the body, adapting behavior to deal with uncertainty, directing focus to stay 1 step ahead, resilience as a defense, and exercise beliefs and reservations. Interpretation of the underlying patterns in the main themes yielded the overarching theme of focus and determination to regain control over shifting balance. CONCLUSIONS: The concept of balance was perceived as both bodily equilibrium and mind-body interplay and was described in the context of remaining in control over one's body and everyday life. Cognitive resources were utilized to direct focus and attention during balance-challenging situations in a process involving internal dialogue. Even participants who did not express beliefs in their ability to affect balance through exercise used psychological resilience to counter the challenges of impaired balance.

Carboxy terminal collagen crosslinks as a prognostic risk factor for fall-related fractures in individuals with established spinal cord injury.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To study associations between specific bone turnover markers and fall-related fractures in individuals with spinal cord injury (SCI). SETTING: Rehabilitation Hospital. METHODS: Carboxy terminal collagen crosslinks (CTX), type-1 procollagen N-terminal (P1NP), albumin-corrected calcium (Ca2+), parathyroid hormone (PTH) and vitamin D were examined in a cohort of 106 participants with SCI at least 1 year post injury. The participants were followed for 1 year monitoring fall-related fractures. RESULTS: In total, 29 out of 106 reported having experienced a fall-related fracture post-injury at baseline, and 5 out of 100 had experienced a fall-related bone fracture during the 1 year follow-up. Our main findings were that high levels of serum CTX increased the odds of being in the fracture group, and that 25-hydroxy vitamin D (25 OHD) levels, Ca2+, PTH or P1NP were not associated with being in the fracture group. CONCLUSIONS: We here present an association between high-CTX plasma levels at baseline and fall-related fractures reported during a 1-year follow-up among individuals with established SCI. We recommend studies with larger SCI populations before further clinical implications can be drawn.

Intraclass correlation - A discussion and demonstration of basic features.

A re-analysis of intraclass correlation (ICC) theory is presented together with Monte Carlo simulations of ICC probability distributions. A partly revised and simplified theory of the single-score ICC is obtained, together with an alternative and simple recipe for its use in reliability studies. Our main, practical conclusion is that in the analysis of a reliability study it is neither necessary nor convenient to start from an initial choice of a specified statistical model. Rather, one may impartially use all three single-score ICC formulas. A near equality of the three ICC values indicates the absence of bias (systematic error), in which case the classical (one-way random) ICC may be used. A consistency ICC larger than absolute agreement ICC indicates the presence of non-negligible bias; if so, classical ICC is invalid and misleading. An F-test may be used to confirm whether biases are present. From the resulting model (without or with bias) variances and confidence intervals may then be calculated. In presence of bias, both absolute agreement ICC and consistency ICC should be reported, since they give different and complementary information about the reliability of the method. A clinical example with data from the literature is given.

Perceptions of balance and falls following a supervised training intervention - a qualitative study of people with Parkinson's disease.

PURPOSE: To explore perceptions of balance and falls among people with mild to moderate Parkinson's disease 3 - 12 months following participation in supervised balance training. MATERIALS AND METHODS: This qualitative study used in-depth individual interviews for data collection among 13 people with Parkinson's disease. Interviews were systematically analyzed using qualitative content analysis with an inductive approach. RESULTS: Three main themes arose: Falls - avoided and intended highlights the wide spectrum of fall perceptions, ranging from worse-case scenario to undramatized events; Balance identity incorporates how gradual deterioration in balance served as a reminder of disease progression and how identifying themselves as "aware not afraid" helped certain participants to maintain balance confidence despite everyday activity restriction; Training as treatment recounts how participants used exercise as disease self-management with the aim to maintain independence in daily life. Interpretation of the underlying patterns of these main themes resulted in the overarching theme Training as treatment when battling problems with balance and falls. CONCLUSIONS: Whereas certain participants expressed a fear of falling which they managed by activity restriction, others described being confident in their balance despite avoidance of balance-challenging activities. Training was used as treatment to self-manage disease-related balance impairments in order to maintain independence in daily life. Implication for Rehabilitation People with Parkinson's disease require early advice about the positive effects of physical activity as well as strategies for self-management in order to ease the psychological and physical burden of progressive balance impairment. Fear of falling should be investigated alongside activity avoidance in this group in order to provide a more accurate insight into the scope of psychological concerns regarding balance and falls in everyday life. Certain people with Parkinson's disease define their balance according to activities they continue to participate in, while others who express fear-related activity avoidance require help to adapt balance-challenging activities in order to maintain balance confidence and avoid physical inactivity.

Predictors of falls in persons with spinal cord injury-a prospective study using the Downton fall risk index and a single question of previous falls.

STUDY DESIGN: Prediction study. OBJECTIVES: To investigate the prediction accuracy of the Downton fall risk index (DFRI) and a question of falls the previous year; further to examine the association between time to first fall and risk indicators for falls in wheelchair users and ambulatory persons with Spinal Cord Injury (SCI). SETTING: Two SCI centres in Norway and Sweden (Sunnaas Rehabilitation Hospital, Rehab Station Stockholm /Spinalis). METHODS: Two hundred and twenty-four persons with traumatic SCI, ≥1 year post-injury, ≥18 years participated. Prospective falls were reported by text messages every second week for one year. Sensitivity, specificity and time to first fall (Kaplan Meier) were investigated for DFRI and the question of falls in the previous year. DFRI ≥3 was defined as a high risk of falls. Cox survival analysis was used to calculate hazard ratios for functional independence, gait speed and fear of falling. RESULTS: The sensitivity was 36-57% for DFRI and 82-89% for the question of falls, while specificity was 74-83%, and 34-49%. For DFRI, time to first fall was shorter in the high-risk group, for both wheelchair users (p = 0.005) and ambulatory persons (p = 0.006). Falls previous year increased the hazard ratio of falls for wheelchair users (HR = 3.35, 95% CI = 1.86 to 6.02) but not for ambulatory persons. CONCLUSIONS: Falls in the previous year showed a better predictive accuracy than DFRI due to the low sensitivity of DFRI. As previous falls had low specificity, it still remains difficult to predict falls in those who have not fallen yet.

Factors Associated With Recurrent Falls in Individuals With Traumatic Spinal Cord Injury: A Multicenter Study.

OBJECTIVE: To identify factors associated with recurrent falls in individuals with traumatic spinal cord injury (SCI). DESIGN: Cross-sectional multicenter study. SETTING: Two specialized rehabilitation centers. PARTICIPANTS: Included: individuals with traumatic SCI ≥1 year postinjury who were aged ≥18 years. Excluded: individuals with motor complete injuries above C5 or below L5. The study sample comprised participants (N=224; 151 wheelchair users, 73 ambulatory; 77% men; mean age ± SD, 50±15y; median time since injury, 15y [range, 1-56y]) who were consecutively recruited at regular follow-up. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Primary outcome was factors associated with recurrent falls (defined as low frequent [0-2] or recurrent [>2]) the previous year. Independent variables were demographic data, wheelchair user or ambulatory, work, health-related quality of life, risk willingness, alcohol consumption, ability to get up from the ground, and exercise habits. RESULTS: Fifty percent reported recurrent falls. In the final multiple logistic regression model, ambulation (odds ratio [OR]=2.67; 95% confidence interval [CI], 1.33-5.37), ability to get up from the ground (OR=2.22; 95% CI, 1.21-4.10), and regular exercise (OR=1.86; 95% CI, 1.05-3.31) were associated with recurrent falls (P≤.05), and with increasing age the OR decreased (OR=.97; 95% CI, .95-.99). CONCLUSIONS: Individuals with SCI should be considered at risk of recurrent falls, and thereby at risk of fall-related injuries. Fall prevention programs should be focused on ambulatory, younger, and more active individuals who had the highest risks for recurrent falls.