Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study.

BACKGROUND: The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. OBJECTIVE: This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). METHODS: Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. RESULTS: A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the "relational space" are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. CONCLUSIONS: Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.

The Effectiveness of Exercise Physiology Services During the COVID-19 Pandemic: A Pragmatic Cohort Study.

BACKGROUND: The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic. METHODS: This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling. RESULTS: Most (59%, n = 82) clients received in-person delivery only, whereas 8% (n = 11) received telehealth delivery only and 33% (n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed > 80% of exercise sessions. Exercise physiology improved mobility by 14% (ß = 0.23, P = 0.003), capacity to complete usual activities by 18% (ß = 0.29, P < 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% (ß = 2.46, P < 0.001), current pain intensity by 16% (ß = - 0.55, P = 0.038) and goal attainment scaling t-scores by 50% (ß = 18.37, P < 0.001). Effectiveness did not differ between delivery modes (all: P > 0.087). CONCLUSIONS: Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.

Impact of the COVID-19 Pandemic on Exercise Physiology Services in Australia: A Retrospective Audit.

INTRODUCTION: The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020). METHODS: This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. RESULTS: During the COVID-19 pandemic, 91% (n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% (n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity (n = 33/80, 41%) and safety (n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference (n = 57/71, 80%), physical capacity (n = 35/71, 49%) and access to reliable delivery platforms (n = 27/71, 38%). Zoom (n = 54/71, 76%) and telephone (n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. CONCLUSIONS: During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted.

Thinking beyond impairment: Recommendations from contemporary models of care for working with children and disability.

BACKGROUND: The National Disability Insurance Scheme emphasises the use of models that move beyond an impairment focus to a holistic and individualised approach to disability. Application of specific biopsychosocial models supports general practitioners (GPs) to advance best practice in disability care within these schemes by meeting the complex care needs of their clients. OBJECTIVE: The aims of this article are to: 1) review current biopsychosocial models that underpin the health and functioning of children living with a disability in order to identify common elements of relevance to the paediatric sector, and 2) provide considerations for applying a biopsychosocial approach to paediatric care in practice. DISCUSSION: A succinct summary of common concepts within biopsychosocial models used in the paediatric setting, and recommendations for how these models can be best applied in practice, are presented in this article. The GP plays a crucial part in initiating and supporting children and adolescents who have complex care needs. Understanding these key concepts is fundamental to this process.

Validity of Two Wheelchair-Mounted Devices for Estimating Wheelchair Speed and Distance Traveled.

This study evaluated the validity of two wheelchair-mounted devices-the Cateye® and Wheeler-for monitoring wheelchair speed and distance traveled. Speed estimates were validated against a calibrated treadmill at speeds from 1.5 to 10 km/hr. Twenty-five wheelchair users completed a course of known distance comprising a sequence of everyday wheelchair activities. Speed estimate validity was very good (mean absolute percentage error ≤ 5%) for the Wheeleri at all speeds and for the Cateye at speeds >3 km/hr but not speeds <3 km/hr (mean absolute percentage error > 20%). Wheeleri distance estimates were good (mean absolute percentage error < 10%) for linear pushing activities and general maneuvering but poor for confined-space maneuvering. Cateye estimates were good for continuous linear propulsion but poor for discontinuous pushing and maneuvering (both general and confined space). Both devices provided valid estimates of speed and distance for typical wheelchair-based exercise activities. However, the Wheeleri provided more accurate estimates of speed and distance during typical everyday wheelchair activities.

Validity of the Apple Watch® for monitoring push counts in people using manual wheelchairs.

Objective: A recent Apple Watch® activity-monitoring innovation permits manual wheelchair users to monitor daily push counts. This study evaluated the validity of the Apple Watch® push count estimate.Design: Criterion validity.Setting: Southern Finland and Southeast Queensland, Australia.Participants: Twenty-six manual wheelchair users from Finland and Australia were filmed completing a standardized battery of activities while wearing the Apple Watch® (dominant wrist).Outcome Measures: Wheelchair pushes as determined by the Apple Watch® were compared to directly observed pushes.Results: Agreement between Apple Watch® push counts and directly observed pushes was evaluated using Intraclass correlation coefficients (ICC), Pearson correlations and Bland-Altman analyses. Apple Watch® pushes and directly observed push counts were strongly correlated (ICC = 0.77, P < 0.01) (r = 0.84, P < 0.01). Bland Altman plots indicated that the Apple Watch® underestimated push counts (M = -103; 95% ULoA = 217; LLoA = -423 pushes). Mean absolute percentage error was 13.5% which is comparable to studies evaluating agreement between pedometer-based step counts and directly observed steps.Conclusion: Apple Watch® push-count estimates are acceptable for personal, self-monitoring purposes and for research entailing group-level analyses, but less acceptable where accurate push-count measures for an individual is required.

Evaluation of a novel intervention to improve physical activity for adults with whiplash associated disorders: Protocol for a multiple-baseline, single case experimental study.

Half of individuals with a whiplash injury experience ongoing pain and disability. Many are insufficiently active for good health, increasing their risk of preventable morbidity and mortality, and compounding the effects of the whiplash injury. This paper describes a protocol for evaluating the efficacy of a physical activity promotion intervention in adults with whiplash associated disorders. A multiple-baseline, single case experimental design will be used to evaluate the effects of a physical activity (PA) intervention that includes evidence-based behaviour change activities and relapse prevention strategies for six adults with chronic whiplash. A structured visual analysis supplemented with statistical analysis will be used to analyse: accelerometer-measured PA, confidence completing PA in the presence of neck pain, and pain interference.

Evaluation of a Physical Activity Intervention for Adults With Brain Impairment: A Controlled Clinical Trial.

BACKGROUND: Individuals with brain impairment (BI) are less active than the general population and have increased risk of chronic disease. OBJECTIVE: This controlled trial evaluated the efficacy of a physical activity (PA) intervention for community-dwelling adults with BI. METHODS: A total of 43 adults with BI (27 male, 16 female; age 38.1 ± 11.9 years; stage of change 1-3) who walked as their primary means of locomotion were allocated to an intervention (n = 23) or control (n = 20) condition. The intervention comprised 10 face-to-face home visits over 12 weeks, including a tailored combination of stage-matched behavior change activities, exercise prescription, community access facilitation, and relapse prevention strategies. The control group received 10 face-to-face visits over 12 weeks to promote sun safety, healthy sleep, and oral health. Primary outcomes were daily activity counts and minutes of moderate-to-vigorous-intensity PA (MVPA) measured with the ActiGraph GT1M at baseline (0 weeks), postintervention (12 weeks) and follow-up (24 weeks). Between-group differences were evaluated for statistical significance using repeated-measures ANOVA. RESULTS: MVPA for the intervention group increased significantly from baseline to 12 weeks (20.8 ± 3.1 to 31.2 ± 3.1 min/d; P = .01), but differences between baseline and 24 weeks were nonsignificant (20.8 ± 3.1 to 25.3 ± 3.2 min/d; P = .28). MVPA changes for the control group were negligible and nonsignificant. Between-group differences for change in MVPA were significant at 12 weeks (P = .03) but not at 24 weeks (P = .49). CONCLUSION: The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.

Measurement of habitual physical activity performance in adolescents with cerebral palsy: a systematic review.

AIM: This systematic review compares the validity, reliability, and clinical use of habitual physical activity (HPA) performance measures in adolescents with cerebral palsy (CP). METHOD: Measures of HPA across Gross Motor Function Classification System (GMFCS) levels I-V for adolescents (10-18 y) with CP were included if at least 60% of items reported HPA performance in the domains of intensity, frequency, duration, and mode. RESULTS: Seven measures of HPA performance met the criteria: StepWatch, pedometers, Uptimer, heart rate flex method, accelerometers, and self-report measures including the Children's Activity Participation and Enjoyment (CAPE) scale and the Physical Activity Questionnaire for Adolescents. The CAPE scale had the strongest validity and reliability but was limited by its inability to measure activity intensity. No study was identified that evaluated the psychometric properties of physical activity measures in non-ambulant adolescents with CP (GMFCS levels IV and V). INTERPRETATION: When deciding on an appropriate measure of HPA in adolescents with CP, clinicians need to consider their research question including the domains of HPA they are evaluating and the population they wish to assess. Accelerometers provide the most robust information about the patterns of HPA, with some evidence of validity but limited data on reliability. Further research is needed to compare the use of tri- and uniaxial accelerometers.

Validity of accelerometry in ambulatory children and adolescents with cerebral palsy.

To evaluate the validity of the ActiGraph accelerometer for the measurement of physical activity intensity in children and adolescents with cerebral palsy (CP) using oxygen uptake (VO(2)) as the criterion measure. Thirty children and adolescents with CP (mean age 12.6 ± 2.0 years) wore an ActiGraph 7164 and a Cosmed K4b(2) portable indirect calorimeter during four activities; quiet sitting, comfortable paced walking, brisk paced walking and fast paced walking. VO(2) was converted to METs and activity energy expenditure and classified as sedentary, light or moderate-to-vigorous intensity according to the conventions for children. Mean ActiGraph counts min(-1) were classified as sedentary, light or moderate-to-vigorous (MVPA) intensity using four different sets of cut-points. VO(2) and counts min(-1) increased significantly with increases in walking speed (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that, of the four sets of cut-points evaluated, the Evenson et al. (J Sports Sci 26(14):1557-1565, 2008) cut-points had the highest classification accuracy for sedentary (92%) and MVPA (91%), as well as the second highest classification accuracy for light intensity physical activity (67%). A ROC curve analysis of data from our participants yielded a CP-specific cut-point for MVPA that was lower than the Evenson cut-point (2,012 vs. 2,296 counts min(-1)), however, the difference in classification accuracy was not statistically significant 94% (95% CI = 88.2-97.7%) vs. 91% (95% CI = 83.5-96.5%). In conclusion, among children and adolescents with CP, the ActiGraph is able to differentiate between different intensities of walking. The use of the Evenson cut-points will permit the estimation of time spent in MVPA and allows comparisons to be made between activity measured in typically developing adolescents and adolescents with CP.