Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework.

QUESTION: From the perspective of intensive care unit (ICU) clinicians, what are the barriers to and facilitators of implementing early mobilisation? DESIGN: A qualitative study using focus groups, with analysis using the Theoretical Domains Framework. PARTICIPANTS: Physicians, nurses, respiratory therapists and physiotherapists from the ICUs of three university-affiliated hospitals in Montreal, Canada. METHODS: Four focus group meetings were conducted with 33 participating ICU clinicians. Two researchers independently performed thematic content analysis on verbatim transcriptions of the audio recordings using the Theoretical Domains Framework. RESULTS: Data saturation was reached after the third focus group. Thirty-six barriers were categorised in 13 domains of the Theoretical Domains Framework. The key barriers to early mobilisation were: lack of conviction and knowledge regarding the available evidence about early mobilisation; lack of attention to the provision of optimal care; poor communication; the unpredictable nature of the ICU; and limited staffing, equipment, time and clinical knowledge. Twenty-five facilitators categorised in ten TDF domains were also identified. These included individual-level facilitators (intrinsic motivation, positive outcome expectations, conscious effort to mobilise early, good planning/coordination, the presence of ICU champions, and expert support by a physiotherapist) and organisational-level facilitators (reminder system, pro-early mobilisation culture, implementation of an early mobilisation protocol, and improved ICU organisation). CONCLUSIONS: A broad array of barriers to and facilitators of early mobilisation in the ICU were identified in this study. Clinicians can consider whether these barriers and facilitators are operating in their ICU. These may inform the design of tailored knowledge translation interventions to promote early mobilisation in the ICU.

A Retrospective Study Investigating Injury Incidence and Factors Associated with Injury Among Belly Dancers.

Belly dance is an appreciably under researched dance form. As such, little is known of the injury prevalence and risk factors for injury among this dance population. Therefore, the primary objective of this study was to examine the most common injury sites and to identify potential factors associated with injury risk within the belly dance community of New Zealand over a 12-month retrospective period. Dancers who had practiced or performed belly dance during that time span were surveyed using an online or paper-based questionnaire. One hundred and nine injury questionnaires (all from female dancers) qualified for the final analysis. The participants had a median age of 44.3 years and danced a median of 3.0 hours per week. The injury rate was 37% (40 injuries in 109 dancers surveyed), the injury incidence proportion was 24.8% (27 dancers reporting at least one injury), and the per hour injury incidence rate was 1.69 per 1,000 dance hours. Of the two most recently sustained injuries reported, lower limb injuries were the most common, followed by trunk injuries. Age, total dance hours per week, and participation in a non-dance exercise regimen of any kind were associated with a decreased risk of injury; performing regularly was associated with an increased injury rate. It is concluded that an understanding of the incidence and sites of injuries may help create awareness that belly dance can be injurious, and subsequently lead to the development of future interventions.

Can Patients With COPD Assimilate Disease-Specific Information During an Acute Exacerbation?: Results of a Pilot Randomized Controlled Trial.

BACKGROUND: The study aimed to determine the feasibility and effectiveness of an introductory disease-specific educational program delivered during an acute exacerbation of COPD (AECOPD) on objective measures of disease-specific knowledge. METHODS: Patients admitted to a community hospital with an AECOPD were randomly assigned to a control group (standard care) or intervention group (standard care + brief education). The intervention group received two 30-min education sessions in hospital or at home within 2 weeks of hospital admission. Feasibility measures included the number of eligible patients, compliance with the sessions, and number of follow-up measures completed. Disease-specific knowledge and informational needs were measured using the Bristol COPD Knowledge Questionnaire (BCKQ) and the Lung Information Needs Questionnaire (LINQ), respectively, before and after the intervention period. RESULTS: Thirty-one patients (mean age, 72 ± 10 years) with an AECOPD participated in the study. Of 102 approached patients, 75 consented to screening (73.5%) and 67 (66%) were eligible for the study. Thirty-four patients declined participation. All intervention patients (n = 15) completed the educational sessions and follow-up measures. Three patients (control group) did not complete the follow-up measures. The mean changes and SDs for the BCKQ in the intervention and control groups were 8 ± 5.14 and 3.4 ± 4.9, respectively (P = .02). No difference between groups was found for the LINQ (P = .80). CONCLUSIONS: A brief educational program delivered at the time of hospitalization for an AECOPD was feasible for a subset of patients, resulted in improved disease-specific knowledge, and may be a bridge to more active approaches. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02321215; URL: www.clinicaltrials.gov.

Rate of, and barriers and enablers to, pulmonary rehabilitation referral in COPD: A systematic scoping review.

BACKGROUND: Despite pulmonary rehabilitation (PR) being an evidence-based treatment recommended for people with chronic obstructive pulmonary disease (COPD), referral to PR seems to be low. Collating the evidence on referral rates and perceived barriers and enablers may help provide knowledge needed to increase referral. OBJECTIVES: The purpose of this scoping review was to determine 1) the rate of referral of patients with COPD to PR by healthcare professionals (HCPs) and 2) the barriers and enablers to referral perceived by HCPs. METHODS: The JBI scoping review manual was used. Ovid Medline, CINAHL, EMBASE, and ProQuest Dissertations and Theses were searched from inception until July 28, 2017. 245 non-duplicate articles were screened. Included articles reported referral rates and/or HCP perceived barriers and/or enablers to PR referral. RESULTS: Forty-two studies were included. Twenty-eight observational studies reported referral rates ranging from 0% to 85%. Seven studies looking at the effects of different interventions to improve COPD care reported a range of 2%-56% referral pre-intervention, and 8%-71% post-intervention. Nine studies reported HCP perceived barriers to referral. The two most common barriers were low knowledge of what PR is and its benefits and low knowledge of the referral process. Six studies reported HCP perceived enablers to referral. The most common enabler was training/experience in PR. CONCLUSION: The rate of referral to PR is suboptimal, but there are commonly reported barriers and enablers that may help with the creation of actionable changes. HCPs need more knowledge of PR and the benefits it provides.