Neuromuscular electrical stimulation for children with dysphagia: a systematic review.

OBJECTIVES: Dysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the effectiveness of neuromuscular electrical stimulation (NMES) for treatment of oropharyngeal dysphagia in children. METHODS: A search was performed on November 2020 in MEDLINE (from 1946), EMBASE (from 1947), PsycINFO (from 1806), CINAHL (from 1937), CENTRAL (from 1996) and Scopus (from 1970) databases. Studies of children (≤18 years) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Cochrane Collaboration's tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa assessment for observational studies. A meta-analysis was not conducted due to clinical heterogeneity in studies. RESULTS: Ten studies were included (5 RCTs, 4 case series, 1 cohort study; including 393 children, mean or median age below 7 years, including children with neurologic impairments). In all studies, swallowing function improved after NMES treatment. The standardised mean difference (SMD) for improvement of swallowing dysfunction in treatment compared with control groups in the RCTs ranged from 0.18 (95% CI -0.7 to 1.06) to 1.49 (95% CI 0.57 to 2.41). Eight of 10 studies reported on the child's feeding ability, and, with one exception, there was improvement in feeding ability. Few studies reported on health status (N=2), impact on caregiver (N=1), adverse events and harms (N=2), and child's quality of life (N=1). In most studies, outcome follow-up was less than 6 months. The studies demonstrated moderate to high risk of bias. CONCLUSIONS: NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, uncertainty remains. Well-designed RCTs are needed to establish its effectiveness before its adoption in clinical practice. PROSPERO REGISTRATION NUMBER: CRD42019147353.

Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial.

BACKGROUND: Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common. OBJECTIVE: This study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA counseling by PCPs and estimate intervention effectiveness on patients' PA levels. METHODS: A pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with 4 pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants before their PHR via an email or a tablet; data were used to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on the Health Action Process Approach behavior change theory. RESULTS: A total of 1028 patients receiving care from 34 PCPs were invited to participate and 530 (51.55%) consented (intervention [n=296] and control [n=234]). Of the participants who completed a process evaluation, almost half (88/178, 49.4%) stated they received a PA prescription, with only 42 receiving the full intervention including tailored resources from their PCP. A cluster-level linear regression analysis yielded a non-statistically significant positive difference in MET-minutes reported per week at follow-up between intervention and control conditions (mean difference 1027; 95% CI -155 to 2209; P=.09). No statistically significant differences were observed for secondary outcomes. CONCLUSIONS: Our results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but suboptimal intervention fidelity suggests greater work must be done to address PCP barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data. TRIAL REGISTRATION: ClinicalTrials.gov NCT03181295; https://clinicaltrials.gov/ct2/show/NCT03181295.

How should family physicians provide physical activity advice? Qualitative study to inform the design of an e-health intervention.

OBJECTIVE: To explore patient attitudes toward interacting with family physicians regarding physical activity in order to inform the development of an e-health intervention aimed at helping family physicians support patients in becoming more physically active. DESIGN: Qualitative study. SETTING: Women's College Hospital in Toronto, Ont. PARTICIPANTS: Ten patients recruited from the academic family practice health centre. METHODS: Semistructured interviews were conducted with patients using maximum variation sampling until thematic saturation was reached. Interviews explored past experiences and preferences for receiving physical activity advice from family physicians, and tools or techniques that might support increasing physical activity. Interviews were audiorecorded, transcribed, and coded independently by members of the research team before undergoing thematic analysis. MAIN FINDINGS: Patient interviews revealed 4 overarching themes that offered insight to physical activity discussions. Family physicians might provide more meaningful and useful physical activity advice to patients by providing individualized recommendations focused on proximal (ie, near-term) health and functional goals; recognizing and addressing unique environmental and social factors influencing physical activity levels; balancing candour and sensitivity in advice provision while incorporating a broad definition of physical activity; and recommending tools that incorporate planning, goal-setting, and goal-monitoring features. CONCLUSION: Ultimately, physical activity recommendations from family physicians cannot make a difference if patients do not act on them. This study elicits input from patients to develop preliminary strategies that might help family physicians provide physical activity advice in a more patient-centred fashion. Further research is needed to test interventions that help implement these strategies and to assess their effect.

Development and content validation of the Muscular Dystrophy Child Health Index of Life with Disabilities questionnaire for children with Duchenne muscular dystrophy.

AIM: To develop a patient-reported outcome measure that comprehensively captures the health-related priorities of children with Duchenne muscular dystrophy (DMD). METHOD: Children with DMD and their parents completed the iteratively revised versions of the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), followed by a cognitive interview to develop a pilot version of a new measure. Multidisciplinary health care professionals completed an item-by-item analysis of the measure and a 14-item sensibility questionnaire. Minimum content validity ratio for each item of the new measure and the mean score (0-7) for the items of the sensibility questionnaire were calculated. RESULTS: The CPCHILD underwent changes over 19 interviews with children and their parents, resulting in the pilot Muscular Dystrophy Child Health Index of Life with Disabilities (MDCHILD). The content validity ratio of each MDCHILD item ranged from 0.85 to 1 based on health care professionals' ratings. The mean score exceeded the threshold of four for all items of the sensibility questionnaire. Based on child, parent, and health care professional recommendations, 16 items were added, six eliminated, and 15 items modified from the original CPCHILD. The MDCHILD consists of 47 items over seven domains. INTERPRETATION: The MDCHILD met all sensibility criteria by children with DMD, their parents, and health care professionals, and is ready for psychometric evaluation. WHAT THIS PAPER ADDS: The Muscular Dystrophy Child Health Index of Life with Disabilities (MDCHILD) is a new patient-reported outcome measure for Duchenne muscular dystrophy (DMD). The Priority Framework of Outcomes underpins the content for the MDCHILD. The MDCHILD incorporates the health-related priorities of males with DMD and their parents. The MDCHILD was deemed sensible by children, their parents, and health care professionals.

Detection and recognition of angular frequency patterns.

Previous research has extensively explored visual encoding of smoothly curved, closed contours described by sinusoidal variation of pattern radius as a function of polar angle (RF patterns). Although the contours of many biologically significant objects are curved, we also confront shapes with a more jagged and angular appearance. To study these, we introduce here a novel class of visual stimuli that deform smoothly from a circle to an equilateral polygon with N sides (AF patterns). Threshold measurements reveal that both AF and RF patterns can be discriminated from circles at the same deformation amplitude, approximately 18.0arcsec, which is in the hyperacuity range. Thresholds were slightly higher for patterns with 3.0 cycles than for those with 5.0 cycles. Discrimination between AF and RF patterns was 75% correct at an amplitude that was approximately 3.0 times the threshold amplitude, which implies that AF and RF patterns activate different neural populations. Experiments with jittered patterns in which the contour was broken into several pieces and shifted inward or outward had much less effect on AF patterns than on RF patterns. Similarly, thresholds for single angles of AF patterns showed no significant difference from thresholds for the entire AF pattern. Taken together, these results imply that the visual system incorporates angles explicitly in the representation of closed object contours, but it suggests that angular contours are represented more locally than are curved contours.