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1.
J Orthop Res ; 2021 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-33951223

RESUMO

Attitudes, priorities, and perceptions of exercise directly influence exercise behaviors. Despite the benefits of exercise-based activities for future health, little is known about how youth who experience an ACL injury view exercise-based activity beyond the immediate recovery period. A qualitative (interpretative description) approach with one-to-one semi-structured interviews was used to probe the current attitudes, priorities, and perceptions of exercise-therapy, physical activity, and sport participation with a purposive sample of youth from an ongoing inception cohort study who experienced an ACL tear or reconstruction in the past 12-24 months. Analyses followed an inductive approach guided by an analytic interpretative description process. Reflexive journaling, memoing, and a detailed audit trail promoted data trustworthiness. A patient-partner was involved throughout. Ten youth (six women, four men), 15-19 years of age, and a median of 20-months (16-26) from injury were interviewed. Three overarching themes were identified. 'Balancing physical activity and future knee health' highlighted ongoing negotiations between what were perceived to be competing priorities for return-to-sport and future knee health. 'Reframing the value of exercise-therapy and physical activity' reflected the importance of reshaping attitudes toward exercise as positive and was linked to exercise adherence. 'Overcoming unforeseen exercise challenges' encompassed persisting psychological and physical challenges perceived to limit exercise-based activities. Clinical Significance: Reframing exercise-based activities in a positive light and leveraging motivation for return-to-sport and life-long knee health may be important strategies for encouraging ongoing exercise-therapy and physical activity following a youth ACL injury. This article is protected by copyright. All rights reserved.

2.
ACR Open Rheumatol ; 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33793083

RESUMO

OBJECTIVE: Decision aids are being developed to support guideline-based rheumatology care in Canada. The study objective was to identify barriers to decision aid use in rheumatoid arthritis (RA) within a behavior change model to inform an implementation strategy. METHODS: Perspectives from Canadian health care providers (HCPs) and patients living with RA were obtained on an early RA decision aid and on perceived facilitators and barriers to decision aid implementation. Data were collected through semistructured interviews, transcribed, and then analyzed by inductive thematic analysis. The lessons learned were then mapped to the behavior change wheel COM-B system (C = capability, O = opportunity, and M = motivation interact to influence B = behavior) to inform key elements of a national implementation strategy. RESULTS: Fifteen HCPs and fifteen patients participated. The analysis resulted in five lessons learned: 1) paternalistic decision-making is a dominant practice in early RA, 2) patients need emotional support and access to educational tools to facilitate participation in shared decision-making (SDM), 3) there are many logistical barriers to decision aid implementation in current care models, 4) flexibility is necessary for successful implementation, and 5) HCPs have limited interest in further training opportunities about decision aids. Implementation recommendations included the following: 1) making the decision aids directly available to patients (O) and providing SDM education (C/M), 2) creating an SDM rheumatology curriculum (C/O/M), 3) using "decision coaches" or patient partners as peer support (C/O/M), 4) linking decision aids to "living" rheumatology guidelines (M), and 5) designing trials of patient decision aid/SDM interventions to evaluate patient-important outcomes (O/M). CONCLUSION: A multifaceted strategy is suggested to improve uptake of decision aids.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33892937

RESUMO

OBJECTIVE: To gain consensus on the Outcome Measures in Rheumatology (OMERACT) core domain set for rheumatology trials of shared decision making (SDM) interventions. METHODS: The process followed the OMERACT Filter 2.1 methodology, and used consensus-building methods, with patients involved since the inception. After developing the draft core domain set in previous research, we conducted five steps: (i) improving the draft core domain set; (ii) developing and disseminating white-board videos to promote its understanding; (iii) conducting an electronic survey to gather feedback on the draft core domain set; (iv) finalizing the core domain set and developing summaries, a plenary session video and discussion boards to promote its understanding; and (v) conducting virtual workshops with voting to endorse the core domain set. RESULTS: A total of 167 participants from 28 countries answered the survey (62% were patients/caregivers). Most participants rated domains as relevant (81%-95%) and clear (82%-93%). A total of 149 participants (n = 48 patients/caregivers, 101 clinicians/researchers) participated in virtual workshops and voted on the proposed core domain set which received endorsement by 95%. Endorsed domains are: 1- Knowledge of options, their potential benefits and harms; 2- Chosen option aligned with each patient's values and preferences; 3- Confidence in the chosen option; 4- Satisfaction with the decision-making process; 5- Adherence to the chosen option and 6- Potential negative consequences of the SDM intervention. CONCLUSION: We achieved consensus among an international group of stakeholders on the OMERACT core domain set for rheumatology trials of SDM interventions. Future research will develop the Core Outcome Measurement Set. CLINICAL SIGNIFICANCE: Prior to this study, there had been no consensus on the OMERACT core domain set for SDM interventions. The current study shows that the OMERACT core domain set achieved a high level of endorsement by key stakeholders, including patients/caregivers, clinicians and researchers.

4.
J Clin Epidemiol ; 135: 125-135, 2021 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-33691153

RESUMO

OBJECTIVES: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. STUDY DESIGN AND SETTING: Rapid systematic review from February 1 until April 27, 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. RESULTS: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose, the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. CONCLUSION: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

5.
Health Expect ; 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33729634

RESUMO

OBJECTIVE: To shorten the Patient Engagement In Research Scale (PEIRS) to its most essential items and evaluate its measurement properties for assessing the degree of patients' and family caregivers' meaningful engagement as partners in research projects. METHODS: A prospective cross-sectional web-based survey in Canada and the USA, and also paper-based in Canada. Participants were patients or family caregivers who had engaged in research projects within the last 3 years, were ≥17 years old, and communicated in English. Extensive psychometric analyses were conducted. RESULTS: 119 participants: 99 from Canada, 74 female, 51 aged 17-35 years and 50 aged 36-65 years, 60 had post-secondary education, and 74 were Caucasian/white. The original 37-item PEIRS was shortened to 22 items (PEIRS-22), mainly because of low inter-item correlations. PEIRS-22 had a single dominant construct that accounted for 55% of explained variance. Analysis of PEIRS-22 scores revealed the following: (1) acceptable floor and ceiling effects (<15%), (2) internal consistency (ordinal alpha = 0.96), (3) structural validity by fit to a Rasch measurement model, (4) construct validity by moderate correlations with the Public and Patient Engagement Evaluation Tool, (5) good test-retest reliability (ICC2,1  = 0.86) and (6) interpretability demonstrated by significant differences among PEIRS-22 scores across three levels of global meaningful engagement in research. CONCLUSIONS: The shortened PEIRS is valid and reliable for assessing the degree of meaningful patient and family caregiver engagement in research. It enables standardized assessment of engagement in research across various contexts. PATIENT OR PUBLIC CONTRIBUTION: A researcher-initiated collaboration, patient partners contributed from study conception to manuscript write-up.

6.
BMJ Open ; 11(3): e043759, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33674373

RESUMO

OBJECTIVES: To obtain stakeholder perspectives to inform the development and implementation of a rheumatoid arthritis (RA) healthcare quality measurement framework. DESIGN: Qualitative study using thematic analysis of focus groups and interviews. SETTING: Arthritis stakeholders from across Canada including healthcare providers, persons living with RA, clinic managers and policy leaders were recruited for the focus groups and interviews. PARTICIPANTS: Fifty-four stakeholders from nine provinces. INTERVENTIONS: Qualitative researchers led each focus group/interview using a semistructured guide; the digitally recorded data were transcribed verbatim. Two teams of two coders independently analysed the transcripts using thematic analysis. RESULTS: Perspectives on the use of different types of measurement frameworks in healthcare were obtained. In particular, stakeholders advocated for the use of existing healthcare frameworks over frameworks developed in the business world and adapted for healthcare. Persons living with RA were less familiar with specific measurement frameworks, however, they had used existing online public forums for rating their experience and quality of healthcare provided. They viewed a standardised framework as potentially useful for assisting with monitoring the care provided to them individually. Nine guiding principles for framework development and 13 measurement themes were identified. Perceived barriers identified included access to data and concerns about how measures in the framework were developed and used. Effective approaches to framework implementation included having sound knowledge translation strategies and involving stakeholders throughout the measurement development and reporting process. Clinical models of care and health policies conducive to outcome measurement were highlighted as drivers of successful measurement initiatives. CONCLUSION: These important perspectives will be used to inform a healthcare quality measurement framework for RA.

7.
Artigo em Inglês | MEDLINE | ID: mdl-33644994

RESUMO

OBJECTIVE: We aim to broaden understanding of the perspectives of persons with arthritis on their use of wearables to self-monitor physical activity, through a synthesis of evidence from qualitative studies. METHODS: We conducted a systematic search of 5 databases (including Medline, CINAHL, and Embase) from inception to 2018. Eligible studies qualitatively examined the use of wearables from the perspectives of persons with arthritis. All relevant data were extracted and coded inductively in a thematic synthesis. RESULTS: Of 4358 records retrieved, 7 articles were included. Participants used a wearable during research participation in 3 studies and as part of usual self-management in 2 studies. In remaining studies, participants were shown a prototype they did not use. Themes identified were: 1) Potential to change dynamics in patient-health professional communication: Articles reported a common opinion that sharing wearable data could possibly enable them to improve communication with health professionals; 2) Wearable-enabled self-awareness; a benefit or downside?: There was agreement that wearables could increase self-awareness of physical activity levels, but perspectives were mixed on whether this motivated more physical activity; 3) Designing a wearable for everyday life: Participants generally felt the technology was not obtrusive in their everyday lives, but it was speculated certain prototypes may embarrass or stigmatize persons with arthritis. CONCLUSION: Themes hint toward an ethical dimension, as participants perceive their use of wearables may positively or negatively influence their capacity to shape their everyday self-management. We suggest ethical questions pertinent to the use of wearables in arthritis self-management for further exploration.

8.
Artigo em Inglês | MEDLINE | ID: mdl-33756068

RESUMO

Saturation is well known in qualitative research as a key methodological concept and criterion for discontinuing data collection and/or analysis. Often, it is used by qualitative researchers in making decisions related to the adequacy of their sample size (1). It is becoming increasingly common for decisions to take place at the planning stage in order to propose sample size to potential funders or ethical review boards.

9.
Artigo em Inglês | MEDLINE | ID: mdl-33775461

RESUMO

OBJECTIVE: Towards developing an instrument to measure knee and hip osteoarthritis (KHOA) flare, the Outcome Measures in Rheumatology (OMERACT) Flares in OA Working Group first sought to identify and define relevant domains of flare in KHOA. METHODS: Guided by OMERACT Filter 2.1, candidate domains were identified from data generated in interviews, in English or French, with persons with KHOA and health professionals (HPs) who treat OA. The first and second rounds of an online Delphi process with patients and HPs, including researchers, selected relevant domains. The third round provided agreement on the selected domains and their definitions. At the virtual OMERACT 2020 workshop, the proposed domains and their definitions were discussed in facilitated breakout groups with patients and HPs. Participants then voted, with consensus set at ≥70%. RESULTS: Qualitative interviews characterizing OA flare were completed with 29 persons with KHOA and 16 HPs. Content was analyzed and grouped into nine clusters. These candidate domains were included in two Delphi rounds, completed by 91 patients and 165 HPs then 50 patients and 116 HPs, per round, respectively. This resulted in selecting five relevant domains. A final Delphi round, completed by 38 patients and 89 HPs, provided agreement on these domains and their definitions. The OMERACT virtual vote included 27 patients and 106 HPs. The domains and their definitions were endorsed with ≥98% agreement. Domains include: Pain, Swelling, Stiffness, Psychological aspects, and Impact of symptoms, all defined "during flare". CONCLUSION: Using OMERACT methodology, we have developed five domains of KHOA flare that were highly endorsed by patients and HPs.

10.
J Rheumatol ; 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589559

RESUMO

On March 11, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19; caused by SARS-CoV-2) a pandemic. By mid-March, all Canadian provinces and territories declared states of emergency, which triggered measures to support the response to the pandemic.1.

11.
Phys Ther ; 101(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33351940

RESUMO

Gait modifications are used in the rehabilitation of musculoskeletal conditions like osteoarthritis and patellofemoral pain syndrome. While most of the research has focused on the biomechanical and clinical outcomes affected by gait modification, the process of learning these new gait patterns has received little attention. Without adequate learning, it is unlikely that the modification will be performed in daily life, limiting the likelihood of long-term benefit. There is a vast body of literature examining motor learning, though little has involved gait modifications, especially in populations with musculoskeletal conditions. The studies that have examined gait modifications in these populations are often limited due to incomplete reporting and study design decisions that prohibit strong conclusions about motor learning. This perspective draws on evidence from the broader motor learning literature for application in the context of modifying gait. Where possible, specific gait modification examples are included to highlight the current literature and what can be improved on going forward. A brief theoretical overview of motor learning is outlined, followed by strategies that are known to improve motor learning, and finally, how assessments of learning need to be conducted to make meaningful conclusions.

12.
J Rheumatol ; 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33191276

RESUMO

OBJECTIVE: To elucidate the essential elements of high-quality rheumatoid arthritis (RA) care in order to develop a vision statement and a set of strategic objectives for a national RA quality framework. METHODS: Focus groups and interviews were conducted by experienced qualitative researchers using a semi-structured interview or focus group guide with healthcare professionals, patients, clinic managers, healthcare leaders and policy makers to obtain their perspectives on elements essential to RA care. Purposive sampling provided representation of stakeholder types and regions. Recorded data was transcribed verbatim. Two teams of 2 coders independently analyzed the de-identified transcripts using thematic analysis. Strategic objectives and the vision statement were drafted based on the overarching themes from the qualitative analysis and finalized by a working group. RESULTS: A total of 54 stakeholders from 9 Canadian provinces participated in the project (3 focus groups and 19 interviews). Seven strategic objectives were derived from the qualitative analysis representing the following themes: 1) early access and timeliness of care, 2) evidence-informed high-quality care for the ongoing management of RA and comorbidities, 3) availability of patient self-management tools and educational materials for shared decision-making, 4) multidisciplinary care, 5) patient outcomes, and 6) patient experience and satisfaction with care, and 7) Equity, which emerged as an overarching theme. The ultimate vision obtained was "Ensuring patient-centered, high quality care for people living with rheumatoid arthritis". CONCLUSION: The seven strategic objectives identified highlight priorities for RA quality of care to be used in developing the National RA Quality Measurement Framework.

13.
Patient ; 13(6): 719-728, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33033937

RESUMO

BACKGROUND: Youths with juvenile idiopathic arthritis (JIA) often experience pain, which reduces their quality of life. A diversity of pain management options exists for these patients, but few discussions happen in clinical settings. Our team is developing a web-based patient decision aid (PDA) to help youths with JIA, parents, and their health care providers (HCPs) make informed and preference-based decisions about pain management options. OBJECTIVE: The objective of this study was to develop a paper-based prototype of the web-based PDA and to assess its acceptability. METHODS: We developed a paper-based prototype of the PDA, called the JIA Option Map, using an iterative process following the International Patient Decision Aid Standards and based on the Ottawa Decision Support Framework. We held three consensus meetings and a follow-up online survey followed by discussions among team members to agree on the format and content of the PDA. We then evaluated acceptability through interviews with 12 youth with JIA (aged 8-18 years), 12 parents, and 11 HCPs. Participants from rheumatology clinics in Canada and the USA reviewed the PDA and assessed its usefulness, content, and format. Interviews were audiotaped, transcribed verbatim, and analyzed using simple descriptive content analysis. RESULTS: The PDA contains an assessment of pain and current treatments, a values-clarification exercise, a list of 33 treatment options with evidence-based information, and a goal-setting exercise. All participants agreed that it would be a useful tool for making decisions about pain management. Participants appreciated the incorporation of scientific evidence and visuals to demonstrate the benefits of treatment options but suggested describing the source of the evidence more thoroughly. Participants suggested adding complementary medicine and nutrition to the available treatment options and removing options that are primarily used to reduce inflammation. Most participants preferred an interactive web-based version of the PDA that would show a few options consistent with their preferences, followed by a discussion with HCPs. CONCLUSION: The PDA was deemed acceptable to all participants, with a few modifications. This feedback was used to improve the PDA by simplifying and clarifying the information and adjusting the number of treatment options presented. Work is underway to develop an interactive web-based version with an algorithm to present options tailored to each user.

14.
Rheumatol Ther ; 7(4): 909-925, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33034861

RESUMO

INTRODUCTION: In collaboration with the Alberta Medical Association's Physician Learning Program we developed individualized physician reports and held a group feedback session on rheumatoid arthritis (RA) performance measures (PM) to facilitate treat-to-target (T2T) strategies and evaluated physician experiences with this process. METHODS: 5 PMs addressing T2T concepts from an established Canadian quality framework were operationalized for physician practice reports at 2 university-affiliated rheumatology clinics. Rheum4U, a quality improvement and research platform, was the data source. The audit results were reviewed in a facilitated group feedback session. Rheumatologists provided experiential feedback on the process through survey and/or an interview. Transcripts from interviews were analyzed using a 6-step thematic analysis. RESULTS: 11 of 12 eligible rheumatologists consented to receive practice reports and provided feedback through surveys (n = 5) and interviews (n = 6). The practice reports from Rheum4U (n = 448 patients) revealed high rates of yearly follow-up (> 85%, PM1) and 100% performance on documentation of disease activity at ≥ 50% of visits (PM2). Only 34% of patients were seen within 3 months if not in remission (PM3) with 62% (2017) and 69% (2018) of those with active RA achieving a LDA state within 6 months (PM4). Approximately 70% of patients were in remission at any time point (PM5). All survey respondents agreed or strongly agreed comparison to peers was valuable and helped them reflect on their practice. Several strategies for improvement were identified, including but not limited to, leveraging of electronic records for future audit and feedback reports, providing additional granularity of results, additional stratification of results, and using high-performing peers as the comparator rather than the group mean. CONCLUSIONS: Audit and feedback was perceived by clinicians as a useful strategy for evaluating T2T efforts in RA. Future work will focus on longitudinal evaluation of the clinical impact of this quality improvement initiative.

15.
Arthritis Care Res (Hoboken) ; 72(12): 1678-1686, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33025679

RESUMO

OBJECTIVE: To identify 24-hour activity-sleep profiles in adults with arthritis and explore factors associated with profile membership. METHODS: Our study comprised a cross-sectional cohort and used baseline data from 2 randomized trials studying activity counseling for people with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or knee osteoarthritis (OA). Participants wore activity monitors for 1 week and completed surveys for demographic information, mood (Patient Health Questionnaire 9), and sitting and walking habits (Self-Reported Habit Index). A total of 1,440 minutes/day were stratified into minutes off body (activity unknown), sleeping, resting, nonambulatory, and intermittent or purposeful ambulation. Latent class analysis determined cluster numbers; baseline-category multinomial logit regression identified factors associated with cluster membership. RESULTS: Our cohort included 172 individuals, including 51% with RA, 30% with OA, and 19% with SLE. We identified 4 activity-sleep profiles (clusters) that were characterized primarily by differences in time in nonambulatory activity: high sitters (6.9 hours sleep, 1.6 hours rest, 13.2 hours nonambulatory activity, and 1.6 hours intermittent and 0.3 hours purposeful walking), low sleepers (6.5 hours sleep, 1.2 hours rest, 12.2 hours nonambulatory activity, and 3.3 hours intermittent and 0.6 hours purposeful walking), high sleepers (8.4 hours sleep, 1.9 hours rest, 10.4 hours nonambulatory activity, and 2.5 hours intermittent and 0.3 hours purposeful walking), and balanced activity (7.4 hours sleep, 1.5 hours sleep, 9.4 hours nonambulatory activity, and 4.4 hours intermittent and 0.8 hours purposeful walking). Younger age (odds ratio [OR] 0.95 [95% confidence interval (95% CI) 0.91-0.99]), weaker occupational sitting habit (OR 0.55 [95% CI 0.41-0.76]), and stronger walking outside habit (OR 1.43 [95% CI 1.06-1.91]) were each associated with balanced activity relative to high sitters. CONCLUSION: Meaningful subgroups were identified based on 24-hour activity-sleep patterns. Tailoring interventions based on 24-hour activity-sleep profiles may be indicated, particularly in adults with stronger habitual sitting or weaker walking behaviors.

18.
BMJ Open ; 10(10): e035527, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33082178

RESUMO

OBJECTIVES: New clinical practice guidelines for the management of mild traumatic brain injury (mTBI) emphasise that family physicians should proactively screen and initiate treatment for depression/anxiety, insomnia and headaches. This study aimed to evaluate the feasibility of delivering an implementation intervention to family physicians. DESIGN: Pilot cluster randomised controlled trial. SETTING: Specialty outpatient clinic (recruitment) and primary care (implementation). PARTICIPANTS: 114 primary care clinics were randomised. These clinics were associated with 137 unique family physicians caring for 148 adult patients who sustained an mTBI within the previous 3 months and were seeking care for persistent symptoms. INTERVENTIONS: Patients completed self-report screening measures for depression/anxiety, insomnia and headaches. A tailored letter that incorporates the patient's screening test results and associated treatment algorithms was sent to their family physician (or walk-in clinic). Physicians at clinics assigned to the control condition received a generic letter, without the screening test results. PRIMARY OUTCOME MEASURES: Feasibility outcomes included the frequency of primary care follow-up, retention rates and reliability of patient recall of their physicians' actions (primary mechanistic outcome). The primary efficacy outcome was the Rivermead Post-Concussion Symptom Questionnaire (RPQ). RESULTS: Most patients (97.8%; 128 of 131) followed up at the primary care clinic they planned to. Retention rates were 88% (131 of 148) and 78% (116 of 148) at the 1-month and 3-month assessments, respectively. Agreement between patient recall of their physicians' actions and medical chart audits was moderate (intraclass correlation coefficient=0.48-0.65). Patients in the experimental group reported fewer symptoms on the RPQ compared with those in the control group, whose physician received a general letter (B=-4.0, 95% CI: -7.3 to -0.7). CONCLUSIONS: A larger trial will need to address minor feasibility challenges to evaluate the effectiveness of this guideline implementation tool for improving mTBI clinical outcomes and confirm the mechanism(s) of intervention benefit. TRIAL REGISTRATION NUMBER: NCT03221218.

19.
Med Sci Sports Exerc ; 52(10): 2217-2223, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32936595

RESUMO

INTRODUCTION: Cortical thinning is associated with aging; however, lifestyle factors can moderate this relationship. Two distinct lifestyle behaviors associated with brain health are regular moderate-to-vigorous physical activity (MVPA) and limited sedentary behavior (SB). However, it is unclear whether MVPA and SB levels contribute to cortical thickness independent of each other. We therefore investigated the independent relationships of MVPA and SB with cortical thickness using baseline data from a randomized controlled trial. METHODS: At baseline, we measured MVPA and SB for 7 d using the SenseWear Mini. A subset of the randomized controlled trial participants (n = 30) underwent a 3T magnetic resonance imaging scan, wherein region-specific cortical surface morphometric analyses were performed using T1-weighted structural magnetic resonance imaging. We conducted regression analyses using a surface-based cluster size exclusion method for multiple comparisons within FreeSurfer neuroimaging software to determine if MVPA and SB are independently correlated with region-specific cortical thickness. RESULTS: This subset of participants had a mean age of 61 yr (SD = 9 yr), and 80% were female. Higher MVPA was associated with greater cortical thickness in the temporal pole (cluster size, 855 mm; cortical thickness range, 2.59-3.72 mm; P < 0.05) and superior frontal gyrus (cluster size, 1204 mm; cortical thickness range, 2.41-3.15 mm; P < 0.05) of the left hemisphere, independent of SB. Sedentary behavior was not associated with greater cortical thickness in any region, independent of MVPA. CONCLUSIONS: Our results indicate that adults with greater MVPA-independent of SB-are associated with greater cortical thickness in regions, which are susceptible to age-associated atrophy.

20.
Artigo em Inglês | MEDLINE | ID: mdl-32898029

RESUMO

OBJECTIVE: To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion. SETTING: Community. PARTICIPANTS: Family physicians in community practice (n = 21 at 5 clinics). DESIGN: Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits. MAIN MEASURES: The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements. RESULTS: Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change. CONCLUSIONS: Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.

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