Feasibility, Outcomes, and Perceptions of a Virtual Group Exercise Program in Multiple Sclerosis.

BACKGROUND AND PURPOSE: Individuals with multiple sclerosis (MS) frequently report low physical activity and psychosocial support due to concerns with transportation, time, finances, access to services, and lack of caregiver support. These barriers can be addressed by online group interventions; however, utility of such programs in individuals with MS has not been examined yet. The purpose of this retrospective study was, therefore, to ( a ) investigate the feasibility, safety, and outcomes of a virtual group exercise program in individuals with MS, and ( b ) explore the participant perceptions after the program. METHODS: Retrospective data from the medical records of 17 individuals with MS (mean [SD] age = 53.5 [12.3] years, body mass index = 28.2 [7.2]) who completed the virtual 13-week group exercise program, pre- and posttraining functional status questionnaires, and the end-of-program feedback were extracted. The exercise program included aerobic, resistance, balance, and flexibility training components recommended for people with MS. Feasibility, safety, outcomes, and participant perceptions were determined by adherence to the prescribed daily exercise dosage, number of adverse events, within-group differences in self-reported functional status, and thematic analysis of the participant feedback, respectively. RESULTS: Participants were adherent (79%), reported minimal adverse effects, and demonstrated significant changes ( P < 0.05) in functional status posttraining. Several themes on the perceived barriers, facilitators, and suggestions for improvement were identified. DISCUSSION AND CONCLUSIONS: A virtual 13-week group exercise program can be feasible, safe, effective, and well received by individuals with MS. Future research should investigate the dose-response effectiveness of telehealth and compare various telehealth models of exercise training using large randomized controlled trials.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A434 , which demonstrates an overview of the study).

Addressing Opportunities and Barriers in Telehealth Neurologic Physical Therapy: Strategies to Advance Practice.

BACKGROUND AND PURPOSE: Since the COVID-19 pandemic, the use and implementation of telehealth has expanded, with implementation moving ahead of best practice recommendations due to necessity. Telehealth has improved access and care coordination for patients with various neurologic conditions; however, information regarding therapeutic intensity, safety, and appropriateness is lacking. In 2021, the Academy of Neurologic Physical Therapy formed a Telehealth Taskforce to provide clinical and educational resources for its members and the neurologic physical therapy (PT) community. The purpose of this special interest article is to provide consensus-driven best practice resources developed by the Taskforce and describe the process of creating these resources to assist with telehealth implementation in neurologic PT practice, advocate for continued utilization, and shine light on opportunities for future research. SUMMARY OF KEY POINTS: In this special interest article, we describe the process, challenges, and opportunities of developing and disseminating resources to educate, train, and support telehealth implementation in neurologic clinical practice. Four key strategies to facilitate telehealth implementation emerged: (1) increase knowledge of resources related to telehealth and mobile applications; (2) develop and disseminate evidence-based and consensus-based best practice recommendations for telehealth in neurologic PT; (3) provide future recommendations for integrating telehealth in PT, education, research, and clinical practice; and (4) encourage advocacy for inclusion of telehealth within the PT community. We explain the need to continue research and provide recommendations to expand telehealth research in neurologic clinical practice. RECOMMENDATIONS FOR CLINICAL PRACTICE: This article highlights the potential and future of telehealth in neurologic PT practice. Our recommendations provide current clinical tools and resources for telehealth implementation following a knowledge-to-action framework and suggest areas for future research.Video Abstract available for more insights from the authors (see the Video, the Supplemental Digital Content, available at: http://links.lww.com/JNPT/A447).

The 21-foot principle: Effects of age and sex on knife attack characteristics.

INTRODUCTION: Knives are commonly-used weapons in criminal activities and interpersonal assaults worldwide. Injury reports have identified the upper body as the most frequent location of knife injuries, and that stabbing attacks are more fatal than slashing attacks. The first two aims of the study explore whether the type of attack and attack location could be predicted from age and sex group. The following aims compared attack times between sex and age groups and evaluated the influence of subject characteristics on attack duration. The exploratory aim surveyed subjects on attack location during the scenario if the target was not wearing body armor. METHODS: A total of 74 subjects (male: n = 40; female: n = 34) participated. Subjects were video recorded during a 21-foot (ft) attack and participated in follow-up questions and completed a push-up test to determine physical strength. Attack time (AT), concealment location, attack type, and demographic information were correlated to age group and sex. RESULTS: Mean AT from 21 ft was 2.40 ± 0.47 s, with the fastest of 1.75 s. The most commonly observed concealment location, attack type, and attack location on the target included the right hip (n = 62), stab (n = 62), and the chest (n = 28), respectively. After controlling for push-up ability (p < 0.05), no differences were reported between any combination of sex and age group in AT from 21 ft. Push-up ability was the sole significant predictor of AT from 21 ft (p < 0.05). Twenty-eight subjects reported they purposely avoided the body armor vest during the 21 ft attack. CONCLUSION: Law enforcement officers are encouraged to train for quick defensive or offensive responses, such as hand-to-knife combat or rapid firearm skills that can be performed in under 1.75 s. Stronger people were predicted to complete the 21 ft attack faster.

Remediation practices for health profession students and clinicians: An integrative review.

BACKGROUND: The current state of practices in health care remediation is not well known. The purpose of this review is to characterize, assess, and present synthesized results of current student and professional remediation practices described in the literature. METHODS: This study used an integrative review process including article extraction and review, descriptive characterization and statistics, classification of levels of evidence, assessment of risk of bias, and examination of relationships between factors and types of remediation. Articles were located in a search of PubMed (MEDLINE) and EBSCO (CINAHL Complete) last accessed in May 2022. INCLUSION CRITERIA: Full text journal articles and Briefs published between January 2001 and May 2022, English language, focus on remediation in health science education programs and professionals, identified key words in title, abstract, or article. EXCLUSION CRITERIA: Published outside the date range; focus of study or article outside health sciences; main focus not on remediation process or program (defined above), books, presentations and abstracts. RESULTS: 97 articles were included. Design rigor clustered around Level 6 (case-controlled studies, case series, case reports). All programs and activities were reported as successful. There was a statistically significant relationship (p < 0.01) between healthcare discipline and type of remediation. CONCLUSIONS: A variety of remediation methods for health care students and professionals are reported to be successful. Higher level studies are needed to help define best practices for remediation activities in health care professional knowledge and skill.

Perinatal Incontinence Assessment Tools: A Psychometric Evaluation and Scoping Review.

Background: Approximately 40% of women report incontinence during pregnancy and postpartum (known as the perinatal period). Due to the lack of an established measurement standard, this scoping review aimed to investigate the psychometric properties of tools, which assess incontinence-related symptoms and quality of life (QOL) during this period. Materials and Methods: Articles in English, which assessed psychometric properties of tools for perinatal incontinence-related symptoms or QOL, were included and evaluated by a 16-item checklist. Nine databases were searched from 2000 to 2020. Results: Four studies met the inclusion criteria, and five assessment tools were identified and included in this review. The modified Pelvic Floor Questionnaire (mPFQ), Leakage Index (LI), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) demonstrated internal consistency (Cronbach's α > 0.60, >0.70, and mean inter-item correlations >0.39, respectively). The mPFQ demonstrated moderate test-retest reliability (intraclass correlation coefficient >0.60). Construct validity of the ICIQ-UI SF was established by significant (p < 0.05) differences across age and obesity, whereas the mPFQ demonstrated significant (p < 0.001) discriminant validity in symptoms prepartum and postpartum. Convergent validity of telephone-administered Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) was established with the written version (p > 0.05, correlation coefficient >0.90). Responsiveness to change was described for the ICIQ-UI SF and mPFQ. Conclusions: The mPFQ and ICIQ-UI SF demonstrated acceptable reliability, validity, and responsiveness to change, therefore suggesting good clinical utility. Since most studies included primiparous women, future research in heterogeneous samples of women with perinatal incontinence may be needed.

Test-Retest Reliability and Response Stability of Gaze Stabilization, Postural Sway, and Dynamic Balance Tests in Persons with Multiple Sclerosis and Controls.

BACKGROUND: Psychometric properties of tests that assess the angular vestibulo-ocular reflex (aVOR) and vestibulospinal reflex function are currently unknown. This study investigated the test-retest reliability and response stability of gaze stabilization, postural sway, and dynamic balance measures in persons with multiple sclerosis (MS) and controls. METHODS: Nineteen adults with MS and 14 controls performed passive horizontal head impulses, quiet standing, and dynamic balance tests on two separate occasions. Gaze stabilization measures included aVOR gain, number of compensatory saccades (CSs) per head rotation, CS latency, and gaze position error. Postural sway included sway amplitude and total sway path. Dynamic balance measure included the Functional Gait Assessment. Intraclass correlation coefficient, standard error of measurement (SEM, SEM%), and minimal detectable difference at 95% confidence level were calculated. RESULTS: Test-retest reliability for aVOR gain, CSs per head rotation, and gaze position error was moderate and for each postural sway and dynamic balance measure was good. Low error (SEM, SEM%) for aVOR gain, CS latency, postural sway, and dynamic balance variables and low minimal detectable difference values for aVOR gain and Functional Gait Assessment scores were seen, suggestive of acceptable response stability. CONCLUSIONS: These results support the utility of some of the gaze and postural measures for examination and treatment efficacy purposes in people with MS.

Gaze Stability, Dynamic Balance and Participation Deficits in People with Multiple Sclerosis at Fall-Risk.

Despite the common complaints of dizziness and demyelination of afferent or efferent pathways to and from the vestibular nuclei which may adversely affect the angular vestibulo-ocular reflex (aVOR) and vestibulo-spinal function in persons with multiple sclerosis (PwMS), few studies have examined gaze and dynamic balance function in PwMS. (1) Determine the differences in gaze stability, dynamic balance and participation measures between PwMS and controls, (2) Examine the relationships between gaze stability, dynamic balance and participation. Nineteen ambulatory PwMS at fall-risk and 14 age-matched controls were recruited. Outcomes included (1) gaze stability (angular aVOR gain [ratio of eye to head velocity]; number of compensatory saccades [CS] per head rotation; CS latency; gaze position error; coefficient of variation [CV] of aVOR gain), (2) dynamic balance (functional gait assessment, FGA; four square step test), and (c) participation (dizziness handicap inventory; activities-specific balance confidence scale). Separate independent t-tests and Pearson's correlations were calculated. PwMS were age = 53 ± 11.7 years and had 4.2 ± 3.3 falls/year. PwMS demonstrated significant (P < 0.05) impairments in gaze stability, dynamic balance and participation measures compared to controls. CV of aVOR gain and CS latency were significantly correlated with FGA. Deficits and correlations across a spectrum of disability measures highlight the relevance of gaze and dynamic balance assessment in PwMS. Anat Rec, 301:1852-1860, 2018. © 2018 Wiley Periodicals, Inc.

Associations Between Fatigue and Disability, Functional Mobility, Depression, and Quality of Life in People with Multiple Sclerosis.

BACKGROUND: Fatigue is a common symptom in people with multiple sclerosis (MS), but its associations with disability, functional mobility, depression, and quality of life (QOL) remain unclear. We aimed to determine the associations between different levels of fatigue and disability, functional mobility, depression, and physical and mental QOL in people with MS. METHODS: Eighty-nine individuals with MS (mean [SD] disease duration = 13.6 [9.8] years, mean [SD] Expanded Disability Status Scale [EDSS] score = 5.3 [1.5]) and no concurrent relapses were retrospectively analyzed. Participants were divided into two groups based on five-item Modified Fatigue Impact Scale (MFIS-5) scores: group LF (n = 32, MFIS-5 score ≤10 [low levels of fatigue]) and group HF (n = 57, MFIS-5 score >10 [high levels of fatigue]). RESULTS: Sixty-four percent of the sample reported high levels of fatigue. Compared with group LF, group HF demonstrated significantly (P < .05) greater impairments in the Timed Up and Go test, Activities-specific Balance Confidence scale, and 12-item Multiple Sclerosis Walking Scale scores; depression; and QOL but not in the EDSS scores, which were not significantly different between groups. CONCLUSIONS: Fatigue was found to be a predominant symptom in the study participants. Individuals reporting higher levels of fatigue concomitantly exhibited greater impairments in functional mobility, depression, and physical and mental QOL. Disability was not found to be related to level of fatigue. These findings can be important for appropriate assessment and management of individuals with MS with fatigue.

Acute effects of muscle fatigue on anticipatory and reactive postural control in older individuals: a systematic review of the evidence.

BACKGROUND: Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue. PURPOSE: The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals. METHODS: An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin). RESULTS: A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics. CONCLUSION: On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.