The effect of ice skating on psychological well-being and sleep quality of children with visual or hearing impairment

Abstract

Purpose: Physical exercise and sports have a key role in preventing physical and psychiatric problems in children. However, children with a disability often experience difficulty participating in physical activity due to a lack of suitable opportunities. Participation in an accessible sport is particularly important for these children, but studies examining which sports are beneficial for which disability groups are rare. In this study, we assessed the effects of ice skating on the psychological well-being, self-concept, and sleep quality of children with hearing or visual impairment. Method: Forty students (20 visually impaired and 20 hearing impaired) aged 8–16 were included in a regular ice skating programme for three months. We examined the sleep quality, self-concept, and behavioural and emotional states of the children before and after participating in the programme. Results: There was a significant improvement in self-concept, behavioural and emotional problems, and sleep quality (p?<?0.05 for each) of the children with hearing impairment. Although the sleep quality (p?=?0.019) and emotional problem scores (p?=?0.000) of the visually impaired children improved; self-concept, peer relations and hyperactivity scores of these children worsened (p?<?0.05 for each). Conclusion: Ice skating is one of the popular sport alternatives that gives children the opportunity to exercise and have fun together. The results of this study revealed that regular ice skating programmes may have positive effects on the psychological well-being of children with hearing impairment. Despite some positive effects, caution must be use when including visually impaired children in ice skating programmes. Generalization of the study's outcomes is limited as the study group were residential students enrolled in special education institutions for children who are blind or deaf.

• Implications for Rehabilitation

• Ice skating is a community-based sport and a popular leisure activity that can also have benefits for people with disabilities.

• Ice skating and children with hearing impairment:

• Self-concept, behavioural and emotional problems, and sleep quality of the children with hearing impairment significantly improved after ice skating.

• Ice skating programmes may be considered as a rehabilitation alternative for children with hearing impairment.

• Ice skating and children with visual impairment:

• Caution must be use when including children with visual impairment in ice skating programmes because of possible negative psychological outcomes.

• Balance exercises before starting the practices on ice should be considered for preventing some possible negative outcomes in children with visual impairment.

     

Treatment of pain following cancer: applying neuro-immunology in rehabilitation practice

Aim: Pain is the second most frequent persistent symptom following cancer treatment. This article aims at explaining how the implementation of contemporary pain neuroscience can benefit rehabilitation for adults following cancer treatment within an evidence-based perspective.

Materials and methods: Narrative review.

Results: First, pain education is an effective but underused strategy for treating cancer related pain. Second, our neuro-immunological understanding of how stress can influence pain highlights the importance of integrating stress management into the rehabilitation approach for patients having cancer-related pain. The latter is supported by studies that have examined the effectiveness of various stress management programmes in this population. Third, poor sleep is common and linked to pain in patients following cancer treatment. Sleep deprivation results in a low-grade inflammatory response and consequent increased sensitivity to pain. Cognitive behavioural therapy for sleep difficulties, stress management and exercise therapy improves sleep in patients following cancer treatment. Finally, exercise therapy is effective for decreasing pain in patients following cancer treatment, and may even decrease pain-related side effects of hormone treatments commonly used in cancer survivors.

Conclusions: Neuro-immunology has increased our understanding of pain and can benefit conservative pain treatment for adults following cancer treatment.

• Implications for Rehabilitation

• Pain education is effective for improving cancer pain; implementation of contemporary pain neuroscience into the educational programme seems warranted.

• Various types of stress management are effective for treating patients following cancer treatment.

• Poor sleep is common in patients following cancer treatment, and rehabilitation specialists can address this by providing exercise therapy, sleep hygiene, and/or cognitive behavioural therapy.

• Exercise therapy is effective for decreasing pain in patients following cancer treatment, including the treatment of pain as a common side effect of hormone treatments for breast cancer survivors.

     

Association of shift-work,daytime napping,and nighttime sleep with cancer incidence and cancer-caused mortality in Dongfeng-tongji cohort study

Background: Few studies investigated the combined effects of night-shift work, daytime napping, and nighttime sleep on cancer incidence and mortality.

Methods: A total of 25,377 participants were included in this study. Information on sleep habits, cancer incidences, and mortalities were collected. Cox proportional hazards models were used to calculate the adjusted hazard ratios and 95% confidence intervals (HRs, 95%CIs).

Results: Male subjects experienced ≥20 years of night-shift work, or without daytime napping had an increased risk of cancer, when compared with males who did not have night-shift work or napped for 1–30?min [HR (95%CI)?=?1.27 (1.01–1.59) and 2.03 (1.01–4.13), respectively]. Nighttime sleep for ≥10?h was associated with a separate 40% and 59% increased risk of cancer [HR (95%CI)?=?1.40 (1.04–1.88)] and cancer-caused mortality [HR (95%CI)?=?1.59 (1.01–2.49)] than sleep for 7–8?h/night. Combined effects of three sleep habits were further identified. Male participants with at least two above risk sleep habits had a 43% increased risk of cancer [HR (95%CI)?=?1.43 (1.07–2.01)] and a 2.07-fold increased cancer-caused mortality [HR (95%CI)?=?2.07 (1.25–3.29)] than those who did not have any above risk sleep habits. However, no significant associations were observed among women.

Conclusions: Long night-shift work history, without daytime napping, and long nighttime sleep duration were independently and jointly associated with higher cancer incidence among males.

• KEY MESSAGES

• Night-shift work of ≥20 years, without napping, and nighttime sleep of ≥10?h were associated with increased cancer incidence.

• Nighttime sleep ≥10?h was associated with a 2.07-fold increased cancer-caused mortality among males.

• Combined effects of night-shift work ≥20 years, without napping, and nighttime sleep ≥10?h on increasing cancer incidence were existed among males.

     

Women’s perceived work environment after stress-related rehabilitation: experiences from the ReDO project

Purpose: The study aimed to investigate (a) if women’s perceptions of their work environment changed during a 16-week rehabilitation period and at a 12-month follow-up; (b) whether such changes were related to outcomes in terms of return to work, well-being and valued occupations. Methods: Eighty-four gainfully employed women on sick-leave due to stress-related disorders responded to instruments assessing perceptions of the work environment, well-being (self-esteem, self-mastery, quality of life, perceived stress, self-rated health) and perceived occupational value. Data about return to work were collected from registers. Non-parametric statistics were used. Results: The increase in the women’s ratings of their work environment was non-significant between baseline and completed rehabilitation but was statistically significant between baseline and the 12-month follow-up. No relationships were found between changes in perceptions of the work environment and outcomes after the rehabilitation. At the follow-up, however, there were associations between perceived work environment changes in a positive direction and return to work; improved self-esteem, self-mastery, quality of life, perceived occupational value and self-rated health; and reduced stress. Conclusion: It seems important to consider the work environment in rehabilitation for stress-related problems, and a follow-up appears warranted to detect changes and associations not visible immediately after rehabilitation.

• Implications for Rehabilitation

• Work environment

• Perceptions of the work environment seem important for return to work, although other factors are likely to contribute as well.

• Perceptions of the work environment are associated with several aspects of well-being.

• When developing rehabilitation interventions a focus on the clients' perceptions of their work environment seems vital.

     

Assessing head and trunk symmetry during sleep using tri-axial accelerometers

Using two types of small, lightweight tri-axial accelerometers, we obtained evidence for the effectiveness of an approach for assessing head–trunk symmetrical or asymmetrical positions during sleep. First, we assessed the accuracy of our monitoring system in five healthy young adults (age range, 22–24 years). The participants wore acceleration monitors on the sternum and forehead; then spent 5?min in six different positions. Once accuracy was confirmed, we assessed head–trunk symmetry during night-time sleep in 10 healthy children (age range, 3–13 years) and 10 young adults (age range, 21–26 years) in their home environments. All participants wore the monitors during one night’s sleep in their homes. After computing head–trunk positions using the orientation data obtained by the accelerometers, head and trunk symmetry were evaluated. The head and trunk positions were correctly detected: the positional data from the trunk had 99% agreement, and the data from the head had 96% agreement. Both the young adults and children were observed to spend time with the head–trunk in asymmetric positions; however, the subjects changed position frequently so the asymmetrical postures were mobile. We concluded that the proposed monitoring system is a reliable and valid approach for assessing head–trunk symmetry during sleep at home.

• Implications for Rehabilitation

• We propose a head and trunk symmetry monitoring system using accelerometers.

• The proposed system could accurately identify head and trunk position.

• Asymmetrical positioning was seen in healthy participants but it was not immobile.

     

Long sleep duration and afternoon napping are associated with higher risk of incident diabetes in middle-aged and older Chinese: the Dongfeng-Tongji cohort study

Background In this study, we investigated the independent and combined effects of sleep duration and afternoon napping on the risk of incident diabetes among a cohort of middle-aged and older Chinese adults.

Methods Information of sleep and napping was obtained by questionnaires during face-to-face interviews. We categorized sleep duration into?<7?h, 7～<8?h (reference), 8～<9?h, 9～<10?h, and?≥?10?h. Afternoon napping was divided into no napping (0?min) (reference), 1–30?min, 31–60?min, 61–90?min, and?>?90?min. Cox proportional hazard regression models were used.

Results Compared with referential sleeping group, subjects sleeping?≥10?h had a 42% higher risk of developing diabetes. The HR was 1.28 for napping?>?90?min when compared with no napping. These associations were more pronounced in individuals without hypertension. Combined effects of long sleep duration and afternoon napping were further identified. Individuals with both sleep duration?≥?10?h and napping?>?60?min had a 72% higher risk of incident diabetes than those with sleeping 7～<8?h and napping 0?min (all above p?Conclusions Both long sleep duration and afternoon napping were independently and jointly associated with higher risk of incident diabetes.

• Key messages

• Sleep duration was associated with diabetes, but whether it is a real cause of incident diabetes especially in Chinese still remains to be elucidated.

• The association of afternoon napping and diabetes was not consistent and definite, we clarified this association in a large prospective study.

• Long sleep duration and afternoon napping were independently and jointly associated with higher risk of incident diabetes.

     

Nighttime sleep duration and risk of nonalcoholic fatty liver disease: the Dongfeng-Tongji prospective study

Background: To examine the association between self-reported nighttime sleep duration and nonalcoholic fatty liver disease (NAFLD) risk by comparing the incidence rates of NAFLD among healthy subjects with different sleep duration during the 5 years follow-up.

Methods: 8965 eligible NAFLD-free subjects with a mean age of 61.6 years (males, 43.4%) from Dongfeng-Tongji cohort study at baseline were enrolled in the study. Logistic regression analysis was used to estimate the association between sleep duration and incident NAFLD with potential confounders adjusted. Sleep duration was categorized into five groups:?<6?h, 6–7?h, 7–8?h, 8–9?h,?≥9?h.

Result: During the 5-years of follow-up, a total of 2,197 participants were newly diagnosed as NAFLD. Compared with those reported 7–8?h per day of nighttime sleep, the multivariable-adjusted odds ratio (95% confidence intervals) were 1.21 (1.07–1.38) for those who sleep 8–9?h/day, and 1.31 (1.13–1.52) for those who sleep over 9?h/day. However, no significant association was found with short nightly sleep duration (<7?h/day).

Conclusion: Long nighttime sleep duration was associated with a modestly increased risk of NAFLD in a middle-aged and elderly Chinese population.

• Key messages

• Long nighttime sleep duration was associated with a modestly increased risk of NAFLD in a middle-aged and elderly Chinese population.

• The effect of long nighttime sleep on the risk of incident NAFLD was attenuated greatly by body mass index (BMI) in men.

     

Emergency Incident Rehabilitation: Resource Document to the Position Statement of the National Association of EMS Physicians

Position Statement: Emergency Incident Rehabilitation

The National Association of EMS Physicians® believes that:

• Emergency operations and training conducted while wearing protective clothing and respirators is physiologically and cognitively demanding.

• The heat stress and fatigue created by working in protective clothing and respirators creates additional risk of illness/injury for the public safety provider.

• Emergency incident rehabilitation provides a structured rest period for rehydration and correction of abnormal body core temperature following work in protective clothing and respirators.

• Emergency incident rehab should be conducted at incidents (e.g. fireground, hazardous materials, and heavy rescue emergencies) and trainings involving activities that may lead to exceeding safe levels of physical and mental exertion.

• Emergency incident rehabilitation is incident care, not fitness for duty, and meant to reduce physiologic strain and prepare the responder to return to duty at the current incident and for the remainder of the shift.

• EMS should play a role in emergency incident rehabilitation with providers trained to understand the physiologic response of healthy individuals to environmental, exertional, and cognitive stress and implement appropriate mitigation strategies.

• An appropriately qualified physician should have oversight over the creation and implementation of emergency incident rehabilitation protocols and may be separate from the roles and responsibilities of the occupational medicine physician.

• There are no peer-reviewed data related to cold weather rehabilitation. Future studies should address this limitation to the literature.

     

Sleep and physical activity: a survey of people with inflammatory arthritis and their engagement by health professionals in rheumatology in Ireland

Purpose: Sleep is important in maintaining the body’s circadian rhythm and in maintaining health. Aim was to investigate sleep and physical activity among people who have inflammatory arthritis and their engagement with Health Professionals.

Materials and methods: Members from a national charitable organisation for patients with arthritis and a national rheumatology health professionals society were invited to participate in separate cross-sectional surveys hosted on SurveyMonkey^(R)TM.

Results: Ninety people responded and report an average of 5.7 (SD 1.46) hours sleep per night. A majority (61%) report their sleep quality as bad, with 31% taking medications at least once a week to help sleep. There was a statistically significant association between longer years with symptoms, taking medication at least once a week and limited in their activities, when rating their sleep quality as bad. Twenty eight (65%) health professional’s responded with 53% discussing sleep with their patients.

Conclusions: People with inflammatory arthritis report low sleep with those having symptoms longer, taking medications regularly and having limitations with their activities, reporting poorer sleep quality. Only half of health professionals discuss sleep. More research is needed in investigating poor sleep quality, disturbances, and physical activity in order to promote health and well-being in this population.

• Implications for Rehabilitation

• People with inflammatory arthritis fall far below the National Sleep Foundations’ “sleep needs spectrum”, which is concerning as those who have reduced levels of sleep have been associated with decreased quality of life and physical function.

• Due to the importance of receiving sufficient sleep, there is a need to develop education and training for health professionals in the importance of engaging their patients in their sleep quality and disturbances.

• The effects of physical activity interventions on poor sleep need to be examined to show if it is a positive non-pharmacological treatment approach for the management of poor sleep in patients with inflammatory arthritis.

     

Career readiness,developmental work personality and age of onset in young adult central nervous system survivors

Purpose: The primary purpose of this paper is to undertake foundational research in the area of career readiness, work personality and age of onset with young adult central nervous system (CNS) survivors. Method: Participants for this study consisted of 43 individuals whose age range from 18 to 30 (M = 21.64, SD = 3.46), an average age of brain tumor onset of 9.50 years (SD = 4.73) and average years off of treatment of 7.25 years (SD = 5.80). Packets were distributed to survivors who were participating in a psychosocial cancer treatment program. Participants completed multiple career instruments and a demographic form. Differences between groups and among the variables were examined and size effect sizes were analyzed. Results: Young adult CNS survivors had significantly lower levels of work personality and career readiness when compared to young adult non-cancer survivors with CNS cancer with those between the ages of 6 and 12 reported significantly lower levels when compared to individuals diagnosed before age 6 and after the age of 13. Conclusions: Young adult CNS survivors at an increased risk for having lower levels of work personality and career readiness then a norm group comparison. Age of onset (between 6 and 12) may be at significant risk factor for developing poor or dysfunctional work and career behaviors.

Implications for Rehabilitation

• Young adults with central nervous system (CNS) cancer are at particular risk for experiencing difficulties related to career and employment.

• Work personality and career readiness are two constructs that have been found to be related to one’s ability to meet the demands of work.

• Young adult CNS cancer survivors have lower levels of work personality and career readiness.

• Individuals diagnosed between the ages of 6 and 12 may be at particular risk and may need specific vocational rehabilitation interventions.

• The results of this study point to the need for comprehensive career and vocational services for young adult CNS cancer survivors.

     

Exploring predictors of treatment outcome in cognitive behavior therapy for sleep disturbance following acquired brain injury

Purpose: To identify predictors of treatment response to cognitive behavior therapy (CBT) for sleep disturbance following acquired brain injury (ABI).

Methods: Classification and regression tree (CART) analysis was conducted on individual patient data from two pilot randomized controlled trials (RCTs): one in traumatic brain injury (TBI), the other in stroke. The combined sample comprised 32 participants; 15 receiving CBT and 17 allocated to treatment as usual (TAU). The outcome was reliable improvement on the Pittsburgh Sleep Quality Index (PSQI).

Results: Study group was a statistically significant predictor of outcome, with CBT participants more likely to achieve reliable improvements than TAU (OR?=?4.88, p?=?0.042). Study group (CBT vs. TAU) exhibited an area under the ROC curve (AUROC) of 69%. In separate CART analyzes, verbal memory (CVLT-II >45.5), age (<47.5) and baseline depression (HADS-D?>?6) predicted positive outcomes in CBT recipients. Each of these variables added a small (～5%) but not statistically significant amount to AUROC over study group.

Conclusions: In this ABI sample, better memory, younger age, and higher baseline depression were associated with positive treatment response to CBT although individually these variables were not better than group alone in predicting outcomes. The present findings generate hypotheses for further investigation in future studies.

• Implications for rehabilitation

• Cognitive behavior therapy improves sleep quality over treatment as usual in persons with acquired brain injury.

• Individuals who are younger in age with better memory and co-morbid symptoms of depression are more likely to respond to the treatment.

• These findings are based on a small sample and can be considered hypothesis generating for future clinical studies.

     

Post-stroke sexual dysfunction: an overlooked and under-addressed problem

Abstract

Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic and psychosocial causes. Sexual function in post-stroke patients is often disregarded by healthcare professionals although sexuality is a fundamental part of quality of life. Beside pharmacological treatment, one of the most important, but underestimated, success factors of SD therapy is undeniably a proper counseling, which is mandatory to provide correct information on post-stroke sexuality helping the patients and their partners to regain intimacy.

• Implications for Rehabilitation

• Sexuality is an integrant and essential part of QoL, and patient affected by stroke should be investigated and treated for sexual disorders.

• Stroke may alter sexual response by changing the process of sexual stimuli to preclude arousal, decreasing or increasing desire, and curtailing genital engorgement.

• There is a need for a better management of stroke-related problems, including SD, providing the patients and their partner information useful to achieve a better sexual health.

     

Sleep characteristics,exercise capacity and physical activity in patients with chronic fatigue syndrome

Abstract

Purpose: Unrefreshing sleep and lowered physical activity are commonly observed in chronic fatigue syndrome (CFS) patients, but how they might influence each other remains unexplored. Therefore, this study simultaneously examined the exercise capacity, sleep characteristics and physical activity in CFS patients. Methods: Handgrip strength and cycle exercise capacity were assessed in 42 female CFS patients and 24 inactive control subjects. During four consecutive days and nights, energy expenditure, activity and sleep–wake pattern were objectively registered using a Sensewear Armband. Results: Exercise capacity was significantly lower in CFS patients. In both groups VO₂peak correlated with the time subjects were physically active. In CFS patients only, VO₂peak correlated negatively with sleeping during the day whilst physical activity level and energy expenditure correlated negatively with sleep latency and lying awake at night. Conclusions: In the present study, CFS patients with higher VO₂peak tend to sleep less over day. Occupation in physical activities was negatively associated with sleep latency and lying awake at night. Increased physical activity potentially has beneficial effects on sleep quality in CFS. However, a close monitoring of the effects of increasing physical activity is essential to avoid negative effects on the health status of patients.

• Implications for Rehabilitation

• Female patients with chronic fatigue syndrome (CFS) have normal sleep latency and sleep efficiency, but sleep more and spent more time in bed as compared to healthy inactive women.

• Female CFS patients have lower exercise capacity, and a lower physical activity level as compared to healthy inactive women.

• CFS patients appear to be more sensitive for sleep quality (sleep latency and lying awake at night), which is associated with a low physical activity level.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

Does the impact of osteoarthritis vary by age,gender and social deprivation? A community study using the International Classification of Functioning,Disability and Health

Abstract

Purpose: The aim of the study was to explore if the impact of osteoarthritis varies with respect to age, gender and social deprivation. Impact was defined as impairment, activity limitations and participation restriction (International Classification of Functioning, Disability and Health (ICF)). Investigating the functioning of the ICF model for subgroups is important both practically and theoretically. Method: The sample comprised a community sample of 763 people diagnosed with osteoarthritis. Uncontaminated measures of the ICF constructs were developed using discriminant content validity from a pool of 134 items, including the WOMAC and SF-36. Multigroup Structural Equation Modelling was used to explore if the same pathways exist for subgroups of gender, age and social deprivation. Results: Different significant paths were found for gender and social deprivation: impairment did not predict participation restriction for women and those most deprived, whereas these paths were significant for men and those less deprived. No difference in the paths was found for age. Conclusions: The impact of osteoarthritis appears to vary with respect to gender and social deprivation but not age. This suggests both that osteoarthritis per se does not adequately explain the health outcomes observed and that different clinical approaches may be appropriate for people of different gender and levels of deprivation.

• Implications of Rehabilitation

• The ICF model appears to vary with respect to gender and social deprivation for people with osteoarthritis.

• The ICF model did not appear to vary with respect to age for people with osteoarthritis.

• Different treatments and interventions for osteoarthritis may need to be targeted for specific gender and social deprivation groups.

     

Perspectives of optic nerve prostheses

A number of projects exist that are investigating the ability to restore visual percepts for individuals who are blind through a visual prosthesis. While many projects have reported the results from a technical basis, very little exists in the professional literature on the human experience of visual implant technology. The current study uses an ethnographic methodological approach to document the experiences of the research participants and study personnel of a optic nerve vision prosthesis project in Brussels, Belgium. The findings have implications for motivation for participating in clinical trials, ethical safeguards of participants and the role of the participant in a research study.

• Implications for Rehabilitation

• Rehabilitation practitioners are often solicited by prospective participants to assist in evaluating a clinical trial before making a decision about participation. Rehabilitation professionals should be aware that:

• The decision to participate in a clinical trial is ultimately up to the individual participant. However, participants should be aware that family members might experience stress from of a lack of knowledge about the research study.

• The more opportunities a participant has to share thoughts and feelings about the research study with investigators will likely result in a positive overall experience.

• Ethical safeguards put in place to protect the interests of an individual participant may have the opposite effect and create stress.

• Rehabilitation professionals can play an important role as participant advocates from recruitment through termination of the research study.

• Participant hope is an important component of participation in a research study. Information provided to participants by investigators during the consent process should be balanced carefully with potential benefits, so it does not destroy a participant’s hope.

     

Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study

Abstract

Introduction This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study.

Method A total of 1,035 patients participated. ARES^TM score?≥6 defined high OSA risk. Moderate depression was defined by a CES-D score?≥16. Moderate anxiety was measured by a BAI score?≥16.

Results The mean age was 62?±?14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02–2.98, p?< 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11–5.15, p?< 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04–1.09, p?< 0.05), but depression was no longer significant.

Conclusion Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA.

• Key messages

• This study assessed associations of moderate to severe depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks with metabolic syndrome.

• Patients with depression had nearly two-fold increased odds of being at risk for OSA.

• Patients with anxiety had three-fold increased odds of being at risk for OSA.

     

Assessment of organizational readiness for e-health in a rehabilitation centre

Purpose: The aims of this study were to assess organizational readiness for e-health among the staff of an out-patient rehabilitation centre and to identify the personal characteristics of potential users that may have influenced readiness. Methods: A cross-sectional study was conducted with 137 clinicians, 28 managers, and 47 nonclinical staff in a rehabilitation centre in Montreal, Quebec, Canada. All participants completed a self-administered questionnaire assessing organizational readiness for e-health. The measure contained three subscales: Individual, Organizational and Technological. Data were also collected on the users’ profile, use of technologies and typical response to new information. Results: Generally, participants considered themselves ready to adopt e-health in their work (X?=?73.8%, SD?=?8.5) and they also had a favorable view of the technologies in place (X?73.8%, SD?=?7.2). However, they perceived the center as being only moderately ready (X?66.6%, SD?=?9.8) for e-health changes. Perceived workload and position/duties in the organization were found to have an impact on readiness for e-health. Conclusions: These results underscore the importance of addressing organizational readiness for change as a multidimensional concept. Based on these results, implementation strategies tailored to the specific profile of a rehabilitation organization were identified.

Implications for Rehabilitation

• The use of e-health, or the application of information and communications technologies (ICT) in the health sector, is growing in rehabilitation but its implementation can be challenging.

• Assessing a rehabilitation facility’s readiness for change reduces the risk of implementation failure of ICT.

• This study revealed personnel of an out-patient rehabilitation facility perceive themselves as being more ready than their organisation to adopt ICT.

• The influence of personal factors of potential users must be considered when planning and implementing ICT projects.

• ICT implementation requires strategies tailored to the organization and to the individuals who support it.

     

Self-rated disability,fear-avoidance beliefs,nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients

Abstract

Purpose: The influence of self-rated disability and fear-avoidance beliefs on whiplash sufferers in their performance of active ranges of motion has not been studied well. We undertook a cross-sectional study to determine this. Methods: Chronic whiplash subjects completed a standard clinical examination. They completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK) and pain visual analog scale (VAS). Active ranges of motion (goniometer) and cervical nonorganic simulation signs (C-NOSS) were obtained by the examiner. Univariate and multivariable analyses were conducted on these scores. Results: Sixty-four subjects (37 female) with a mean age of 41.4 (SD 16.1) years completed all scores. NDI, pain VAS and C-NOSS correlated significantly with ROM. In a multivariable model, only the NDI score contributed significantly to the variance of the ROM scores (14%). Conclusion: As chronic whiplash sufferers perform ROM in a clinical examination, these ranges are importantly influenced by their self-perceived disability. Cervical nonorganic simulation signs can be helpful in distinguishing high from very high levels of disability and motion restriction. The lack of correlation with the TSK may present a challenge to the Fear Avoidance Model in whiplash.

• Implications for Rehabilitation

• Self-ratings of disability in chronic whiplash sufferers are influenced by their fear-avoidance beliefs.

• While self-ratings of disability are known to predict chronicity of whiplash, there is less known about how these ratings affect impairment assessment during recovery.

• This study shows that self-ratings of disability influence the presentation of impairment by chronic whiplash sufferers with respect to their ranges of neck motion.

• Signs of nonorganic behavior also influence ranges of motion and self-ratings of disability.

• These findings should be incorporated into the interpretation of impairment findings in chronic whiplash sufferers in order to improve management.

     

Self-management of stress urinary incontinence: effectiveness of two treatment programmes focused on pelvic floor muscle training,one booklet and one Internet-based

Abstract

Objectives: In a previous study, self-management of stress urinary incontinence (SUI), via an Internet-based programme or a booklet improved symptoms and quality of life. We wanted to evaluate the effectiveness of these programmes when implemented for free use, as well as to characterize the users.

Design: Pragmatic prospective cohort study.

Setting and subjects: Information about the Internet programme and the booklet was provided at www.tät.nu and by nurse midwives. Both programmes included a three-month pelvic floor muscle training (PFMT) programme. Questionnaires were used at the start and after three months.

Main outcome measures: Characteristics of the participants regarding age and education. Reductions in symptom severity was measured using the validated ICIQ-UI SF.

Results: 109 women using the booklet, and 166 women using the Internet-based programme responded to the pre-treatment questionnaire. Of these, 53 (48.6%) in the booklet group and 27 (16.3%) in the Internet group responded to the follow-up. The mean age of booklet users was higher, 59.4 years vs. 54.5 years (p?=?.005). The proportion of women with post-secondary education was high, 59% in the booklet group and 67% in the Internet group. The mean reduction in the symptom score was 2.6 points (SD 3.4) in the booklet group, and 3.4 (SD 2.9) in the Internet group. These reductions were significant within both groups, with no difference between the groups, and in the same order of magnitude as in the previous randomised controlled study.

Conclusion: Two self-management programmes for SUI, one provided as a booklet and one as an Internet-based programme, also rendered clinically relevant improvements when made freely available.

• KEY POINTS

• Female stress urinary incontinence can be treated using self-management programmes focused on pelvic floor muscle training. This study evaluates the effect of two different programmes, one provided as a booklet and one Internet-based, when made freely available to the public.

• ?Both programmes rendered clinically relevant improvements, in the same order of magnitude as in the previous randomised controlled study.

• ?Self-management of stress urinary incontinence should be recommended to women that request treatment.