Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial

BackgroundLifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome.ObjectivesTo examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome.Research design and methodA randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n = 115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects.ResultsWomen in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β = 846, p = .01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β = −0.17, p = .003), and decreased the number of metabolic risks from 4.0 to 3.6 (β = −0.50, p < .001), compared to the usual care group (4.4–4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean = 4.0 vs. 4.6, β = −0.2, p = .02) compared to the usual care group.ConclusionsMotivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.     

Perceived barriers to and facilitators of physical activity in people with knee osteoarthritis: Development of the Evaluation of the Perception of Physical Activity questionnaire

BackgroundThe physical activity (PA) level of individuals with knee osteoarthritis is lower than in the general population. International recommendations recommend a non-pharmacological intervention including a self-management education program, weight loss and an adapted exercise program. However, we have no scale assessing the perceived barriers to and facilitators of PA in this population.ObjectiveWe constructed and validated a self-administered questionnaire assessing perceived barriers to and facilitators of regular practice of PA in people with knee osteoarthritis.MethodsSemi-structured interviews identified 24 barriers and facilitators. We developed a 24-item questionnaire, Evaluation of the Perception of Physical Activity (EPPA) that was completed by 548 individuals with knee osteoarthritis, to assess acceptability, construct validity, internal consistency and convergent validity. Participants also completed the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and International Physical Activity Questionnaire (IPAQ). Reliability and sensitivity to change were evaluated in a second group of 168 people with knee osteoarthritis at a 3-week spa therapy resort.ResultsFactorial analysis identified 17 items grouped into 4 subscales (Barriers, Facilitators, Motivation and Beliefs). The internal consistency was good for Barriers, Facilitators and Motivation subscales (Cronbach α > 0.70) and intermediate for the Beliefs subscale (Cronbach α = 0.64). The EPPA subscale scores were significantly correlated with KOFBeQ and WOMAC scores but not associated with IPAQ physical activity level. Reliability was good for all subscales, with intraclass correlation coefficients > 0.60. A sensitivity to change was found for only the Beliefs subscale, with a moderate effect size.ConclusionsThe EPPA questionnaire has good psychometric properties and can help guide the management of knee osteoarthritis. It can be used in research for evaluating the perception of physical activity.     

Process evaluation of physical activity counselling with and without the use of mobile technology: A mixed methods study

BackgroundA monitoring-and-feedback tool was developed to stimulate physical activity by giving feedback on physical activity performance to patients and practice nurses. The tool consists of an activity monitor (accelerometer), wirelessly connected to a Smartphone and a web application. Use of this tool is combined with a behaviour change counselling protocol (the Self-management Support Programme) based on the Five A's model (Assess–Advise–Agree–Assist–Arrange).ObjectivesTo examine the reach, implementation and satisfaction with the counselling protocol and the tool.DesignA process evaluation was conducted in two intervention groups of a three-armed cluster randomised controlled trial, in which the counselling protocol was evaluated with (group 1, n = 65) and without (group 2, n = 66) the use of the tool using a mixed methods design.SettingsSixteen family practices in the South of the Netherlands.ParticipantsPractice nurses (n = 20) and their associated physically inactive patients (n = 131), diagnosed with Chronic Obstructive Pulmonary Disease or Type 2 Diabetes, aged between 40 and 70 years old, and having access to a computer with an Internet connection.MethodsSemi structured interviews about the receipt of the intervention were conducted with the nurses and log files were kept regarding the consultations. After the intervention, questionnaires were presented to patients and nurses regarding compliance to and satisfaction with the interventions. Functioning and use of the tool were also evaluated by system and helpdesk logging.ResultsEighty-six percent of patients (group 1: n = 57 and group 2: n = 56) and 90% of nurses (group 1: n = 10 and group 2: n = 9) responded to the questionnaires. The execution of the Self-management Support Programme was adequate; in 83% (group 1: n = 52, group 2: n = 57) of the patients, the number and planning of the consultations were carried out as intended. Eighty-eight percent (n = 50) of the patients in group 1 used the tool until the end of the intervention period. Technical problems occurred in 58% (n = 33). Participants from group 1 were significantly more positive: patients: χ²(2, N = 113) = 11.17, p = 0.004, and nurses: χ²(2, N = 19) = 6.37, p = 0.040. Use of the tool led to greater awareness of the importance of physical activity, more discipline in carrying it out and more enjoyment.ConclusionsThe interventions were adequately executed and received as planned. Patients from both groups appreciated the focus on physical activity and personal attention given by the nurse. The most appreciated aspect of the combined intervention was the tool, although technical problems frequently occurred. Patients with the tool estimated more improvement of physical activity than patients without the tool.     

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior

AimThe purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients.BackgroundPhysical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes.MethodsThis quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010–June 2016 (N = 419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined.ResultsYounger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p < 0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n = 1639) or Surveillance (n = 1183). Few were Case Management (n = 46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p = 0.03) and change in Physical activity Knowledge (p < 0.001).ConclusionThis study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.     

Concurrent validity of handheld dynamometer measurements for scapular protraction strength

BackgroundHandheld dynamometers (HHD) provide quick and low-cost assessments of muscle strength and their use has been increasing in clinical practice. There is no available data related to the validity of HHD for this measurement.ObjectiveTo verify the concurrent validity of scapular protraction measurements using an HHD.MethodsIndividuals with traumatic anterior glenohumeral instability were allocated in Instability Group (n = 20), healthy swimmers were allocated in Athletes Group (n = 19) and healthy subjects were allocated in Sedentary Group (n = 21). Concurrent validity was verified by the Pearson correlation test between HHD and isokinetic measurements. The agreement between instruments was verified by Bland–Altman plots, for each of the two HHD positions.ResultsA moderate correlation was observed between seated (r = 0.59) and lying supine HHD (r = 0.54) and isokinetic dynamometer measurements for the all groups. Separated group analysis exhibited a strong correlation between seated HHD and isokinetic dynamometer measurements in the Instability Group (r = 0.80), Sedentary Group (r = 0.79) and Athletes Group (r = 0.76). The Bland–Altman plot showed greater agreement in the seated position than the lying supine position when comparing measurements with the HHD and isokinetic in both the general sample and separated groups.ConclusionThe HHD may be considered a valid tool for assessing scapular protraction muscle strength among healthy athletes, non-athletes and subjects with shoulder instability. We recommend to assess subjects in the seated position and to be aware that the HHD tends to overestimate the peak force, compared with the gold-standard isokinetic dynamometer.     

Complementary therapists’ training and cancer care: A multi-site study

PurposeTo explore professional experience and training of complementary therapists working within cancer care.MethodA Questionnaire survey of complementary therapists practising in three cancer care settings in North West England.ResultsRespondents (n = 51; n = 47 female; mean age 50 years, range 23–78 years) had varied career backgrounds; 24 were healthcare professionals who also practised as complementary therapists (nurse n = 19; physiotherapist n = 3; doctor n = 2) whilst 27 were complementary therapists with no prior healthcare background. Twenty-eight respondents reported working as therapists within a supportive and palliative care setting for over 6 years. Forty-seven respondents had undertaken healthcare-related continuing professional development in complementary therapies, although only just over half of the sample (n = 27) had received cancer-specific training. Cancer-related complementary therapy training related to the adaptation of therapies and comprised predominantly short courses. There was a lack of standardisation in the training received, nor was it clear how many courses were accredited.ConclusionFindings highlight the need for standardisation of training for complementary therapy provision in cancer care and statutory review of continuing professional development within this emerging field.     

Translation of the short version of the Smartphone Addiction Scale into Brazilian Portuguese: cross-cultural adaptation and testing of measurement properties

BackgroundSmartphone use has been constantly increasing. Smartphone addiction can lead to changes in the emotional state and musculoskeletal system of users. To identify smartphone addicts, the Smartphone Addiction Scale-Short Version was developed; however, this scale has not been translated into Brazilian Portuguese and tested for its measurement properties.ObjectiveTo translate and cross-culturally adapt the Smartphone Addiction Scale-Short Version into Brazilian Portuguese; to assess the internal consistency, reliability and construct validity of the scale among university students.MethodsThe cross-cultural adaptation was performed following the guidelines for cross-cultural adaptation of self-report measures, and data were collected via online surveys administered to 59 university students over 18 years of age for test–retest. To test the measurement properties of the final version of the Smartphone Addiction Scale-Short Version, a convenience sample including 130 university students was used.ResultsThe Smartphone Addiction Scale-Short Version showed good reliability for test–retest scores (ICC_3,1 = 0.82; 95% CI = 0.70–0.89) and good internal consistency considering all 10 items (Cronbach's alpha = 0.95). The construct validity was calculated comparing the Smartphone Addiction Scale-Short Version score to data from a questionnaire prepared by the authors of this study, including frequency per day (r = 0.35; p < 0.001), leisure time on the smartphone (r = 0.33; p < 0.001), and time working on the smartphone (r = 0.18; p = 0.04) that were significantly positively associated with higher Smartphone Addiction Scale-Short Version scores. The results show a high prevalence of smartphone addiction among university students (33.1%).ConclusionIt can be concluded that the Brazilian Portuguese version of the Smartphone Addiction Scale-Short Version is a reliable and valid tool for screening smartphone addiction in university students.     

Canadian-French adaptation and test-retest reliability of the leisure time physical activity questionnaire for people with disabilities

ObjectivesThe Leisure Time Physical Activity Questionnaire (LTPAQ) measures the duration of physical activities performed during the past 7 days, and results are expressed in minutes. This study aimed to translate this questionnaire into Canadian-French and to evaluate the content validity and its test-retest reliability in people with physical disabilities.MethodsThe LTPAQ was translated from English to French by forward and backward translation. To assess content validity, 9 adults with physical disabilities read and provided comments regarding the relevance, wording and understanding of the items of the preliminary Canadian-French version of the questionnaire. For test-retest reliability, 37 adults with physical disabilities completed the questionnaire 2 or 3 times at T1 (baseline), T2 (2 days from baseline) and T3 (7 days from baseline). The test–retest reliability was investigated by intra-class correlation coefficients (ICCs), paired t test and Bland and Altman tests.ResultsThe translation and the content validation process resulted in a Canadian-French version of the LTPAQ (LTPAQ-CF). Total LTPAQ-CF scores between T1-T2 and T1-T3 featured strong ICCs, 0.90 and 0.75 (P ≤ 0.01). Paired t tests and Bland and Altman analyses confirmed the good reproducibility of results.ConclusionThe LTPAQ-CF has good test–retest reliability when self-administered or administered by interview to people with physical disabilities.     

Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study

BackgroundPhysical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions.ObjectivesWe examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L).MethodsThis observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes.ResultsWe included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1–4, P < 0.001) and moderate (NIHSS score 5–10, P = 0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (P < 0.001) and was associated with mRS score (P = 0.001) and weakly correlated with EQ-5D-3L score at 6 months (P = 0.032, r = 0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable.ConclusionAA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures.Trial registrationClinicalTrials.gov (NCT00924638).     

Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure: A cross-sectional study

BackgroundHeart failure is associated with high rates of hospitalization and mortality. The majority of patients with heart failure suffer from physical symptoms, and these symptoms are strongly associated with poor health-related quality of life. To improve physical symptoms and health-related quality of life, the modifiable factors associated with physical symptoms need to be examined.PurposeTo examine modifiable psychosocial and behavioral factors associated with physical symptoms and health-related quality of life, and the mediator effects of physical symptoms on the relationships between the modifiable factors and health-related quality of life in patients with heart failure.MethodsData on potential correlates of physical symptoms (i.e., depressive symptoms, perceived control, social support, medication adherence, sodium intake, and self-care management) were collected from 109 patients with heart failure (mean age 58 ± 14 years, 46% male, 89% New York Heart Association class II/III). Data on physical symptoms (Symptom Status Questionnaire-Heart Failure) and health-related quality of life (Minnesota Living with Heart Failure) also were collected. Simple and multiple regression analyses were used to analyze the data.ResultsAmong the potential correlates, depressive symptoms and sodium intake were associated with physical symptoms (F = 11.63, p < .001), and depressive symptoms and perceived control were associated with health-related quality of life (F = 9.917, p < .001). Physical symptoms mediated the relationship between depressive symptoms and health-related quality of life.ConclusionImproving depressive symptoms and eating the appropriate amount of sodium may be primary intervention targets to improve physical symptoms. To improve health-related quality of life, depressive symptoms as well as physical symptoms need to be managed appropriately.     

Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis

ObjectiveTo systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke.MethodsThis meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies.ResultsThree studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD] = −1.89, 95% confidence interval [CI] −2.44 to −1.34; I² 79%, P < 0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD = 3.50, 95% CI −3.45 to 10.45; I² 54.7%, P = 0.32), shoulder flexion (MD = −1.20, 95% CI −8.95 to 6.55; I² 0%, P = 0.76) or wrist extension (MD = −0.32, 95% CI −6.98 to 5.75; I² 38.5%, P = 0.92). No data were available concerning the mobility of other joints.ConclusionThis meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed.Clinical Trial RegistrationPROSPERO (CRD42017078784).     

Limited effect of a self-management exercise program added to spa therapy for increasing physical activity in patients with knee osteoarthritis: A quasi-randomized controlled trial

BackgroundThe efficacy of spa therapy in osteoarthritis (OA) has ever been demonstrated, with a good level of evidence for pain and disability. The effect of a self-management program with spa therapy on physical activity (PA) level has never been demonstrated.ObjectiveThis study aimed to assess, at 3 months, the effectiveness of 5 sessions of a self-management exercise program in patients with knee OA (KOA) who benefit from 18 days of spa therapy and received an information booklet (on proposed physical exercises) on improvement in at least one PA level.MethodsThis was an interventional, multicentre, quasi-randomized controlled trial with a cluster randomized design (1-month period). People 50 to 75 years old with symptomatic knee OA were included in 3 spa therapy centres in France (Bourbon Lancy, Le Mont Dore, Royat). Both groups received conventional spa therapy sessions during 18 days and an information booklet on the benefits of PA practice for KOA. The intervention group additionally received 5 self-management exercise sessions. The main outcome was improvement in at least one PA level according to the International Physical Activity Questionnaire (IPAQ) short-form categorical score (low to moderate or high, or moderate to high) at 3 months. Secondary outcomes were the evolution of PA (MET-min/week), disability, pain, anxiety, depression, self-efficacy, fears and beliefs concerning KOA, barriers to and facilitators of regular PA practice, consumption of painkillers and adherence to physical exercise program at 3 months. Assessors but not participants or caregivers were blinded.ResultsIn total, 123 patients were randomized, 54 to the intervention group and 69 to the control group. Considering the main outcome, at 3 months, 37% of patients in the intervention group showed improvement in at least one PA level according to the IPAQ categorical score versus 30.4% in the control group (P = 0.44). In the intervention group, 13 (24.1%) patients showed improvement from low to moderate PA level (vs. 8 [11.6%] in the control group), 2 (3.7%) from low to high (vs. 2 [2.9%]) and 5 (9.3%) from moderate to highvs. 11 [15.9%]). Both intervention and control groups showed increased IPAQ continuous scores (MET-min/week) at 3 months, although not significantly. HAD anxiety and depression scores were significantly reduced in the intervention group (P = 0.001 and P = 0.049, respectively) and the perception of PA was better in the intervention than control group for motivation and barriers scores (P = 0.019 and P = 0.002, respectively).ConclusionsThis study showed the lack of impact of a short self-management program on PA level in addition to 18-day spa therapy for KOA, but both intervention and control groups showed improved PA level.     

The validity and reliability study of the Turkish version of the evidence based practice evaluation competence questionnaire

IntroductionIdentifying the competence of nursing students in evidence-based practice in nursing is important in planning education to train nurses to know, apply and improve evidence-based practice.PurposeTo perform a validity and reliability study for the Turkish version of the “Evidence-based Practice Competence of Nursing Students” questionnaire.DesignThis methodological study was conducted with 199 undergraduate nursing students in a university located in eastern Turkey, between April 1 2014 and February 4 2016. Written permission of the authors, relevant institutions and the students' verbal consent were obtained before administering the questionnaire. The Evidence-based Practice Evaluation Competence Questionnaire (EBP-COQ), developed by Ruzafa-Martinez in Spain, was used for data collection. The 5-point Likert-type scale includes 25 items and three subscales.ResultsThe opinions of eight experts were consulted to test content validity, and the content validity index was found to be 0.93. In the factor analysis of the scale, the KMO index was 0.856, and Barlett's sphericity test yielded the results, X² = 2174.93, df = 300 and p = 0.000. Cronbach's alpha coefficient was found to be 0.826. The scale's goodness of fit index (AGFI) is 0.755, and its ratio of chi-square statistic to degrees-of-freedom was (X2/df) 2.416 (X2 = 657.364 df = 272). Its root mean square error of approximation (RMSEA) was 0.076, its Tucker-Lewwas index (TLI) 0.902, and its comparative fit index (CFI) value was 0.926.ConclusionIt was determined that the Turkish version of the scale is a valid and reliable tool for determining the competence of students in evidence-based practice.     

Effect of individualized coaching at home on walking capacity in subacute stroke patients: A randomized controlled trial (Ticaa’dom)

BackgroundThe gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients.MethodsStroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age ≥ 18 years, first ischemic or hemorrhagic stroke, and stroke within < 6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (T0), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1.ResultsEighty-three participants (age: 61y [IQR = 22]; time post-stroke: 2.4 month [IQR = 1.7]; Barthel index: 100[IQR = 5]) were included in the study: (EG, n = 41; CG, n = 42). The difference between the two groups was not significant at T1(418 m [IQR = 165] for the EG and 389 m [IQR = 188] for the CG; P = 0.168) and at T2(425 m [IQR = 121] for the EG vs. 382 m [IQR = 219] for the CG; P = 0.208).ConclusionOur study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. http://ClinicalTrials.gov (NCT01822938).     

Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia. A pilot study

ObjectiveFibromyalgia is a pathological entity characterized by chronic widespread musculoskeletal pain and the presence of “tender points”. It constitutes a significant health problem because of its prevalence and economic impact. The aim of the present study was to determine the therapeutic benefits of low impact aerobic exercise alone or in combination with music therapy in patients with fibromyalgia.MethodsA single-blind randomized controlled pilot trial was performed. Thirty-five individuals with fibromyalgia were divided into three groups: (G1) therapeutic aerobic exercise with music therapy (n = 13); (G2) therapeutic aerobic exercise at any rhythm (n = 13) and (CG) control (n = 9). The intervention period lasted eight weeks. Depression, quality of life, general discomfort and balance were assessed before and after intervention.ResultsAt post-intervention, group G1 improved in all variables (depression (p = 0.002), quality of life (p = 0.017), general discomfort (p = 0.001), and balance (p = 0.000)), while group G2 improved in general discomfort (p = 0.002). The change observed in balance was statistically different between groups (p = 0.01).ConclusionTherapeutic aerobic exercise is effective in improving depression and general discomfort in individuals with fibromyalgia. However, effectiveness is higher when combined with music therapy, which brings about further improvements in quality of life and balance.     

Mass colorectal cancer screening: methodological quality of practice guidelines is not related to their content validity

ObjectivesIt is not clear if good methodological quality in developing practice guidelines (GLs) necessarily leads to valid recommendations that, when implemented, are more likely to improve the balance between benefits and harms/costs. We assessed whether or not there is a link between methodological quality and recommendation validity in GLs for the use of fecal occult blood test (FOBT) as a screening test for colorectal cancer (CRC) in the average-risk population.MethodsWe systematically searched for such practice GLs published in English or in French within the last 7 years. Our inclusion criteria limited the initial 36 GLs to 12. Scores for methodological quality based on the AGREE criteria were attributed to each of these 12 GLs. Likewise, we searched for meta-analysis and other systematic reviews (SRs) addressing the issue, and we selected for inclusion 8 SRs that met basic quality criteria according to the Critical Appraisal Skills Programme (CASP) of the National Health Service of the United Kingdom (NHS). We used the results and conclusions of these 8 SRs to establish the validity of recommendations made in the 12 included GLs.ResultsRegarding methodological quality, the GLs were labeled either “strongly recommend” (n = 3), “recommend with provisos or alterations" (n = 3), “would not recommend" (n = 2), or “unsure” (n = 4). The nine GLs recommending for, as well as the three GLs recommending against, mass-screening are equally valid, because the former base their recommendation on the fact that this can decrease CRC-mortality, whereas the latter base their recommendation on the facts that: (1) this procedure would be too expensive and/or not adapted to their local organization of care, and (2) to a lesser extent, the balance between benefits and harms is not crystal-clear from an individual patient perspective.ConclusionThe fact that the 12 GLs fell short of basic quality criteria confirms many previous observations in various areas of medicine. Because the 12 GLs were found to be equally valid regarding their FOBT-related recommendations, no relation could be found between their methodological quality and their content validity.     

Psychometric comparison of single-item,short, and comprehensive depression screening measures in Korean young adults

BackgroundIntegrating long depression-screening instruments into routine clinical practice and research studies is often impractical, necessitating short-item if not single-item measures with comparable psychometric properties.ObjectiveTo examine whether single-item or short depression-screening measures are comparable to a comprehensive screening measure in reliability (i.e., internal consistency and test–retest reliability) and validity (i.e., convergent, concurrent, and predictive validity) in Korean young adults within a Classical Testing Theory framework.MethodA total of 458 students from six nursing colleges in South Korea completed three depression measures: the 20-item Center for Epidemiologic Studies-Depression screening instrument (CES-D; comprehensive measure); the five-item Profile of Mood States-Brief depression subscale (POMS-B depression subscale; short measure); a single-item Likert measure; and a single-item numeric rating scale. Internal consistency reliability was tested by Cronbach's alpha and item-total correlations; test–retest reliability by intraclass correlation coefficient (ICC); convergent validity by correlation with the CES-D; concurrent validity by the correlation with perceived stress level and sleep quality; and predictive validity by receiver operating characteristic curve to predict the two groups with different depression levels.ResultsThe POMS-B depression subscale was comparable to the comprehensive CES-D scale in internal consistency reliability (alpha = .85); test–retest reliability (ICC = .76); and convergent (r = .81 with CES-D), concurrent (r = .64 with perceived stress level, r = .34 with sleep quality), and predictive validity (area under the curve = .88). The two single-item options were not comparable to the comprehensive CES-D.ConclusionThe short POMS-B depression subscale shows an acceptable balance between practical clinical and research needs and psychometric quality.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

Reliability of the Modified CKCUEST and correlation with shoulder strength in adolescent basketball and volleyball players

BackgroundPhysical performance tests provide a more complete picture of the functional status of the athlete's upper extremity.ObjectivesThe primary purpose was to evaluate the reliability of the Modified Closed Kinetic Chain Upper Extremity Stability Test (MCKCUEST) in adolescent volleyball and basketball players. The secondary objective was to evaluate the relationship between the MCKCUEST and shoulder rotation isometric strength in this population.MethodsSeventy-three healthy basketball (n = 39) and volleyball (n = 34) players participated to establish the reliability and correlations of the MCKCUEST. We used a two-session measurement design to evaluate the reliability of the MCKCUEST. Shoulder rotation isometric strength was performed to determine relationships with the MCKCUEST.ResultsThe intraclass correlation coefficients (ICC_2,1) for intra-session reliability of the MCKCUEST ranged from 0.86 to 0.89, and the between days test–retest reliability (ICC_3,1) was 0.93. The standard error of measurement (1 touch) and the minimal detectable change (3 touches) showed clinically acceptable absolute reliability values. A weak correlation was found between the MCKCUEST power score and shoulder rotation isometric strength (r values between 0.3 and 0.4).ConclusionsResults demonstrated good to excellent relative reliability and clinically acceptable absolute reliability values for the MCKCUEST on adolescent basketball and volleyball athletes. Performances on the MCKCUEST were weakly associated with shoulder rotation strength.