Effectiveness of pelvic floor muscle training and bladder training for women with urinary incontinence in primary care: a pragmatic controlled trial

Background

Although the efficacy of pelvic floor muscle training (PFMT) and bladder training are well established, there is a paucity of patient centered models using these interventions to treat women with UI at primary level of health assistance in Brazil.

Effects of exercise training in water and on land in patients with COPD: a randomised clinical trial

Objectives

To compare the effects of two similar 6-month protocols of high-intensity exercise training, in water and on land, in patients with chronic obstructive pulmonary disease (COPD).

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 effects of progressive resistance training on daily physical activity in young people with cerebral palsy: a randomised controlled trial

Purpose: To examine if individualised resistance training increases the daily physical activity of adolescents and young adults with bilateral spastic cerebral palsy (CP). Method: Young people with bilateral spastic CP were randomly assigned to intervention or to usual care. The intervention group completed an individualised lower limb progressive resistance training programme twice a week for 12?weeks in community gymnasiums. The primary outcome was daily physical activity (number of steps, and time sitting and lying). Secondary outcomes included muscle strength measured with a one-repetition maximum (1RM) leg press and reverse leg press. Outcomes were measured at baseline, 12?weeks and 24?weeks. Results: From the 36 participants with complete data at 12?weeks, there were no between-group differences for any measure of daily physical activity. There was a likely increase in leg press strength in favour of the intervention group (mean difference 11.8?kg; 95% CI ?1.4 to 25.0). No significant adverse events occurred during training. Conclusions: A short-term resistance training programme that may increase leg muscle strength was not effective in increasing daily physical activity. Other strategies are needed to address the low-daily physical activity levels of young people with bilateral spastic CP.

• Implications for Rehabilitation

• Progressive resistance training may increase muscle strength but does not lead to increases in daily physical activity of young people with bilateral spastic cerebral palsy (CP) and mild to moderate walking disabilities.

• Other strategies apart from or in addition to resistance training are needed to address the low daily physical activity levels of young people with bilateral spastic CP and mild to moderate walking disabilities.

     

Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial

Fatigue is a frequent problem after surgical treatment of solid tumours. Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients. Therefore, we compared the effect of the two therapies on fatigue in a randomised controlled study. Seventy-two patients who underwent surgery for lung (n=27) or gastrointestinal tumours (n=42) were assigned to an aerobic exercise group (stationary biking 30 min five times weekly) or a progressive relaxation training group (45 min three times per week). Both interventions were carried out for 3 weeks. At the beginning and the end of the study, we evaluated physical, cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC-QLQ-30) questionnaire, and maximal physical performance with an ergometric stress test. Physical performance of the training group improved significantly during the programme (9.4±20 watts, p=0.01) but remained unchanged in the relaxation group (1.5±14.8 watts, p=0.37). Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all 0.01); however, there was no significant difference between changes in the scores of both groups (p=0.67). We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours. However, exercise is not better than progressive relaxation training for the treatment of fatigue in this setting.     

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

Background

People with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness.

Objectives

To assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers.

Setting

Community mental health facility in a large regional centre in Central Queensland, Australia.

Design/methods

Community based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers.

Results

Data collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.     

A physical exercise programme for palliative care patients in a clinical setting: Observations and preliminary findings

Abstract

Introduction

Reduced physical function and increased dependency have a significant negative impact on the quality of life of people who are terminally ill. Previous research indicates that participation in physical exercise can reduce distressing symptoms and improve physical functioning and quality of life in palliative care patients with a diagnosis of cancer. We describe the preliminary evaluation of an outpatient rehabilitation and exercise programme implemented in a hospice setting specifically designed for patients with a palliative diagnosis, and aimed at improving and maintaining physical functioning.

Methods

Eligible patients completed a programme of 10 gym-based exercise sessions including exercises to strengthen arms, legs, and core muscles, and to improve balance and cardiovascular fitness. This was further supported by a home-based exercise programme. Assessments of physical performance, fatigue, and quality of life were completed at baseline and immediately post-completion of the exercise programme.

Results

Improvements were observed in physical performance, fatigue, and overall quality-of-life scores post-intervention. There were high levels of attrition and many patients were lost to follow-up.

Discussion

While acknowledging the limitations of our design and small sample size, our findings contribute to the literature around the benefits of exercise for patients receiving palliative care. We recommend that exercise programmes implemented in clinical practice for palliative care patients should be individually tailored and supported by educational initiatives promoting the benefits of exercise to patients, families, and healthcare providers, and promoting early referral. Future work should explore the mechanisms by which such programmes might support improvements in quality of life, and how outcomes may differ for patients with different demographic and disease characteristics.     

Effect of postoperative physical training on activity after curative surgery for non-small cell lung cancer: a multicentre randomised controlled trial

Objective

To evaluate the effect of a combined hospital plus home exercise programme following curative surgery for non-small cell lung cancer (NSCLC).

Design

Randomised controlled trial.

Setting

Teaching hospital.

Participants

One hundred and thirty-one subjects with NSCLC admitted for curative surgery.

Interventions

Participants were randomised to usual care or a hospital plus home exercise programme.

Outcomes

The primary outcome was the between-group difference in physical activity 4 weeks after surgery. Secondary outcomes were the difference in quadriceps strength, exercise tolerance and quality of life [Short Form-36 (SF-36) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-LC13] from pre-operatively (baseline) to 4 weeks after surgery.

Results

The participants (n = 131) had a mean age of 68 [standard deviation (SD) 11] years and mean forced expiratory volume in 1 second of 2.4 (SD 1.1) l. There were no significant differences in physical activity between the groups 4 weeks after surgery [mean difference adjusted for baseline 12 minutes/day, 95% confidence interval (CI) −20.2 to 44.1]. In addition, there were no significant differences in total SF-36 or EORTC QLQ-LC13 scores from baseline to 4 weeks after surgery. Both groups had recovered their pre-operative walking distance 4 weeks after surgery, and there were no differences between the groups (mean difference in Incremental Shuttle Walk Test from baseline to 4 weeks after surgery (−26 m, 95% CI −94.2 to 42.3).

Conclusions

A hospital plus home exercise programme showed little benefit in unselected patients with NSCLC following surgery. Regardless of group allocation, the patients had recovered their pre-operative exercise tolerance levels by 4 weeks after surgery.     

Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial.

Objective

To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain (LBP) in reducing pain and disability.

Design

Randomized controlled trial.

Setting

A physiotherapy outpatient setting in Hong Kong.

Participants

Patients with chronic LBP (N=46) were recruited and randomly assigned to either a control (n=22) or an intervention (n=24) group.

Interventions

An 8-week intervention; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group.

Main Outcome Measures

Visual analog pain scale, Aberdeen Low Back Pain Disability Scale, and physical fitness measurements were taken at baseline, 8 weeks, and 12 months from the commencement of the intervention. Multivariate analysis of variance was performed to examine between-group differences.

Results

Both groups demonstrated a significant reduction in pain (P<.001) and an improvement in disability (P<.001) at 8 weeks and 12 months; however, no differences were observed between groups. There was no significant difference in LBP relapse at 12 months between the 2 groups (χ²=2.30, P=.13).

Conclusions

The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP.     

Long‐term follow‐up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

This study examined long‐term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One‐hundred and twenty‐two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow‐up assessments two‐year post‐treatment were completed by 65 participants. According to per‐protocol analyses, short‐term effects were maintained in both groups for the primary outcome, pain‐related disability. The TT‐group reported lower disability levels compared with the EBT‐group. Intention‐to‐treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self‐efficacy were maintained over the 2‐year post‐treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT‐group, and EBT participants reported higher fear of movement/(re)injury two years post‐treatment compared to TT. The study supports tailoring of treatments in concordance with patients’ needs and preferences of activity goals and functional behavioural analyses including predictors of pain‐related disability, for successful immediate outcomes and their maintenance in the long run. Exercise‐based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2‐year follow‐up period.     

Promoting physical activity among women with mobility impairments: a randomized controlled trial to assess a home- and community-based intervention

OBJECTIVE: To assess the effectiveness of an intervention to promote physical activity and fitness in physically disabled women. DESIGN: Randomized controlled trial. SETTING: Home or community. PARTICIPANTS: Seventy-five adult women with mobility limitations. INTERVENTION: Incorporated behavioral techniques, social support, and education to promote exercise. MAIN OUTCOME MEASURES: Fitness measures included weight, body mass index, resting blood pressure and heart rate, time to complete a mobility course, and heart rate during and blood pressure after navigating the course. Also collected self-reported experience of secondary conditions and weekly self-reports of physical activity. RESULTS: We found no significant fitness differences between groups, except for peak heart rate. However, paired t tests of the physical activity data revealed the experimental group significantly increased its total weekly physical activity minutes (P=.04), and the increase in weekly cardiovascular activity approached significance (P=.06). CONCLUSIONS: The experimental group did not experience better fitness or fewer secondary conditions than the controls. However, the experimental group's physical activity data indicate that this group significantly increased its activity over 6 months. Thus, although this study did not detect health changes, it showed that mobility-impaired women can adopt and maintain a physical activity program.     

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.     

Water-based exercise for cardiovascular fitness in people with chronic stroke: a randomized controlled trial

OBJECTIVE: To evaluate the effect of an 8-week, water-based exercise program (experimental group) with that of an upper-extremity function program (control group) to increase cardiovascular fitness within a community setting for people with stroke. DESIGN: Single-blind randomized controlled trial. SETTING: Public community center. PARTICIPANTS: A volunteer sample of 12 community-dwelling people with stroke with mild to moderate residual motor deficits. INTERVENTION: Study subjects participated in group exercise programs for 1 hour, 3 times a week for 8 weeks. The experimental group exercised in chest-deep water at targeted heart rates. The control group performed arm and hand exercises while sitting.Main outcome measures The primary outcome measure was cardiovascular fitness (V(O2)max). Secondary measures were maximal workload, muscle strength, gait speed, and the Berg Balance Scale score. RESULTS: The experimental group attained significant improvements over the control group in cardiovascular fitness, maximal workload, gait speed, and paretic lower-extremity muscle strength. The relatively short program (8 wk) of water-based exercise resulted in a 22% improvement in cardiovascular fitness in a small group of people with stroke who had relatively high function. CONCLUSIONS: A water-based exercise program undertaken as a group program may be an effective way to promote fitness in people with stroke.     

2型糖尿病患者锻炼自我效能与体育锻炼的相关性研究

目的描述2型糖尿病患者的锻炼自我效能,探讨锻炼自我效能与体育锻炼的相关性。方法采用锻炼自我效能量表和业余体育活动问卷,用方便抽样方法调查117例2型糖尿病患者。结果2型糖尿病患者锻炼自我效能均分为（52．42±18．30）分,患者锻炼自我效能与过去1年平均每周体育锻炼时间呈正相关（r=0．415,P〈0．01）,与过去1年平均每周体育锻炼能量支出呈正相关（r=0．452,P〈0．01）。结论2型糖尿病患者锻炼自我效能处于中等水平,2型糖尿病患者锻炼自我效能越高,过去1年平均每周体育锻炼时间越多,体育锻炼能量支出越多。     

Effects of a postdischarge transitional care programme for patients with coronary heart disease in China: a randomised controlled trial

Aim. To test the effects of a postdischarge transitional care programme among patients with coronary heart disease. Background. Coronary heart disease is a leading cause of death worldwide. Effective postdischarge care can help patients maintain a healthy lifestyle and thereby control the risk factors. Transitional care is under‐developed in mainland China. Design. A randomised controlled trial. Method. The control group (n = 100) received routine care and the study group (n = 100) received the postdischarge transitional care programme, which consisted of predischarge assessment, structured home visits and telephone follow‐ups within four weeks after discharge. Subjects were recruited in 2002–2003, with data collected at baseline before discharge, two days and four and 12 weeks after discharge. Results. Participants in the study group had significantly better understanding in diet, medications and health‐related lifestyle behaviour at day 2 and in weeks 4 and 12 and better understanding in exercise at weeks 4 and 12. There were significant differences between the control and study groups in diet and health‐related lifestyle at day 2 and weeks 4 and 12, in medication at weeks 4 and 12 and exercise at week 12. There was no difference in hospital readmission between the two groups. The study group was very satisfied with the care. There was no difference in willingness to pay for nurse follow‐up services between groups. Conclusion. This study is an original effort to establish and test a nurse‐led transitional care model in China. Results demonstrate that transitional care is effective in mainland China, concurring with studies done elsewhere. Relevance to clinical practice. This study has constructed a transitional care model for patients with coronary heart disease in the context of the Chinese population which is effective in enhancing healthy lifestyle among these patients.     

Effectiveness of a patient-centred,empowerment-based intervention programme among patients with poorly controlled type 2 diabetes: A randomised controlled trial

BackgroundDespite extensive efforts and advances in evidence-based diabetes management, poor glycaemic control still remains a challenge in many countries. There is a paucity of research addressing the needs of patients with poorly controlled type 2 diabetes, or exploring the effectiveness of empowerment-based interventions in this vulnerable population.ObjectivesTo evaluate the effectiveness of a patient-centred, empowerment-based programme on glycaemic control and self-management behaviours among patients with poorly controlled type 2 diabetes.DesignA prospective multi-centre, single-blind, randomised controlled trial.Settings and participantsAdult patients with poorly controlled type 2 diabetes [Haemoglobin A1c (HbA1c) ≥7.5% in the recent six months] were recruited from two tertiary hospitals in Xi’an city, China.MethodsA total of 242 eligible patients were recruited and randomly assigned to the intervention or attentional control groups after baseline measurement. Participants in the intervention group received a 6-week patient-centred, empowerment-based self-management programme, which is theoretically grounded on the principles of the Empowerment Process Model-setting personally meaningful goals, taking action towards goals and reflecting on the impact of action plans. Those in the attentional control group received health education classes and post-discharge follow-up. Outcome measures included glycaemic control (measured by HbA1c) and self-management behaviours. Data were collected at baseline, and at 8th and 20th week after enrolment. Intervention effect were analysed using the generalised estimating equation model on the basis of the intention-to-treat principle.ResultsCompared with the attention control group, the intervention group showed a non-significant HbA1c reduction of 0. 476% (Cohen’s d effect size = 0.31, p = 0.162). The intervention group exhibited significant improvements in general diet management at the 8th-week (β = 0.740; p = 0.013), specific diet management at 8th-week (β = 0.646; p = 0.022) and 20th-week (β = 0.517; p = 0.043), and blood glucose self-monitoring at both the 8th- (β = 0.793; p = 0.009) and 20th-week (β = 0.739; p = 0.017) follow-ups. No intervention-related adverse events were observed.ConclusionsFindings indicate that the patient-centred, empowerment-based self-management intervention program did not induce a significant HbA1c reduction. Whereas this intervention yields improvements in diet management and blood glucose self-monitoring among patients with poorly controlled type 2 diabetes.     

Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up

Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.

Design: Parallel-group controlled pragmatic pilot trial.

Subjects: There was a total of 83 patients with COPD (mean age 70?±?8 years with a forced expiratory volume in first second percent predicted of 60?±?17%). The intervention group (n?=?43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n?=?40) received usual care alone.

Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.

Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR]?=?4.4, P?<?.001), increased conceptual knowledge in five domains (OR = 2.6–4.2, all P?<?.05), and altered disease management strategies (e.g., increased PA) (OR ≥ 2.7 P?<?.05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P?=?.044). Knowledge of PA was correlated with level of PA (ρ?=?.425–.512, P?<?.05) as well as to the use of PA as a strategy to manage their disease (χ²?=?11.2–32.9, P?<?.05).

Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.

• Key points

• Even though self-management strategies are an important part of chronic obstructive pulmonary disease (COPD) management, access to support for such strategies are limited for a large part of the COPD-population.

• Promoting self-management through the COPD Web might increase short-term levels of physical activity, promote conceptual knowledge and alter disease management strategies.

• The primary care COPD population in this study experienced limited impact of the disease in daily life, limited exertional dyspnea, and high generic quality-of-life, but vastly reduced levels of physical activity.

• A future large scale study should include strategies to encourage greater exposures to the COPD Web, including an extended analysis of factors associated with using or not using the tool over time and its impact on outcome measures, objective measures of conceptual knowledge, and physical activity, and it should include a large enough sample size to enable sub-group analyses and strategies to enhance recruitment.

     

Effectiveness of graded activity versus physiotherapy in patients with chronic nonspecific low back pain: midterm follow up results of a randomized controlled trial

Background

Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term.