A qualitative exploration of the impact of a 12-week group exercise class for those moderately affected with multiple sclerosis

Purpose: The evidence base to support therapeutic exercise for people with multiple sclerosis (MS) is improving; however few studies have considered the patients’ perspective. This study aimed to explore the experiences and views of people moderately affected with MS following participation in a 12-week exercise programme. Method: Twenty people with MS participated in a group exercise class. Subsequently, four men and ten women took part in one of two focus groups. Semi-structured questions were used to elicit participants’ views on the exercise class, outcomes from exercise and the exercise class and any perceived facilitators or barriers to exercise. Data were analysed using a general inductive method. Results: Benefits to participating in exercise for those with MS included social support and symptom improvement. Psychosocial factors, symptoms and lack of service emerged as exercise barriers. Three inter-related themes emerged; (1) The exercise class developed as a bridge to allow participants to realise, (2) the benefits of the class, helping them to overcome and (3) barriers to exercise. Conclusion: Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.

Implications for Rehabilitation

• People moderately affected with multiple sclerosis (MS) feel group exercise offers symptom improvement and social benefits.

• MS-related symptoms and a lack of service options may prevent those with MS exercising.

• Physiotherapists should work alongside exercise professionals to establish exercise services for those with MS.

     

“I refer to them as my colleagues”: the experience of mutual recognition of self,identity and empowerment in multiple sclerosis

Abstract

Purpose: To explore how persons with multiple sclerosis (MS) experience participating in inpatient rehabilitation, and how it might provide psychosocial benefits. Method: Ten participants with MS who had completed inpatient rehabilitation in Norway and on Tenerife participated in two focus groups. A semi-structured interview protocol was used. Data were analyzed using qualitative content analysis informed by a phenomenological perspective. Results: During inpatient rehabilitation participants shared experiences with symptoms of the disease, of social stigma and coping strategies. They communicated experiences of living with MS and they created a sense of community, they became “colleagues”. This experience gave rise to mutual recognition of ability, impairment, self and identity, and thus facilitated personal empowerment to counteract social stigma through adequate coping strategies. Conclusion: Participating in inpatient rehabilitation gave people with MS the possibility to exchange information and communicate strategies for coping with the disease-related conditions and societal demands. They established social relations recognizing each other’s resources. Participants felt equipped to make decisions and to mobilize individual and collective resources. Recognition of the individual with both ability and impairment can be a key to empowerment.

• Implications for Rehabilitation

• In multiple sclerosis (MS), the clinical symptoms and the unpredictability of the disease may have consequences for how patients relate to self and to others, and hence how they perform socially.

• Stigmatization is commonly experienced among people with MS.

• The recognition experienced from peers create a sense of community.

• We recommend health care professionals to acknowledge the importance of peer support for self, identity and empowerment in MS.

     

Maximal and submaximal aerobic tests for wheelchair-dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation

Purpose: To summarize the available maximal and submaximal aerobic exercise tests for wheelchair-dependent persons with a spinal cord injury (SCI) and to identify useful applications for clinical rehabilitation.

Method: The databases of PubMed, CINAHL^®, EMBASE, and PsycINFO^® were searched for English-language studies published prior to March 2015. Two independent raters identified and examined studies that reported on laboratory-based aerobic exercise tests in persons with an SCI, according to the PRISMA statement.

Results: The test protocols of maximal (n?=?105) and submaximal (n?=?28) exercise tests, covered by 95 included studies, were assessed. A large variety in patient characteristics, test objectives, test protocols, exercise modes, and outcome parameters was reported. Few studies reported on adherence to recommendations, adverse events, and peak outcome validation.

Conclusions: An incremental test protocol with small, individualized, increments per stage seems preferable for testing maximal aerobic capacity, but additional validation of the available test modes is required to draw conclusions. Submaximal testing is relevant for assessing the performance at daily life intensities and for estimating VO_2peak. Consensus regarding reporting test procedures and outcomes needs to be achieved to enhance comparability of rehabilitation results.

• Implications for Rehabilitation

• Regularly testing the cardiovascular capacity during SCI rehabilitation will enable us to monitor the impact of rehabilitation interventions on an individual level.

• The incremental arm ergometry test with small increments per stage is most relevant for the assessment of the peak cardiovascular capacity.

• For the assessment of daily life functioning, the submaximal wheelchair ergometer test is preferable.

• Hand cycling is a promising exercise mode for both testing and training.

• Systematically reporting on test termination, criteria for attaining valid peak outcomes and adverse events is necessary to enhance comparability of results.

     

Further validation of the Multiple Sclerosis Self-Efficacy Scale

Abstract

Purpose: This study examined the factorial and construct validity of the Multiple Sclerosis Self-Efficacy (MSSE) Scale in two samples of people with multiple sclerosis (MS). Method: Two samples (n's?=?292, 275) of participants with MS were recruited from across the United States. Participants in both studies completed a questionnaire battery that included the MSSE and measures of symptoms, dysfunction, disability, psychosocial aspects, mental/emotional well-being, and quality of life. Factorial validity was tested using confirmatory factor analysis (CFA), whereas construct validity was examined based on bivariate correlations with scores from other measures. Results: The two-factor measurement model provided a poor fit for the 18 items on the MSSE in both the samples. This model provided a good fit for a modified, 10-item scale in both samples. The 10-item version of the MSSE was highly correlated with the original MSSE (r?=?0.97, p?<?0.001) and related constructs (e.g. disability, r?=?0.69, p?<?0.0001). The standardized Cronbach's αs of the two subscales (function and control) of the 10-item version ranged between 0.78 and 0.94 for both samples. Conclusions: Scores from the modified, 10-item version of the MSSE provide a valid and reliable measure of MS-specific self-efficacy among persons with MS.

• Implications for Rehabilitation

• The importance of self-efficacy in managing the consequences of multiple sclerosis (MS) has increased.

• The Multiple Sclerosis Self-Efficacy (MSSE) Scale was developed and validated for measuring self-efficacy in function maintenance and control over MS from patients' perspectives. In the past almost 20 years, this scale has not undergone additional validation of its factor structure and construct validity in large-scale samples of persons with MS.

• The original two-factor construct did not provide a good fit for the 18 items on the MSSE in two independent samples. We modified the MSSE and found the 10 items fitted by the two-factor construct well with one sample and demonstrated cross-validity of the 10 items in the second sample.

• The 10-item version of the MSSE has good reliability and construct validity in both independent samples. Researchers and clinicians should adopt these 10 items when examining MS self-efficacy of patients.

     

Piloting an email-based resource package for job seekers with multiple sclerosis

Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated.

• Implications for Rehabilitation

• Research indicates a high unemployment rate among working-age adults with MS.

• A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group.

• This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes.

• Work and MS has potential applicability to other disability groups.

     

Reference system of competence and engagement in adapted physical activities of people with recent spinal cord injury

Abstract

Purpose: This study tested whether persons with Recent Spinal Cord Injury (RSCI) who practice adapted physical activities (APA) and those who do not differ with regard to achievement goals, physical self-perceptions, and global self-esteem. Method: Adults with RSCI in rehabilitation centers voluntarily completed questionnaires of achievement goals and self-esteem. Then, based on whether they engaged or not in APA programs, they were considered participants or non-participants in APA. Results: Compared to participants in APA, non-participants were more oriented toward mastery-avoidance goals and had lower scores of physical self-worth and global self-esteem. No differences were found for other achievement goals and for low-level dimensions of physical self. Conclusions: These findings suggest that mastery-avoidance goals are associated with a maladaptive motivational pattern when intrapersonal comparison conveys a threat for the self. Practical implications for rehabilitation programs for persons with RSCI are offered.

• Implications for Rehabilitation

• Adapted Physical Activities (APA) programs are supervised physical activity programs in which the choice of the activity as well as the frequency, the duration, and the intensity of practice are adapted to the inpatients’ capabilities.

• Attempts to master physical activities can be seen as threatening experiences to be avoided by persons with Recent Spinal Cord Injury (RSCI) in rehabilitation centers.

• Comparing one’s capabilities in physical activities with those of other persons with RSCI is not motivationally detrimental with respect to the practice of these activities.

• Upon persons with RSCI’ arrival in rehabilitation centers, physical educators should promote a friendly competitive climate in the practice of APA to help inpatients recover healthy levels of physical self-perceptions and global self-esteem as well as motivation to exercise.

     

Work-related problems in multiple sclerosis: a literature review on its associates and determinants

Purpose: To explore which variables are associated to or determinants of work-related difficulties or unemployment in persons with multiple sclerosis (MS). Method: Papers published between 1993 and February 2015 were included. Quality was judged as poor, acceptable, good or excellent. Determinants were extracted from prospective and retrospective data, associated variables from cross-sectional data; variables were grouped by similarity. Evidence was judged as strong if there were at least two good studies reporting the same results; limited if there was only one good and some acceptable studies. Results: Forty-two papers were selected, for a total of 31?192 patients (75% females). Work-related difficulties were referred as unemployment, lower amount of worked hours or job cessation. Strong evidence of impact over work-related difficulties was found for a core set of variables, i.e. expanded disability status scale, MS duration, patients’ age, fatigue and walking problems. Little evidence exists on the impact of contextual factors. Discussion: Most of the variables identified as associated to or determinants of work-related difficulties can be treated through rehabilitative interventions. It is important that future research addresses not only unemployment issues in MS, but also the amount and severity of problems affecting work-related tasks relying on specific assessment instruments.

• Implications for Rehabilitation

• Multiple sclerosis (MS) affects young persons of working age and limitation in work activities is part of MS-related disability, but they are not consistently addressed in MS research: EDSS, MS duration, patients’ age, fatigue, walking problems, cognitive and neuropsychological impairments were the factors most commonly found as associated to or determinant of difficulties with work.

• Evidence exists that rehabilitation interventions are effective for fatigue, cognitive impairment, mobility and walking difficulties. However, research did not address the impact of rehabilitation programmes on vocational outcomes.

• Rehabilitation researchers should include MS-specific assessment instruments for work-related difficulties to standardised clinical protocols, so that the benefits of rehabilitation on persons’ ability to work can be demonstrated directly: in this way, cost-benefit balance analyses can be added to the evaluation of treatment effectiveness.

     

Commitment to physical activity and health: a case study of a Paralympic Gold medallist

Background: Physical activity has been documented as both beneficial and detrimental for individuals with multiple sclerosis (MS). The varied experience highlights challenges associated with physical activity and MS, requiring a greater understanding of the experiences of exercise for individuals with MS.

Objective: The purpose of this study was to explore how physical activity played a role in the life of a Paralympic Gold medallist. Carol was diagnosed with MS and went onto achieve the highest accolade in Paralympic sport.

Methods: Narrative inquiry, within a single-case design, explored how physical activity played a role in Carol’s life. The narrative was analysed through the lens of a salutogenic framework, which explores how individuals create health despite adverse circumstances.

Findings: Carol’s physical activity pathway explores life before and after her diagnosis, motivations to return to exercise and pathway to Paralympic Gold. Carol’s experiences highlight how physical activity played a role during various stages of her life. Exercise had a significant role in Carol’s life prior to diagnosis, it assisted in the management of MS and she cycled the elite level, winning a Paralympic Gold medal in para-cycling.

• Implications for Rehabilitation

• Physical activity has been reported as beneficial for multiple sclerosis management; however, there can be a fine line between the benefits and an overload that can harm.

• An elite athlete with multiple sclerosis maintained and sustained physical activity to the highest level in elite sport, incorporating a positive health outlook throughout different stages of her life.

• The case highlights how commitment and self-awareness of capabilities and limits may be useful self-management tools in increasing physical activity for individuals living with multiple sclerosis.

     

Maximizing gait and balance: behaviors and decision-making processes of persons with multiple sclerosis and physical therapists

Purpose: To describe the behavioral decisions used by persons with multiple sclerosis (MS) and physical therapists to maximize gait and balance following outpatient physical therapy.

Methods: A multi-method case series with seven matched pairs (persons with MS–physical therapists). Quota sampling maximized variability among persons with MS (disease steps score range 3–6). Three of the four physical therapists were MS or neurology certified. Persons with MS completed a phone survey, follow-up interview, and standardized questionnaires. Physical therapists completed an interview. Data were collected 2–8 weeks following discharge. Content and constant comparison analyses were used for thematic development and triangulation.

Results: Core themes arose exemplifying the decision-making processes and actions of persons with MS (challenging self by pushing but respecting limits) and physical therapists (finding the right fit). One overarching theme, keeping their lived world large, or participation in valued life roles, emerged integrating both perspectives driving decision-making.

Conclusions: Participants have a shared goal of maximizing gait and balance so persons with MS can participate in valued life roles. Understanding the differences in the behavioral decisions and optimizing skill sets in shared decision-making and self-management may enhance the therapeutic partnership and engagement in gait- and balance-enhancing behaviors.

• Implications for Rehabilitation

• Persons with MS and physical therapists have a shared goal of maximizing gait and balance so persons with MS can participate in valued activities and life roles, or more poetically, keep their lived world large.

• Knowledge that persons with MS aim to challenge themselves by pushing but respecting limits can provide physical therapists with greater insight in helping persons with MS resolve uncertainty, set meaningful goals, and build the routines and resilience needed for engagement in gait- and balance-enhancing behaviors.

• Enriching skill sets in shared decision-making, behavior change and self-management may optimize the physical therapist toolbox.

     

Within-session responses to high-intensity interval training in spinal cord injury

Aim: Completion of high-intensity interval training (HIIT) increases maximal oxygen uptake and health status, yet its feasibility in persons with spinal cord injury is unknown.

Purpose: To compare changes in cardiorespiratory and metabolic variables between two interval training regimes and moderate intensity exercise.

Method: Nine adults with spinal cord injury (duration?=?6.8?±?6.2?year) initially underwent determination of peak oxygen uptake. During subsequent sessions, they completed moderate intensity exercise, HIIT, or sprint interval training. Oxygen uptake, heart rate, and blood lactate concentration were measured.

Results: Oxygen uptake and heart rate increased (p?p?>?0.05) to moderate intensity exercise. Peak oxygen uptake and heart rate were higher (p?Conclusions: Despite a higher intensity and peak cardiorespiratory strain, all participants preferred interval training versus moderate exercise. Examining long-term efficacy and feasibility of interval training in this population is merited, considering that exercise intensity is recognized as the most important variable factor of exercise programming to optimize maximal oxygen uptake.

• Implications for Rehabilitation

• Spinal cord injury (SCI) reduces locomotion which impairs voluntary physical activity, typically resulting in a reduction in peak oxygen uptake and enhanced chronic disease risk.

• In various able-bodied populations, completion of high-intensity interval training (HIIT) has been consistently reported to improve cardiorespiratory fitness and other health-related outcomes, although its efficacy in persons with SCI is poorly understood.

• Data from this study in 9 men and women with SCI show similar changes in oxygen uptake and heart in response to HIIT compared to a prolonged bout of aerobic exercise, although peak values were higher in response to HIIT.

• Due to the higher peak metabolic strain induced by HIIT as well as universal preference for this modality versus aerobic exercise as reported in this study, further work testing utility of HIIT in this population is merited.

     

The intention to exercise and the execution of exercise among persons with multiple sclerosis – a qualitative metasynthesis

Purpose: This review was designed as a qualitative metasynthesis aiming to identify factors influencing the intention to exercise and the execution of exercise among persons with multiple sclerosis (PwMS). Method: Based on principles laid out by Sandelowski and Barroso, this qualitative metasynthesis started with a systematic literature search for studies of PwMS’s experiences relating to exercise in the following databases: CINAHL, Rehabilitation and Sports Medicine Source, PubMed, Web of Science and Psychology & Behavioral Science. The metasynthesis procedure also included critical appraisal using the Consolidated Criteria for Reporting Qualitative Research checklist, and integrating synthesis of the articles’ findings. Results: The metasynthesis included nine articles. Factors identified as influencing intention to exercise and the execution of exercise included social support, professional support and outcome expectations. Strong relationships between these three themes were detected for the intention to exercise, the execution of exercise or both among PwMS. Conclusions: The present metasynthesis offers a comprehensive understanding of factors influencing the intention to exercise and the execution of exercise among PwMS. Our findings reveal that health professionals influence the part of the process where PwMS enter the exercise setting, as well as the PwMS’s intention to exercise.

• Implications for Rehabilitation

• Social support, professional support and outcome expectations are potential facilitators and barriers for the intention to exercise and the execution of exercise among PwMS.

• Health professionals specializing in MS rehabilitation can influence the intention and the execution of physical exercise among PwMS when there exists a personal and supportive patient–professional relationship.

• Outcome expectations may impact the motivational and volitional phases of physical exercise.

     

Development of a balance,safe mobility and falls management programme for people with multiple sclerosis

Abstract

Purpose: To utilise stakeholder input to inform the structure, format and approach of a multiple sclerosis (MS) balance, safe mobility and falls management programme.

Materials and methods: Using a three-round nominal group technique, participants individually rated their agreement with 20 trigger statements, followed by a facilitated group discussion and re-rating. Three mixed groups included service users (n?=?15) and providers (n?=?19). Quantitative analysis determined agreement, whilst qualitative responses were analysed thematically.

Results: Median scores for each of the 20 trigger statements did not change significantly over sequential rounds, however, deviations around the medians indicated more agreement amongst participants over time.

Key recommendations were:

Aims and approach: The programme should be tailored to the needs of people with MS. Falls and participation-based outcomes are equally important.

Structure and format: The programme should balance expected burden and anticipated benefit, moving away from models requiring weekly attendance and promoting and supporting self-efficacy.

Optimising engagement: Support to maintain engagement and intensity of practice over the long term is essential.

Sustainability: Adequate funding is necessary. Staff should have MS specific knowledge and experience.

Conclusions: Participants collaboratively identified critical components of a MS balance, safe mobility and falls management programme. They also highlighted the importance of a collaborative, user-centred, MS-specific approach.

• Implications for Rehabilitation

• People with multiple sclerosis need condition-specific interventions focussed on maximising balance and safe mobility and reducing falls.

• Programme design should support self-efficacy and flexible engagement.

• Adequate support and funding are seen as essential by both service users and providers.

     

Influences on students’ assistive technology use at school: the views of classroom teachers,allied health professionals,students with cerebral palsy and their parents

Abstract

Purpose: This study explored how classroom teachers, allied health professionals, students with cerebral palsy, and their parents view high-tech assistive technology service delivery in the classroom.

Methods: Semi-structured interviews with six classroom teachers and six parents and their children were conducted. Additionally, two focus groups comprising 10 occupational therapists and six speech pathologists were carried out. Ethical and confidentiality considerations meant that the groups were not matched.

Results: Results revealed that it is often untrained staff member who determine students’ educational needs. The participants’ experiences suggested that, particularly in mainstream settings, there is a need for support and guidance from a professional with knowledge of assistive technology who can also take a lead and guide classroom teachers in how to meet students’ needs. Students’ motivation to use the technology was also found to be critical for its successful uptake.

Conclusions: The study points to the need for classroom teachers to be given sufficient time and skill development opportunities to enable them to work effectively with assistive technology in the classroom. The participants’ experiences suggest that such opportunities are not generally forthcoming. Only in this way can it be ensured that students with disabilities receive the education that is their right.

• Implications for Rehabilitation

• Classroom teachers, allied health professionals, students, parents need ongoing support and opportunities to practise operational, strategic and linguistic skills with the assistive technology equipment.

• System barriers to the uptake of assistive technology need to be addressed.

• To address the lack of time available for training, programing and other support activities around assistive technology, dedicated administrative support is crucial.

• Professional development around the use of the quality low cost ICF-CY checklist is recommended for both school and allied health staff.

     

Experiences of using mobile phones in everyday life among persons with stroke and their families in Uganda – a qualitative study

Aim The aim of this study was to describe the experiences and meaning of using mobile phones in everyday life after stroke, among persons with stroke and their family members. Methods Qualitative semi-structured interviews were conducted among 11 persons with stroke and 9 family members 2 months to 2 years after the stroke. The interviews were analysed by using constant comparative grounded theory (GT) approach. Results Seven categories were identified from the analysis of the participants’ experiences. The mobile phone: (1) as an enabler of communication and connections with other people, (2) a source of inspiration for agency, (3) structuring routine and activities in daily life, (4) as a facilitator of social and economic wellbeing of an individual or family, (5) promoter of belonging and participation in social relationships, (6) facilitator of reintegration to community living and (7) enabler of family members to feel secure. From these categories, a core category emerged: The mobile phone as a “life line” and an extension of the body enabling connection, belonging and agency to act in a complex everyday life situation. Conclusion The study gives support for the possibility of using mobile phones to facilitate change and community integration in the rehabilitation process after stroke.

• Implications for Rehabilitation

• Stroke leads to decreased functioning in everyday life due to impairments, activity limitations and participation restrictions as well caregiver burden.

• Mobile phones seem to be an accessible and affordable technology used in daily life of persons with stroke and family members and connects them to the needed services and social relationships.

• The mobile phone technology reduces resource and infrastructural challenges and increases accessibility to rehabilitation interventions.

• The mobile phone was an important instrument that facilitated the quality of life of persons with stroke and their family members and could increase their participation in rehabilitation interventions.

     

“They don’t understand that we also exist”: South African participants in competitive disability sport and the politics of identity

Purpose: To describe how athletes with disabilities talk about their experiences of participating in competitive disability sport in South Africa.

Method: In-depth semi-structured interviews were conducted with 20 athletes with disabilities. Data were analysed via thematic content analysis using an inductive data driven process.

Results: Participants described their involvement in competitive sport as a positive experience; they described it as a catalyst for the recasting of identities and reframing an understanding of physical impairment, a context for empowerment and resistance of disablist attitudes, and an arena in which a sense of inclusion and belonging is experienced. However, their narratives also lay bare something of the struggle on the part of persons with disabilities to be seen as fully human and reveal how participants reproduce some unhelpful disablist discourses.

Conclusions: There are complex contradictions and cross-currents in the way athletes with disabilities describe their participation in competitive disability sport. These narratives highlight political and ideological tensions about inclusion and representation and remind us of the need to document the experiences of persons with disabilities and the potential dangers inherent in idealizing disability sport.

• Implications for Rehabilitation

• Competitive sport is a useful context for rehabilitation and the empowerment of persons with disabilities.

• Athletes with disabilities say that they are able to resist dominant stereotypes about disability and recast their identities through participation in competitive sport.

• Disability sport seems to provide a setting in which persons with disabilities can reproduce unhelpful disablist discourses.

• There are dangers inherent in idealizing competitive disability sport.

• Even where athletes with disabilities are competing at the highest level and are successful, rehabilitation professionals must be aware of these issues, must be able to listen for experiences of exclusion and low self-esteem, and to engage with athletes on these issues.

     

The efficacy and feasibility of aquatic physiotherapy for people with Parkinson’s disease: a systematic review

Abstract

Purpose: To critically evaluate the literature regarding the efficacy and feasibility of aquatic physiotherapy in people with Parkinson’s disease.

Method: Relevant studies were identified through searches in nine health-related databases. Two independent reviewers assessed study quality using either the PEDro scale or a customised tool for safety and feasibility.

Results: Database searches yielded 88 articles, of which 10 met the inclusion criteria. Studies varied greatly in methodology, quality, interventions and outcome measures. Study quality was generally low in items reporting on safety precautions, adverse events, attrition, and adherence. Results suggest that aquatic physiotherapy may have a positive effect on motor symptoms, quality of life and balance.

Conclusions: Aquatic physiotherapy may improve aspects of motor performance, quality of life and balance in people with Parkinson’s disease, however, it remains unclear whether it is a safe and feasible treatment modality. The development of standardised outcome measures for people with Parkinson’s disease (unified Parkinson’s disease rating scale and Parkinson’s disease questionnaire-39) would aid study comparability and validate study outcomes. As safety criteria was grossly underreported, guidelines for mandatory reporting of safety criteria are essential to make conclusions regarding the feasibility of aquatic physiotherapy for people with Parkinson’s disease.

• Implications for Rehabilitation

• Aquatic physiotherapy may be a beneficial treatment modality for people with Parkinson’s disease.

• A minimum data set that includes the unified Parkinson’s disease rating scale and Parkinson’s disease questionnaire 39 is required to aid future meta-analysis and to allow more definitive conclusions to be made regarding aquatic physiotherapy for people with Parkinson’s disease.

• People with Parkinson’s disease are a vulnerable population, where safety within an aquatic physiotherapy program needs to be well documented and addressed.

     

The potential impact of intelligent power wheelchair use on social participation: perspectives of users,caregivers and clinicians

Purpose: To explore power wheelchair users’, caregivers’ and clinicians’ perspectives regarding the potential impact of intelligent power wheelchair use on social participation. Methods: Semi-structured interviews were conducted with power wheelchair users (n?=?12), caregivers (n?=?4) and clinicians (n?=?12). An illustrative video was used to facilitate discussion. The transcribed interviews were analyzed using thematic analysis. Results: Three main themes were identified based on the experiences of the power wheelchair users, caregivers and clinicians: (1) increased social participation opportunities, (2) changing how social participation is experienced and (3) decreased risk of accidents during social participation. Conclusion: Findings from this study suggest that an intelligent power wheelchair would enhance social participation in a variety of important ways, thereby providing support for continued design and development of this assistive technology.

• Implications for Rehabilitation

• An intelligent power wheelchair has the potential to:

• Increase social participation opportunities by overcoming challenges associated with navigating through crowds and small spaces.

• Change how social participation is experienced through “normalizing” social interactions and decreasing the effort required to drive a power wheelchair.

• Decrease the risk of accidents during social participation by reducing the need for dangerous compensatory strategies and minimizing the impact of the physical environment.

     

Conceptualizing participation in context for children and youth with disabilities: an activity setting perspective

Abstract

This article considers the conceptualization, operationalization and implications of “activity settings” for research on the recreation and leisure participation of children and youth with disabilities. Activity settings are contextualized settings that situate child and youth activities and their participation experiences. We discuss activity settings as an important construct for considering environmental qualities that provide opportunities for beneficial participation experiences for children and youth with disabilities. The article considers existing research using the concept of activity settings, the conceptualization of environment and contemporary issues in the measurement of participation and environment, indicating how these are addressed by an activity settings approach. We then describe the development of two quantitative measures of recreation and leisure activity settings – one assessing environmental qualities and the other assessing youth experiences – that have the potential to inform researchers, managers and clinicians about relationships between environmental qualities and participation experiences. Finally, we consider the implications of an activity settings approach for research, theory building and clinical practice.

• Implications for Rehabilitation

• An activity setting perspective can enhance understanding of the recreation and leisure participation of children and youth with disabilities.

• The Measure of Environmental Qualities of Activity Settings (MEQAS) and Self-reported Experiences of Activity Settings (SEAS) provide unique assessments of environmental qualities and experiences from an activity setting perspective.

• Clinicians might use the SEAS alone to understand particular youth experiences in certain types of settings, which may be limiting or facilitating development.

• The combined use of the SEAS and MEQAS can provide experiential profiles linked to activity setting qualities such as structure, type of activity and social partners, providing a valuable source of information about youth programs.

     

Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals

Purpose: To explore perspectives and experiences of people with multiple sclerosis (MS) and health care professionals of mental health support for MS in the UK.

Method: 24 people with MS, 13 practice nurses, 12 general practitioners (GPs) and 9?MS specialist nurses were recruited through community groups and primary care practices across North West England. Semi-structured interviews were conducted, and data analyzed thematically using constant comparative analysis within and across the data sets. The theoretical framework of candidacy was used to interrogate data.

Results: Four themes were identified: candidates for care, management choices, defining roles, and permeability and responsiveness.

Discussion: Candidacy for care, and symptom management, depended on the framing of symptoms through a social or medical model of depression. Normalizing symptoms could prevent help-seeking by patients. Reported referral behavior varied by professional group, based on perceived remit, competency and training needs. GPs were perceived by patients and other professionals as central for management of mental health needs in MS, but may not perceive this role themselves, suggesting a need for increased knowledge, training, and improved access to specialist care.

• Implications for Rehabilitation

• Anxiety and depression are common in people with MS.

• Management of mental health needs in people with MS relies on complex decisions made by both people with MS and health care professionals.

• General practitioners may play a key role in the ongoing management of mental health needs of people with MS.