Sitting time and physical activity after stroke: physical ability is only part of the story

Background: Understanding factors that influence the amount of time people with stroke spend sitting and being active is important to inform the development of targeted interventions.

Objective: To explore the physical, cognitive, and psychosocial factors associated with daily sitting time and physical activity in people with stroke.

Method: Secondary analysis of an observational study (n?=?50, mean age 67.2?±?11.6 years, 33 men) of adults at least 6 months post-stroke. Activity monitor data were collected via a 7-day, continuous wear (24 hours/day) protocol. Sitting time [total, and prolonged (time in bouts of ≥?30 minutes)] was measured with an activPAL3 activity monitor. A hip-worn Actigraph GT3X+ accelerometer was used to measure moderate-to-vigorous-intensity physical activity (MVPA) time. Univariate analyses examined relationships of stroke severity (National Institutes of Health Stroke Scale), physical [walking speed, Stroke Impact Scale (SIS) physical domain score], cognitive (Montreal Cognitive Assessment), and psychosocial factors (living arrangement, SIS emotional domain score) with sitting time, prolonged sitting time, and MVPA.

Results: Self-reported physical function and walking speed were negatively associated with total sitting time (r?=???0.354, P?=?0.022 and r?=???0.361, P?=?0.011, respectively) and prolonged sitting time (r?=???0.5, P?=?0.001 and ??0.45, P?=?0.001, respectively), and positively associated with MVPA (r?=?0.469, P?=?0.002 and 0.431, P?=?0.003, respectively).

Conclusions: Physical factors, such as walking ability, may influence sitting and activity time in people with stroke, yet much of the variance in daily sitting time remains unexplained. Large prospective studies are required to understand the drivers of activity and sitting time.     

What are the correlates of cognition and participation to return to work after first ever mild stroke?

Abstract

Background:

The percentage of working age people with mild stroke has risen. Evidence indicates that even mild stroke impact cognition, executive functioning, and daily functioning, consequently affecting participation, quality of life (QoL) and return to work (RTW).

Objectives:

(1) Compare cognition, participation and QoL between people 3 months post-mild stroke who RTW and those who did not; and (2) To determine the correlates of these variables to RTW of participants 3 months post-stroke.

Methods:

We visited at home 163 stroke survivors (117 men, 46 women) 3 months post-mild stroke ranging from 50 to 89 years. Participants who returned to work (n?=?114) and those who did not (n?=?49). Data collection at home included measures for cognitive status (MoCA), executive functions (EFPT, DEX), depression (GDS), participation (RNL), and QoL (SIS recovery).

Results:

Significant differences were found between RTW participants and those who did not RTW in measures of cognition, depression, participation and QoL (t?=?2.36 to ??5.62, P?<?0.022–0.001). No difference was found on age or gender. Stepwise regression showed that significant correlates of RTW were participation (RNL), executive functions (EFPT), and QoL (SIS recovery).

Conclusions:

To enable RTW after mild stroke, participation, executive functions and QoL must be considered in planning interventions.     

Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness

Abstract

Objectives:

To assess whether a weaning protocol reduces the mechanical ventilation (MV) duration compared to physician's judgement-based weaning in neurological patients and to determine whether patient consciousness influences this reduction.

Methods:

A randomised controlled trial was conducted in a neurological intensive care unit (NCU) of a tertiary hospital; 144 patients requiring MV for more than 24?hours were randomly allocated to protocol-directed (intervention) (n?=?71) or physician-directed (control) group (n?=?73).

Results:

The intervention group displayed a significantly shorter median weaning time than the control group (2.00 vs 5.07?days, P?<?0.05). The median MV duration tended to be shorter in the intervention group (10.8 vs 14.2?days, P?=?0.106). The median length of NCU stay was 19.0 and 26.1?days in the intervention and control groups, respectively (P?=?0.063). The median NCU cost was 9.26?×?10⁴ and 12.24?×?10⁴ ¥ in the intervention and control groups, respectively (P?=?0.059). The unsuccessful weaning, ventilator-associated pneumonia (VAP) and mortality rates were similar between the groups. Among conscious patients, the median weaning time (2.00 vs 7.00?days, P?<?0.05) and the median MV duration (8.8 vs 18.0?days, P?=?0.017) were significantly reduced in the intervention group. Among unconscious patients, the intervention group displayed a reduced median weaning time (1.00 vs 3.10?days, P?<?0.05), but not median MV duration (11.6 vs 11.1?days, P?=?0.702), compared to the control group.

Conclusion:

Protocol-directed weaning reduces weaning time, MV duration, length of NCU stay and NCU cost in neurological patients, and these effects are more significant in conscious patients than in unconscious patients.     

Effects of whole body vibration training on people with chronic stroke: a systematic review and meta-analysis

Abstract

Background:

The effects of whole body vibration (WBV) on chronic stroke (CS) patients have been investigated by some previous studies. However, controversy still exists.

Objective:

The objective of this meta-analysis was to review existing studies that assess the effects of WBV training on CS patients.

Methods:

We searched Medline, Web of Science, EMBASE, and the Cochrane Library for papers published between January 2000 and January 2014.The meta-analyses were performed using Review Manage Version 5.2.Weighted mean difference (WMD) or standard mean difference (SMD) and its 95% confidence intervals (CI) were used as summary statistics. Funnel plot was used to assess the publication bias.

Results:

Seven studies with 298 CS patients (159 patients underwent WBV training in experimental group and 139 patients underwent nothing or the same exercise without vibration or with a “placebo” vibrating platform in control group) were included. No significant difference was found in muscle strength (isometric knee extension strength: SMD?=???0.15, 95% CI, ??0.43 to 0.13, P?=?0.30; isometric knee flexion strength: WMD?=???0.05, 95% CI, ??0.13 to 0.03, P?=?0.22), balance (berg balance scale, WMD?=???0.23, 95% CI, ??1.54 to 1.09; P?=?0.74) and gait performance (6-min walk test, WMD?=???50.40, 95% CI, ??118.14 to 17.34; P?=?0.14) between groups. No indication of publication bias was found in the funnel plot.

Conclusions:

WBV training had no beneficial effects in muscle strength, balance and gait performance of CS patients.     

Classifying physical activity research following stroke using the behavioral epidemiologic framework

Abstract

Background:

Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework.

Objective:

To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice.

Methods:

Specific key words were identified and then searched through EBSCOhost, PubMed, and Google Scholar. Physical activity and stroke literature from 2000–2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice.

Results:

A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n?=?141), 11% in Phase 2 (n?=?23), 10% in Phase 3 (n?=?20), 8% in Phase 4 (n?=?15), and 1% in Phase 5 (n?=?3).

Conclusion:

Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.     

Evaluation of brief interventions for managing depression and anxiety symptoms during early discharge period after stroke: a pilot randomized controlled trial

Abstract

Background:

Prevalence estimates for depression and anxiety in individuals post-stroke are approximately 33 and 29%, yet there are few effective preventive interventions. Interventions which commence pre-discharge and continue during the early post-discharge period may support individuals during the critical transition to home adjustment period. This study aimed to evaluate the efficacy of a self-management intervention and a coping skills intervention, compared to usual care, on anxiety and depression post-stroke.

Methods:

A pilot, three-arm randomized trial involving 33 stroke patients (coping skills: n?=?11, self-management: n?=?12, usual care: n?=?10) recruited from an Australian stroke unit. Both interventions were eight 1-hour weekly sessions, with the first two pre-discharge and the remainder at home; targeted both anxiety and depression; and tailored content to individuals. Primary outcome was severity of depressive and anxiety symptoms (measured using Montgomery andÅsberg Depression Rating Scale and Hospital Anxiety and Depression Scale). Secondary measures were: self-efficacy, stroke knowledge, basic and extended activities of daily living, and quality of life. Outcome measures were administered at baseline, one week post-intervention, and at a three month follow-up by a blinded assessor.

Results:

Thirty (91%) participants completed the trial. Immediately post-intervention there was a small improvement in stroke knowledge and a small increase in depression symptoms (on one of the two measures of depression symptoms) in the coping skills group compared to usual care. These differences did not remain significant at the 3-month follow-up, nor were there any other significant differences.

Conclusion:

Neither a coping skills nor self-management intervention reduced anxiety nor depression symptoms early post-stroke more than usual care. Lack of statistical power may have contributed to the non-significant findings in this pilot study.     

Increasing physical activity in stroke survivors using STARFISH,an interactive mobile phone application: a pilot study

Background: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users’ physical activity is visualized by fish swimming.

Objective: To evaluate the potential effectiveness of STARFISH in stroke survivors.

Method: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index.

Results: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group–time interaction). Similar patterns of data and group–time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group–time interactions for other outcome measures.

Conclusion: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.     

Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward

Abstract

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients’ involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients’ experiences and the use of coercion.

Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n?=?685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n?=?19) and after (n?=?46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n?=?685).

Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.

Conclusion: Results suggest that the intervention could decrease the inpatients’ experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.     

Improving Special Olympics volunteers’ self-esteem and attitudes towards individuals with intellectual disability

Background: Information regarding how the Special Olympics programs affect volunteers’ self-esteem and attitudes towards individuals with intellectual disability (ID) is limited. We conducted a quasi-experimental study to address this gap.

Method: The intervention group participants (n?=?120) were Chinese volunteers for the Special Olympics Eunice Kennedy Shriver University Day. They were asked to attend a pre-service training program and provide a half-day service. Results were compared with a control group (n?=?123).

Results: Our findings showed that the volunteers’ self-esteem and attitudes immediately improved after intervention. In addition, change in participants’ self-esteem contributed to their positive attitude change.

Conclusions: The Special Olympics may provide an avenue for promoting the volunteers’ self-esteem and attitudes regarding inclusion towards individuals with ID. Future research should include follow-up tests to examine the lasting effects of intervention.     

Improving arm function in chronic stroke: a pilot study of sensory amplitude electrical stimulation via glove electrode during task-specific training

Abstract

Objective:

To investigate the effects of sensory amplitude electrical stimulation (SES) delivered by glove electrode during task-specific exercise on arm movement, function, and sensation in chronic stroke.

Methods:

The design was an intervention pilot study, pre-test, post-test, follow-up design. The settings used were a university research laboratory and home-based intervention. Participants comprised of 11 individuals with chronic stroke (7.2?±?4.1 years post onset) and moderate arm paresis, 10.82/20?±?2.27 on the Stroke Rehabilitation Assessment of Movement (STREAM) — Arm Subscale. Participants were seven males and four females (mean age: 59 years). Participants were recruited from university-based database. Intervention- Participants engaged in task-specific training at home for 30 min, twice daily, for 5 weeks, while receiving SES via glove electrode. Participants received supervised task practice at least twice during intervention period for 1 hour. Main outcome measures- Jebsen–Taylor Hand Function Test (JTHFT), STREAM — Arm Subscale, Motor Activity Log-14 (MAL-14) — Amount and Quality Subscales, and Nottingham Stereognosis Assessment (NSA).

Results:

Significant changes were found in group mean pre- and post-test comparisons on the NSA (P?=?0.042), MAL amount subscale (P?=?0.047), and JTHFT (with writing item 29 excluded) (P?=?0.003) and in pre-test to follow-up comparisons on NSA (P?=?0.027) and JTHFT (writing item excluded) (P?=?0.009). There was no significant change on the STREAM (P?=?1.0). Individuals with a greater baseline motor capacity determined by STREAM scores (P?=?0.048) and more recent stroke (P?=?0.014) had significantly greater improvements.

Conclusion:

Combining task-specific training with glove-based SES in chronic stroke resulted in changes in arm sensation and function that were maintained at 3-month follow-up.     

Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized,controlled trial

Background: Trunk performance and sitting balance, especially lateral sitting control, are important predictors of functional outcome after stroke. However, no studies have focused only on trunk function in the frontal plane for persons with acute-phase stroke.

Objective: To investigate the effects of lateral sitting training on a tilting platform in persons with stroke.

Methods: An assessor-blinded, randomized, controlled trial was carried out involving inpatients at a stroke rehabilitation center. Patients were allocated to either an experimental group (n?=?15) or a control group (n?=?15). The experimental group sat without leg support on a platform tilted 10° to the paretic side in the frontal plane, while the controls sat on a horizontal platform. Both groups were asked to move their trunk laterally from the paretic side to the nonparetic side. In addition to conventional therapy, this training was performed 60 times/session, with 6 sessions/week. Trunk function was assessed using the Trunk Control Test (TCT), and the ability to move the trunk laterally was evaluated kinematically. Measurements were performed at baseline and after training. Two-way repeated measures analysis of variance was used to test the significance between and within treatments for each dependent variable.

Results: None of the demographic data differed between the groups. After training, a significant improvement was noted in the experimental group compared to the controls in the TCT and the ability for lateral trunk transference (P?<?0.05, 1???β?=?0.98, effect size?=?0.4).

Conclusion: Lateral sitting training on the tilting platform improved the impaired trunk function of persons with stroke.     

The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke

Abstract

Background:

Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke.

Objective:

The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke.

Method:

A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n?=?16) or a Control Group (n?=?15). The intervention included 12?weeks of PFMT.

The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire.

Results:

Thirty participants (median age: 68 years; interquartile range: 60–74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P?<?0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant.

Conclusion:

The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.     

The effects of a short-term memory task on postural control of stroke patients

Abstract

Background:

Many studies have been conducted on the changes in the balance capabilities of stroke patients. However, results regarding the effects of dual-task activities on postural control in these patients have been variable.

Objective:

To evaluate the effects of a short-term memory task on the sway characteristics of stroke patients.

Method:

Center of pressure (COP) fluctuations were measured in three levels of postural difficulty (rigid surface with closed and open eyes and foam surface with closed eyes), as well as two levels of cognitive difficulty (easy and difficult). COP parameters included mean velocity, standard deviation of velocity in both medial–lateral (M.L) and anterior–posterior (A.P) directions, total phase plane portrait, area. Nineteen stroke patients and 19 gender, age, height, and weight matching healthy volunteers participated in this study.

Results:

Our findings indicate that mean velocity (F?=?14.21, P?=?0.001), standard deviation of velocity in both M.L (F?=?17.50, P?=?0.000) and A.P (F?=?11.03, P?=?0.002) directions, total phase plane portrait (F?=?44.12, P?=?0.001), and area (F?=?13.95, P?=?0.01) of center of pressure of patients were statistically greater than normal subjects, while significant interaction of group?×?postural difficulty and postural?×?cognitive difficulty were observed for all parameters of postural sway.

Conclusions:

Different measures of postural sway showed complex response to postural and cognitive difficulties between stroke patients and normals. Cognitive error was not affected by the main effects of group and postural difficulty, while greatly increased at more difficult cognitive task (F?=?75.73, P?=?0.000).     

Cognitive impairments and mood disruptions negatively impact instrumental activities of daily living performance in the first three months after a first stroke

Abstract

Background:

Cognition and mood play crucial roles in post-stroke recovery; however, the stroke literature is unclear as to how impairments in both domains influence performance of instrumental activities of daily living (IADL).

Objective:

(1) Evaluate the extent to which mood and cognition at two weeks post-stroke predict performance three months post-stroke. (2) Assess performance differences in patients with impairments in both cognition and mood to patients with impairments in either cognition or mood.

Methods:

Inpatients with a first-ever ischemic or hemorrhagic stroke were assessed at 2 weeks (n?=?52) and at 3 months (n?=?41) post-stroke. Patients completed a battery of neuropsychological tests, self-report measures and performance-based tests. Cognitive impairments and mood disruptions were assessed at 2 weeks and three months and IADL performance, as assessed by the Executive Function Performance Test, was evaluated at three months.

Results:

Complete data from the 41 patients assessed at both time points were analyzed. Regression analysis showed that composite cognition and composite mood variables at two weeks post-stroke predicted 48% of the variance in IADL performance at three months (F_3,37?=?12.04; adjusted R²?=?0.48, P?<?0.001). Statistically significant differences were found in performance scores for patients with a single impairment (M?=?7.86, SD?=?7.81) and for those with impairments in both mood and cognition (M?=?19.2, SD?=?13.2) (t(39)?=???3.41, P?=?0.008).

Conclusion:

The results of this study suggest that cognitive and mood impairments at two weeks post-stroke are important predictors of performance in complex activities required for full independence at home and should be routinely assessed in stroke rehabilitation.     

Evaluation of self-care skills training and solution-focused counselling for health professionals in psychiatric medicine: a pilot study

Objective: The purpose of this pilot study was to implement and to evaluate a self-care skills training with solution-focused counselling to support psychiatrists in handling their daily work challenges.

Methods: A total of 72 psychiatrists working in a psychiatric clinic were randomised in a single-blind trial to either an intervention group or a control group. Outcomes were measured at baseline and at the end of the training (follow-up 1: after 3 months; follow-up 2: after 6 months). A validated questionnaire including the Perceived Stress Questionnaire, the Copenhagen Psychosocial Questionnaire, Brief Resilient Coping Scale, Self-Efficacy Scale and the Quality of Relationship Inventory was used.

Results: Psychiatrists in the intervention group reached a significant reduction in perceived job stress (p?=?0.01, d?=?0.05), improvements in job satisfaction (p?=?0.02, d?=?0.04), resilience (p?=?0.02, d?=?0.04) and self-efficacy (p?=?0.04, d?=?0.02) from baseline to all follow-ups with no comparable results seen in the control group. Psychiatrists stated an improved quality of physician–patient relationship (e.g. support, conflict management; p?Conclusions: A self-care skills training, including solution-focused counselling, for psychiatrists was associated with significant improvements in perceived stress, job satisfaction, individual protective skills and quality of relationship to patients. This training is suitable to implement as a group training program for psychiatrists.     

Relation between health utility score and physical activity in community-dwelling ambulatory patients with stroke: a preliminary cross-sectional study

Background: The health utility score in patients with stroke relates to physical, psychological, and various other factors. However, the relationship between the health utility score in patients with stroke and objective physical activity has not been clarified.

Objective: To clarify the relation between the health utility score and objective physical activity in community-dwelling ambulatory patients with stroke.

Design: A cross-sectional study.

Method: Patients who received outpatient consultation from a stroke certified nurse after discharge were recruited. We assessed health-related quality of life with the EuroQoL 5-Dimension 3-Level questionnaire and calculated the health utility score. We measured the daily number of steps taken as the index of objective physical activity using an accelerometer.

Results: Twenty-two patients (72.7% men, 69.5 years old) were included. The health utility score was 0.78 ± 0.14. The physical activity value as indicated by the number of steps taken was 6276.3 ± 4640.7 steps. The health utility score showed a significant positive correlation with the number of steps taken (r = 0.466, p = 0.029).

Conclusions: The present study showed that the health utility score correlated significantly with objective physical activity in community-dwelling ambulatory patients with stroke. The more the patients with stroke walked, the higher their health utility score was. Further studies should assess other domains of health-related quality of life to comprehensively verify this relationship.     

Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention

Abstract

Background:

Approximately 800?000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking.

Objective:

The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year.

Methods:

Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n?=?36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis.

Results:

The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation).

Conclusions:

These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.     

The effects of practicing target-shooting sport on the severity of inattentive,hyperactive, and impulsive symptoms in children: a non-randomised controlled open-label study in Denmark

Abstract

Purpose: Target-shooting sport requires mental effort and concentration. Training may reduce inattentiveness and distractibility. There is little knowledge if children with symptoms of attention-deficit/hyperactivity disorder (ADHD) benefit from practicing target-shooting sport.

Materials and methods: Our study aims to investigate this in a non-randomised controlled open-label study of 128 children, 10–14 years of age, with ADHD-symptoms. The intervention-group (n?=?64) practiced target-shooting in local shooting associations once a week for 6 months. The control group (n?=?64) received treatment as usual. Primary outcome: teacher-rated ADHD-RS-IV-total score. Secondary outcomes: (a) parent-rated ADHD-RS-IV-total score; (b) teacher- and parent-rated Strengths-and-Difficulties-Questionnaire (SDQ); (c) self-rated quality of life (KIDSCREEN-27-total score); and (d) four objective measurements of ADHD-symptoms using the QbTest^?. The data were collected at baseline and after 6 months.

Results: When estimating the marginal effect of the intervention on our primary outcome, the teacher-rated ADHD-RS-IV, we found no significant effect (mean change between groups (contrast)=2.23; p?=?0.193). However, we did find significant beneficial effects on four of the eight secondary outcomes, including the parent-rated ADHD-RS-IV-total score (contrast = 4.76; p?=?0.024), the parent-rated SDQ-total score (contrast = 2.09; p?=?0.027), and on the QbTest^? measurements of the Reaction Time Variation (RTVar) (contrast = 36.96; p?=?0.013), and of Omission Errors (contrast = 7.57; p?=?0.019).

Conclusions: Despite the negative result on the primary outcome, the robust findings on these secondary outcomes in this open-label study indicate proof of concept that practicing target-shooting sport may have some beneficial effects on the severity of ADHD-symptoms in children. No adverse events were reported. Randomised trials of this non-pharmacological intervention are needed.     

Effects of weight-shift training on walking ability,ambulation, and weight distribution in individuals with chronic stroke: a pilot study

Background: People with gait difficulties after a stroke usually have an asymmetrical gait and slower gait speed than age-matched controls. These difficulties restrict people with stroke in their daily life activities.

Objective: This pilot study sought to evaluate the effects of weight-shift training on gait, weight distribution in standing, and ambulation in people with gait difficulties after a stroke.

Methods: Ten subjects with chronic stroke (3–11?years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program. Spatial and temporal gait parameters were assessed pre-, post-, and 3-month post-training with a motion analysis system. Weight distribution was assessed with force plates and ambulation with the Swedish version of the Clinical Outcome Variables Scale (S-COVS). Wilcoxon signed-rank tests were used to explore differences between test occasions.

Results: Significant changes were seen between pre-and post-tests in decreased stance time on the non-paretic leg (P?=?0.005) and increased score on the S-COVS (P?=?0.043). At the 3-month follow-up test, the subjects had also increased their gait speed significantly (P?=?0.037). Standing weight distribution did not change between pre- and post-tests (P?=?0.575), but between the pre-and follow-up tests it shifted from the paretic leg to the non-paretic (P?=?0.007).

Conclusion: Weight-shift training seems to improve gait and ambulation in subjects with chronic stroke, but not with standing weight distribution. However, this pilot study has several limitations and a larger sample size with a control group is necessary.     

Going beyond the identification of change facilitators to effectively implement a new model of services: Lessons learned from a case example in paediatric rehabilitation

Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation.

Methods: Over 3 years, different stakeholders responded to SWOT questionnaires (n?=?139) and participated in focus groups (n?=?19) and telephone interviews (n?=?13). A framework based on socio constructivist theories made sense of the data.

Results: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors’ intentions, actions and consequences and their relations with structural elements.

Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.