A small group aerobic exercise programme that reduces body weight is feasible in adults with severe chronic schizophrenia: a pilot study

Purpose.?To evaluate the feasibility and effects of an exercise programme on people with severe, chronic schizophrenia.

Method.?A single-group, pre-post pilot study incorporating a baseline familiarisation phase was followed by a 24-week, small-group aerobic exercise programme for up to 30-min each session, twice a week and a 30-min weekly walking session. Adherence was assessed by attendance, and by analysing the exercise supervisor's comments in a programme diary and in each participant's exercise logbook. Body weight, cardio-respiratory fitness (VO₂ max), walking endurance (6-min walk test) and psychiatric symptoms (the Positive and Negative Syndrome Scale) were measured at each time point.

Results.?Eight participants (6 men, 2 women; mean age 45 years, 9 months (SD 10 years, 1 month); mean body mass index 27.0 (SD 4.2)) attended a mean of 73%% of the scheduled exercise sessions, and 83%% of the walking sessions, with no adverse events and no dropouts. All participants displayed positive and negative behaviours during training sessions. There were significant reductions in weight (2.4%%) and body mass index (2.2%%), but no changes in other measures.

Conclusions.?It was feasible and safe to conduct a small-group aerobic exercise programme for adults with severe chronic schizophrenia that reduced body weight.     

Adaptations to pain rehabilitation programmes for non-native patients with chronic pain

Purpose.?(i) To determine whether adaptations for non-native patients have been implemented in pain rehabilitation programmes; (ii) to determine whether characteristics of the rehabilitation institute are related to having adaptations for non-native patients in place.

Subjects.?Rehabilitation institutes and rehabilitation departments of general hospitals in The Netherlands who offer a pain rehabilitation programme.

Method.?A questionnaire was handed over in person or by e-mail to the rehabilitation physicians of the participating institutes. Twenty-seven (90%%) questionnaires were returned. The questionnaire concerned programme adaptations and institute characteristics. The data were analysed by χ² tests or Fischer's exact tests and logistic regression analysis.

Results.?Twelve institutes (44.4%%) reported having adaptations in place for non-native patients in their pain rehabilitation programme. The most common adaptations were as follows: increased number of consultations (25.9%% of the institutes); longer consultations (25.9%%) and education for employees regarding cultural competency (11.1%%). Institutes which treated a high percentage (≥11%%) of non-native patients had implemented significantly more frequently adaptations to their rehabilitation programme (p == 0.04). The number of adaptations was neither associated with the proportion of non-native citizens in the local population nor with the number of the institutes' employees.

Conclusion.?Less than half of the institutes had implemented one or more programme adaptations for non-native patients. Institutes which had made adaptations to their rehabilitation programme treated more non-native patients.     

Influencing physiotherapy student attitudes toward exercise for adolescents with Down syndrome

Background.?Negative attitudes of physiotherapists may prevent them from implementing exercise as an intervention among people with disabilities. The aim of this study was to examine whether physiotherapy student attitudes towards the barriers to exercise for adolescents with Down syndrome changed as a result of participating in a 10-week exercise programme.

Method.?Data were collected as part of a randomised controlled trial. Twenty physiotherapy students (2 men, 18 women; mean age 19.5±1.3 years) volunteered to act as mentors. Each mentor was matched with an adolescent with Down syndrome from the same metropolitan suburb, who had been randomly allocated to either the intervention or the control group. The 10 adolescents and students in the intervention group all completed a 10-week, twice a week progressive resistance exercise training programme. The 10 adolescents and students in the control group continued with their usual activities. The students completed the 18-item Exercise Barriers Scale at baseline and after 10 weeks.

Results.?There was a positive change in attitudes, significant at the p <0.05 level, favouring the intervention group on 9 of the 18 items on the Exercise Barriers Scale.

Conclusions.?After engagement in a 10-week exercise programme with an adolescent with Down syndrome, physiotherapy students identified fewer barriers that would prevent adolescents with Down syndrome from exercising. Results indicate that contact with adolescents with Down syndrome during clinical placement can positively influence attitudes towards exercise for people with Down syndrome among physiotherapy students.     

The effectiveness of a functional training programme for patients with chronic low back pain – a pilot study

Introduction.?To investigate the effect of an individualised functional training programme for patients with low back pain (LBP).

Methods.?A randomised, controlled trial with single-blind design was conducted. Patients with non-specific LBP for at least 3 months were recruited and randomised into training and control groups. Both groups maintained their current treatment, and the training group participated in an additional programme for 100 h. Measures were performed initially and after completing the programme, and included rating determining impairment associated with pain, Oswestry disability index (ODI) and functional capacity evaluation (FCE).

Results.?Thirteen in the training group completed the training and measurements, and 12 in the control group completed their measurements. Twelve items in FCE had significant improvement in training group, but only one in control group. Severity of pain (11.8 ± 3.6–5.6 ± 3.6), activity limitation from pain (3.2 ± 1.5–1.5 ± 1.1) and emotional disturbance by pain (4.3 ± 1.7–2.2 ± 1.4) significantly decreased in the training group, no significant change in the control group. The ODI demonstrated a significant reduction (p = 0.044) in the training group (22 ± 9–16 ± 9), but not in the control group.

Conclusion.?An individualised functional training programme benefits chronic LBP patients.     

Use of the International Classification of Functioning,Disability and Health to identify preliminary comprehensive and brief core sets for Guillain Barre syndrome

Purpose.?To identify the preliminary comprehensive and brief core sets for Guillain Barre syndrome (GBS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method.?Focus groups and a consensus process were used to identify ICF core sets for GBS. This included: preliminary ICF studies; empirical patient data collection for 77 GBS participants; review of the evidence base and treatment in GBS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results.?The expert consensus selected 99 second level ICF categories (in three rounds) which identify health domains relevant to GBS for multidisciplinary assessment. These domains were consistent with current practice and existing GBS literature. The comprehensive core set includes: 27 (23%%) categories from the component ‘body function’, 7 (12%%) categories from ‘body structures’, 43 (36%%) from ‘activities and participation’ and 22 (29%%) from the component ‘environmental’ factors. The brief set comprised 20 categories, 20%% of categories in the comprehensive core set.

Conclusion.?The core set categories for GBS-related health need to be addressed in multidisciplinary care programs. Future clinical ‘rating’ of this set may facilitate scale development using the ICF in GBS. Further research is needed to confirm the generalisability of this set in clinical settings.     

Health of people with spinal cord injury in Singapore: implications for rehabilitation planning and implementation

Purpose.?This study aimed to provide a broad overview of the health of people with spinal cord injury (SCI) in Singapore, so as to highlight areas of potential need. These areas could then guide future research and rehabilitation programme development.

Methods.?Demographic data, injury information and information about SCI-related secondary impairments, chronic conditions and their associated risk factors, medical and hospital utilisation, participation (Craig Handicap Assessment and Reporting Technique) and life satisfaction (Satisfaction with Life Scale) were collected via interviews from people living with traumatic SCI.

Results.?On average, participants (50 men and 5 women) were aged 48.3 ± 16.54 years and had had their SCIs for 5 years. ?75%% with tetraplegia. The most prevalent SCI-related secondary impairments were pain, spasms, bladder problems, bowel problems and oedema. Chronic conditions and their associated risk factors were prevalent. Participation and life satisfaction scores were lower than those reported for similar populations cross-culturally.

Conclusion.?The study revealed several health areas that may be affecting the overall health of people with SCI in Singapore. By focusing on community reintegration and health promotion, physiotherapists and other rehabilitation professionals may augment health outcomes and improve the quality of life of this population in Singapore.     

Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors

Purpose.?To establish the feasibility and effectiveness of a community-based exercise programme for ambulatory patients with stroke discharged from rehabilitation

Method.?Eighteen participants were recruited 3–12 months after onset of first stroke. Using a time series experimental design, the group completed a baseline period of 4 weeks (A1), a group exercise programme of low-intensity progressive resistive exercise and functional tasks for lower limb muscles (B) and repeat assessment after cessation of exercise (A2). Fitness instructors delivered sessions at Leisure Centres twice weekly for 14 weeks with physiotherapy support and the minimum attendance requirement was 16 sessions. Measures included muscle strength, gait velocity, Berg Balance Scale and Nottingham Extended Activities of Daily Living.

Results.?Lower limb muscle strength improved after training (ANOVA, p?<?0.02). Paretic knee extension strength increased from 43.4?±?5.9 to 60.4?±?6.8 Nm after 16 exercise sessions. Walking velocity increased significantly (ANOVA, p?<?0.001), from 0.54?±?0.07 to 0.75?±?0.08 m/s (t?=??3.31, p?<?0.01). Balance and everyday function were also significantly improved (p?<?0.003). There were marked individual variation in the response to training, and those who completed additional training did not show benefit.

Conclusions.?This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.     

Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life

Purpose.?To measure the prevalence of urinary incontinence (UI) in a community-dwelling sample and the impact of self-reported UI on well-being and activity in older men and women.

Method.?Participants were older adults aged ≥65 years. Measures included the frequency of urgency incontinence, depression, positive and negative affect and social activity, independence in activities of daily living (IADL) and self-rated health. The data were collected by face to face interview (1994) and computer assisted telephone interviews (1996).

Results.?Of the 796 participants, 28%% experienced urgency incontinence and 21%% reported stress incontinence occasionally or often, with higher rates among women. The threshold for the impact on depression, negative affect and IADL was with occasional occurrence of urinary urgency incontinence. For positive affect and self-rated health, the threshold was experiencing urinary urgency incontinence often. The presence of urinary stress incontinence was associated with depression, IADL dependence, self-rated health and positive affect. Overall, women with incontinence had higher negative affect scores, but men with stress incontinence had higher scores than those without.

Conclusions.?The impact of incontinence highlights the need for more effective management of the condition. The threshold for the effects of urinary urgency incontinence on mental health and functionality is lower than for the effects on general health. There is a need to consider how older people judge the impact of UI in the design of targeted health promotion programmes.     

Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach

Purpose.?To investigate patient's perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain.

Methods.?Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview.

Results.?There were no significant differences (p > 0.05) in the participant's and clinician's initial assessment of function. However, at discharge participants scored their function significantly (p < 0.05) lower than clinicians. This difference was not apparent 6 weeks later (p > 0.05). However, there was a significant difference (p < 0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult.

Conclusions.?Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.     

Multidisciplinary cognitive behavioural pain management programmes for people with a spinal cord injury: design and implementation

Purpose.?This article seeks to outline the design and implementation of cognitive behavioural pain management programmes (PMPs) for people with spinal cord injury (SCI), illustrated by the experiences in a recently evaluated programme (SpinalADAPT). It is hoped that this will provide an easily accessible account of the relevant design and implementation issues for those who seek to deliver such programmes to persons with a SCI.

Methods.?A collaborative team of pain and SCI professionals developed a modified version of a standard cognitive behavioural pain management programme (ADAPT) based upon experiences of those with SCI who had previously attempted ADAPT. A number of structural and content elements of the programme were identified that required modification in order to accommodate the particular needs of those with SCI.

Results.?The modified programme was subsequently successfully delivered by a combination of SCI and pain health professionals. Three groups of individuals completed the SpinalADAPT, and an evaluation of outcomes compared to standard care are reported elsewhere (Nicholson Perry et al., Clin J Pain 2010;26:206–216).

Conclusions.?It appears feasible to appropriately modify standard PMPs for participants with SCI, and that such programmes may offer benefits in terms of improved quality of life. Further revision and evaluation of such programmes is required.     

Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery – a randomised controlled trial

Objective.?Coronary artery bypass grafting (CABG) is accompanied by severe impairment of cardiac autonomous regulation (CAR). This study aimed to determine whether a short-term physiotherapy exercise protocol post-CABG, during inpatient cardiac rehabilitation (CR), might improve CAR.

Design.?Seventy-four patients eligible for CABG were recruited and randomised into physiotherapy exercise group (EG) or physiotherapy usual care group (UCG). EG patients underwent a short-term supervised inpatient physiotherapy exercise protocol consisting of an early mobilisation with progressive exercises plus usual care (respiratory exercises). UCG only received respiratory exercises. Forty-seven patients (24 EG and 23 UGC) completed the study. Outcome measures of CAR included linear and non-linear measures of heart rate variability (HRV) assessed before discharge.

Results.?By hospital discharge, EG presented significantly higher parasympathetic HRV values [rMSSD, high frequency (HF), SD1)], global power (STD RR, SD2), non-linear HRV indexes [detrended fluctuation analysis (DFA)α1, DFAα2, approximate entropy (ApEn)] and mean RR compared to UCG (p?<?0.05). Conversely, higher values of mean HR, low frequency (LF) (sympathetic activity) and the LF/HF (global sympatho-vagal balance) were found in the UCG.

Conclusions.?A short-term supervised physiotherapy exercise protocol during inpatient CR improves CAR at the time of discharge. Thus, exercise-based inpatient CR might be an effective non-pharmacological tool to improve autonomic cardiac tone in patient's post-CABG.     

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial

Purpose: To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. Method: A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30–50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5?mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). Results: There was a statistically significant difference observed between the two groups in terms of FIM score (F?=?5.09, p?=?0.03) and MFES (F?=?3.52, p?=?0.007) but no difference was observed in terms of PPA scores (F?=?0.96, p?=?0.36). Conclusions: Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants.

• Implications for Rehabilitation

• Vibration training (VT) may assist in reducing the risk of falling among at risk older people.

• Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people.

• Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

     

Do Multidimensional Pain Inventory Scale score changes indicate risk of receiving sick leave benefits 1 year after a pain rehabilitation programme??

Purpose.?To study whether scale score changes in the Multidimensional Pain Inventory ((MPI)) can predict which persons disabled by pain will receive sick leave benefits 1 year after completing a pain rehabilitation programme.

Method.?An observational study of MPI data derived from 1468 patients, 388 men and 1080 women, who had participated in multidisciplinary cognitive-behavioural oriented pain rehabilitation programmes in Sweden, collected from the Swedish Quality Register for Pain Rehabilitation, before, at the end and 1 year after the programme.

Results.?Most MPI scale scores showed improvements after completing a pain rehabilitation programme and this improvement was sustained after 1 year. Moreover, we found that a decrease in MPI scales scores for Pain severity and Interference immediately after the pain rehabilitation programme decreased the risk of being on full-time sick leave 1 year later [[OR 0.85, ((95%% CI 0.73–0.99)) and OR 0.73, ((95%% CI 0.61–0.87)), respectively]]. The Interference scale, which may be considered to include ICF components of both activities and participation, might represent the core of suffering among persons disabled with pain.

Conclusions.?A rehabilitation intervention directed to combating the consequences of pain in activities and participation rather than against pain per se might lead to improved working capacity.     

Hemiarthroplasty for displaced femoral neck fracture: good clinical outcome but uneven distribution of occupational therapy

Purpose.?To assess rehabilitation, type of follow-up visits and outcome after bipolar hemiarthroplasty for femoral neck fracture.

Method.?Two hundred thirty-six consecutive patients with femoral neck fractures treated with hemiarthroplasty were followed for 30 months.

Results.?One hundred sixty-eight (71%%) were women, 175 (74%%) over 80 years old and 53 (22%%) were demented. Of 150 patients with available 3-month data, 7 patients (5%%) had not regained their walking ability. Seventy (47%%) were pain-free and 112 (75%%) were back in their original habitat. A hip-related complication leading to a contact with the orthopaedic department occurred in 20 of all patients (8%%), and 7 (3%%) of these underwent a revision surgery. One hundred eighty-seven patients (79%%) received occupational therapy (OT). Demented patients received OT more seldom (p < 0.001), as did patients aged 90 and older (p == 0.049).

Conclusion.?Due to the low rate of orthopaedic complications, these patients are now referred to their general practitioners, without any further follow-up at the orthopaedic department. Rehabilitation efforts are unevenly distributed. The need of increased rehabilitation efforts for demented or ‘old old’ patients is discussed.     

Physiotherapy students’ self-reported assessment of professional behaviours and skills while working with young people with disability

Abstract

Purpose: To quantify self-reported changes in student professional behaviours and skills after a 10-week community-based experience. Method: Twenty-eight physiotherapy students (22 women, 6 men; mean age 21.9 years, SD 2.9) were each matched with a young person with Down syndrome, who was randomly allocated to an intervention or control group. The intervention group completed a 10-week, twice a week progressive resistance training (PRT) programme. The control group completed a 10-week, once a week social programme. Before and after the experience, the students completed a self-reported assessment of their skills in prescribing and supervising PRT, professional behaviours, confidence and the likelihood they would work with people with intellectual disability in the future. Between-group differences were analysed using analysis of covariance with baseline measures as covariate. Results: There were between-group differences for 7 items rating skills implementing PRT, in favour of the intervention group, but not for any other outcome. Across both groups, students self-reported positive changes in their professional behaviours, confidence and the likelihood they would work with people with intellectual disability after the programme. Conclusions: A 10-week community-based experience produced changes in physiotherapy student professional behaviours. Students who completed the exercise programme self-reported an improvement in their professional skills relating to PRT.

• Implications for Rehabilitation

• Community-based experiences working with young people with disability offer physiotherapy students the opportunity to development their professional behaviours, skills and confidence.

• Students who completed a 10-week experience working with a young person with Down syndrome reported they were more likely to work with people with intellectual disability in the future.

• Improvements in the students’ skills in delivering progressive resistance training were only found for the students who completed an experience that included an exercise intervention.

     

Progressive resistance exercise for people with multiple sclerosis

Purpose. This study aimed to determine if participation in a progressive resistance exercise (PRE) programme can: (1) increase the ability to generate maximal muscle force, (2) increase muscle endurance, (3) increase functional activity, and (4) improve overall psychological function of people with multiple sclerosis (MS).

Methods. A pre-post single group research design with a 4-week baseline familiarisation phase was used. Nine people (mean age 45.6 years, SD 10.7) with MS attended a gymnasium three times over 4 weeks for familiarization. Participants then completed a twice-weekly 10-week PRE programme, with two sets of 10 – 12 repetitions of each exercise. Outcome measures of muscle strength (1RM for arms and legs), muscle endurance (repetitions at half 1RM), walking speed, the 2-min walk test (2MWT), a timed stairs test, and the impact of MS on physical and psychological function were taken at weeks 2, 4, and 14.

Results. Participants attended 94.3% (SD 8.2%) of the training sessions, with no adverse events. After accounting for baseline stability, significant improvements (P < 0.05) were found in arm strength (14.4%), leg endurance (170.9%), fast walking speed (6.1%), and there was a trend for increased distance in the 2MWT (P = 0.06). The perceived impact of MS on physical function was reduced (P = 0.02).

Conclusions. Adults with MS benefited from a PRE programme by improving muscle performance and physical activities, without adverse events. These findings suggest that PRE may be a feasible and useful fitness alternative for people with mild to moderate disability due to MS.     

Poor functional status immediately after discharge from an intensive care unit

Purpose.?To evaluate the functional status of patients within the first week of discharge from an intensive care unit (ICU), and to identify predictors and explanatory factors of functional status.

Methods.?A prospective, observational, cohort study was conducted with consecutive ICU patients who had stayed in a mixed, closed-format, university-level ICU for longer than 48 h.

Results.?Between 3 and 7 days of discharge from the ICU, functional status (as primary outcome), walking ability, muscle strength, and sensory and cognitive functioning were assessed in 69 survivors. The overall functional status was poor (median Barthel Index 6). In their ability to perform basic activities of daily living, 67% percent were severely dependent, 15% were moderately dependent, and 9% were slightly dependent on other people. Independent walking was impossible for 73% of participants, grip strength was reduced for 50%, and 30% had cognitive impairments. Duration of ventilation was associated with functional status after ICU discharge. Reduced grip strength and walking ability were identified as explanatory factors for poorer functional status shortly after discharge from the ICU.

Conclusion.?In the first week after discharge from the ICU, the majority of the patients had substantial functional disabilities in activities of daily living. These disabilities were more severe in patients who experienced ventilation for a longer period of time. There is a need for prospective studies focusing on functional recovery to support informed decision-making concerning the care of critically ill patients after ICU discharge.     

Vocational training integrated into inpatient psychosomatic rehabilitation – short and long-term results from a controlled study

Purpose.?The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation.

Method.?1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups.

Results.?More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers.

Conclusion.?An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.     

Is walking endurance associated with activity and participation late after stroke??

Purpose.?After stroke, impaired walking ability may affect activity and participation. The aim was to investigate whether self-reported activity and participation were associated with walking endurance late after stroke.

Method.?A non-randomised sample of 31 persons with a mean age of 59.7 years and time since stroke of 7–10 years was studied. Walking endurance was measured by the 6-minute walk test (6MWT). Self-reported activity and participation were measured by the Physical Activity Scale for the Elderly and the Stroke Impact Scale. Relationships were analysed with linear regression.

Results.?A regression model including activities of daily living and 6MWT explained 44%%, mobility and 6MWT explained 25%% and a model including physical activity level and 6MWT explained 21%% of the variation in activity. Regarding participation, the explanatory level of the model of participation and 6MWT was 30%%.

Conclusions.?Walking distance several years after stroke was partly associated with self-reported difficulties in activity and participation.