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Background and objective: Ongoing symptoms of COVID-19 can persist for weeks or months after the initial COVID-19 infection. The aim of this study was to identify persistent symptoms (fatigue, cognition, quality of life, anxiety, depression and physical measures) in unvaccinated community-managed patients following COVID-19 infection. Methods: This was a prospective nested observational study of health and wellbeing measures determined seven and 13 months after COVID-19 infection, alongside physical abilities after 18 months. Results: Data analyses were completed on 62 participants (60% female, median age 35 years). Severe fatigue was noted in 47% of participants at seven months and this had not improved significantly by 13 months (45%). Quality of life and mental health scores were significantly worse in individuals with severe fatigue. One-quarter of participants demonstrated mild cognitive impairment at seven months. After 18 months, walking and lung function were normal, but grip strength was reduced in 26% of participants. Discussion: A significant proportion of unvaccinated COVID-19 patients had not returned to pre-illness levels of health and function after one year; screening functional ability and mental wellbeing is warranted in unvaccinated people with COVID-19. [ABSTRACT FROM AUTHOR]

Rationale: Long-term recovery after critical illness can be affected by post–intensive care syndrome (PICS), a significant burden, which can impact return to activities and work. There is a need for streamlined support for intensive care unit (ICU) patients in their recovery while enduring PICS symptoms. Objectives: To explore critical illness recovery from the experiences, perspectives, and beliefs of former ICU patients, their caregivers, and multidisciplinary clinicians to design a future rehabilitation intervention prototype to support ICU patients. Methods: This was an experience-based codesign (EBCD) study underpinned by the Behavior Change Wheel framework involving ICU patients (<5 years after illness), caregivers, and multidisciplinary clinicians with current clinical experience with ICU recovery at any point along the care continuum (ICU, acute, subacute, or community settings) from two metropolitan hospitals in Melbourne, Australia. Two rounds of experience-based codesign workshops were held between August 2021 and February 2022. Workshop content was analyzed via a reflective thematic approach to determine themes and develop an intervention. The intervention was mapped according to the template for intervention description and replication framework. Results: Forty people participated in the codesign process: 15 ICU patients, 2 caregivers, and 23 clinicians. Fifteen major themes were identified in the experience of ICU recovery. Returning home was a key time point for change, acceptance, and adjustment, with the burden of physical limitations and mental health problems becoming apparent. Most participants expressed that PICS was poorly understood in the community, and there was a lack of support to aid recovery. Based on these results, an intervention prototype was developed with a primary goal of improving care after hospital discharge. This was further refined in the second round of workshops. A resource toolkit was deemed most acceptable to end-users, including a hospital-directed support program involving psychology and physical therapy and an accompanying digital health package. Conclusions: A critical time point for more support in the recovery journey was the transition from hospital to home. To address this, a rehabilitation prototype including a physical and psychological support intervention and supporting digital health toolkit was codesigned. The intervention package will be developed and trialed with future ICU patients and their families. Clinical trial registered with (NCT 05044221). [ABSTRACT FROM AUTHOR]

To determine the ability of clinical measures collected within 72 hours of neurological insult to predict independent gait 6 and 12 months after a stroke. Patients with a confirmed stroke diagnosis were eligible for inclusion in this prospective cohort study. Sitting balance, National Institutes of Health Stroke Scale (NIHSS) motor leg, NIHSS motor arm, and Motricity Index (MI) were measured within 72 hours post-stroke. Follow-up assessments were conducted at 6 and 12 months post-stroke to measure gait recovery. A total of 78 patients were included at baseline for analysis. At 6 and 12 months, 38% (n = 38) and 35% (n = 42) of patients used a gait aid, and 80% and 87% were independently ambulant, respectively. Sitting balance, NIHSS motor leg, and NIHSS motor arm were not significantly associated with ambulation at 6 or 12 months or with the use of a gait aid. Thrombolysis was significantly associated with independent outdoors ambulation at 6 months (p =.011). A worse MI score was significantly associated with a higher number of falls at 6 months (p <.010) but not with the need for a gait aid. The number of falls at 6 months was independently predicted by urinary incontinence post-stroke (p <.001), NIHSS leg score (p <.005), and depression and anxiety while in acute care (p <.005). Clinical bedside assessments may be less important in predicting safe, independent gait than previously thought. Urinary incontinence and poor mental health should be addressed in the hospital. Increased utilization of reperfusion techniques may alter functional recovery patterns. [ABSTRACT FROM AUTHOR]

Objectives: To quantify physical activity in patients prior to and during an acute general medical hospital admission and explore relationships between mobility, pre‐ and in‐hospital physical activity. Methods: This was a prospective, single‐site secondary observational study conducted on general medical wards at a tertiary hospital. Prehospital physical activity was measured via the Physical Activity Scale for the Elderly (PASE; scored 0–400); in‐hospital physical activity was measured via accelerometry (time at metabolic equivalents [METs] > 1.5), and mobility was measured via the de Morton Mobility Index (DEMMI). Associations were determined via Spearman's correlations. Results: Forty‐six participants were included: median age 81 [76–85] years, 59% female, DEMMI on admission 39 [30–49]. Prehospital physical activity was low (PASE median 27.1 [1.6–61.9]). In‐hospital physical activity was also low (0.5 [0.2–1.5] hours per day being physically active and 54 [16–194] steps per day taken). No statistically significant relationships existed between pre‐ and in‐hospital physical activity (Spearman's rho (ρ) 0.24, 95% CI −0.08–0.53, p = 0.07). However, physical activity levels in the pre‐ and in‐hospital settings were positively associated with patients' mobility in‐hospital (Spearman's ρ 0.44, 95% CI 0.15–0.67, p = 0.002; Spearman's ρ 0.40, 95% CI 0.08–0.645, p = 0.011 respectively). Conclusions: Physical activity is low both before and during a general medical admission. Assessment of usual physical activity patterns should be part of the clinical assessment of patients in general medicine; however, the low activity levels observed indicate a need for valid and reliable tools suitable for an older, frail cohort. Findings will inform the development of physical activity guidelines during hospitalisation. [ABSTRACT FROM AUTHOR]

Health service waiting areas commonly provide health information, resources and supports for consumers; however, the effect on health literacy and related outcomes remains unclear. This scoping review of the literature aimed to explore the use of waiting areas as a place to contribute to the health literacy and related outcomes of consumers attending health appointments. Articles were included if they focussed on health literacy or health literacy responsiveness (concept) in outpatient or primary care health service waiting areas (context) for adult consumers (population) and were published after 2010. Ten bibliographic databases, one full-text archive, dissertation repositories and web sources were searched. The search yielded 5095 records. After duplicate removal, 3942 title/abstract records were screened and 360 full-text records assessed. Data were charted into a standardized data extraction tool. A total of 116 unique articles (published empirical and grey literature) were included. Most articles were set in primary and community care (49%) waiting areas. A diverse range of health topics and resource types were available, but results demonstrated they were not always used by consumers. Outcomes measured in intervention studies were health knowledge, intentions and other psychological factors, self-reported and observed behaviours, clinical outcomes and health service utilization. Intervention studies overall demonstrated positive trends in health literacy-related outcomes, although the benefit declined after 3–6 months. Research on using waiting areas for health literacy purposes is increasing globally. Future research investigating the needs of consumers to inform optimal intervention design is needed. [ABSTRACT FROM AUTHOR]

Background: Moderate- to high-certainty evidence supports the benefits of pre- and post-operative exercise for people undergoing surgical resection for lung cancer. Despite this, exercise programs are not commonly provided. Previous data regarding exercise practices are a decade old. Therefore, this study aimed to understand current exercise practices in surgical lung cancer care in Australia and New Zealand. Methods: An online cross-sectional survey of Australian and New Zealand allied health professionals specialising in exercise-based interventions was carried out. Survey development and reporting adhered to CHERRIES and CROSS checklists. Institutions with thoracic surgery departments were invited to participate via email, and additional responses were sought via snowballing. Results: The response rate was 81%, with a total of 70 health services responding. A total of 18 (26%) pre-operative services, 59 (84%) inpatient post-operative services, and 39 (55%) community/outpatient post-operative services were identified. Only eight (11%) services provided a pre-operative exercise program. Half of the respondents referred less than 25% of patients to community/outpatient exercise programs on hospital discharge. Respondents reported that their clinical management was predominantly influenced by established workplace practices and personal experience rather than evidence. Conclusions: The availability and uptake of pre- and post-operative exercise remain low, and work should continue to make pre/post-operative exercise training usual practice. [ABSTRACT FROM AUTHOR]

Background: Growing evidence supports exercise for people with lung cancer. This overview aimed to summarise exercise intervention efficacy and safety across the care continuum. Methods: Eight databases (including Cochrane and Medline) were searched (inception—February 2022) for systematic reviews of RCTs/quasi-RCTs. Eligibility: population—adults with lung cancer; intervention: exercise (e.g., aerobic, resistance) +/− non-exercise (e.g., nutrition); comparator: usual care/non-exercise; primary outcomes: exercise capacity, physical function, health-related quality of life (HRQoL) and post-operative complications. Duplicate, independent title/abstract and full-text screening, data extraction and quality ratings (AMSTAR-2) were completed. Results: Thirty systematic reviews involving between 157 and 2109 participants (n = 6440 total) were included. Most reviews (n = 28) involved surgical participants. Twenty-five reviews performed meta-analyses. The review quality was commonly rated critically low (n = 22) or low (n = 7). Reviews commonly included combinations of aerobic, resistance and/or respiratory exercise interventions. Pre-operative meta-analyses demonstrated that exercise reduces post-operative complications (n = 4/7) and improves exercise capacity (n = 6/6), whilst HRQoL findings were non-significant (n = 3/3). Post-operative meta-analyses reported significant improvements in exercise capacity (n = 2/3) and muscle strength (n = 1/1) and non-significant HRQoL changes (n = 8/10). Interventions delivered to mixed surgical and non-surgical populations improved exercise capacity (n = 3/4), muscle strength (n = 2/2) and HRQoL (n = 3). Meta-analyses of interventions in non-surgical populations demonstrated inconsistent findings. Adverse event rates were low, however, few reviews reported on safety. Conclusions: A large body of evidence supports lung cancer exercise interventions to reduce complications and improve exercise capacity in pre- and post-operative populations. Additional higher-quality research is needed, particularly in the non-surgical population, including subgroup analyses of exercise type and setting. [ABSTRACT FROM AUTHOR]

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel’s initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel’s initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors. [ABSTRACT FROM AUTHOR]

To examine the minimal clinically important difference (MCID) in the treadmill 6-minute walk test (6MWT) in women with breast cancer. A secondary analysis of cross-sectional data from 112 women who were undergoing chemotherapy or had undergone anticancer treatment was conducted. Participants completed the 6MWT on a treadmill and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC-QLQ-C30) twice, eight weeks apart. Change in the physical function domain of the EORTC-QLQ-C30 was used to classify the "positive change" subgroup (≥5 points difference) and the "unchanged" subgroup (<5 points difference). This was combined with the distance difference from the 6MWTs, determining the MCID as the cut-off from the area under the receiver operating characteristic (AUROC) curve (anchor-based determination). The MCID was also determined from (1) the effect size and (2) the difference in standard error (SEM) of the results of the first and second 6MWT (distribution-based determination). The MCIDs in the during-chemotherapy group was 66.5 and 41.5 m and those in the after-treatment group to be 41.4 and 40.5 m (SEM and effect size based respectively). The MCID in the treadmill 6MWT distance could be used to interpret changes in the physical health status of women with breast cancer. The MCID for the 6MWT on treadmill in active women with breast cancer is of approximately 54 m during chemotherapy, and 41.6 m after treatment. The MCID on treadmill 6MWT distance could be used to interpret a decline in the physical health status of women with breast cancer. The 6MWT on treadmill could be an easy, feasible, performed under controlled conditions, alternative to the 6MWT to obtain valuable information in this population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of inspiratory muscle training (IMT) in addition to conventional physical rehabilitation on muscle strength, functional capacity, mobility, hemodynamics, fatigue, and quality of life in hospitalized patients undergoing hematopoietic stem cell transplantation (HSCT). Methods: We conducted a randomized controlled trial in 57 inpatients with hematological diseases undergoing HSCT. Conventional inpatient physical rehabilitation was delivered to the IMT (n = 27) and control (CON; n = 30) groups according to usual care, and the first group additionally performed IMT. The IMT was prescribed according to clinical and laboratory parameters at 40% of maximal inspiratory pressure (MIP), 5 days/week throughout the hospitalization, in sessions of 10–20 min. The primary outcome was MIP and the secondary outcomes were maximal expiratory pressure (MEP), peripheral muscle strength (handgrip and sit-to-stand tests), functional capacity (6-min step test), mobility (timed up and go test), blood pressure, quality of life (EORTC-QLQ-C30), and fatigue (FACT-F) at admission and hospital discharge. Results: The population was predominately autologous HSCT. The IMT group significantly increased the MIP (P < 0.01) and decreased both fatigue (P = 0.01) and blood pressure (P < 0.01) compared with control. No differences were found between admission and hospital discharge in peripheral and expiratory muscle strength, functional capacity, mobility, and quality of life in both groups (P > 0.05). Conclusions: Our results support the effectiveness of IMT as part of rehabilitation for HSCT inpatients, improving inspiratory muscle strength, and reducing fatigue and blood pressure. Trial registration: NCT03373526 (clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Background: Patients presenting for major surgery with low cardiorespiratory fitness (deconditioning) and other modifiable risk factors are at increased risk of postoperative complications. This study investigated the feasibility of delivering prehabilitation in high-risk patients scheduled for major abdominal cancer surgery. Methods: Eligible patients in this single-center cohort study included patients with poor fitness (objectively assessed by cardiopulmonary exercise testing, CPET) scheduled for elective major abdominal cancer surgery. Patients were recruited to participate in a prehabilitation program that spanned up to 6 weeks pre-operatively and comprised aerobic and resistance exercise training, breathing exercise, and nutritional support. The primary outcome assessed pre-specified feasibility targets: recruitment >70%, retention >85%, and intervention adherence >70%. Secondary outcomes were assessed for improved pre-operative functional status and health-related quality of life and for postoperative complications. Results: Eighty-two (34%) out of 238 patients screened between April 2018 and December 2019 were eligible for recruitment. Fifty (61%) patients (52% males) with a median age of 71 (IQR, 63–77) years participated in the study. Baseline oxygen consumption the at anaerobic threshold and at peak exercise (mean±SD: 9.8±1.8 and 14.0±2.9 mL/kg/min, respectively) confirmed the deconditioned state of the study cohort. The retention rate within the prehabilitation program was 84%, with 42 participants returning for repeat CPET testing. While >60% of participants preferred to do home-based prehabilitation, adherence to the intervention was low—with only 12 (28%) and 15 (35%) of patients having self-reported compliance >70% with their exercise prescriptions. Conclusion: Our prehabilitation program in high-risk cancer surgery patients did not achieve pre-specified targets for recruitment, retention, and self-reported program adherence. These findings underpin the importance of implementation research and strategies for the prehabilitation programs in major surgery. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000073909) retrospectively registered. [ABSTRACT FROM AUTHOR]

To identify assessment tools and patient factors statistically associated with discharge destination in general medical inpatients. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Four electronic databases were searched. Studies were eligible if they were a quantitative study design, had adult acute general medical inpatients and published in English. Outcomes of interest were tools or factors with statistical correlations with discharge destination (home, subacute or residential care). Articles were screened by two independent assessors. Data were extracted by one reviewer and independently checked by a second reviewer. Data were analysed/described descriptively. Twenty-three studies were included. Twenty-three tools and 44 factors were identified, which spanned Health Condition, Body Structure and Function, Activity, Participation, Environment and Personal concepts of the World Health Organisation International Classification of Function, Disability and Health (WHO ICF). The large number of tools and factors found and their distribution across several WHO ICF concepts exemplifies the complexities of predicting discharge. No single assessment tool that best predicts discharge destination was identified, but rather there were a variety of potential tools identified. Further research is needed to determine the psychometric properties of the identified assessment tools as well as additional predictors of subacute care (including rehabilitation). This is important as it may allow for timely clinical decision making. A priori, PROSPERO (CRD42017064209). This systematic review identified a large number of assessment tools and patient factors associated with discharge destination (home, subacute and residential care) in general medical inpatients. All of the domains of the WHO ICF framework are associated with discharge destination and must be considered. Clinicians in the acute setting can use these findings to assist selection of assessment tools to identify patients likely to need rehabilitation or subacute care. Early identification of patients who are unable to return to their place of residence is essential as it allows for provision of early rehabilitation and subsequent discharge planning. [ABSTRACT FROM AUTHOR]

Purpose: Exercise is emerging as a vital aspect of care to alleviate the physical and psychosocial symptom burden associated with allogeneic bone marrow transplantation (BMT). Understanding the patient perspective regarding exercise is important to move towards implementation. This study aimed to characterise experiences and views regarding participation in an exercise program in adults receiving treatment for haematological disease with allogeneic BMT. Methods: Individual semi-structured interviews were conducted with 35 participants from either an early- or late-commencing supervised group-based exercise program. Using an inductive, conventional approach to qualitative content analysis data were independently analysed by two researchers. Results: Six major themes and 33 sub-themes were identified: this encompassed motivation, physical opportunity and capability to exercise; psychosocial effects of group-based exercise; experienced impact of participation in an exercise program; and intervention design considerations. Key barriers to exercise included symptom severity and fluctuating health and distance or difficult access to an exercise facility or equipment, whilst facilitators included encouragement from staff; peer support in the group-based setting; flexibility; education; and ability to measure change. Conclusion: This study highlights the importance of a flexible approach to exercise with consideration of individual symptoms and preferences. The perceived psychological impact of exercise should not be underestimated; future exercise programs should be designed in partnership with patients, with consideration of group-based activities to reduce social isolation if this is feasible in the treatment context. Intervention design should also acknowledge the individual's physical and psychological capability, opportunity and automatic and reflective motivation to direct and sustain exercise behaviours following BMT. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility and preliminary efficacy of a group self-management exercise and education program in people with multiple sclerosis. Design: Feasibility randomised controlled trial. Setting: Outpatient rehabilitation facility. Subjects: Twenty-three adults (age 48.6 (11.7) years) recruited from a Multiple Sclerosis Clinic register. Interventions: The intervention group undertook a 12-week group program incorporating behaviour change education, exercise and community integration. This was compared with a waitlist control group. Main measures: Feasibility was measured by recruitment, adherence and safety. Efficacy outcomes included measures of physical function (6-metre and 6-min walk, Functional Reach) and self-report questionnaires (fatigue, quality of life, exercise benefits and barriers) at baseline, 6, 12 and 24 weeks. Results: Of 74 individuals identified through the register, 48 (65%) were contacted and deemed eligible, and 23 (48%) agreed to participate. There was high adherence for attendance at education (57 of 72, 79%) and exercise (135 of 174, 78%) sessions. No adverse safety events occurred within the intervention sessions. Missed attendances at assessment sessions was high (5 to 8 participants missed at each time point) predominately due to health issues. The intervention group demonstrated positive changes in walking endurance, Functional Reach and fatigue, whereas the control had some reductions in walking speed and more perceived exercise barriers. Conclusions: The MANAGE program appears feasible and safe for people with mild-to-moderate multiple sclerosis, with high adherence to exercise and education sessions. Future trials should consider strategies such as flexible scheduling or alternative methods of data collection to improve follow-up assessment attendance. [ABSTRACT FROM AUTHOR]

In this research, we explore and theorize on the potential of hospital outpatient rehabilitation waiting areas to respond and contribute to the health literacy needs of consumers. Constructivist grounded theory informed the sampling and analytical procedures. Thirty-three consumers attending outpatient rehabilitation for a range of health conditions were recruited to this multi-site study. Semi-structured interview and participant observation data were collected and analyzed concurrently using the constant comparison method. The substantive theory of "seeking choice to fulfill health literacy needs" and five interdependent categories were developed. Results indicated that consumers sought choice reflective of their needs; however, the waiting area offered limited choice. Consumers shared ideas to address the lack of choice. Results provide insight into the health literacy needs of consumers in hospital outpatient waiting areas and how health services can appropriately respond to these needs. Future research should investigate the effect of health service environments on health outcomes. [ABSTRACT FROM AUTHOR]

Aim: The study aim was to (1) investigate the barriers and enablers experienced by consumers to accessing and engaging with health tools in hospital waiting areas and (2) evaluate consumers' ideas for designing a health literacy responsive waiting area. Background: Health information, resources, and supports ("health tools") in waiting areas should be responsive to the health literacy needs of consumers. However, consumers' experiences of using health tools and their ideas for improving them are not known. Methods: Multicenter study was set in hospital waiting areas of outpatient rehabilitation services. Semistructured in-person interviews were conducted with 33 adult consumers attending appointments for various health conditions. Seven stages of the Framework Method were used to analyze data. Results: Six themes were identified which explained barriers and enablers from the perspective of consumers. The barriers were accessibility issues; personal factors—physical condition, emotional state, and preferences; and poorly presented and outdated resources. The enablers were design suits consumer needs and preferences; usable in available time or portable; and compatible environment for engaging and sharing. Consumers shared design ideas which fit within four typologies. Conclusions: A range of barriers and enablers exist which have an impact on consumers' ability to engage with available health information, resources, and supports in hospital outpatient waiting areas. Practical insights from the perspective of consumers can be applied to future health service design. Consumer's design ideas suggest that partnerships with consumers should be formed to design health literacy responsive waiting areas. [ABSTRACT FROM AUTHOR]

Objective For people with hematological malignancies treated with bone marrow transplantation (BMT), this systematic review aimed to identify, evaluate, and synthesize the evidence examining the effect of exercise training on the outcomes of exercise capacity, health-related quality of life (HRQoL), and hospital length of stay (LOS) and to identify any difference in the effect on people treated with allogeneic versus autologous transplantation. Methods Five electronic databases were systematically searched from inception to December 5, 2020. Prospective studies with a comparator group, with or without randomization, were included if they investigated the effects of an exercise intervention compared with usual care or another intervention in adults who had a hematological malignancy and were undergoing BMT. Primary outcomes of interest were functional exercise capacity and HRQoL; secondary outcomes included strength, fatigue, hospital LOS, and feasibility. Only randomized controlled trials were included in the meta-analyses. Risk of bias was evaluated using the Physiotherapy Evidence Database or Newcastle-Ottawa Scale; the quality of evidence for meta-analyses was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results Twenty-four randomized controlled trials and 3 prospective nonrandomized experimental trials were included (n = 2432). There was moderate-quality evidence that exercise improves functional exercise capacity (mean difference [MD] = 29 m; 95% CI = 12.59 to 45.4), global HRQoL (MD = 3.38 points; 95% CI = 0.37 to 6.39), and fatigue (MD = 2.52 points; 95% CI = 0.42 to 4.63) and low-quality evidence for reduced hospital LOS (MD = 2.07 days; 95% CI = 0.43 to 3.72). These effects were more pronounced in recipients of allogeneic transplantation. No serious adverse events were associated directly with exercise in the included studies. Conclusion Exercise is safe and improves outcomes, including functional exercise capacity, HRQoL, and hospital LOS in adults undergoing BMT. Impact The results of this systematic review support the implementation of exercise programs in adults undergoing BMT, particularly recipients of allogeneic transplantation. [ABSTRACT FROM AUTHOR]

Aim: To investigate: (1) the types of health information, resources, and supports available to consumers in hospital outpatient waiting areas and (2) whether these are accessed by consumers. Background: Outpatient waiting areas commonly offer health information, resources, and supports to improve the health literacy of waiting consumers. It is not known what is available to or accessed by consumers in hospital outpatient rehabilitation waiting areas. Methods: A multicenter, prospective, observational, cross-sectional study was conducted in the waiting areas of two hospital outpatient rehabilitation services. Direct observations (in person and video recordings) of the waiting areas were used to describe what health information, resources, and supports were available and, if present, what was being accessed and for how long by consumers. Results: Fifteen hours of in-person and video-recorded observations were documented on purpose-designed instruments across the two sites during 18 observation sessions over 8 days. A total of 68 different health information and resources were identified. Approximately half were specifically for consumers (Site 1: 57%; Site 2: 53%). Only seven (10%) were accessed by consumers across both sites. Each resource (n = 7) was only accessed once. Health resources were used by consumers for 0.8% (3/360 min) of the observation time at each site. Health and social supports and use of other non health resources were also observed. Conclusions: Available health information, resources, and supports were infrequently and briefly accessed by consumers. Further research is required to explore what consumers want and need to improve the health literacy responsiveness of hospital outpatient waiting areas. [ABSTRACT FROM AUTHOR]

Purpose: Prehabilitation programs are effective in optimising patient's functional reserve prior to surgery and increasingly associated with reduced postoperative complications. However, acceptability of programs among patients is largely unknown. This study set out to explore the acceptability of prehabilitation from the perspective of patients awaiting major cancer surgery. Methods: Adult patients awaiting major gastrointestinal and urological cancer surgeries were surveyed. Patients were excluded if they were unable to complete the survey due to language, intellectual impairment and/or visual/hearing deficit. The survey was designed to explore categories related to patient demographics, level of physical activity and perceived enablers and barriers to prehabilitation. Results: One hundred and three participants presenting to a pre-anaesthesia clinic completed the survey over a 5-month period, with 83% response rate. Approximately, half of the respondents were female (55%) and were currently physically active (53%). Fewer than one third (30%) felt they completed 'enough exercise'. The majority of participants (83%) were unfamiliar with the concept of prehabilitation but two thirds (68%) were interested in such a program after explanation. The majority of participants (72%) indicated a strong preference to exercise in a home-based environment. Medical recommendation increased willingness to participate (p < 0.001), while program costs (p = 0.01) were potential barriers to participation. Conclusion: Patients are willing to participate in prehabilitation prior to major cancer surgery but practical barriers and facilitators should be considered when designing prehabilitation programs to maximise patient commitment to facilitate improved postoperative outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the feasibility of an individualized exercise program for people undergoing hematopoietic stem cell transplantation. This is a feasibility study of an individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation. Participants performed the exercise program based on daily clinical, hemodynamic and hematological assessment. The program was carried out on a daily basis for 20–40 min during their hospital admission. The primary outcome was feasibility (recruitment, adherence and attrition rates) of the exercise program. The secondary outcomes were functional capacity, peripheral muscle strength, and health-related quality of life evaluated on admission and prior to hospital discharge. The adverse events rate was recorded during the intervention. Twenty-six participants (58% female), aged 40 ± 15 (mean ± SD) years were included. The exercise program feasibility was demonstrated by 100% recruitment, 86% exercise adherence and 12% attrition rates with no adverse events recorded. Significant differences were observed in functional capacity (p = 0.03), upper and lower-limb muscle strength (p = 0.01) from admission to discharge (23 ± 7 d). An individualized exercise training program based on daily clinical parameters is feasible for hospitalized patients undergoing hematopoietic stem cell transplantation. This intervention warrants further investigation in a randomized controlled trial. The individualized in-hospital exercise training program guided by daily clinical, hemodynamic and hematologic parameters is feasible, safe and with good adherence in people undergoing hematopoietic stem cell transplantation. People undergoing hematopoietic stem cell transplantation may improve functional capacity and upper and lower limb muscle strength following in-hospital exercise training program. The individualized in-hospital exercise training program could tentatively be introduced as part of the rehabilitation process in people undergoing hematopoietic stem cell transplantation. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence of long-term bladder, bowel and sexual dysfunction in pelvic trauma patients, and to identify any unmet need for screening for pelvic dysfunction and intervention in the rehabilitation period. This cross-sectional observational study included 48 participants admitted to a tertiary trauma hospital with at least one conservatively or surgically managed pelvic fracture. The Australian Pelvic Floor Questionnaire was used to assess the prevalence of bladder, bowel and sexual dysfunction in women and to detect bladder and bowel dysfunction in males. The International Index of Erectile Function questionnaire was selected to assess sexual dysfunction in males. Potentially eligible patients were asked to complete two copies of the questionnaires based on their pre-injury pelvic floor status and current post-recovery level of function. Consent was implied if the questionnaires were completed and returned. The mean age of respondents was 54 years; 63% were male. Mean time post-injury was 13 months for females and 12 months for males. Overall Australian Pelvic Floor Questionnaire scores were significantly higher for women one year post-fracture, but not for men. Similarly, scores in both the bladder and bowel domains were significantly higher one year post-injury in women only. A significant reduction in sexual function was reported in both men and women at one year post-fracture. Pelvic floor dysfunction is prevalent in the female pelvic trauma population one year post-injury. The feasibility of a screening process and targeted interventions to rehabilitate the pelvic floor musculature is therefore warranted. [ABSTRACT FROM AUTHOR]

Exercise training is playing an increasing role in lung cancer care. Lung cancer is associated with significant burden to the individual and healthcare system. There is now substantial evidence that exercise training is safe, feasible and effective at improving several outcomes in people with lung cancer, especially in those with NSCLC. Exercise is beneficial across the lung cancer disease and treatment pathway, including in patients with early stage disease before and after surgery, and in patients with advanced disease. This review describes the impact of lung cancer and lung cancer treatment on patient health outcomes and summarizes the aims, safety, feasibility and effects of exercise training in the context of both early stage and advanced stage lung cancer. The paper also includes a discussion of current topical discussion areas including the use of exercise in people with bone metastases and the potential effect of exercise on suppression of tumour growth. Finally, seven clinical questions are included, which are a priority to be addressed by future research over the next decade as we strive to progress the field of lung cancer and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background International guidelines recommend exercise for all people with cancer. Effective supportive care interventions are required for people diagnosed with lung cancer to reduce morbidity associated with the disease process, frequently occurring comorbidities and treatment-related side effects. Objective This article summarises the evidence regarding the safety, effectiveness and patient experiences of exercise and physical activity interventions for people with lung cancer. Discussion Exercise interventions for people with lung cancer are safe and effective at improving physical fitness, muscle strength and patient-reported outcomes including cancer-related fatigue, dyspnoea and health-related quality of life. Increasing evidence supports the use of exercise prior to treatment (prehabilitation) to improve outcomes following surgery. Individuals with lung cancer should be encouraged to be as physically active as possible. Throughout the patient's cancer journey, consideration and prescription of individualised exercise is an important component of care. General practitioners are well placed to coordinate this care, often in conjunction with exercise physiologists or physiotherapists. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the feasibility of conducting a rehabilitation program for patients following surgery for abdomino-pelvic cancer.Methods: A non-randomised controlled before-and-after study. Patients who had undergone surgery for stage I-III abdomino-pelvic cancer (colorectal, gynaecological or prostate cancer) were recruited. The rehabilitation group (n = 84) received an 8-week, bi-weekly education and exercise program conducted by a physiotherapist, exercise physiologist, health psychologist and dietician, supplemented by exercise diaries and telephone coaching sessions. The comparator group (n = 104) completed postal questionnaires only. Feasibility measures, functional exercise capacity, muscle strength, physical activity levels, pelvic floor symptoms, anxiety and depression, health-related quality of life (HRQoL) and self-efficacy were measured at baseline (time 1), immediately post-intervention (time 2) and at 6 months post-baseline (time 3) and compared within- and between-groups.Results: The consent rate to the rehabilitation program was 24%. Eighty-one percent of the rehabilitation group attended 85-100% of 16 scheduled sessions. Overall satisfaction with the program was 96%. Functional exercise capacity, handgrip strength in males, bowel symptoms, physical activity levels, depression and HRQoL were significantly improved in the rehabilitation group (p < 0.05) at time 2. The improvements in all these outcomes were sustained at time 3. The rehabilitation group had significantly improved physical activity levels, depression and HRQoL compared with the comparator group at times 2 and 3 (p < 0.05).Conclusion: Recruitment to this oncology rehabilitation program was more difficult than expected; however, attendance and patient satisfaction were high. This program had positive effects on several important clinical outcomes in patients following abdomino-pelvic cancer treatment.Trial Registration: ANZCTR 12614000580673. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility, safety, and preliminary effect of a 12-week multi-modal rehabilitation program targeted at improving health-related quality of life and physical activity levels of patients with lung cancer following treatment. Methods: Patients with stage I to IIIA non-small cell lung cancer were included 6 to 12 weeks following completion of treatment. The intervention comprised of aerobic exercise (brisk walking), resistance training and 8-style Tai Chi. The 12-week program included 2 supervised center-based sessions per week of 90 minutes duration and home-based exercise. The primary outcomes were the feasibility and safety of the intervention. Secondary outcomes (assessed pre and post program) were physical and patient-reported outcomes. Results: Seventy-eight patients were approached during the 6-month recruitment period and 17 (22%) consented to the study. Eight participants (47%) met the definition of adherence to the program (attending at least 70% of supervised sessions). No serious adverse events occurred. A significant reduction in anxiety and depression was observed post-program. In addition, improvements in respiratory function, sleep quality, and some health-related quality of life domains were observed post-program. There were no significant differences in functional capacity or physical activity levels. Conclusion: This multi-modal exercise training program was safe, although the feasibility of the program in its current state is not supported given the low consent rate and low adherence to the intervention. [ABSTRACT FROM AUTHOR]

Background: Prehabilitation to maximize exercise capacity before lung cancer surgery has the potential to improve operative tolerability and patient outcomes. However, translation of this evidence into clinical practice is limited. Aims: To determine the acceptability and perceived benefit of prehabilitation in lung cancer among thoracic surgeons. Procedure: 198 cardiothoracic surgeons within Australia and New Zealand were surveyed to evaluate their attitudes and perceived benefits of prehabilitation in lung cancer. Results: Response rate was 14%. A moderate proportion of respondents reported that there is a need to refer lung resection patients to preoperative physiotherapy/prehabilitation, particularly high-risk patients or those with borderline fitness for surgery. 91% of surgeons were willing to delay surgery (as indicated by cancer stage/type) to optimize patients via prehabilitation. The main barriers to prehabilitation reported were patient comorbidities and access to allied health professionals, with 33% stating that they were unsure who to refer to for prehabilitation in thoracic surgery. This is despite 60% of the cohort reporting that pulmonary rehabilitation is available as a preoperative resource. 92% of respondents believe that further research into prehabilitation in lung cancer is warranted. Conclusion: The benefits of prehabilitation for the oncology population have been well documented in the literature over recent years and this is reflected in the perceptions surgeons had on the benefits of prehabilitation for their patients. This survey demonstrates an interest among cardiothoracic surgeons in favor of prehabilitation, and therefore further research and demonstration of its benefit is needed in lung cancer to facilitate implementation into practice. [ABSTRACT FROM AUTHOR]

Purpose: Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program.Methods: Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). Individual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes.Results: Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years; male 52%; disease stage n (%) III = 9 (36), IV = 11 (44); radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support; motivation to be stronger and better prepared for future challenges; and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence.Conclusions: This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the psychometric properties of the shortened version of the Functional Difficulties Questionnaire (FDQ). Design: This is a multisite observational study. Setting: The study was conducted in four tertiary care hospitals in Australia. Subjects: A total of 225 participants, following cardiac surgery, were involved in the study. Intervention: Participants completed the original 13-item FDQ and other measures of physical function, pain and health-related quality of life. Method: Item reduction was utilized to develop the shortened version. Reliability was evaluated using intraclass correlation coefficients (ICCs), the smallest detectable change and Bland–Altman plots. The validity and responsiveness were evaluated using correlation. Anchor and distribution-based calculation was used to calculate the minimal clinical important difference (MCID). Results: Item reduction resulted in the creation of a 10-item shortened version of the questionnaire (FDQ-s). Within the cohort of cardiac surgery patient, the mean (SD) for the FDQ-s was 38.7 (19.61) at baseline; 15.5 (14.01) at four weeks and 7.9 (12.01) at three months. Validity : excellent internal consistency (Cronbach's α > 0.90) and fair-to-excellent construct validity (>0.4). Reliability : internal consistency was excellent (Cronbach's α > 0.8). The FDQ-s had excellent test–retest reliability (ICC = 0.89–0.92). Strong responsiveness overtime was demonstrated with large effect sizes (Cohen's d > 1.0). The MCID of the FDQ-s was calculated between 4 and 10 out of 100 (in cm). Conclusion: The FDQ-s demonstrated robust psychometric properties as a measurement tool of physical function of the thoracic region following cardiac surgery. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review synthesized evidence supporting interventions aimed at mitigating cognitive bias associated with the decision-making of social work professionals. Methods: A systematic search was conducted within 10 social services and health-care databases. Review authors independently screened studies in duplicate against prespecified inclusion criteria, and two review authors undertook data extraction and quality assessment. Results: Four relevant studies were identified. Because these studies were too heterogeneous to conduct meta-analyses, results are reported narratively. Three studies focused on diagnostic decisions within mental health and one considered family reunification decisions. Two strategies were reportedly effective in mitigating error: a nomogram tool and a specially designed online training course. One study assessing a consider-the-opposite approach reported no effect on decision outcomes. Conclusions: Cognitive bias can impact the accuracy of clinical reasoning. This review highlights the need for research into cognitive bias mitigation within the context of social work practice decision-making. [ABSTRACT FROM AUTHOR]

Purpose: To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers.Methods: Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454.Results: Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment.Conclusions: The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Despite evidence and clinical practice guidelines supporting physical activity (PA) for people with lung cancer, this evidence has not translated into clinical practice. This review aims to identify, evaluate and synthesise studies examining the barriers and enablers for patients with lung cancer to participate in PA from the perspective of patients, carers and health care providers (HCPs).Methods: Systematic review of articles using electronic databases: MEDLINE (1950-2016), CINAHL (1982-2016), EMBASE (1980-2016), Scopus (2004-2016) and Cochrane (2016). Quantitative and qualitative studies, published in English in a peer-reviewed journal, which assessed the barriers or enablers to PA for patients with lung cancer were included. Registered-PROSPERO (CRD4201603341).Results: Twenty-six studies (n = 9 cross-sectional, n = 4 case series, n = 11 qualitative) including 1074 patients, 23 carers and 169 HCPs were included. Barriers and enablers to PA were identified (6 major themes, 18 sub-themes): Barriers included patient-level factors (physical capability, symptoms, comorbidities, previous sedentary lifestyle, psychological influences, perceived relevance), HCP factors (time/knowledge to deliver information) and environmental factors (access to services, resources, timing relative to treatment). Enablers included anticipated benefits, opportunity for behaviour change and influences from HCPs and carers.Conclusion: This systematic review has identified the volume of literature demonstrating that barriers and enablers to PA in lung cancer are multidimensional and span diverse factors. These include patient-level factors, such as symptoms, comorbidities, sedentary lifestyle, mood and fear, and environmental factors. These factors should be considered to identify and develop suitable interventions and clinical services in attempt to increase PA in patients with lung cancer. [ABSTRACT FROM AUTHOR]

Pulmonary rehabilitation is a core aspect in the management of patients with chronic respiratory diseases. This paper describes a practical approach to establishing pulmonary rehabilitation for patients with non‐COPD diagnoses using examples from the interstitial lung disease (ILD), pulmonary hypertension (PH), bronchiectasis and lung cancer patient populations. Aspects of pulmonary rehabilitation, including the rationale, patient selection, setting of programmes, patient assessment and training components (both exercise and non‐exercise aspects), are discussed for these patient groups. Whilst there are many similarities in the rationale and application of pulmonary rehabilitation across these non‐COPD populations, there are also many subtle differences, which are discussed in detail in this paper. With consideration of these factors, pulmonary rehabilitation programmes can be adapted to facilitate the inclusion of respiratory patients with non‐COPD diagnoses. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is associated with poor health-related quality of life (HRQoL) and high symptom burden. This trial aimed to assess the efficacy of home-based rehabilitation versus usual care in inoperable lung cancer.Methods: A parallel-group, assessor-blinded, allocation-concealed, randomised controlled trial. Eligible participants were allocated (1:1) to usual care (UC) plus 8 weeks of aerobic and resistance exercise with behaviour change strategies and symptom support (intervention group (IG)) or UC alone. Assessments occurred at baseline, 9 weeks and 6 months. The primary outcome, change in between-group 6 min walk distance (6MWD), was analysed using intention-to-treat (ITT). Subsequent analyses involved modified ITT (mITT) and included participants with at least one follow-up outcome measure. Secondary outcomes included HRQoL and symptoms.Results: Ninety-two participants were recruited. Characteristics of participants (UC=47, IG=45): mean (SD) age 64 (12) years; men 55%; disease stage n (%) III=35 (38) and IV=48 (52); radical treatment 46%. There were no significant between-group differences for the 6MWD (n=92) at 9 weeks (p=0.308) or 6 months (p=0.979). The mITT analyses of 6MWD between-group differences were again non-significant (mean difference (95% CI): 9 weeks: -25.4 m (-64.0 to 13.3), p=0.198 and 6 months: 41.3 m (-26.7 to 109.4), p=0.232). Significant 6-month differences, favouring the IG, were found for HRQoL (Functional Assessment of Cancer Therapy-Lung: 13.0 (3.9 to 22.1), p=0.005) and symptom severity (MD Anderson Symptom Inventory-Lung Cancer: -2.2 (-3.6 to -0.9), p=0.001).Conclusions: Home-based rehabilitation did not improve functional exercise capacity but there were improvements in patient-reported exploratory secondary outcomes measures observed at 6 months.Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12614001268639). [ABSTRACT FROM AUTHOR]

Purpose: To examine physical activity participation amongst individuals with lower limb amputation. Method: Adults with lower limb amputation were convenience-sampled from a major metropolitan hospital outpatient amputee service and completed the International Physical Activity Questionnaire. Results: Seventy-two individuals (65% male), mean age 53.6 (SD = 16.8) years, who were 10.8 (SD = 12.6) years post amputation (60% transtibial) participated in the study. Thirty-eight percent of participants (n = 27) undertook "high" levels, 26% (n = 19) undertook "moderate" levels, and 36% (n = 26) undertook "low" levels of physical activity but cumulative activity levels were low. Participants most commonly undertook domestic-related activities (n = 53, 74%) and moderate-intensity activities (n = 54, 75%). Physical activity levels were found to be significantly lower amongst individuals who did not work, individuals with dysvascular amputation and individuals who lived with others. Physical activity levels showed a weak, significant, correlation to age (rs (70) = −0.259, p = 0.028) and time post amputation (rs (70) = 0.237, p = 0.049). Conclusion: This study provides clinicians with information about physical activity participation amongst individuals with lower limb amputation. The majority of participants in this study (n = 44, 61%) did not accumulate sufficient "total physical activity" to be classified as "sufficiently active" and 33% (n = 24) of participants were classified as "sedentary". Regular physical activity participation is associated with many health benefits. This study found the majority of individuals with lower limb amputation (61%) did not undertake sufficient total physical activity to be classified as "sufficiently active". Health professionals working in rehabilitation can play an important role in encouraging individuals to increase physical activity participation. The study's findings may guide health professionals on where to direct their focus to promote increased physical activity participation amongst individuals with lower limb amputation. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of evidence on changes in pelvic floor outcomes in patients with colorectal cancer (CRC) following general oncology rehabilitation. Objective: In patients following surgery for CRC, to explore changes in pelvic floor muscle function before and after a general oncology rehabilitation program; and to compare pelvic floor symptoms in patients undergoing the rehabilitation program to a matched control group. Methods: This pilot study was conducted as an observational study nested within a prospective study evaluating the feasibility of a general oncology rehabilitation program for patients following surgery for abdomino-pelvic cancer. In this nested study, pelvic floor muscle function was measured in 10 participants with CRC (rehabilitation group) before and immediately after the 8-week rehabilitation program and at 6-month follow-up. Data of 10 matched participants from the prospective study who completed questionnaires only at the same assessment time points were used as a control group. Symptom measurement tools were the Australian Pelvic Floor Questionnaire (APFQ) and the International Consultation on Incontinence Questionnaire-Bowel module (ICIQ-B). Descriptive statistics were used to summarize data on pelvic floor muscle function of the rehabilitation group, and repeated measures analysis of variance was used to assess within- and between-group changes in pelvic floor symptom scores over time in the rehabilitation group and control group matched for gender and level of tumor. Results: Scores in the bowel domain of the APFQ (p = 0.037) and bowel control domain of the ICIQ-B (p = 0.026) improved in the rehabilitation group only and the improvement in ICIQ-B was sustained at 6-month follow-up. There were no significant differences in bladder and bowel symptoms between the rehabilitation and matched control groups (p > 0.05) at any assessment time-point. Conclusions: Patients undergoing a general rehabilitation program following surgery for CRC demonstrated improved bowel symptoms from pre- to post-rehabilitation program; however, there were no differences when compared with matched controls who did not undertake rehabilitation. Further studies with larger sample sizes and longer-term follow-up are needed confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives: Advanced musculoskeletal physiotherapy (AMP) services are a safe, effective model of care, but without broad‐scale healthcare implementation to date. The aim of the present study was to identify the barriers and enablers to implementation of 12 AMP services from the perspective of clinical staff. Methods: In a qualitative study, 12 participants (physiotherapists), from 12 different healthcare networks (seven metropolitan, three regional, two rural), were included. Their departments implemented AMP services (orthopaedic postoperative joint replacement review, n = 10; general orthopaedic, n = 1; emergency, n = 1; and neurosurgery n = 1) over a 12‐month period. Participants completed a structured survey specifically designed for the study. Thematic analysis was used, with themes mapped to the validated Theoretical Domains Framework. Results: Nine major themes emerged from the data regarding barriers and enablers to the implementation of the AMP services from the perspective of clinical staff. These were: demand/capacity; model of care; the organization; stakeholders; communication; planning and processes; evaluation; workforce; and learning and assessment framework. Important enablers included engagement and buy‐in from key stakeholders and medical staff, and well‐established AMP learning frameworks for training and operational frameworks. Barriers included competitive funding environment, and issues that hindered effective communication. The knowledge, skills, availability, motivation and experience of the advanced musculoskeletal physiotherapists had a large impact on the implementation. Conclusions: The study identified a number of factors that should be considered for successful implementation of AMP services across healthcare services or wider healthcare networks. [ABSTRACT FROM AUTHOR]

Purpose. This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. Methods. This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. Results. No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had “mild” symptoms of PTSD. At 6 months, 64% of patients had “mild” and 8% had “moderate” PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger (P = .003), had a lower smoking pack history (P = .012), displayed less sedentary behavior (P < .005), or initially had worse cancer symptoms, including fatigue (P = .001) and poorer HRQoL (P = .004). Conclusions. Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer. [ABSTRACT FROM AUTHOR]

Aims: To explore physiotherapists perceptions regarding barriers and enablers to embedding exercise into routine lung cancer clinical care. Design: Qualitative study (content analysis). Eight physiotherapists working in the area of lung cancer at five hospitals participated. The focus group was conducted, transcribed verbatim and independently crosschecked. Thematic analysis was utilized. Results: The data generated four major themes: evidence justifying exercise; staffing and services; maximising the efficacy of interventions; and hospital culture. Physiotherapists perceived that barriers included lack of evidence, lack of physiotherapy time and funding, inconsistencies in patient access to outpatient exercise programs, lack of clear referral pathways, limited knowledge about exercise by the wider multi-disciplinary team, and poor culture of physical activity in the inpatient setting. Recommendations included developing a stronger evidence-base, establishing set patient pathways into exercise programs, re-allocating physiotherapy services to high-risk patients, and integrating/involving the multi-disciplinary team particularly through education and communication. Conclusion: This study has identified barriers to, and potential strategies for, the embedding of exercise into lung cancer clinical practice. Evidence, education and multi-disciplinary integration are viewed by physiotherapists as critical for success. A targeted gradual approach, by applying these strategies at defined stages across the lung cancer pathway, is recommended to facilitate future practice change. [ABSTRACT FROM AUTHOR]

Purpose: Physical activity (PA) is an important outcome in lung cancer; however, there is lack of consensus as to the best method for assessment. The Physical Activity Scale for the Elderly (PASE) is a commonly used questionnaire. The aim of this study was to assess the clinimetric properties of the PASE in lung cancer, specifically validity, predictive utility and clinical applicability (floor/ceiling effects, responsiveness and minimal important difference [MID]).Methods: This is a prospective observational study. Sixty-nine participants (62 % male, median [IQR] age 68 years [61-74]) with lung cancer completed the PASE at diagnosis at 2, 4 and 6 months. Additional measures included movement sensors (steps/day), physical function, health-related quality of life, functional capacity (6-min walk distance [6MWD]), and muscle strength. Spearman's rank correlation coefficient was used to assess relationships. Linear regression analyses were conducted to determine predictive utility of the PASE for health status at 6 months. Responsiveness (effect size) and MID (distribution-based estimation) were calculated.Results: The PASE was administered on 176 occasions. The PASE had moderate convergent validity with movement sensors (rho = 0.50 [95 %CI = 0.29-0.66], p < 0.005) and discriminated between participants classed as sedentary/insufficient/sufficient according to PA guidelines (p < 0.005). The PASE had fair-moderate construct validity with measures of physical function (rho = 0.57 [95 %CI = 0.46-0.66], p < 0.005), 6MWD (rho = 0.40 [95 %CI = 0.23-0.55], p < 0.005), and strength (rho = 0.37 [95 %CI = 0.18-0.54], p < 0.005). The PASE (at diagnosis) exhibited predictive utility for physical function (Bcoef = 0.35, p = 0.008) and quality of life (Bcoef = 0.35, p = 0.023) at 6 months. A small floor effect was observed (3 %); however, there was no ceiling effect. There was a small responsiveness to change (effect size = 0.23) and MID between 17 and 25 points.Conclusions: The PASE is a valid measure of self-reported PA in lung cancer. [ABSTRACT FROM AUTHOR]