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BACKGROUND: People with interstitial lung disease (ILD) want to actively manage their condition; however, the effects of self-management interventions (SMIs) in this population have not been synthesized. This review summarizes the effects of SMIs on health-related quality of life (HRQOL), functional status, psychological and social factors, symptoms, exacerbations, health care utilization, and survival in people with ILD. METHODS: The protocol of this systematic review was registered (PROSPERO ID: CRD42022329199). Six digital databases were searched in May 2022 with monthly updates until August 2023. Studies implementing SMIs in people with any type of ILD were included. Risk of bias (RoB) and quality of evidence were assessed with the Cochrane tool for RoB assessment and the grading of recommendations, assessment, development, and evaluations. Meta-analysis was used to summarize the results. RESULTS: Four studies that examined 217 participants (81% male, 71 y old, 91% idiopathic pulmonary fibrosis) were included. SMIs were highly heterogeneous. Meta-analysis showed no difference in HRQOL (standardized mean difference: 0.08 [95% CI 20.21 to 0.37], P .58) nor in the secondary outcomes. No evidence for the effects of SMIs on functional capacity, exacerbations, and survival was found. The quality of evidence ranged from low to very low. CONCLUSIONS: There is low to very low-quality evidence that SMIs have no effect in people with ILD. However, this conclusion is limited by high methodological heterogeneity. A consensus definition of SMIs is needed to implement more comparable interventions and strengthen results. [ABSTRACT FROM AUTHOR]

• First study developing a home-based physical activity programme for people with ILD. • iLiFE is feasible, present a high adherence and no adverse events. • iLiFE is meaningful for people with ILD, allowing them to control their daily life. People with interstitial lung disease (ILD) present low levels of physical activity (PA) and spend most of their time at home, especially in advanced stages of the disease. The Lifestyle Integrated Functional Exercise for people with ILD (iLiFE) embedding PA in patients' daily routines was developed and implemented. This study aimed to explore the feasibility of iLiFE. A pre/post mixed-methods feasibility study was conducted. Feasibility of iLiFE was determined by participant recruitment/retention, adherence, feasibility of outcome measures and adverse events. Measures of PA, sedentary behaviour, balance, muscle strength, functional performance/capacity, exercise capacity, impact of the disease, symptoms (i.e., dyspnoea, anxiety, depression, fatigue and cough) and health-related quality of life were collected at baseline and post-intervention (12-weeks). Semi-structured interviews with participants were conducted in-person immediately after iLiFE. Interviews were audio-recorded, transcribed and analysed by deductive thematic analysis. Ten participants (5♀, 77±3y; FVCpp 77.1 ± 4.4, DLCOpp 42.4 ± 6.6) were included, but only nine completed the study. Recruitment was challenging (30%) and retention high (90%). iLiFE was feasible, with excellent adherence (84.4%) and no adverse events. Missing data were associated with one dropout and non-compliance with the accelerometer (n = 1). Participants reported that iLiFE contributed to (re)gain control in their daily life, namely through improving their well-being, functional status and motivation. Weather, symptoms, physical impairments and lack of motivation were identified as threats to keep an active lifestyle. iLiFE seems to be feasible, safe and meaningful for people with ILD. A randomised controlled trial is needed to strengthen these promising findings. [ABSTRACT FROM AUTHOR]

To determine how total physical rehabilitation needs have been distributed per relevant condition groups (musculoskeletal and pain, neurologic cardiothoracic, neoplasms, pediatric, human immunodeficiency virus [HIV] related), globally and across countries of varying income level. Subgroup, secondary analyses of data from the Global Burden of Disease 2017. Data for the year 2017 are used for determining current needs and data from every year between 1990 and 2017 for determining changing trends. Globally and high-, upper-middle-, lower-middle-, and low-income countries. Not applicable. Not applicable. Years lived with disability (YLD) rates per 100,000 people for the 6 condition groups. In 2017, musculoskeletal and pain conditions accounted for 52.6% of the total physical rehabilitation needs worldwide, : HIV related for 5.7% of the physical rehabilitation needs in low-income nations, but about 1% in all other locations. Worldwide, significant increases in YLD rates were observed since 1990 for the 6 condition groups (P <.01). However, across country types, we observed significant decreases in YLD rates for specific conditions: pediatric in high-income countries, and neurologic and neoplasm conditions in low-income countries (P <.01). In upper-middle-income countries, YLD rates from neurologic and neoplasm conditions grew exponentially since 1990, with overall increases of 67% and 130%, respectively. At a global scale, physical rehabilitation needs per capita are growing for all major condition groups, with musculoskeletal and pain conditions currently accounting for over half of those needs. Countries of varying income level have different typologies and evolutionary trends in their rehabilitation needs. [ABSTRACT FROM AUTHOR]

Background: Stroke-specific protocols for the 10-meter and 6-minute walk tests that include instructions for people with aphasia, accessible walkway lengths, and allow provision of assistance to walk are needed to facilitate uptake in hospital settings. Objectives: To estimate the test-retest reliability, measurement error, and construct validity of stroke-specific protocols for the 10-meter walk test (10mWT), and 6-minute walk test conducted using a 15-meter walkway (6MWT15m) and 30-meter walkway (6MWT30m), in people post-stroke. Methods: A quantitative, cross-sectional study involving ambulatory people post-stroke was conducted. Results: Data were collected from 21 and 20 participants at baseline and retest, respectively, 1–3 days apart. Mean age was 61 years, median time post-stroke was 134 days, and 90% had experienced an ischemic stroke. Performance on the 10mWT, 6MWT15m, and 6MWT30m across sessions yielded intraclass correlation coefficient (ICC2, 1) estimates of test-retest reliability of 0.83, 0.97, 0.95, respectively, and minimal detectable change values at the 95% confidence level of 0.40m/s, 44.0m, and 67.5m, respectively. Pearson correlation coefficients were 0.80–0.95 (p <.001) between results on all three walk tests and 0.27–0.48 (p <.25) between walk test results and strength subscale scores on the Stroke Impact Scale. Conclusions: Findings showed excellent test-retest reliability; measurement error values similar to current literature; and support for construct validity of the 10mWT, 6MWT15m, and 6MWT30m. Due to the shorter walkway, the 6MWT15m may be more feasible to implement than the 6MWT30m in hospital settings. A larger sample with more severe deficits is required to improve generalizability. [ABSTRACT FROM AUTHOR]

Airway suctioning is an important health care intervention that can be associated with serious adverse effects. Given the risks involved with suctioning, it is important to ensure the clinical competence of health care professionals who perform it. A scoping review was conducted to identify the nature and extent of research related to the assessment of airway-suctioning competence for health care professionals working with adults. This included an examination of the assessment context, the type of suctioning and health care professionals being assessed, and the methods used to assess competence. Four scientific electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Library) were searched from inception to March 9, 2018. A gray literature search was also performed. Two reviewers independently screened articles and resources for inclusion, and data were extracted using a form created by the authors. Seventy full text articles and resources were screened for eligibility, with 36 included in the review. Endotracheal suctioning was the most common type, and intensive or critical care units were the primary setting of interest (28 of 36, 78%). Competence or a component of competence for nurses, nursing students, nursing assistants, or nurse technicians was specifically addressed in 97% (35 of 36) of the included articles and resources; 4 of 36 (11%) also included physical therapists, 1 of 36 (3%) included respiratory therapists, and 1 of 36 (3%) was aimed toward all clinicians who perform suctioning. Nine (25%) used questionnaire-based assessments, 11 (31%) used checklists, audit forms, or other observational tools, and 16 (44%) used both. Directed content analysis revealed 3 major themes: consistency across overarching evaluation frameworks, inconsistency across detailed components, and inconsistency in the evaluation or reporting of assessment tool measurement properties. Additional gaps in the literature included limited consideration of health care professionals beyond nursing, limited consideration of settings beyond intensive and critical care, a lack of tools to assess nasotracheal and orotracheal suctioning, and limited detail regarding assessment tool development. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background and Purpose: Aerobic training (AT) is recommended for people after stroke, yet uptake and operationalization of AT in clinical practice in Canada have not been measured. We surveyed inclusion of structured AT and barriers to implementation in public inpatient/outpatient stroke rehabilitation programs across Canada. Methods: A Web-based questionnaire was sent to 89 stroke rehabilitation program leads. Results: Forty-six programs from 7 of 9 eligible Canadian provinces/territories completed the questionnaire. Seventy-eight percent of programs reported including AT, with most (75%) excluding participants with severe physical impairments, and 28% excluding those with coexisting cardiac conditions. A greater proportion of dedicated stroke rehabilitation programs prescribed AT, compared to nondedicated stroke units (68.8% vs 31.3%, P = 0.02). The top 2 challenges for programs that included and did not include AT were "insufficient time within therapy sessions" and "length of stay in rehabilitation." Programs that did not include AT ranked "not a goal of most patients" and "not an organizational/program priority" as third and fourth, whereas they were ranked eighth and thirteenth by programs with AT. Best practice recommendations were inconsistently followed for conducting preparticipation exercise testing (36.1%) and for monitoring patients from higher-risk populations, specifically people with diabetes at risk for hypoglycemia (78.8%) and hypertension (36.6%). Of programs conducting preparticipation exercise testing, 91% did not monitor electrocardiography. Discussion and Conclusions: Most stroke rehabilitation programs across Canada include AT. People with severe physical impairment and those with cardiac, metabolic, and hemodynamic comorbidities may be excluded or not appropriately monitored during exercise. More detailed guidelines and training practices are needed to address these challenges. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A233). [ABSTRACT FROM AUTHOR]

Background and Objective Despite gains made with rehabilitation, gait and balance remain limited post-stroke. Dance is a fun and motivating activity which has shown benefits in individuals with Parkinson’s disease. The purpose of this article is to investigate the feasibility of a dance program for individuals with chronic stroke. Methods Pre-post intervention feasibility study where twenty individuals with chronic stroke participated in a dance class twice a week for 10 weeks. Feasibility measures included interest, enrollment, attendance, adverse events, and participant satisfaction. Outcomes of interest were spatiotemporal gait parameters and balance assessed with the MiniBESTest before and after the dance program. Pre and post measures were compared with paired t-tests. Results Of the 33 individuals approached, 30 (90.9%) were interested in participating; however, scheduling conflicts were a common barrier. Ultimately, 22 individuals consented and 20 individuals completed the dance program without adverse events. The mean age was 62.3 (10.4) years, time post-stroke was 6.4 (6.0) years and National Institutes of Health Stroke Scale score was 3.1 (2.0). Average attendance was 92.5% with 10 classes missed across 8 participants and satisfaction ratings were high (e.g. 17/20 strongly agreed they enjoyed the program). No significant differences in spatiotemporal gait parameters were found; however, MiniBESTest scores significantly increased from 16.5 (6.0) to 18.6 (4.9) (p = 0.0005). Discussion and Conclusions A dance program is safe and feasible post-stroke. Attendance and satisfaction were high and participants perceived walking and balance benefits. Future work will include a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background Despite well-established improvements following rehabilitation, functional gains often diminish following discharge. Objective To explore the attitudes of older adults with HF and COPD, who have completed rehabilitation, toward community-based exercise maintenance. Methods Semi-structured interviews were conducted with 11 individuals with HF or COPD. Results Deductive thematic analysis uncovered three themes: 1) transitioning to community exercise is challenging, highlighting participants' struggle with unstructured maintenance and a lack of appropriate programs; 2) a structured, group-based program tailored to functional ability facilitates adherence, describing participants views on the importance of routine, and accountability; and 3) “We are all there for the same purpose” – participant support for integrated exercise, including the benefit of multiple perspectives and sustainability. Conclusions A motivating program leader and access to appropriate facilities are key features to support adherence to prescribed activity. Tailored programs can be delivered consecutively to older adults with HF and COPD. [ABSTRACT FROM AUTHOR]

Background and Purpose: Systematic reviews of research evidence describing the quality and methods for administering standardized outcome measures are essential to developing recommendations for their clinical application. The purpose of this systematic review was to synthesize the research literature describing test protocols and measurement properties of time-limited walk tests in people poststroke. Methods: Following an electronic search of 7 bibliographic data-bases, 2 authors independently screened titles and abstracts. One author identified eligible articles, and performed quality appraisal and data extraction. Results: Of 12 180 records identified, 43 articles were included. Among 5 walk tests described, the 6-minute walk test (6MWT) was most frequently evaluated (n = 36). Only 5 articles included participants in the acute phase (<1 month) poststroke. Within tests, protocols varied. Walkway length and walking aid, but not turning direction, influenced 6MWT performance. Intraclass correlation coefficients for reliability were 0.68 to 0.71 (12MWT) and 0.80 to 1.00 (2-, 3-, 5- and 6MWT). Minimal detectable change values at the 90% confidence level were 11.4 m (2MWT), 24.4 m (5MWT), and 27.7 to 52.1 m (6MWT; n = 6). Moderate-to-strong correlations (≥0.5) between 6MWT distance and balance, motor function, walking speed, mobility, and stair capacity were consistently observed (n = 33). Moderate-to-strong correlations between 5MWT performance and walking speed/independence (n = 1), and between 12MWT performance and balance, motor function, and walking speed (n = 1) were reported. Discussion and Conclusions: Strong evidence of the reliability and construct validity of using the 6MWT poststroke exists; studies in the acute phase are lacking. Because protocol variations influence performance, a standardized 6MWT protocol poststroke for use across the care continuum is needed. Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A150 ). [ABSTRACT FROM AUTHOR]

Background and Objective: Cardiac rehabilitation programs (CRPs) are common for cardiac patients; however, most individuals post transient ischemic attack (TIA) receive no rehabilitation despite similar pathologies. The objective of this study is to determine effects of cardiac rehabilitation (CR) on cardiovascular fitness (peak oxygen uptake [VO2peak]) and 6-minute walk distance (6MWD) post TIA. Secondary outcomes included other clinical and process indicators.Methods: Eighty-five people post TIA (mean age 67.5 ± 10.7, 47% female) were referred to CR (2006-2014). The retro-TIA cohort included 65 consecutively enrolled individuals who were evaluated retrospectively. To collect additional measures, the pro-TIA cohort included 20 participants who were followed prospectively with a 3-month nonintervention period followed by 6-months of CR with 6MWD, cognition, depression score, and anthropometrics measured at each time point. Baseline, 6-month cardiopulmonary exercise test results, depression score, and anthropometrics were examined separately for both cohorts.Results: Among all participants, 62% completed CR with 72.8 ± 17.7% attendance to prescheduled classes. CR resulted in improvements in VO2peak for both cohorts (both, P < .02). In the retro-TIA cohort, there were improvements in resting heart rate and body mass index, with reductions in the proportion of people with obesity and abdominal obesity (all, P < .04). In the pro-TIA cohort, compared to the stable baseline period there was a significant improvement with the CR intervention in the depression score (Δ1.1 ± 4.3 and Δ-3.3 ± 3.9, respectively; P = .04) but not in 6MWD (Δ4.8 ± 42 m and Δ61.0 ± 73.5 m, respectively; P = .06). For all participants, regression analysis revealed a higher depression score (β = 1.10, P = .02), male sex (β = 4.932, P = .02), and less social support (β = 4.085, P = .04) as predictors of dropout.Conclusions: A CRP is feasible and effective for improving cardiovascular health. Strategies to promote adherence in men, in those with depressive symptoms, and in those with less social support require investigation. [ABSTRACT FROM AUTHOR]

Background: The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments.Methods: Sixty participants (male, 71.7%; 13.5 ± 22.5 [mean ± standard deviation] months post stroke; age 64.5 ± 12.5 years, with a Chedoke-McMaster Stroke Assessment score of 4.9 ± .9 of the leg) underwent 6MWT, CPET, balance, strength, and cognition assessments.Results: 6MWT heart rate (hr) was significantly lower than VAT-hr (92.3 ± 14.8 beats⋅min(-1) versus 99.8 ± 15.7 beats⋅min(-1), respectively, P < .001; correlation r = .7, P < .001). Bland-Altman analysis revealed that the 6MWT underestimated the VAT-hr by 7.7 ± 11.5%. The 95% confidence interval of the mean bias was large (14.8% and -30.3%), reflecting poor agreement, with 71.7% (n = 43) of the participants unable to reach a walking intensity at or above the VAT-hr. Lower oxygen uptake at the VAT (β = .655, P = .004), higher 6MWT-hr (β = 1.07, P = .01), and better balance (β = 1.128, P = .04) were associated with greater utility of the 6MWT for prescribing exercise.Conclusions: The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included. [ABSTRACT FROM AUTHOR]

Background: Falls are common among community-dwelling stroke survivors. The aims of this study were (1) to compare motor and cognitive outcomes between individuals who fell in the 6 months' postdischarge from in-patient stroke rehabilitation and those who did not fall, and (2) to explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function.Methods: Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a 6-month falls monitoring period using postcards with follow-up. Nonfallers and fallers were compared at the 6-month follow-up assessment on the Berg Balance Scale (BBS), the Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and the Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed.Results: Twenty-three fallers were matched to 23 nonfallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (P = .0066) and CMSA foot scores (P = .0033) were significantly lower for fallers than for nonfallers. The 2 groups did not differ on CMSA leg scores (P = .049), gait speed (P = .47), or MoCA score (P = .23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r = .27, P = .08).Conclusions: Performance in balance and motor recovery of the foot were compromised in fallers when compared to nonfallers at 6 months post discharge from in-patient stroke rehabilitation. [ABSTRACT FROM AUTHOR]

Objective To compare length of stay, functional status, and discharge destination between individuals who fell during inpatient stroke rehabilitation and those who did not fall. Design Retrospective cohort study. Setting Rehabilitation hospital. Participants Individuals who fell during inpatient stroke rehabilitation (n=106; fallers group; mean age, 67.8±12.9y; mean time poststroke, 26.4±28.3d) were matched to individuals who did not fall (n=106; nonfallers group; mean age, 67.3±13.6y; mean time poststroke, 21.9±28.8d) on age and functional status (N=212). Interventions Not applicable. Main Outcome Measures Total length of stay, FIM assessed at discharge, and discharge destination. Results The mean length of stay for fallers was 11 days longer than nonfallers ( P =.0017). Nonfallers and fallers did not differ on discharge total FIM scores ( P =.19), and both groups were discharged home after inpatient rehabilitation (nonfallers: 77%; fallers: 74%; P =.52). Conclusions This study suggests that falls experienced during inpatient stroke rehabilitation may have contributed to a longer length of stay; however, falls did not affect discharge functional status or discharge destination. [ABSTRACT FROM AUTHOR]

Background: Effective balance reactions are essential for avoiding falls, but are not regularly measured by physical therapists. Physical therapists report wanting to improve reactive balance assessment, and theory-based approaches are recommended as the foundation for the development of interventions. This article describes how a behavior change theory for health care providers, the theoretical domains framework (TDF), was used to develop an intervention to increase reactive balance measurement among physical therapists who work in rehabilitation settings and treat adults who are at risk of falls. Case Description: We employed published recommendations for using the TDF-guided intervention development. We identified what health care provider behavior is in need of change, relevant barriers and facilitators, strategies to address them, and how we would measure behavior change. In this case, identifying strategies required selecting both a reactive balance measure and behavior change techniques. Previous research had determined that physical therapists need to increase reactive balance measurement, and identified barriers and facilitators that corresponded to 8 TDF domains. A published review informed the selection of the Balance Evaluation Systems Test (Reactive Postural Responses Section) as addressing the barriers and facilitators, and existing research informed the selection of 9 established behavior change techniques corresponding to each identified TDF domain. Outcomes: The TDF framework were incorporated into a 12-month intervention with interactive group sessions, local champions, and health record modifications. Intervention effect can be evaluated using health record abstraction, questionnaires, and qualitative semistructured interviews. Summary: Although future research will evaluate the intervention in a controlled study, the process of theory-based intervention development can be applied to other rehabilitation research contexts, maximizing the impact of this work. Video Abstract is available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A123). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the factors affecting attendance at an adapted cardiac rehabilitation program for individuals poststroke.Methods: A convenience sample of ambulatory patients with hemiparetic gait rated 20 potential barriers to attendance on a 5-point Likert scale upon completion of a 6-month program of 24 prescheduled weekly sessions. Sociodemographic characteristics, depressive symptoms, cardiovascular fitness, and comorbidities were collected by questionnaire or medical chart.Results: Sixty-one patients attended 77.3 ± 12% of the classes. The longer the elapsed time from stroke, the lower the attendance rate (r = -.34, P = .02). The 4 greatest barriers influencing attendance were severe weather, transportation problems, health problems, and traveling distance. Health problems included hospital readmissions (n = 6), influenza/colds (n = 6), diabetes and cardiac complications (n = 4), and musculoskeletal issues (n = 2). Of the top 4 barriers, people with lower compared to higher income had greater transportation issues (P = .004). Greater motor deficits of the stroke-affected leg were associated with greater barriers related to health issues (r = .7, P = .001). The only sociodemographic factor associated with a higher total mean barrier score was non-English as the primary language spoken at home (P = .002); this factor was specifically related to the barriers of cost (P = .007), family responsibilities (P = .018), and lack of social support (P = .001). No other associations were observed.Conclusion: Barriers to attendance were predominantly related to logistic/transportation and health issues. People who were more disadvantaged socioeconomically (language, finances), and physically (stroke-related deficits) were more affected by these barriers. Strategies to reduce these barriers, including timely referral to exercise programs, need to be investigated. [ABSTRACT FROM AUTHOR]

Objective To identify patient characteristics that influence physiotherapist's decisions on enrollment and attendance in a structured aerobic exercise program early after stroke. Design Retrospective chart review. Setting Rehabilitation hospital. Participants Consecutive sample of people (N=345) admitted to inpatient stroke rehabilitation over a 2-year period. Interventions Not applicable. Main Outcome Measures Patient demographic characteristics, preexisting medical conditions, and poststroke outcome variables (neurological deficit, physical impairment, balance control, and functional mobility and independence) were compared between individuals enrolled and not enrolled in a structured aerobic exercise program. The rate of attendance was calculated for the enrolled group. Results One hundred twenty-nine patients (38%) were enrolled in the structured aerobic exercise program. Patients who were older ( P =.0093) and had cardiac disease ( P =.012), cardioembolic sources ( P =.0094), and arthritis ( P =.031) were less likely to be enrolled in the structured aerobic exercise program. Poststroke outcome variables were not associated with enrollment. Among those enrolled, the rate of attendance was positively correlated with the FIM cognitive rating ( r =.27; P =.0031). Conclusions Enrollment in structured aerobic exercise programs during inpatient stroke rehabilitation can be limited by safety concerns related to patients' cardiovascular and musculoskeletal status. Barriers associated with the perception of cardiovascular risk factors should be confronted because they do not preclude participation in cardiac rehabilitation. In addition, poststroke deficits do not limit participation in adapted aerobic exercise early after stroke. It is likely that the characteristics of the structured aerobic exercise program were integral to accommodate the breadth of poststroke deficits encountered in this study. Future research investigating physiotherapist and practice environment factors that influence the decision to prescribe and implement aerobic exercise is warranted. [ABSTRACT FROM AUTHOR]

Background: Individuals referred to cardiac rehabilitation programs (CRPs) after stroke have demonstrated postprogram improvements in cardiovascular fitness (VO2peak). However, the effect of CRPs on other physiological/quality-of-life outcomes and effect of time from stroke on these results has not been investigated. The objectives of the present study are (1) to evaluate the effects of a CRP in participants with motor impairment after stroke and (2) to explore the effects of elapsed time from stroke on physiological/quality-of-life outcomes. Methods: The CRP included 24 weeks of resistance and aerobic training. Primary outcomes in 120 participants, 25.4 ± 42.3 (mean ± standard deviation) months after stroke, included 6-minute walk distance (6MWD), VO2peak, timed repeated sit-to-stand performance, and affected-side isometric knee extensor strength (IKES). Secondary measures included gait characteristics (cadence, step lengths, and symmetry), walking speed, balance (Berg Balance Scale), affected-side range of motion (ROM), elbow flexor and grip strength, anaerobic threshold, and perceptions of participation/social reintegration. Results: After adjusting for multiple comparisons, participants demonstrated significant improvements (all P < .001) in 6MWD (283.2 ± 126.6 to 320.7 ± 141.8 m), sit-to-stand performance (16.3 ± 9.5 to 13.3 ± 7.1 seconds), affected-side IKES (25.9 ± 10.1 to 30.2 ± 11 kg as a percentage of body mass), and VO2peak (15.2 ± 4.5 to 17.2 ± 4.9 mL·kg·min−1). Participants also demonstrated post-CRP improvements in secondary outcomes: anaerobic threshold, balance, affected-side hip/shoulder ROM, grip and isometric elbow flexor strength, participation, walking speed, cadence (all P < .001), and bilateral step lengths (P < .04). In a linear regression model, there was a negative association between the change in 6MWD and time from stroke (β = −42.1; P = .002) independent of baseline factors. Conclusions: A CRP yields improvements over multiple domains of recovery; however, those who start earlier demonstrate greater improvement in functional ambulation independent of baseline factors. These data support the use of adapted CRPs as a standard of care practice after conventional stroke rehabilitation. [Copyright &y& Elsevier]

Background: Rating of perceived exertion (RPE) is used to monitor or prescribe workload of exercise, but its utility among individuals with a stroke remains in question. Objective: To examine the validity of RPE at multiple percentages of peak aerobic capacity (Vo2peak) in individuals in the subacute stage of stroke recovery. Methods: Thirty-seven patients with stroke in the subacute stage of recovery from an inpatient rehabilitation institute completed a graded maximal exercise test on a semi-recumbent cycle ergometer. Respiratory gas exchange was monitored for analysis of Vo2, while heart rate and RPE (Borg CR10 Scale) were measured at the end of each minute. RPE was compared with expected ranges when at 60%, 70%, and 80% of Vo2peak. Post hoc analyses were performed to determine whether patient characteristics differed between participants who fell within and outside the expected RPE range at 80% of Vo2peak. Results: Median (interquartile range) RPE at 60%, 70%, and 80% Vo2peak were 3.0 (3.0-3.5), 3.0 (3.0-5.0), and 4.75 (3.0-5.75), respectively; 76.2%, 69.0%, and 38.9% of participants fell into the expected RPE range at each intensity. Patient characteristics were similar between participants who fell within and outside the expected RPE range at 80% Vo2peak. Conclusion: RPE appears to be a reasonable indicator of exercise intensity after stroke at moderate (60%-70% Vo2peak) but not high-intensity exercise (80% Vo2peak). This conclusion is based on the high degree of between-subject variability in RPE at 80% Vo2peak. Future research should identify whether RPE can be adapted to accurately capture exertion during high-intensity exercise after stroke. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate, for individuals with chronic stroke with cognitive impairment, (1) the effects of a practice test on peak cardiorespiratory fitness test results; (2) cardiorespiratory fitness test-retest reliability; and (3) the relationship between individual practice test effects and cognitive impairment. Design: Cross-sectional. Setting: Rehabilitation center. Participants: A convenience sample of 21 persons (men [n=12] and women [n=9]; age range, 48–81y; 44.9±36.2mo poststroke) with cognitive impairments who had sufficient lower limb function to perform the test. Interventions: Not applicable. Main Outcome Measure: Peak oxygen consumption (Vo 2peak, ml·kg−1·min−1). Results: Test-retest reliability of Vo 2peak was excellent (intraclass correlation coefficient model 2,1 [ICC2,1]=.94; 95% confidence interval [CI], .86–.98). A paired t test showed that there was no significant difference for the group for Vo 2peak obtained from 2 symptom-limited cardiorespiratory fitness tests performed 1 week apart on a semirecumbent cycle ergometer (test 2–test 1 difference, −.32ml·kg−1·min−1; 95% CI, −.69 to 1.33ml·kg−1·min−1; P=.512). Individual test-retest differences in Vo 2peak were, however, positively related to general cognitive function as measured by the Mini-Mental State Examination (ρ=.485; P<.026). Conclusions: Vo 2peak can be reliably measured in this group without a practice test. General cognitive function, however, may influence the effect of a practice test in that those with lower general cognitive function appear to respond differently to a practice test than those with higher cognitive function. [Copyright &y& Elsevier]

Background: Although the short-term benefits of pulmonary rehabilitation (PR) are well established, improvements in exercise tolerance and health status diminish over time. The objectives of this study were to determine the feasibility and within-subject effects of a 1-year community-based maintenance exercise program for patients with COPD following completion of hospital-based PR. Methods: A single-arm longitudinal study was undertaken. After completion of PR, consecutive patients with COPD were recruited to attend a twice weekly exercise program supervised by fitness consultants at a local community centre. The transition from hospital to the community was facilitated by a case manager. Outcome measurements at baseline (pre-PR), post-PR, 6-months and 1-year included the 6-minute walk test (6MWT) for exercise capacity and the Chronic Respiratory Questionnaire (CRQ) for health-related quality of life. Feasibility was assessed primarily through subject adherence. Results: A total of 29 patients (mean age 66.8 ± 7.8 years, mean FEV1 45.1 ± 18.8 percent predicted) were enrolled in the program. Mean compliance to twice weekly exercise was 70%. No adverse events were reported. Statistically significant and clinically important improvements in the 6MWT and CRQ total and dyspnea domain were observed at 6-months and 1-year after PR compared to baseline (all p < 0.01). Conclusions: A community-based maintenance exercise program is feasible and can successfully preserve exercise capacity and health-related quality of life following institutionallybased PR in patients with moderate to severe COPD. A more formal evaluation of this approach is warranted. [ABSTRACT FROM AUTHOR]

The authors discuss recommendations from the International Society of Physiotherapy Journal editors on clinical trial registration in physiotherapy journals. They mention several potential benefits of prospective registration, which include unnecessary duplication of trials and allowing people with health problems to identify trails in which they would participate. They state that prospective clinical trial is valuable to the clinicians, consumers and researchers who rely on clinical trial data.

Summary: Background: The original method for determining endurance shuttle walk test (ESWT) speed involves components that are time consuming for clinicians. We sought to determine: (i) whether components described in the original method for determining ESWT speed held true and; (ii) the agreement between speeds derived using the original method and that equivalent to 85% of the peak speed achieved during the incremental shuttle walk test (ISWT). Methods: Patients with chronic obstructive pulmonary disease (COPD) performed two ISWTs and one ESWT on separate days, wearing a calibrated portable gas analysis unit. A retrospective analysis of these data allowed us to determine whether: (i) the peak rate of oxygen uptake () can be accurately estimated from the incremental shuttle walk distance (ISWD) and; (ii) ESWTs performed at a speed derived using the original method elicited 85% of . Agreement between walks speeds was determined using Bland–Altman analysis. Results: Twenty-two participants (FEV1 48 ± 13% predicted, age 66 ± 8 yr) completed the study. The estimated from the ISWD was less than that measured during the ISWT (mean difference −4.4; 95% confidence interval (CI), −6.0 to −2.9 ml· kg−1·min−1). The ESWT and ISWT elicited similar (mean difference −0.2; 95% CI, −1.5 to 1.2 ml·kg−1·min−1). The mean difference (±limits of agreement) between ESWT speeds was 0.15 (±0.34) km·h−1. Conclusions: Components of the original method for determining the ESWT speed did not hold true in our sample. ESWT speed can be derived by calculating 85% of the peak speed achieved during the ISWT. [ABSTRACT FROM AUTHOR]

Abstract: Hill K, Dolmage TE, Woon LJ, Brooks D, Goldstein RS. Rollator use does not consistently change the metabolic cost of walking in people with chronic obstructive pulmonary disease. Objectives: To (1) evaluate whether the use of a rollator changed metabolic cost during a controlled walking task, and (2) explore relationships between the difference in dyspnea and metabolic cost associated with rollator use. Design: Single-group interventional study in which patients completed 2 corridor walks: 1 without and 1 with a rollator, at the same individualized constant speed. Setting: Rehabilitation hospital. Participants: Patients with chronic obstructive pulmonary disease (N=15; 10 men; median age [interquartile range; IQR]=69 [12]y; forced expiratory volume in 1 second=42 [20]% predicted). Intervention: Rollator use. Main Outcome Measures: Oxygen uptake, converted to metabolic equivalent units (METs), and minute ventilation were measured throughout both tasks using a portable gas analysis system; dyspnea and arterial oxygen saturation (SpO2) were collected on completion. Results: Median [IQR] walk speed [IQR] was 48 (10)m/min. Walking with a rollator, compared with walking without, reduced dyspnea (median [IQR]=1.0 [1.5] vs 2.0 [2.0]; P=.01) without changing energy expenditure (median [IQR]=2.8 [1.2] vs 3.2 [0.9] METs; P=.65), minute ventilation (median [IQR]=30.3 [9.6] vs 27.7 [9.9]L/min; P=.50), or SpO2 (median [IQR]=92 [8]% vs 94 [10]%; P=.41). The association between the reduction in dyspnea and any difference in energy expenditure related to rollator use was of borderline significance (rs=.50; P=.06). Six of the 8 participants who experienced a reduction in dyspnea also demonstrated a reduction in the metabolic cost of walking. Conclusions: The mechanism responsible for the amelioration in dyspnea during rollator-assisted walking is multifactorial. A reduction in the metabolic cost of walking may play a part in some, but not all, patients. [Copyright &y& Elsevier]

Wong R, Sibley KM, Hudani M, Roeland S, Visconti M, Balsano J, Hill K, Brooks D. Characteristics of people with chronic lung disease who rest during the six-minute walk test. Objectives: To examine the incidence of resting during the 6-minute-walk test (6MWT) in patients with chronic lung disease (CLD) and to explore differences in functional exercise capacity and response to pulmonary rehabilitation (PR) between resters and nonresters. Design: Retrospective chart review. Setting: Inpatient PR program. Participants: Individuals (N=211) who performed the 6MWT at admission and discharge from PR. Interventions: Not applicable. Main Outcome Measures: Primary outcomes were total distance walked (6-minute walk distance [6MWD]) and rest frequency and duration. Secondary outcomes were walking speed, end-test dyspnea, and the Chronic Respiratory Questionnaire (CRQ). Results: At admission, 45 people (21%) rested 1 to 4 times during the 6MWT (total duration, 105±80s) and 166 people walked continuously. At discharge, 9 people continued to rest (total duration, 28±55s). At admission, nonresters walked 315±93m, whereas resters walked 197±83m (P<.0001), and 6MWD increased in both groups after PR (P<.0001). Nonresters increased their walking speed at discharge, but resters did not (interaction P<.001). At admission, the mastery domain of the CRQ was 0.8 point lower in resters (3.7±1.2) compared with nonresters (4.5±1.7; P=.01). Resters' end-test dyspnea scores decreased from 5.7±0.3 to 4.3±0.2 from admission to discharge, whereas nonresters' end-test dyspnea scores did not significantly change from 4.5±0.2 to 4.2±0.2 at discharge (interaction P<.05). Conclusions: One in 5 individuals with CLD rest during the 6MWT. Decreasing rest duration or increasing walking speed reflects different strategies used to improve 6MWD after rehabilitation, both suggesting a positive effect of PR. This may be related to improvements in an individual's sense of control over dyspnea. Future work should investigate potential factors related to resting during the 6MWT. [Copyright &y& Elsevier]

Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease. Objectives: To describe within-subject effects of pulmonary rehabilitation (PR) on balance in persons with chronic obstructive pulmonary disease (COPD) and to determine whether any observed changes in balance were associated with change in exercise tolerance or health-related quality of life. Design: Single-arm longitudinal study. Setting: Inpatient PR center. Participants: Subjects with COPD (N=29; mean ± SD age, 69.8±10.3y; forced expiratory volume in 1 second, 46.3%±22.3% predicted; 59% men [n=17]). Interventions: A standardized 6-week multidisciplinary PR program (exercise training, breathing exercises, education, and psychologic support). Main Outcome Measures: Balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Activities-Specific Balance Confidence (ABC) scale. Exercise tolerance was determined from the 6-minute walk test (6MWT), and health-related quality of life from the Chronic Respiratory Questionnaire (CRQ). Results: Subjects showed small improvements in BBS (2.8±2.8 points; P<.001) and TUG (−1.5±2.4s; P=.003) scores, but not in ABC scores (4.8±15.4 points; P>.05). There was a weak relationship between change in BBS and change in CRQ scores (r=.40; P=.045) and no relationship with change in 6MWT. Conclusions: PR contributed to minor improvements in balance and had no effect on balance confidence in subjects with COPD. Further work is warranted to determine the optimal intervention for improving balance in this population. [Copyright &y& Elsevier]

Abstract: Brooks D, Davis L, Vujovic-Zotovic N, Boulias C, Ismail F, Richardson D, Goldstein RS. Sleep-disordered breathing in patients enrolled in an inpatient stroke rehabilitation program. Objective: To report the prevalence of sleep-disordered breathing in an inpatient stroke rehabilitation unit and to explore correlations with functional status and health-related quality of life. Design: Cross-sectional study. Setting: Rehabilitation center. Participants: Consecutive patients (N=45; mean age, 67±12y) (28 men) enrolled in inpatient rehabilitation after ischemic (84%) or hemorrhagic stroke (16%). Interventions: Not applicable. Main Outcome Measures: Overnight respiratory polysomnography was performed on all subjects. Interviewer-administered scales of sleepiness (Epworth Sleepiness Scale) and functional status (FIM, Barthel Index) were completed. Health-related quality of life was assessed by using a general questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]). Results: Of the 45 subjects tested, only 4 (9%) had an apnea-hypopnea index of less than 10 per hour. The mean apnea-hypopnea index was 32.2 (19.4) per hour; most events were obstructive. There was no relationship between the respiratory index and the components of SF-36 (P values>.2). Conclusions: There was a dramatically high prevalence of respiratory events in patients after stroke enrolled in an inpatient stroke rehabilitation unit. The awareness of this will influence patient evaluation and management. [Copyright &y& Elsevier]

Summary: The purpose was to update an original systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). The original MEDLINE and CINAHL search to August 2003 was updated to January 2007 and EMBASE was searched from inception to January 2007. Randomized controlled trials, published in English, with adults with stable COPD, comparing IMT to sham IMT or no intervention, low versus high intensity IMT, and different modes of IMT were included. Nineteen of 274 articles in the original search met the inclusion criteria. The updated search revealed 17 additional articles; 6 met the inclusion criteria, all of which compared targeted, threshold or normocapneic hyperventilation IMT to sham IMT. An update of the sub-group analysis comparing IMT versus sham IMT was performed with 10 studies from original review and 6 from the update. Sixteen meta-analyses are reported. Results demonstrated significant improvements in inspiratory muscle strength (PImax, PImax % predicted, peak inspiratory flow rate), inspiratory muscle endurance (RMET, inspiratory threshold loading, MVV), exercise capacity (Vemax, Borg Score for Respiratory Effort, 6MWT), Transitional Dyspnea Index (focal score, functional impairment, magnitude of task, magnitude of effort), and the Chronic Respiratory Disease Questionnaire (quality of life). Results suggest that targeted, threshold or normocapneic hyperventilation IMT significantly increases inspiratory muscle strength and endurance, improves outcomes of exercise capacity and one measure of quality of life, and decreases dyspnea for adults with stable COPD. [Copyright &y& Elsevier]

Abstract: Liu J, Drutz C, Kumar R, McVicar L, Weinberger R, Brooks D, Salbach NM. Use of the six-minute walk test poststroke: is there a practice effect? Objectives: To determine whether a practice effect occurs across 2 trials of the six-minute walk test (6MWT) among community-dwelling people within 1 year poststroke and to identify characteristics distinguishing people who show a practice effect from those who do not. Design: Secondary analysis of scores on 2 trials of the 6MWT administered approximately 30 minutes apart at baseline in a randomized controlled trial. Setting: General community. Participants: People (N=91) living in the community with a residual walking deficit within the first year of a first or recurrent stroke. Interventions: Not applicable. Main Outcome Measure: Distance walked on the 6MWT. Results: Mean 6MWT scores ± SD for trials 1 and 2 were 196±119m and 197±126m, respectively (n=83). The mean difference in 6MWT performance across trials was 0±35m (95% confidence interval [CI], –7 to 8m). The Pearson correlation coefficient between 6MWT distances was .96 (P<.001), and the intraclass correlation coefficient was .98 (95% CI, .97–.99). The Bland-Altman plot showed no clear pattern. Participants whose improvement was equal to or greater than the minimal detectable change of 29m between trials (14%) did not significantly differ from those in the rest of the study sample; however, they tended to be younger (P=.05) and more likely to have a mild or moderate gait deficit (P=.06). Conclusions: Findings do not support a practice effect across 2 trials of the 6MWT in individuals within 1 year poststroke. Thus, a practice walk does not appear necessary. Further research is recommended to evaluate the influence of young age, acute stroke, and mild-to-moderate gait deficit on practice effects. [Copyright &y& Elsevier]

Abstract: Hill K, Goldstein R, Gartner EJ, Brooks D. Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease. Objective: To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD). Design: Cross-sectional observational study. Setting: Community. Participants: COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period. Interventions: Not applicable. Main Outcome Measures: Three questionnaires were administered in random order. The St. George''s Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records. Results: Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%±22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men (P=.008). Thirteen (48%) patients reported being embarrassed while using the device. Conclusions: COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors. [Copyright &y& Elsevier]

Cardiorespiratory fitness, along with sensorimotor recovery, is important for optimal function after stroke. Development of exercises that simultaneously address aerobic training and increase paretic limb involvement may improve outcomes and maximize productivity of therapy sessions. This case series assessed the feasibility of and characterized the cardiorespiratory and sensorimotor demands of adapted aerobic cycle ergometer activities hypothesized to increase paretic limb use. Mechanically loaded and electromyographic (EMG) feedback pedaling were compared to traditional pedaling in three poststroke case studies and a healthy control group. Submaximal oxygen uptake (Vo2), heart rate, perceived rate of exertion (RPE), and EMG of four leg muscles were assessed. Mechanically loaded ergometry increased RPE and altered muscle activity in healthy participants, while participants with stroke did not consistently increase paretic limb activation. EMG feedback pedaling increased target limb activity in healthy participants and decreased nonparetic activity in stroke participants. This paper highlights the challenges involved in adapting training tasks for individuals who are not able to walk at training intensities. Further work is necessary to refine adapted tasks for optimal effectiveness, and consideration of additional methods that permit differential interlimb loading may have additional value. [ABSTRACT FROM AUTHOR]

Summary: Background: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory condition associated with considerable personal and social burden yet little is known about how patients manage their condition. Purpose: The purpose of this study was to identify, from the perspective of individuals living with COPD, their management approaches. Methods: A mailed survey was conducted with individuals living in Ontario with physician confirmed COPD who experienced daily respiratory symptoms. Potential participants were identified through existing databases. Questionnaire development was based on focus groups and pilot testing. Results: Completed questionnaires were received from 353 of the 452 eligible participants, representing a 78% response rate. The mean age of responders was 68±12 years (sd) with 52% male, 85% ex-smokers, 52% with moderate COPD (self-report) and 52% treated by a family physician. Common strategies used by participants included inhaled bronchodilators (100%), annual influenza vaccination (90%), aerobic types of activity (75%), regular physician visits (72%), breathing exercises (69%) and inhaled steroids (67%). Forty-four percent of participants had scores indicative of depression. Participants (68%) reported using a shared decision-making model for management decisions and were satisfied with their interactions with the health care team (physician and non-physician). Conclusion: Most individuals with COPD use several strategies to manage their disease. Health care professionals have an important role in ensuring that evidence-based guidelines for COPD are translated to patients. [Copyright &y& Elsevier]

Abstract: Tang A, Sibley KM, Thomas SG, McIlroy WE, Brooks D. Maximal exercise test results in subacute stroke. Objectives: To establish the feasibility and reliability of graded maximal exercise testing, suitability of standard indexes of maximum oxygen consumption (V̇o 2max), and evidence of trial-to-trial practice effects in subacute stroke. Design: Descriptive, cross-sectional study. Setting: Rehabilitation hospital. Participants: Consecutive sample of 35 participants (mean age, 65.7±2.6y; mean days poststroke, 17.6±2.2d). Interventions: Not applicable. Main Outcome Measures: Graded maximal exercise test using semirecumbent cycle ergometry. A subset (n=20) performed repeated tests to determine test-retest reliability and presence of practice effects. Results: Thirty-one (89%) participants completed the exercise test without symptomatic responses (mean peak level of oxygen consumed [Vo 2peak], 10.7mL·kg−1·min−1; peak work rate, 39W). Twelve (34%), 15 (44%), and 3 (9%) participants achieved oxygen consumption per unit time (V̇o 2) plateau, respiratory exchange ratio, and heart rate criteria, respectively. Although test-retest correlations were high (intraclass correlation coefficient range, .67–.87), higher Vo 2peak (1.0mL·kg−1·min−1, P=.04) and work rate (7.3W, P=.01) were observed with repeated testing, with no associated increase in reaching standard criteria for V̇o 2max. Conclusions: This work has important implications for developing guidelines for measuring aerobic capacity early after stroke. Although maximal exercise testing using semirecumbent cycle ergometry is feasible, standard V̇o 2max criteria are not consistently appropriate. At least 1 practice trial is recommended before the actual evaluation is performed. [Copyright &y& Elsevier]

Abstract: Brooks D, Davis AM, Naglie G. Validity of 3 physical performance measures in inpatient geriatric rehabilitation. Objective: To evaluate the construct validity and the responsiveness of 3 measures of physical performance measures as outcome measures for frail older persons. Design: Pre-post design with measures at admission and discharge. Setting: Three inpatient geriatric rehabilitation programs. Participants: Fifty-two subjects (35 women, 17 men; age, 80±8y). Interventions: Not applicable. Main Outcome Measures: Physical performance measures were Timed Up & Go (TUG) test, two-minute walk test (2MWT), and functional reach. Functional status was measured with the FIM instrument and the Modified Barthel Index. Results: The TUG and 2MWT scores differed significantly in groups of patients using different ambulatory aids (P=.006), whereas no such difference was observed for the functional reach (P=.40). The correlations between the TUG test and FIM and between the 2MWT and FIM were –.59 and .59 (P<.001), respectively, at admission, and –.42 and .47 (P≤.04), respectively, at admission and discharge. The correlations between functional reach and the FIM were not significant (P≥.09). Standardized response means were 1.1 for the TUG, 0.7 for the 2MWT, and 0.5 for functional reach. Conclusions: The TUG test and 2MWT are valid and responsive outcome measures in older persons participating in geriatric rehabilitation. Functional reach was a moderately responsive outcome measure but did not consistently reflect ambulatory or functional status. [Copyright &y& Elsevier]

Summary: The purpose of this study was to conduct a systematic review to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and endurance, exercise capacity, dyspnea and quality of life for adults with chronic obstructive pulmonary disease (COPD). A systematic review of the literature was conducted according the Cochrane Collaboration protocol using Medline and CINAHL. Nineteen of 274 extracted articles met the inclusion criteria and addressed comparisons of interest which included: IMT versus sham; IMT versus no intervention; low- versus high-intensity IMT; and two different modes of IMT. Thirteen meta-analyses were reported. Results indicate that targeted resistive or threshold IMT was associated with significant improvements in some outcomes of inspiratory muscle strength (PImax (cm H2O)) and endurance (Inspiratory Threshold Loading (kPa)), exercise capacity (Borg Scale for Respiratory Effort (modified Borg scale), Work Rate maximum (Watts)), and dyspnea (Transition Dyspnea Index), whereas IMT without a target or not using threshold training did not show improvement in these variables. There was no conclusive evidence regarding quality of life measures. IMT is effective for adults with COPD when using threshold or targeted devices that control or provide a target for training intensity. [Copyright &y& Elsevier]

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD; however, current international guidelines do not include balance training and fall prevention strategies. Objective: The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in individuals with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence, and functional lower body strength, and to estimate the cost-effectiveness of the program. Methods: A total of 400 individuals from nine PR centers across Canada, Europe, and Australia will be recruited to participate in a randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last 2 years, or recent near fall will be randomly assigned to an intervention or control group. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive monthly phone calls to provide support and collect health care utilization and loss of productivity data. Both groups will receive home visits at 3, 6, and 9 months to ensure proper technique and progression of home exercise programs. The primary outcome will be incidence of falls at 12-month follow-up. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in prepaid envelopes each month. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR, and 12- month follow-up will include clinical measures of balance, balance confidence, functional lower body strength, and health status. The cost-effectiveness of the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality-adjusted life years gained. Results: Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. Conclusions: Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. [ABSTRACT FROM AUTHOR]

Background: Hip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. Objective: The objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. Methods: The search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. Results: This review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. Conclusions: The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide an overview of the research literature on distance and speed requirements for adults to walk outside the home. Data Sources: We conducted a systematic review and searched PubMed, MEDLINE (Ovid), EMBASE, CINAHL, Scopus, PEDro, and The Cochrane Library from 1948 to May 2012, and other sources. Search terms included communities, walk, ambulation, and neighborhood. Study Selection: Full-text peer-reviewed articles written in English, French, or Spanish reporting distance and/or speed requirements for individuals walking outside the home were considered eligible. Two authors independently screened titles and abstracts. One author reviewed full-text articles to determine inclusion. Of the 3191 titles and abstracts screened, 15 studies (.47%) were selected for detailed review. One author appraised methodological quality. Inadequate description of the reliability of the measurement methods and the population of the town/city assessed was noted. Data Extraction: One author extracted data from included studies. A second reviewer independently verified extracted data for accuracy. Data Synthesis: Seven studies examining 24 community sites and crosswalks in the United States, Australia, and Singapore were included. Three sites with the largest mean distance requirements for adults to walk were club warehouses (677m), superstores (183–607m), and hardware stores (566m). Three sites with the lowest mean distance requirements were walking at the front (16m) and back (19m) of the house, and at cemeteries (18m). The average speed required to cross the street in the time of a walk signal varied from .44 to 1.32m/s. Conclusions: Distance and speed requirements for adults to walk in the community environment vary widely. Findings are relevant to judging capacity for community ambulation to carry out essential activities of daily living, educating patients, and setting rehabilitation goals. [Copyright &y& Elsevier]