Search

Background: Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Methods: This study was a phase 1, single-group, pre–post pilot trial of My Back My Plan, a primary care program for acute low back pain. The trial was conducted at MQ Health Primary Care at Macquarie University in Sydney, Australia. The primary outcomes were feasibility and acceptability. Results: Fourteen participants were recruited to the study, with 79% and 93% followed up at 1 and 3 months respectively. Ten general practitioners and four physiotherapists at MQ Health Primary Care delivered the intervention. Although the rate of patient recruitment to the trial was low, other aspects of feasibility (such as intervention adherence and safety) were high. Participating clinicians reported that the program was useful for patients, and the majority stated that the program facilitated person-centred care. Patients rated My Back My Plan as highly acceptable, indicating that they had a better understanding of their low back pain, they were given personalised care and were more confident in self-managing their low back pain. At the 3 month follow-up, 85% of participants stated they were very likely to recommend the program to others. Conclusions: This study suggests that the co-designed, contextually refined MBMP program for MQ Health Primary Care is acceptable to people with acute onset low back pain and warrants further evaluation. Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. Our study evaluated the feasibility and acceptability of My Back My Plan, a primary care program for acute low back pain. My Back My Plan facilitates delivery of person-centred care and was rated as highly acceptable to people with acute onset low back pain, and thereby warrants further evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Intervention studies to date have shown limited evidence of falls reduction in community-dwelling stroke survivors. This study tests the acceptability and feasibility of the Stepping On after Stroke programme in Singapore. Method: A pre–post-intervention study design was used over a 6-month period. Falls incidence was the main outcome measure, with the recruitment process and attendance rate recorded to test feasibility. Data analysis from evaluation questionnaires (descriptive statistics) and interviews (content analysis) were applied to determine acceptability. Results: Eight stroke participants and seven caregivers completed the programme at two community sites facilitated by two programme leaders. Stroke participants achieved full attendance over the 7-week programme but family caregivers did not (38%). All participants highlighted their acceptability of the group-based falls-prevention programme. Both programme leaders achieved 92% fidelity in session delivery. Four stroke participants fell during the study period. Stroke participants demonstrated clinically meaningful improvements in community participation at 1 month post-intervention. Family caregivers reported no changes in pre–post evaluations. Conclusion: The Stepping On after Stroke programme appears feasible and acceptable to therapists and service users in Singapore; however, caregivers' participation was limited. Findings can be used to further improve the programme and its methodology before testing its effectiveness in a larger-scale trial. [ABSTRACT FROM AUTHOR]

Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11–19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke. [ABSTRACT FROM AUTHOR]

Background. People living with acquired brain injury (ABI) are more likely to be physically inactive and highly sedentary and, therefore, to have increased risks of morbidity and mortality. However, many adults with ABI experience barriers to participation in effective physical activity interventions. Remotely delivered self-management programs focused on teaching patients how to improve and maintain their physical activity levels have the potential to improve the overall health of adults with ABI. Obj'ective. The study objective was to evaluate the acceptability and feasibility of a remotely delivered self-management program aimed at increasing physical activity among adults who dwell in the community and have ABI. Design. A single-group design involving comparison of baseline measures with those taken immediately after intervention and at a 3-month follow-up was used in this study. Methods. The myMoves Program comprises 6 modules delivered over 8 weeks via email. Participants were provided with regular weekly contact with an experienced physical therapist via email and telephone. The primary outcomes were the feasibility (participation, attrition, clinician time, accessibility, and adverse events) and acceptability (satisfaction, worthiness of time, and recommendation) of the myMoves Program. The secondary outcomes were objective physical activity data collected from accelerometers, physical activity self-efficacy, psychological distress, and participation. Results. Twenty-four participants commenced the program (20 with stroke, 4 with traumatic injury), and outcomes were collected for 23 and 22 participants immediately after the program and at a 3-month follow-up, respectively. The program required very little clinician contact time, with an average of 32.8 minutes (SD=22.8) per participant during the 8-week program. Acceptability was very high, with more than 95% of participants being either very satisfied or satisfied with the myMoves Program and stating that it was worth their time. All participants stated that they would recommend the program to others with ABI. Limitations. The results were obtained from a small sample; hence, the results may not be generalizable to a larger ABI population. Conclusions. A remotely delivered self-management program aimed at increasing physical activity is feasible and acceptable for adults with ABI. Further large-scale efficacy trials are warranted. [ABSTRACT FROM AUTHOR]

Objective: one-third of community-dwelling older adults fall annually. Exercise that challenges balance is proven to prevent falls. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years. Methods: searches for relevant trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences and 95% confidence intervals (CI) were calculated using random-effects models. Methodological quality of trials was assessed using the 10-point Physiotherapy Evidence Database (PEDro) Scale. Results: six trials of relatively high methodological quality, totalling 307 participants, were identified and had data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (Hedges'g= 0.40, 95% CI 0.15-0.65, 6 trials) and a medium effect on physical mobility (Hedges'g = 0.50, 95% CI 0.06-0.95, 3 trials). Conclusion: yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people. PROSPERO Registration number CRD42015015872. [ABSTRACT FROM AUTHOR]

Abstract: Question: After stroke, does treadmill training provide greater benefit to the subgroup of community-dwelling people who walk faster than 0.4m/s than those who walk more slowly? Design: Subgroup analysis of a randomised trial: the AMBULATE trial. Participants: 68 people with stroke living in the community. Intervention: The experimental group received 30 minutes of treadmill and overground walking, three times a week for four months; the control group received no intervention. Outcome measures: The primary outcome was walking distance covered during the six-minute walk test. Other outcomes were comfortable and fast walking speed and health status. Results: At four months, in the subgroup of participants with a baseline comfortable walking speed of > 0.4m/s, treadmill training produced an extra distance of 72m (95% CI 23 to 121) and an increased comfortable speed of 0.16m/s (95% CI 0.00 to 0.32), compared with the subgroup with a speed of ≤0.4m/s. There was also a trend towards an extra fast speed of 0.17m/s (95% CI –0.04 to 0.36). There was no extra effect of treadmill training in the faster walkers in terms of EuroQol 5Q-5D. There were no differences between the experimental and control groups between subgroups in the long term. Conclusion: Treadmill training is more likely to benefit people who walk at a speed of > 0.4m/s. Clinicians should use comfortable walking speed to predict the potential for improvement and to guide intervention. Trial registration: ACTRN12607000227493. [Dean CM, Ada L, Lindley RI, (2014) Treadmill training provides greater benefit to the subgroup of community- dwelling people after stroke who walk faster than 0.4 m/s: a randomised trial. Journal of Physiotherapy 60: 97–101] [Copyright &y& Elsevier]

Aim. To investigate predictors of adherence to group-based exercise and physical activity participation among stroke survivors. Methods. 76 stroke survivors participated (mean age 66.7 years). Adherence was the percentage of classes attended over one year. Physical activity was the average pedometer steps/day measured over seven days at the end of the trial. Possible predictors included baseline measures of demographics, health, quality of life, falls, fear of falling, cognition, and physical functioning. Results. Mean class attendance was 60% (SD 29%). Only one variable (slow choice stepping reaction time) was an independent predictor of higher class attendance, explaining 5% of the variance. Participants completed an average of 4,365 steps/day (SD 3350). Those with better physical functioning (choice stepping reaction time, postural sway, maximal balance range, 10-m walk, or 6-min walk) or better quality of life (SF-12 score) tookmore steps. A model including SF-12, maximal balance range, and 6-min walk accounted for 33% of the variance in average steps/day. Conclusions. The results suggest that better physical functioning and health status are predictors of average steps taken per day in stroke survivors and that predicting adherence to group exercise in this group is difficult. [ABSTRACT FROM AUTHOR]

Question: What is the free-living physical activity of community-dwelling people with stroke compared with that of agematched healthy controls? Design: A cross-sectional observational study. Participants: 42 people with stroke and 21 agematched healthy controls aged 52 to 87 years living in Sydney, Australia. Outcome measures: Free-living physical activity was measured using the Intelligent Device for Energy Expenditure and Activity (IDEEA) and reported as duration (time on feet in min) and frequency (activity counts). Results: People with stroke spent 79 (95% CI 20 to 138) fewer min on their feet and performed 5308 (95% CI 3171 to 7445) fewer activity counts than healthy controls. The observation period of the free-living physical activity of stroke survivors was significantly less than that of the healthy controls. Data adjusted to a fixed observation period (12 hr) showed no relative difference in time on feet between the groups (mean difference 36 min, 95% CI -27 to 99) but that people after stroke still had relatively fewer activity counts than healthy controls (mean difference 4062 counts, 95% CI 1787 to 6337). Conclusions: The reduction in physical activity after stroke is not primarily because of a decrease in the time spent being active but rather a decrease in frequency of activity during that time. Future research into physical activity after stroke needs to consider energy expenditure because stroke survivors exhibit a reduced frequency of physical activity due to the nature of their impairments. [ABSTRACT FROM AUTHOR]

Background Older people who have been recently discharged from hospital are at increased risk of falls and deterioration in physical functioning. Objective To investigate the cost-effectiveness of a 12-month home-exercise program for older adults after hospitalization. Method An economic evaluation was conducted alongside a randomized controlled trial. The analysis was conducted from the health and community service provider perspective. A total of 340 people aged 60 years and older, with a recent hospital admission, were randomized into exercise and usual care control groups. Incremental costs per extra person showing improvement in mobility performance (using the Short Physical Performance Battery), per person indicating improvement in health (self-reported using a 3-point Likert scale) and per quality-adjusted life year (QALY) gained (utility measured using the EQ-5D) were estimated. Uncertainty was represented using cost-effectiveness acceptability curves. Subgroup analyses for participants with better cognition (above the median MMSE score of 28) also were undertaken. Results The average cost of the intervention was $A751 per participant. The incremental cost-effectiveness of the program relative to usual care was $A22,958 per extra person showing an improvement in mobility, $A19,020 per extra person indicating an improvement in health, and $A77,403 per QALY. The acceptability curve demonstrates that the intervention had an 80% probability of being cost-effective relative to the control at a threshold of $A48,000 per extra person achieving mobility improvement and $A36,000 indicating an improvement in self-reported health. There was no threshold value at which the program can be considered as having an 80% probability of cost-effectiveness for the QALY outcome. Subgroup analyses for participants with better cognitive status indicated improved cost-effectiveness for all outcomes. Conclusion The exercise intervention appeared to offer reasonable value for money for mobility outcomes and self-reported health status. Value for money for all measures was greater in the higher cognitive status subgroup. [ABSTRACT FROM AUTHOR]