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Stephanie Chauvin,1 Renata Kirkwood,1 Dina Brooks,1,2 Roger S Goldstein,2– 4 Marla K Beauchamp1,2,5 1School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; 2Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; 3Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 5Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, Hamilton, Ontario, CanadaCorrespondence: Marla K BeauchampMcMaster University, 1400 Main Street West, Hamilton, ON L8S 1C7, IAHS 430 CanadaTel +1 905 525-9140 x 21732Email beaucm1@mcmaster.caRationale: Chronic obstructive pulmonary disease (COPD) is an increasingly prevalent lung disease linked to dysfunctional balance and an increased risk of falls. The Balance Evaluation Systems Test (BESTest) evaluates the six underlying subcomponents of functional balance. The aim of this study was to determine the specific balance subcomponents and cut-off scores that discriminate between fallers and non-fallers with COPD to guide fall risk assessment and prevention.Methods: A secondary analysis of cross-sectional data from two prior studies in COPD was performed. Independent samples t-tests were used to explore the differences in the BESTest sub-system scores between fallers and non-fallers. Receiver operating characteristic curves were used to determine the optimal subcomponent cut-off scores that identified fallers, and the area under the curve (AUC) was used to assess test accuracy.Results: Data from 72 subjects with COPD (mean age, 70.3 ± 7.4y; mean forced expiratory volume in 1 second, 38.9 ± 15.8% predicted) were analyzed. Two BESTest subcomponents, stability limits/verticality (fallers: 75.4%, non-fallers: 83.8%; p=0.002) and postural responses (fallers: 67.5%, non-fallers: 79.7%; p=0.008) distinguished between fallers and non-fallers. Stability limits/verticality had an AUC of 0.70 and optimal cut-off score of 73.8% for identifying fallers; postural responses had an AUC of 0.67 and optimal cut-off score of 69.4%.Conclusion: The stability limits/verticality and postural responses subcomponents of the BESTest distinguished between fallers and non-fallers with COPD. The stability limits/verticality subcomponent can also be used to identify whether an individual with COPD is at risk of falling using a cut-off score of 73.8%. These findings suggest that specific subcomponents of balance could be targeted to optimize fall risk assessment and prevention in COPD.Keywords: BESTest, chronic obstructive pulmonary disease, balance, falls, rehabilitation

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Additional file 2. Physiotherapist Interview Guide & Instructions.

Motivators and barriers to exercise participation in women with coronary artery disease remain poorly understood. With evidence suggesting that women with coronary artery disease are less likely to adhere to exercise during cardiac rehabilitation and are more likely to drop out, it is important to understand these factors in order to optimize cardiac rehabilitation programs for women. We contribute to the discussion by presenting findings from a qualitative study using two focus groups with nine women with coronary artery disease sharing their experiences with attending cardiac rehabilitation and exercising in this setting, in addition to their perceived motivators and barriers to performing aerobic interval training. Focus group transcripts were analysed using a deductive thematic approach with Bandura���s Social Cognitive Theory as the guiding conceptual framework. Four themes were identified regarding the attitudes and experiences of attending and exercising at cardiac rehabilitation, while five themes capturing the motivators and barriers for these women to perform aerobic interval training were identified for the first time. These novel themes encompassed the daunting nature of it, the physical discomfort associated with it, and conversely, the potential sense of enjoyment and accomplishment that it could bring. This study demonstrates the complexity of implementation of aerobic interval training into clinical practice, and suggests that further research is warranted to explore this domain.IMPLICATIONS FOR REHABILITATIONDespite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml��kg���1��min���1 in favour of aerobic interval training.The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs.Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient. Despite challenges in feasibility of conducting a randomised controlled trial in female patients with coronary artery disease examining the effects of aerobic interval training versus moderate-intensity continuous exercise on aerobic exercise capacity, there was a significant per protocol treatment effect of 0.95 ml��kg���1��min���1 in favour of aerobic interval training. The cardiac rehabilitation environment provides key facilitators and perceived benefits for exercising and attending cardiac rehabilitation for women, and thus emphasises the need for improving referral and enrolment processes specifically for women into cardiac rehabilitation programs. Aerobic interval training may elicit feelings of fear and physical discomfort, or may be precluded by comorbid conditions, therefore, judicious consideration must be taken in examining the suitability of implementation into clinical practice for each female patient.

Supplemental material, Supplemental_material_search_strategy_MEDLINE for Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review by Stacey J Butler, Lauren Ellerton, Andrea S Gershon, Roger S Goldstein and Dina Brooks in Palliative Medicine

Additional file 1. Stroke Participant Interview Guide & Instructions.