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AbstractPurposeMethodsResultsConclusions\nImplications for rehabilitationTo determine the prevalence of metabolic syndrome and explore its association with clinical outcomes (pain, quality of life, and physical function) in adults participating in an education and exercise program (GLA:D®).An observational study of adults with hip and/or knee osteoarthritis who participated in GLA:D® between 2019 and 2022. Metabolic syndrome status was determined through self-report. Differences in clinical outcomes among people with, at risk of (1–2 risk factors), or without metabolic syndrome were compared at baseline, 3-, and 12-months using linear mixed models (age, sex, and baseline outcomes as covariates).Of 6846 participants (aged 65(SD 9) years), 20% (n = 1337) had, and 68% (n = 4632) were at risk of metabolic syndrome. Adults with metabolic syndrome reported higher pain (0–100 VAS: 7.3, 95% CI 5.4–9.1), lower health-related quality of life (EQ5D 0–100, VAS: −8.6, 95% CI −10.2 to −7.0), and slower gait speed (−0.26 m/s, 95%CI -0.3 to −0.23) at baseline compared to those with no metabolic risk factors. Differences remained at 3- and 12-months for pain and quality of life.Metabolic syndrome risk factors were common in adults with osteoarthritis. Clinical outcomes remain impaired in people with metabolic syndrome compared to those without after education and exercise, suggesting further intervention may be required.Metabolic syndrome risk factors were prevalent in people with hip and/or knee osteoarthritis attending an education and exercise program.The presence of metabolic syndrome was associated with greater pain severity and disability, and poorer quality of life.People with metabolic syndrome participating in education and exercise programs for osteoarthritis may need additional specific physical activity and diet interventions to improve their outcomes.Metabolic syndrome risk factors were prevalent in people with hip and/or knee osteoarthritis attending an education and exercise program.The presence of metabolic syndrome was associated with greater pain severity and disability, and poorer quality of life.People with metabolic syndrome participating in education and exercise programs for osteoarthritis may need additional specific physical activity and diet interventions to improve their outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of interventions to increase physical activity (PA) in people with spinal cord injury (SCI). Method: Online databases PubMed, Medline, AMED and CINAHL were searched from the earliest date available to July 2022. Randomised controlled trials (RCT) exploring the effect of interventions on physical activity in people with SCI were eligible. The search identified 1191 studies, after screening 16 reports of 15 RCT's were included. Data were extracted on participant characteristics, intervention characteristics and physical activity outcomes. Methodological quality was assessed using the PEDro Scale and certainty of evidence assessed using GRADE. Post intervention means and standard deviations were pooled in meta-analyses to calculate standardised mean differences or mean differences and 95% confidence intervals. Results: Fifteen trials with 693 participants (mean age 41–52) were included. There was moderate certainty evidence that exercise interventions had no effect on subjectively or objectively measured PA. There was moderate to high certainty evidence that behavioural interventions and combined behavioural and exercise interventions increased subjectively, but not objectively measured physical activity. Conclusion: Behaviour change techniques are an important intervention component for increasing PA in people with SCI. IMPLICATIONS FOR REHABILITATION: Only half of people with spinal cord injury (SCI) meet physical activity guidelines Physical activity (PA) is important in managing primary and secondary complications Exercise intervention alone does not increase PA in people with SCI Interventions should include behavioural techniques to increase PA in people with SCI Interventions that include behavioural techniques are shown to be effective across a wide range of SCI populations [ABSTRACT FROM AUTHOR]

Introduction Methods Consumer involvement Findings Conclusion PLAIN LANGUAGE SUMMARY The revised functional autonomy measurement system (SMAF‐R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF‐R as a routine outcome measure in acute and subacute inpatients.This was a mixed‐methods implementation study. Occupational therapists were asked to complete the SMAF‐R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12‐month period (n = 13,348). A baseline audit of SMAF‐R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF‐R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated.Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions.Peak completion of the SMAF‐R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF‐R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF‐R influenced acceptability; (2) using the SMAF‐R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF‐R scores during their hospital stay (median difference 16.5 [6.5–27.0], p < 0.001, n = 764).Although most occupational therapists reported the SMAF‐R was acceptable, there were mixed opinions regarding the relevance of the SMAF‐R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF‐R relevance to practice) may assist with improving SMAF‐R completion. Further research is required to assess the psychometric properties of the SMAF‐R in the hospital environment.The revised functional autonomy measurement system (SMAF‐R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve.This study aimed to measure (1) how often occupational therapists use the SMAF‐R with patients in hospital, (2) how acceptable occupational therapists find the SMAF‐R, and (3) whether the SMAF‐R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF‐R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF‐R completion over 12 months. After this, completion of the SMAF‐R improved to between 9% and 38% in different hospital settings. Changes in SMAF‐R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF‐R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF‐R was not fit for purpose in this setting or that more support is needed to increase completion. [ABSTRACT FROM AUTHOR]

Background Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes. Objective This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries. Methods Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy. Results Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings. Conclusions Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture. [ABSTRACT FROM AUTHOR]

Background Hospital falls continue to be a persistent global issue with serious harmful consequences for patients and health services. Many clinical practice guidelines now exist for hospital falls, and there is a need to appraise recommendations. Method A systematic review and critical appraisal of the global literature was conducted, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Web of Science, Embase, CINAHL, MEDLINE, Epistemonikos, Infobase of Clinical Practice Guidelines, Cochrane CENTRAL and PEDro databases were searched from 1 January 1993 to 1 February 2024. The quality of guidelines was assessed by two independent reviewers using Appraisal of Guidelines for Research and Evaluation Global Rating Scale and Appraisal of Guidelines of Research and Evaluation Recommendation Excellence (AGREE-REX). Certainty of findings was rated using Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research. Data were analysed using thematic synthesis. Results 2404 records were screened, 77 assessed for eligibility, and 20 hospital falls guidelines were included. Ten had high AGREE-REX quality scores. Key analytic themes were as follows: (i) there was mixed support for falls risk screening at hospital admission, but scored screening tools were no longer recommended; (ii) comprehensive falls assessment was recommended for older or frail patients; (iii) single and multifactorial falls interventions were consistently recommended; (iv) a large gap existed in patient engagement in guideline development and implementation; (v) barriers to implementation included ambiguities in how staff and patient falls education should be conducted, how delirium and dementia are managed to prevent falls, and documentation of hospital falls. Conclusion Evidence-based hospital falls guidelines are now available, yet systematic implementation across the hospital sector is more limited. There is a need to ensure an integrated and consistent approach to evidence-based falls prevention for a diverse range of hospital patients. [ABSTRACT FROM AUTHOR]

Background: Inadequate physical activity is a problem for people with Down syndrome and objective monitoring using accelerometers may be inaccurate in this population. Method: This was a cross-validation and reliability study comparing two triaxial accelerometers (the SenseWear and RT3) to a criterion measure (the OxyCon Mobile) in 10 young people (M age = 20 ± 2) with Down syndrome. A ROC curve analysis was conducted to determine intensity thresholds from RT3 activity counts. Results: During self-selected pace walking, the accelerometers overestimated energy expenditure and had large limits of agreement (SenseWear: -0.5-3.6 METs; RT3: -0.2-2.7 METs). At this pace, SenseWear armband step counts were highly correlated with observed steps (r = .98) but underestimated steps by up to 12%. We developed RT3 thresholds that demonstrated good to excellent sensitivity and specificity in classifying physical activity intensity. Conclusions: SenseWear steps and RT3 activity count thresholds can be used to monitor physical activity in young people with Down syndrome, although energy expenditure estimates should be used with caution in this population.

To determine the criterion validity of the activPAL and ActiGraph for measuring steps and sitting/sedentary time, compared to observation, in people hospitalised following orthopaedic lower limb injury who were weight bearing (WB) (i.e., walking) or non-weight bearing (NWB) (i.e., hopping). Participants wore an activPAL and ActiGraph on the hip/thigh/unaffected (UA)/affected ankle (AA) while completing bouts of walking and sitting. Lin's concordance correlation coefficient, Bland–Altman methods, and ratio of agreement were used to compare device-measured to observed (videoed) step count, sitting/sedentary time. In 42 participants, the ActiGraph demonstrated excellent concordance with the observed step count when worn on the ankle (LCC 0.91–0.92) compared to the hip (LCC 0.56) in participants that were WB. The ActiGraph AA achieved the highest concordance (LCC 0.71) with observed steps in participants NWB. The activPAL had poor concordance with observed steps, particularly at slow gait speeds, in participants that were WB (LCC 0.38–0.46), however was less influenced by gait speed and had good concordance in NWB participants (LCC 0.52–0.69). The activPAL (LCC 0.79–0.88) and ActiGraph UA (LCC 0.94) showed excellent concordance with observed sitting and sedentary time, respectively. The ActiGraph worn at the ankle provided the most valid measure of steps in people who are WB and NWB following orthopaedic injury, while the activPAL was best for measuring sitting time. To accurately measure both steps and sitting time in people with lower limb orthopaedic injuries, a combination of activity monitors should be used (i.e., ActiGraph for steps, activPAL for sitting time). The ActiGraph device when worn on the ankle demonstrated the strongest agreement with observed step count in people who were weight bearing and non-weight bearing. Caution is needed when using thigh- or hip-worn devices in people who walk slowly. [ABSTRACT FROM AUTHOR]

Music listening is widely used during exercise, but effects on physical activity are unknown. This review aimed to examine the effectiveness of music listening on physical activity of adults. Searches were conducted until September 2022. Eligible randomised controlled trials examined intentional music listening to enhance physical activity in adults. Trials were assessed using the Revised Cochrane risk-of-bias tool. The GRADE approach assessed certainty of evidence. One high and two low risk-of-bias trials (113 participants, 63–68 years) from cardiac and pulmonary rehabilitation programs were included. Moderate certainty evidence favoured music listening for total amounts of physical activity (n = 112, δ = 0.32, 95% CI = −0.06–0.70) and weekly moderate intensity physical activity (n = 88, MD = 52 min, 95% CI = −8–113). Low certainty evidence favoured music listening for exercise capacity (6-min walk test) (n = 79, MD = 101 metres, 95% CI = 2.32–199.88). There is imprecise, moderate certainty evidence that music listening increases physical activity by a small amount in older adults. Future research including adults of all ages with and without health conditions might investigate music listening with focussed behaviour change interventions. There is uncertainty in the current evidence but listening to music may lead to small increases physical activity in older adults with health conditions. Listening to music while walking may lead to improved exercise capacity. Rehabilitation professionals might consider using music listening as an adjunct with focussed behaviour change interventions aiming to increase physical activity. [ABSTRACT FROM AUTHOR]

Objective: To explore how personal characteristics and social engagement impact the physical activity levels of chronic stroke survivors. Design: A mixed-methods study comprising in-depth semi-structured interviews and objective 24-h physical activity monitoring. Interviews were thematically analysed, and activity diaries were compared to activity monitor data to attain a complete picture of physical activity. Triangulation explored the relationship between perceptions, beliefs, activity levels and social engagement. Setting: Community. Participants: Community-dwelling, independently mobile, adult stroke survivors (n = 19). The mean age was 74 (11 SD) years, 52% female, mean time post-stroke 41 (SD 61) months. Main measures: Qualitative and quantitative measures including individual semi-structured interviews, accelerometry, activity diaries, self-efficacy, Frenchay Activities Index and Barthel Index. Results: Individual identity had the greatest perceived influence on post-stroke physical activity. Pre-stroke identity, meaningful activities and family culture contributed to identity; while social and community activities, self-efficacy, co-morbidities, stroke symptoms and exercise, also impacted physical activity. Participants averaged 5365 (IQR 3378–7854) steps per day and reported a mean self-efficacy for exercise score of 51 (SD 20). Triangulation showed convergent relationships between post-stroke physical activity levels and participant motivation, comorbidities, level of social and community participation, self-efficacy and pre-stroke activity levels. Conclusion: Personal identity, social engagement and community participation are important factors to consider when implementing a person-centred approach to increasing physical activity participation post-stroke. [ABSTRACT FROM AUTHOR]