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Casey L Peiris,1 Amy Gallagher,2 Nicholas F Taylor,1,3 Sionnadh McLean2 1School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; 2Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK; 3Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaCorrespondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email S.McLean@shu.ac.ukBackground: Exercise and physical activity interventions improve short-term outcomes for people with metabolic syndrome, but long-term improvements are reliant on sustained adherence to lifestyle change for effective management of the syndrome. Effective ways of improving adherence to physical activity and exercise recommendations in this population are unknown. This systematic review aims to determine which interventions enhance adherence to physical activity and/or exercise recommendations for people with metabolic syndrome.Methods: Electronic databases MEDLINE, PubMed, CINAHL, SPORTdiscuss and ProQuest were searched to July 2022. Risk of bias was assessed using the Cochrane risk of bias tool and overall certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation approach.Results: Four randomized controlled trials with 428 participants (mean age 49– 61 years) were included. There was very low certainty evidence from two trials that goal setting interventions may improve adherence to physical activity recommendations over three to six months. There was low certainty evidence from two trials that self-monitoring and feedback interventions increased adherence to physical activity interventions over 12 months for people with metabolic syndrome.Conclusion: Clinicians and researchers may consider using behavior change strategies such as goal setting, monitoring and feedback in interventions for people with metabolic syndrome to increase adherence to physical activity and exercise recommendations over 3 to 12 months, but high-quality evidence is lacking.Keywords: metabolic syndrome, adherence, long-term condition, behavior change, physical activity, exercise

Laila El Haddad,1 Casey L Peiris,2 Nicholas F Taylor,2,3 Sionnadh McLean1 1Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK; 2School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia; 3Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, AustraliaCorrespondence: Sionnadh McLean, Collegiate Campus, Sheffield Hallam University, L108, 36 Collegiate Crescent, Sheffield, S10 2BP, UK, Tel +447342 092 340, Email S.McLean@shu.ac.ukBackground: Long-term adherence to exercise or physical activity (EPA) is necessary for effective first-line management of metabolic syndrome (MetS). Little is known about the determinants of adherence in this population. This systematic review aims to identify the determinants of adherence to EPA in people with MetS.Methods: Six databases (MEDLINE, CINAHL Complete, PubMed, PsycINFO, SPORTDiscus, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies published before April 26, 2021. Primary research studies investigating factors affecting EPA adherence in adults with MetS in outpatient settings were included. Risk of bias was assessed using the QUIPS (Quality in Prognostic Factor Studies) and CASP (Critical Appraisal Skills Program) tools, for quantitative and qualitative methodologies, respectively.Results: Four quantitative studies (n = 766) and one qualitative (n = 21) study were included in the review, evaluating 34 determinants of adherence to EPA in MetS. Limited evidence was found for an association between ten determinants and non-adherence to EPA: lower self-rated health, lower baseline EPA, lower high-density lipoprotein cholesterol (HDL-C), fewer walk-friendly routes within 1 km, less consciousness raising, lower self-re-evaluation, lower self-liberation, reporting more arguments against EPA (cons), lower social support, and fewer positive psychological constructs. There was limited evidence of no association or conflicting evidence for the remaining 24 determinants.Conclusion: A small number of included studies, most of low methodological quality, resulted in limited confidence in the findings for all determinants. The identified determinants associated with non-adherence are all potentially modifiable, thus further high-quality studies are required to increase confidence in the determinants of EPA in people with MetS, and test interventions.Keywords: adherence, long-term condition, behavior change

Background and Purpose: Many physically capable stroke survivors are insufficiently active, with low self-efficacy considered an important contributor. However, validity and reliability of self-efficacy measures in stroke survivors have not been established. This research aims to evaluate the test-retest reliability and construct validity of 3 self-efficacy measures: Self-Efficacy for Exercise Scale (SEE), Spinal Cord Injury Exercise Self-Efficacy Scale (SCI-ESES), and Participation Strategies Self-Efficacy Scale (PS-SES)., Methods: A repeated measures study with community-dwelling, independently mobile adult stroke survivors (n = 51, mean age 74 years, 45% female, median 22 months poststroke) was completed. Test-retest reliability was assessed using intraclass correlation coefficients and Bland-Altman analyses. Construct validity was assessed using 8 pre-determined hypotheses concerning physical activity level (subjective and objective), comorbidities, work and volunteering, and measures of function., Results: Retest reliability was established for the SEE (intraclass correlation coefficient, ICC = 0.77) and PS-SES (ICC = 0.78) but not for the SCI-ESES (ICC = 0.68). Bland-Altman analysis showed participants consistently scored higher on the second test for all measures. The SEE achieved construct validity by meeting 75% of hypotheses, whereas the PS-SES and SCI-ESES did not. Self-efficacy was positively related to steps/day, functional capacity, self-reported activity levels, and work or volunteering participation., Discussion and Conclusions: The SEE was found to be the most appropriate tool to measure exercise self-efficacy in independently mobile chronic stroke survivors in terms of retest reliability and validity., Trial Registration: N/A., Video Abstract Available: for more insights from the authors (see the Video, Supplemental Digital Content 1 "Espernberger-JNPT-Video-Abstract," available at: http://links.lww.com/JNPT/A489)., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2024 Academy of Neurologic Physical Therapy, APTA.)

ObjectiveThis study aimed to evaluate the feasibility of a workplace-delivered outpatient multidisciplinary service (ReCOV) for staff experiencing post COVID-19 condition ('Long COVID').MethodsA mixed-methods study of staff at a large, tertiary hospital with Long COVID who attended the service was conducted. Participants completed questionnaires to determine baseline symptoms and were offered allied health appointments for up to 12weeks each based on clinical indication. Acceptability, implementation, practicality and limited efficacy were evaluated via one-on-one semi-structured interviews and analysed using inductive thematic analysis. Limited efficacy was evaluated via pre- and post-questionnaires and demand via multidisciplinary utilisation.ResultsTwenty-three (median age 37 [interquartile range 30-45] years, 52% female) participants were included. Participants had appointments with a median of 4 [3-5] different professions; most commonly exercise physiology (n=19, 83%), occupational therapy (n=17, 74%) and neuropsychology (n=15, 65%). Median time spent on the ReCOV service was 15 [9-19] weeks. Thirteen semi-structured interviews were completed and analysed. Participants valued ReCOV for being a COVID-19 specific, convenient, flexible and multidisciplinary service at their workplace. Participants preferred the service to have been available for longer than 12weeks to achieve further benefits as many participants perceived little change in physical health.ConclusionsAttending a multidisciplinary service located at their workplace was feasible for staff to manage post COVID-19 symptoms. Further research is required to confirm the efficacy on patient outcomes.

Purpose: Specialised group-based exercise rehabilitation is beneficial for cancer survivors but access to these services is limited. Telerehabilitation provides an opportunity to expand reach, but we do not know about the experiences of those who participate in this way. This study explored participant experiences of an exercise-based telerehabilitation program for people with cancer., Method: A qualitative study using semi-structured interviews was completed. Twenty-two cancer survivors were purposively sampled from the experimental group of a randomised controlled trial evaluating exercise-based cancer telerehabilitation delivered in groups using synchronous videoconferencing. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed inductively by thematic analysis., Results: 'A feeling of connection' was the overarching theme. Participants perceived they connected with the health service, expert health professionals, and peers through participating in the telerehabilitation program. These connections provided a personalised rehabilitation experience and improved perceptions of physical and emotional well-being. Two subthemes suggested connection was facilitated by (1) the acceptability of telerehabilitation and (2) enhanced accountability to exercise. Participants felt disconnected when they were unable to participate in the program due to cancer treatment and side effects (e.g. fatigue), feeling unwell, and co-morbidities., Conclusion: We identified that telerehabilitation facilitated connections that enhanced the reach of exercise to cancer survivors. Our findings support using telerehabilitation to deliver specialised group-based exercise programs alongside more traditional models of care to increase participation in exercise among people with cancer., (© 2024. Crown.)

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., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Objectives: To determine the knowledge, attitudes, and current practice of primary care physiotherapists in recognising and managing clients with metabolic syndrome., Design: Mixed-methods research design comprising an online survey and focus groups., Participants: Australian and English physiotherapists (n = 183) working in a primary care setting responded to the survey. Twelve physiotherapists participated in focus groups., Results: Metabolic syndrome was not on physiotherapists radar. They did not screen for metabolic syndrome nor provide management for it in primary care. Although most physiotherapists had some awareness of metabolic syndrome, they were not knowledgeable. Physiotherapists reported a need to focus on their clients' presenting condition, and there was uncertainty on whether metabolic syndrome management was within their scope of practice. Despite this, physiotherapists felt they had an important role to play in exercise and physical activity prescription for chronic disease management and were keen to further their knowledge and skills related to metabolic syndrome. Survey responses and focus group data were convergent., Conclusion: Physiotherapists working in primary care settings are well-placed to identify metabolic risk factors in their clients and provide physical activity interventions to enhance management but currently lack knowledge to embed this in clinical practice. Training and resources are required to enable physiotherapists to identify and manage metabolic syndrome within their practice. CONTRIBUTION OF PAPER., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To determine the prevalence of metabolic syndrome in clients presenting for primary care physiotherapy within private practice settings, and the factors that may be associated with metabolic syndrome. The secondary aim was to determine client's attitudes towards lifestyle change., Design: A cross-sectional study in which self-report and biometric data were collected. The study was conducted in physiotherapy private practices across metropolitan and regional areas, Australia., Participants: 230 clients (mean age 54 (SD18) years, 64% women) presenting for physiotherapy participated., Main Outcome Measures: Participant socio-demographic and lifestyle characteristics were collected. Metabolic syndrome presence was determined by the existence of three or more risk factors on physical examination and capillary blood sample: abdominal obesity, hypertension, elevated random blood glucose, elevated triglycerides and/or reduced HDL cholesterol., Results: Thirty-seven percent of participants had metabolic syndrome, but none knew they had it. Metabolic syndrome was associated with older age and poorer socio-economic status and may have been associated with lower levels of physical activity but not diet. Of those identified as having hypertension and elevated triglycerides, many were undiagnosed (56% and 29% respectively)., Conclusion: Metabolic syndrome is prevalent and undiagnosed in clients attending private practice physiotherapy. Clients felt lifestyle change was important and they were willing to make changes. This study highlights the need for greater screening of metabolic risk factors in primary care and presents an opportunity for physiotherapists in private practice to identify risk and intervene to improve the overall health of their clients and contribute to chronic disease prevention. CONTRIBUTION OF THE PAPER., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID., Methods: A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage)., Results: During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control ( p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004])., Conclusions: A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.

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., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society.)

Objectives: To 1) explore physiotherapy students' experience in caring for people with dementia; 2) develop a rich understanding of their perceived preparedness to work with people with dementia upon graduation; and 3) identify opportunities to improve dementia education from the perspectives of students., Design: A qualitative study comprised of semi-structured interviews via web conferencing software. Thematic analysis was undertaken, with themes/subthemes derived and a qualitative framework generated., Setting: Three Victorian Universities in Australia., Participants: Physiotherapy students of entry-to-professional practice education programs (n = 17; mean age 23.7 years, 65% female), having completed at least 15 weeks of clinical placements., Results: The overarching theme was that students' experience of providing care for people with dementia was variable. The three sub-themes were: 1) students experience significant challenges when working with people with dementia, 2) students experience a range of emotions when working with people with dementia, and 3) the quality of dementia learning experiences during entry-to-professional practice training is mostly inadequate. Students described the importance of the supervisor during clinical placements, and suggested incorporating 'real-life' scenario training in the classroom to assist them learn to manage the challenging symptoms of dementia., Conclusion: Physiotherapy students believe that entry-to-practice dementia education is insufficient. These findings have important implications for the future planning and delivery of physiotherapy dementia education. CONTRIBUTION OF THE PAPER., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Purpose: To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months., Methods: Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied., Results: Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I 2  = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I 2  = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I 2  = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I 2  = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I 2  = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I 2  = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence., Conclusion: Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion., Implications for Cancer Survivors: Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: The aim of this review was to assess the effectiveness of multidisciplinary, activity-based interventions on adults with chronic musculoskeletal or widespread pain who identify as ethnoculturally diverse (ECD) compared to adults belonging to the predominant culture of the host country., Methods: Online databases Medline, CINAHL, AMED, Psych Info and PubMed were searched from the earliest date available until April 2023. The quality of the included studies were assessed against the Risk of Bias in Non Randomized Studies of Interventions (ROBINS-I). Postintervention data were analyzed using meta-analyses and the certainty of evidence determined using the Grading of Recommendation, Assessment, Development and Evaluation approach (GRADE)., Results: Nine cohort studies with 3467 participants living in America and north-western European countries were included. ECD adults had higher pain intensity (SMD 1.36, 95%CI 0.29 to 2.35, p  = 0.03), higher levels of depression (SMD 0.96, 95%CI 0.40 to 1.52, p  < 0.01) and a nonsignificant difference in pain-related disability (SMD -1.45, 95%CI -3.28 to 0.39, p  = 0.12) following multidisciplinary pain intervention compared to adults of the predominant culture., Conclusion: Adults from ECD backgrounds in Western nations have poorer outcomes after multidisciplinary, activity-based chronic pain interventions compared to adults from predominant cultural groups in these countries suggesting program adaptations may be required.

Purpose: To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture., Materials and Methods: Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender., Results: Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p  = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p  = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p  = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p  < 0.001) were negatively associated with meeting higher physical activity thresholds., Conclusion: Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.

Purpose: 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)., Materials and Methods: 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., Results: 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., Conclusions: 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.Implications for rehabilitationTo 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.

Purpose: 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., Materials and Methods: 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., Results: 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)., Conclusions: 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.IMPLICATIONS FOR REHABILITATIONThere 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.

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 REHABILITATIONOnly half of people with spinal cord injury (SCI) meet physical activity guidelinesPhysical activity (PA) is important in managing primary and secondary complicationsExercise intervention alone does not increase PA in people with SCIInterventions should include behavioural techniques to increase PA in people with SCIInterventions that include behavioural techniques are shown to be effective across a wide range of SCI populations.

Background: Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults., Objective: This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs., Methods: Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria., Results: Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed., Conclusion: Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Questions: What do private practitioners perceive to be the benefits, barriers, costs and risks of hosting physiotherapy students on clinical placement? What models of placement are used and what support would private practitioners like to enable them to continue hosting students?, Design: A national mixed-methods study comprising a survey and four focus groups., Participants: Forty-five private practitioners from six states and territories who host on average 208 students per year (approximately one-third of all physiotherapy private practice placements in Australia) completed the survey. Fourteen practitioners participated in focus groups., Results: Participants reported that hosting placements helped to recruit graduates and assisted private practitioners in developing clinical and educator knowledge and skills. Cost (both time and financial) and difficulties securing a sufficient caseload for students were perceived barriers to hosting placements. Hosting placements was perceived to be low risk for clients due to supervised care, but there was potential for risk to business reputation and income when hosting a poorly performing student. Participants mostly described a graded exposure placement model whereby final-year students progressed from observation to shared care to providing care under supervision. Participants perceived that they could be assisted in hosting placements if they were to receive additional financial and personalised support from universities., Conclusion: Private practitioners perceived hosting students to be beneficial for the practice, the profession, staff and clients; however, they did report them to be costly and time-consuming. Universities are perceived to play a vital role in providing training, support and communication with educators and students for ongoing placement provision., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

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.

Background: Diastasis of the rectus abdominis muscle (DRAM) commonly occurs in pregnancy and postnatally. Physiotherapists routinely guide women in its management, although the effectiveness of these treatments is unknown., Objectives: To determine the effectiveness of conservative interventions to reduce the presence and width of DRAM in pregnant and postnatal women., Data Sources: EMBASE, Medline, CINAHL, PUBMED, AMED and PEDro searched until August 2021., Study Selection/eligibility: Randomised control trials examining any conservative interventions to manage DRAM during the ante- and postnatal periods were included., Study Appraisal and Synthesis Methods: Methodological quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were performed using a random effects model to calculate mean differences (MD) and odds ratios (OR). A GRADE approach determined the certainty of evidence for each meta-analysis., Results: Sixteen trials with 698 women during the postnatal period were included. No trials evaluated interventions during the antenatal period. All interventions included some form of abdominal exercise. Other interventions included abdominal binding, kinesiotape and electrical stimulation. There was moderate certainty evidence from six trials (n = 161) that abdominal exercise led to a small reduction in inter-recti distance (MD -0.43 cm, 95% CI -0.82 to -0.05) in postnatal women compared to usual care., Limitations: Three of the 16 trials had a low risk of bias., Conclusion and Implications: Conservative interventions do not lead to clinically significant reductions in inter-recti distance in women postnatally but abdominal exercises may have other physical and psychosocial benefits in the management of DRAM. Systematic Review Registration Number PROSPERO (CRD42020172529)., (Copyright © 2023 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objective: To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture., Design: A randomized controlled trial with embedded qualitative analysis., Setting: Community., Participants: Aged at least 60 years and living in the community after hip fracture., Interventions: In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking., Main Outcome Measures: Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy., Results: Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand . Participants considered the walking programme highly acceptable . The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy , there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2-13). There were no between-group differences in mobility, walking confidence or quality of life., Conclusion: A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.

Heterogeneity of descriptors and outcomes measured and reported in sedentary behaviour (SB) research hinder the meta-analysis of data and accumulation of evidence. The objective of the Core Research Outcomes for Sedentary Behaviour Interventions (CROSBI) consensus study was to identify and validate, a core outcome set (COS) to report (what, how, when to measure) in interventional sedentary behaviour studies. Outcomes, extracted from a systematic literature review, were categorized into domains and data items (COS v0.0). International experts (n = 5) provided feedback and identified additional items, which were incorporated into COS v0.1. A two round online Delphi survey was conducted to seek consensus from a wider stakeholder group and outcomes that achieved consensus in the second round COS (v0.2), were ratified by the expert panel. The final COS (v1.0) contains 53 data items across 12 domains, relating to demographics, device details, wear-time criteria, wear-time measures, posture-related measures, sedentary breaks, sedentary bouts and physical activity. Notably, results indicate that sedentary behaviour outcomes should be measured by devices that include an inclinometry or postural function. The proposed standardised COS is available openly to enhance the accumulation of pooled evidence in future sedentary behaviour intervention research and practice.

Objective: To investigate the effect of rehabilitation on the physical, social, and psychological dimensions of community reintegration after hip fracture., Data Sources: Electronic databases Embase, EMCare, MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health, and SPORTDiscus were searched from the earliest date available to second June 2021., Study Selection: Searching identified 1844 potentially relevant articles. Twenty randomized controlled trials evaluating physical retraining, cognitive retraining, and model of care interventions on physical, social and psychological aspects of community reintegration for 3075 adults after hip fracture were included., Data Extraction: Data were extracted using predetermined templates for participant characteristics, intervention type and setting, and outcomes related to community reintegration. Methodological quality was assessed using the Physiotherapy Evidence Database scale, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was applied to each meta-analysis., Data Synthesis: Post intervention data were pooled to calculate risk ratios (RRs), mean differences, standardized mean differences, and 95% confidence intervals (CIs) using inverse variance methods and a random-effects model. Compared with usual care or no rehabilitation, there was moderate-quality evidence to suggest that physical retraining interventions improved outdoor mobility (RR, 1.45; 95% CI, 1.09-1.91; I 2 =0%) and moderate-quality evidence to suggest that physical retraining improved Nottingham Extended Activities of Daily Living Scale scores (physical and social reintegration) by a mean 3.5 units (95% CI, 0.99-6.01; I 2 =0%). Meta-analyses showed no significant effect for cognitive retraining and model of care interventions on any dimension of community reintegration., Conclusions: Preliminary evidence suggests that physical rehabilitation after hip fracture improves physical and social aspects of community reintegration. The effect of psychological and home-based interventions on community reintegration is currently unclear. Further research is needed to determine the effect of rehabilitation on community reintegration, using interventions and measures that encompass all dimensions of community reintegration., (Copyright © 2021 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise-based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy., Objective: We aimed to evaluate the efficacy of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors., Methods: A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed., Results: The trial commenced in April 2022. As of June 2022, we enrolled 14 participants., Conclusions: This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr., International Registered Report Identifier (irrid): PRR1-10.2196/38553., (©Amy M Dennett, Katherine E Harding, Casey L Peiris, Nora Shields, Christian Barton, Lauren Lynch, Phillip Parente, David Lim, Nicholas F Taylor. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 18.07.2022.)

Background: University students are mostly sedentary in tertiary education settings which may be detrimental to their health and learning. This review aimed to examine the feasibility and efficacy of classroom movement breaks (CMB) and physically active learning (PAL) on physical and cognitive outcomes in university students in the tertiary setting. Methods: Five electronic databases (MEDLINE, CINAHL, Embase, PsychINFO, and PubMed) were searched for articles published up until November 2021. Manual searching of reference lists and citation tracking were also completed. Two reviewers independently applied inclusion and exclusion criteria and completed quality assessment. Articles were included if they evaluated CMB or PAL interventions delivered to university students in a tertiary setting. Results: Of the 1691 articles identified, 14 studies with 5997 participants met the inclusion criteria. Average study quality scores were poor for both CMB and PAL studies. CMBs and PAL are feasible in the tertiary setting and increase physical activity, reduce sedentary behaviour, increase wellbeing, and reduce fatigue in university students. In addition, CMBs increased student focus and attention in class and PAL had no detrimental effect on academic performance. Conclusions: University educators should feel confident in introducing CMB and/or PAL interventions into their classes to improve student health and wellbeing.

Objective: The purpose of this study was to determine the relationships between noncognitive traits (grit, resilience, and mindset-type), academic success, and clinical performance in physical therapist students., Methods: This cross-sectional study using self-administered surveys was undertaken with final-year physical therapist students enrolled in 4 Australian universities. Participants completed validated questionnaires measuring grit, resilience, and mindset type. Academic transcripts were obtained to quantify academic success and clinical performance. A multiple regression analysis explored predictors of academic success and clinical performance in relation to sociodemographic factors, grit, resilience, and mindset type., Results: A total of 266 students participated in the study (80% recruitment rate). Overall, 25% of students had low resilience, 20% had low grit, and 14% had a fixed mindset type. Grittiness was positively associated with academic success (r = 0.24) and clinical performance (r = 0.22) and negatively associated with failing a clinical placement (r = -0.20). Grit was an independent predictor of overall academic success (β = 0.24, P ≤ .01) and clinical performance (β = 0.15). Students with low grit were twice as likely to fail a clinical placement compared with students with moderate or high grit (risk ratio = 2.03, 95% CI = 1.06 to 3.89)., Conclusion: Grit was an independent predictor for overall academic success and clinical performance in final-year physical therapist students. Low grit may impact negatively on learning and students' ability to cope with challenges associated with university studies and clinical education. Further studies should investigate interventions that best develop grit in health professional students and the overlapping nature of grit, resilience, and a growth mindset., Impact: This study helps universities and educators understand noncognitive factors predicting academic success and clinical performance in physical therapist students. Universities and clinical educators may consider screening and providing proactive strategies for students with low grit to improve success and general wellbeing., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Question: What are the extent and characteristics of clinical placements in private practice for physiotherapy students? What do university clinical education managers perceive to be the benefits, risks, barriers and enablers of clinical placements in private practice for physiotherapy students? What training and support are available for private practitioners?, Design: Mixed methods study combining a national survey and in-depth, semi-structured focus group interviews., Participants: Twenty clinical education managers from Australian universities who had graduating students in entry-level physiotherapy programs in 2017 (95% response rate) responded to the survey with data on 2,000 students. Twelve clinical education managers participated in the focus groups., Results: It was found that 44% of physiotherapy graduates in Australia in 2017 completed a 5-week private practice placement. Private practice placement experiences were perceived to be safe and beneficial for students, private practices and universities. The main risks identified by clinical education managers were related to the quality and consistency of the student's experience on placement and not risks to service or clients. The main perceived barriers were time costs (both practitioner and university clinical education managers) and perceived lost earning capacity. Clinical education managers emphasised that more time and resources to establish and support private practitioners would enable them to reduce risk and overcome barriers to increasing private practice placement capacity and quality. Engaging private practitioners and working collaboratively appear vital for establishing, monitoring and supporting private practice placements., Conclusion: By working collaboratively, universities and private practice physiotherapists can enhance private practice placement capacity and quality., (Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.)

Purpose: To explore the clinician experience of the feasibility of a supervised, exercise-based rehabilitation program co-located within a cancer treatment unit., Method: A qualitative study using individual semi-structured interviews was completed. Fifteen clinicians were purposively sampled from a cancer unit at a tertiary hospital where a new, exercise-based rehabilitation program was implemented. Interviews were audio-recorded and transcribed verbatim. Data were coded independently by two reviewers and analysed by thematic analysis., Results: The main theme was, 'a co-located cancer rehabilitation program was perceived to initiate a cultural change'. A positive culture for exercise-based rehabilitation was demonstrated by consistent, positive messaging about exercise from a broad range of hospital staff. The culture shift was facilitated by the program being convenient for patients and staff, being visible, and by rapport building all within the context of filling a service gap., Conclusion: This study identified key practical elements in initiating a positive culture around exercise-based rehabilitation within a cancer unit. These data may inform future implementation of rehabilitation programs to improve access to exercise for cancer survivors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

To determine whether lifestyle intervention programs comprising dietary intervention and prescribed, unsupervised exercise improve outcomes for people with metabolic syndrome. A systematic review and meta-analysis of randomised controlled trials. Online databases CINAHL, MEDLINE, PubMed and Embase were searched from the earliest date available to October 2020. Post-intervention data were pooled to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) using inverse variance methods and random effects models. Trial methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale and overall quality of each meta-analysis was assessed using the Grading of Recommendation Assessment, Development and Evaluation approach. Eleven studies from 9 randomised controlled trials with 1,835 participants were included. There was high quality evidence that lifestyle intervention programs with unsupervised exercise reduced waist circumference (MD -2.82 cm, 95%CI -5.64 to 0.00, I 2 91%) and blood pressure (systolic: MD -3.89 mmHg, 95%CI -5.19 to -2.58, I 2 4%; diastolic: MD -3.16 mmHg, 95%CI -4.83 to -1.49, I 2 50%) and increased physical activity levels (SMD 0.47, 95%CI 0.24 to 0.70, I 2 45%) when compared to usual care. There was low quality evidence that they improved quality of life (SMD 0.59, 95%CI 0.05 to 1.13, I 2 84%). Unsupervised programs had no significant effect on fasting blood glucose (unless > 3 months duration), metabolic syndrome prevalence or cholesterol. Lifestyle intervention programs with prescribed, unsupervised exercise are a practical alternative to supervised programs for people with metabolic syndrome when time, access or resources are limited or when social distancing is required., (© 2021. Crown.)

Purpose: To establish the feasibility of embedding a flexible, exercise-based rehabilitation program into a cancer treatment unit to allow cancer survivors early exercise support., Method: A pre-post study was conducted using Bowen's Framework to describe key domains of feasibility: demand (referrals), acceptability (uptake, attendance, satisfaction), implementation (resources), practicality (adverse events, costs) and limited-efficacy (function, quality of life, self-efficacy). Participants were medically stable, adult cancer survivors receiving curative or palliative treatment for cancer at the health service. Participants completed an 8-week home or hospital-based exercise program. Data were analysed descriptively. Standardised mean differences (Hedge's g) and mean differences were calculated to determine effect size and clinical significance., Results: The exercise-based rehabilitation service received 155 referrals over 6 months. Of those eligible, 73/119 (61%) commenced. Participants opting for twice-weekly, hospital-based exercise attended 9/16 (56%) sessions. Participants reported high satisfaction and there were no major adverse events. The program utilised existing resources, with the predominant cost being staff. The average health service cost per participant was AUD $1,104. Participants made clinically significant gains in function (6-min walk distance; + 73 m, 95% confidence interval 49 to 96) and quality of life (EORTC QLQ-C30 Global quality of life; + 8 units, 95% confidence interval 3 to 13)., Conclusion: Implementation of exercise-based rehabilitation in a co-located cancer unit was safe and feasible. Access, patient and staff education and establishing funding streams are important implementation considerations. Implications for cancer survivors Access to exercise in a cancer unit provides opportunity for early intervention to optimise function during treatment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Metabolic syndrome has been associated with poorer outcomes in the immediate postoperative period following joint replacement surgery for osteoarthritis. The aim of this study was to determine whether a multidisciplinary, preoperative intervention would minimize postoperative differences between people with and without metabolic syndrome who underwent joint replacement surgery for osteoarthritis. Method: A retrospective cohort study of older adults with multiple comorbidities ( n  = 230) attending a preoperative intervention service before lower limb joint replacement surgery. The intervention aimed to optimize the patient's health and functional reserve before surgery through weight loss, physical activity and medical management. Patient outcomes were adverse events, discharge destination and function. Health service outcomes were length of stay, hospital readmissions and emergency department presentations over a 2-year follow-up. Results: Two-thirds of participants ( n  = 151) had metabolic syndrome. There were no significant differences between those with and without metabolic syndrome in terms of discharge destination or adverse events during the acute hospital admission. There were no differences in function during rehabilitation but people with metabolic syndrome had significantly more adverse events ( P  = 0.037) during rehabilitation. In the 2 years following surgery, there were no differences in hospital readmission rates but people with metabolic syndrome had a higher observed frequency of potentially avoidable emergency department presentations ( P  = 0.066). Conclusions: Providing a preoperative intervention may help minimize differences between people with and without metabolic syndrome in the immediate postoperative period. However, having a diagnosis of metabolic syndrome may still adversely affect some long-term health service outcomes following joint replacement surgery.

Objective: To explore entry-level physiotherapy students' attitudes and beliefs relating to weight bias and stigmatisation in healthcare., Design: Cross sectional survey of physiotherapy students., Methods: All final year physiotherapy students (n = 215) enrolled in entry-level physiotherapy programmes in the Republic of Ireland were invited to participate. Each received a questionnaire, consisting of 72 questions, within four key sections. Descriptive statistics and frequencies were used to analyse the data., Results: A response rate of 83% (179/215) was achieved. Whilst physiotherapy students, overall, had a positive attitude towards people with obesity, 29% had a negative attitude towards people with obesity, 24% had a negative attitude towards managing this population and most (74%) believed obesity was caused by behavioural and individual factors. Over one third of students (35%) reported that they would not be confident in managing patients with obesity and more than half (54%) felt treating patients with obesity was not worthwhile., Conclusion: This study provides preliminary findings to suggest that weight stigma-reduction efforts are warranted for physiotherapy students. Helping students to understand that obesity is a complex, chronic condition with multiple aspects requiring a multi-faceted approach to its management might be the first step towards dispelling these negative attitudes towards patients living with obesity. Inclusion of a formal obesity curriculum should perhaps now be part of the contemporary physiotherapy students' education., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To determine the personal and social factors perceived to influence physical activity levels in stroke survivors., Data Sources: Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches., Study Selection: The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke., Data Extraction: Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed., Data Synthesis: Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than 'exercise' is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity., Conclusions: Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.

Introduction: Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation., Methods and Analysis: An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews., Ethics and Dissemination: Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars., Trial Registration Number: ACTRN12619000936123., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

This mixed-methods study aimed to determine the feasibility of incorporating movement breaks into university classes in terms of acceptability (disruption, engagement, satisfaction), practicality (ease of scheduling and conducting breaks) and efficacy (sedentary time, concentration, alertness, enjoyment). Movement breaks of five to 10 min duration were scheduled after 20 min of sedentary time during 2-h classes. Classes without movement breaks were used as a comparison. Data were collected using surveys, objective physical activity monitoring and focus group interviews of students ( n = 85) and tutors ( n = 6). Descriptive statistics (quantitative data) and independent coding and thematic analysis (qualitative data) were completed. Students (mean age 23 ± 2 years, 69% female) actively engaged in movement breaks with no adverse events. Movement breaks were perceived to be beneficial for concentration, engagement and productivity. Timing of the break was perceived to be important to enhance the benefit and reduce disruption. Students preferred outdoor or competitive movement breaks. Students spent 13 min less time sitting (95%CI 10 to 17), took 834 more steps (95%CI 675 to 994) and had higher levels of concentration, alertness and enjoyment ( p < 0.001) in classes with movement breaks compared to classes without. Classroom movement breaks are feasible and may be considered for incorporation into university classes to reduce sedentary behaviour and increase physical activity, alertness, concentration and enjoyment.

Background and Purpose: To investigate whether physical activity levels are predictive of short-term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short-term recovery in physical activity, physical function, walking confidence, health-related quality of life and walking participation., Methods: This prospective cohort study comprised 57 older adults (39 females, mean age 80.4, SD 8.4 years) living independently in the community after hip fracture. Accelerometer-based physical activity, physical function (Functional Independence Measure [FIM], de Morton Mobility Index, Frenchay Activities Index and Participation in outdoor walking), walking confidence and health-related quality of life were measured after discharge from rehabilitation services (baseline) and 12 weeks later. Multiple linear regression analyses determined the ability of physical activity (daily steps), walking self-confidence, health-related quality of life and demographic factors (age, sex and time since fracture) to predict Week 12 physical function using Week 0 physical function as a covariate., Results: Participants at baseline averaged 4439 daily steps which did not change 12 weeks later. There were small increases in all measures of physical function and walking confidence, but not health-related quality of life. Increased walking self-confidence was associated with an increase in FIM total, FIM mobility and de Morton Index scores. Physical activity did not predict change in measures of physical function., Conclusions: Walking confidence of adults discharged from rehabilitation services after hip fracture had a greater association with short-term recovery of physical function than level of physical activity. Community-dwelling adults continue to make small short-term improvements in physical function and walking confidence after discharge home and withdrawal of rehabilitation services., (© 2020 John Wiley & Sons Ltd.)

Question: What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function?, Design: Systematic review with meta-analysis of randomised controlled trials., Participants: Adults diagnosed with cancer., Intervention: Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors., Outcome Measures: Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach., Results: Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported., Conclusion: Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care., Trial Registration: PROSPERO CRD42019130593., (Copyright © 2020. Published by Elsevier B.V.)

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To test whether the Functional Independence Measure (FIM) could be mapped to the EQ-5D-3L to give researchers a viable but "second-best" option for calculating quality-adjusted life-years (QALYs) and conducting a cost-utility analysis when only clinical outcomes have been collected. Materials and methods: Secondary analysis of repeated measures data collected during a randomized controlled trial ( n  = 3506 observations) at two inpatient rehabilitation centres. Participants had a mean age of 74 (SD 13) years, 63% were women and 58% were admitted with an orthopaedic diagnosis. Ordinary least-squares regression and adjusted limited dependent variable mixture models were used to estimate regression-based mappings. Performance was evaluated based on mean absolute error and the proportion of errors in excess of the minimally important difference. Results: In orthopaedic and neurological patients, high mean absolute errors (0.2 on the quality-adjusted life years scale) and a high proportion of errors (60%) in excess of the minimally important difference suggest that predicted EQ-5D-3L values provided a poor substitute for observed EQ-5D-3L values. Conclusions: Regression-based mappings from the FIM to the EQ-5D-3L are error-prone and unsuitable for calculating QALYs in rehabilitation patients. Researchers and rehabilitation professionals should therefore include a multi-attribute utility instrument such as the EQ-5D as well as the FIM to evaluate the effect of rehabilitation interventions and in rehabilitation registries. This will provide additional information on health-related quality of life and support cost-utility analyses.Implications for rehabilitationThe Functional Independence Measure (FIM) cannot be used to calculate quality-adjusted life-years (QALYs) for cost-utility analyses.Predicting QALYs from FIM data is a poor substitute for direct measurement of QALYs in orthopaedic or neurological rehabilitation populations.Multi-attribute utility instruments (MAUIs) allow direct measurement of QALYs, as well as providing a patient-reported measure of clinical quality and outcomes in rehabilitation.A MAUI should be included routinely in clinical practice by rehabilitation professionals as well as in rehabilitation trials and registries to track patient outcomes and improve clinical practice.

Objective: To assess the effect of Saturday allied health services on a geriatric evaluation and management ward., Methods: A controlled before-and-after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre-intervention (N = 331) and intervention (N = 462)., Results: Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7-10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6-5.7) and no difference in the proportion discharged home. Cost-effectiveness demonstrated no significant difference in cost ($2639, 95% CI $-386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8-6.5) favouring the experimental ward., Conclusion: These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay., (© 2019 AJA Inc.)