Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

Wearable Computing for Health and Fitness: Exploring the Relationship between Data and Human Behaviour

Health and fitness wearable technology has recently advanced, making it easier for an individual to monitor their behaviours. Previously self generated data interacts with the user to motivate positive behaviour change, but issues arise when relating this to long term mention of wearable devices. Previous studies within this area are discussed. We also consider a new approach where data is used to support instead of motivate, through monitoring and logging to encourage reflection. Based on issues highlighted, we then make recommendations on the direction in which future work could be most beneficial

Smart sensing and AI for physical therapy in IoT era

It is well known that medical spending increase with disability status. Per capita spending for people with five or more limitations in activities of daily living (ADLs) is nearly five times the amount incurred by those with limitations in only one instrumental activities of daily living (IADLs). Physical therapy is the way to improve the motor capabilities however it takes a lot of time, it requires physiotherapists services, is often painful and the outcome are evaluated in subjective way. New technologies including smart sensors were adopted in healthcare including wearable solutions for cardiac and respiratory activity monitoring and successfully are contributing to reduce the costs of services. In the case of motor activity and particularly in physical rehabilitation the developments are still reduced the physical therapy services are using as hardware mechanical equipment without sensing, embedded processing and internet connectivity that significatively reduce the possibility to measure and evaluate the physical training outcomes in objective way. In this paper the disruptive solutions for physical therapy are presented that are based on hot technologies such as smart sensors, IoT, virtual reality (VR), mixed reality (MR), and artificial intelligence (AI). Applied AI may conduct to develop models, classifiers (gait classification) and short term or medium term prediction of physical therapy outcomes. Highly motivation of the patients under physical rehabilitation can be increased promoting serious game characterized by VR and MR scenariosinfo:eu-repo/semantics/publishedVersio

Physical activity promotion to older adults attending out-patient rehabilitation

Background: Physical inactivity is identified as a leading risk factor for global mortality. Physical activity benefits have been extensively demonstrated. Being physically active is essential for healthy ageing; with regular physical activity reported as the most effective strategy to prevent and reduce disability and maintain functional independence among older adults. Nonetheless, an overwhelming majority of people aged 65 years and above do not meet physical activity recommendations. Physiotherapists in out-patient rehabilitation settings are well placed to assist older adults to achieve an active lifestyle by incorporating physical activity into care plans and transitioning patients from a therapeutic to a healthier lifestyle focus. However, it is not known whether physiotherapists actively plan for this transition and incorporate this aspect of care into out-patient rehabilitation programs for older adults. The overall aim of this research program was to investigate current physiotherapy practice of physical activity promotion to older adults attending an out-patient rehabilitation program. Method: Pragmatism is the theoretical perspective that underpins this program of research. A multimethod approach was taken to answer the research questions for this research program. Two studies, a quantitative and a qualitative study, were undertaken to gain valuable insights in the promotion of physical activity to older adults attending out-patient rehabilitation. Study 1 comprised an audit of physiotherapists’ documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital. Study 2, a qualitative study, comprised three focus groups with a total of 16 physiotherapists involved in the delivery of rehabilitation to older adults. Data were analysed using reflexive thematic analysis. Results: In Study 1, 56 medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records. In Study 2, four themes were identified: 1. Patient-centred approach; 2. Support required; 3. Exercise program targeting impairments versus physical activity for health, and 4. Inadequate community follow-up systems. Participants described a patient-centred approach when promoting physical activity to older adults attending out-patient rehabilitation. Participants identified the importance of getting patients engaged and willing to participate in physical activity by setting patient-centred goals and finding activities that are enjoyable, meaningful and relevant. Physiotherapist support was identified as a crucial factor to facilitate engagement in physical activity. Education, therapeutic rapport, encouragement and motivation were topics often discussed by participants. Physical activity assessment was rarely reported by participants in this study. Participants acknowledged focusing on the primary goal of restoring older adults’ functional capacity by treating physical impairments, and concomitantly promoting an active lifestyle for health benefits. Participants perceived that inadequate community follow-up was a major barrier to transition older adults to an active lifestyle post discharge from rehabilitation. Conclusion: The findings from this research program suggest that physiotherapists are not widely applying evidence-based practice to the promotion of physical activity to older adults attending out-patient rehabilitation. Increasing physical activity is a global priority, with the World Health Organisation Global Action Plan on Physical Activity (GAPPA) 2018-2030, ‘More active people for a healthier world’, calling for a systems-wide approach to patient assessment and counselling on physical activity across all primary health care settings. Physiotherapists are ideally placed to be actioning this strategy, though there is scope for improvement in physical activity promotion to older adults attending out-patient rehabilitation. Furthermore, the establishment of tailored physical activity programmes and services to support older adults starting and maintaining regular physical activity is recommended. Implementation research providing a guiding pathway to support physiotherapists promoting physical activity to older adults is warranted. Physiotherapists working in out-patient rehabilitation settings can and should drive older adults’ transition from a restorative and therapeutic context to a self-managed active lifestyle in the community, by integrating physical activity promotion into routine practice

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Feasibility Study of a Socially Assistive Humanoid Robot for Guiding Elderly Individuals during Walking

The impact of the world-wide ageing population has commenced with respect to society in developed countries. Several researchers focused on exploring new methods to improve the quality of life of elderly individuals by allowing them to remain independent and healthy to the maximum possible extent. For example, new walking aids are designed to allow elderly individuals to remain mobile in a safe manner because the importance of walking is well-known. The aim of the present study involves designing a humanoid robot guide as a walking trainer for elderly individuals. It is hypothesized that the same service robot provides an assistive and social contribution with respect to interaction between elderly users by motivating them to walk more and simultaneously provides assistance, such as physical assistance and gait monitoring, while walking. This study includes a detailed statement of the research problem as well as a literature review of existing studies related to walking companion robots. A user-centred design approach is adopted to report the results of the current first feasibility study by using a commercially available humanoid robot known as Pepper developed by Softbank-Aldebaran. A quantitative questionnaire was used to investigate all elements that assess intrinsic motivation in users while performing a given activity. Conversely, basic gait data were acquired through a video analysis to test the capability of the robot to modify the gait of human users. The results in terms of the feedback received from elderly subjects and the literature review improve the design of the walking trainer for elderly individuals

The role of technology on adherence to physical activity programs in patients with chronic diseases experiencing fatigue: a systematic review

Background The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. Methods This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: “Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”. Results The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3). Conclusion The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs

Physiotherapy goal setting in anterior cruciate ligament rehabilitation : an exploration of training, practice and beliefs

Despite the growing interest into the role of physiotherapists providing psychological interventions within anterior cruciate ligament (ACL), literature surrounding goal setting practices within this field is minimal. The main purpose of this research was to explore physiotherapists’ approaches, training and beliefs into goal setting practices used within ACL rehabilitation. The thesis consisted of seven chapters, two of which were empirical studies. The empirical chapters aimed to gain further insight into physiotherapists understanding on the psychological aspects of patients following ACL surgery, theoretical knowledge of goal setting, experiences of implementing goals, training received on goal setting and future training needs. Study four involved a UK cross sectional online survey of one hundred and twenty four physiotherapists (N=124). The survey provided an insight of perceptions and goal setting approaches used within ACL rehabilitation. These findings were further explored in study five which involved a UK semi-structured interview study including twenty four physiotherapists (N=24), using an inductive approach. Study five provided a much deeper understanding in to physiotherapist’s goal setting practices, training and experiences within ACL rehabilitation and also revealed issues surrounding the initial consultation process. The research findings were conceptualised into a theoretical, innovative goal setting model. The goal of this model is to outline a multi-phase conceptual model of an appropriate ACL rehabilitation goal setting strategy for physiotherapists in an attempt to guide both practice, teaching and research

Salford postgraduate annual research conference (SPARC) 2012 proceedings

These proceedings bring together a selection of papers from the 2012 Salford Postgraduate Annual Research Conference (SPARC). They reflect the breadth and diversity of research interests showcased at the conference, at which over 130 researchers from Salford, the North West and other UK universities presented their work. 21 papers are collated here from the humanities, arts, social sciences, health, engineering, environment and life sciences, built environment and business