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

A proposal of sensitive indicators of the rehabilitation nursing care of people in the surgical process, to be included in the ontology of aging

Given the complex surgical scenario observed today, it is necessary to change the urgent definition of a specific ontology, especially in terms of aging. The interventions of the Specialist Nurse in Rehabilitation Nursing to the person in the surgical process are primordial for the maintenance of the functional capacities, prevention of complications and impediment of incapacities. However, it is necessary to provide individualized and fostered care in a practice of excellence, and the consequent organized reading of records of an aging ontology for decision making on rehabilitation indicators. Method: a systematic review of the literature was carried out using the EBSCO host (MEDLINE with Full Text, CINAHL Plus with Full Text and MedicLatina), using the PI [C] O method, and 11 articles were selected. Results: 41 indicators were identified to be included in the ontology classes of aging: pain control, patient and family education, support and communication, reduction of postoperative complications, gain of functionality, restoration of physical function, mobility, multidisciplinary intervention and the frequency of interventions. Conclusion: it is considered that it was imperative to identify sensitive indicators for rehabilitation nursing care, based on scientific evidence and thus provide an opportunity for nurses to reflect on their daily practices and conduct their actions towards excellence in care, to propose a set of 41 classes internationally on the ontology of aging

Human Preference-Based Learning for High-dimensional Optimization of Exoskeleton Walking Gaits

Optimizing lower-body exoskeleton walking gaits for user comfort requires understanding users’ preferences over a high-dimensional gait parameter space. However, existing preference-based learning methods have only explored low-dimensional domains due to computational limitations. To learn user preferences in high dimensions, this work presents LINECOSPAR, a human-in-the-loop preference-based framework that enables optimization over many parameters by iteratively exploring one-dimensional subspaces. Additionally, this work identifies gait attributes that characterize broader preferences across users. In simulations and human trials, we empirically verify that LINECOSPAR is a sample-efficient approach for high-dimensional preference optimization. Our analysis of the experimental data reveals a correspondence between human preferences and objective measures of dynamicity, while also highlighting differences in the utility functions underlying individual users’ gait preferences. This result has implications for exoskeleton gait synthesis, an active field with applications to clinical use and patient rehabilitation

Contributions to the ontology of aging, the sensitive indicators of rehabilitation nursing care, in terms of self-care, in people with respiratory disorders

With the increase in the average life expectancy, the appearance of chronic diseases and, in particular, in the respiratory forum and its disadvantages in the autonomy and self-care of patients, brought an important paradigm for health care and, in particular, rehabilitation nursing, with implications for the development of ontologies of aging. Thus, it is imperative to systematize them in scientifically measurable indicators to demonstrate the benefit that rehabilitation nursing brings to improve patients' quality of life, thus ensuring excellence. Each area of scientific health should contribute to the construction of aging ontology. Objective: to identify indicators sensitive to nursing care of rehabilitation, in terms of self-care, in relation to those with respiratory pathology, to be integrated into the ontology of aging. Methods: A systematic review of the literature was performed using the EBSCO (full-text MEDLINE, CINAHL, Full-Text Plus, British Nursing Index), using the PI [C] O method with 6 emergent articles. Results: A total of 20 indicators were identified, including: Ability to perform activities, increase physical and functional independence, symptom management, reduction of complications, increase in quality of life, which can be allocated as a proposal for classes of the aging ontology. Conclusion: Knowledge of indicators sensitive to nursing care recognition of the importance of rehabilitation nursing in increasing self-care and autonomy for people with respiratory pathology, and research in this area is fundamental for its effectiveness and efficiency, and its integration in the ontologies of aging is fundamental

Non-speech oro-motor exercise use in acquired dysarthria management : regimes and rationales

Non-speech oro-motor exercises (NSOMExs) are described in speech and language therapy (SLT) manuals, and are thought to be much used in acquired dysarthria intervention, though there is no robust evidence of an influence on speech outcome. Opinions differ as to whether, and for which dysarthria presentations, NSOMExs are appropriate. The investigation sought to collect development phase data, in accordance with the Medical Research Council evaluation of complex interventions. The aims were to establish the extent of NSOMExs use in acquired disorders, the exercise regimes in use for dysarthria, with which dysarthric populations, and the anticipated clinical outcomes. A further aim was to determine the influencing rationales where NSOMExs were or were not used in dysarthria intervention. SLTs throughout Scotland, Wales and Northern Ireland, working with adult acquired dysarthria, were identified by their service heads. They received postal questionnaires comprising 21 closed and two open questions, covering respondent biographics, use of NSOMExs, anticipated clinical outcomes, and practice influencing rationales. One hundred and ninety one (56% response) completed questionnaires were returned. Eighty-one per cent of respondents used NSOMExs in dysarthria. There was no association with years of SLT experience. Those who used and those who did not use NSOMExs provided similar influencing rationales, including evidence from their own practice, and Higher Education Institute (HEI) teaching. More experienced SLTs were more likely than those more recently qualified to be guided by results from their own practice. Input from the attended HEI was more influential for those less experienced than for those more experienced. Clinical outcome aims were not confined to speech, but included also improvements in movement, sensory awareness, appearance, emotional status, dysphagia and drooling. NSOMExs were used with many neurological disorders, especially stroke, all dysarthria classes, especially flaccid, and all severity levels. Tongue and lip exercises were more frequent than face, jaw and soft palate. The most common regimes were 4-6 repetitions of each exercise, during three practice periods daily, each of 6-10 minutes. Conclusions & Implications: NSOMExs are a frequent component of dysarthria management in the UK devolved government countries. This confirmation, along with the details of SLT practice, provides a foundation for clinical research which will compare outcomes for people with dysarthria, whose management includes and does not include NSOMExs. SLT practice may be guided by evidence that speech outcome is or is not affected by NSOMExs

Grounded theory of nursing\u27s contribution to inpatient rehabilitation

There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing\u27s contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses\u27 reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution. Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses\u27 everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory. The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses\u27 and patients\u27 understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing\u27s contribution as they acted individually and synergistically to constrain nursing\u27s contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing\u27s potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity. From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing\u27s contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research

Sitting time and patterns of activity in post-stroke rehabilitation: week versus weekend activity

Background: High levels of active task practice are recommended after stroke. However, the in-patient rehabilitation day is largely spent sitting. Understanding patterns of sitting across the rehabilitation week may facilitate strategies to promote greater activity. We aimed to compare differences in weekday and weekend sitting time and 24-hour activity patterns during the last week of in patient rehabilitation. Methods: Participants with stroke (n=34) from two rehabilitation units wore an activity monitor continuously during the final 7-days of in-patient rehabilitation. Linear mixed models (adjusted for waking hours) were performed with activity time as the outcome and weekday and weekend as the exposure. Patterns of activity accumulation were determined by averaging patient activity in 60-minute epochs, and then generating a heat map of activity level as a function of time. Results: Participant mean age was 68 [SD 13] years (53% male) mean NIHSS score 7 [SD 5]. There was no significant difference in total sitting time between weekdays and weekends. On the weekend, mean walking time was 8.35 minutes less (95% CI -12.13, -4.56 p ≤0.001), and steps/day were 624 fewer (95% CI -951, -296 p ≤0.001) than during the week. Activity patterns were similar across weekdays and weekends, with more morning than afternoon activity observed. Conclusion: Sitting time did not change in relation to the 7-day rehabilitation week, while walking (time and steps) was less on weekends. Morning activity was observably greater than afternoon activity across the 7-days. Strategies targeting afternoon, evening and weekend activity may increase overall physical activity during rehabilitation