Physical activity preferences of people living with brain injury : Formative qualitative research to develop a discrete choice experiment

Background and Objective The World Health Organization physical activity guidelines for people living with disability do not consider the needs of people living with moderate-to-severe traumatic brain injury. This paper describes the qualitative co-development of a discrete choice experiment survey to inform the adaption of these guidelines by identifying the physical activity preferences of people living with moderate-to-severe traumatic brain injury in Australia. Methods The research team comprised researchers, people with lived experience of traumatic brain injury and health professionals with expertise in traumatic brain injury. We followed a four-stage process: (1) identification of key constructs and initial expression of attributes, (2) critique and refinement of attributes, (3) prioritisation of attributes and refinement of levels and (4) testing and refining language, format and comprehensibility. Data collection included deliberative dialogue, focus groups and think-aloud interviews with 22 purposively sampled people living with moderate-to-severe traumatic brain injury. Strategies were used to support inclusive participation. Analysis employed qualitative description and framework methods. Results This formative process resulted in discarding, merging, renaming and reconceptualising attributes and levels. Attributes were reduced from an initial list of 17 to six: (1) Type of activity, (2) Out-of-pocket cost, (3) Travel time, (4) Who with, (5) Facilitated by and (6) Accessibility of setting. Confusing terminology and cumbersome features of the survey instrument were also revised. Challenges included purposive recruitment, reducing diverse stakeholder views to a few attributes, finding the right language and navigating the complexity of discrete choice experiment scenarios. Conclusions This formative co-development process significantly improved the relevance and comprehensibility of the discrete choice experiment survey tool. This process may be applicable in other discrete choice experiment studies

Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology (AMOUNT) in Australia: A randomised controlled trial

Background: Digitally enabled rehabilitation may lead to better outcomes but has not been tested in large pragmatic trials. We aimed to evaluate a tailored prescription of affordable digital devices in addition to usual care for people with mobility limitations admitted to aged care and neurological rehabilitation. Methods and findings: We conducted a pragmatic, outcome-assessor-blinded, parallel-group randomised trial in 3 Australian hospitals in Sydney and Adelaide recruiting adults 18 to 101 years old with mobility limitations undertaking aged care and neurological inpatient rehabilitation. Both the intervention and control groups received usual multidisciplinary inpatient and post-hospital rehabilitation care as determined by the treating rehabilitation clinicians. In addition to usual care, the intervention group used devices to target mobility and physical activity problems, individually prescribed by a physiotherapist according to an intervention protocol, including virtual reality video games, activity monitors, and handheld computer devices for 6 months in hospital and at home. Co-primary outcomes were mobility (performance-based Short Physical Performance Battery [SPPB]; continuous version; range 0 to 3; higher score indicates better mobility) and upright time as a proxy measure of physical activity (proportion of the day upright measured with activPAL) at 6 months. The dataset was analysed using intention-to-treat principles. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000936628). Between 22 September 2014 and 10 November 2016, 300 patients (mean age 74 years, SD 14; 50% female; 54% neurological condition causing activity limitation) were randomly assigned to intervention (n = 149) or control (n = 151) using a secure online database (REDCap) to achieve allocation concealment. Six-month assessments were completed by 258 participants (129 intervention, 129 control). Intervention participants received on average 12 (SD 11) supervised inpatient sessions using 4 (SD 1) different devices and 15 (SD 5) physiotherapy contacts supporting device use after hospital discharge. Changes in mobility scores were higher in the intervention group compared to the control group from baseline (SPPB [continuous, 0–3] mean [SD]: intervention group, 1.5 [0.7]; control group, 1.5 [0.8]) to 6 months (SPPB [continuous, 0–3] mean [SD]: intervention group, 2.3 [0.6]; control group, 2.1 [0.8]; mean between-group difference 0.2 points, 95% CI 0.1 to 0.3; p = 0.006). However, there was no evidence of a difference between groups for upright time at 6 months (mean [SD] proportion of the day spent upright at 6 months: intervention group, 18.2 [9.8]; control group, 18.4 [10.2]; mean between-group difference −0.2, 95% CI −2.7 to 2.3; p = 0.87). Scores were higher in the intervention group compared to the control group across most secondary mobility outcomes, but there was no evidence of a difference between groups for most other secondary outcomes including self-reported balance confidence and quality of life. No adverse events were reported in the intervention group. Thirteen participants died while in the trial (intervention group: 9; control group: 4) due to unrelated causes, and there was no evidence of a difference between groups in fall rates (unadjusted incidence rate ratio 1.19, 95% CI 0.78 to 1.83; p = 0.43). Study limitations include 15%–19% loss to follow-up at 6 months on the co-primary outcomes, as anticipated; the number of secondary outcome measures in our trial, which may increase the risk of a type I error; and potential low statistical power to demonstrate significant between-group differences on important secondary patient-reported outcomes. Conclusions: In this study, we observed improved mobility in people with a wide range of health conditions making use of digitally enabled rehabilitation, whereas time spent upright was not impacted. Trial registration: The trial was prospectively registered with the Australian New Zealand Clinical Trials Register; ACTRN1261400093662

Market-dependent production set

A country’s production possibility frontier or PPF is defined as the boundary of its economy’s production set in the net output space for a given technology and fixed quantities of primary factors of production. In general equilibrium theory, exogenous changes in technology or primary-factor supplies alter equilibrium prices; however, government-policy induced domestic relative commodity price changes do not alter the shape of an economy’s production set. We show that, under international capital mobility, which is empirically significant, the shape of a country’s production set does, in fact, depend on market forces and this shape can be manipulated by government policy

Implementing digitally enabled rehabilitation: implementation strategies delivered as part of a hybrid type II feasibility randomised controlled trial

Background: Recent research has demonstrated improvements in mobility in people undertaking rehabilitation when using digital devices such as virtual reality videogames, activity monitors and handheld computer devices in addition to usual rehabilitation. A next step is to understand how best to implement these devices into clinical practice and whether similar mobility outcomes can be achieved.Aims: To describe the implementation strategies being tested as part of a feasibility study.Methods: A feasibility hybrid type II implementation-effectiveness randomised controlled trial is being undertaken at Prince of Wales Hospital, Sydney. Physiotherapists working on the rehabilitation ward are recruited to receive the implementation strategies and 30 people undertaking inpatient rehabilitation will be randomised to receive digital devices for mobility exercises in addition to usual care or usual care alone. The implementation strategies have been informed from previous research and developed using the Capabilities, Opportunities, Motivation- Behaviour (COM-B) model of behaviour change. Implementation strategy usage is recorded using a study-specific log.Results: The implementation strategies include: i) enablement (loaning of devices, resources); ii) clinical champion who is a physiotherapist at the site; iii) education (face-to-face or online); iv) training in device use; v) facilitation (clinical reasoning sessions) and audit and feedback of dosage recorded on practice sheets. To date 14 physiotherapists and 36 students have received implementation strategies. Implementation challenges thus far include IT support, staff turn-over and recording of dosage.Conclusions: Implementation in a large public hospital is challenging and therefore testing strategies to overcome implementation challenges are crucial in translational research

The effects of sport or physical recreation for adults with physical or intellectual disabilities: a systematic review with meta-analysis

This is the Dataset, Supplementary Table, and Supplementary File for the article: Hassett L, McKay MJ, Cole J, Moseley AM, Chagpar S, Geerts M, Kwok WS, Jensen C, Sherrington C, Shields N. The effects of sport or physical recreation for adults with physical or intellectual disabilities: a systematic review with meta-analysis. British Journal of Sports Medicine 2023This is the Dataset, Supplementary Table, and Supplementary File for a systematic review. The Dataset is a Review Manager Version 5.4 file. The Supplementary Table is an Excel file. The Supplementary File is a PDF file

The effects of sport or physical recreation for adults with physical or intellectual disabilities: a systematic review with meta-analysis

This is the Dataset, Supplementary Table, and Supplementary File for the article: Hassett L, McKay MJ, Cole J, Moseley AM, Chagpar S, Geerts M, Kwok WS, Jensen C, Sherrington C, Shields N. The effects of sport or physical recreation for adults with physical or intellectual disabilities: a systematic review with meta-analysis. British Journal of Sports Medicine 2023This is the Dataset, Supplementary Table, and Supplementary File for a systematic review. The Dataset is a Review Manager Version 5.4 file. The Supplementary Table is an Excel file. The Supplementary File is a PDF file

Additional file 4 of Implementing digital devices to increase mobility training for people receiving inpatient rehabilitation: protocol for a feasibility hybrid type II randomized controlled trial

Additional file 4.Therapist-participant questionnaire to explore determinants of implementation success. Questionnaire used to capture the physiotherapists change in capability, opportunity, and motivation to prescribing and delivering rehabilitation using digital devices, developed based upon the COM-B self-evaluation questionnaire

Additional file 1 of Implementing digital devices to increase mobility training for people receiving inpatient rehabilitation: protocol for a feasibility hybrid type II randomized controlled trial

Additional file 1. SPIRIT Checklist. Filled in SPIRIT Checklist for manuscript submission

Additional file 2 of Implementing digital devices to increase mobility training for people receiving inpatient rehabilitation: protocol for a feasibility hybrid type II randomized controlled trial

Additional file 2. Intervention protocol. Document guiding decision of digital device selection for intervention