Implementation of the HiBalance training program for Parkinson’s disease in clinical settings: A feasibility study

BACKGROUND: Translating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson’s disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings. METHOD: Feasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild–moderate PD were enrolled in this pre–post feasibility study. The dose of the original program was adapted by reducing therapist-led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health-related quality of life) were also evaluated. RESULTS: Regarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD. CONCLUSION: The findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long-term effects as the original program

Balance control in older adults with Parkinson’s disease : effects of medication and exercise

Aim: To investigate the effects of dopaminergic medications on turning while walking in older adults with mild to moderate Parkinson’s disease (PD). A further aim was to develop a training program targeting balance impairments related to PD, to verify the progression of this program and the specific effects on balance and gait, as well as the transfer effects on everyday living. Methods: This thesis contains an experimental and a clinical part. In the experimental part, quantitative motion analysis was used to evaluate pre- and unplanned walking turns. Nineteen individuals with PD were tested after overnight withdrawal of dopaminergic medication and approximately one hour after taking their usual dose of medication, and were compared with 17 healthy control subjects. In the clinical part, a training program with highly-challenging balance exercise and dual-tasking was developed through workshops and pilot testing. Thereafter, training progression of dynamic exercises throughout this program was evaluated with accelerometers in two training groups (n = 6 and 4). In a randomized controlled trial, 100 individuals with PD were randomized, either to a training group that received a 10-week highly-challenging balance exercise intervention with dual-tasking or to a control group (usual care). The efficacy of this intervention was evaluated before and after the intervention which included specific effects; balance, gait with and without performing a concurrent cognitive task, and transfer effects which were concerns about falling, level of physical activity and activities of daily living. Results: Dopaminergic medication had a positive increasing effect on turning distance, whereas no effects on body rotation were found. Compared with the healthy control group, individuals with PD demonstrated lower turning distance and body rotation, and turned with a narrower step width. The objective evaluation of training activity revealed that training progression was accomplished in two independent training groups. The randomized controlled trial demonstrated significant improvements in balance control and gait performance in the training group, compared with the control group. The training group also improved their performance of the cognitive task while walking; however, no group differences were found for any gait parameters during dual-tasking. Significant differences, in favor of the training group, were found for the level of physical activity and activities of daily living, while no group difference was found for concerns about falling. Conclusions: Compared with the performance of the healthy control group, dopaminergic medication does not normalize turning performance. These residual turning impairments were accompanied by difficulties alternating step width during turning, which could be important to address in the rehabilitation of individuals with PD. Highly-challenging balance exercises, including dual-task, for a 10-week period was progressive and improved balance and gait performance in older adults with PD, compared with usual care. Positive transfer effects on activities of everyday living were also revealed, indicating that appropriate training programs could promote physical activity and daily activities in individuals with PD

Differences between initial and sale prices of Swedish forest properties

The Swedish market for forest properties is on fire. The prices of forestland is increasing all over the country and in year 2015 record prices occurred in some parts of Sweden. A probable explanation is that forestland generates a relatively good yield from a stable investment. In addition, the interest rate is low which is facilitates for potential investors. It is predicted that 1,5 million hectares of forestland, with a value of approximately 77 billion SEK will change owner in the next five years. The valuation of forest properties is a complex matter as they hold both monetary and non-monetary values. For example, the value depends on: standing volume, growth, geographic location, infrastructure, land consolidation, local capital density and recreational values. Previous studies have examined how both monetary and non-monetary values affect the prices of forest properties. However, there is a gap in the studies about factors affecting the price development from initial price to sale price. A possible explanation is the phenomenon underpricing which implies that brokers use an initial price below the estimated market value in order to attract many potential bidders. Hence, this phenomenon is investigated as one of the reasons for the potential differences between initial and sales prices. The aim of this paper is to examine and explain potential differences between the initial and sale prices of pure forest properties in Sweden. Pure forest properties have neither arable land nor buildings. The aim is fulfilled by finding whether differences occur and how potential dif-ferences may be explained. A mixed methods design is used containing a quantitative part in-cluding data from the SLU Market Price database during the years 2011 to 2016. The data is reduced to 214 observations that is compiled and analyzed by a regression analysis. The study also contains a qualitative part where brokers are interviewed in order to aid the explanation of the quantitative results and to include another perspective to the study. The findings display an average percentage difference between initial and sale prices in the Swedish market for pure forest properties of 8,1 percent. Neither the average percentage differences nor differences for the individual brokers indicates the use of underpricing. However, 21 percent of the properties sold in Sweden during the period have differences between initial and sale prices that may indicate underpricing. Further, 42 percent of the properties sold in Sweden have differences below 10 percent or no differences and 37 percent have differences between 10 and 25 percent. Capital density, county and the dummy variable “small property” are variables with a positive affect on the difference between initial price and sale price. Another variable affecting the difference positively is bidding neighbors. A variable that affects the difference between initial and sale price negatively is standing volume.Den svenska marknaden för skogsfastigheter glöder. Priserna på skogsmark ökar i hela landet och i vissa delar av Sverige var priserna år 2015 rekordhöga. En trolig förklaring är att skogen ger en förhållandevis bra avkastning från en stabil investering samtidigt som räntan är låg. Det förutspås att 1,5 miljoner hektar skogsmark till ett värde av ungefär 77 miljoner kronor ska byta ägare inom de kommande fem åren. Att värdera skogsfastigheter är komplext eftersom de har både monetära och icke-monetära värden. Dessa är exempelvis: virkesförråd, bonitet, geografisk position, infrastruktur, arronde-ring, kapitaltäthet på orten samt rekreationsvärden. Tidigare studier har behandlat både mone-tära och icke-monetära värdens påverkan på skogsfastigheters pris. Däremot finns det ett teo-retiskt gap i studier kring faktorer som påverkar skogsfastigheters prisutveckling från utgångspris till försäljningspris. En tänkbar orsak är exempelvis fenomenet lockprissättning som innebär att mäklaren sätter ett pris lägre än det förväntade försäljningsvärdet för att locka många potentiella köpare. Således ska detta fenomen undersökas som en av orsakerna till eventuella skillnader mellan utgångspris och försäljningspris. Syftet med denna studie är att undersöka och förklara potentiella skillnader mellan försäljningspris och utgångspris på rena skogsfastigheter i Sverige. Rena skogsfastigheter har varken åkermark eller byggnader. Syftet uppfylls genom att utreda huruvida skillnader finns och därefter förklara hur de potentiella skillnaderna kan uppstå. En mixad metod används innehållande en kvantitativ del byggd på data ifrån databasen SLU Marknadspris under åren 2011 till 2016. Denna data reduceras till 214 observationer som sammanställs och analyseras genom en regressionsanalys. Studien innehåller även en kvalitativ del där mäklare har intervjuats för att ge ett ytterligare djup och en klarhet i såväl teoretiska frågor som utfall från den kvantitativa metoden. Resultatet från denna studie visar en procentuell genomsnittlig skillnad mellan utgångspris och försäljningspris på 8,1 procent. Varken denna skillnad eller skillnaden för enskilda mäklare indikerar att lockprissättning förekommer. Däremot har 21 procent av fastigheterna sålda i Sverige under tidsperioden skillnader mellan utgångspris och försäljningspris som kan indikera lockprissättning. Vidare har 42 procent av de sålda fastigheterna skillnader under 10 procent eller inga skillnader samt 37 procent har skillnader mellan 10 och 25 procent. Kapitaltäthet, län och dummy-variabeln ”liten fastighet” har en positiv påverkan på skillnaden mellan utgångspris och försäljningspris. En annan variabel som påverkar skillnaden positivt är bjudande grannar. En variabel som har en negativ påverkan på skillnaden mellan utgångspris och försäljningspris är virkesförråd

The role of environmental factors on health conditions, general health and quality of life in persons with spinal cord injuries in South Africa

The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa. Methods: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life. Results: The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends’ (p = 0.003) and colleagues’ (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health

Synthesis and characterization of the all-silica pure polymorph C, and the enriched polymorph B intergrowth material of Beta zeolite

Cantin Sanz, A.; Corma Canós, A.; Díaz Cabañas, MJ.; Jorda Moret, JL.; Moliner Marin, M.; Rey Garcia, F. (2006). Synthesis and characterization of the all-silica pure polymorph C, and the enriched polymorph B intergrowth material of Beta zeolite. Angewandte Chemie International Edition. 45(47):8013-8015. doi:10.1002/anie.200603027S80138015454

Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa

Little is known about physical activity (PA) in people with stroke living in low-income areas. The aim of this study was to characterize and contrast the levels and patterns of PA between stroke survivors with different ambulation status living in low-income areas in Cape Town, South Afric

Factors influencing employment among people with spinal cord injury in South Africa

Theunemploymentratepostspinalcordinjury(SCI)in SouthAfricais highwithlimitedknow-ledgeof environmentalfactorsoutsidethehealthservices,especiallyin an unevenlydevelopedresourcesettinglikeSouthAfrica,affectingtheemploymentratein peoplewithSCI.Ourpurposewasto investi-gatefactorsassociatedwithemploymentin peoplewithSCIin SouthAfrica. TwohundredpersonswithSCIparticipatedin a cross-sectionalsurveydesign.Thisstudyformedpartof theInternationalSpinalCordInjuryCommunitySurvey.Subsectionsof thequestionnaireresponseswereusedas explanatoryvariablesto predictemploymentafterSCIusinglogisticregres-sionanalysis

Establishing accelerometer cut-points to classify walking speed in people post stroke

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waistand ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41–0.8 m/s, 0.81–1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively

Whole home exercise intervention for depression in older care home residents (the OPERA study) : a process evaluation

Background: The ‘Older People’s Exercise intervention in Residential and nursing Accommodation’ (OPERA) cluster randomised trial evaluated the impact of training for care home staff together with twice-weekly, physiotherapist-led exercise classes on depressive symptoms in care home residents, but found no effect. We report a process evaluation exploring potential explanations for the lack of effect. Methods: The OPERA trial included over 1,000 residents in 78 care homes in the UK. We used a mixed methods approach including quantitative data collected from all homes. In eight case study homes, we carried out repeated periods of observation and interviews with residents, care staff and managers. At the end of the intervention, we held focus groups with OPERA research staff. We reported our first findings before the trial outcome was known. Results: Homes showed large variations in activity at baseline and throughout the trial. Overall attendance rate at the group exercise sessions was low (50%). We considered two issues that might explain the negative outcome: whether the intervention changed the culture of the homes, and whether the residents engaged with the intervention. We found low levels of staff training, few home champions for the intervention and a culture that prioritised protecting residents from harm over encouraging activity. The trial team delivered 3,191 exercise groups but only 36% of participants attended at least 1 group per week and depressed residents attended significantly fewer groups than those who were not depressed. Residents were very frail and therefore most groups only included seated exercises. Conclusions: The intervention did not change the culture of the homes and, in the case study homes, activity levels did not change outside the exercise groups. Residents did not engage in the exercise groups at a sufficient level, and this was particularly true for those with depressive symptoms at baseline. The physical and mental frailty of care home residents may make it impossible to deliver a sufficiently intense exercise intervention to impact on depressive symptoms