Physical therapy for survivors of torture: A scoping review

Background: Torture can result in impaired function, reduced quality of life, and chronic pain. Physical therapy (PT) is recommended for wholistic care of survivors of torture (SOT), however there are limited evidenced-based guidelines. We conducted a scoping review to identify and describe the approach and gaps in knowledge around the PT treatment of SOT.Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Nine databases were searched from inception to 2023. Eligible sources were those involving PT treatment for SOT. Extracted data included the source of evidence, PT description, mode of delivery, and research study outcomes. Interventions were categorized into themes based on recommendations from the Physiotherapy and Refugees Education Project: trauma-informed care, body-awareness and empowerment, and pain management. Source-reported treatment approach and expected effect of the interventions informed the thematic categorization.Results: The final analysis included thirteen sources with a combined total of 18 different interventions. Thematically, two sources described interventions targeting body-awareness and empowerment, while five sources targeted body-awareness and empowerment and pain management. Six sources included all three themes. Two of these six sources were research studies examining PT outcomes. Findings were significant favoring the PT, but results must be taken cautiously due to methodological limitations. Studies assessing treatment related to only one theme resulted in no between group differences. Conclusions: We describe the scope of the literature regarding PT for SOT. A trauma-informed PT approach, coordinated with pain management, and body-awareness and empowerment interventions may address the complex needs of survivors. However, rigorous studies of this approach are lacking. As the number of displaced persons continues to rise globally, we must be prepared to care for these vulnerable people. Physical therapists are encouraged to utilize a wholistic approach, and to examine outcomes of this approach for survivors of torture

On human correspondence

Funded by European Research CouncilPeer reviewedPostprin

Political apologies and the question of a ‘shared time’ in the Australian context

Although conceptually distinct, ‘ time ’ and ‘community’ are multiply intertwined within a myriad of key debates in both the social sciences and the humanities. Even so, the role of conceptions of time in social practices of inclusion and exclusion has yet to achieve the prominence of other key analytical categories such as identity and space. This article seeks to contribute to the development of this field by highlighting the importance of thinking time and community together through the lens of political apologies. Often ostensibly offered in order to re-articulate both the constitution of ‘the community’ and its future direction, official apologies are prime examples of deliberate attempts to intervene in shared understandings of political community and its temporality. Offering a detailed case study of one of these apologies, I will focus on Australian debates over the removal of indigenous children from their families, known as the Stolen Generations, and examine the temporal dimensions of the different responses offered by former prime ministers John Howard and Kevin Rudd

Predictors of Upper Extremity Discomfort: A Longitudinal Study of Industrial and Clerical Workers

Upper extremity discomfort associated with work activity is common with a prevalence of over 50% in many settings. This study followed a cohort of 501 active workers for an average of 5.4 years. Cases were defined as workers who were asymptomatic or had a low discomfort score of 1 or 2 at baseline testing and went on to report a discomfort score of 4 or above on a 10-point visual analog scale. This change is considered clinically significant. Controls had a low baseline discomfort score and continued to have a low discomfort rating throughout the study. The risk factors found to have the highest predictive value for identifying a person who is likely to develop a significant upper extremity discomfort rating included age over 40, a BMI over 28, a complaint of baseline discomfort, the severity of the baseline discomfort rating and a job that had a high hand activity level (based upon hand repetition and force). The risk profile identified both ergonomic and personal health factors as risks and both factors may be amenable to prevention strategies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45012/1/10926_2005_Article_871.pd

A Longitudinal Study of Industrial and Clerical Workers: Predictors of Upper Extremity Tendonitis

Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the follow-up evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45013/1/10926_2005_Article_872.pd

Technology Support Challenges and Recommendations for Adapting an Evidence-Based Exercise Program for Remote Delivery to Older Adults: Exploratory Mixed Methods Study

BackgroundTele-exercise has emerged as a means for older adults to participate in group exercise during the COVID-19 pandemic. However, little is known about the technology support needs of older adults for accessing tele-exercise. ObjectiveThis study aims to examine the needs of older adults for transition to tele-exercise, identify barriers to and facilitators of tele-exercise uptake and continued participation, and describe technology support challenges and successes encountered by older adults starting tele-exercise. MethodsWe used an exploratory, sequential mixed methods study design. Participants were older adults with symptomatic knee osteoarthritis (N=44) who started participating in a remotely delivered program called Enhance Fitness. Before the start of the classes, a subsample of the participants (n=10) completed semistructured phone interviews about their technology support needs and the barriers to and facilitators for technology adoption. All of the participants completed the surveys including the Senior Technology Acceptance Model scale and a technology needs assessment. The study team recorded the technology challenges encountered and the attendance rates for 48 sessions delivered over 16 weeks. ResultsFour themes emerged from the interviews: participants desire features in a tele-exercise program that foster accountability, direct access to helpful people who can troubleshoot and provide guidance with technology is important, opportunities to participate in high-value activities motivate willingness to persevere through the technology concerns, and belief in the ability to learn new things supersedes technology-related frustration. Among the participants in the tele-exercise classes (mean age 74, SD 6.3 years; 38/44, 86% female; mean 2.5, SD 0.9 chronic conditions), 71% (31/44) had a computer with a webcam, but 41% (18/44) had little or no experience with videoconferencing. The initial technology orientation sessions lasted on average 19.3 (SD 10.3) minutes, and 24% (11/44) required a follow-up assistance call. During the first 2 weeks of tele-exercise, 47% of participants (21/44) required technical assistance, which decreased to 12% (5/44) during weeks 3 to 16. The median attendance was 100% for the first 6 sessions and 93% for the subsequent 42 sessions. ConclusionsWith appropriate support, older adults can successfully participate in tele-exercise. Recommendations include individualized technology orientation sessions, experiential learning, and availability of standby technical assistance, particularly during the first 2 weeks of classes. Continued development of best practices in this area may allow previously hard-to-reach populations of older adults to participate in health-enhancing, evidence-based exercise programs

The Inventory of Physical Activity Barriers: Development and Preliminary Validation

The level of inactivity among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases. To confront this concern, healthcare providers need to address the reasons for inactivity. Unfortunately, limited tools exist to address barriers to physical activity (PA). The purpose of our study was to develop and psychometrically evaluate a PA barrier scale for adults 50 years and older. The Inventory of Physical Activity Barriers (IPAB) scale was developed, refined, and evaluated using a cross-sectional and a modified Delphi study. We had two groups of participants: First, 39 adults (50 years and older) provided survey pilot data for psychometric evaluation and then nine interprofessional PA experts assisted with finalizing the scale. Participants completed a demographic questionnaire, Physical Activity Vital Sign questionnaire, and the IPAB. The IPAB’s refinement was guided by item-scale correlations, descriptive statistics, and consensus among the PA experts. Construct validity was examined by comparing mean IPAB scores of inactive and active participants via independent t-test. Internal consistency was assessed via Cronbach Alpha. The IPAB was refined from 172 items to 40 items and found to be internally consistent (α=.97) and able to differentiate individuals who do and do not meet the recommended 150 minutes of PA (p=0.01). The IPAB is a reliable assessment of PA barriers for adults 50 years and older. Preliminary analyses are promising for the scale’s construct validity and support further psychometric evaluation of the tool

A Feasibility Study of Multi-component Fall Prevention for Homebound Older Adults Facilitated by Lay Coaches and Using a Tablet-Based, Gamified Exercise Application

Although homebound older adults face high risk for falls, they are unable to utilize community-based fall prevention programs due to their mobility limitations. In this article, we report a feasibility study of a four-session, multicomponent fall prevention program for low-income homebound older adults using pre, post, mixed-method design. The manualized program was delivered by lay coaches who were trained and supervised by a physical therapist. The program also used an iPad-based gamified strength and balance exercise app (called KOKU) that was operable without the need to connect to the internet. Participants (N = 28) in this study were highly receptive to the program and approved all components: psychoeducation, the KOKU app, home-safety checks, safe ambulation training, and medication review. The study showed that a brief, multicomponent fall prevention program for homebound older adults is feasible and acceptable. Further research is needed to evaluate its effectiveness