Hjertepasienters opplevelse av fysisk aktivitet og trening: En kvalitativ metasyntese

Source at https://www.fysioterapeuten.no/fagfellevurdert-fysioterapi-hjerterehabilitering/hjertepasienters-opplevelse-av-fysisk-aktivitet-og-trening-en-kvalitativ-metasyntese/143221.Bakgrunn: Treningsbasert hjerterehabilitering kan øke livskvalitet, bedre arbeidskapasitet og redusere risikofaktorer for reinnleggelse og kardiovaskulær død. Likevel klarer mange pasienter ikke fortsette med trening etter et rehabiliteringsopphold, og kun halvparten klarer å opprettholde det anbefalte nivået for fysisk aktivitet. Derfor er det viktig å undersøke hvilke erfaringer pasientene har med trening etter hjertesykdom. Hensikten med denne studien var å undersøke pasienters opplevelse av trening etter institusjonsbasert hjerterehabilitering. Metode: Litteraturstudie med metasyntese av kvalitative data ble valgt som metode. Litteratursøk ble utført i databasene MEDLINE, Embase, Cinahl, AMED, PEDro og SveMed+. Metaetnografi ble anvendt til analyse og syntetisering av datamateriale. Resultat: Seks kvalitative intervjustudier oppfylte inklusjonskriteriene. Et hovedtema; indre og ytre påvirkninger, og fire tilhørende undertemaer; rutiner og motivasjon, oppfølging og støtte, trening, og håndtering av negative og positive tanker, ble identifisert i analysen. Personer som klarte å gjøre treningen til en livsstil, mente at dannelse av rutiner var viktig for å lykkes. Oppfølging, støtte og håndtering av negative og positive tanker kan hjelpe pasienter til en mer aktiv livsstil. Støtte fra treningspartnere og oppfølging fra fysioterapeut er viktig for motivasjon til frisktrening. Konklusjon: Studien viser at deltakerne har ulike opplevelser av frisktrening etter institusjonsbasert hjerterehabilitering. Noen mestrer frisktrening, mens andre opplever utfordringer. Rutinedannelse, treningsglede, opplevde forbedringer og mestringstro er viktig for treningsmotivasjon. Pasientene peker på utfordringer hvor mangel på organisert treningstilbud og lang reisevei hindrer dem i å opprettholde frisktreninge

mHealth Support to Stimulate Physical Activity in Individuals With Intellectual Disability: Protocol for a Mixed Methods Pilot Study

Background: Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. Objective: We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. Methods: A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. Results: Enrollment commenced in May 2021. Data collection was completed in March 2022. Conclusions: This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology

The association between timed up and go test and history of falls: The Tromsø study

BACKGROUND: Fall-related injuries in older adults are a major health problem. Although the aetiology of falls is multifactorial, physical factors are assumed to contribute significantly. The "Timed up and go test" (TUG) is designed to measure basic mobility function. This report evaluates the association between TUG times and history of falls. METHODS: A retrospective, observational, population-based study was conducted on 414 men and 560 women with mean age 77.5 (SD 2.3). TUG time and falls during the previous 12 months were recorded. Covariates were age, sex, medical history and health-related mobility problems. Means, confidence intervals and test characteristics for TUG were calculated. Odds ratios and influence of covariates were examined by logistic regression. RESULTS: The mean TUG time was 11.1s (SD 2.5) among male non-fallers and 13.0s (SD 7.8) among fallers. The difference was 1.9s (95%CI 0.9–3.0). The odds ratio for fallers being in the upper quartile was 2.1 (95%CI 1.4–3.3). Adjusted for covariates, the odds ratio was (OR = 1.8, 95%CI 1.1–2.9). The corresponding mean was 13.0s (SD 5.74) among female non-fallers and 13.9s (SD 8.5) among fallers. The difference was 0.9 (95%CI -0.3–2.1). The odds ratio for fallers being in upper quartile was 1.0 (95%CI 0.7–1.4). The area under the ROC curve was 0.50 (95%CI 0.45–0.55) in women and 0.56 (95%CI 0.50–0.62) in men. CONCLUSION: TUG is statistically associated with a history of falls in men but not in women. The ability to classify fallers is poor, and the clinical value of the association is therefore limited

Arm function and constraint-induced movement in early post-stroke rehabilitation

Constraint-induced movement therapy (CIMT) is a treatment for mild-to-moderate upper extremity motor dysfunction in post-stroke patients. However, as the ideal time to initiate post-stroke treatment remains uncertain, more information is needed regarding the effects of CIMT and arm use in the early stages of stroke recovery. This thesis aimed to: 1) examine the correlations between arm motor impairment and real world arm use and its relationship with dependency in self-care activities in patients in the stroke unit. (Paper I) 2) assess the effects of modified CIMT applied within 28 days after stroke occurrence (Paper II) 3) review existing literature for the effects of CIMT on body function, activity, and participation in post-stroke patients (Paper III) In Paper I, we found a high correlation between motor impairment and the patient’s actual use of the more affected arm. Further findings revealed that both the Fugl-Meyer motor assessment scores and arm use are related to dependency in self-care activities, but the finding might be confounded by lower extremity motor function. In Paper II, we found that CIMT initiated within 28 days after stroke occurrence was safe and feasible but did not improve long-term motor function. However, there was a significant effect on movement speed immediately after the treatment, and CIMT might promote a faster recovery compared to standard care. There were no differences between the groups with respect to reduced arm motor impairment or increased arm use. In the systematic review and meta-analysis conducted in Paper III, we found that CIMT can improve arm motor function and arm motor activities and may have a lasting effect on arm motor activity. The effects were especially stable in the sub-acute and chronic groups, and CIMT is therefore advocated for selected patients in these post-stroke stages. Taken together, our study revealed that early CMIT has an immediate effect on timed measures of arm activity but does not improve long-term motor activity. The meta-analysis also showed uncertain effects of CIMT in the early post-stroke phase. This rehabilitative treatment should preferably be offered to patients in sub-acute and chronic stages after stroke. As learned nonuse might not be pronounced in the acute stage of stroke, the treatment should be aimed at preventing its development

Behandling av pasienter med uspesifikke nakkesmerter gjennom påvirkning av motorisk kontroll

Dette prosjektet vil bestå av 6 casestudier på pasienter med uspesifikke nakkesmerter. Prosjektet har som mål å integrere teori om funksjonell motorisk kontroll i vår behandling av disse pasientene. Gjennom aksjonsforskning vil prøver vi å utvikle vår personlige praksis med bakgrunn i teorien, og vurdere om teorien må endres på bakgrunn av denne erfaringen med reelle praksissituasjoner

A meta-analysis of constraint-induced movement therapy after stroke

Objective: To evaluate the effect of constraint-induced movement therapy in adult stroke patients and to examine the impact of time since stroke and various treatment modalities. Data sources: PubMed, EMBASE, Cochrane and PEDro trial registers were searched for clinical trials published before November 2012. Study selection: Randomized or quasi-randomized controlled trials of constraint-induced movement therapy lasting 2–7 h/day for 8–28 days were included. Data extraction: Measurements were classified into the following categories: arm motor function, arm motor activity, activities of daily living, and participation. A pooled standardized mean difference (SMD) was calculated for each category. Moderators were: trial quality, behavioural techniques, amount of training, time since stroke, shaping, and the nature of the control group. Data synthesis: Of 3842 records initially screened 23 trials were included. A small post-treatment effect was found on arm motor function (SMD 0.28, 95% confidence interval (CI) 0.11–0.44). Meanwhile, a moderate effect on arm motor activity was found post-treatment (SMD 0.51, 95% CI 0.30–0.73) and at 3–6 months follow-up (SMD 0.41, 95% CI 0.08–0.74). Conclusion: Constraint-induced movement therapy can improve arm motor function and improve arm motor activities and may have a lasting effect on arm motor activit

Spasticity, gait, and balance in patients with multiple sclerosis: A cross‐sectional study

Objective - More than 80% of people with multiple sclerosis (MS) are affected by spasticity. Spasticity is known to reduce quality of life and contribute to additional symptoms, such as pain and reduced mobility, but the association between spasticity, balance, and mobility has not yet been established. Our aim was to examine whether a relationship exists between spasticity in the lower limbs, balance, and gait, as well as to explore the involvement of different muscle groups. Methods - This study employed a cross‐sectional design. Thirty patients with MS were included. The Modified Ashworth Scale (MAS) was used to examine spasticity in the ankle plantar flexors, knee extensors, and hip adductors. Balance was measured using the Mini-Balance Evaluation Systems Test, and gait with the 2-Minute Walk Test. The participants were tested once with no additional follow-up. Spearman's correlation, recursive partitioning, and linear regression analyses were used to explore the association. Results - A significant correlation between gait distance and spasticity in the ankle plantar flexors (ρ = −.69, p ρ = −.45, p = .012) was observed. Balance significantly correlated with spasticity in ankle plantar flexors (ρ = −.69, p ρ = −.52, p = .003), and hip adductors (ρ = −.5, p = .005). The relationship between spasticity in ankle plantar flexors and hip adductors was significant, even from low levels of spasticity, whereas MAS score ≥ 2 was clinically correlated with a decrease in gait and balance function. Adjustments for sex, age, or years since diagnosis had only minor impact on the results. Conclusions - This study indicates that spasticity in the lower limbs is clinically significantly associated with mobility in people with MS

Arm use in patients with subacute stroke monitored by accelerometry : association with motor impairment and influence on self-dependence

OBJECTIVE: To assess the effect of arm motor impairment on actual arm use in the early post-stroke period and explore its association with self-care dependency. SUBJECTS: Thirty-one patients recruited within the 30 first days after stroke. METHODS: Motor impairment of the upper extremity was measured with Fugl-Meyer Motor Assessment (FMA) and arm use was measured with accelerometry. Arm movement ratio (AMR), the ratio of arm use duration between the more and less affected arm, was calculated. Self-care dependency was defined as needing personal assistance in primary self-care activities. RESULTS: FMA of the more affected arm was strongly associated with AMR (Spearman's correlation coefficient -0.851, p > 0.001), although some patients deviated considerably from the regression line. Covariates did not have any influence on this relation. Both arm motor function and actual arm use related to self-care dependency, but were no longer significant when we controlled for lower extremity motor function. CONCLUSION: FMA and AMR correlated highly in the early post-stroke period. These measures relate to different dimensions of the International Classification of Functioning and Health, and could be supplementary measures to reveal non-use of the affected arm. Arm use and arm impairment were not significantly associated with self-care dependency in our sample

Upper limb kinematics during the first year after stroke: the stroke arm longitudinal study at the University of Gothenburg (SALGOT)

Background - Reduction of compensation and improved movement quality indicate recovery after stroke. Since clinical measures alone are often inadequate to distinguish between behavioral recovery and compensation, kinematic analysis of functional tasks has been recommended. Objective - To quantify longitudinal changes and residual deficits in movement performance and quality during the first year after stroke using kinematic analysis of drinking task. Methods - A total of 56 participants with first ever stroke causing upper extremity impairment were extracted from a non-selected stroke unit cohort (Stroke Arm Longitudinal Study at the University of Gothenburg-SALGOT). Participants needed to able to perform the drinking task with the more-affected arm at least on 2 occasions out of 6 (3 days, 10 days, 4 weeks, and 3, 6, and 12 months) during the first year to be included. A cohort of 60 healthy individuals was used as reference. Longitudinal changes were analyzed using linear mixed models. Results - Movement time, number of movement units, peak angular velocity of the elbow, peak hand velocity, and trunk displacement improved significantly over the first 3 months with a peak at 6 months. Movement time and peak hand velocity reached levels comparable to healthy at 3 months, but number of movement units, peak elbow angular velocity, trunk displacement, and arm abduction remained different from healthy over the first year after stroke. Conclusions - Even when the recovery patterns of kinematics follow the known nonlinear pattern, not all kinematic measures reach the levels in par with healthy controls at one year post stroke. Since the number of movement units, peak angular velocity, trunk displacement, and arm abduction remained impaired over the first year, they might be the most suited measures to distinguish behavioral recovery from compensation strategies

Activity-related pain in patients with chronic musculoskeletal disorders

Purpose. Activity related pain may be a barrier to rehabilitation in patients with chronic musculoskeletal disorders. This study investigated patients’ reports of increased pain during activity, and the association between such pain and psychological factors and pain variables. Method. Questionnaires from 232 adults with chronic musculoskeletal pain measured pain intensity, spread of pain and pain duration. Pain during activity was assessed both on a 11 point Numeric Rating Scale (NRS), and operationalized as a dichotomous measure, where responders defined if they experienced pain during general activity and exercise. Psychological factors were measured by the Hopkins Symptom Check List 25, the Tampa Scale for Kinesiophobia and a subscale of the Arthritis Self – Efficacy Scale. Multiple and logistic regression was used to analyse associations between increased pain during activity and associated variables. Results. Increased pain during activity was reported by 69 % of participants. Fear of movement was a significant factor for reporting increased pain during activity, both general activity and exercise, also in a subsample with low psychological distress. Other significant factors were spread of pain and a low sense of self efficacy. Conclusion. Patients with high fear of movement, large spread of pain and low self efficacy were more likely to report increased pain during activity even in the absence of psychological distress