Predicting interest to use mobile-device telerehabilitation (mRehab) by baby-boomers with stroke

Context and purpose: Demand for stroke rehabilitation services are reaching unprecedented levels due to an overall population aging, driven by the aging of the baby-boomer generation. Delivery of rehabilitation via mobile-device technologies may provide advantages towards meeting the increasing demands on the rehabilitation system by providing individuals with rehabilitation services in their homes and communities. The aim of this paper is to gain an understanding of the interest of current baby-boomers with stroke to use mobile-device technology to receive rehabilitation services such as education, assessments and exercise programs (mRehab). Methods: People living in the community with stroke born between 1946 and 1964 (i.e., baby-boomer generation) who participated in a larger telerehabilitation survey were included in this study. Regression modeling was used to evaluate personal, health/disability and technological predictors of interest to use mobile-devices for telerehabilitation. Results and significance: Fifty people with stroke, mean age 62.7 (4.4) years, 58% male, 54.2% with moderate or moderately severe disability were included; 86% had access to a mobile phone or tablet. Regression analysis resulted in statistically significant personal (education, β = 0.29 [95% CI = 0.05 to 1.11], population of residence, β = 0.30 [95% CI = 0.07 to 0.69]), health (comorbid conditions, β = 0.30 [95% CI = 0.02 to 0.20]) technology (ownership, β = 0.26 [95% CI = 0.01 to 0.86] and attitude towards telerehabilitation, β = 0.25 [95% CI = 0.01 to 0.79]) predictors of interest to use mobile-devices for telerehabilitation (R2 = 33.1%).This study identifies personal, health and technological factors which predict interest of baby-boomers with stroke with ongoing and complex health needs to use mRehab. Health professionals can use this information as they integrate mRehab into their practice and inform future development of mRehab solutions

Implementation of increased physical therapy intensity for improving walking after stroke: Walk 'n Watch protocol for a multi-site stepped-wedge cluster randomized controlled trial

Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n=75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality of life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where we enable the entire unit to use the protocol as part of standard of care. What is the effect of introducing structured, progressive exercise (termed the Walk 'n Watch protocol) to standard of care on the primary outcome of walking in adult participants with stroke over the hospital inpatient rehabilitation period? Secondary outcomes will be evaluated and include quality of life.Methods and sample size estimates: This national, multisite clinical trial will randomize 12 sites using a stepped-wedge design where each site will be randomized to deliver Usual Care initially for 4, 8, 12 or 16-months (three sites for each duration). Then, each site will switch to the Walk 'n Watch phase for the remaining duration of a total 20-month enrolment period. Each participant will be exposed to only one of Usual Care or Walk 'n Watch. The trial will enrol a total of 195 participants with stroke to achieve a power of 80% with a Type I error rate of 5%, allowing for 20% dropout. Participants will be medically stable adults post-stroke and able to take 5 steps with a maximum physical assistance from one therapist. The Walk 'n Watch protocol focuses on completing a minimum of 30-minutes of weight-bearing, walking-related activities (at the physical therapists' discretion) that progressively increases in intensity informed by activity trackers measuring heart rate and step number.Study outcome(s): The primary outcome will be the change in walking endurance, measured by the Six-Minute Walk Test, from Baseline (T1) to 4-weeks (T2). This change will be compared across Usual Care and Walk 'n Watch phases using a linear mixed-effects model. Additional physical, cognitive, and quality of life outcomes will be measured at T1, T2, and 12-months post-stroke (T3) by a blinded assessor. The implementation stepped-wedge cluster-randomized trial enables the protocol to be tested under real-world conditions, involving all clinicians on the unit. It will result in all sites and all clinicians on the unit to gain expertise in protocol delivery. Hence, a deliberate outcome of the trial is facilitating changes in best practice to improve outcomes for participants with stroke in the trial, and for the many participants with stroke admitted after the trial ends

Towards an understanding of self-efficacy with using a manual wheelchair

Self-efficacy with using a manual wheelchair is the belief individuals have in their ability to use their wheelchair in challenging situations. It is a new construct that may have important implications on the health and well-being of wheelchair users, but has received minimal investigation. There is a need to develop an understanding of this construct in community-dwelling wheelchair users. Purpose: To investigate: the associations between self-efficacy, participation frequency (Chapter 2), and life-space mobility (Chapter 3); the health, personal, and environmental factors that predict self-efficacy (Chapter 4); and the measurement properties of the 65-item Wheelchair Use Confidence Scale (WheelCon) (Chapter 5). Methods: Multiple regression analyses were used to: examine the self-efficacy effects on participation frequency, measured using the Late-Life Disability Instrument, and life-space mobility, measured using the Life-Space Assessment; and develop a predictive model of self-efficacy, measured with the WheelCon, in a sample (n=124) of wheelchair users, ≥50 years old. Principal components analyses were used to evaluate the dimensionality of the WheelCon. Rasch analyses were used to examine the WheelCon’s item reliability in a sample (n=220) of wheelchair users, ≥19 years old. Results: Self-efficacy was a statistically significant predictor of participation frequency and life-space mobility, after controlling for important confounders. The association between self-efficacy and participation frequency was mediated by life-space mobility and perceived participation limitations. The association with life-space mobility was mediated by wheelchair skills. The models accounted for 55.0% and 39.0% of the participation frequency, and life-space mobility variance, respectively. Age, sex, need for a seating intervention, hours of daily wheelchair use, and formal training and assistance with wheelchair use were statistically significant predictors of self-efficacy. The model accounted for 44.0% of the self-efficacy variance. The WheelCon was found to be comprised of two dimensions. Several items were eliminated due to their non-compliance with the Rasch model. The 13-item mobility efficacy, 8-item self-management efficacy subscales, and the combined 21-item short form have good reliability, and provide accurate and precise measurements. Conclusion: Self-efficacy has important implications on the participation frequency and life-space mobility in community-dwelling wheelchair users, ≥50 years old. The construct may be assessed efficiently and precisely.Medicine, Faculty ofGraduat

The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study

Background: Cardiometabolic multimorbidity (CM) is defined as having a diagnosis of at least two of stroke, heart disease, or diabetes, and is an emerging health concern, but the prevalence of CM at a population level in Canada is unknown. The objectives of this study were to quantify the: 1) prevalence of CM in Canada; and 2) association between CM and lifestyle behaviours (e.g., physical activity, consumption of fruits and vegetables, and stress). Methods: Using data from the 2016 Canadian Community Health Survey, we estimated the overall and group prevalence of CM in individuals aged ≥50 years (n = 13,226,748). Multiple logistic regression was used to quantify the association between CM and lifestyle behaviours compared to a group without cardiometabolic conditions. Results: The overall prevalence of CM was 3.5% (467,749 individuals). Twenty-two percent (398,755) of people with diabetes reported having another cardiometabolic condition and thus CM, while the same was true for 32.2% (415,686) of people with heart disease and 48.4% (174,754) of stroke survivors. 71.2% of the sample reported eating fewer than five servings of fruits and vegetables per day. The odds of individuals with CM reporting zero minutes of physical activity was 2.35 [95% CI = 1.87 to 2.95] and having high stress was 1.89 [95% CI = 1.49 to 2.41] times the odds of the no cardiometabolic condition reference group. The odds of individuals with all three cardiometabolic conditions reporting zero minutes of physical activity was 4.31 [95% CI = 2.21 to 8.38] and having high stress was 3.93 [95% CI = 2.03 to 7.61]. Conclusion: The number of Canadians with CM or at risk of CM is high and these individuals have lifestyle behaviours that are associated with adverse health outcomes. Lifestyle behaviours tend to diminish with increasing onset of cardiometabolic conditions. Lifestyle modification interventions focusing on physical activity and stress management for the prevention and management CM are warranted.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

The influence of a virtual reality entertainment program on depressive symptoms and sedentary behaviour in inpatient stroke survivors : a research protocol for a pilot randomized controlled trial

Background: Sedentary behaviour among stroke inpatients may be due to high rates of depressive symptoms after stroke. Thus, efforts to address depressive symptoms among stroke inpatients are warranted to in turn lessen sedentary behaviour. Despite evidence that virtual reality (VR) is emerging as a method to help with depression, the use of VR to improve depression among inpatient stroke survivors has yet to be studied. In this paper, we report on the protocol investigating the feasibility of a VR entertainment system at improving depressive symptoms among stroke survivors receiving inpatient rehabilitation. Methods: In this single-blind randomized controlled trial, 30 inpatient stroke survivors from the rehabilitation unit at Kelowna General Hospital will be randomized to either (1) intervention: 3 times per week of VR entertainment for duration of inpatient rehabilitation or (2) control: usual care. Individuals will be included if they have a confirmed diagnosis of stroke, are 19 years of age or older, able to provide informed consent, have physician clearance to participate in the study (medically stable or fit), or are able to understand English. Outcome measures to address depressive symptoms (primary outcome), sedentary behaviour, motivation, anxiety, stress, and happiness (secondary outcome) will be administered at two timepoints: (1) baseline (T1) and (2) post-intervention (T2). Study analyses will consider study feasibility indicators and clinical (statistical) outcomes. Means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) will be used to summarize the variables. Feasibility indicators will be dichotomized into either ‘success’ if they meet the a priori criteria, or ‘revise’ if they do not meet the criteria. Intervention effects post-intervention (T2) for the primary and secondary clinical outcomes will be estimated using linear regression including baseline (T1) controlling for age and sex. Discussion: The results of this trial will add to our understanding of depression and sedentary behaviour among individuals receiving inpatient stroke rehabilitation as well as the feasibility of a VR entertainment program to improve depressive symptoms, which will in turn may lessen sedentary behaviour in inpatient stroke survivors.Graduate and Postdoctoral StudiesMedicine, Faculty ofNon UBCOccupational Science and Occupational Therapy, Department ofReviewedFacultyResearcherGraduat

Healthcare utilization after stroke in Canada- a population based study

Background: More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke. Methods: This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey. Healthcare utilization was assessed by a computer-assisted personal interview asking about visits to healthcare professionals in the last 12 months. Negative binomial regression was used to estimate the incidence rate ratios (IRR) and 95% confidence intervals (CI) for the number of health professional visits between stroke survivors and people without a stroke. The regression models were adjusted for demographics, as well as for mobility, mood/anxiety disorder and cardiometabolic comorbid conditions. Results: The study sample included 35,759 respondents (948 stroke, 34,811 non-stroke) and equate to 12,396,641 (286,783 stroke; 12,109,858 non-stroke) when sampling weights were applied. Stroke survivors visited their family doctor the most, and stroke was significantly associated with more visits to most healthcare professionals [e.g., family doctor IRR 1.6 (CI 1.4–1.8); nurse IRR 3.0 (CI 1.8–4.8); physiotherapist IRR 1.8 (CI 1.1–1.9); psychologist IRR 4.0 (CI 1.1–5.7)] except the dental practitioner, which was less [IRR 0.7 (CI 0.6–0.9)]. Mood/anxiety condition, but not cardiometabolic comorbid condition increased the probability of visiting a family doctor or social worker/ counsellor among people with stroke. Conclusion: Stroke survivors visited healthcare professionals more often than people without stroke, and were approximately twice as likely to visit with those who manage problems that may arise after a stroke (e.g., family doctor, nurse, psychologist, physiotherapist). The effects of a stroke include mobility impairment and mood/ anxiety disorders. Therefore, adequate access to stroke-related healthcare services should be provided for stroke survivors, as this may improve functional outcome and reduce future healthcare costs.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

Clinical effects of Emblica officinalis fruit consumption on cardiovascular disease risk factors : a systematic review and meta-analysis

Background: Emblica officinalis (EO) fruit consumption has been found to have a beneficial effect on cardiovascular disease (CVD) physiological risk factors in preliminary clinical intervention trials; however, questions remain regarding the overall effectiveness of EO on CVD risk. The purpose of this systematic review and meta-analysis is to: 1) systematically describe the clinical research examining EO; and 2) quantitatively assess the effects of EO on CVD physiological risk factors. Methods The Pubmed, Embase, Web of Science, and Google Scholar electronic platforms were searched for relevant randomized controlled trials (RCTs) published until April 7, 2021. Studies were included if they involved adults (age ≥ 18 years) ingesting a form of EO fruit; included blood lipids, blood pressure, and/or inflammatory biomarkers as outcomes; had clearly defined intervention and control treatments with pre- and post-intervention data; were peer-reviewed; and were written in English. Studies were excluded if they compared EO with another risk reduction intervention without a usual care control group. RCTs were assessed for methodological quality using the Cochrane risk-of-bias version 2 (ROB2) tool, qualitatively described, and quantitatively evaluated using random and fixed effect meta-analysis models. Results A total of nine RCTs (n = 535 participants) were included for review. Included studies followed parallel-group (n = 6) and crossover (n = 3) designs, with EO dosage ranging from 500 mg/day to 1500 mg/day, and treatment duration ranging from 14 to 84 days. Meta-analyses revealed EO to have a significant composite effect at lowering low-density lipoprotein cholesterol (LDL-C; Mean difference (MD) = -15.08 mg/dL [95% Confidence interval (CI) = -25.43 to -4.73], I2 = 77%, prediction interval = -48.29 to 18.13), very low-density lipoprotein cholesterol (VLDL-C; MD = -5.43 mg/dL [95% CI = -8.37 to -2.49], I2 = 44%), triglycerides (TG; MD = -22.35 mg/dL [95% CI = -39.71 to -4.99], I2 = 62%, prediction interval = -73.47 to 28.77), and high-sensitivity C-reactive protein (hsCRP; MD = -1.70 mg/L [95% CI = -2.06 to -1.33], I2 = 0%) compared with placebo. Conclusions Due to statistical and clinical heterogeneity in the limited number of clinical trials to date, the promising effects of EO on physiologic CVD risk factors in this review should be interpreted with caution. Further research is needed to determine if EO offers an efficacious option for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy.Medicine, Faculty ofScience, Irving K. Barber Faculty of (Okanagan)Biology, Department of (Okanagan)Occupational Science and Occupational Therapy, Department ofSouthern Medical Program (Okanagan)Library, UBCReviewedFacultyResearcherGraduateUnknow