H11Implementing physiotherapy Huntington's disease guidelines in clinical practice: a global survey

Background Clinical practice guidelines are often not optimally translated to clinical care. Following the publication of the Huntington’s disease (HD) physiotherapy clinical practice guidelines in 2020, the European Huntington’s Disease Network Physiotherapy Working Group (EHDN PWG) identified a need to explore perceived facilitators and barriers to their implementation. The aims of this study were to explore physiotherapists’ awareness of and perceived barriers and facilitators to implementation of the 2020 guidelines. Methods An observational study was carried out using an online survey. Participants were physiotherapists recruited via the EHDN and physiotherapy associations in the United Kingdom, Australia, and United States of America. The survey gathered data on agreement and disagreement with statements of barriers and facilitators to implementation of each of six recommendations in the guidelines using Likert scales. Results There were 32 respondents: 18 from Europe, 7 from Australia, 5 from the USA, 1 from Africa (1 missing data). The majority were aware of the guidelines (69%), with 75% working with clients with HD < 40% of their time. Key findings were that HD specific attributes (physical, behavioural and low motivation) were perceived to be barriers to implementation of recommendations ( ≥ 70% agreement). Support from colleagues (81-91% agreement), an individualised plan (72-88% agreement) and physiotherapists’ expertise in HD (81-91% agreement) were found to be facilitators of implementation in all six of the recommendations. Conclusions This study is the first to explore implementation of guidelines in physiotherapy clinical practice. Resources from PWG to support physiotherapists need to focus on ways to implement recommendations specifically related to management of physical, behavioural and motivational problems associated with HD. This would enhance physiotherapists’ expertise, a facilitator to implementation of clinical practice guidelines

Facilitated group work for people with long-term conditions: a systematic review of benefits from studies of group-work interventions

Background About 15.4 million people in the UK live with a long-term condition. Of the health and social care spend, 70% is invested in caring for this population. Evidence suggests that group-work interventions offer patient support, improved outcomes, and reduce the costs of care. Aim To review the current evidence base examining the effectiveness of group work in long-term physical disease where such groups are facilitated by healthcare professionals. Design and setting Systematic review and narrative synthesis of studies of group-work interventions led by health professionals for adults with specified long-term illnesses. Method MEDLINE, EMBASE, PsycINFO, and Cochrane databases were systematically searched using terms relating to group work and long-term conditions. Studies were included if they were randomised controlled trials (RCTs) with a control group that did not include group work. Results The 14 included studies demonstrated a high degree of heterogeneity in terms of participant characteristics, interventions, and outcome measures and were of varying quality. The studies demonstrated some statistically significant improvements in pain, psychological outcomes, self-efficacy, self-care, and quality of life resulting from intervention. Conclusion This review demonstrates significant benefits resulting from group participation, in adults with long-term disease. Results were mixed and some benefits were short-lived. Nevertheless, these results suggest that group work should be more widely used in the management and support of adults with long-term illness. There is a need for larger and better-quality studies to explore this potentially important area further

Management of respiratory problems in people with neurodegenerative conditions: a narrative review

Background Respiratory failure and dysfunction are problems common in many neurodegenerative conditions and although physiotherapists manage these problems, it is not known which treatments have been studied and the efficacy of those treatments. Objective The purpose is to review, using the PRISMA approach, evidence related to the management of respiratory problems in people with neurodegenerative conditions in order to provide evidence for physiotherapy practice. Data sources Comprehensive searches were conducted using the following electronic databases from inception to May 2010: HUGEnet, SIGLE, British Library Direct, CINAHL, Medline, AMED, and Web of Knowledge. Bibliographies of all studies and systematic reviews were searched by hand. Study selection Studies were selected based on: self ventilating participants with neurodegenerative conditions; interventions aimed at improving respiratory function; outcomes were any valid and reliable measures of respiratory function. Study appraisal Studies were appraised by one reviewer using the Critical Appraisal Skills Programme. Data was synthesised using a narrative approach. Results Thirty five studies were included in the review. The strongest evidence was for the use of non-invasive ventilation for people with amyotrophic lateral sclerosis, although this was weak. The evidence for the use of respiratory muscle training and methods to increase peak cough flow shows a positive effect, but is also weak. Conclusion There is weak evidence for the positive effects of physiotherapy interventions for respiratory problems in people with neurodegenerative conditions. Further work is necessary in specific neurodegenerative conditions to identify why respiratory problems occur and larger scale studies to investigate management of these problems

The role and staffing of physiotherapy in critical care: a scoping review

ntroduction Physiotherapy services are provided to critical care units across the U.K. and internationally. U.K. guidance documents highlight potential physiotherapy roles and recommended staffing levels. However, this guidance is based on limited evidence and this scoping review was needed to inform workforce planning and future recommendations. Objectives The objectives of this scoping review were to: • Map the volume and nature of evidence in relation to physiotherapy in critical care. • Describe the role of physiotherapy within critical care. • Describe recommended physiotherapy staffing ratios in critical care. Methods Available literature between January 2009–December 2021 was searched utilising relevant databases. Studies focusing on the role of physiotherapy or physiotherapy staffing levels were included. Data extraction and appraisal was performed using relevant Joanna Briggs Institute proformas. Results A total of 1121 titles were screened, with 22 full text papers reviewed. Studies were commonly based in South Africa and United States of America and were survey based (n = 16, 72%). Literature available to define the role of physiotherapy in critical care was limited, which was further complicated by variation of practice across countries. Variability was observed for existing physiotherapy staffing levels ranging from 1:4 to 1:50 critical care beds. Discussion Based on our findings, there is limited evidence to define the role of physiotherapy within critical care, with widespread variation in existing staffing levels. Further research is required to define the role of physiotherapy in critical care and identify appropriate staffing levels in the U.K., including a focus on patient outcomes

Exploration of a co-production approach to developing a walking group with people with Huntington's Disease

Background: People with Huntington’s disease (HD) struggle to maintain regular physical activity despite evidence of the benefits of exercise. This study aimed to evaluate the experiences of people who co-produced a walking group for people with HD. Methods: Three people with HD, a specialist HD advisor (sHDA), two project officers from Let’s Walk Cymru (LWC) and the research team co-produced and participated in a walking group for people with HD. A walking group for people with HD was supported weekly by LWC for eight weeks and fortnightly for a further 12 weeks. Semi-structured interviews were undertaken with three people with HD, a sHDA and two project LWC project officers. Interviews were transcribed verbatim and analysed using thematic analysis. Findings: Interviews identified six themes across participants: “organisation and planning”; “purpose of the walks”; “benefits”; “barriers”, “the group” and “the future”. People with HD enjoyed participating in the walks and reported increased confidence to be more active outside the home. All participants noted challenges including apathy, diminished planning skills, social stigma and motor problems specific to HD; people with HD perceived a lack of influence in relation to co-planning and co-execution of the walking group. Conclusions: The walking group was perceived as enjoyable, beneficial, and motivational. This is the first study to report co-production of a walking group with people with HD and the findings suggest that further research is needed to adapt models of co-production for people with a long-term complex condition

The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status:a systematic review and meta-analysis

Abstract Background Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. Methods A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. Results Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (− 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. Discussion Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population