Carol Clark

Adherence to community based group exercise interventions for older people: A mixed-methods systematic review

OBJECTIVE Lifelong physical activity provides some of the best prospects for ageing well. Nevertheless, people tend to become less physically active as they age. This systematic review assessed the views and adherence of participants attending community based exercise programmes of ≥6months duration. METHOD Searches were carried out in eight online scientific databases (January 1995-May 2014) to identify relevant primary studies. Studies were assessed for quality and data extracted. Results were synthesised thematically and narratively. Qualitative findings were compared against quantitative studies. RESULTS A total of 2958 studies were identified and screened against the inclusion/exclusion criteria. Ten studies met the inclusion criteria (five quantitative, three qualitative and two mixed-methods study designs). None were excluded on the basis of quality. Six key themes were identified from the qualitative studies as important for adherence to group exercise programmes: social connectedness, participant perceived benefits, programme design, empowering/energising effects, instructor and individual behaviour. The mean adherence rate of studies with comparable measures was (69.1% SD 14.6). When the views of participants from the qualitative synthesis were juxtaposed against the quantitative studies, programme design was a common feature across all studies. CONCLUSION Evidence surrounding these programmes is limited both in terms of long-term adherence measures and the views of participants. However, based on limited findings there is some indication that community based group exercise programmes have long-term adherence rates of almost 70%. Incorporating the views of older people into programme designs may provide guidance for innovative interventions leading to sustained adherence.

An exploration of the prevalence of Hypermobility and Joint Hypermobility Syndrome in Omani women attending a hospital physiotherapy service

BACKGROUND AND OBJECTIVES Joint hypermobility syndrome (JHS) is an inherited disorder of connective tissue. It presents as a condition in which there are neuromusculoskeletal signs and symptoms, including pain, without the inflammatory component of a joint disease such as rheumatoid arthritis. Re-attendance in rheumatology clinics, re-injury and prolonged rehabilitation are also features of JHS. The primary aims of this study were to establish the prevalence of hypermobility and JHS in those attending physiotherapy clinics with neuromusculoskeletal disorders in Oman. METHODS A cross-sectional case control study design was used. The participant population included Omani women, aged 18-50 years, attending physiotherapy services for musculoskeletal complaints. The comparison population comprised women of a similar age and ethnic origin who were staff at the hospital. The primary outcome measures were the Beighton Score and the Brighton Criteria. RESULTS A total of 184 subjects were recruited into the study. These consisted of 94 in the participant group and 90 in the comparison group. Hypermobility was recorded in 51% of the participant group and 30% of the comparison group. The number of participants with JHS was 55%, while 21% of the comparison group exhibited features of the JHS phenotype without pain. A significant number of participants with JHS were re-attending for treatment compared with those without JHS. CONCLUSIONS This study confirms a high prevalence of JHS among subjects with musculoskeletal signs and symptoms and that re-attendance for physiotherapy treatment is more frequent in subjects with JHS than in those without.

Living with joint hypermobility syndrome. Patient experiences of diagnosis, referral and self-care

Background. Musculoskeletal problems are common reasons for seeking primary health care. It has been suggested that many people with ‘everyday’ non-inflammatory musculoskeletal problems may have undiagnosed joint hypermobility syndrome (JHS), a complex multi-systemic condition. JHS is characterized by joint laxity, pain, fatigue and a wide range of other symptoms. Physiotherapy is usually the preferred treatment option for JHS, although diagnosis can be difficult. The lived experience of those with JHS requires investigation. Objective. The aim of the study was to examine patients’ lived experience of JHS, their views and experiences of JHS diagnosis and management. Methods. Focus groups in four locations in the UK were convened, involving 25 participants with a prior diagnosis of JHS. The focus groups were audio recorded, fully transcribed and analysed using the constant comparative method to inductively derive a thematic account of the data. Results. Pain, fatigue, proprioception difficulties and repeated cycles of injury were among the most challenging features of living with JHS. Participants perceived a lack of awareness of JHS from health professionals and more widely in society and described how diagnosis and access to appropriate health-care services was often slow and convoluted. Education for patients and health professionals was considered to be essential. Conclusions. Timely diagnosis, raising awareness and access to health professionals who understand JHS may be particularly instrumental in helping to ameliorate symptoms and help patients to self-manage their condition. Physiotherapists and other health professionals should receive training to provide biopsychosocial support for people with this condition.

Older people’s adherence to community-based group exercise programmes: a multiple-case study

BackgroundPhysical inactivity is a global phenomenon, with estimates of one in four adults not being active enough to achieve health benefits, thus heightening the risk of developing non-communicable diseases. In order to realise the health and wellbeing gains associated with physical activity the behaviour must be sustained. Community-based group exercise programmes (CBGEP) utilising social supports have been shown to be one means of not only increasing activity levels for older people, but sustaining physical activity.A gap in the literature was identified around older people’s long-term adherence to real-life CBGEP within a UK context. This study therefore sought to address this gap by understanding older people’s ongoing adherence to CBGEP with a view to gaining further insight about which factors contribute to enabling people to sustain their physical activity levels.MethodsA multiple case study research design was employed to understand older people’s (≥60 years, n = 27) adherence (≥ 69%, for ≥ 1 year) to three current CBGEP in the South- West of England. Qualitative data (participant observation, focus groups, documents, and interviews) were collected and analysed using inductive thematic analysis followed by the analytic technique of explanation building. Quantitative data were analysed using descriptive statistics and used to set the context of the study.ResultsThe current study offers five unique insights into real-life programmes which have been successful in helping older people maintain adherence for a year or longer. These included: factors relating to the individual, the instructor (particularly their personality, professionalism and humanised approach), programme design (including location, affordability, the use of music, and adaptable exercise content), social features which supported a sense of belonging, and participant perceived benefits (physical and psycho-social). These all served to explain older people’s adherence to CBGEP.ConclusionsThese factors related to participant adherence of CBGEP must be considered if we wish to support older people in sustaining a physically active lifestyle as they age. These findings are of interest to practitioners and policy makers in how CBGEP serve to aid older people in maintaining a physically active lifestyle with a view to preventing non-communicable diseases and in maintaining social connectivity.

Development and Psychometric Properties of A Screening Tool for Assessing Developmental Coordination Disorder in Adults

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder affecting motor coordination. Evidence suggests this disorder persists into adulthood and may be associated with biomechanical dysfunction and pain. We report on the development and initial validation of a questionnaire to assess for DCD in adults. Methods: An initial item pool (13 items) was derived from the American Psychiatric Association criteria and World Health Organisation definition for DCD. An expert panel assessed face and content validity which led to a 9-item Functional Difficulties Questionnaire (FDQ-9) with possible scores ranging from 9-36 (higher scores indicating greater functional difficulties). The FDQ-9 was piloted on individuals recruited from convenience samples. The underlying factor structure and aspects of reliability, validity and accuracy were tested. The Receiver Operating Characteristic Curve was employed to evaluate the diagnostic accuracy of the test using self-reported dyspraxia as the reference standard. Results: Principal Axis Factoring yielded a two factor solution relating to gross and fine motor skills; for conceptual parsimony these were combined. Internal reliability was high (0.81), the mean inter-item correlation was 0.51 and preliminary findings suggested satisfactory construct validity. The Area under the Curve was 0.918 [95% CI 0.84-1.00] indicating a diagnostic test with high accuracy. A cut-off score was established with a sensitivity and specificity of 86% [95% CI 78%-89%] and 81% [95 % CI 73%-89%] respectively. Test-retest reliability was good (ICC 0.96 [95% CI 0.92 to 0.98]. Conclusion: The psychometric properties of the FDQ-9 appear promising. Work is required to conduct further psychometric evaluations on new samples and apply the scale to clinical practice.

Association between Joint Hypermobility Syndrome and Developmental Coordination Disorder – A Review

Introduction: The term joint hypermobility syndrome (JHS) was adopted after clinicians became aware of the myriad of symptoms associated with this multisystemic condition. JHS is an inherited disorder of connective tissues affecting the musculoskeletal and visceral systems which may contribute to a reduction in health related physical fitness. Pain associated with JHS may be influenced by hypermobility and biomechanical dysfunction. Biomechanical dysfunction observed in patients with JHS may be as a result of impaired motor control and in particular developmental coordination disorder (DCD). DCD (described in the literature utilising the terms clumsy child syndrome; perceptual motor dysfunction; dyspraxia) is a neurodevelopmental condition characterised by coordination difficulties affecting function. The objective of this review is to examine the association between hypermobility, JHS, motor control impairment and DCD. Methods and data sources: EMBASE, MEDLINE, CINAHL, ASSIA, PsychARTICLES, SPORTDiscus and PsycINFO from 1989 - 2009. Research articles written in English and peer reviewed were included. Results: Five research papers were identified. The studies employed a variety of methodologies and assessment tools for reporting joint hypermobility, JHS, motor delay, motor impairments and DCD. All five studies reported on children between the ages of six months and 12 years. Three out of four studies reported on association between impaired motor development, motor delay and joint hypermobility. There was no consensus as to whether motor delay, impaired motor development and joint hypermobility continued as the child matured. One study ascertained that children with JHS reported similar functional difficulties as children with DCD.

The within-day and between-day reliability of using sacral accelerations to quantify balance performance

OBJECTIVES To investigate the between-day and within-day reliability of a sacral mounted accelerometer to quantify balance performance and different balance metrics. DESIGN Experimental, cross-sectional. SETTING Laboratorial experiment. PARTICIPANTS Thirty healthy volunteers. MAIN OUTCOME MEASURES Balance tasks were double leg stance, tandem stance and single leg stance with eyes open and closed. Performance was measured by converting accelerations into path length (PL, length of the sway trace), jerk (jerkiness of sway trace) and root mean square (RMS) of the accelerations. RESULTS Within-day ICC for PL were excellent (mean 0.78 95%CI 0.68-0.89), with Jerk and RMS demonstrating means of 0.60 and 0.47, respectively. The mean percentage minimal detectable change (MDC) within-day were small for PL (mean 6.7%, 95%CI 5.3-8.1). Between-day ICC were good for PL (mean 0.61, 95%CI 0.50-0.71), but more varied for Jerk and RMS. The mean percentage MDC was small for PL (mean 6.1%, 95%CI 5.0-7.2). No significant differences were determined for measurements between-days for any metric or task. PL had the highest discriminatory value between the 8 tasks. CONCLUSIONS The sacral mounted accelerometer reliably measured balance performance within- and between-days. The PL is the recommended metric as it was the most reliable, most discriminatory and most sensitive to change.

Differences in sit-to-stand, standing sway and stairs between community-dwelling fallers and non-fallers: a review of the literature

Background: Falls are extremely common and have a significant impact on an individual’s wellbeing. Individuals who fall often display altered function however to date no synthesis pertaining to the nature of these alterations is available. Such information is important to guide assessment and management strategies. Objectives: To appraise and synthesize literature directly comparing community- dwelling elderly fallers with non-fallers across tasks of sit-to-stand, standing postural sway with eyes open and stairs. Methods: A structured search of Medline, SPORTDicuss, Science Citation Index, OAIster, CINAHL, Academic Search Complete, Science Direct and Scopus databases was conducted in July 2017. Articles were limited to peer-reviewed in the English language comparing elderly community-dwelling fallers to non-fallers. Results: Eight articles were included relating to sit-to-stand, seven for postural sway and one for stairs. Fallers stood from sitting significantly slower, with lower linear velocity and maximum power than non-fallers. This was best observed when arms were not used and when the stand was attempted as quickly as possible. Fallers displayed significantly greater sway path lengths and center of pressure velocity compared with non-fallers, but only when assessed in narrow or near narrow stance. Fallers used less force during stepping up compared with non-fallers. Conclusion: The findings of this review suggest that activities of daily living may be able to discriminate between fallers and non-fallers therefore offering the potential for community based assessment of fallers.

Corrigendum to “The within-day and between-day reliability of using sacral accelerations to quantify balance performance” [Phys. Ther. Sport vol. 17 (2015) 45–50]

DLSFNEO Median 141.1 5.8 3.3 ICC 0.85 0.61 0.74 SEM 8.3 7.2 0.7 %MDC 16.3 344.2 62.6 DLSFNEC Median 142.1 6.1 2.9 ICC 0.88 0.48 0.77 SEM 6.8 13.5 1.0 %MDC 13.2 163.9 96.5 DLSFTEO Median 150.7 7.6 4.1 ICC 0.44 0.09 0.42 SEM 31.9 18.6 1.7 %MDC 58.7 677.9 115.1 DLSFTEC Median 156.0 8.3 3.5 ICC 0.90 0.59 0.77 SEM 8.1 6.0 0.9 %MDC 13.1 200.7 72.8 TandEO Median 189.3 11.5 4.2 ICC 0.69 0.03 0.26 SEM 27.3 74.9 3.3 %MDC 40.

Does assisted cycling improve function in those with Parkinson’s disease?

Background: Functional decline is a cardinal sign of Parkinson’s disease (PD), a neurodegenerative disease that affects 1% of individuals over the age of 60. Physical symptoms have a detrimental effect on activities of daily living and quality of life. High intensity exercise has enhanced neuroplasticity and reduced the rate of dopaminergic cell loss in animal studies. One form of high intensity exercise is assisted cycling, which has been shown to be effective for those with other neurological disorders. There is no consensus as to the efficacy in those with PD. Objective: To explore the efficacy of assisted cycling in improving motor function in people with PD. Method: A systematic search of PsycINFO, ScienceDirect, SPORTDiscus, CINAHL, arXiv, MEDLINE and Web of Science was conducted, including articles from January 2003 to October 2016. Studies were assessed for quality using a critical appraisal tool. No articles were excluded due to quality. Results: Seven studies were included in this review, with a total sample of 179 participants with a diagnosis of PD. Four studies were randomised control trials, the others included two case control trials, and a single-subject design trial. The level of cycle assistance, length of intervention and sessions varied between studies. All interventions showed improvements in motor function, with a greater effect on those with more advanced PD. Conclusion: There is moderate evidence to show the efficacy of assisted cycling in improving global motor function in individuals with PD. Future research is required to determine optimum assisted cycling interventions in terms of frequency, duration of sessions and length. The long-term effects of assisted cycling should also be explored in future research.