Catherine Bulley

Comparison of Breast Cancer-Related Lymphedema (Upper Limb Swelling) Prevalence Estimated Using Objective and Subjective Criteria and Relationship with Quality of Life

This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95–10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema.

A critical review of the validity of measuring stages of change in relation to exercise and moderate physical activity

Many professionals are integrally involved in the promotion of exercise and physical activity, for specific therapeutic purposes, and with the aim of improving population health and quality of life. Design and evaluation of intervention strategies are frequently underpinned by the Transtheoretical Model, a process-oriented approach to behaviour change. One component of this model is the stage of change structure, which describes a persons behaviour in the context of a change process. It is frequently used to assess current levels of exercise or physical activity participation, and as a measure of change in behaviour following intervention. This paper discusses the importance of validity in the assessment of stages of change for exercise and physical activity. Various different scales exist and have been investigated for validity using comparisons with self-reported outcome measures and physiological markers of activity. Generally, comparative data provide evidence of stage hierarchies relating to both exercise and physical activity. However, this does not establish actual levels of activity represented by stage allocation, limiting its applicability. Further appropriately designed comparisons with objective measures are required if the stage of change structure is to be applied as a meaningful, accurate and sensitive tool for the measurement of physical activity and exercise.

Personal meanings, values and feelings relating to physical activity and exercise participation in female undergraduates: a qualitative exploration

Understanding was sought of the ways that female students understand and feel about physical activity and exercise participation, to inform effective and ethical intervention. Sixteen women participated in semi-structured interviews which were analysed thematically, using QSR NUD*IST 4. Physical activity and exercise proved emotive topics and meant different things to different people. Some women associated physical activity and exercise with enjoyment, or achieving their goals. Others saw exercise in particular as a duty, associated with feelings of guilt and inadequacy. Findings supported the value of promoting realistic goals, and careful choice of activities according to individual preferences.

Influences on physiotherapists when deciding to study at Masters level: An exploratory study

Within the physiotherapy profession, there are increasing expectations in relation to specialization and life-long learning. This has led to increasing prominence of Masters level study as a route for professional development. Despite this, little is known regarding the thought processes of physiotherapists in relation to postqualification study. This qualitative study aimed to explore the influences on physiotherapists when deciding to undertake taught Masters level study. Semi-structured interviews were carried out with nine physiotherapists in two Scottish Higher Education institutions. Thematic analysis highlighted motivators and barriers that were intrinsic and extrinsic to the individual. Physiotherapists were strongly influenced by the desire to develop professionally, but had to overcome barriers such as lack of confidence to study at this level and lack of familiarity with the context and content of Masters level study. Findings suggest that increasing the familiarity of clinicians with aspects of Masters education would facilitate them in their decision to undertake postqualification study. Increasing early support strategies for Masters students would enable them to gain confidence and continue with their studies.

Stages of exercise behaviour change: A pilot study of measurement validity

Abstract Objectives The Stage of Exercise Behaviour Change (SEBC) scale is used to monitor physical activity levels and change in a variety of contexts. However, there is insufficient conceptual discussion relating to its use and a lack of objective evidence for its validity. Pilot work was undertaken to explore the issues involved in validating a SEBC scale using objective monitoring of exercise behaviour, and subsequent discussion aims to inform future validity studies. Design Estimates of physical activity energy ex-penditure (kilocalories) were calculated for 20 participants, while minutes spent in moderate and vigorous activity were extrapolated from heart rate data in 23 participants. The SEBC scale was completed after a three-day objective monitoring period. Data were compared descriptively and using analysis of variance. Results Inter-stage differences in objective measurements of energy expenditure and minutes of vigorous activity participation provided hierarchical confirmation of the SEBC scale. Conclusions Objectively monitored exercise participation supported previous work in its confirmation of the Stage of Change hierarchy. However, in order to build confidence in the tool, it will be necessary to explore minutes of exercise participation over a six-month period. This would enable comparison of objectively monitored activity levels against the threshold level of exercise described as the target behaviour. Suggestions are made as to how this could be carried out. A word of caution is provided in relation to current use of SEBC tools in measurement contexts.

Validation and modification of the Scottish Physical Activity Questionnaire for use in a female student population

Abstract Objectives Two trials were undertaken to establish and improve the validity of seven-day physical activity (PA) recall using the Scottish Physical Activity Questionnaire (SPAQ) in a female student population. Fifty-five female students were recruited to Trials One and Two (n=30; n=25). Methods The SPAQ was completed following a monitoring period. Heart rate (HR) data was collected for three days, following which the SPAQ was completed. HR data were converted to minutes spent in moderate and vigorous PA. This required the monitoring of HR during rest and three activities selected to reflect light, moderate and vigorous activity. Questionnaire modification was informed by data analysis and the responses of 16 Trial One participants who agreed to attend group interviews. In Trial Two the method was replicated using the modified SPAQ. Results The mean of three days of HR data were compared with the equivalent SPAQ data. Parametric statistical analysis was carried out on log-transformed data owing to skewed data distributions. In all but six cases the SPAQ estimate exceeded objective estimates of time in activity, with a median difference of 40.70 minutes, found to be statistically significant on t-test (95% CI: −1.39, 0.23) and poorly correlated (r=0.03). Limits of Agreement analysis demonstrated poor agreement between estimates. Following questionnaire modification the difference between median estimates of time in PA reduced to 10.60 minutes, no longer significantly different (95% CI: −0.75,9.18E−02). The correlation improved to 0.59 and Limits of Agreement also improved. Conclusions Students undergo substantial lifestyle changes that may have a detrimental effect on their activity participation. As women are at particular risk, the measurement of PA in female students is important to allow epidemiological and interventional research. The SPAQ was found to require modification for use in this population. Alterations included reordering of questions and the provision of examples to aid the estimation of time spent in routine and intermittent activities. The modified SPAQ for students demonstrated reduced bias and improved agreement with an objective measure. It was therefore felt to be appropriate for the measurement of PA in female students.

Are physiotherapy guidelines for the management of osteoporosis being implemented? A UK-wide survey

The availability of increasing amounts of research has led to the development of clinical guidelines to facilitate evidence-based decisions. However, effective implementation must be evaluated. A survey was carried out to evaluate a clinical guideline for osteoporosis, endorsed by the Chartered Society of Physiotherapy (CSP). A stratified proportional sample of 588 relevant National Health Service providers was selected from Strategic Health Authorities/Health Boards throughout the UK. Random samples of 31 independent hospitals and 102 private practitioners were obtained from lists of seven UK-based service providers and the CSP website. One hundred and twenty further surveys were sent through the clinical interest group, AGILE. The survey was developed to investigate awareness and use of the clinical guideline, current implementation strategies and barriers to implementation. Of the clinical sites sampled, 25% responded, giving 243 usable surveys. While guidelines were available in 62% of responding sites, only 35% reported its use – although this was higher in services with a primary osteoporosis caseload (45%). Only 6% reported formal implementation. Barriers to guideline use frequently highlighted a lack of resources and training. Survey responses indicate a lack of guideline use; this should be facilitated through formal implementation strategies, requiring training and resources.

Physiotalk: connectedness and constructive change – a qualitative study

Physiotalk: connectedness and constructive change – a qualitative study Janet Thomas, Naomi McVey and Cathy Bulley Queen Margaret University, Edinburgh, UK; NHS Fife, Dunfermline, UK; Centre for Professional Workforce Development, Salford, UK

Physical activity participation of female students: Prevalence and change during the first academic year

Abstract Objectives This study aimed to explore the prevalence, and change over time, of participation in vigorous exercise and moderate lifestyle physical activity (PA) in a female student population in Scotland. Methods A survey was carried out to assess Stages of Behaviour Change (SOBC) for exercise and moderate PA at the start of the first academic year (n=425, response rate: 67.6%). At the start of the second year a sample of the previously surveyed female students (n=16), stratified by SOBC, were interviewed to retrospectively explore change in their activity choices throughout the first academic year and summer vacation. Results Greater participation in moderate lifestyle PA than in exercise was noted, with a high prevalence of inactivity: 50.6 per cent in the survey. Qualitative data suggested a decrease in participation during semester one. Interview responses indicated that students were affected by transitions, including the move into higher education and intermittent vacations. Although some adjusted to the changes over time, others experienced sporadic activity patterns in response to frequent changes in circumstances. A response bias towards mature students from health-related courses was noted throughout the study. Conclusions The high prevalence of inactivity in this female student population raises concerns regarding their current and future health. Although higher education is thought to provide a useful forum for health promoting activities, the impact of regular transition periods must be addressed.