Darren Nickel

Effectiveness of Home Visiting Programs on Child Outcomes: A Systematic Review

BackgroundThe effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families.MethodsA comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies.ResultsStudies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.ConclusionsHome visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.

Using a multilevel approach to examine the relationship between task cohesion and team task satisfaction in elite ice hockey players

Of numerous studies conducted over the years examining cohesion in the sport setting, very few have acknowledged that participants are nested within teams, which has resulted in analysis of data at the individual level. Given that members of sport teams are interdependent, valuable information might be lost if constructs such as cohesion are examined only at an individual level. The purpose of this study was to illustrate how multilevel modeling could be used to handle this interdependence among observations within teams when examining the relationship between task cohesion and team satisfaction. Male ice hockey players (N = 194) on 10 teams completed the cohesion and satisfaction measures near the end of the regular season. Using multilevel analysis, task cohesion predicted variance in team task satisfaction at the individual (33%) and group (55%) levels. Results highlight the value of multilevel models as well as extend research finding a relationship between cohesion and individual satisfaction to team satisfaction.

Self-regulatory Efficacy as a Mediator between Attributions and Intention for Health-related Physical Activity

The purpose of the present study was to examine whether self-regulatory efficacy would mediate the relationship between individual attributional dimensions for typical exercise levels and intentions to maintain these levels during final exams among university students. Using a prospective design, participants completed measures of attributions for typical activity levels, self-regulatory efficacy and intention to be active during a forthcoming exam period. Results revealed that self-regulatory efficacy partially mediated the relationship between attributional dimensions and intentions for both moderate and mild exercise levels. The results provide initial support for the suggestion that when examining moderate and mild intensity exercise, it is plausible that causality flows from stability of attributions to intentions, at least partially through self-regulatory efficacy.

Step-length variability in minimally disabled women with multiple sclerosis or clinically isolated syndrome.

Gait is one of the most frequently impaired bodily functions in multiple sclerosis (MS). Determining abnormal parameters of gait in early MS could influence MS treatment and rehabilitation. The purpose of this study was to determine whether increased step-length variability could be detected in minimally disabled patients with MS or clinically isolated syndrome (CIS) using a sensored walkway gait analysis system. Nine participants with MS/CIS and nine age- and gender-matched controls were recruited for this study. MS/CIS participants underwent a neurologic examination, and all participants completed a screening interview. Each participant completed three walks at a self-selected pace and three walks at a brisk pace across the GAITRite walkway (MAP/CIR Inc, Havertown, PA). Mean values for step-length variability, step length, and velocity were calculated for each participants self-selected and brisk trials. Independent t tests were used to compare MS/CIS participants with controls, and effect sizes were calculated. Step-length variability in the left leg at the self-selected pace was found to be greater in participants with MS/CIS than in controls, although no significant differences were found in velocity or step length. Step-length variability measurement shows promise in detecting subtle gait dysfunction. Larger, prospective studies exploring step-length variability may determine its clinical viability for detecting subtle gait dysfunction and could lead to improved prognostication of disability progression in MS.

Attributions and Self-regulatory Efficacy for Health-related Physical Activity

Two studies were conducted to examine associations among past activity behaviour, attributions and self-regulatory efficacy for maintaining physical activity sufficient for health benefits. The studies differed in that success for being sufficiently active for health benefits was externally referenced in the first study, but not in the second. In both studies, results revealed that attributional dimensions improved the prediction of self-regulatory efficacy beyond that of past physical behaviour. Results suggested that while past experience may influence an individual’s self-regulatory efficacy to be active enough for health benefits, how people think about their past behaviour also needs to be considered.

Attributions and self-efficacy for physical activity in multiple sclerosis

Self-efficacy is an important predictor of health-related physical activity in multiple sclerosis (MS). While past experiences are believed to influence efficacy beliefs, the explanations individuals provide for these experiences also may be critical. Our objective was to test the hypothesis that perceived success or failure to accumulate 150 min of physical activity in the previous week would moderate the relationship between the attributional dimension of stability and self-efficacy to exercise in the future. Forty-two adults with MS participated in this cross-sectional descriptive study. Participants completed questions assessing physical activity, perceived outcome for meeting the recommended level of endurance activity, attributions for the outcome, and exercise self-efficacy. Results from hierarchical multiple regression revealed a significant main effect for perceived outcome predicting self-efficacy that was qualified by a significant interaction. The final model, which included perceived outcome, stability, and the interaction term, predicted 37% of the variance in exercise self-efficacy, F (3, 38) = 7.27, p = .001. Our findings suggest that the best prediction of self-efficacy in the MS population may include the interaction of specific attributional dimensions with success/failure at meeting the recommended physical activity dose. Attributions may be another target for interventions aimed at increasing the physical activity in MS.

Total knee arthroplasty in multiple sclerosis

We present a case report of total knee arthroplasty complicated by spasticity and contractures in a patient with multiple sclerosis (MS). Four previous case reports in the literature describe adverse outcomes after total knee arthroplasty in persons with MS secondary to severe spasticity. Preoperative, intraoperative, and postoperative considerations for persons with MS, which may help to improve functional outcomes, are discussed. Prospective research is needed among persons with MS to help determine the timing and selection of persons for arthroplasty and to minimize complications related to spasticity.

Predictors of institutionalization for people with multiple sclerosis

BACKGROUND Multiple Sclerosis (MS) is a chronic, progressive disease of the central nervous system with a high prevalence in Canada. While the disease course is highly variable, a significant portion of people with MS may spend more than 10 years living with severe disability, and many of those will eventually require full time institutional care. Despite the high personal and economic cost of this care, little is known about predictors of institutionalization. OBJECTIVE The objective of this study was to identify predictors of institutionalization. METHODS Longitudinal data from a university MS clinic database were extracted to explore nursing home placement over time of an urban subgroup. Cox regression analysis was performed with age of MS onset and sex, as well as baseline information obtained at the first MS clinic assessment: MS course, Kurtzke Expanded Disability Status Scale score, and functional system scores. RESULTS Older age of onset (p = .019) and higher baseline scores in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) were significant (p = .000, p = .000, p = .001, p = .000 respectively) predictors of nursing home placement. CONCLUSIONS Patients with older age of MS onset and those with baseline impairment in specific functional systems (cerebellar, bowel/bladder, brainstem, and cerebral/mental) may be at higher risk for future institutionalization and should be assessed with particular care to determine potential avenues of support to minimize this.

Prevalence of Extracranial Venous Narrowing on Magnetic Resonance Venography Is Similar in People With Multiple Sclerosis, Their Siblings, and Unrelated Healthy Controls: A Blinded, Case-Control Study

Purpose The study sought to assess and compare the prevalence of narrowing of the major extracranial veins in subjects with multiple sclerosis and controls, and to assess the sensitivity and specificity of magnetic resonance venography (MRV) for describing extracranial venous narrowing as it applies to the chronic cerebrospinal venous insufficiency theory, using catheter venography (CV) as the gold standard. Methods The jugular and azygos veins were assessed with time-of-flight MRV in this assessor-blinded, case-control study of subjects with multiple sclerosis, their unaffected siblings, and unrelated controls. The veins were evaluated by diameter and area, and compared with CV. Collateral vessels were also analyzed for maximal diameter, as a potential indicator of compensatory flow. Results A high prevalence of extracranial venous narrowing was demonstrated in all study groups, collectively up to 84% by diameter criteria and 90% by area, with no significant difference between the groups when assessed independently (P = .34 and .63, respectively). There was high interobserver variability in the reporting of vessel narrowing (kappa = 0.32), and poor vessel per vessel correlation between narrowing on MRV and CV (kappa = 0.064). Collateral neck veins demonstrated no convincing difference in maximum size or correlation with jugular narrowing. Conclusion There is a high prevalence of narrowing of the major extracranial veins on MRV in all 3 study groups, with no significant difference between them. These findings do not support the chronic cerebrospinal venous insufficiency theory. Although MRV has shown a high sensitivity for identifying venous narrowing, time-of-flight imaging demonstrates poor interobserver agreement and poor specificity when compared with the gold standard CV.

Perspectives on walking from people with multiple sclerosis and reactions to video self-observation

Abstract Purpose: People with multiple sclerosis (MS) rank walking among the most challenging aspects of their condition. A greater understanding of people’s perspectives concerning their walking may help to prioritize walking outcomes and strategies for optimizing walking. The purpose was to explore perceptions of walking in people with MS and to describe their reactions after observing themselves walk on video. Materials and methods: An interpretive thematic analysis study using face-to-face, semi-structured interviews was conducted with 14 people who self-identified a change in their walking due to MS. Participants were video-recorded walking and watched their video during the interview. Results: Four themes were identified: “awareness,” “acceptance,” “constant change,” and “increased effort.” People with MS develop awareness of how their walking performance looks and awareness of constantly-changing internal factors and external factors which impact their walking. Awareness of change in fatigue, temperature, terrain, and the use of aids in particular are perceived relevant to walking and to impact the effort required to walk. People with MS also describe differences in their acceptance of how others view their walking and the changes related to walking. An analogy with a marionette performing describes how people perceive walking as no longer automatic; instead walking requires the person to consciously pull the strings to walk. An increase in both the physical and cognitive effort is required to walk and an awareness and acceptance of a variety of changes in oneself and the lived world may help or hinder walking. People with MS are willing to watch themselves walk on video and are not surprised by what they observe. Conclusions: People with MS develop a learned self-awareness with variable levels of acceptance about their walking function and what it looks like. The perceptions on walking from persons with MS suggest that focusing on reducing the effort to walk and minimizing the constantly-changing variables may help to optimize walking. Implications for rehabilitation People with multiple sclerosis are challenged by the increased effort and constant change required to walk in their day-to-day lives. A focus on minimizing both the effort to walk and the changing variables (i.e., fluctuating symptoms and environmental factors) is warranted. People with multiple sclerosis develop a learned awareness of how they walk and how their walking looks. Acceptance of loss of walking function is variable. Video self-observation is a feasible tool which warrants further exploration for enhancing acceptance of walking function and accommodating strategies.