Denise Taylor

Facilitators and barriers to engagement in physical activity for people with multiple sclerosis: a qualitative investigation

Purpose. To explore the barriers and facilitators to engagement in physical activity from the perspective of people with multiple sclerosis (MS). Method. This study adopted a qualitative descriptive design, using semi-structured interviews. Participants were recruited through local MS Societies and one District Health Board as part of a larger study. Ten people with a definite diagnosis of MS were purposefully selected aiming for diversity on a range of characteristics. Results. A number of factors were identified that seemed to interact and work to tip the decisional balance regarding physical activity engagement for people with MS. The most prominent themes included beliefs about physical activity; related emotional responses; and the role of fatigue in the decision to take part in physical activity. One of the most striking findings was the apparent tension surrounding the decision to take part in physical activity which seemed to be related to the co-existence of conflicting beliefs. Conclusions. For people with MS, the decision to engage in physical activity (or not) is complex, fluid and individual; made more complex by the unpredictable nature of MS. Rehabilitation professionals attempting to engage people with MS in a physical activity programme should consider adopting an individualised approach to barrier management which takes into account personal beliefs and perceptions regarding physical activity engagement.

Physical activity is medicine for older adults

There is evidence from high quality studies to strongly support the positive association between increased levels of physical activity, exercise participation and improved health in older adults. Worldwide, around 3.2 million deaths per year are being attributed to inactivity. In industrialised countries where people are living longer lives, the levels of chronic health conditions are increasing and the levels of physical activity are declining. Key factors in improving health are exercising at a moderate-to-vigorous level for at least 5 days per week and including both aerobic and strengthening exercises. Few older adults achieve the level of physical activity or exercise that accompanies health improvements. A challenge for health professionals is to increase physical activity and exercise participation in older adults. Some success in this has been reported when physicians have given specific, detailed and localised information to their patients, but more high quality research is needed to continue to address this issue of non-participation in physical activity and exercise of a high enough level to ensure health benefits.

Effectiveness of Tai Chi as a Community-Based Falls Prevention Intervention: A Randomized Controlled Trial

To compare the effectiveness of tai chi and low‐level exercise in reducing falls in older adults; to determine whether mobility, balance, and lower limb strength improved and whether higher doses of tai chi resulted in greater effect.

Does clinic-measured gait speed differ from gait speed measured in the community in people with stroke?

Objective: To compare the extent to which gait speed measured in the clinic setting differs from that measured in the community. Design: Participants completed the 10-m walk test at a self-selected speed in a clinic setting. Following this they completed a 300-m community-based walking circuit that covered a variety of environmental conditions. Gait velocity was sampled at different points in the circuit. The same circuit and sampling points were used for all participants. Clinic gait velocity was compared to gait velocity measured on five occasions during the community-based circuit. Setting: Physiotherapy clinic and local shopping mall. Participants: Twenty-eight chronic stroke patients who regularly accessed the community divided into two groups based on their gait velocity in the clinic. Main outcome measures: Walking velocity. Results: Spearman rank correlation coefficient indicated that there was a strong correlation between the total time taken to walk the 300-m course and the clinic-based gait velocity (r=-0.88, P<0.0001). A linear mixed model with repeated measures analysis revealed significant interaction between community measures for group A versus group B (F4,26=4.49, P=0.0068) and significant differences across community conditions (F4,26=7.12, P=0.0005). Conclusion: The clinic-based 10-m walk test is able to predict walking velocity in a community setting in chronic stroke patients who score 0.8 m/s or faster. However, for those who score less than 0.8 m/s in the clinic test, gait velocity in the community may be overestimated.

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis

Purpose. To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). Methods. This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey – Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Results. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Conclusions. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

Exploring Actical Accelerometers as an Objective Measure of Physical Activity in People With Multiple Sclerosis

OBJECTIVE To assess the feasibility, acceptability, and psychometric properties of Actical accelerometers in people with multiple sclerosis (MS). DESIGN Participants attended 2 testing sessions 7 days apart in which they completed 6 activities ranging in intensity while wearing an Actical accelerometer and Polar heart rate monitor. Perceived exertion was recorded after each activity. SETTING University research center. PARTICIPANTS People (N=31) with a definite diagnosis of MS were purposefully selected, aiming for diversity in level of reported disability, age, sex, and type of MS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Actical accelerometer, Polar S810i and RS800sd heart rate monitors, Borg rating of perceived exertion, six-minute walk test (6MWT), 30-second chair stand test. RESULTS Accelerometers had good feasibility and acceptability in people with MS. Test-retest reliability was poor for sedentary and free-living activities, with low to moderate intraclass correlation coefficients (.00-.75), but was better for more vigorous or rhythmic activities (.85-.90). Bland-Altman 95% limits of agreement for average accelerometer counts were wide, ranging from +/-16 (newspaper reading) to +/-1330 (6MWT). Validity was not established with 95% prediction intervals showing high variability for all activities. CONCLUSIONS The psychometric problems highlighted here suggest Actical accelerometers should be used with caution in people with MS as a measure of physical activity, particularly when measuring comparatively sedentary or free-living activities.

The Physical Activity and Disability Survey (PADS): reliability, validity and acceptability in people with multiple sclerosis

Objective: To explore the test—retest reliability and construct validity of the standardized Physical Activity and Disability Survey (PADS) and its acceptability to people with multiple sclerosis. Design: Participants completed the PADS twice with seven days between repeated measures, while also wearing an Actical accelerometer. Semi-structured interview questions were used to explore the acceptability of the PADS. Subjects: Thirty participants were recruited from the Multiple Sclerosis Society of Auckland, New Zealand. Mean age of participants was 54 years (range 27–76).. Main Measuress: Physical Activity and Disability Survey (PADS) and Actical accelerometer. Results: A wide range of standardized PADS scores were recorded at each time-point (ranges 6.7-83.3 and 6.7-87.4). While standardized PADS scores between time-points had a high intraclass correlation coefficient of 0.92 (95% confidence interval (CI) 0.88, 0.98), Bland–Altman 95% limits of agreement (–17.4, 17.4) were modest. Accelerometer activity counts were not accurately predicted by standardized PADS scores (wide 95% prediction intervals). Participants reported the PADS was easy to understand and complete, enabling them to give an accurate picture of their physical activity. Conclusions: The PADS appears to be a potentially appropriate measure of activity for people with multiple sclerosis, particularly in terms of the wide range of activities it covers and its ability to detect varying levels of physical activity. We suggest the test–retest reliability and validity of the PADS could be improved with some minor revisions.

Short-term outpatient EEG-video monitoring with induction in a veterans administration population.

Summary: The gold standard for diagnosis of psychogenic non-epileptic seizures (PNES) is EEG-video monitoring. EEG-video monitoring is usually prolonged and inpatient, but the availability of this procedure for veterans is limited. This study thought to evaluate the yield of short-term outpatient EEG-video monitoring for the diagnosis of PNES in a V.A. population. We reviewed the data on all short-term outpatient EEG-video monitoring performed at our V.A. hospital over a 2-year period. Short-term EEG-video monitoring was performed with induction according to a published protocol [Benbadis et al., 2000]. Briefly, induction is performed without a placebo, using hyperventilation, photic stimulation, and verbal suggestion. This was performed on patients in whom there was a clinical suspicion of PNES on clinical grounds. A total of 52 short-term EEG-video monitoring sessions were performed. Of those, 40 patients (77%) were men. In 35 patients (67%) the procedure recorded the habitual episode and resulted in a clear diagnosis of PNES. The procedure was inconclusive in 17 patients (33%), either because a non-habitual event was induced (7 patients, 14%), or no event was recorded (10 patients, 19%). The yield of EEG-video monitoring with induction in a (predominantly male) V.A. population is high, and comparable to a non-V.A. population [Benbadis et al., 2000].

The Physical Activity and Disability Survey — Revised (PADS-R): an evaluation of a measure of physical activity in people with chronic neurological conditions

Objective: To revise the Physical Activity Disability Scale (PADS) and to explore the acceptability and test—retest reliability of the revised measure, the PADS-R, in people with multiple sclerosis. Design: This study was conducted over three phases: (1) PADS-R questionnaire development including modification to the original PADS, field testing and refinement; (2) PADS-R scoring; (3) PADS-R acceptability and reliability assessment, where participants completed the PADS-R twice over the telephone, three days apart, and then answered a series of semi-structured questions on the instruments acceptability. Subjects: Participants were recruited from the local Multiple Sclerosis Society, Stroke Foundation and Auckland District Health Board depending on the purpose of each phase: (1) PADS-R questionnaire development (n = 30, multiple sclerosis); (2) PADS-R scoring (n = 293, multiple sclerosis; and n = 83, stroke); and (3) PADS-R acceptability and reliability assessment (n = 29, multiple sclerosis). Main measures: Physical Activity Disability Scale-Revised (PADS-R) Results: The PADS-R took approximately 20 minutes to administer and most (n = 25; 86%) participants reported it to be easy to understand and complete. All participants reported that it enabled them to give an accurate picture of their physical activities. In terms of test—retest reliability, the intraclass correlation coefficient was high (0.87 (95% confidence intervals (CI) 0.78, 0.96)), but the 95% limits of agreement were wide (±1.13). When observations which potentially represented important changes in activity were excluded, these limits narrowed considerably (±0.89). Conclusions: The PADS-R appears to be a conceptually and psychometrically sound measure of physical activity for people with chronic neurological conditions.

Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial

BackgroundIn New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent.Methods/designThis study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study.DiscussionThe lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home.Trial registrationACTRN12612000464864