Fiona Barnett

Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review.

Global concern on the potential impact of dementia is mounting. There are emerging calls for studies in older populations to investigate the potential benefits of combining cognitive and exercise interventions for cognitive functions. The purpose of this systematic review is to examine the efficacy of combined cognitive and exercise training in older adults with or without cognitive impairment and evaluate the methodological quality of the intervention studies. A systematic search of Cinahl, Medline, PsycINFO, ProQuest, EMBASE databases and the Cochrane Library was conducted. Manual searches of the reference list from the included papers and additional internet searches were also done. Eight studies were identified in this review, five of which included a cognitively impaired population and three studies included a cognitively healthy population. The results showed that combined cognitive and exercise training can be effective for improving the cognitive functions and functional status of older adults with and without cognitive impairment. However, limited evidence can be found in populations with cognitive impairment when the evaluation included an active control group comparison. Further well-designed studies are still needed to explore the potential benefits of this new intervention paradigm.

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Introduction: Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness. Method: This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998–2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically. Findings: The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment. Implications: Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.

Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial

OBJECTIVE the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment. DESIGN a single-blind randomised control trial with the intervention group compared with an active control group. SETTING out-patient clinic. PARTICIPANTS older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community. METHODS participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test. RESULTS the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up. CONCLUSION a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment. TRIAL REGISTRATION NUMBER ACTRN12610001025022.

Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies

Abstract Purpose: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions. Methods: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence participation in PA by individuals with a NMS condition. Fifteen peer-reviewed articles published between 2003 and 2013 were analysed for common themes and critically appraised. Results: Results were categorised using the International Classification of Functioning, Disability and Health framework. The most common demotivators reported for the three areas of functioning, body function and structures, activities and participation were lack of walking balance, muscle weakness, pain, stiffness, bladder and blower problems, depression, thermoregulation and fear of injury. Fluctuating symptoms and fatigue were mentioned as demotivators in all of the progressive conditions. Maintaining independence, function and weight, and the prevention of secondary conditions were the leading motivators reported in this domain. Most common environmental barriers include accessibility, costs, transport and insufficient information and knowledge from health professionals. Social support is a consistent determinate of PA and is reported as a facilitator in every study. The most common personal demotivators include lack of motivation, feelings of self-consciousness and embarrassment in public, anxiety, frustration and anger. Personal motivators include goal setting and achieving, enjoyment, feeling good, feeling “normal”, motivation and optimism, redefining self and escapism from everyday boundaries. Conclusions: Individuals with NMS conditions report complex common barriers, facilitators, demotivators and motivators to participation in PA. The way these factors influence participation in PA is unique to the individual; therefore, it is necessary to adopt an individually tailored approach when designing interventions. Implications for Rehabilitation Individuals with neuromusculoskeletal conditions report common factors that influence participation in physical activity. It is the characteristics, attitude and beliefs of an individual that determine the way in which these factors influence participation in physical activity. Health professionals should be guided by the International Classification of Functioning, Disability and Health framework when assessing individuals, as the model will ensure all major factors of interest with regard to disability and physical activity behaviour are considered. Interventions to promote participation in physical activity in people with neuromusculoskeletal conditions require an individual approach that facilitates the assessment and management of an individual’s barriers to physical activity. A multi-disciplinary approach may be required to address factors that influence participation in physical activity. Health professionals must be informed about other areas of expertise and draw on this when necessary.

Integration of occupation based intervention in hand injury rehabilitation: A Randomized Controlled Trial

STUDY DESIGN Randomized Controlled Trial (RCT). INTRODUCTION Engagement in daily occupations and day to day activities helps to restore function in individuals with injured hands and provides a platform to practise selected occupations. PURPOSE The purpose of this study was to investigate the effectiveness of a combination of Occupation Based Intervention (OBI) and Therapeutic Exercise (TE) compared to TE alone for the rehabilitation of hand injuries. METHOD A single center RCT, parallel group was conducted at the Kuala Lumpur General Hospital (KLGH), Malaysia. Forty-six adult clients with hand injuries who consented to participate were randomly allocated to either the OBI + TE group or to the TE group. RESULTS Following a ten week intervention program, statistical significance differences were found in DASH score (TE = 18.64 ± 14.84 vs OBI + TE = 9.50 ± 9.14, p = 0.02); total active motion (TE = 1035.85 ± 179.84 vs OBI + TE = 1203.65 ± 133.60, p = 0.01); neuropathic pain (TE = 2.90 ± 2.79 vs OBI + TE = 1.05 ± 2.01, p = 0.02); COPM performance (TE = 7.62 ± 2.03 vs OBI + TE = 9.53 ± 0.64, p < 0.001); and COPM satisfaction (TE = 7.60 ± 2.11 vs OBI + TE = 9.49 ± 0.76, p < 0.001) in favor of OBI + TE group. CONCLUSION This study highlighted the integration of OBI into hand injury rehabilitation improved outcomes for clients.

Do physical activity levels influence the cardiovascular-related physiological characteristics of postmenopausal women?

Aim:  This study aimed to determine whether cardiovascular‐related physiological differences existed among postmenopausal women in relation to their physical activity levels.

Planning for sedentary behaviour interventions: office workers' survey and focus group responses

Aims: As sedentary behaviour is becoming more prominent in office-based work environments, this study aimed to explore office workers’ perceptions of sedentary behaviour, explore potential behavioural strategies to reduce sedentary behaviour in the workplace and identify barriers which may hamper behaviour change. Methods: A total of 140 office workers were recruited and surveyed from the same workplace. The survey included questions regarding perceptions of the relationship between sitting time and health. Following the survey, 12 employees also participated in focus groups to identify potential sedentary behaviour intervention strategies and barriers. The responses from the survey and focus groups were thematically analysed. Results: In total, 88% of all participants surveyed agreed that there was a relationship between sitting time and their health. The most prominent theme identified was musculoskeletal complaints followed by general health and weight gain or obesity. The focus groups identified that interventions targeting reducing sitting time should include education, supportive and knowledgeable managers, and a variety of behaviour change strategies to address individual preferences and barriers. Conclusion: Multiple behavioural strategies were identified, which appear to be appropriate for sedentary behaviour change.

Occupation-based intervention in hand injury rehabilitation: experiences of occupational therapists in Malaysia

Abstract Introduction: In a previous study consensus was sought from Malaysian occupational therapists of occupation-based intervention (OBI) that was perceived as a means and an end. Occupation as a means refers to occupational and purposeful tasks as a therapeutic agent while occupation as an end refers to occupation as an outcome of intervention. The purpose of this follow-up study was to describe the occupational therapists’ experiences of providing OBI in hand injury rehabilitation in Malaysia. Methods: Sixteen occupational therapists with more than five years of experience in hand rehabilitation were individually interviewed on their experiences of using OBI in practice. Data were thematically analysed using interpretative phenomenological analysis. Results: Definition of “Occupation as a means”, and “Occupation as an end” was broadened after data analysis of interviews to include two new themes: “Rewarding yet challenging” and “Making OBI a reality”. Occupational therapists had positive experiences with OBI and perceived that occupation as a means and an end can be merged into a single therapy session when the occupational therapists use an occupation that is therapeutic. Conclusion: Although occupation as a means and as an end have different purposes, when the ultimate goal is to enhance the clients’ maximum level of functioning both can be used for successful rehabilitation of hand injuries.

The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review

Abstract Purpose: This systematic literature review aims to explore the relationship between social determinants of health (SDH), and the rehabilitation of neurological conditions. In particular, the review will consider relationships between social determinants and peoples’ attendance and sustained adherence to rehabilitation programs, and motivation regarding neurological rehabilitation. Method: A systematic search of peer-reviewed literature from electronic databases; MEDLINE, Scopus, CINAHL and Informit health, was conducted. Papers published between 2004 and 2014 were considered. Results: Eleven quantitative studies met the inclusion criteria. There was a lack of research addressing SDH and neurological rehabilitation simultaneously. Cardiac and cancer rehabilitation studies reported employment and income, social support, transport, housing and food security as the most frequent SDH factors influencing attendance, sustained adherence and motivation. Given this association, a similar relationship between neurological rehabilitation and SDH is plausible. Conclusions: Rehabilitation of neurological conditions can be a long and difficult process. To pursue optimal outcomes, an individual’s social circumstances should be considered. Understanding how SDH interact with neurological rehabilitation may enhance service delivery, thus maximizing the possible rehabilitation outcomes for individuals. Future research that considers SDH and rehabilitation of neurological conditions jointly may benefit service providers and those requiring neurological rehabilitation. Implications for Rehabilitation Social determinants of health are important to consider in the rehabilitation of neurological conditions. Understanding the interplay between the social determinants of health and neurological rehabilitation may enhance the possible outcomes for those requiring rehabilitation. Increased awareness and capacity of health care professionals involved in neurological rehabilitation may hasten momentum towards decreased health disparities instigated by undesirable social determinants of health.

A consensus definition of occupation-based intervention from a Malaysian perspective: A Delphi study

Introduction Descriptions and definitions for occupation-based intervention vary in the literature. Occupation-based intervention is assumed to be based on occupation and is seen as both a means and an end. Occupation-based intervention also includes all levels of interventions in occupational therapy as long as the goal is occupational performance. Occupation-based intervention can also be described as a therapeutic process that emerges during the therapy session. The purpose of this study was to achieve a consensus definition of occupation-based intervention among Malaysian occupational therapists. Method A three-round Delphi technique using a sequential questionnaire was conducted. Fifteen occupational therapists and occupational therapy educators completed all rounds. The Delphi process began with open-ended questions, asking the participants some questions about occupation-based intervention. The second and third rounds asked participants to rank their agreement with statements about occupation-based intervention. Results Occupation-based intervention is seen by therapists to be both a means and an end, with occupational performance as the main outcome. It is believed that using occupation alone is not enough; preparatory and purposeful methods may have to be incorporated to achieve the outcomes. Conclusion It is important to adopt a common definition of occupation-based intervention in practice and education to signify occupation at the centre of occupational therapy.