Irene Boller

Perceived barriers to walking in the neighbourhood environment and change in physical activity levels over 12 months

Objectives: To investigate whether, and to what extent, perceived barriers to neighbourhood walking (BTNW) may be associated with physical activity levels. Design: Prospective survey with 12-month follow-up. Subjects and methods: 750 people attending walking schemes throughout England and Scotland; 551 completed the follow-up. independent variables were demographic characteristics, examples of possible “external” barriers to walking—for example, “worries about personal safety”, and one item concerning ill health. The main outcome measures were “metabolic equivalent” (MET) hours’ walking and overall physical activity in the preceding week. Results: Baseline and follow-up demographic characteristics were similar and physical activity levels generally high. Leisure walking changed little over 12 months, while total physical activity levels reduced significantly from a mean (SD) of 71.26 (78.14) MET hours per week at baseline to 59.57 (181.40) at the 12-month follow-up (p<0.001). External BTNW cited between baseline and 12 months increased significantly from a mean (SD) of 1.24 (1.61) at baseline to 1.43 (1.72) at the 12-month follow-up (p<0.001); only “worries about personal safety” reduced. A significant association was found between citing a health-related BTNW and the total number of external BTNW that were reported at baseline. The strength of this association increased over 12 months. Neither changes in reporting external BTNW that occurred over 12 months (increased vs decreased, vs unchanged) nor changes in the presence of a health-related BTNW were significantly related to levels of leisure walking and overall physical activity (MET hours in the preceding week) over the same period. Conclusion: Among older people who attended walking schemes, having a health problem that restricted walking had a detrimental influence on people’s perceptions about external BTNW, which increased over time. Actual levels of walking and overall physical activity levels did not appear to be significantly affected by this.

Minimally important change was estimated for the Manchester-Oxford Foot Questionnaire after foot/ankle surgery.

OBJECTIVES To ascertain the smallest amounts of change for the three Manchester-Oxford Foot Questionnaire (MOXFQ) domains that are likely to be clinically meaningful and beyond measurement error for conditions affecting the foot/ankle. Estimates were compared with those from the Short-Form 36 (SF-36). STUDY DESIGN AND SETTING A prospective observational study of 671 consecutive patients undergoing foot or ankle surgery at an orthopedic hospital. Before and 9 months after surgery, patients completed the MOXFQ and SF-36; transition items (anchor) asked about perceived changes in foot/ankle pain or problems since the surgery. RESULTS Four hundred ninety-one patients completed pre- and postoperative questionnaires. Anchor-based minimal clinically important change (MCIC) values were ~13 points for each of the MOXFQ Walking/standing (W/S), Pain, and Social Interaction (S-I) domains [and greater than the standard error of measurement (SEM)]. MCIC values for all SF-36 domains fell within the SEM. Between-group MCIDs for the MOXFQ were W/S, 16.2; Pain, 9.9; S-I, 9.3. Distribution-based minimal detectable change (MDC90) values for the MOXFQ were ~11, ~12, and ~16 score points for the W/S, Pain, and S-I scales, respectively. CONCLUSION This article provides information for aiding the interpretability of MOXFQ outcomes data and for planning future studies. The SF-36 is not recommended as a primary outcome for foot/ankle surgery.