Julia Bowman

Effect of an office worksite-based yoga program on heart rate variability: outcomes of a randomized controlled trial

BackgroundChronic work-related stress is an independent risk factor for cardiometabolic diseases and associated mortality, particularly when compounded by a sedentary work environment. The purpose of this study was to determine if an office worksite-based hatha yoga program could improve physiological stress, evaluated via heart rate variability (HRV), and associated health-related outcomes in a cohort of office workers.MethodsThirty-seven adults employed in university-based office positions were randomized upon the completion of baseline testing to an experimental or control group. The experimental group completed a 10-week yoga program prescribed three sessions per week during lunch hour (50 min per session). An experienced instructor led the sessions, which emphasized asanas (postures) and vinyasa (exercises). The primary outcome was the high frequency (HF) power component of HRV. Secondary outcomes included additional HRV parameters, musculoskeletal fitness (i.e. push-up, side-bridge, and sit & reach tests) and psychological indices (i.e. state and trait anxiety, quality of life and job satisfaction).ResultsAll measures of HRV failed to change in the experimental group versus the control group, except that the experimental group significantly increased LF:HF (p = 0.04) and reduced pNN50 (p = 0.04) versus control, contrary to our hypotheses. Flexibility, evaluated via sit & reach test increased in the experimental group versus the control group (p < 0.001). No other adaptations were noted. Post hoc analysis comparing participants who completed ≥70% of yoga sessions (n = 11) to control (n = 19) yielded the same findings, except that the high adherers also reduced state anxiety (p = 0.02) and RMSSD (p = 0.05), and tended to improve the push-up test (p = 0.07) versus control.ConclusionsA 10-week hatha yoga intervention delivered at the office worksite during lunch hour did not improve HF power or other HRV parameters. However, improvements in flexibility, state anxiety and musculoskeletal fitness were noted with high adherence. Future investigations should incorporate strategies to promote adherence, involve more frequent and longer durations of yoga training, and enrol cohorts who suffer from higher levels of work-related stress.Trial registrationACTRN12611000536965

Challenges to measuring outcomes in occupational therapy : a qualitative focus group study

The aim of this study was to explore the process used by occupational therapists to measure the effect of their interventions. A second aim was to explore the challenges associated with this process. Stroke rehabilitation was chosen as the focus for the study. This qualitative study was conducted in Sydney, Australia. Ten occupational therapists from both hospital and community-based services participated in one of three focus groups. The data were analysed using constant comparison techniques. The participants struggled when describing the process used to measure outcomes. They focused more on the challenges to measuring outcomes, which were described as focusing on occupation, deconstructing occupation and lacking knowledge, skills and assistance. The participants in this study had difficulty in articulating and setting measurable goals linked to interventions. As a result, they could not easily select appropriate outcome measures. Education is needed to help such occupational therapists to develop the required skills and to begin to measure clinical outcomes. Further research should determine if similar experiences and challenges are faced in other areas of practice and by occupational therapists in other countries.

Psychological therapies for the management of co-morbid depression following a spinal cord injury: A systematic review

The evidence about psychological therapies used to manage co-morbid depression after a spinal cord injury is presented here. A comprehensive search of five electronic databases identified nine studies (participants, n = 591) meeting inclusion criteria. Pooled statistical analyses were conducted in combination with narrative synthesis. Overall, multimodal cognitive behavioural therapy was found to be moderately effective (standardised mean difference = −0.52; 95% confidence interval = −0.85, −0.19). Activity scheduling, psychoeducation, problem solving and cognitive therapy may be particularly beneficial therapies within cognitive behavioural therapy. Further high-quality randomised controlled trials are needed to better substantiate these findings.

Occupational Therapists Report Increased Use of Outcome Measures after Participation in an Education Programme

This before-and-after study involved 36 occupational therapists who attended a one-day workshop on outcome measurement. The participants were given nine ready-to-use outcome measures and follow-up support. Outcome measure use was evaluated after 4 months using a self-report questionnaire. The proportion of therapists reporting use of outcome measures increased from 65.7% at baseline (23/36 participants) to 91.4% at 4 months post-workshop (32/35 participants). There was a small increase in the range of outcome measures used across the sample, from 15 at baseline to 18 after 4 months. Although the proportion of therapists measuring outcomes improved markedly after 4 months, it is not known if these behaviours were maintained in the longer term.

The development, content validity and inter-rater reliability of the SMART-Goal Evaluation Method: A standardised method for evaluating clinical goals

INTRODUCTION Goal setting is a complex skill. The use of formal goal writing procedures (including the use of the SMART goal model) has been advocated. However, a standardised method of writing and evaluating SMART goals is currently lacking. This study comprised of two phases. The aims of phase one was to (i) develop the SMART Goal Evaluation Method (SMART-GEM) based on a SMART goal model; and (ii) investigate the content validity of the SMART-GEM. The aim of phase two of the study was to test the inter-rater reliability of the SMART-GEM. METHODS Development of the SMART- GEM involved defining and constructing evaluation criteria suitable for auditing goal statements. A content validity assessment was conducted using an expert panel of Occupational Therapists (n = 10). Inter-rater reliability of the SMART-GEM was examined using a purposive sample of multiple raters (n = 24). RESULTS The SMART- GEM was rated as having good content validity (individual items CVI ranged from 0.90 to 1.00; total SMART- GEM CVI = 0.99, ρ = 0.05). Agreement between raters on individual items ranged from poor (κ = 0.254) to excellent (κ = 0.965) and agreement of overall grades was fair to good (κ = 0.582). Inter-rater agreement on total scores was found to be very good (ICC = 0.895, 95% CI = 0.743 to 0.986, ρ = 0.001) with excellent internal consistency (α = 0.995). CONCLUSION The SMART-GEM demonstrated good construct validity and very good inter-rater reliability on total score and shows promise as a standardised method to writing and evaluating clinical goals.