Leigh Hale

Self-report scales/checklists for the measurement of concussion symptoms: a systematic review

Objective: To identify self-reported sport concussion symptom scales and to describe the psychometric properties of these identified scales. Design: Systematic review. Intervention: PubMed, Medline, CINAHL, Scopus, Web of Science, Sport Discus, PsycINFO and AMED were searched from their establishment until December 2008. The medical subject heading terms “brain concussion”, “signs or symptoms” and “athletic injuries”. The search was limited to articles published in English. An additional search of the reference lists of the retrieved articles was conducted. Only full-text articles were considered for this study and these were retrieved to determine whether they met the inclusion criteria. Results: The initial search resulted in 421 articles, which were reduced to 290 articles after removing duplicates. The hand search resulted in 17 articles, thus giving a total of 307 articles. Full text was available for 295 articles of which 60 met the criteria for inclusion. The excluded 235 articles were case reports, reviews and guidelines on concussion management or studies that had not used a symptom scale or checklist. Conclusions: Six core scales were identified with a broad range of symptom items but with limited information on their psychometric properties. There were numerous derivative scales reported, most of which have not been methodically developed or subjected to scientific scrutiny. Despite this, they do make a contribution to the detection, assessment and return to play decisions but there is a need for the clinical user to be aware that many of these scales have “evolved” rather than being scientifically developed.

Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer.

OBJECTIVE To investigate the reliability, validity, and utility of a triaxial accelerometer to measure physical activity in the free-living environment in adults with and without neurologic dysfunction. DESIGN Repeated-measures design. SETTING General community. PARTICIPANTS Volunteer sample of 17 men and 30 women (age range, 28-91y) living in the community with stroke of greater than 6 months in duration (n=20), Parkinson disease (n=7), or multiple sclerosis (n=11), and healthy but sedentary controls (n=9). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Physical activity measured with the TriTrac RT3 accelerometer, 7-day recall questionnaire, and activity diary. RESULTS The accelerometer reliably measured free-living physical activity (intraclass correlation coefficient, .85; 95% confidence interval, .74-.91; P=.000). The standard error of measurement indicated that a second test would differ from a baseline test by +/-23%. Mean daily RT3 data collected in the first 3 days differed significantly from that of the mean daily RT3 data collected over 7 days. The RT3 appeared to distinguish level of mobility better than the 7-day recall questionnaire, and participants found the RT3 to be a user-friendly and acceptable measure of physical activity. CONCLUSIONS The triaxial accelerometer provided a stable measure of free-living physical activity, was found to distinguish between people with varying levels of mobility, and was well tolerated by participants. The results indicate that collecting data for 3 days was not reflective of data collected over 7 days.

A Randomized Controlled Trial to Investigate the Effects of Water-Based Exercise to Improve Falls Risk and Physical Function in Older Adults With Lower-Extremity Osteoarthritis

OBJECTIVE To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis (OA). DESIGN Randomized controlled trial. SETTING Community. PARTICIPANTS Persons (N=39; mean±SD age, 74±6y; 26 women) with mild to moderate OA and at risk for falling met study criteria, were measured at baseline, and were randomly assigned to the intervention (n=23) and control groups (n=16). INTERVENTIONS Water-based program (12wk, twice weekly; intervention group) or a time-matched computer training program (control group). MAIN OUTCOME MEASURE The primary outcome was the short-form Physiological Profile Assessment (PPA). Secondary outcomes included the Step Test, Timed Up and Go Test, Western Ontario and McMaster Universities OA Index (Likert 3.0 version), Arthritis Impact Measurement Scales 2, and Activity-specific Balance Confidence Scale. RESULTS No statistically significant between-group differences were found for any outcome measured (n=35; 4 lost to follow-up). Within-group analysis indicated that Step Test results improved significantly in both groups (mean change: control group, left leg, 2.07; 95% confidence interval, 3.19-.95; P=.002; intervention group, 2.14; 95% confidence interval, 3.20-1.08; P=.000). Two PPA item scores (reaction time, contrast sensitivity) improved significantly (86.83; 95% confidence interval, 9.86-163.79; P=.03; 1.43; 95% confidence interval, 2.35-.50; P=.005, respectively) in the control group, resulting in a lower falls risk score. CONCLUSIONS Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class. Our study is, to our knowledge, the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity. Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation.

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.

Bilateral upper-limb rehabilitation after stroke using a movement-based game controller

This study aimed to determine the effectiveness of a bilateral, self-supported, upper-limb rehabilitation intervention using a movement-based game controller for people with chronic stroke. Fourteen participants received a control treatment, followed by a washout period, and then the intervention. The intervention comprised playing computer games with the CyWee Z (CyWee Group Ltd; Taipei, Taiwan), a movement-based game controller similar to the Nintendo Wii remote. The CyWee Z was incorporated into a handlebar, making bilateral exercises possible by allowing the unaffected side to support and assist the affected side. The intervention lasted for 8 to 10 sessions of 45 to 60 minutes over a period of 2.5 weeks. The Fugl-Meyer Assessment upper-limb section (FMA-UL) was used as the primary outcome. The Wolf Motor Function Test and the Disabilities of Arm, Shoulder, and Hand outcome measure were used as secondary outcomes. Postintervention, motor performance as measured by the FMA-UL was significantly improved compared with all preintervention assessments (p < 0.001), whereas no changes were found on both secondary outcomes. It can be concluded from this pilot study that upper-limb motor performance of adults with chronic stroke improves with repetitive, game-assisted, self-supported bilateral exercises.

“Tell me what you want, what you really really want….”: asking people with multiple sclerosis about enhancing their participation in physical activity

Purpose: This paper provides a review of research that emphasizes the importance of listening to the people whom health professionals serve when promoting participation and engagement in rehabilitation. We report on the development of an approach aiming to optimize long-term adherence in physical activity for people with multiple sclerosis (MS). This approach was very different to those based on current evidence-based exercise recommendations, although the objectives for both approaches were similar. Key message: We argue that only by ensuring that people living with chronic disability not only have a voice but a voice that is listened to, can health professionals truly engage in evidenced-based practice that works in application and meets the needs, desires and capabilities of people with MS and other chronic health conditions. Implications for Rehabilitation Participation in physical activity is important for people living with chronic disability to maintain long-term health and well-being and prevent secondary complications of disability. To truly engage in evidenced-based practice the needs, desires and capabilities of the people for whom the intervention is targeted need to be considered and addressed. Service development and refinement which draws on perspectives of people living with chronic disabling conditions may enhance longer term adherence.

The impact of bilateral therapy on upper limb function after chronic stroke: a systematic review

Purpose. To determine the evidence for bilateral therapy interventions aimed at improving upper limb (UL) function in adults with a range of UL activity limitations due to a first time chronic stroke. Method. Seven databases were searched prior to 2008 for articles reporting experimental studies investigating bilateral UL interventions on functional outcome in participants with a first stroke, 6 or more months prior. Included articles were evaluated with the quality index, a tool which evaluates the quality of both randomised and non-randomised studies. Data relating to study design and functional outcome were extracted. Results. Nine articles were included; three reported on randomised controlled trials (RCT) and six on cohort studies. Eight studies incorporated a mechanical device as their bilateral intervention. Bilateral arm training with rhythmic auditory cueing (BATRAC) was the most commonly used mechanically based intervention, and three of the four uncontrolled BATRAC studies reported significant improvements in UL function post-intervention, however these results were not substantiated by a RCT study of the BATRAC intervention. One study demonstrated significant functional improvements after 6 days of training with a non-mechanical bilateral task. Of the four studies that performed a follow-up assessment, three reported significant improvement in UL function. Quality index ratings of the included studies ranged from 18 to 25 out of 27. Conclusion. There is some evidence that bilateral therapy improves function in adults with chronic stroke, however more quality RCTs are required to strengthen this evidence.

Utility of the RT3 triaxial accelerometer in free living: An investigation of adherence and data loss

There is strong evidence for the protective effects of physical activity on chronic health problems. Activity monitors can objectively measure free living occupational and leisure time physical activity. Utility is an important consideration when determining the most appropriate monitor for specific populations and environments. Hours of activity data collected, the reasons for activity hours not being recorded, and how these two factors might change over time when using an activity monitor in free living are rarely reported. This study investigated user perceptions, adherence to minimal wear time and loss of data when using the RT3 activity monitor in 21 healthy adults, in a variety of occupations, over three (7 day) repeated weeks of measurement in free living. An activity diary verified each day of monitoring and a utility questionnaire explored participant perceptions on the usability of the RT3. The RT3 was worn for an average of 14 h daily with 90% of participants having complete data sets. In total 6535.8 and 6092.5h of activity data were collected from the activity diary and the RT3 respectively. An estimated 443.3h (6.7%) of activity data were not recorded by the RT3. Data loss was primarily due to battery malfunction (45.2%). Non-adherence to wear time accounted for 169.5h (38.2%) of data loss, of which 14 h were due to occupational factors. The RT3 demonstrates good utility for free living activity measurement, however, technical issues and strategies to manage participant adherence require consideration with longitudinal and repeated measures studies.

Evaluation of a peer-led falls prevention program for older adults.

OBJECTIVE To evaluate measures of strength and balance and falls incidence in participants attending fall prevention exercise classes taught by volunteer peer leaders, paid professional (Age Concern Otago group), or a comparison class (comparison group). DESIGN Quasi-experimental evaluation with 12-month follow-up. SETTING Community. PARTICIPANTS Older adults with increased fall risk (N=118; mean age, 75.5 y; age range, 65-94 y), with 23% drop out at 12 months. INTERVENTION Peer-led group (n=52) and Age Concern Otago (n=41) weekly 1-hour strength and balance classes adapted from a home-based nurse/physical therapist-administered program and comparison group (n=25) 1-hour weekly seated exercise classes. MAIN OUTCOME MEASURES Timed Up and Go test, 30-second chair stand, functional reach, step touch, Single Leg Stand, and balance confidence at baseline, 10 weeks, and 6 and 12 months. Falls diaries collected monthly for 12 months. Continued exercise participation questionnaire at 6 and 12 months. RESULTS At baseline, the peer-led group achieved normative standards on most tests and performed significantly better than the Age Concern Otago and comparison groups (overall P<.05). The Age Concern Otago group reached normative standards on most tests at 10 weeks. Functional improvements were similar in the peer-led group and Age Concern Otago groups from 10 weeks to 12 months, and all functional measures were significantly greater than in the comparison group (overall P<.02). Poisson regression showed a tendency for a 27% decrease in falls for the peer-led group compared with the comparison group (incidence rate ratio [IRR], .73; 95% confidence interval, .48-1.1; P=.07). Continued participation in strength and balance classes at 12 months was greater in the peer-led group and Age Concern Otago groups compared with the comparison group. CONCLUSIONS This peer-led model maintained measures of strength and balance and was superior to seated exercise. People in the Age Concern Otago group chose to continue these classes over other activities, whereas the comparison group had discontinued exercise classes by 12 months. Peer-led classes may decrease the fall incidence, although larger studies are needed to confirm this finding.

How does fatigue influence community-based exercise participation in people with multiple sclerosis?

Purpose. Regular exercise is considered important for long-term health outcomes and fatigue management in persons with multiple sclerosis (MS); however, little is known about the experiences of individuals with MS-related fatigue, who participate in community-based exercise activities. The aim of this study was to describe the experiences of people with MS-related fatigue, who engaged in community-based exercise activities in order to discover how fatigue influenced their exercise participation. Method. In this study, we used qualitative methodology based on the interpretive description approach to collect and analyse data. Individuals with MS, who experienced fatigue and regularly participated in community-based exercise activities, were interviewed. Interviews were audiotaped and transcribed verbatim. Data were analysed using an inductive thematic approach with multi-step verification strategies. Results. We found that perceived control over MS-related fatigue influenced exercise choices in our participants. Furthermore, perceived control over fatigue was influenced by seven factors: wellness philosophy, a related goal, belief that control was possible, feeling safe and supported, ability to manage limits, being satisfied with trade-offs and positive definition of self. Conclusion. Identification of factors influencing perceived control over fatigue will assist health care providers when facilitating community exercise choices for people with MS.