Rosanna Cousins

Assessing caregiving distress: a conceptual analysis and a brief scale.

OBJECTIVES Although it is well known that informal caregiving can have negative outcomes, and is an important factor in institutionalization, there is currently no common model to assess psychological distress in caregivers. In this study, we considered the conceptualization of caregiving distress, and present a five-dimension, 17-item Caregiving Distress Scale (CDS). DESIGN The CDS was developed by administering several scales from the caregiving literature to a sample of 80 Parkinsons disease caregivers longitudinally. METHOD A total of 58 items from published questionnaires were reduced initially by a hierarchical cluster analysis, then by factor analysis. RESULTS This procedure produced five distinctive subscales - relationship distress, emotional burden, care-receiver demands, social impact, and personal cost - that also had high internal reliability. CONCLUSION The CDS is quick to administer and score, and has the potential to be used to profile an individual caregiving situation. Of critical importance for the application of findings from the caregiving literature, the scale can be used to target the type of intervention for the amelioration of caregiving distress.

Achieving saturation in thematic analysis: development and refinement of a codebook.

Reaching a saturation point in thematic analysis is important to validity in qualitative studies, yet the process of achieving saturation is often left ambiguous. The lack of information about the process creates uncertainty in the timing of recruitment closure. This exploratory study was conducted to demonstrate a rigorous approach to reaching saturation through two-stage establishment of a codebook used for thematic analysis. The codebook development involved inductive analysis with six interviews, followed by a refinement of the coding system by applying them to an additional 33 interviews. These findings are discussed in relation to plausible pattern in code occurrence rate and suggested sample sizes for thematic analysis. Read More: http://www.amsciepub.com/doi/abs/10.2466/03.CP.3.4

Nurse prescribing in general practice: a qualitative study of job satisfaction and work-related stress

BACKGROUND Studies examining the impact nurse prescribing have largely focused on the efficacy of the service. It was suggested in pro-prescribing policy arguments that extending the nursing role to include prescribing would increase job satisfaction. This assertion has not been fully explored. OBJECTIVES To investigate the impact of independent prescribing for experienced nurse practitioners (NPs) working in general practice. METHODS In-depth interviews were conducted with six NPs who each had at least 3 years experience of independent prescribing in a busy inner city general practice. RESULTS Analysis of interview data yielded two main themes: as independent prescribers NPs experienced increased levels of both job satisfaction and work-related stress. Increased satisfaction was associated with having greater autonomy and being able to provide more holistic care. Increased work-related stress emerged from greater job demands, perceived insufficient support and perceived effort-reward imbalance that centred upon the enhanced role not being recognized in terms of an increase in grade and pay. CONCLUSIONS Independent prescribing increases job satisfaction for NPs in general practice, but there is also evidence of stressors associated with the role. It is important that NPs in general practice are encouraged and supported towards providing the effective patient-centred care in the community envisaged by current UK government. We acknowledge that the results presented in this paper are based on a sample limited to one city; however, it provides information that has important implications for the well being of NPs and ultimately patient care.

Experience of long-term use of non-invasive ventilation in motor neuron disease: an interpretative phenomenological analysis

Objective Although non-invasive ventilation (NIV) can promote quality of life in motor neuron disease (MND), previous studies have disregarded the impact of progression of illness. This study explored how patients’ perceptions of NIV treatment evolve over time and how this was reflected in their adherence to NIV. Methods Five patients with MND (male=4, mean age=59 years), from a bigger cohort who were prospectively followed, had multiple post-NIV semistructured interviews, covering more than 12 months, along with ventilator interaction data. The transcribed phenomenological data were analysed using qualitative methodology. Results Three themes emerged: experience of NIV, influence on attitudes and perceived impact of NIV on prognosis. The ventilator interaction data identified regular use of NIV by four participants who each gave positive account of their experience of NIV treatment, and irregular use by one participant who at interview revealed a negative attitude to NIV treatment and in whom MND induced feelings of hopelessness. Conclusions This exploratory study suggests that a positive coping style, adaptation and hope are key factors for psychological well-being and better adherence to NIV. More studies are needed to determine these relationships.

Determinants of accepting non-invasive ventilation treatment in motor neurone disease: a quantitative analysis at point of need.

Objectives: Motor neurone disease (MND) progressively damages the nervous system causing wasting to muscles, including those used for breathing. There is robust evidence that non-invasive ventilation (NIV) relieves respiratory symptoms and improves quality of life in MND. Nevertheless, about a third of those who would benefit from NIV decline the treatment. The purpose of the study was to understand this phenomenon. Design: A cross-sectional quantitative analysis. Methods: Data including age, sex, MND symptomatology, general physical and mental health and psychological measures were collected from 27 patients and their family caregivers at the point of being offered ventilatory support based on physiological markers. Results: Quantitative analyses indicated no difference in patient characteristics or symptomatology between those who tolerated (n = 17) and those who declined (n = 10) NIV treatment. A comparison of family caregivers found no differences in physical or mental health or in caregiving distress, emphasising that this was high in both groups; however, family caregivers supporting NIV treatment were significantly more resilient, less neurotic and less anxious than family caregivers who did not. Regression analyses, forcing MND symptoms to enter the equation first, found caregiver resilience:commitment the strongest predictor of uptake of NIV treatment adding 22% to the 56% explained variance. Conclusion: Patients who tolerated NIV treatment had family caregivers who cope through finding meaning and purpose in their situation. Psychological support and proactive involvement for family caregivers in the management of the illness situation is indicated if acceptance of NIV treatment is to be maximised in MND.

Concussion in University Level Sport: Knowledge and Awareness of Athletes and Coaches

Using a cross-sectional survey concussion knowledge was evaluated among forty university-level athletes (n = 20, rugby union players; n = 20, Gaelic football players) and eight experienced team coaches (n = 2, rugby union; n = 2, Gaelic football; n = 1, soccer; n = 1, hockey; n = 1, netball; n = 1, basketball). Levels of knowledge of concussion were high across all participants. Coaches had higher knowledge scores for almost all areas; however, there was evidence of important gaps even in this group. Knowledge was not sufficient in identifying concussion, and when it is safe to return to play following a concussion. Impaired knowledge of how to recognise a concussion, and misunderstanding the need for rest and rehabilitation before return to play presents a hazard to health from second impact and more catastrophic brain injury. We discuss reasons for these guideline misconceptions, and suggest that attitude issues on the significance of concussion may underlie a willingness to want to play with a concussion. This suggests the current education on sport-related concussion needs to be expanded for the appropriate management of university-level contact sports.

S57 Qualitative assessment of the experience of telemonitoring in ventilated patients with motor neurone disease

Background The National Institute for Health and care Excellence (NICE) has recently issued recommendations on the care of people with motor neurone disease (MND), promoting tailored care for each patient, Guideline 42, 2016. Previous studies suggest remote monitoring offers a facility to regularly monitor and interact with patients, providing timely interventions so it may facilitate delivery of the recommendations. The efficacy of this approach is dependent upon acceptability of telemonitoring to patients. Aim To understand the experiences of using telemonitoring in ventilated patients with MND. Methods Semi-structured interviews were conducted with seven patients (male = 5; mean age = 63 yrs). The median illness duration was 14 m (range = 7 m–13 yrs 7 m) and the median non-invasive ventilation (NIV) usage was 12 m (range = 0 m–3 yrs). Participants used a telemonitoring device (Docobo CAREPORTAL®) for six months, completed weekly nocturnal pulse oximetry and symptom-related questions. Five caregivers were present at the interviews and provided their feedback. Interviews were audio recorded and transcribed verbatim. Thematic analysis was conducted to find overarching themes. The interpretation was reviewed and supported by a multidisciplinary team examination. Findings Five themes were identified: Technical Challenges, Increased Self-Awareness, Taking Initiative, Benefits of Timely Intervention, and Reducing the Unnecessary. Whilst participants expressed general ease of Careportal® use, technical issues included; messaging system challenges, oximetry transmission, device fault, mobile signal loss. No other negative experience of using Careportal® was reported. Overall, participants expressed how telemonitoring enabled symptom awareness and interpretation. The device also enabled the participants to raise their concerns and/or requests to the healthcare professionals via the messaging system, and this was depicted as a sharp contrast to current communication with hospitals. Timely interventions were observed as a result of regular monitoring, contributing to both physical and psychological well-being of the participants. It was also suggested that using Careportal® could reduce unnecessary cost/time and hassles created by attending hospital appointments. Conclusions Telemonitoring enabled participants to be actively involved in their care and they felt that the interventions were timely delivered to meet their needs. The findings suggest potential benefits of utilising Careportal ® in routine care as a contact point to accommodate different individual’s needs. Supported by an SBRI Grant

The awareness level of concussion injuries among amateur athletes and coaches

Although injury rates between elite female and male players are comparable, female players are more likely to sustain an anterior cruciate ligament (ACL) (Walden et al., 2011, Knee Surgery, Sports Traumatology, Arthroscopy, 19, 11–19). A common mechanism of ACL injury is non-contact trauma sustained when landing from a jump. The Tuck Jump Assessment (TJA) uses 10 criteria to identify technique flaws when jumping and landing (Myer et al., et al., 2008, Athletic Therapy Today, 13, 39–44) although interrater reliability has been challenged (Dudley et al., 2016, Journal of Strength and Conditioning Research, 30, 1510–1516). The aim of this study was to identify commonly occurring technique JOURNAL OF SPORTS SCIENCES s37 flaws during the TJA and to determine inter-rater agreement for each criterion and the composite score. Following institutional ethical approval, 60 female soccer players were recruited from one international squad (mean (SD): age = 20.27 ± 3.44 years; height = 168.02 ± 5.26 cm; mass = 62.54 ± 6.33 kg). Video recordings (sagittal and coronal plane) of each player undertaking the TJA on an artificial 4G playing surface were taken. Four raters (2 physiotherapists and 2 strength and conditioning coaches) independently assessed each TJA criterion post hoc (flaw present = 1 point, flaw absent = 0 points) and the composite score calculated for each player. There were 665 technique flaws. Criterion 2 “Thighs do not reach parallel” was most common (N = 147/665), followed by criterion 1 “Knee valgus on landing” (N = 80/665). Criterion 9 “Pause between jumps” was least common (N = 23/665).The most common fault category was “Knee and thigh motion” (N = 234/720, 32.5% composite of 3 criteria weighted for maximum possible faults). There were clinically acceptable levels of agreement between raters for “Lower extremity valgus at landing”, k = .83 (95% CI, .72–.93); “Thighs do not reach parallel (peak of jump)”, k = .84 (95% CI, .74–.94); “Thighs not equal side to side”, k = .86 (95% CI, .75–.96). The level of agreement for the composite score of all 10 criteria ranged from kw = .62 (95% CI, .48–.76) to kw = .80 (95% CI, .70–.90) suggesting a “fair-to-very good” level of inter-rater agreement. The “knee and thigh” motion category of the TJA may provide the most useful information for knee mechanics and potential risk factors for knee injury. We recommend its use for screening elite female soccer players.The advancements in micro-technology have enabled the quantification of external load in many team sports using GPS derived data. However, it has been proposed that an accelerometer derived variable, such as player load (PL), may provide a superior measurement system (Boyd, Ball, & Aughey, 2011, International Journal of Sports Physiology and Performance, 6, 311-321). The aim of this study was to examine the relationship between PL and distance covered in hockey competition. With institutional ethics approval, 25 elite male hockey players wore tracking devices in 8 international matches. Players were classified into 3 positional groups (defenders, midfielders and forwards). Absolute and relative values were determined for PL and distance. The Pearson product-moment correlation coefficient (r) was calculated to determine the relationship between PL and distance. The Fisher Z test was used to compare the relationships between groups. There were very large correlations between absolute distance and load for all positions (r = 0.902-0.956, P < 0.01) and overall (r = 0.910, P < 0.01). The absolute distance to load relationship was not different between positions. There were very large correlations between relative distance and load for all positions (r = 0.702-0.927, P < 0.01) and overall (r = 0.872, P < 0.01). The relative distance to load relationship was weaker in defenders compared with midfielders (Z = 3.48, P = 0.0005) and forwards (Z = 2.14, P = 0.0324). The strong relationships between these variables suggest that PL is simply a proxy for distance covered and it appears to be heavily influenced by the vertical accelerations that occur during foot strike at any running speed. Therefore, additional research is required to examine how PL can be modified to fully represent all hockey specific activities. The numerical spread of data may have influenced the positional relationships for the relative values.Concussion occurs following a forceful impact to the brain inducing sudden trauma, and may lead to chronic physical, cognitive and/or emotional impairments (Kerr et al, 2013, SAGE, 7, 138-153). As physical activity patterns increase across recreational teams, high schools, colleges, and at professional level, so do the amount of sports - related concussions (SRC) (Fraas et al, 2014, Irish Journal of Medical Science, 184, 425-430). In amateur university sports where participation is high (Kasamatsu et al, 2016, Athletic Training and Sports Health Care, 8, 112-120), there is a lack of data on the awareness level of SRC among athletes and coaches. Therefore, this investigation sought to evaluate concussion knowledge among university level athletes and coaches. Following institutional ethical approval, forty healthy male rugby union (n = 20) and Gaelic football (n = 20) players (age: 22 ± 2 years and 21 ± 1 years, respectively; playing experience: 7.5 ± 1 and 5.0 ± 1 years, respectively) (mean ± s) and eight male coaches from Gaelic football, rugby union, soccer, hockey, netball, and basketball (age: 23 ± 2 years; coaching experience: 6.0 ± 1 years) (mean ± s) completed two validated surveys (Cusimano et al, 2009, Canadian journal of neurological sciences, 36, 315-320; McKinlay, Bishop and McLellan, Brain injury, 25, 761-766) examining knowledge of concussive signs, symptoms, management and return to play guidelines. Respondents had significant misconceptions surrounding SRC; 35% of athletes believed that a player must lose consciousness to suffer from a concussion and 20% believed that it was safe to play with a concussion. About 40% of rugby union athletes believed players could return to play two days after suffering a concussion. Despite having greater concussion knowledge in comparison to the athletes, 25% of coaches did not know how to identify a concussion and 25% were unaware of the return to play guidelines. Rugby union and Gaelic football athletes exhibited a similar sub-optimal level of concussion knowledge. In summary, a marked number of athletes and coaches hold misconceptions surrounding concussive signs and symptoms. Additionally, a number were unaware of the management procedure and return to play guidelines post-concussion. There is a need for educational concussion strategies to be implemented in university sport, to maximise the health and safety of those participating. However, the effectiveness of such an educational programme requires further investigation prior to implementation (Fraas & Burchiel, 2016, European Journal of Sports Sciences, 1-7).Shooting is one of the key technical skills required by wheelchair basketball players (Zwakhoven, Evaggelinou, Daly, & Vanlandewijck, 2003, European Bulletin of Adapted Physical Activity, 2 (3)). Previous studies have focused on examining the technique of free-throw shooting (Goosey-Tolfrey, Butterworth, & Morriss, 2002, Adapted Physical Activity Quarterly, 19, 238–250); however, free-throws only equate to approximately 15–22% of the total number of shots taken during a game (Gomez, Perez, Molik, Szyman, & Sampaio, 2014, Journal of Sports Sciences, 32 (11), 1066–1075). To date, no attempts have been made to explore the determinants of two-point and three-point shooting. This study explores the key determinants of two-point and threepoint shooting and develops a valid prediction model. Following ethical approval, footage of all of the twopoint and three-point shots taken when the top five teams played each other (nine games; 1144 shots) at the 2015 Men’s European Wheelchair Basketball Championships was analysed in SportsCode (version 10, SportsTec Ltd). A valid and reliable shooting specific performance analysis template was developed by three elite wheelchair basketball coaches and the lead researcher (Inter-operator reliability ± 1: 0.00%; Intraoperator reliability ± 1: 0.00%). The template contained 61 action variables within 20 categories: Point, Quarter, Match Status, Classification, Shot Hand, Shot Handed, Shot Type, Shot Clock, Pre-Shot, Shot Movement, Shot Positioning, Zone, Pressure, Number of Defenders, Defender Marking-Shooting Hand, Defender Marking-Non-Shooting Hand, Defender Marking-Space and Defenders Positioning-Defender In Front, Defenders Positioning-Defender Behind and Defenders Positioning-Defender on Side. Chi-squared test highlighted seven categories were significant (P < 0.001) when shot outcome was compared (successful versus unsuccessful). The Shot Positioning category was the most significant category and produced a P-value of 2.2e-16. The forward selection method was used and a 30% sample of the data set selected to create a shooting specific generalised linear regression model that involved 10 categories. The model was tested against the entire data set and an area under the curve value of 0.850 was achieved. The model demonstrated that when an athlete was able to “catch and shoot” in a “square to basket” position whilst “stationary” and taking a “set shot” from the “two-point centre long” zone whilst a defender is placing “no pressure” on the shooter the individual achieved a 96.87% success rate. The findings provide objective evidence of the key determinants of shooting success. Coaches are able to utilise this information to adjust training sessions and game strategies to meet the needs of the performer.Intensive strength-training (ST) can result in exercise induced muscle damage (EIMD), which commonly leads to reductions in acute muscle function. Post-exercise ingestion of carbohydrate and protein mixtures attempt to attenuate the effects of EIMD. This study aimed to compare the effectiveness of whey-protein-hydrolysate and milk-based formulated drinks on recovery of muscle function following ST. Thirty resistance-trained males (age: 25.2 ± 5.5 years, mass: 79.4 ± 8.4 kg, stature: 1.77 ± 0.45 m) provided written informed consent to participate. The study was approved by the local ethics committee inline with Helsinki Declarations. Participants were randomly equally assigned to either; whey-hydrolysate and dextrose drink (WH), milk-based drink (MB), flavoured dextrose (PLACEBO) and performed baseline assessments of perceived muscle-soreness (SORENESS), static-squat jump (SSJ), countermovement jump (CMJ), seated medicine-ball throw (MBT) and isokinetic assessments of the knee-extensors and flexors. Subsequently, participants performed a ST session consisting of various multi-joint barbell exercises. Participants then consumed either WH, MB or PLACEBO 10 min following ST, subsequently repeating all assessments 24 h and 48 h post-ST. In relation to within-group changes, all groups experienced substantial increases in SORENESS at 24 h and 48 h (P < 0.001). However, for dynamic power measures (SSJ, CMJ and MBT), PLACEBO experienced a decrease for only CMJ at 48 h (−1.8 cm), whereas WH and MB experienced significant decreases across SSJ (WH; −3 cm at 24 h, MB; −2.6 cm at 24 h, −2.0 cm at 48 h), CMJ (WH; −2.4 cm at 24 h, MB; −3.7 cm at 24 h, −3.3 cm at 48 h) and MBT (WH; −0.25 m at 48 h, MB; −0.33 cm at 24 h, −0.38 m at 48 h) (P < 0.05). All groups experienced significant decreases in isokinetic-extension torque at both 24 h and 48 h; however, flexion torque was decreased for PLACEBO only at these time points (24 h: −10 N · m, 48 h: −13 N · m) (P < 0.05). Isokinetic-extension power and work were significantly decreased at 24 h and 48 h for both WH [Power (24 h: −18 W, 48 h: −13 W) Work (24 h: −30 J, 48 h: −22 J)] and PLACEBO [Power (24 h: −15 W, 48 h: −14 W) Work (24 h: −25 J, 48 h: −28 J)] (P < 0.05); however, no decreases occurred for MB. Flexion power was significantly decreased for only PLACEBO at 24 h and 48 h (24 h: −7 W, 48 h: −6 W) (P < 0.05). Decreases in flexion work occurred across all conditions at 48 h, but only for PLACEBO at 24 h (WH, 48 h: −6 J) (MB, 48 h: −15 J) (PLACEBO, 24 h: −11 J, 48 h: 13 J) (P < 0.05). Consumption of WH or MB had no effect on recovery of dynamic power-producing ability or soreness compared to PLACEBO. However, WH and MB seemingly had positive effects on recovery of isokinetic muscle-function.Common mental disorder (CMD) have a high prevalence in retired rugby players (Gouttebarge, Kerkhoffs and Lambert, 2015, European College of Sports Science, doi.org/10.1080/17461391:2015.1086819). The physical, psychosocial and organisational stressors Rugby Football League (RFL) players experience may all contribute to inducing symptoms of CMD. The aim of this study was to assess RFL players’ perceived level of welfare support and to explore the experiences of Player Welfare Officers (PWO) attached to RFL’s Super League. This two year, mixed-methods project, commissioned by the RFL Player Welfare Director was undertaken with institutional ethics approval. The quantitative phase utilised an anonymised internet based survey to assess players’ perceptions of welfare support and aspects of mental health. Independent t-test results from the first survey (n=75) indicate a significantly higher risk of depression with higher stress levels (t(73) = 5.88 p<0.001) and with higher athletic identity (t(73) = 2.00 p<0.4). Players at low risk of depression reported more positive attitudes towards welfare policy (t(74) = 2.26 p<0.2). Better mental health was found when the club had a PWO, if they knew who the PWO was and if they knew how to access counselling services (second year survey results to follow, n=196). The qualitative phase utilised semi-structured interviews and were analysed using Template Analysis (Brooks, McCluskey, Turley and King, 2015, Qualitative Research in Psychology, 12(2), 202-22). In the first year 11 PWOs were interviewed, 12 in the second year. PWOs perceived the services they provided to be a potentially valuable asset for players. The uptake depended on the level of support from the club. The attitude of the coaching staff determined whether players were given time to access the PWO and whether or not this was seen as a valuable use of their time: “the PWO is only as important as the club want it to be...you need the backing of the coach in certain situations and you need time to build that relationship”. The PWOs have seen a cultural shift over the last year towards their role, and the services they signpost on to, being seen as more acceptable. The results suggest that the PWO’s role is integral to supporting RFL players’ mental health. This requires a full-time, not part-time role, and central funding from the RFL. This change would be advantageous in both increasing the time PWOs have available to support players, and the recognition of the value of the service they provide.