Sabrina Figueiredo

Nordic walking for geriatric rehabilitation: a randomized pilot trial.

Purpose: There is a need to identify effective interventions to promote walking capacity in seniors. This study compares nordic walking (NW) and usual overground walking (OW) and estimates the relative efficacy in improving walking capacity (endurance and gait speed) of the elderly. Method: Single blind, site-stratified, randomized, pilot trial designed to estimate the amount of change with NW and OW. Main outcomes were distance walked measured by 6-min walk test (6MWT) and comfortable gait speed measured by 5-meter walk test (5MWT). Explanatory variables were age, sex, number of comorbidities, walking aids, balance, pain, and leg function. Results: NW and OW participants improved, respectively, 45 and 41 m on 6MWT and increased their gait speed by 0.14 and 0.07 m/s, respectively. NW effect sizes were moderate for 6MWT (ES = 0.53) and large for gait speed (effect size (ES) = 0.68). OW demonstrated moderate effect size for 6MWT (ES = 0.53) but a small one for gait speed (ES = 0.33). Relative efficacy, which was obtained from the ratio of NW and OW effects’ sizes, was 1 for 6MWT and 2.06 for gait speed. Conclusions: NW is 106% more effective in improving gait speed among elderly than OW. Implications for Rehabilitation Elderly are the fastest growing segment of the population. With advanced age, greater number of disabilities, and consequently mobility limitations, are observed among this group. Nordic walking is a more intensive form of walking, using muscles of upper and lower body. There’s evidence that nordic walking leads to greater cardiorespiratory workload without an increase in the level of exertion. In this study, nordic walking was 106% more efficient than regular walking in improving gait speed among the elderly. Clinicians specialized in geriatric rehabilitation may contribute to improve gait speed of seniors by adding nordic walking, a non-expensive and feasible option, to their physiotherapy sessions.

Use of the LIFE-H in stroke rehabilitation: A structured review of its psychometric properties

Purpose. To perform a structured review of the psychometric properties specific to the stroke population of the Assessment of Life Habits (LIFE-H). This tool measures quality of social participation, an important but under-evaluated aspect of stroke recovery. Method. A structured review of publications at MEDLINE; Embase, CINAHL, and the Cochrane Library using the following terms: LIFE-H, life habits, psychometric properties, measurement properties, reliability, repeatability, validity, responsiveness, appropriateness, ceiling effects, and floor effects. Results. Eleven studies were identified specific to stroke. Test–retest reliability was excellent (Intraclass correlation coefficients [ICCs] ranging from 0.80 to 0.95). Inter-rater reliability ranged from adequate to excellent (r = 0.64–0.91) as well as agreement between responses of clients with stroke and their proxies (ICC ranging from 0.73 to 0.82). Convergent validity was adequate to excellent (r = 0.57–0.91) between the LIFE-H and two measures of functional independence. Two studies, one using patients and one using caregivers, suggest the LIFE-H is able to detect change over time. Conclusions. The LIFE-H is a psychometrically sound measure of quality of social participation for use in post-stroke assessment and is responsive to change.

How Do We Value Postoperative Recovery?: A Systematic Review of the Measurement Properties of Patient-reported Outcomes After Abdominal Surgery.

Objective: To appraise the level of evidence supporting the measurement properties of patient-reported outcome measures (PROMs) in the context of postoperative recovery after abdominal surgery. Background: There is growing interest in using PROMs to support value-based care in abdominal surgery; however, to draw valid conclusions regarding patient-reported outcomes data, PROMs with robust measurement properties are required. Methods: Eight databases (MEDLINE, EMBASE, Biosis, PsycINFO, The Cochrane Library, CINAHL, Scopus, Web of Science) were searched for studies focused on the measurement properties of PROMs in the context of recovery after abdominal surgery. The methodological quality of individual studies was evaluated using the consensus-based COSMIN checklist. Evidence supporting the measurement properties of each PROM was synthetized according to standardized criteria and compared against the International Society of Quality of Life Research minimum standards for the selection of PROMs for outcomes research. Results: We identified 35 studies evaluating 22 PROMs [12 focused on nonspecific surgical populations (55%), 4 focused on abdominal surgery (18%), and 6 generic PROMs (27%)]. The great majority of the studies (74%) received only poor or fair quality ratings. Measurement properties of PROMs were predominantly supported by limited or unknown evidence. None of the PROMs fulfilled International Society of Quality of Life Researchs minimum standards, hindering specific recommendations. Conclusions: There is very limited evidence supporting the measurement properties of existing PROMs used in the context of recovery after abdominal surgery. This precludes the use of these PROMs to support value-based surgical care. Further research is required to bridge this major knowledge gap. Review Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42014014349.

Where have all the pilot studies gone? A follow-up on 30 years of pilot studies in Clinical Rehabilitation

Introduction: Pilot studies are meritorious for determining the feasibility of a definitive clinical trial in terms of conduct and potential for efficacy, but their possible applications for planning a future trial are not always fully realized. The purpose of this review was to estimate the extent to which pilot/feasibility studies: (i) addressed needed objectives; (ii) led to definitive trials; and (iii) whether the subsequent undertaking of a definitive trial was influenced by the strength of the evidence of outcome improvement. Methods: Trials published in the journal Clinical Rehabilitation, since its inception, were eligible if the word ‘pilot’ or ‘feasibility’ was specified somewhere in the article. A total of 191 studies were reviewed, results were summarized descriptively, and between-group effect sizes were computed. Results: The specific purposes of piloting were stated in only 58% (n = 110) of the studies. The most frequent purpose was to estimate the potential for efficacy (85%), followed by testing the feasibility of the intervention (60%). Only 12% of the studies were followed by a definitive trial; <4% of studies had a main study underway or a published study protocol. There was no relationship between observed effect size and follow-up of pilot studies, although the confidence intervals were very wide owing to small number of trials that followed on. Discussion: Labelling and reporting of pilot studies needs to be improved to be concordant with the recently issued CONSORT guidelines. Feasibility needs to be fully tested and demonstrated prior to committing considerable human and monetary resources.

Classification of gait quality for biofeedback to improve heel-to-toe gait

A feature of healthy gait is a clearly defined heel strike upon initial contact of the foot with the ground. However, a common consequence of ageing is deterioration of the heel first nature of gait towards a shuffling gait (flat foot at contact). Physiotherapy can be effective in correcting this but is costly and labour intensive. Gait rehabilitation could be accelerated with home exercise, guided by a biofeedback device that distinguishes between heel first and shuffling gait. This paper describes an algorithm that distinguishes between heel-to-toe gait and shuffling gait on the basis of angular velocity of the foot, using an inertial measurement unit. Measurements were made of normal and abnormal gait and used to develop an algorithm that distinguishes between good and bad steps. Results demonstrate very good algorithm performance, with a classification accuracy at the accuracy-optimal threshold of 92.7% when compared with physiotherapist labels. The sensitivity and specificity at this threshold are 84.4% and 97.5% respectively. These performance metrics suggest that this algorithm is usable in a biofeedback device.

How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years

Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016. A total of 390 articles whose titles suggested a clinical trial of an intervention, with or without randomization to form groups, were reviewed. Questions often still focused on methods to be used (57%) rather than what knowledge was to be gained. Less than half (43%) of the studies delineated between primary and secondary outcomes; multiple outcomes were common; and sample sizes were relatively small (mean 83, range 5 to 3312). Blinding of assessors was common (72%); blinding of study subjects was rare (19%). In less than one-third of studies was intention-to-treat analysis done correctly; power was reported in 43%. There is evidence of publication bias as 83% of studies reported either a between-group or a within-group effect. Over time, there was an increase in the use of parameter estimation rather than hypothesis testing and there was evidence that methodological rigour improved. Rehabilitation trialists are answering important questions about their interventions. Outcomes need to be more patient-centred and a measurement framework needs to be explicit. More advanced statistical methods are needed as interventions are complex. Suggestions for moving forward over the next decades are given.

Design and Validation of a Biofeedback Device to Improve Heel-to-Toe Gait in Seniors

A feature of healthy human walking gait is a clearly defined heel-strike at initial contact, known as heel-to-toe gait. However, a common consequence of ageing is the deterioration of this heel first gait toward a flat foot, or “shuffling” gait. This leads to a shortened stride length, slowed gait speed, and an increased fall risk. Shuffling gait is normally treated by physiotherapy, however, therapist time is limited and training is restricted to a clinical environment. Gait rehabilitation could be expedited with the use of a device that distinguishes between heel-to-toe and shuffling gait and gives feedback to the user. This paper describes the design and validation of a device to achieve this. The device is innovative in that it both analyses the kinematics of the foot in real time and uses this information to classify the step quality in a manner that agrees with the subjective judgement of a physiotherapist. The device comprises a sensing module and a biofeedback module. The sensing module is a six axis inertial measurement unit that is strapped to the patients foot. Raw data are streamed wirelessly to the biofeedback module (a smartphone), which runs an algorithm to detect step quality on the basis of angular velocity of the foot, and gives binary feedback to the user. Results from a validation study on the target population demonstrate very good classification performance, with an accuracy of 84.1% when compared with physiotherapist labels. The sensitivity is 92.4% at an operating point of 75% specificity, and the area under the ROC curve is 0.937. This performance should be more than adequate for clinical use and opens the door for investigations to determine how it can be used most effectively.

Planning Health Services for Seniors: Can We Use Patient’s Own Perception?

Objectives The objectives of this study were to identify needs and to estimate whether self-reported health can be used as an indicator of service needs among seniors. Methods This was a cross-sectional survey. Age- and sex-adjusted logistic regression was used to estimate the link between functional status indicators and fair or poor self-reported health. Forward stepwise logistic regression was performed to identify the strongest contributors of poor health. Positive predictive value (PPV), sensitivity, and specificity were calculated to identify whether health perception could be used to identify people in need of physical rehabilitation services. Results 142 seniors agreed to answer the survey, yielding a response rate of 73%. Among the respondents (mean age 79±7; 60% women), 40% rated their health as fair or poor. Seniors perceiving their health as fair or poor had higher odds of reporting impairments, activity limitations, and participation restrictions (OR ranging from 2.37 95%CI: 1.03-5-45 to 12.22 95%CI: 2.68–55.78) in comparison to those perceiving their health as good or better. The strongest contributors for poor/fair health were depression, difficulty performing household tasks, pain, and dizziness (c-statistic = 0.91 and a maximum adjusted r-squared of 0.60). Self-rated health used as single-item showed a positive predictive value (PPV) of 1, sensitivity of 52%, and specificity of 100%. Conclusion Our results indicate that all seniors participating in this study and reporting fair or poor health have indicators of need for further rehabilitation services. Asking patients to rate their own health may be an alternate way of querying about need, as many older persons are afraid to report disability because of fear of further institutionalization.

What pilot studies tell us

ISSN: 0963-8288 (Print) 1464-5165 (Online) Journal homepage: http://www.tandfonline.com/loi/idre20 What pilot studies tell us! Sabrina Figueiredo & Nancy E. Mayo To cite this article: Sabrina Figueiredo & Nancy E. Mayo (2015) What pilot studies tell us!, Disability and Rehabilitation, 37:18, 1694-1695, DOI: 10.3109/09638288.2015.1043471 To link to this article: http://dx.doi.org/10.3109/09638288.2015.1043471

Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework

BackgroundWe initiated a research program to develop a novel patient-reported outcome measure (PROM) to assess postoperative recovery from the perspective of abdominal surgery patients. In light of FDA recommendations, the first stage of our program aimed to, based on previous literature and expert input, develop a hypothesized conceptual framework portraying the health domains that are potentially relevant to the process of recovery after abdominal surgery.MethodsThis study was conducted in three phases: (1) systematic review to identify PROMs with measurement properties appraised in the context of recovery after abdominal surgery, (2) content analysis to categorize the health domains covered by the PROMs according to the ICF, and (3) two-round Delphi study to gain expert input regarding which of these health domains are relevant to the process of recovery. Participants were experts in perioperative care identified through two major surgical societies (35 invited).ResultsThe systematic review identified 19 PROMs covering 66 ICF domains. 23 experts (66%) participated in the Delphi process. After Round 2, experts agreed that 22 health domains (8 body functions, 14 activities and participation) are potentially relevant to the process of recovery after abdominal surgery. These domains were organized into a diagram, representing our hypothesized conceptual framework.ConclusionsThis hypothesized conceptual framework is an important first step in our research program and will be further refined based on in-depth qualitative interviews with patients. The sound methodological approach used to derive this framework may be valuable for studies aimed to develop PROMs according to FDA standards.Visual Abstract