Activiteit

OBJECTIVES Does adapted cardiac rehabilitation (CR) improve the physical behaviours of people with mild-to-moderate stroke in the sub-acute recovery phase using a compositional data analysis (CoDA) approach? DESIGN Before-after. SETTING University Hospitals of Leicester, Glenfield Hospital, UK. PARTICIPANTS 24 individuals completed CR and provided valid physical activity (PA) data (mean (SD) 63.1 (14.6) years, 58% male (14/24)). INTERVENTION 6-week adapted CR program within 6-months of stroke. MAIN OUTCOME MEASURES Physical behaviours were assessed using waist-worn accelerometry. Step count, stationary time (ST), light PA (LPA), and moderate-to-vigorous PA (MVPA) were compared pre post CR using conventional analyses and CoDA. Analysed compositions were Waking day (ST, LPA, MVPA); ST (1-9-minutes, 10-29-minutes, ≥30-minutes bouts); and MVPA (1-4-minutes, 5-9-minutes, ≥10-minutes bouts). RESULTS Following CR, patients took significantly more steps (mean (SD) 3255 (2864) vs 3908 (3399) steps/day, P=0.004) and engaged in more bouts of MVPA lasting ≥5 and ≥10-minutes (≥5-minutes mean (SD) 0.7 (1.4) vs 1.2 (1.8) bouts/day, P=0.008). Using CoDA, no changes in waking day or ST compositions occurred. For waking day, 42% (10/24) increased their LPA and MVPA at the expense of ST. For ST, 33% (8/24) increased their short bouts at the expense of medium and long bouts. For MVPA, 13% (3/24) increased their medium and long bouts at the expense of short bouts. CONCLUSION People with stroke in the sub-acute stage of recovery exhibited low levels of PA. CR appears to be an effective intervention to increase step count but did not alter the overall proportion of time individuals spent being sedentary, or engaging in LPA or in MVPA. REGISTRATION ISRCTN65957980. BACKGROUND OR CONTEXT Routine imaging for non-specific low back pain is advised against in guidelines yet imaging continues to occur. Patient and public beliefs regarding imaging may be a driving factor contributing to this. OBJECTIVES To review the current evidence in relation to patient and public beliefs regarding imaging for low back pain. DATA SOURCES A systematic scoping review was conducted in databases Medline, Embase, Cinahl, Psyc info (inception – Jan 2018). STUDY SELECTION Any method of study including beliefs of adults about imaging for non-specific low back pain. DATA EXTRACTION AND DATA SYNTHESIS Descriptive data was extracted and patient and public beliefs about imaging for low back pain was analysed using conventional qualitative content analysis. RESULTS 12 studies from an initial search finding of 1135 were analysed. 3 main themes emerged; (1) The Desire for imaging; (2) Influences on patient desire for imaging including (a) clinical presentation, (b) past experience and (c)relationships with care professionals and (3) Negative consequences of imaging. LIMITATIONS Few qualitative studies were found, all studies were in English language, the majority of studies were older than 2003. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS There is little available evidence on patient and public beliefs about imaging but what evidence there is suggests that imaging is seen as positive in the management of low back pain and patient desire for a diagnosis is a big driver of this. Human cathelicidin datasheet There is also a suggestion that these beliefs may still be being influenced by health care professionals. OBJECTIVES Investigate upper limb (UL) capacity and performance from less then 14-days to 24-months post stroke. DESIGN Longitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. SETTING Two acute stroke units. MAIN OUTCOME MEASURES Examination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0-14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0-5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. RESULTS Thirty-four participants were enrolled median age 67.7 years (IQR 60.7-76.2), NIHSS 11.5 (IQR 8.5-16), female n=10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group. CONCLUSION This study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12- to 18-months post stroke, but at the individual level improvements were observed at 24-months. CLINICAL TRIAL REGISTRATION ACTRN12612000123842. OBJECTIVES The aim of this study was to examine the validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF) as a measure of physical activity (PA) in young people with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Participants were recruited through 8 National Health Service (NHS) trusts, one school, one university and through organisations that provide services for people with disabilities in England. PARTICIPANTS Sixty-four, ambulatory young people aged 10-19 years with CP [Gross Motor Function Classification System (GMFCS) levels I-III] participated in this study. MAIN OUTCOME MEASURE The IPAQ-SF was administered to participants. Participants were then asked to wear a wGT3X-BT triaxial accelerometer (ActiGraph, Pensacola, FL) for 7 days to objectively assess PA. Time spent in sedentary behaviour, in moderate to vigorous PA (MVPA) and in total PA (TPA) was compared between measures. RESULTS Young people with CP self-reported less time in sedentary behaviour and underestimated the time spent in TPA, when compared to accelerometer measurements.