Journal of Neurologic Physical Therapy最新文献

Background and purpose: Many physically capable stroke survivors are insufficiently active, with low self-efficacy considered an important contributor. However, validity and reliability of self-efficacy measures in stroke survivors have not been established. This research aims to evaluate the test-retest reliability and construct validity of 3 self-efficacy measures: Self-Efficacy for Exercise Scale (SEE), Spinal Cord Injury Exercise Self-Efficacy Scale (SCI-ESES), and Participation Strategies Self-Efficacy Scale (PS-SES).

Methods: A repeated measures study with community-dwelling, independently mobile adult stroke survivors (n = 51, mean age 74 years, 45% female, median 22 months poststroke) was completed. Test-retest reliability was assessed using intraclass correlation coefficients and Bland-Altman analyses. Construct validity was assessed using 8 pre-determined hypotheses concerning physical activity level (subjective and objective), comorbidities, work and volunteering, and measures of function.

Results: Retest reliability was established for the SEE (intraclass correlation coefficient, ICC = 0.77) and PS-SES (ICC = 0.78) but not for the SCI-ESES (ICC = 0.68). Bland-Altman analysis showed participants consistently scored higher on the second test for all measures. The SEE achieved construct validity by meeting 75% of hypotheses, whereas the PS-SES and SCI-ESES did not. Self-efficacy was positively related to steps/day, functional capacity, self-reported activity levels, and work or volunteering participation.

Discussion and conclusions: The SEE was found to be the most appropriate tool to measure exercise self-efficacy in independently mobile chronic stroke survivors in terms of retest reliability and validity.

Trial registration: N/A.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 "Espernberger-JNPT-Video-Abstract," available at: http://links.lww.com/JNPT/A489 ).

Background and purpose: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis.

Methods: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP).

Results: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, "floating" sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm.

Discussion and conclusion: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487).

Background and purpose: It is unclear to what extent Canadians with stroke engage in moderate-vigorous physical activity (MVPA) and muscle-strengthening activities (MSA). The purpose of this study was to describe overall physical activity, aerobic MVPA, and MSA participation in Canadians with stroke; determine the functioning, disability, and health classes that best characterize this population; and examine the relationship between-class membership and physical activity participation.

Methods: Activity levels were quantified using the Physical Activity Scale for the Elderly in 2094 adults with stroke or transient ischemic attack (mean age 67.9 years, 9.5 years poststroke) from the CLSA. Means and percentages were used to characterize participation. Latent class analysis was used to create health and disability classes, and activity levels were compared between classes.

Results: Only 6.2% (95% confidence interval [CI], 4.8%-8.0%) met both MVPA and MSA guidelines. Most (88.2%, 95% CI, 85.0%-88.9%) engaged in MVPA <3 times/wk and 76.7% (95% CI, 73.7%-79.1%) never engaged in MSA. In latent class analyses, 2 classes for males and females were characterized by high-positive or low-negative levels of intrinsic capacity (eg, grip strength), functional mobility (eg, walking speed), and environment (eg, social support). Those in the low-negative classes had the lowest Physical Activity Scale for the Elderly scores and aerobic MVPA levels compared to the high-positive (healthiest) classes. MSA participation was not different between classes.

Discussion and conclusions: Canadians with stroke are not engaging in sufficient physical activity. Clinicians should encourage regular participation in physical activity, especially among those with lower levels of intrinsic capacity, functional mobility, and environmental support.

Video Abstract available for more insights from the authors (see Supplementary Digital Content 3 available at: http://links.lww.com/JNPT/A494).

Background and purpose: Growing numbers of clinical practice guidelines (CPGs) are available to neurologic physical therapists to guide and inform evidence-based patient care. Adherence to CPG recommendations often necessitates behavior change for therapists and patients. The purpose of this qualitative study was to gain insight into the experiences, perspectives, and drivers of behavioral change for therapists working to improve adherence to a CPG. We also sought to understand the perspectives of patients impacted by this work.

Methods: Five sites participated in a 6-month implementation study integrating a CPG into local practice using the Knowledge to Action model. At the conclusion of the intervention, therapists and patients were recruited to participate in semi-structured interviews or focus groups. An inductive phenomenological approach was used for data analysis. Two authors coded data to generate primary themes. A secondary analysis used the Capability, Opportunity, Motivation, Behavior (COM-B) model to explain the drivers of behavior change for therapists and patients.

Results: Perspectives from 16 therapists generated 6 themes around feedback/accountability, teamwork/belonging, complexity/adaptability, leadership/prioritization, engagement/benefit, and motivation/growth. Twelve patients' perspectives generated 2 themes around communication/personalization and support/recovery. Drivers for behavior change associated with the COM-B model are highlighted.

Discussion and conclusions: Therapist adherence to CPG recommendations was supported by inclusive and goal-directed teams, regular quantitative audit and feedback, opportunities for learning, and a sense of accountability to their coworkers, patients, and themselves. Patients' engagement in rehabilitation was supported by personalized education, objective measures of progress, and a strong therapeutic relationship.

Video abstract available: for more insights from the authors (see the video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A491).

Background and purpose: In individuals with unilateral vestibulopathy (UVP), physical activity (PA) is recommended to stimulate central vestibular compensation. However, the presence of fear avoidance beliefs might negatively influence PA. The objectives of this study were to investigate the relationship between fear avoidance beliefs and PA and to compare PA levels between individuals with UVP in an acute/subacute vs chronic phase.

Methods: In this cross-sectional study, PA was measured using a triaxial accelerometer. Fear avoidance beliefs were quantified using the Vestibular Activities Avoidance Instrument. The correlation between fear avoidance beliefs and PA was evaluated using regression analyses, with other potential influencing factors also considered.

Results: A total of 102 participants were included. The average age was 56.1 (SD 15.2) years, and 57.8% were male. Participants with chronic UVP presented with shorter sedentary time (4,591 vs 5129 min/wk; P = 0.004), longer standing time (1443 vs 1165 min/wk; P = 0.025), higher vigorous PA (187 vs 107 min/wk; P = 0.005), and higher total PA (773 vs 623 min/wk; P = 0.003) compared to participants with acute/subacute UVP. In participants with acute/subacute UVP, variability in total PA was explained up to 54.7% by fear avoidance beliefs, etiology of the UVP, and gender (R2 = 0.547, F4,45 = 13.6, P < 0.001). In participants with chronic UVP, fear avoidance beliefs explained 4.1% of the variability in total PA (R2 = 0.041, F1,49 = 2.086, P = 0.155).

Discussion and conclusions: In acute/subacute UVP, assessing fear avoidance beliefs helps to understand physical inactivity. In chronic UVP, no significant association between fear avoidance beliefs and PA was observed.

Video abstract available: for more insights from the authors (see the video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A488).

Background and purpose: Chronic diabetes is a prevalent systemic disease that impairs neuromotor functioning and often leads to increased risk of falls. Adopting an external focus of attention during motor skill practice has been shown to improve learning outcomes; however, it has not been examined in this population. We examined how attentional focus instructions (internal vs external) affect balance performance and learning in older adults with and without diabetes.

Methods: Fifty-three older adults (27 with diabetes, 63.7 ± 7.0 years) participated in the randomized, pre-post intervention study. The balance training involved 50 practice trials of a stabilometer task that was novel to all participants. Participants were randomized to receive either internal or external focus task instruction. Task performance was assessed at baseline, during training, and during a retention test. Primary outcomes were changes in balance task performance before and after training.

Results: Participants who received external focus instruction showed a significantly greater increase in balance performance than individuals who received internal focus instruction (95% confidence interval, 0.02-4.05; P = 0.048). While participants with diabetes exhibited poorer baseline task performance (P = 0.02), both groups improved their relative task performance after training (95% confidence interval, 5.25-18.14; P < 0.0001).

Discussion and conclusions: Adopting an external focus of attention benefits performance during short-term training of a novel balance task in older adults with and without diabetes. Participants with diabetes were capable of learning the challenging balance task with practice, at a relative rate similar to those without diabetes. This information may be useful for designing interventional strategies to improve physical function and mitigate fall risks in older adults with diabetes.

Background and purpose: Telerehabilitation represents an alternative for individuals who have difficulty accessing services to receive care. Therefore, telerehabilitation measures must be studied for their reliability and validity. This study evaluated the validity and reliability of the videoconference-based Berg Balance Scale assessment in stroke survivors.

Methods: Thirty-one stroke survivors were assessed. Rater A conducted in-person and remote assessments via videoconferencing at 2 different times (test-retest), and rater B conducted an assessment using the second recording made remotely. The validity and agreement between the in-person and remote assessments were analyzed using the Pearson's correlation coefficient and the Bland-Altman plots limits of agreement (LoA), respectively. Test-retest and inter-rater reliability were analyzed using the intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI), and individual item reliability was assessed by weighted Kappa. The standard error of measurement and minimal detectable change were computed. Cronbach's alpha was used for the analysis of internal consistency, and the ceiling effect was investigated.

Results: In-person and remote assessments showed a strong positive correlation (r = 0.96) and less than a 1-point difference between the 2 assessments. Both the test-retest (ICC = 0.96; 95% CI, 0.93-0.98) and inter-rater (ICC = 0.93; 95% CI, 0.87-0.97) reliability were excellent. The standard error of measurement and minimal detectable change were 1.8 and 5.1 points, respectively. Results showed adequate internal consistency and no ceiling effect.

Discussion and conclusions: The Tele-Berg demonstrated validity, excellent test-retest and inter-rater reliability, low measurement error, adequate internal consistency, and lack of ceiling effect. These findings suggest that the Tele-Berg is comparable to in-person Berg Balance Scale in stroke survivors.

Video abstract available for more insights from the authors (see Supplemental Digital Content, available at: http://links.lww.com/JNPT/A509).

Background: Sustainable utilization of neurology and allied health professions' services is pivotal for effective management of Parkinson disease (PD) and is correlated with positive health-related outcomes.

Objectives: (1) To describe the utilization of neurology and allied health services by people with PD (PwP); (2) to explore the associations between demographic and structural variables and utilization; and (3) to test associations between utilization and unplanned hospitalizations.

Methods: A retrospective observational cohort study of 1761 PwP in the years 2014-2019 was conducted. Utilization of neurology and allied health services was mapped. Regression models were examined to test associations between demographic and structural variables, utilization of neurology and physical therapy (PT), and unplanned hospitalizations.

Results: Approximately 50% of the study population utilized neurology services. Utilization rate of allied health services ranged between 0% and 19%. The likelihood of utilizing neurology services increased for people with extended health insurance and people with more years since diagnosis and decreased for women and for people living at a great distance from a neurology service. The likelihood of utilizing PT increased for Jews and people with extended health insurance and decreased for people with more years since diagnosis and for people living at a great distance from a PT service. Among patients with fewer years since diagnosis (<5 years), those who utilized PT had a higher likelihood of unplanned hospitalization.

Conclusions: Neurology and allied health services are underutilized by PwP, particularly by minorities and women. Policymakers should take proactive steps to increase utilization.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A496 ).

Background and Purpose: Lower limb (LL) weakness and gait impairment are prevalent among persons with multiple sclerosis (PwMS) and can impede functional independence and impact health-related quality of life (HR-QoL). The purpose of this study was to examine the mediation effect of walking speed and perceived walking ability on the relationship between LL weakness and HR-QoL in ambulatory PwMS.

Methods: Participants (n = 175) were PwMS in this secondary analysis of a cross-sectional study. Demographics, pain (visual analog scale), fatigue (5-item Modified Fatigue Impact Scale), LL strength (hip extensors [HE] and flexors [HF], knee extensors [KE] and flexors [KF], and ankle plantarflexors [APF] and dorsiflexors [ADF]), Timed 25-Foot Walk, 12-item MS Walking Scale, and HR-QoL (MS Impact Scale-Physical [MSIS-29-Phys] and Psychological [MSIS-29-Psych]) were collected. Bivariate and mediation analyses using Hayes' PROCESS were performed to determine if LL strength had an indirect effect through walking speed or perceived walking ability on physical and psychological HR-QoL while controlling for fatigue and pain.

Results: There were significant ( P < 0.01) correlations for all strength measures with the MSIS-29-Phys and for HF, KE, KF, and APF with the MSIS-29-Psych. In the mediation analyses, LL strength indirectly influenced PwMS' MSIS-29-Phys through walking speed and perceived walking ability. There was only partial mediation between HE, HF, KF, ADF, and MSIS-29-Phy when walking speed was in the model. LL strength did not influence MSIS-29-Psych.

Discussion and conclusions: LL strength impacts physical HR-QoL through walking but does not indirectly affect PwMS' perceived psychological HR-QoL. These findings may prompt physical therapists to create individualized care plans that address LL weakness and walking impairments with the goal of promoting optimal outcomes and improving HR-QoL.

Video abstract available: for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A504 ).