Disability and Rehabilitation最新文献

Purpose: This knowledge translation (KT) descriptive study aimed to improve adherence to upper quadrant lymphedema clinical practice guideline (CPG) volume measurement recommendations.

Methods: Physical therapists and leaders from 3-outpatient clinics who receive referrals for surveillance and treatment of cancer-related upper quadrant lymphedema were included in this 2-year descriptive study. The Knowledge to Action and Consolidated Framework for Implementation Research were used to improve fidelity and adherence to CPG recommended practices.

Results: Clinicians and leaders scored highly on readiness for change questions at baseline. Chart audits (n = 176) showed improvement in all fidelity metrics: use of consistent increment of circumference measures improved from 0% to 94%, bilateral measures 43% to 94%, follow-up circumference measures 60% to 77%, and use of evidence-based volume difference metrics for appropriate referral 0% to 80%. Adherence decreased over time, ranging between 33% to 90% at the last chart audit. There was variability in the changes to clinician knowledge and beliefs about lymphedema measures documented at the end of the project.

Conclusions: This study demonstrated a feasible KT process to improve adherence to lymphedema measurement guidelines in outpatient clinics. Inconsistent adherence may impact clinical decision-making and limit patient access to appropriate care to manage this chronic condition.

Purpose: To understand the stroke recovery experience of Aboriginal Peoples living with stroke on Gamilaraay/Gomeroi country in New South Wales, Australia.

Materials and methods: Community participatory action research methods were undertaken incorporating individual and group yarn-ups with Aboriginal Peoples in the community living with stroke and their family. A non-Aboriginal qualitative researcher undertook inductive narrative analysis of the emergent themes in the yarns, with frequent review and input from Aboriginal and non-Aboriginal clinician researchers and the Aboriginal working group.

Results: Yarns were completed with (i) people living with stroke (n = 5, 60% female), (ii) family and carers of people living with stroke (n = 5, 80% female) and a (iii) well-established community group (n = 6, 100% female). The four themes were: (i) The role of family in stroke recovery, (ii) Trusted relationships with people aware of stroke and support options, (iii) Importance of culturally appropriate interactions with health service, and (iv) Disrespect and racism impacts stroke care access.

Conclusions: The role of family, trusted relationships, community connection, cultural safety and respect must be considered in improving the post-stroke quality of life for Aboriginal Peoples on Gamilaraay/Gomeroi country. These learnings can be used as a framework to inform future work with other Australian Aboriginal communities.*Our research group works with Aboriginal Peoples from Gamilaraay/Gomeroi country located in the North-western Plains of New South Wales Australia. We recognise the diversity of Aboriginal and Torres Strait Islander Peoples from across the many Countries of this place we now call Australia. Recognising this, throughout this text, we have used the preferred term "Aboriginal Peoples".

Purpose: Caregivers of children diagnosed with cerebral palsy (CP) frequently engage with healthcare professionals (HCPs) when seeking help on behalf of their children. However, little is known about their health-seeking experiences, particularly in low-resourced townships.

Materials and methods: A qualitative descriptive case study research design, underpinned by a phenomenological approach. A series of semi-structured interviews were conducted with fifteen caregivers who live in a township in South Africa and were selected using purposive and snowball sampling. Data were analysed using interpretative phenomenological analysis.

Results: The results revealed three main themes which include: (i) A primary focus in healthcare systems on child-centred care which neglects the needs of caregivers, (ii) Brief disease-focused consultations with HCPs that have a negative impact on caregiver health-seeking experiences, and (iii) Dismissal of caregivers' expert knowledge.

Conclusion: The findings indicate that caregivers have needs that are separate from those of their children. To ensure that caregivers receive helpful help during their health-seeking attempts, there must be a shift from the traditional paternalistic roles of healthcare providers. Instead, HCPs should view themselves as collaborators with caregivers to ensure that they provide family-centred services. Additionally, the voice of the lifeworld needs to become a central feature of the care provided to caregivers and their children.

Purpose: Decades of communication research have focused on the so-called "deficits" of autistic people and on interventions to remediate these. This study takes a different perspective in line with the neurodiversity paradigm to examine what non-autistic communication partners do to enable or undermine the ability of autistic people to think and to contribute their own knowledge and ideas to the conversation.

Materials and methods: In-depth, longitudinal case studies of the communication exchanges between three autistic women and two autistic men and their chosen, non-autistic communication partners (one man and six women) were undertaken over 4-12 months via semi-structured interviews, observation, reflective conversations, and diary records.

Results: Conversation transcripts were analysed thematically to identify the communication of the non-autistic participants as broadly helpful ("grease" or "flow") or unhelpful ("blocks"). Sub-themes included how to optimise engagement, respond to disengagement, build shared understanding, and provide prompts at the right time. Interrupting, giving ideas and asking unhelpful questions often functioned as a block to thinking and contribution to the conversation.

Conclusion: The "grease" and "blocks" identified could provide a powerful and timely reframing for the focus of autism communication training towards promoting interactional expertise, especially for anyone involved in important consultation with autistic people.

Purpose: To identify characteristics of participants, intervention features and outcomes in studies examining aquatic exercise for adolescents and adults with cerebral palsy (CP).

Materials and methods: Four electronic databases were systematically searched on 15 August 2024. Studies that included people with a diagnosis of CP (mean age ≥15 years), and an intervention that involved an aquatic based activity were considered for inclusion. Quantitative and qualitative results were reported using narrative syntheses.

Results: Database searches yielded 299 studies of which 11 met inclusion criteria with 66 participants in total. Eight studies used a non-experimental quantitative design. Three studies included participants with greater disability (Gross Motor Function Classification System Level V); four studies included participants older than 30 years. Aquatic program components were variable. Reporting of parameters such as intensity, adverse events, and safety measures was generally poor. Participation outcomes were included in only three studies. No study formally gathered participant experiential data.

Conclusions: Aquatic programs for individuals with CP appear predominantly focused on younger people and those with mild to moderate disability. Poor reporting of program design has led to non-reproducible studies and inconsistent approaches to aquatic exercise for adolescents and adults with CP. Participant, carer, and clinician perspectives on aquatic programs remain unknown.

Purpose: The National Clinical Guideline for Stroke for the United Kingdom and Ireland was published in 2023 with an increased focus and detail regarding cardiorespiratory training. This study aimed to explore physiotherapists' perspectives into the feasibility of implementing cardiorespiratory training for people with stroke as per this new guideline.

Materials and methods: A qualitative descriptive study was conducted using semi-structured interviews with professionally registered physiotherapists, who had worked with stroke patients in the past two years. Data was inductively analysed using reflexive thematic analysis.

Results: Fifteen physiotherapists participated in interviews from a variety of healthcare settings and geographical locations across the Republic of Ireland. Three themes were constructed: 1) How cardiorespiratory training is prioritised, 2) Current practices of cardiorespiratory training and the challenges faced, and 3) Creative and resourceful solutions to improving cardiorespiratory implementation. Facilitating factors included one-to-one support, accessibility/inclusivity of services, education, promotion, and developing a stroke-specific rehabilitation programme.

Conclusions: These findings inform on current practices and challenges to implementation of cardiorespiratory training in stroke rehabilitation. Physiotherapists had innovative ideas and solutions that could enhance the delivery and implementation of cardiorespiratory training for people with stroke.

Purpose: With the increasing prevalence of early onset Parkinson's disease (EOPD) world-wide, there is a need to understand consumer views on the benefits and barriers to community exercise programs for people with this progressive condition.

Materials and methods: A physiotherapist-led, 1:1 strength training program was implemented in adults with EOPD by exercise trainers who were educated and supervised to ensure safe exercise delivery. We applied a qualitative descriptive approach to collect and thematically analyse data from two groups of consumers: (i) people ≤ 50 years with EOPD (ii) exercise trainers.

Results: Interviews from 16 participants were transcribed and inductively coded with three main themes emerging: (i) a community gym program was acceptable and of benefit in individuals with EOPD (ii) exercise delivery was safe and feasible provided that exercise trainers were educated about PD and supported (iii) challenges to regular exercise participation included work and family commitments, gym access and matching exercise times to PD medication cycles.

Conclusions: Adults with EOPD valued participating in a community gymnasium program and exercise trainers reported benefits of being educated and supervised in exercise delivery. Physiotherapists play a key role in the design, supervision, and modification of exercise programs to optimise safety and benefit.

Purpose: The aim was to examine disease-related challenges and rehabilitation needs among adults with Myasthenia Gravis (MG) to target future support initiatives.

Materials and methods: The study involved a cross-sectional questionnaire based on patient-reported outcomes within 11 domains/95 items, covering potential challenges and needs in living with MG. Data were compared against the subgroups gender, age, and years with MG.

Results: In total, 197 participants responded. The median number of challenges across all domains was 15 out of 95 with a higher prevalence in women than men and with no differences in relation to age or years with MG. The most prominent challenges were muscle strength, physical tiredness, and mental fatigue. The median number of total rehabilitation needs was three out of 95 with a higher prevalence in women than men, but with no differences between age and years with MG. The most prominent rehabilitation needs were physical tiredness, mental fatigue, and knowledge on existing interventions. Many participants reported unmet psychological needs, especially women, participants from 40 years of age, and participants who had lived with MG for more than five years.

Conclusions: MG significantly impacts on everyday functioning and activities. Disease-related challenges and rehabilitations needs manifested differently across genders. A profound difference was found between the number of challenges and rehabilitation needs reported.

Purpose: To examine the effectiveness of Pilates on fatigue, quality of life and physical function in persons with chronic conditions and explore potential intervention moderators.

Materials and methods: PubMed, SPORTDiscus, AMED and CINAHL were systematically searched from database inception to September 2024, to identify relevant studies. Two independent reviewers screened and selected the articles and evaluated methodological quality. Studies were included if they were randomised controlled trials of Pilates to improve fatigue in persons with chronic conditions.

Results: Eighteen studies involving 812 participants were included. Pilates had a significant effect on fatigue, quality of life and physical function. Meta-analyses showed Pilates had significant effect on physical function [Hedge's g = 0.85 (95% CI: 0.30; 1.40), p = 0.01] but the effects on fatigue [Hedge's g = -0.43 (95% CI: -0.96; 0.11), p = 0.12] and quality of life [Hedge's g = 0.49 (95% CI: -0.40; 1.37), p = 0.28] were not significant. Interventions with smaller duration (6-8 weeks) influenced Pilates effect on fatigue. The type of chronic condition and control did not influence effect.

Conclusions: Pilates has beneficial effects on physical function and may help reduce fatigue and improve quality of life in persons with chronic conditions. Pilates exercises used in rehabilitation settings can influence health outcomes.

Purpose: Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. This study aimed to explore how cognitive reserve, measured by education, is related to neuropsychological outcomes, return-to-work and life satisfaction after ABI.

Methods: Long term follow-up of 83 patients with ABI, 5-15 years after specialized brain injury rehabilitation. Logistic regression was used to analyze the relationship between independent variables and outcomes (return-to-work and life satisfaction).

Results: Return-to-work was associated with cognitive reserve (OR = 1.31, p = 0.024), age (OR = 0.95, p = 0.042), general fatigue (OR = 0.77, p = 0.034), and Cognitive Profiency Index (measures of working memory and processing speed, OR = 1.06, p = 0.037). Verbal and spatial abilities were related to education, but not to return-to-work. General fatigue was related to satisfaction with mental health in both univariate (OR = 0.78, p = 0.008) and multivariate analyses (OR = 0.8, p = 0.037), but no other variables were significantly associated with life satisfaction in multivariate analyses.

Conclusion: Patients with lower cognitive reserve paired with slower processing speed and poor working memory may need additional support for successful return-to-work, while life satisfaction appears to depend more on other factors.