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MEANINGFUL MULTIDISCIPLINARY REHABILITATION FOR HEART AND LUNG CONDITIONS: A COLLABORATION BETWEEN ORGANISATIONS AND SECTORS TOWARDS SELF-MANAGEMENT 对心肺疾病进行有意义的多学科康复治疗:组织和部门之间的合作,实现自我管理
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.502
Mrs Katrina Ghidella
It is well documented that mainstream services are not always well attended by Aboriginal and Torres Strait Islander people due to a range of issues including transport and culturally safe practice. Establishing these services within the community-controlled sector is one way to increase access and culturally responsive care. This initiative involved a new model of service delivery, whereby a partnership between Hospital Health Services and community-controlled Aboriginal and Torres Strait Islander primary healthcare organisations enabled the establishment of new Cardiac and Pulmonary Rehabilitation Programs within the Institute for Urban Indigenous Health (IUIH) Network for First Nations people. This Network is comprised of the five Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ATSICCHO’s) who operate as a regional collective with IUIH providing leading strategic direction and coordination. Through a multidisciplinary team, specialised cardiac and pulmonary rehabilitation is provided to First Nations people as a culturally capable alternative to hospital cardiac and pulmonary rehabilitation, particularly for those not currently accessing treatment. The specialised rehabilitation programs are supported by the IUIH System of Care that supports clients to access a wide array of holistic health services and programs designed to meet community needs and strengthen pathways for clients to self-manage their health needs in a self-led manner. The Rehabilitation Programs are a multidisciplinary exercise and education program delivered by a range of health professionals including Accredited Exercise Physiologist’s, Physiotherapists, Nurses and Aboriginal and Torres Strait Islander Allied Health Assistants. Clients also have access to a range of other Allied Health Professionals, including Dieticians Occupational Therapists, Pharmacists, Social Health, Podiatrists, Optometrists, Speech Therapists and Audiologists. Referrals are received from ATSICCHOS, Queensland Health and Primary Health General Practitioners and Specialists. The client journeys through a multidisciplinary assessment to then determine their goals and health needs. This presentation will provide insights into the First Nations-led partnership, challenges and solutions to working across the whole health sector and outcomes for clients.
有资料表明,由于交通和文化安全实践等一系列问题,土著居民和托雷斯海峡岛民并不总是能很好地接受主流服务。在社区控制的部门内建立这些服务,是增加获得服务机会和文化适应性护理的一种方式。这一举措涉及一种新的服务提供模式,即医院卫生服务部门与社区控制的原住民和托雷斯海峡岛民初级医疗保健组织合作,在城市原住民健康研究所(IUIH)网络内为原住民建立新的心脏和肺康复计划。该网络由五个由土著居民和托雷斯海峡岛民社区控制的医疗机构(ATSICCHO's)组成,这些医疗机构作为一个地区性的集体,由城市土著健康研究所(IUIH)提供主要的战略指导和协调。通过多学科团队,向原住民提供专门的心脏和肺部康复治疗,作为医院心脏和肺部康复治疗之外的一种文化上可行的替代方案,尤其是针对那些目前无法获得治疗的原住民。专门的康复计划得到了 IUIH 护理系统的支持,该系统支持客户获得广泛的整体健康服务和计划,旨在满足社区需求,并加强客户以自我主导的方式自我管理其健康需求的途径。康复计划是一项多学科运动和教育计划,由一系列医疗专业人员提供,包括认可运动生理学家、物理治疗师、护士以及土著居民和托雷斯海峡岛民专职医疗助理。客户还可求助于一系列其他专职医疗人员,包括营养师、职业治疗师、药剂师、社会保健师、足病治疗师、验光师、言语治疗师和听力学家。转诊来自 ATSICCHOS、昆士兰州卫生局和初级卫生保健全科医生和专科医生。客户通过多学科评估来确定他们的目标和健康需求。本演讲将深入介绍原住民领导的合作伙伴关系、在整个卫生部门开展工作所面临的挑战和解决方案,以及为客户带来的成果。
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引用次数: 0
INDIVIDUAL STRENGTH CHANGES FOLLOWING A VERY BRIEF INTERVENTION ON NATIONAL STRENGTH TRAINING GUIDELINES IN ADULTS AGED 50 - 75 YEARS 对 50 - 75 岁成年人进行国家力量训练指南的简短干预后个人力量的变化
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.351
Dr. Ashley Gluchowski
There is little evidence that the public or healthcare practitioners are aware of and implementing the strength training component of the United Kingdom’s (UK) Chief Medical Officers’ physical activity guidelines in practice. Our study aimed to objectively measure strength following a very brief intervention with the strength component to determine if this practice could increase muscle strength. This was a mixed method, one-arm, pre-post six-month study. Thirty adults aged 50-75 years had hand grip (upper) isometric strength and ankle plantarflexion (lower) isometric strength measured. The average of two trials on the dominant limb were recorded. Participants were provided a physical copy of the guidelines and were asked to follow the strength recommendations. The very brief intervention (five minutes) included information on why and how to follow the strength guidelines, example exercises, along with a proven behaviour change technique (providing a journal to record training sessions). Strength was tested after six-months. The group average indicated that there was no change in upper or lower body strength from baseline. However, when data were viewed individually, upper body strength was gained in 21 of 30 participants and lost in 9 (range: -4.5 to +6 kg). 42% of participants gained more than 2 kg in hand strength after six-months. Lower body strength was gained in 15 participants and lost in 15 (range: -12.4 to +8.65 kg). 43% of participants lost more than 2 kg. Qualitatively participants took the opportunity to ‘procure some new weights’ as they found their weights at home ‘too easy.’ Participants had a new-found realisation that ‘strength training is vital to muscle strength.’ Some mentioned that ‘strength training is now part of my life.’ On the other hand, other participants wanted more, noting that ‘there should be more publicity, information about [strength training] to the general public’ and found it unnecessarily ‘hard to find [follow up information] online.’ In the movement to make ‘every contact count,’ a very brief intervention has been shown to raise awareness and change strength training behaviour. Healthcare practitioners should focus on lower body exercise examples alongside progression techniques to avoid rapid loss in lower body strength. Public health stakeholders need to work together to provide easily accessible strength training resources.
几乎没有证据表明公众或医疗从业人员了解英国首席医疗官体育锻炼指南中的力量训练部分并在实践中加以实施。我们的研究旨在通过对力量部分进行非常简短的干预,客观地测量力量,以确定这种做法是否能增强肌肉力量。 这是一项为期 6 个月的单臂前-后混合法研究。对 30 名 50-75 岁的成年人进行了手部握力(上部)等长力量和踝关节跖屈(下部)等长力量的测量。记录主导肢体两次试验的平均值。向参与者提供了一份指南的实物,并要求他们遵循力量建议。非常简短的干预(5 分钟)包括关于为什么和如何遵循力量指南的信息、示例练习以及一种行之有效的行为改变技术(提供记录训练课程的日志)。六个月后进行了力量测试。 小组平均值显示,上半身或下半身力量与基线相比没有变化。然而,在对个人数据进行分析时,30 名参与者中有 21 人的上肢力量有所增强,9 人的上肢力量有所减弱(范围:-4.5 至 +6 千克)。42% 的参与者在 6 个月后手部力量增加了 2 公斤以上。15 名参与者的下半身力量有所增强,15 名参与者的下半身力量有所减弱(范围:-12.4 至 +8.65 千克)。43% 的参与者减重超过 2 公斤。从质量上看,参与者利用这次机会 "购买了一些新的重量",因为他们发现家里的重量 "太简单了"。参与者重新认识到 "力量训练对肌肉力量至关重要"。有些人提到,"力量训练现在已经成为我生活的一部分。'另一方面,其他参与者则希望得到更多,他们指出'应该向公众进行更多的宣传,提供更多有关[力量训练]的信息',并认为'在网上很难找到[后续信息]'是不必要的。 在 "让每一次接触都有意义 "的运动中,一项非常简短的干预措施已被证明能够提高人们的意识并改变力量训练行为。医疗保健从业人员应将重点放在下半身锻炼的实例上,同时采用循序渐进的技巧,以避免下半身力量的快速流失。公共卫生利益相关者需要共同努力,提供易于获取的力量训练资源。
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引用次数: 0
THE SMALLEST WORTHWHILE EFFECT OF EXERCISE THERAPY FOR PEOPLE WITH CHRONIC LOW BACK PAIN: A DISCRETE CHOICE EXPERIMENT STUDY 运动疗法对慢性腰背痛患者的最小价值效应:离散选择实验研究
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.378
Mr Harrison Hansford, Matthew D Jones, Aidan G. Cashin, R. Ostelo, Alessandro Chiarotto, Sam A. Williams, Saurab Sharma, Jack J. Devonshire, Michael C. Ferraro, M. Wewege, James H McAuley, John M Rose
Understanding the magnitude of treatment effect patients need to see to consider a treatment worthwhile is of clear clinical and research importance. Current measures of clinical importance, such as the minimum clinical important difference, are limited as they are not determined by patients, and do not reflect specific costs, risks or inconveniences of individual treatments, i.e. you could have the same MCID for surgery as for exercise. We aimed to identify the smallest worthwhile effect (SWE), a new measure of clinical importance, of exercise therapy for people with non-specific chronic low back pain (CLBP) using discrete choice experiment. The SWE was estimated as the lowest reduction in pain that participants would consider exercising worthwhile, compared to not exercising i.e., effects due to natural history and other components (e.g., regression to the mean). We recruited English-speaking adults in Australia with non-specific CLBP to our online survey via email from a registry of previous participants and advertisements on social media. We used discrete choice experiment to estimate the SWE of exercise compared to no exercise for pain intensity. We analysed the discrete choice experiment using a mixed logit model, and mitigated hypothetical bias through certainty calibration, with sensitivity analyses performed with different certainty calibration thresholds. 213 participants completed the survey. Mean age (±SD) was 50.7±16.5, median (IQR) pain duration 10 years (5-20), and mean pain intensity (±SD) was 5.8±2.3 on a 0-10 numerical rating scale. For people with CLBP the SWE of exercise was a between-group reduction in pain of 20%, compared to no exercise. This means, for a baseline pain of 5, the SWE would be a 1/10 between-group reduction in pain. This patient-informed threshold of clinical importance should guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
了解患者需要看到多大的治疗效果才能认为治疗是值得的,这显然具有重要的临床和研究意义。目前对临床重要性的衡量标准(如最小临床重要差异)是有限的,因为它们不是由患者决定的,也不能反映个别治疗的具体成本、风险或不便之处,例如,手术和运动的最小临床重要差异可能是相同的。我们的目标是利用离散选择实验确定运动疗法对非特异性慢性腰背痛患者的最小值得效应(SWE),这是衡量临床重要性的新标准。 SWE被估算为与不运动相比,参与者认为值得运动的最低疼痛减轻程度,即自然史和其他因素(如向均值回归)导致的影响。我们通过先前参与者登记处的电子邮件和社交媒体上的广告,招募澳大利亚讲英语的非特异性慢性前列腺炎成人参与我们的在线调查。我们使用离散选择实验来估算运动与不运动相比对疼痛强度的影响。我们使用混合 Logit 模型对离散选择实验进行了分析,并通过确定性校准减轻了假设偏差,同时使用不同的确定性校准阈值进行了敏感性分析。 213 名参与者完成了调查。平均年龄(±SD)为 50.7±16.5,疼痛持续时间中位数(IQR)为 10 年(5-20),疼痛强度平均值(±SD)为 5.8±2.3(0-10 分)。与不运动相比,运动对慢性前列腺痛患者的SWE在组间减少了20%。这意味着,如果基线疼痛为 5,那么 SWE 就是组间疼痛减轻的 1/10。 在解释运动疗法与不运动疗法相比的随机试验和荟萃分析结果时,应以患者知情的这一临床重要性阈值为指导。
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引用次数: 0
EXERCISE IN ADULTS WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: A SYSTEMATIC REVIEW 运动对注意力缺陷/多动症成人的影响:系统回顾
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.387
Christopher Hanbury-Brown, P. Am, Dr Michael Inskip, Dr Michelle Ogrodnik, Dr Jennifer Heisz, Dr Yorgi Mavros
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in adults. Stimulant medications are first-line treatments, they have many side effects and do not address common comorbidities such as cardiometabolic disease, depression, and anxiety. Exercise, by contrast, not only improves ADHD symptoms in youth but effectively treats such comorbidities, making it a potentially valuable treatment option. However, exercise efficacy in adults with ADHD has not been systematically reviewed. Therefore, we aimed to summarise the results of acute exercise and training interventions on health-related outcomes for adults with ADHD, including ADHD symptoms, cognitive function, and psychological well-being. Using PRISMA guidelines, fifteen databases were searched (including grey literature) on 27/08/2020, yielding 22,088 unique publications. Database alerts were created to capture additional studies (n= 2). Screening, data extraction, Risk of Bias and GRADE assessment was conducted by CEHB. Seven acute (6 cycling, 1 self-selected, 1 yoga) and 6 training studies (Yoga, Pilates, Kickboxing, Tai Chi, General Coordination, Group Circuit Class, Cycling) were included. Among acute studies, those reporting small-to-moderate improvements in cognitive function were characterised by longer duration exercise (>30 minutes), withholding ADHD medication before exercise, and using cohorts with clinician-confirmed ADHD diagnosis. Among the training studies, only one reported an improvement in cognition following Pilates when compared to an inactive control. It was longer (6 months vs. <8 weeks), prescribed progressive intensity and volume, and had high adherence compared to the non-significant trials. The certainty of evidence was low or very low for all outcomes. Overall, acute exercise may have a small positive effect on cognition in adults with ADHD; however, certainty of the evidence is low. Further research is needed to investigate the impact of different modalities, durations, and intensities of acute exercise and chronic exercise on adult ADHD.
注意力缺陷/多动障碍(ADHD)是成人中最常见的神经发育障碍之一。兴奋剂药物是一线治疗药物,但副作用很大,而且不能解决常见的合并症,如心脏代谢疾病、抑郁症和焦虑症。相比之下,运动不仅能改善青少年多动症的症状,还能有效治疗这些并发症,因此是一种有潜在价值的治疗方法。然而,运动对成人多动症患者的疗效尚未得到系统的研究。因此,我们旨在总结急性运动和训练干预对成人多动症患者健康相关结果的影响,包括多动症症状、认知功能和心理健康。 利用 PRISMA 指南,我们于 2020 年 8 月 27 日检索了 15 个数据库(包括灰色文献),共获得 22,088 篇独特的出版物。还创建了数据库警报,以捕捉更多研究(n= 2)。筛选、数据提取、偏倚风险和 GRADE 评估由 CEHB 负责。 共纳入了 7 项急性研究(6 项自行车运动、1 项自选运动、1 项瑜伽运动)和 6 项训练研究(瑜伽、普拉提、跆拳道、太极、综合协调、集体循环课程、自行车运动)。在急性研究中,那些报告认知功能有轻微至中度改善的研究具有以下特点:运动持续时间较长(超过30分钟)、运动前未服用ADHD药物以及使用了经临床医生确诊的ADHD队列。在培训研究中,只有一项研究报告称,与非活动对照组相比,普拉提运动改善了认知功能。该研究的时间较长(6 个月对小于 8 周),规定了渐进的强度和运动量,与非显著性试验相比,其依从性较高。所有结果的证据确定性都较低或很低。 总体而言,急性运动可能会对患有多动症的成年人的认知能力产生微小的积极影响;但证据的确定性较低。需要进一步研究不同方式、持续时间和强度的急性运动和慢性运动对成人多动症的影响。
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引用次数: 0
THE EFFECTS OF ACUTE AND CHRONIC HYPOXIC PLYOMETRIC EXERCISE ON POST ACTIVATION POTENTIATION 急性和慢性缺氧负重运动对激活后电位的影响
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.524
Dr Betul Coskun, Prof Michael J. Hamlin
In the literature, only acute effects of exercise, mostly combined with plyometrics or blood flow restriction (BFR), have been examined on post-activation-potentiation (PAP). Although systemic and local hypoxia have some similar effects, we found only one study (Ramos-Campo et al., 2020) reporting a PAP effect with systemic hypoxia. There is no study investigating chronic effects, and there is also no study examining acute and chronic effects of exercise together, not only in hypoxia but also in normoxia. The aim of this study is to examine the acute and chronic effects of plyometric exercise in hypoxia on PAP, and to test differences between high and low hypoxia. Nineteen team-sports athletes undertook 8-week drop-jump (DJ) training in Low-Hypoxia (LH, n=8), Normoxia (N, n=6), and High-Hypoxia (HH, n=5) using a hypoxicator set using a biofeedback system to sustain a SpO2 of 90%, 97-100%, and 80%, respectively. PAP assessments were applied under both normoxia and hypoxia on different days. Two DJ trials from 40-cm height were obtained as baseline measurements, and then 7.5 min passive rest was given under each group’s hypoxia level. Following 1x5 DJs for pre-test, and 1x8 DJs for post-test as PAP protocol, DJ tests were applied at 2nd and 4th min. RM-ANOVA, to assess acute effect, showed a significant conditionxtest interaction (F=3.40, p=0.044), and only under normoxia condition DJ-height was significantly higher at 2nd (31.7cm) and 4th min (31.6cm) than baseline (30.1cm)(p<0.05). For chronic effect, mixed-ANOVA represented a significant groupxtest interaction (F=2.70, p=0.048). Only HH significantly increased DJ-height from baseline (30.0cm) to 2nd (31.9cm) and 4th min (32.9cm) (p<0.05). We conclude that while acute hypoxia drop jump exercise may damage net balance between potentiation and fatigue which occurred after conditioning activity, high hypoxia drop jump training may affect this balance in favour of potentiation without any condition difference.
在文献中,只有运动(大多与负重运动或血流限制(BFR)相结合)对激活后强化(PAP)的急性效应进行了研究。虽然全身性缺氧和局部缺氧有一些类似的影响,但我们发现只有一项研究(Ramos-Campo 等人,2020 年)报告了全身性缺氧对激活后强化(PAP)的影响。目前还没有研究对慢性效应进行调查,也没有研究将运动的急性和慢性效应结合在一起,不仅在低氧状态下,而且在常氧状态下。本研究旨在探讨在低氧条件下进行负重运动对肺活量的急性和慢性影响,并测试高低氧之间的差异。 19 名团队运动运动员分别在低氧(LH,人数=8)、常氧(N,人数=6)和高氧(HH,人数=5)条件下进行了为期 8 周的跳投(DJ)训练,训练中使用了生物反馈系统设置的低氧器,使 SpO2 分别维持在 90%、97-100% 和 80%。在常氧和低氧条件下,在不同的日期进行 PAP 评估。从 40 厘米的高度进行两次 DJ 试验作为基线测量,然后在各组的低氧水平下进行 7.5 分钟的被动休息。按照 PAP 方案,前测进行 1x5 次 DJ 试验,后测进行 1x8 次 DJ 试验,然后在第 2 和第 4 分钟进行 DJ 试验。 评估急性效应的 RM-ANOVA 显示,条件与测试之间存在显著的交互作用(F=3.40,p=0.044),只有在常氧条件下,第 2 分钟(31.7 厘米)和第 4 分钟(31.6 厘米)的 DJ 高度才显著高于基线(30.1 厘米)(p<0.05)。在慢性效应方面,混合方差分析表明组与试验之间存在明显的交互作用(F=2.70,p=0.048)。从基线(30.0 厘米)到第 2 分钟(31.9 厘米)和第 4 分钟(32.9 厘米),只有 HH 能明显增加 DJ 高度(p<0.05)。 我们的结论是,虽然急性缺氧跳落运动可能会破坏调节活动后出现的增效和疲劳之间的净平衡,但高缺氧跳落训练可能会影响这种平衡,使其有利于增效,而没有任何条件差异。
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引用次数: 0
PHYSICAL ACTIVITY RECOMMENDATIONS FOR PEOPLE WITH CHRONIC KIDNEY DISEASE: ARE RESEARCH PARTICIPANTS REPRESENTATIVE OF REAL-WORLD PATIENTS? 针对慢性肾脏病患者的体育锻炼建议:研究参与者能代表现实世界中的患者吗?
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.424
Mr Thai Binh Tran, Ms Noor Ul Eman Tahir, Mr Alexander Bates, Ms Jennifer Nguyễn, Doctor Hicham Ibrahim Cheikh Hassan, A/Prof Jeanette Thom, Dr Shaundeep Sen, Assoc Prof Kelly Lambert, Ria Arnold
Physical activity is important to maintain good health for people with chronic kidney disease (CKD). However, people with CKD often have a complex health status which necessitates advice tailored to their safety profile. As such, this study aimed to review clinical practice recommendations on physical activity for people with CKD and evaluate how representative research participants are compared to a real-world cohort. A systematic search was completed to identify physical activity recommendations for people with CKD Stage 3-5. Primary studies that informed these recommendations were identified and data extracted. Meta-analysis of proportion was undertaken for sex, age, and comorbidities and compared to n=679 people with CKD from the Centre for Health Research Illawarra-Shoalhaven Population database. There were 17 physical activity recommendations for people with CKD. Thirteen provided physical activity guidelines for general adult populations. Three provided specific guidance on exercise prescription. Thirty-four primary studies informed these recommendations, including 22 intervention (65%); 6 aetiology (18%); 4 prognosis (12%); and 2 screening studies (6%). Twelve interventional studies were randomised controlled trials (55%). Primary intervention studies comprised 1,792 participants. Compared to the real-world cohort, research participants were significantly younger (mean age 59.7 vs 78.2); had higher proportions of male (60% vs 51%), hypertension (89% vs 80%) and peripheral vascular disease (12% vs 6%); but lower proportions of coronary artery disease (16% vs 20%) and diabetes (35% vs 38%). Physical activity recommendations for people with CKD lacked specific, tailored advice to address the complex health status and safety profile of people with CKD. Primary intervention studies that inform these recommendations included participants that were younger and had different comorbid profile when compared to a real-world cohort. Future intervention trials with pragmatic design are needed to improve the evidence base and specificity of recommendations.
体育锻炼对慢性肾脏病(CKD)患者保持健康非常重要。然而,慢性肾脏病患者的健康状况往往比较复杂,因此需要针对他们的安全状况提出建议。因此,本研究旨在回顾有关 CKD 患者体育锻炼的临床实践建议,并评估研究参与者与真实世界队列相比的代表性。为了确定针对 CKD 3-5 期患者的体育锻炼建议,我们进行了系统性检索。确定了为这些建议提供依据的主要研究并提取了数据。根据性别、年龄和合并症对比例进行了元分析,并与伊拉瓦拉-肖尔海文健康研究中心人口数据库中的 679 名 CKD 患者进行了比较。针对慢性肾脏病患者的体育锻炼建议有 17 项。其中 13 项为普通成年人提供了体育锻炼指南。三项建议为运动处方提供了具体指导。这些建议参考了 34 项主要研究,包括 22 项干预研究(65%)、6 项病因研究(18%)、4 项预后研究(12%)和 2 项筛查研究(6%)。12 项干预研究为随机对照试验(55%)。主要干预研究包括 1,792 名参与者。与真实世界队列相比,研究参与者明显更年轻(平均年龄为 59.7 岁 vs 78.2 岁);男性(60% vs 51%)、高血压(89% vs 80%)和外周血管疾病(12% vs 6%)的比例更高;但冠状动脉疾病(16% vs 20%)和糖尿病(35% vs 38%)的比例较低。针对慢性肾脏病患者的体育锻炼建议缺乏针对慢性肾脏病患者复杂的健康状况和安全状况的具体、有针对性的建议。为这些建议提供依据的初级干预研究中的参与者更年轻,与现实世界中的队列相比,他们的合并症情况也有所不同。未来需要进行具有实用性设计的干预试验,以提高建议的证据基础和针对性。
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引用次数: 0
SCOPING THE AVAILABILITY AND APPROPRIATENESS OF EXERCISE SERVICES FOR PEOPLE WITH CANCER IN REGIONAL WESTERN AUSTRALIA 对澳大利亚西部地区癌症患者运动服务的可获得性和适宜性进行界定
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.434
Mr Christopher Andrew, Dr Annie De Leo, Dr Carolyn McIntyre, Dr Joshua Lewis, Dr Amy Dennett, Dr Yvonne Zissiadis, Dr Mar Kennedy
National guidance directs oncology healthcare professionals to refer patients to exercise in standard care, yet referrals happen rarely in practice resulting in a critical research-to-practice gap. One major barrier preventing referrals—especially in rural and regional areas—is the lack of appropriate exercise programming available to people with cancer. Therefore, the aims of this study are to 1) determine the availability of exercise oncology programs in a regional area of Western Australia; and 2) explore the appropriateness of these resources to meet the needs of people living with cancer in this region so that a comprehensive referral resource can be created for the region. A comprehensive online search identified all exercise services available in the region for people with cancer. Services were categorised using the Cancer Rehabilitation to Recreation (CaReR) framework to describe the level of care each provided. The geographical makeup and demographics of the cancer population in the region were matched to the services to identify service-gaps. Approximately 194 000 people live in the Soutwest, with ∼1300 residents diagnosed with cancer each year. Sixty-six exercise oncology services were identified as appropriate for serving this entire population. 62% of all programs were located in the two largest shires across the region. 66% of services were categorised as CaReR Phase 1, providing targeted, supervised care for high-needs patients; 79% as Phase 2, providing targeted, supervised care for medium needs patients; and 28 percent as Phase 3, independent, community-based care for low needs patients. The Southwest region is significantly under-resourced to meet the national directive to embed exercise referrals into care for people with cancer. Lack of available exercise services for this population, and few programs catering for a diverse range of patient needs underpin this. Implementation-focused research is required to address this critical research-to-practice gap.
国家指南指示肿瘤医护人员在标准护理中将患者转介给运动治疗,但在实践中却很少出现转介情况,导致研究与实践之间存在严重差距。阻碍转诊的一个主要障碍--尤其是在农村和地区--是缺乏适合癌症患者的运动计划。因此,本研究的目的是:1)确定西澳大利亚地区是否有肿瘤运动项目;2)探索这些资源是否适合满足该地区癌症患者的需求,以便为该地区创建全面的转诊资源。 通过全面的在线搜索,确定了该地区为癌症患者提供的所有运动服务。我们使用癌症康复到娱乐(CaReR)框架对服务进行了分类,以描述每种服务所提供的护理水平。该地区癌症患者的地理构成和人口统计学特征与服务相匹配,以确定服务差距。 西南部地区约有 19.4 万人,每年有 1300 名居民被诊断出患有癌症。经确认,有 66 项肿瘤运动服务适合为这部分人口提供服务。62%的项目位于该地区最大的两个郡。66% 的服务被归类为 CaReR 第 1 阶段,为高需求患者提供有针对性的监督护理;79% 为第 2 阶段,为中等需求患者提供有针对性的监督护理;28% 为第 3 阶段,为低需求患者提供独立的社区护理。 西南地区的资源严重不足,无法满足将运动转介纳入癌症患者护理的国家指令。这主要是由于缺乏针对这一人群的运动服务,以及很少有项目能满足患者的不同需求。需要开展以实施为重点的研究,以解决从研究到实践的这一关键差距。
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引用次数: 0
PAINFUL VS NON-PAINFUL EXERCISE ON CREPITUS IN PEOPLE WITH KNEE OSTEOARTHRITIS: A MIXED-METHODS ANALYSIS 膝关节骨性关节炎患者的疼痛性运动与非疼痛性运动对crepitus的影响:混合方法分析
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.477
Mr Alexandre Kovats, Mr Adrian Ram, Matthew D Jones, A/Prof John Booth, Dr Mitchell T. Gibbs, A/Prof Jeanette Thom
Crepitus (or physiological noise) is a key criterion in the diagnosis of knee osteoarthritis (OA). Exercise is foundational to guideline-based care for knee OA, however the effect exercise on knee crepitus is unknown. This study aimed to explore the perceptions of people with knee OA following a 6-week accredited exercise physiologist (AEP) led intervention involving painful vs non-painful exercise, especially in relation to their knee crepitus. Participants were randomly assigned to either a painful (higher intensity) or non-painful (lower intensity) exercise program supervised by an AEP twice a week for six weeks with concurrent education. Volunteers partook in a post-intervention semi-structured interview with questions surrounding their experience and perceived outcomes of the program. Thematic qualitative analysis was conducted and compared to the Knee Injury and Osteoarthritis Outcome Score (KOOS) crepitus question (0 - 4 scale). Eleven participants volunteered. Qualitatively, approximately half of the participants self-reported a decrease in their knee crepitus following the program “I haven’t had the creaky knees so much”, with the rest stating their crepitus did not change. No participants perceived their crepitus increased (n=9 no change, n=2 decreased) or said that their crepitus was worse, “the noise and grinding doesn’t become evident (now) until the weights become higher”. Quantitatively, KOOS crepitus scores also did not change following the intervention [mean (SD) (2.4(1.0) to 2.1(1.3), p=0.19)]. There were no differences between exercise groups in self-perceived crepitus results, and most said that the exercise program was beneficial “Right after this whole program, I find that I can move much easier.” Exercise at higher intensities (into painful range) does not change crepitus or may improve it for some. People with OA perceive that exercise at both higher and lower intensity is beneficial and enjoyable.
吱吱声(或生理噪音)是诊断膝关节骨性关节炎(OA)的一个重要标准。运动是膝关节 OA 指导性治疗的基础,但运动对膝关节褶皱的影响尚不清楚。本研究旨在探讨膝关节OA患者在接受为期6周的由认证运动生理学家(AEP)主导的疼痛与非疼痛运动干预后的感受,尤其是与膝关节皱褶有关的感受。 参与者被随机分配到一个痛苦(较高强度)或非痛苦(较低强度)的运动项目中,该项目由一名运动生理学家指导,每周两次,为期六周,并同时进行教育。志愿者参加了干预后的半结构式访谈,问题围绕他们的经历和对项目成果的感知。我们进行了专题定性分析,并将其与膝关节损伤和骨关节炎结果评分(KOOS)的皱褶问题(0 - 4 级)进行了比较。 有 11 名参与者自愿参加。从定性角度来看,约有一半的参与者自称参加该计划后膝关节褶皱减少了,"我的膝盖不再那么嘎吱作响了",其余的人则表示他们的褶皱没有变化。没有参与者认为膝关节疼痛加剧(9 人无变化,2 人减轻),也没有参与者表示膝关节疼痛加剧,"(现在)直到负重增加,疼痛和磨擦才会明显减轻"。从数量上看,KOOS 痉挛评分在干预后也没有变化[平均值(标清)(2.4(1.0) 至 2.1(1.3),P=0.19)]。在自我感觉的疼痛结果方面,各运动组之间没有差异,大多数人都表示运动项目是有益的,"在整个项目结束后,我发现我可以更轻松地活动了"。 较高强度的运动(达到疼痛范围)并不会改变某些人的皱褶感,或者可能会有所改善。有 OA 的人认为高强度和低强度的运动都是有益和愉快的。
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引用次数: 0
FOSTERING RECOVERY: A CASE STUDY ON THE JOURNEY FROM UNCERTAINTY TO DIAGNOSIS IN POST-COVID POTS 促进康复:关于卵巢癌后盆腔从不确定性到诊断过程的案例研究
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.375
Olivia Powrie
Imagine, one day you are an active 20-year-old, then after a COVID-19 infection, your life is now limited by debilitating symptoms: fainting, palpitations, and exercise intolerance. Your whole world has changed, and you have no diagnosis and no treatment options. This was reality for a patient referred to cardiac rehabilitation in early 2023 as a unique case, not meeting usual service criteria. In the absence of a formal diagnosis, there was no clear pathway for treatment and no rehabilitation guidelines to follow. After a comprehensive assessment, marking the start of the road to recovery, a conservative and gradual approach to re-introducing exercise was developed, whereby progressions were only made when no symptoms were experienced during nor following the sessions. Across the next nine months, further symptoms were identified, prompting further research, which shaped a plausible diagnosis: Postural Orthostatic Tachycardia Syndrome (POTS). Whilst initially dismissed as a possibility by the patient’s cardiologist, after further questioning, gaining objective data and referral to specialist physicians, this plausible diagnosis was confirmed. Through months of rehabilitation, lifestyle modifications and commencing medication, this patient has improved symptom control and increased activity tolerance. Importantly, this has allowed return to studying, return to part time work and return to tolerating daily activities. As exercise physiologists, we often spend more time with patients than medical practitioners, and resultingly identify characteristics which may otherwise be missed in busy clinics. This case study acts as a reminder of the importance of trusting your instinct and not being afraid to advocate for patients - doing so may just re-direct them down the road to recovery. With the increasing prevalence of dysautonomia, particularly POTS, as consequences of COVID-19 infections, there is an ever-increasing need for awareness, in addition to clinician upskilling to ensure best support and management of these patients.
试想一下,有一天你还是一个活泼好动的 20 岁年轻人,但在感染 COVID-19 后,你的生活却受到了令人衰弱的症状的限制:晕厥、心悸和运动不耐受。你的整个世界都变了,你没有诊断,也没有治疗方案。这就是 2023 年初转介到心脏康复中心的一名患者的现实情况,他是一个特殊病例,不符合通常的服务标准。 在没有正式诊断的情况下,没有明确的治疗路径,也没有康复指南可循。经过全面评估后,患者开始了康复之路,并制定了保守和循序渐进的方法来重新开始锻炼,只有在训练期间和训练后没有出现任何症状时,才会继续训练。在接下来的九个月中,患者出现了更多的症状,这促使他们进行了进一步的研究,并得出了一个合理的诊断:体位性正位性心动过速综合征(POTS)。虽然患者的心脏病专家起初认为这种可能性不大,但经过进一步询问、获取客观数据并转诊至专科医生后,这一可信的诊断得到了证实。 通过几个月的康复治疗、生活方式调整和开始服药,这名患者的症状控制得到了改善,活动耐受力也有所提高。重要的是,这使得患者能够重返校园,重新开始兼职工作,并恢复了对日常活动的耐受力。 作为运动生理学家,我们往往比医生花更多的时间与患者在一起,因此能够发现在繁忙的临床工作中可能被忽略的特征。本病例研究提醒我们,必须相信自己的直觉,不要害怕为患者争取权益--这样做可能会重新引导他们走上康复之路。随着 COVID-19 感染导致的自律神经失调症(尤其是 POTS)发病率的增加,除了提高临床医生的技能以确保为这些患者提供最佳支持和管理外,还需要不断提高人们的认识。
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引用次数: 0
CONSUMER EXPERIENCE OF AN AUSTRALIAN MULTIDISCIPLINARY LONG COVID CLINIC THAT INCORPORATES PERSONALISED EXERCISE PRESCRIPTION: A QUALITATIVE ANALYSIS 澳大利亚多学科长期慢性病诊所结合个性化运动处方的消费者体验:定性分析
Pub Date : 2024-05-01 DOI: 10.31189/2165-7629-13-s2.501
Ms Tanya Buettikofer, Ms Allison Maher, Ms Veronica Rainbird, Ms Michelle Bennett, Associate Professor Nicole Freene, Professor Imogen Mitchell, Dr Hsin-Chia Carol Huang, Dr Phil Gaughwin, Mary Johnson, Jenny Paratz, Bernie Bissett
Little is known about the Australian experience of Long COVID recovery, particularly with respect to exercise prescription. The aim of this study was to understand the consumer experience and acceptability of a novel Australian Long COVID Recovery Clinic that incorporates personalised exercise prescription, including respiratory and peripheral strengthening and carefully monitored cardiovascular training. Qualitative study; semi-structured interviews with a convenience sample of participants who have completed a multidisciplinary, individually-tailored and supervised programme at our Long COVID Recovery Clinic. Interviews were conducted by a researcher external to the clinic delivery. Major themes were identified by inductive thematic analysis. 15 participants were interviewed. 14/15 (93%) participants described the clinic model as acceptable or highly acceptable. Five core themes were identified, including (1) encouraging staff and light-filled facilities are key to support recovery; (2) individually tailored, supervised exercise and pacing helped to improve confidence in building exercise capacity; (3) peer support and group therapy augments recovery; (4) recovery from Long COVID is incomplete, and other services augment the Long COVID Recovery Clinic model; and (5) importance of GP involvement in connection with clinic participation. Suggestions for improvement included extending the duration of the clinic programme beyond 2 months, reducing wait times by increasing staffing levels and adjusting the clinic schedule to broaden access options. The majority of participants found the Long COVID Recovery Clinic, which incorporates both supervised exercise and pacing, acceptable and would recommend it to others. From the consumer perspective, the Long COVID Recovery Clinic aids recovery alongside GP management through a combination of peer support and an individually tailored program.
人们对澳大利亚的 Long COVID 恢复经验知之甚少,尤其是在运动处方方面。本研究旨在了解消费者对澳大利亚新型长 COVID 恢复诊所的体验和接受程度,该诊所结合了个性化运动处方,包括呼吸和外周强化训练以及精心监测的心血管训练。 定性研究;半结构式访谈,访谈对象为在我们的长COVID康复诊所完成了多学科、个性化定制和监督计划的参与者。访谈由一名诊所外的研究人员进行。通过归纳式主题分析确定了主要的主题。 共对 15 名参与者进行了访谈。14/15(93%)名参与者认为诊所模式可以接受或非常可以接受。确定了五个核心主题,包括:(1)鼓励性的工作人员和光线充足的设施是支持康复的关键;(2)个人定制、监督下的运动和步调有助于提高建立运动能力的信心;(3)同伴支持和小组治疗可增强康复效果;(4)长期慢性阻塞性肺病的康复是不完整的,其他服务可增强长期慢性阻塞性肺病康复诊所模式的效果;以及(5)全科医生的参与对诊所参与的重要性。改进建议包括将门诊计划的持续时间延长至两个月以上,通过增加人员配置减少等待时间,以及调整门诊时间表以扩大就诊选择。 大多数参与者认为,长效COVID康复门诊结合了监督锻炼和步调训练,是可以接受的,并会向其他人推荐。从消费者的角度来看,Long COVID 康复诊所通过结合同伴支持和个人定制计划,在全科医生管理的同时帮助患者康复。
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引用次数: 0
期刊
Journal of clinical exercise physiology
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