Objectively Measured Steps/Day in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Although individual studies have reported on the number of steps/day taken by individuals with chronic obstructive pulmonary disease (COPD), this evidence has not been systematically reviewed or synthesized. METHODS: MEDLINE and PsycINFO were searched for studies reporting objectively-measured steps/day and percent predicted forced expiratory volume in 1 second (FEV1%) in patients with COPD. Meta-analyses were used to estimate steps/day across studies, while metaregression was used to estimate between-study variance based on clinical and demographic factors (year and location of study, activity monitor brand, number of days wearing the monitor, whether participants were about to enter pulmonary rehabilitation, 6-minute walk distance (6MWD), FEV1%, age, and sex). RESULTS: 38 studies including 2621 participants met inclusion criteria. The pooled mean estimate was 4579 steps/day (95% CI:4310 to 5208) for individuals with COPD. Only 6MWD, FEV1% and whether patients were about to undergo pulmonary rehabilitation explained a significant portion of the variance (P < 0.1) in univariate meta-regression. In a multivariate model including the above risk factors, only FEV1% was associated with steps/day after adjustment for other covariates. CONCLUSIONS: These results indicate that patients with COPD achieve extremely low levels of physical activity as assessed by steps/day, and that severity of airflow obstruction is associated with activity level.

The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting.

PURPOSE: The objective of this study was to assess the psychometric properties of the Stroke Impact Scale (SIS). METHODS: Data was derived from a study assessing a community-based stroke rehabilitation program. Patients were administered the SIS and Euroqol-5D (EQ-5D-5L) on admission to the study, and at six month and 12 month follow-up. The psychometric performance of each domain of the SIS was assessed at each time point. RESULTS: A total of 164 patients completed outcome measures at baseline, 108 patients at six months and 37 patients at 12 months. Correlation of the SIS domains with the EQ-5D-5L suggested that the dimensions of health contributing to a patient's perception of health-related quality of life changes over time. CONCLUSION: The SIS performed well in a sample of patients undergoing stroke rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor rehabilitation interventions to target the dimensions of health that are most important to a patient's overall health and perceived quality of life over time. Implications for Rehabilitation There is an increased need for valid and reliable measures to evaluate the outcomes of patients recovering from stroke in the community. The Stroke Impact Scale (SIS) measures multiple domains of health and is well-suited for use in patients recovering from stroke in the community. There is a high level of internal consistency in the eight SIS domains with no evidence of floor effects; ceiling effects were noted for several domains. Correlation of the SIS with the Euroqol-5D suggested that the dimensions of health contributing to a patient's perception of health related quality of life changes over time.

The Short Questionnaire to Assess Health-Enhancing (SQUASH) Physical Activity in Adolescents: A Validation Using Doubly Labeled Water.

BACKGROUND: Accurate assessment of physical activity energy expenditure (PAEE) among adolescents is important for surveillance, evaluating interventions, and understanding the relation between energy balance and normal physiological and behavioral growth and development. The purpose of this study was to examine the validity of the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH)13 for measuring PAEE among adolescents. METHODS: The participants were seventeen adolescents (9 females; Mean age = 17.53; SD = 0.62). Energy expenditure was measured during a 9-day period with doubly labeled water (DLW). The SQUASH was self-administered on the morning of the 10th day and assessed commuting activities, leisure time activities, household activities, and activities at work and school over the previous 9 days. RESULTS: A Bland-Altman plot indicated that the SQUASH underestimated PAEE compared with DLW by a mean difference of 126 kcal·d-1 (95% limits of agreement: -1,207 to 1,459 kcal·d-1), representative of a 10% underestimation. The Spearman rank order correlation coefficient showed there was a significant association between the SQUASH and DLW (r = .50, P = .04), for estimating PAEE. CONCLUSION: When using a sample of highly active adolescents, the SQUASH is a valid self-report tool for measuring PAEE at the group and individual rank order level.

Screening and facilitating further assessment for cognitive impairment after stroke: application of a shortened Montreal Cognitive Assessment (miniMoCA).

PURPOSE: The purpose of this study is to examine the performance of a shortened version of the MoCA (miniMoCA), as a clinical cognitive impairment screening tool in stroke rehabilitation patients. METHODS: Cognitive status was assessed using the MoCA and Cognistat in 72 patients. Agreement between the tests was assessed using the Kappa statistic. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of a miniMoCA to a MoCA score <26 was also examined. RESULTS: A significant level of agreement was found between the MoCA and miniMoCA to the Cognistat in classifying patients by level of cognitive function. The miniMoCA showed a sensitivity of 93% and specificity of 92% (PPV 98%, NPV 75%) to abnormal MoCA scores (<26). CONCLUSIONS: This study extends the utility of the miniMoCA as an optimal brief screening tool for cognitive impairment in stroke patients. Further research is needed to determine the validity of the miniMoCA against a neuropsychological test. IMPLICATIONS FOR REHABILITATION: Although the Montreal Cognitive Assessment (MoCA) is a recommended tool to screen for cognitive impairment in stroke patients, its lengthy administration can lead to inconsistent screening of patients for post-stroke cognitive function. In the current work, a shortened version of the MoCA (miniMoCA) was administered in a sample of stoke inpatients, utilizing only five of the eight original subtests. The proposed miniMoCA was found to streamline the administration of this screen test, while maintaining a heightened level of sensitivity for accurately identifying which patients do not require a more in-depth cognitive assessment.

Methodological Quality of Motor Intervention Randomized Controlled Trials in Stroke Rehabilitation.

PURPOSE: The objective of the study was to evaluate the methodological quality of motor intervention randomized controlled trials (RCTs) published in the stroke rehabilitation literature and to examine trends in quality over time. METHODS: A systematic literature search was conducted for all English articles (published up to December 2013) examining rehabilitation for motor recovery poststroke. All RCTs with a human sample, of which at least 50% had a stroke, were included in the analysis. A Physiotherapy Evidence Database (PEDro) score was assigned to assess methodological quality. A one-way analysis of variance was conducted to examine adherence to quality items overall and over time, with post hoc t-tests performed where appropriate. RESULTS: Six hundred seventy-six RCTs met inclusion criteria, of which 32.0% had excellent, 42.0% good, 23.1% fair, and 3.0% poor methodological qualities. The overall mean PEDro score was 6.6 ± 1.6; with scores improving significantly between 1979-1983 and 2009-2013 (5.0 ± 1.4 versus 7.0 ± 1.5; P = .0003); however, no significant improvements in individual items were found (P > .05). CONCLUSIONS: This study showed improvements in the total methodological quality of motor intervention RCTs in stroke rehabilitation over time. However, no relationship was found between individual quality items and improvement over time.

Bridging the gap: the role of Physiatrists in caring for adults with cerebral palsy.

PURPOSE: Individuals with cerebral palsy (CP) experience a significant gap in care as they move from interdisciplinary pediatric programs to limited or non-existent care in the adult sector. A lack of knowledgeable adult care providers has repeatedly been identified as a challenge in transitioning those with CP from pediatric to adult care. The objective of this study was to determine the extent to which Physiatrists provide care to adults with CP and to identify barriers to their engagement with this population. METHOD: A survey was distributed to Physiatrists across Canada. Results were analyzed descriptively using SPSS software. RESULTS: Most Physiatrists provide care to very few adults with CP (10 or less), but over 80% feel that Physiatry is the most appropriate specialty to provide disability-related care to adults with CP following their pediatric discharge. Among the most frequently identified barriers to caring for this population were lack of accessible resources (i.e. social work, funded therapy, equipment) and lack of referrals. CONCLUSIONS: Physiatrists are willing and appropriate partners in transitioning patients with CP to adult care. Barriers to Physiatrists' engagement with this population appear to be amenable to change. IMPLICATIONS FOR REHABILITATION: A lack of knowledgeable and interested adult practitioners has repeatedly been identified as a challenge in transition planning for young adults with cerebral palsy (the vast majority of whom survive into adulthood). Physiatrists are ideally suited to manage adults with cerebral palsy, yet in this survey-based study, a majority of Canadian Physiatrists report caring for less than five adults with cerebral palsy on a regular basis. Barriers to further physiatric involvement in this population were reported to include lack of accessible resources and lack of referrals.

A Domain-Specific Approach for Assessing Physical Activity Efficacy in Adolescents: From Scale Conception to Predictive Validity.

OBJECTIVE: To develop and test the utility of a domain-specific physical activity efficacy scale in adolescents for predicting physical activity behaviour. DESIGN: Two independent studies were conducted. Study 1 examined the psychometric properties of a newly constructed Domain-Specific Physical Activity Efficacy Questionnaire (DSPAEQ) and study 2 tested the utility of the scale for predicting leisure- and school-time physical activity. METHODS: In study 1, descriptive physical activity data were used to generate scale items. The scales factor structure and internal consistency were tested in a sample of 272 adolescents. A subsequent sample of Canadian (N = 104) and New Zealand (N = 29) adolescents, was recruited in study 2 to explore the scale's predictive validity using a subjective measure of leisure- and school-time physical activity. RESULTS: A principle axis factor analysis in study 1 revealed a 26-item, five-factor coherent and interpretable solution; representative of leisure and recreation, household, ambulatory, transportation, and school physical activity efficacy constructs, respectively. The five-factor solution explained 81% of the response variance. In study 2 the domain-specific efficacy model explained 16% and 1% of leisure- and school-time physical activity response variance, respectively, with leisure time physical activity efficacy identified as a unique and significant contributor of leisure-time physical activity. CONCLUSION: Study 1 provides evidence for the tenability of a five factor DSPEAQ, while study 2 shows that the DSPEAQ has utility in predicting domain-specific physical activity. This latter finding underscores the importance of scale correspondence between the behavioral elements (leisure-time physical activity) and cognitive assessment of those elements (leisure-time physical activity efficacy).

The Cognistat (neurobehavioural cognitive status exam): Administering the full test in stroke patients for optimal results.

BACKGROUND: One of the most commonly administered tools occupational therapists use for stroke patients is the Cognistat, which was designed as a brief screening tool of cognitive functioning. Evaluations in samples of patients have identified a high false-negative rate if the Cognistat is administered using the 'screen metric' approach. Assessing the Cognistat based on its intended design can ensure consistency and accuracy among occupational therapists for this commonly administered tool. Thus, this study examined the accuracy of administering the entire Cognistat in comparison to the screen-metric approach and the factor analytic structure within stroke patients. METHODS: The full Cognistat was administered to stroke patients receiving inpatient rehabilitation. RESULTS: Seventy-five patients who experienced a recent stroke met inclusion criteria. An inconsistency between the screen and metric items was found for five of 10 subscales. Additionally, a principal component analysis (PCA) found the Cognistat to be a two factor structure with six of the subscales loading on Factor 1, while the remaining subscales loaded on Factor 2. CONCLUSIONS: Our findings confirm that occupational therapists should administer the full Cognistat to stroke patients rather than the original screen-metric approach. A two-factor structure was also supported in our results, suggesting that occupational therapists' scoring practices should reflect this finding and use the differentiated score out of 10 rather than a global sum. However, additional research is necessary to consider the clinical and theoretical significance of the Cognistats' subscale clustering.

The next revolution in stroke care.

Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.

The Actiheart in adolescents: a doubly labelled water validation.

BACKGROUND/OBJECTIVE: This study investigated the validity of the Actiheart device for estimating free-living physical activity energy expenditure (PAEE) in adolescents. SUBJECTS/METHODS: Total energy expenditure (TEE) was measured in eighteen Canadian adolescents, aged 15-18 years, by DLW. Physical activity energy expenditure was calculated as 0.9 X TEE minus resting energy expenditure, assuming 10% for the thermic effect of feeding. Participants wore the chest mounted Actiheart device which records simultaneously minute-by-minute acceleration (ACC) and heart rate (HR). Using both children and adult branched equation modeling, derived from laboratory-based activity, PAEE was estimated from the ACC and HR data. Linear regression analyses examined the association between PAEE derived from the Actiheart and DLW method where DLW PAEE served as the dependent variable. Measurement of agreement between the two methods was analyzed using the Bland-Altman procedure. RESULTS: A nonsignificant association was found between the children derived Actiheart and DLW PAEE values (R = .23, R(2) = .05, p = .36); whereas a significant association was found between the adult derived Actiheart and DLW PAEE values (R = .53, R(2) = .29, p < .05). Both the children and adult equation models lead to overestimations of PAEE by the Actiheart compared with the DLW method, by a mean difference of 31.42 kcal.kg(-1).d(-1) (95% limits of agreement: -45.70 to -17.15 kcal.kg(-1).d(-1) and 9.80 kcal.kg(-1).d(-1) (95% limits of agreement: -21.22-1.72 kcal.kg(-1).d(-1)), respectively. CONCLUSION: There is relatively poor measurement of agreement between the Actiheart and DLW for assessing free-living PAEE in adolescents. Future work should develop group based branched equation models specifically for adolescents to improve the utility of the device in this population.

The effect of a multifaceted efficacy intervention on exercise behavior in relatives of colon cancer patients.

BACKGROUND: Regular physical activity (PA) provides health benefits; however, at least 60% of the population fails to engage in the recommended amount of PA required to produce these health benefits. PURPOSE: The primary purpose of the study was to examine over a 12-week structured exercise program the effect of a multifaceted efficacy intervention (MEI-i.e., task and specific types of self-regulatory efficacy) on objectively measured exercise behavior. Secondary purposes were to examine the effect of the MEI on both task and self-regulatory efficacy levels; and to determine whether efficacy beliefs could predict exercise behavior. METHODS: Relatives of colon cancer patients (N = 140) were enrolled in an exercise program, and were randomized to either a MEI or attention control condition, and took part in classroom sessions. Behavior was assessed throughout the 12-week program using objective measures of frequency, duration, and intensity of exercise, and dropout rates, while self-reported task, barrier, scheduling, goal-setting, and relapse prevention efficacy were assessed at baseline and weeks 4, 8, and 12. RESULTS: The MEI group exercised for longer duration in the early phase of the program (i.e., 0-4 weeks); however, no significant differences were noted for exercise frequency and intensity. Differential dropout was found favoring the MEI group at weeks 8 and 12. No treatment condition differences were found for reported efficacy beliefs. Proceeding self-efficacious beliefs were associated with objective measures of behavior. CONCLUSIONS: A MEI grounded in Social Cognitive Theory was partially effective in influencing colon cancer relatives' exercise behavior.