A feasibility study to evaluate a purposeful walk intervention with a distance goal using a commercially available activity monitor in elderly people post total hip replacement surgery.

Introduction: Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). Method: Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. Results: Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6 months were recruited from the local community. Conclusion: The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted.

Can a Purposeful Walk Intervention with a Distance Goal Using an Activity Monitor Improve Individuals' Daily Activity and Function Post Total Hip Replacement Surgery. A Randomized Pilot Trial.

Individuals have increasingly high expectations of return to activity following total hip replacement (THR) surgery. The current literature demonstrates marked improvements in pain following THR. However, there is limited evidence showing objective improvement in daily activity. This randomized pilot trial aimed to determine the effect of an intervention where outdoor walking distance is used as a goal to increase daily activity of older adults using a commercial activity monitor at 3 to 6 months post THR. Findings suggested that the participants in the intervention group had higher activity levels after THR, compared to those in the control group. The Cohen's effect sizes were larger for the changes in the gait, Hip Disability and Osteoarthritis Outcome Score, and Psychosocial Impact of Assistive Devices Scale data in the intervention group in contrast to the control group. However, further research with a larger sample size is required to provide tangible evidence on the significance of the effect of the purposeful walk compared to step count.

A review of current use of commercial wearable technology and smartphone apps with application in monitoring individuals following total hip replacement surgery.

The advent of commercially available wearable activity monitors and smartphone apps allows objective digital monitoring of daily activities of patients before and after THR surgery. A wide variety of wearable activity monitors and smartphone apps are being marketed to assist with enhancing physical activity following surgery. A systematic review of commercial wearable technology and smartphone apps was undertaken to assess the evidence supporting their efficacy in assisting rehabilitation and patient monitoring following THR. A search was conducted using the electronic databases including Medline, CINAHL, Cochrane, PsycARTICLES and PubMed of studies from January 2000 to January 2019. Five studies met the eligibility criteria. A review of the studies found very little evidence to support long term efficacy of the technology in enhancing rehabilitation and patient monitoring post THR. Future work is required to establish which commercially available monitoring technology is most valuable to patients, which ones improve clinical outcomes post THR, and what are the best economical models for their deployment.

Why Do People Undergo THR and What Do They Expect to Gain-A Comparison of the Views of Patients and Health Care Professionals.

Little concerted effort has been made to understand why individuals undergo total hip replacement (THR) surgery and their rehabilitation goals. Similarly, insight of views and perspective of health care professionals' (HCPs) regarding surgery and what objective measures help them with decision-making is lacking. This patient and public involvement report aimed to explore both patients' and HCPs' perspectives of THR surgery. Twenty patients, 10 pre-THR, 10 post-THR, 9 physiotherapists, and 6 surgeons took part. Results suggest a consensus among patients and HCPs on pain reduction being the main reason for undergoing THR. The inability to carry out simple daily activities such as dog walking and sleep deprivation had a significant effect on patients' mental and physical well-being. This article is the first to explore the views of THR patients and HCPs on reasons behind THR surgery amalgamated into a single report. As walking is important, wearable activity monitors are suggested as a possible motivator to enhance patient compliance to self-care rehabilitation and increase quality of life. A future research project on the use of such wearable activity monitors in enhancing mobility post-THR is therefore planned.

Management of chronic fatigue syndrome/myalgic encephalomyelitis in a pediatric population: A scoping review.

Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) negatively impacts the quality of life for children with the condition. Although up to 2% of children have CFS/ME, the bulk of research investigates adults with CFS/ME. Using the PRISMA extension for a scoping review and the work of Arksey and O'Malley (2005), a scoping review was conducted of all relevant peer-reviewed research investigating nutrition, exercise, and psychosocial factors within a pediatric population diagnosed with CFS/ME. Key themes found were nutrition and dietary components, exercise therapy, psychosocial factors, and multifaceted treatment. Nutrition was explored on its own as a tool to decrease symptoms; however, there were very few studies found to examine nutritional deficiency or treatment with those under the age of 18. Graded exercise and resistance training improved fatigue severity and symptoms of depression in adolescents with CFS/ME. Research exploring psychosocial factors of CFS/ME presented attributes that could lead to being diagnosed as well as barriers to treatment. The multifaceted treatment undertaken typically consists of graded activities/exercise, cognitive behavioral therapy, nutritional advice, and family sessions. This has shown to increase school attendance and decrease the severity of the fatigue for adolescents. Minimal literature exploring CFS/ME within a prepubescent population presents the need for further research.

Closing the gap on nurse retention: A scoping review of implications for undergraduate education.

OBJECTIVES: Newly qualified nurses leave the profession at a higher rate than any other year of experience. Undergraduate education influences nurse retention following qualification. However, it is unclear if the factors associated with intent to leave are included within programmes to aid retention once qualified. A scoping review was conducted to explore the literature within nursing as well as social work undergraduate education to obtain viewpoints from an allied profession with similar retention barriers. DESIGN AND DATA SOURCES: Following PRISMA extension guidelines for scoping review, the research question used to explore the literature was: What is the impact of undergraduate nurse and social work education on retention when newly qualified? Databases searched were BNI, CINAHL complete, Science Direct, PsycINFO, Medline Complete, Academic Search Complete and ERIC. REVIEW METHOD: One author undertook a comprehensive electronic and hand-search of relevant research articles. These were then discussed with two authors for inclusion within the review and data extracted for thematic analysis. RESULTS: Limited through search inclusion and quality of research, ten research papers met the criteria for this review. Main themes found were resilience and commitment, perceived knowledge and confidence, preparation for transition and expectation of supervision. CONCLUSION: The literature presents the need to strengthen resilience-building within undergraduate education in the transition to newly qualified practitioner, support to cope with the emotional and physical impact of professional practice as well as developing confidence in one's skills, guidance for career progression, promotion of authentic leadership in work-place mentors and commitment of both the University and health or social organisation to support staff to be healthy and feel valued.

Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews.

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS-a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)-developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. OBJECTIVE: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. METHODS: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. RESULTS: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management. CONCLUSIONS: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution.

Qualitative insights into the feelings, knowledge, and impact of SUDEP: A narrative synthesis.

People with epilepsy (PWE) have a two- to threefold increased chance of premature death due to the condition. Interested in exploring the first-person perspective on this topic, we conducted a narrative synthesis to present the qualitative insight of PWE, their family, friends, and healthcare providers (HCPs) in relation to epilepsy-related death. A comprehensive electronic search of all peer-reviewed qualitative studies was conducted through databases using relevant keywords and Medical Subject Headings (MeSH) terms. Handsearching and exploration of pertinent gray literature was conducted thereafter. After a comprehensive literature search, the decisions of inclusion of literature were discussed and confirmed between the two authors. A total of 20 peer-reviewed papers were included. Within this, 17 were qualitative or mixed methods studies, and three were gray literature and guidelines/recommendations in discussing sudden unexpected death in epilepsy (SUDEP) with PWE and their families. The resultant main categories were the following: a) understanding of SUDEP and b) discussion of SUDEP. Findings show that there is an overall lack of understanding of unexpected epilepsy-related death for PWE and their relations. The literature focused on the education of PWE and their family in relation to SUDEP, and therefore, there is a lack of discussion on the general topic of epilepsy-related death. Findings show the conflicting perceptions, feelings, and thought processes that occur in learning about and deciding to discuss SUDEP as a HCP, PWE, or family/friend of a PWE. The literature suggests that it would be appropriate and necessary to discuss the topic of SUDEP with patients and their family members upon diagnosis.

'I'd rather you didn't come': The impact of stigma on exercising with epilepsy.

Epilepsy is a common but hidden disorder, leading to stigma in everyday life. Despite stigma being widely researched, little is known about the impact of stigma for people with epilepsy within a sports and exercise setting. Using constructionist grounded theory, we explored the barriers and adaptations to exercise for people with epilepsy. Three focus groups (2-3 participants per group) and three semi-structured interviews were conducted (11 participants in total). Stigma negatively impacted joining team sports, running groups, and disclosure to others. The effect of stigma was reduced by educating others about epilepsy, thus creating more awareness and understanding.

How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy.

Exercise has been shown to be a physiological and psychological benefit for people with epilepsy (PWE). However, barriers prevent many PWE from exercising safely and confidently. This research explored current perceived barriers to exercise and adaptation techniques used by PWE in order to maintain physical activity levels. Three focus groups (2-3 participants per group) and three semi-structured interviews were conducted (11 participants total). Constructive grounded theory was used to frame the study and analyse the findings, presenting new insight into the motivation, perceived barriers, and adaptation techniques used to exercise. The main motivator to maintain physical activity levels was the benefit of exercise on physical and mental health. This was shown in an increase in mood, higher social interaction, and perceived improvement in overall physical health as a result of exercise. Current barriers to exercise included a fear of injury, lack of social support, and exercise-induced seizures (e.g., through overheating and/or high exercise intensity level). Adaptation techniques used were self-monitoring through the use of technology, reducing exercise frequency and intensity level, and exercising at certain times of the day. The importance of social support was shown to provide increased confidence and positive encouragement to exercise, contrasting with family and friends worrying for his/her safety and medical professionals requesting termination of some physical activities. These findings provide new insight into current adaptation techniques that are used and developed by PWE to overcome common barriers to exercise. These new additions to the literature can lead to further development of such techniques as well as examine current medical professionals' knowledge of the benefits of exercise for PWE.

The psychosocial impact of exercising with epilepsy: A narrative analysis.

Research has presented the benefits of and barriers to exercise for people with epilepsy through quantitative means. However, individual experiences through qualitative investigations have been absent. This research will present the narratives of people with epilepsy exercising over time and, as a result, develop further understanding of the psychosocial impact of exercising with epilepsy. Four interviews were conducted over the course of one year (one every three to four months) with four participants (aged 23-38years) who varied in seizure type and control (16 interviews in total). A narrative analysis was used to analyze their exercise experiences. Results showed that exercise creates a positive effect on psychological and physical well-being. However, prevention from exercise as a result of medical advice or recurrent seizures can create negative effects such as social isolation, anxiety, lack of confidence, frustration, and anger. Adaptations of decreasing exercise intensity level and partaking in different physical activities are techniques used to lessen the negative impact and maintain an exercise routine. Time was shown to be an important factor in this adaptation as well as portrayed the cyclical responses of negative and positive emotions in regard to their exercise life. These findings provide valuable insight into the psychosocial benefits of and barriers to exercising with epilepsy and draw attention to the individual differences in how a person with epilepsy copes with uncontrolled seizures and their impact on his/her exercise routine. This knowledge can lead to future research in exploring how a person with epilepsy can overcome these barriers to exercise and encourage more people with epilepsy to enjoy the benefits of exercise.

Preconception health promotion: analysis of means and constraints.

OBJECTIVES: To assess means and constraints of preconception care implementation. METHODS: Three strategies were applied to promote preconception health: organisation of a campaign, production of guidelines, and implementation of a preconception pilot clinic. Three surveys investigated the knowledge and practices of women before and after the campaign, and one survey assessed the attitudes of gynaecologists. RESULTS: Posters and leaflets are more efficient than TV spots; implementation of a pilot clinic enhances all activities in the field of preconception health. With regard to constraints, we observed that (i) preconception care could not be provided when pregnancy was unplanned; (ii) the necessity of postponing pregnancy interfered with vaccinations; (iii) the compliance of women with regard to the prolonged intake of folates is poor; (iv) the application of guidelines by providers is inconsistent; (v) providers lack training regarding genetic ethical stakes; and (vi) practitioners find it difficult to integrate the concept of private eugenics and to envision the probabilistic character of the clinical manifestations of inherited diseases. CONCLUSIONS AND RECOMMENDATIONS: We propose (i) flour fortification with folic acid; (ii) timely immunisation by preventive medicine at school, and (iii) continuous training of health care providers in the provision of preconception care.

Using the Rasch model to validate stages of understanding the energy concept.

In recent years, there have been efforts to bridge science education with developmental psychology to develop theories on students developing understanding of science concepts from elementary to high school and beyond. The present study intends to test one such theory on students developing understanding of the energy concept. The theory states that students develop understanding of the energy concept by going through the following qualitatively distinct stages: (a) energy as activity/work; (b) energy as sources/forms, (c) energy transfer, (d) energy degradation, and (e) energy conservation. Three classes, one each from 4th grade, 8th grade, and high school physics class (grades 10, 11, and 12), completed a performance assessment. Students' performances were scored based on three traits of energy understanding: attention capacity, qualitative relations, and quantitative relations; each of the traits was defined into five hierarchical levels consistent with the five stages of understanding the energy concept. The Many-Facet Rasch Measurement (MFRM) model was used to analyze the effects of rater scoring severity, students' stages of energy understanding (theta), and difficulties of energy understanding traits. Results show that there was a discontinuity among the stages of understanding the energy concept, supporting the theory on students developing the understanding of the energy concept.