To increase physical activity in sedentary patients with affective - or schizophrenia spectrum disorders - a clinical study of adjuvant physical therapy in mental health.

Purpose: To understand if physical therapy in addition to individualized psychiatric specialist treatment could aid sedentary patients with schizophrenia spectrum disorders or affective spectrum disorders to become more physically active and also to identify assessments suitable for measuring physical activity, physical function and movement motivation.Materials and methods: In a longitudinal, clinical study 18 sedentary patients that filled inclusion criteria were consecutively included. The patients were diagnosed with affective disorders (n = 10) or schizophrenia spectrum disorders (n = 8).Results: Fifteen patients fulfilled the 6-month treatment. The affective group significantly improved physical activity, walking capacity, physical function, exercise habits and attitudes. The schizophrenia spectrum group significantly improved the attitudes to the body and movements but did not increase their physical activity. Instruments to study physical activity, physical function and movement motivation were identified.Conclusion: The study revealed that physical therapy in addition to individualized psychiatric specialist treatment might be an aid for the patients to become more physically active. Patients with affective disorders reached recommended levels of moderate physical activity according to World Health Organization guidelines. Sedentary patients with schizophrenia spectrum disorders revealed positive attitude-changes, but no behavioral change.

Clinician perspectives of Basic Body Awareness Therapy (BBAT) in mental health physical therapy: An international qualitative study.

INTRODUCTION: Body awareness is a movement therapy used in Physical Therapy in Mental Health especially in Scandinavia. The method Basic Body Awareness Therapy has been scientifically investigated in particular for patients with Depression, Schizophrenia and Post Traumatic Stress Syndrome (PTSD). METHODS: Thirty-four Physical Therapists from 13 countries working with the Basic Body Awareness Therapy method in Mental Health Care were interviewed in six focus groups about what effects they have experienced in their work with patients. The Physical Therapists worked within the whole Mental Health spectra. Content analysis was used to analyze the informants' experiences of the clinical effects of body awareness. RESULTS: Five categories emerged: To be in contact, Refocus and coping, Sense of Self, Relations to others and Daily life activities. The results are discussed in relation to previous research, existing theories of body awareness and cognitive neuroscience and findings of experimental psychology. CONCLUSION: The informants experienced that Basic Body Awareness Therapy worked mainly by helping the patients to be in better contact with their "bodily self." Stability, balance, improved grounding and the ability to relax were understood as the basis to establish an improved sense of self and leading to improved acceptance of oneself and one's ability to relate to others.

Understanding one's body and movements from the perspective of young adults with autism: A mixed-methods study.

BACKGROUND: There are but a few studies of how persons with autism perceive their bodies and movements. Difficulties in perceiving the surrounding world along with disturbed motor coordination and executive functions may affect physical and psychological development. AIMS: To explore the experiences of body and movements in young adults with autism and how two physiotherapeutic instruments may capture these experiences. PROCEDURES: Eleven young adults (16-22 years) with autism were interviewed and assessed using Bruininks-Oseretsky Test of Motor Proficiency (BOT2) and Body Awareness Scale Movement Quality and Experience (BAS MQ-E). Following a mixed- methods design, the interviews were deductively analyzed and conceptually integrated to the results of the two assessments. RESULTS: Experiencing conflicting feelings about their bodies/movements, led to low understanding of themselves. The assessments captured these experiences relatively well, presenting both movement quality and quantity. Positive experiences and better movement quality related to having access to more functional daily strategies. CONCLUSION: Combining motor proficiency and body awareness assessments was optimal to understand the participants' experiences. IMPLICATIONS: To capture body and movement functions in persons with autism in this standardized manner will lead to improved and reliable diagnoses, tailored interventions, increased body awareness and activity, and enhanced quality of life.

Bodily symptoms in patients with post traumatic stress disorder: A comparative study of traumatized refugees, Danish war veterans, and healthy controls.

BACKGROUND: Post traumatic stress disorder (PTSD) is associated with increased general health symptoms and patients suffer from numerous bodily complaints such as increased pain, increased muscular tension, and restricted breathing. METHODS AND MATERIAL: This study applied the Body Awareness Movement Quality and Experience scale (BAS MQ-E) in assessing and comparing bodily symptoms, including movement function, in traumatized refugees (N = 14) and Danish war veterans with PTSD (N = 19) and healthy controls (N = 20). RESULTS: Patients with PTSD had significantly poorer stability, balance, flexibility and coordination in movement, had more muscular tension, more complaints of pain, more restricted breathing, and more limitation in function of daily life than healthy controls. CONCLUSION: The BAS MQ-E was found to be an applicable and useful measure of bodily symptoms in patients with PTSD. Further research may add to the validity of BAS MQ-E and might be considered in future studies evaluating the efficacy of physiotherapy for patients with PTSD.

One-year follow-up of basic body awareness therapy in patients with posttraumatic stress disorder. A small intervention study of effects on movement quality, PTSD symptoms, and movement experiences.

The present study with mixed methods design evaluated the long-term effects of Basic Body Awareness Therapy (BBAT) for patients with posttraumatic stress disorder (PTSD). Fifteen patients received 12 individual sessions of BBAT treatment as usual (TAU) when needed. The patients were assessed at baseline (T0), directly after treatment (T1) and at one-year follow-up (T2), using the Body Awareness Scale Movement Quality and Experience (BAS MQ-E), the Visual Analog Scale (VAS), and the Impact of Event Scale-Revised (IES-R). The results at T1 showed significant improvement in the quality of movement (p = 0.001), body experience (p = 0.007), and symptoms (p = 0.001). At T2, the improvements were sustained. Pain in stillness (p = 0.017) and during movement (p = 0.007) had decreased. The verbal ability to describe the body experiences in words was poor at T0, but became more detailed at T1 and even more so at T2. Our findings suggest that BBAT in addition to TAU can be a viable physiotherapeutic treatment for patients with PTSD. This knowledge may influence future treatment strategies for patients with PTSD and be of guidance to physiotherapists working with persons with trauma experiences in the community or psychiatry/mental healthcare areas.

Computerized physical activity training for persons with severe mental illness - experiences from a communal supported housing project.

PURPOSE: To study the effectiveness of Exergames in communal psychiatry for persons with severe mental illness, a randomized cluster study was performed. The hypothesis was to increase physical activity habits to improve somatic health. To identify factors promoting or impeding the use of the Exergames. METHODS: Assessments of BMI, blood pressure, physical fitness, SF36, GAF and social interactions were studied at baseline and 10 months. An integrated methods design using content analysis of focus group interviews was integrated with a statistical analysis. Forty-three persons were randomized to the intervention and 30 to the control group. The qualitative interviews included 18 users, 11 staffs and one technical assistant. RESULTS: There were no significant between-group changes in physical activity behaviours or somatic health parameters after 10 months. Only 5% of the intervention group made systematic use of the intervention. Technological difficulties and staff attitudes were found to be barriers. The Exergames were perceived as technically complicated. The staff did not see playing TV games as important and negative attitudes were found. CONCLUSIONS: Exergames was not a successful intervention to increase physical activity behaviours in persons with severe mental illness in the community. Exergames and motivation for physical activity in this group is problematic. Implications for rehabilitation There are difficulties to change passive physical activity habits for persons with severe mental illness, living in sheltered housing conditions in the community due to negative symptoms with depression, low motivation and bad self -confidence. An exergame intervention was not successful in this group of persons. No somatic health benefits were found. Simple physical activities and offering different choices meeting different user needs should be offered. Ensuring user and staff engagement, good technical knowledge and good monitoring is a need for a successful intervention, if Exergames are offered as an alternative physical activity.

Assessing movement quality in persons with severe mental illness - Reliability and validity of the Body Awareness Scale Movement Quality and Experience.

Motor disturbances and disturbed self-recognition are common features that affect mobility in persons with schizophrenia spectrum disorder and bipolar disorder. Physiotherapists in Scandinavia assess and treat movement difficulties in persons with severe mental illness. The Body Awareness Scale Movement Quality and Experience (BAS MQ-E) is a new and shortened version of the commonly used Body Awareness Scale-Health (BAS-H). The purpose of this study was to investigate the inter-rater reliability and the concurrent validity of BAS MQ-E in persons with severe mental illness. The concurrent validity was examined by investigating the relationships between neurological soft signs, alexithymia, fatigue, anxiety, and mastery. Sixty-two persons with severe mental illness participated in the study. The results showed a satisfactory inter-rater reliability (n = 53) and a concurrent validity (n = 62) with neurological soft signs, especially cognitive and perceptual based signs. There was also a concurrent validity linked to physical fatigue and aspects of alexithymia. The scores of BAS MQ-E were in general higher for persons with schizophrenia compared to persons with other diagnoses within the schizophrenia spectrum disorders and bipolar disorder. The clinical implications are presented in the discussion.

Considering the Role of Physical Therapists Within the Treatment and Rehabilitation of Individuals With Eating Disorders: An International Survey of Expert Clinicians.

PURPOSE: Recent research has demonstrated that physical therapy may benefit the physical and mental health of people with eating disorders (EDs). Because this is a new and developing field, this study aimed to investigate the experience, practices and knowledge of international physical therapy experts to inform clinical practice, education and research. METHODS: An international cross-sectional survey design was undertaken with experienced physical therapists within the field of EDs. Physical therapist responses were analysed with descriptive statistics and thematic analysis as appropriate. RESULTS: Twenty-eight international physical therapists participated. On average, participants had 6.9 years (95% confidence interval: 3.1-10.7, n = 27) of clinical experience working in ED settings and devoted approximately 39.3% (95% confidence interval: 23.8-54.8, n = 27) of their time to treating individuals with EDs. Participants reported that physical therapy interventions have a diverse range of benefits on the physical, mental and disease-specific factors (e.g. binges) in people with EDs. The key role of physical therapists includes improving body awareness, especially during physical activity combined with psycho-education about healthy doses of physical activity. Physical therapists were able to identify a range of barriers and facilitators to physical activity in people with EDs. DISCUSSION: This paper provides a first step towards understanding the role and value of physical therapists working with individuals with EDs. Copyright © 2015 John Wiley & Sons, Ltd.

A psychometric study of the multidimensional fatigue inventory to assess fatigue in patients with schizophrenia spectrum disorders.

Fatigue is frequently reported by patients with mental illness. The multidimensional fatigue inventory (MFI-20) is a self-assessment instrument with 20 items including five dimensions of fatigue. The purpose of this study was to examine the test-retest reliability, internal consistency, convergent construct validity and feasibility of using MFI-20 in patients with schizophrenia spectrum disorders. Patients completed two self-assessment instruments, MFI-20 (n = 93) and Visual Analogue Scale (n = 79), twice within 1 week ± 2 days. Fifty-three patients also rated the feasibility of responding to the MFI-20 with a Likert scale. The test-retest reliability and validity were analysed by using Spearman's correlations and internal consistency by calculating Cronbach's α. The test-retest showed a correlation between .66 and .91 for all subscales of MFI. The internal consistency was .92. The analysis of convergent construct validity showed a correlation of .68 (time 1) and .77 (time 2). No item was systematically identified as being difficult to answer.

The physiotherapists' experience of Basic Body Awareness Therapy in patients with schizophrenia and schizophrenia spectrum disorders.

BACKGROUND: Scandinavian physiotherapists (PT) treat patients with schizophrenia and schizophrenia spectrum disorder, mainly because of the latter's bodily difficulties. One commonly used method is Basic Body Awareness Therapy (BBAT), targeting the difficulties with sensory motor dysfunction and disembodiment. The aim of the study is to describe the physiotherapist's experiences of using BBAT for patients with Schizophrenia. METHOD: In a qualitative study, eight physiotherapists, who use BBAT when treating patients with schizophrenia were interviewed. The interview transcriptions were analysed according to content analysis. RESULTS: Three stage related themes were created: "encountering" "discovery towards embodiment", and "inner space towards outer world". In "encountering" the PTs described important aspects at the beginning of treatment. "Discovery towards embodiment" revealed how the PTs conceived that the patients' attention is directed toward their own body and their bodily experiences. The theme, "inner space towards outer world" reflects the PTs experience of the changes achieved and how patients turn their attention to the outside world as a more competent self.

International Organization of Physical Therapy in Mental Health consensus on physical activity within multidisciplinary rehabilitation programmes for minimising cardio-metabolic risk in patients with schizophrenia.

PURPOSE: The excess cardiovascular morbidity associated with schizophrenia is attributed to an interplay between behavioural (physical inactivity, unhealthy diet, substance abuse), genetic and illness related factors, as well as the effects of antipsychotic treatment. Patients have limited access to physical healthcare with less opportunity for cardiovascular risk prevention and treatment programmes than the non-psychiatric population. The aim of this paper is to improve physical activity (PA) within rehabilitation programmes for people with schizophrenia. METHOD: The development process consisted of: a) systematic literature review on PA in schizophrenia in eight databases up to May 2010; b) review on existing national and international guidelines; c) consensus meetings, and d) formulation of the final consensus document. RESULTS: There is insufficient evidence for the relative contribution of PA reducing cardio-metabolic risks in people with schizophrenia. Demographical, biological, psychological, cognitive-behavioural, emotional, social and environmental barriers for PA could be identified. CONCLUSIONS: Although PA outcomes on cardio-metabolic parameters are still unknown, the benefits of physical activity as part of a larger lifestyle programme are sufficient for the recommendation that persons with schizophrenia follow the 2008 U.S. Department of Health and Human Services PA Guidelines with specific adaptations based on disease and treatment-related adverse effects.

Test-retest reliability of two instruments for measuring public attitudes towards persons with mental illness.

BACKGROUND: Research has identified stigmatization as a major threat to successful treatment of individuals with mental illness. As a consequence several anti-stigma campaigns have been carried out. The results have been discouraging and the field suffers from lack of evidence about interventions that work. There are few reports on psychometric data for instruments used to assess stigma, which thus complicates research efforts. The aim of the present study was to investigate test-retest reliability of the Swedish versions of the questionnaires: FABI and "Changing Minds" and to examine the internal consistency of the two instruments. METHOD: Two instruments, fear and behavioural intentions (FABI) and "Changing Minds", used in earlier studies on public attitudes towards persons with mental illness were translated into Swedish and completed by 51 nursing students on two occasions, with an interval of three weeks. Test-retest reliability was calculated by using weighted kappa coefficient and internal consistency using the Cronbach's alpha coefficient. RESULTS: Both instruments attain at best moderate test-retest reliability. For the Changing Minds questionnaire almost one fifth (17.9%) of the items present poor test-retest reliability and the alpha coefficient for the subscales ranges between 0.19 - 0.46. All of the items in the FABI reach a fair or a moderate agreement between the test and retest, and the questionnaire displays a high internal consistency, alpha 0.80. CONCLUSIONS: There is a need for development of psychometrically tested instruments within this field of research.

Embodied identity--a deeper understanding of body awareness.

The aims of this study were to explore and generate an understanding of the meaning of body awareness through explanations of the experience of body awareness given by professionals and patients in psychiatric rehabilitation. A total of 20 strategically selected healthy informants were interviewed individually and in groups. Thirteen previous interviews with physiotherapists and 11 previous interviews with patients in psychiatric rehabilitation, describing their experiences of body awareness therapy and its effects were reanalyzed and included in the data for this study; in all 44 informants were included. Grounded theory methods guided the data construction and analysis. A theoretical understanding was conceptualised from which a core category of body awareness emerged: the embodied identity. This core category was related to two categories: living in the body and living in relation to others and in society. The subcategory "living in the body" was conceived as an important aspect to become more aware of the body and to experience oneself fromwithin in order to recognize one's needs. A key point was the fact that bodily experiences always exists in the present moment. The experience of the body, the balance, and stability of the physical self were basic experiences that were connected to the conception of well-being and control. To understand one's emotions and needs through the awareness of the body were understood as the base for self-confidence, trust in one-self, and the ability to take care of oneself and one's needs physically and mentally. The subcategory "living in relation to others and in society" was conceived as an important aspect for the embodied self to interact with others and for societal participation. Working with the body in physiotherapy practice should include an understanding that body awareness is inseparable from the identity and may have an impact on the health of the individual. This implies that interventions to address problems in body awareness should be integrated into physiotherapy practice.

The experiences of basic body awareness therapy in patients with schizophrenia.

BACKGROUND: Basic Body Awareness Therapy (BBAT) is a physiotherapeutic treatment method that is commonly used in Scandinavian mental health services. However, for patients with schizophrenia, there are few studies that verify the effectiveness of BBAT, or explain which dysfunctions or disabilities BBAT has an effect on in this group of patients. The aim of the present study was thus to describe patients' experiences of BBAT, focusing on perceived main treatment effects. The areas of perceived effects are to be investigated in future research. METHOD: In a qualitative study, eight patients with schizophrenia were interviewed. The interview transcriptions were analysed with content analysis methodology. RESULT: Patients with schizophrenia report positive treatment effects of physiotherapy with BBAT. Four main categories were identified: affect regulation, body awareness and self-esteem, effects described in a social context and effects on the ability to think. These should be targeted in a future randomized and controlled study.

Attitudes towards mental illness among health care students at Swedish universities--a follow-up study after completed clinical placement.

The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.

Reliability of the Body Awareness Scale-Health.

In physical therapy the clinical assessment Body Awareness Scale-Health (BAS-H) focusing on the quality of movements and movement behaviour has previously been studied for validity. The aim of this study was to address the inter-rater reliability and test-retest reliability in three groups. The groups assessed were: patients in psychiatric care with eating disorders (n = 26), patients in rehabilitation of prolonged musculoskeletal pain (n = 22) and healthy individuals (n = 22). Results revealed inter-rater reliability (n = 70) of the BAS-H total to be 79.9 % with acceptable agreement (accepting one scale-step of difference) and 48.7% with perfect agreement. Weighted Kappa ranged between 0.34 and 0.92. Test-retest reliability (n = 54) as a mean for both raters were found to be 90.5% for the BAS-H total with acceptable agreement and 60.4% with perfect agreement. Weighted Kappa ranged between 0.65 and 0.92. The BAS-H seems to be a reliable assessment in the rehabilitation of patient with prolonged pain, psychiatric disorders and healthy controls when used according to the manual. The authors, however, suggest some revisions.