A consumer co-created infographic improves short-term knowledge about physical activity and self-efficacy to exercise in women with gestational diabetes mellitus: a randomised trial.

QUESTION: In women with gestational diabetes mellitus, does the addition of a consumer co-created infographic to usual education about gestational diabetes mellitus improve knowledge about physical activity and self-efficacy to exercise? DESIGN: A randomised trial with concealed allocation, a blinded assessor and intention-to-treat analysis. PARTICIPANTS: Sixty-nine women diagnosed with gestational diabetes mellitus. INTERVENTION: In addition to gestational diabetes education, the experimental group received a paper copy of a consumer co-created infographic about physical activity during a gestational diabetes pregnancy. The control group received gestational diabetes education alone. OUTCOME MEASURES: Participants completed outcome measures at baseline and again 1 week later. Knowledge of physical activity in a gestational diabetes mellitus pregnancy was assessed using a 19-item questionnaire modified to reflect current physical activity guidelines, with a total score from 0% (worst) to 100% (best). Self-efficacy was measured using the nine-item Self-Efficacy for Exercise Scale, with a total score from 0 (not confident) to 10 (very confident). RESULTS: Provision of the infographic led to a clinically important between-group difference in knowledge (MD 12%, 95% CI 10 to 15) and self-efficacy (MD 2.5 units, 95% CI 1.9 to 3.0). CONCLUSION: In women with gestational diabetes mellitus, short-term knowledge about physical activity and self-efficacy to exercise were improved when usual education was supplemented with a consumer co-created infographic that provided specific and relevant information about physical activity during a gestational diabetes mellitus pregnancy. TRIAL REGISTRATION: ACTRN12619001207101.

Women with gestational diabetes mellitus want clear and practical messages from credible sources about physical activity during pregnancy: a qualitative study.

QUESTIONS: What are the attitudes of women diagnosed with gestational diabetes mellitus (GDM) towards physical activity during pregnancy? What are the perceived barriers to and enablers of physical activity during pregnancy in women with GDM? DESIGN: A qualitative study with phenomenology and interpretative description as theoretical frameworks. PARTICIPANTS: Pregnant women experiencing an uncomplicated singleton pregnancy, diagnosed with GDM, and aged 18 to 40 years were recruited using purposive sampling. METHOD: Semi-structured interviews were recorded, transcribed verbatim and returned to participants for member checking. Three researchers independently and thematically analysed the qualitative data using an inductive method. Data were coded and compared, and themes were developed, discussed and defined. Recruitment continued until data saturation. Emergent themes were sent to participants and peer reviewed for confirmation. RESULTS: The participants were 27 women, with mean age 32 years (SD 3), mean gestation 30 weeks (SD 5), mean pre-pregnancy body mass index 26 kg/m2 (SD 5), and born in 10 different countries. The process of communicating information about physical activity (messaging) was the main theme to emerge. Sub-themes included: wanting information about physical activity from credible sources; wanting clear, specific information about safe physical activity during a GDM pregnancy; receiving information at GDM diagnosis because this event triggered women's desire to be more physically active; understanding why physical activity is important to improving outcomes for themselves and their babies; and wanting information about flexible, convenient and practical physical activity options. CONCLUSION: To feel confident and safe about being physically active during pregnancy, women with GDM wanted clear, simple and GDM-specific messages from credible sources. Health professionals can support women with a GDM pregnancy with targeted physical activity messages.

Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review.

QUESTION: What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? DESIGN: In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. PARTICIPANTS: Pregnant women. INTERVENTION: Not applicable. OUTCOME MEASURES: Attitudes and perceived barriers and enablers to physical activity during pregnancy. RESULTS: Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. CONCLUSION: Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation. REGISTRATION: PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].

Living with traumatic brain injury in a rural setting: supports and barriers across the continuum of care.

PURPOSE: Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being. METHODS: A qualitative descriptive interview study was conducted by a multidisciplinary team. Content analysis was completed with data-derived coding and iterative modifications to analysis, coalescing codes into categories and themes. RESULTS: Thirteen people with TBI and six caregivers participated in the interview. Categories that emerged in analysis included the experiences under each locus of care; themes included relationships, functional competence, and participation in meaningful activity. CONCLUSION: Relationships represented both barriers and facilitators of well-being. Major unmet needs persisted in terms of medical problems, support for caregivers, community linkages, and participation in meaningful activities. Recommendations are made regarding avenues for addressing unmet needs. Implications for Rehabilitation People with TBI are living with chronic conditions and may need intensive rehabilitation after the injury and intermittent rehabilitation throughout life to develop and maintain functional competence. Rehabilitation providers need to understand the unique aspects of the rural home environment to which a patient will be discharged (e.g., mountainous terrain, lack of transportation, dimensions of home) and communicate with rural providers directly. Rehabilitation providers need additional focus on improving patient's and caregiver's abilities to advocate for themselves. Patients with TBI should be referred to vocational rehabilitation as soon as possible to make the transition to meaningful activity at home more of a possibility.

Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review.

QUESTION: Does exercise improve postprandial glycaemic control in women diagnosed with gestational diabetes mellitus? DESIGN: A systematic review of randomised trials. PARTICIPANTS: Pregnant women diagnosed with gestational diabetes mellitus. INTERVENTION: Exercise, performed more than once a week, sufficient to achieve an aerobic effect or changes in muscle metabolism. OUTCOME MEASURES: Postprandial blood glucose, fasting blood glucose, glycated haemoglobin, requirement for insulin, adverse events and adherence. RESULTS: This systematic review identified eight randomised, controlled trials involving 588 participants; seven trials (544 participants) had data that were suitable for meta-analysis. Five trials scored ≥ 6 on the PEDro scale, indicating a relatively low risk of bias. Meta-analysis showed that exercise, as an adjunct to standard care, significantly improved postprandial glycaemic control (MD -0.33mmol/L, 95% CI -0.49 to -0.17) and lowered fasting blood glucose (MD -0.31 mmol/L, 95% CI -0.56 to -0.05) when compared with standard care alone, with no increase in adverse events. Effects of similar magnitude were found for aerobic and resistance exercise programs, if performed at a moderate intensity or greater, for 20 to 30minutes, three to four times per week. Meta-analysis did not show that exercise significantly reduced the requirement for insulin. All studies reported that complications or other adverse events were either similar or reduced with exercise. CONCLUSION: Aerobic or resistance exercise, performed at a moderate intensity at least three times per week, safely helps to control postprandial blood glucose levels and other measures of glycaemic control in women diagnosed with gestational diabetes mellitus. REGISTRATION: PROSPERO CRD42015019106. [Harrison AL, Shields N, Taylor NF, Frawley HC (2016) Exercise improves glycaemic control in women diagnosed with gestational diabetes mellitus: a systematic review.Journal of Physiotherapy62: 188-196].

The impact of cigarette smoking on sleep quality of patients with masticatory myofascial pain.

AIM: To evaluate the impact of cigarette smoking on the sleep quality of patients with masticatory myofascial pain and to determine whether the association between smoking and impaired sleep is influenced by other factors such as demographic, psychological, and behavioral variables. METHODS: Data from a retrospective case series of 529 patients diagnosed with masticatory myofascial pain according to group I of the Research Diagnostic Criteria for Temporomandibular Disorders were obtained. Patients completed a standardized pain questionnaire and psychometric tests. Differences between smokers and nonsmokers were evaluated using independent samples t tests and chi-square tests. Hierarchical linear multiple regression models were used to examine predictors of sleep disturbances. RESULTS: Of the entire sample, 170 (32%) reported that they were smokers. Smokers reported higher pain severity and more sleep disturbances and psychological distress than nonsmokers. Cigarette smoking significantly predicted sleep disturbance (ß = 0.229, P < .001), but this relationship was attenuated after controlling for pain severity and psychological distress (ß = 0.122, P < .001). CONCLUSION: Cigarette smoking is associated with numerous adverse health outcomes, including pain severity, alterations in mood, and disrupted sleep, and seems to be a significant predictor of sleep quality in patients with masticatory myofascial pain.

A proposed diagnostic classification of patients with temporomandibular disorders: implications for physical therapists.

SYNOPSIS: Physical therapists have an important role on the interprofessional team to provide care for people with temporomandibular disorders (TMDs). Diagnostic classification is a challenge in this population, given the complexities inherent in presentations of headache and orofacial pain, and is critical to selecting the appropriate intervention. The objectives of this paper were (1) to characterize the epidemiology and pathophysiology of the TMDs most commonly seen in the outpatient clinic, (2) to describe a systems screen to be used in the physical therapy examination to determine the need for interprofessional referral, and (3) to propose an approach for physical therapists to examine, evaluate, and classify patients with TMDs, based on previously validated methodologies. A modification of the diagnostic framework of the International Headache Society has provided the basis for the systems screen of people presenting with orofacial pain. The physical therapy examination and evaluation is based on the Diagnostic Criteria for TMD, developed and validated by a consortium of specialists from the American Academy of Orofacial Pain. LEVEL OF EVIDENCE: Diagnosis, level 5.

Effect of dystrophin deficiency on selected intrinsic laryngeal muscles of the mdx mouse.

BACKGROUND: Intrinsic laryngeal muscles (ILM) show biological differences from the broader class of skeletal muscles. Yet most research regarding ILM specialization has been completed on a few muscles, most notably the thyroarytenoid and posterior cricoarytenoid. Little information exists regarding the biology of other ILM. Early evidence suggests that the interarytenoid (IA) and cricothyroid (CT) may be more similar to classic skeletal muscle than their associated laryngeal muscles. Knowledge of the IA and CT's similarity or dissimilarity to typical skeletal muscle may hold implications for the treatment of dysphonia. PURPOSE: The purpose of this study was to further define IA and CT biology by examining their response to the biological challenge of dystrophin deficiency. METHOD: Control and dystrophin-deficient superior cricoarytenoid (SCA; mouse counterpart of IA) and CT muscles were examined for fiber morphology, sarcolemmal integrity, and immunohistochemical detection of dystrophin. RESULTS: Despite the absence of dystrophin, experimental muscles did not show disease markers. CONCLUSIONS: The SCA and the CT appear spared in dystrophin-deficient mouse models. These laryngeal muscles possess specializations that separate them from typical skeletal muscle. Considered in light of previous research, the CT and IA may represent transitional form of muscle, evidencing properties of typical and specialized skeletal muscle.

Aging thyroarytenoid and limb skeletal muscle: lessons in contrast.

Voice production is vital throughout life because it allows for the communication of basic needs as well as the pursuit and enjoyment of social encounters. Unfortunately, for many older individuals the ability to produce voice is altered. Structural and functional declines in the neuromuscular system occur with aging and likely contribute to the modification of voice. One specific target of the aging process is the thyroarytenoid (TA) muscle, the primary muscle of voice production. The objectives of this overview article are to (1) share current findings related to the aging of limb skeletal muscle, (2) identify age-related morphological and physiological features of TA muscle, (3) compare and contrast age-related changes in TA with those in limb skeletal muscle, and (4) describe therapies for reversing sarcopenia in limb muscle and consider the applicability of these therapies for addressing vocal fold atrophy and age-related voice changes. The article shares current knowledge from the basic sciences related to skeletal muscle aging and compares/contrasts typical muscle aging to TA aging. Current evidence suggests that (1) the TA muscle undergoes notable remodeling with age, (2) aging of the TA is multifactorial, resulting from a myriad of neurologic, metabolic, and hormonal changes, many of which are distinct from the age-related processes of typical limb skeletal muscle, (3) investigation of the aging of the TA and its role in the aging of voice is in its infancy, and (4) potential behavioral and nonbehavioral therapies for reversing aging of the TA must be further examined.

Aging of the somatosensory system: a translational perspective.

Balance in the elderly population is a major concern given the often catastrophic and disabling consequences of fall-related injuries. Structural and functional declines of the somatosensory system occur with aging and potentially contribute to postural instability in older adults. The objectives of this article are: (1) to discuss the evidence regarding age-related anatomical and physiological changes that occur in the peripheral proprioceptive and cutaneous systems, (2) to relate the basic science research to the current evidence regarding clinical changes associated with normal aging, and (3) to review the evidence regarding age-related proprioceptive and cutaneous clinical changes and relate it to research examining balance performance in older adults. The article is organized by an examination of the receptors responsible for activating afferent pathways (muscle spindle, golgi tendon organ, and articular and cutaneous receptors) and the corresponding sensory afferent fibers and neurons. It integrates basic science laboratory findings with clinical evidence suggesting that advanced aging results in a decline in cutaneous sensation and proprioception. The potential relationship between postural instability and sensory impairments in older adults also is discussed. Current laboratory and clinical evidence suggests that aging results in: (1) diverse and nonuniform declines in the morphology and physiological function of the various sensory structures examined, (2) preferential loss of distal large myelinated sensory fibers and receptors, and (3) impaired distal lower-extremity proprioception, vibration and discriminative touch, and balance. These findings provide foundational knowledge that emphasizes the importance of using reliable and valid sensory testing protocols for older adults and the need for further research that clarifies the relationship between sensory impairment and balance.

The influence of pathology, pain, balance, and self-efficacy on function in women with osteoarthritis of the knee.

BACKGROUND AND PURPOSE: The determinants of function in people with osteoarthritis include both psychosocial and physiological variables. Studies that simultaneously integrate both domains are limited. The aim of this study was to determine the following in a sample of women with osteoarthritis (OA) of the knee: (1) the relationships among pathology (grade of OA of the knee), pain level, balance, and self-efficacy and (2) the relative effects of pathology, pain level, balance, and self-efficacy on function. SUBJECTS: Fifty community-dwelling women, 50 to 84 years of age (mean = 69.2, SD = 8.8), with symptoms of OA of the knee participated. METHODS: Radiographs, standardized questionnaires (the Western Ontario and McMaster Universities Osteoarthritis Index, the Arthritis Self-Efficacy Scale, the Functional Reach Test, and timed performance tests were used to quantify the variables. Bivariate analyses and stepwise multiple regression modeling with analysis of variance calculations for beta weight testing were used in data analysis. RESULTS: In regression analysis, functional self-efficacy and balance accounted for 42% of the variance in physical performance of function, whereas functional self-efficacy and pain accounted for 74% of the variance in self-report of functional difficulty. DISCUSSION AND CONCLUSION: Functional self-efficacy is an important factor affecting the functional performance outcome for people with OA of the knee. Suggestions are given to address self-efficacy in health care management.