Disabled People or Their Support Persons' Perceptions of a Community Based Multi-Sensory Environment (MSE): A Mixed-Method Study.

Multi-sensory environments (MSEs) are specialised spaces purposely designed to stimulate the senses, whilst providing a calming and relaxing environment for leisure and enjoyment, predominantly intended for disabled people. Most MSEs are in institutions, hospitals, or educational settings, with a few in community-based settings. We explored disabled users' experiences of a community based MSE in a large metropolitan area in New Zealand, with a view to expanding access to MSE-type environments within the area. We used a convergent mixed method design with a web-based electronic survey (e-survey; n = 105), as well as semi-structured interviews (n = 14) with disabled MSE users (adults and children), who were supported, where necessary, by their support person/s. We collected the MSE users' demographics, frequency of use with respect to age, disability, and ethnicity, and experiences of the room, equipment, and accessibility. The participants and their support persons' perspectives about their experiences of using the MSE were represented by four themes: (i) Self-determination; (ii) Enhancing wellbeing opportunities; (iii) the MSE itself; (iv) Accessibility. While the MSE was considered positively, the MSE experience could be enhanced by addressing access challenges and broadening the scope of equipment to improve the usability and make it a more inclusive environment for all.

Perceived strengths and weaknesses of paediatric physiotherapy services: Results from an international survey.

BACKGROUND AND PURPOSE: Ensuring access to high quality services in paediatric physiotherapy (PT) is important to respond to the diverse needs of children. The accessibility and quality of paediatric PT services has however never been explored internationally. The purpose of this study is to explore the perceived strengths, weaknesses, opportunities, and threats (SWOT) of paediatric PT services offered around the world. METHOD: A cross-sectional survey design method was used with a subsample of physiotherapists (PTs) who had previously participated in an online survey. The survey used for this study included close- and open-ended questions about access to services and the SWOT of PT services within participants' country. Descriptive statistics were used to summarize quantitative data and a content analysis was performed on open-ended questions. RESULTS: Overall, 47 PTs from 47 countries completed the survey; 36% of participants reported that free access was available to all children in their country while 34% stated that a referral was always required when accessing services. Lack of direct access, insufficient specialized PT, financial and geographical issues were the main perceived barriers to access services. Access also emerged as one of the nine themes following the SWOT analysis. Other themes included education, quality of PT approaches, PT practices, communication and cooperation, teamwork, government, resources, and attitudes of PTs. DISCUSSION: Despite variations in accessing services and how services are delivered across countries, some similar themes influencing PTs practices were found. Future opportunities for PTs working with children should aim at optimizing the initial training and professional development of PTs in paediatrics, increasing access to services for all children and advocating for sustainable and well-coordinated models of care building on best practices.

Co-Design of an Educational Resource with Female Partners of Male Stroke Survivors to Support Physical Activity Participation.

Many male stroke survivors find it challenging to meet the recommended physical activity (PA) guidelines for health benefits. The spouse/partner is an important source of self-management for stroke survivor PA participation; however, they feel unsupported by health professionals. This study aimed to co-design an educational resource prototype to guide and empower female partners in supporting male stroke survivors' participation in PA. We used a participatory action research (PAR) methodology. Thirteen support persons of male stroke survivors from Canterbury, New Zealand participated in four PAR cycles. The data were collected using individual interviews and focus groups and analyzed inductively using the general inductive approach. Three themes were reflected in the data and informed the prototype content: (1) managing an unwanted and challenging new life, (2) inconsistent access to meaningful information, and (3) considerations for successful stroke survivor PA participation. If partners are to be an essential source in supporting stroke survivors' self-management of PA, they require resources that are meaningful and credible to enhance their confidence and self-efficacy. Further research is needed to explore the acceptability and usability of the educational resource with a wider audience and evaluate the co-design process. An inclusive and collaborative approach where support persons were valued for their expertise was essential in co-designing a meaningful resource intended to support stroke survivors and support persons' self-management of their PA.

Client perceptions of engaging with a health and social care navigation service: A qualitative study.

OBJECTIVES: Health and social care navigation services provide support for people with long-term conditions. Such services are available in the New Zealand (NZ) context. However little is known nationally or internationally about clients' experience of engaging with such services. This study aimed to describe client perspectives of engaging with a health and social care navigation service in a NZ metropolitan city. METHODS: The manager and navigators of the service recruited clients who were previous users of the service. We individually interviewed nine clients (F = 7; M = 2; aged between 30-80 years) in their homes. Many of the participants reported social isolation, and some were without regular income. We transcribed interviews verbatim and analysed data thematically. RESULTS: There was one overall theme: Restoration of my essence or being (in the Maori language, wairua), and sense of belonging (turangawaewae) through a regenerative approach developed in partnership between the navigator and the client. Thus, participants felt renewed and validated as human beings. DISCUSSION: Enabling clients to feel re-valued as human beings captures the concept of personhood whereby a person has capability and capacity for life choices. We suggest enabling a client to feel valued assists in development of self-determination and consequently improved health and well-being.

Scope and Practices of Physical Therapists Working With Children: Results From an International Online Survey.

PURPOSE: To describe the scope of practice of physical therapists (PTs) working with children worldwide. METHODS: PTs working with children in any context and country were invited via social media and email campaigns to complete an online survey containing 42 questions about work context and service delivery. Descriptive statistics were computed. RESULTS: Of the 1133 participants from 77 countries, most worked with children full-time (51.8%), and in government-funded work settings (57.5%). Modalities of access to services varied across countries, work settings, and children's conditions, yet 46.7% of PTs reported that most children had direct access to services. PTs provided services to children with a variety of conditions, with cerebral palsy being most reported (83.3%). Interventions focused primarily on improving body function (42.0%) and on providing face-to-face individual treatment (96.6%). CONCLUSIONS: This study provides an international portrait of pediatric PT practice and illustrates the diversity of services in pediatric PT.

Strengthening community connection and personal well-being through volunteering in New Zealand.

Volunteering is a way for people to develop meaningful relationships within a social group and can lead to the building of social capital, from which both individuals and the wider group can benefit in the form of enhanced well-being. This study aimed to explore and describe the impact of volunteering on the volunteer coordinators and volunteers themselves in the eastern suburbs of Christchurch, New Zealand, an area particularly impacted by the devastating earthquakes in the period 2010/2011. Data were collected via semi-structured interviews with volunteer coordinators and volunteers (n = 35; 16 men, 19 women) from November 2018 to mid-January 2019. Thematic analysis of data highlighted a key theme of Creating and strengthening valued community connections, with subthemes of Personal growth, Community connections and Role of coordination. The key theme illustrated how formal volunteering created effort and opportunities towards the strengthening of personal and community connectedness. Our study demonstrates the importance of social connection for both individual and community well-being, emphasises the important role of "champions" in facilitating the building of bridging and bonding relationships between individuals and communities, and suggests a role for healthcare professionals to prescribe volunteering as a way to improve individual health and well-being outcomes.

Components of community rehabilitation programme for adults with chronic conditions: A systematic review.

BACKGROUND: Health services for individuals with chronic conditions often include a disease specific community rehabilitation programme to assist these individuals to maintain physical function and develop self-management skills. Nurses are often involved in the delivery of such programmes. Many individuals however live with more than one chronic condition and find it difficult to manage the rehabilitation demands for their different diagnoses. OBJECTIVE: To identify core programme components and clinically meaningful measures for a generic rehabilitation programme. DATA SOURCES: Full text English language journal articles identified from CINAHL, MEDLINE (Ovid), AMED and PubMed, plus reference lists of included articles. REVIEW METHOD: A systematic search of databases using keywords and MeSH terms for randomised controlled trials detailing a group based community programme for adults with chronic conditions. Study quality was appraised using the Cochrane Collaboration Tool for assessing risk of bias for randomised controlled trials. Data summarising characteristics of the studies such as participant numbers, programme components and the questionnaires, scales and measures were extracted and tabulated. An additional search of wider literature was undertaken to identify the minimal clinically important difference for each questionnaire, scale or measure used within the included studies. RESULTS: Fifteen good quality studies were identified. At baseline, there were 3856 participants (age range 42-84 years), with 642 participants lost to follow-up. Programmes were led by health professionals and/or lay leaders. Programme duration ranged from four to 12 weeks and included educational components targeting symptom management, and development of self-efficacy. Only three programmes included a supervised exercise component. Although many of the 64 outcomes measured across the programmes demonstrated statistically significant results, only three measures demonstrated clinically meaningful change for study participants and these measures were used in only two studies. CONCLUSIONS AND RECOMMENDATIONS: The findings suggest community rehabilitation programmes for individuals with chronic conditions be a minimum of 4-6 weeks to cover necessary education for management of symptoms, be led by a health professional/s in combination with lay leaders, and include development of self-management skills. We recommend consideration be given to health literacy level of the programme, and that because of the known positive benefit of exercise on physical functioning, quality of life and in slowing progression of chronic conditions, an exercise time should be included. Lastly, we recommend that reporting and interpreting effect sizes of interventions within studies would facilitate more useful choice of outcome measures to be able to demonstrate clinically meaningful change.

Maintenance and Development of Social Connection by People with Long-term Conditions: A Qualitative Study.

Social connection is important for people's health and well-being. Social isolation arising from a lack of meaningful connection with others can result in deterioration of well-being with negative consequences for health. For people living with multiple long-term conditions, the building and maintaining of social connection may be challenging. The aim of this study was to explore with people with long-term conditions how they perceive they maintain and develop social connections. We undertook semi-structured interviews with seventeen adults, and analyzed the data for themes. Themes were "Meaningful connection", "Wherewithal for social connection" and "Impact of a major change in life course". The findings suggest that social connection is valued, and facilitates meaningful ways to reciprocate support with others, thus enabling access to knowledge and resources for better health and well-being. However, people with long-term conditions can experience challenges to developing and maintaining social connectedness after a major change in life course. We suggest that healthcare providers are well placed to facilitate ways for people with long-term conditions to socially connect with others in their neighbourhood and community, and that this in particular be attended to after a major life change.

Views of healthcare professionals on training for and delivery of a fatigue self-management program for persons with multiple sclerosis.

Purpose: To explore the experiences and perspectives of the healthcare professionals who were trained to and delivered "Minimise Fatigue, Maximise Life" (MFML), a patient-centered group-based fatigue self-management program for persons with multiple sclerosis.Methods: A qualitative descriptive study with semi-structured individual interviews at two time points. Data were analyzed for themes. Six healthcare professional facilitators who were trained to and delivered "Minimise Fatigue, Maximise Life" participated in a first interview, and five in a second. Participants were all female, aged between 23 and 66 years old and either occupational therapists or physiotherapists.Results: Two themes were evident in the data. The first, "Reciprocity," showed how the healthcare professionals were trained to deliver MFML, then reciprocated in the program delivery as active participants, which then provided feelings of personal reward and expansion of their usual practice. The second, "Enhancements," encompassed suggested directions for future training and deliveries of the program.Conclusion: This study suggests that multidimensional patient centered interventions also benefit the healthcare professionals who provide them because it expands their practice. Healthcare professionals who recognize the benefits of innovative and patient-centered interventions, supports both the patients with whom they work, and adds value to the health services they provide.Implications for rehabilitationHealthcare professionals who undergo training to facilitate delivery of self-management programs, which are based in an empowerment model, report an enhancement or expansion of their traditional practice.An empowerment-based program delivered in a group situation encourages and facilitates people to draw on their own and peers' knowledge and expertise to problem solve for self-management.Healthcare professional education should facilitate the healthcare professional's learning, and ability and willingness to acknowledge the richness in knowledge and expertise held by their patients.

The accessibility of fitness centers for people with disabilities: A systematic review.

BACKGROUND: Fitness centers could be ideal places for people with disabilities to engage in the recommended levels of physical activity for healthy well-being. However, one of the primary barriers to participation at fitness centers is an inaccessible built environment. OBJECTIVE: This review study aimed to evaluate the accessibility of public indoor fitness centers for people with disabilities. METHODS: We searched electronic databases and web based search engines using keywords and synonyms for fitness centers, people with disability and accessibility. Observational studies that used standardized measures to evaluate fitness centers were included and critically appraised using a modified version of the checklist for randomized and non-randomized studies developed by Downs and Black. We analyzed the data descriptively. This systematic review protocol is registered in PROSPERO (ID:CRD42016043945). RESULTS: A total of 533 fitness centers were evaluated for accessibility across 14 studies. Ten (85%) of the 14 studies were undertaken in the United States of America. Instruments (n = 2) used to evaluate fitness centers were based on the Americans with Disabilities Act compliance legislation and measured domains of physical access (e.g., bathrooms, equipment, parking) and system access (e.g., policies, programs, professional behavior). We calculated weighted percentage mean scores per accessibility domain. The least accessible domain was "hot tubs/whirlpools/saunas/steam rooms" at 33%, with "programs" being the most accessible domain at 68%. CONCLUSIONS: Fitness center accessibility for people with disabilities remains poor. Adopting the principles of universal design in legislation would achieve equitable access for all, thereby allowing people with disabilities to participate actively in their communities with dignity and autonomy.

How older adults and their informal carers prevent falls: An integrative review of the literature.

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons. AIM: To synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines. DATA SOURCES: Health sciences databases for full text articles published in English plus reference list searching of included articles. REVIEW METHOD: An integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes. RESULTS: Of the seventeen studies included in the review, eleven identified older adults' falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence. CONCLUSIONS: The fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.

"I do like the activities which I can do " Leisure participation experiences of children with movement impairments.

AIM: To explore in depth the leisure participation experiences of children with movement impairments. METHODS: We used Interpretative Phenomenological Analysis approach to interpret and understand the experiences of 22 children with movement impairments, aged between 6 and 12 years. Children expressed their views through flexible child-centred methods of data collection that allowed the children to draw, paint, use stickers, and demonstrate their leisure activities and equipment while communicating about their experiences. RESULTS: Children participated in leisure activities of their choice, and expressed positive experience of fun, challenge, independence and achievement. The choice of activities depended on a combination of the motor functioning of the individual child, inspiration and support from families, friends and health professionals, as well as the possibility of adaptations and availability of community programmes. At times children felt disappointed and avoided some activities due to associated negative experience such as injury, fear, non-inclusion and the difficulty they had experienced in adapting and performing certain activities. CONCLUSION: Families, therapists and community service providers such as disability organisations could enhance leisure participation experiences by suggesting and creating opportunities that could increase children's choices of leisure activities. Implications for rehabilitation Children's choice of activities, places and friends is important for positive experiences of fun, achievement, challenge, independence and motivation in leisure participation. Families and health professionals could assist children make appropriate choices for leisure activities that depends on factors such as motor abilities, adaptations and availability of activities in the community. In the community, widening the options for leisure activities such as non-competitive adaptive sports and indoor sports for children with variable levels of movement impairment could improve leisure participation experiences.

A Child-centered Method of Interviewing Children with Movement Impairments.

AIMS: Children are increasingly included in qualitative research and new methods for interviewing children are emerging. The aim of this article is to describe and discuss the strategies of a child-centered method of data collection for interviewing children with movement impairments to explore their leisure participation experiences. METHODS: A study was conducted using an Interpretative Phenomenological Approach (IPA) to explore leisure participation experiences of children with movement impairments aged 6 to 12 years. Various strategies, guided by children, were used to facilitate children's active involvement in the interview process. RESULTS: Twenty-two children (mean age 8.7 years) participated in the interview study, most of them in the presence of their parents or guardian (18 children) and some of them (9 children) with their siblings present. Children enjoyed and were actively engaged in the interview process. Along with talking, 19 children did drawings, 5 children used stickers, 4 children played quiet games, six children shared pictures of their leisure activities, and 16 children physically demonstrated some of their leisure activities, environment, and equipment. CONCLUSIONS: A wide range of data collection strategies facilitated children to communicate their leisure participation experiences and to represent children's views without being overly influenced by parental views.

Experiences of persons with spinal cord injury undertaking a physical activity programme as part of the SCIPA 'Full-On' randomized controlled trial.

BACKGROUND: For individuals with spinal cord injury the long term benefits of physical activity are well documented, however the majority of this population report inactivity secondary to participatory barriers. Research investigating physically intensive exercise programs for people with spinal cord injury is limited, with even less attention paid to the experience of the participants. OBJECTIVE: To explore the experiences of persons with spinal cord injury of their participation in the New Zealand arm of the Spinal Cord Injury and Physical Activity (SCIPA) 'Full-On' randomized controlled trial. METHOD: Eight participants recruited to SCIPA Full-On completed individual virtual video diary interviews three times across the duration of their twelve week Full-On trial. Expectations and highs and lows of the program were recorded via a webcam. The video diary data were transcribed verbatim and analyzed inductively for themes. RESULTS: Three independent themes were identified from the data: the participants' excitement of opportunity to participate in SCIPA Full-On' randomized controlled trial, personal rewards from participation and also the frustrations to participation they experienced. CONCLUSION: This study provides valuable information on factors that motivate participation in physical activity for individuals with spinal cord injury, within a research setting. The findings highlighted the importance of accessibility and a supportive network which may be a way to provide individuals with spinal cord injury the means to become self-efficacious to participate in community physical activity outside of the research environment.

Inclusive design in architectural practice: Experiential learning of disability in architectural education.

BACKGROUND: The built environment can facilitate or impede an individual's ability to participate in society. This is particularly so for people with disability. Architects are well placed to be advocates for design that enhances societal equality. OBJECTIVE: This qualitative study explored architectural design students' perceptions of inclusive design, their reflections resulting from an experiential learning module and the subsequent influence of these on their design practice. METHODS: Twenty four architectural design students participated in focus groups or individual interviews. Data were analyzed thematically. RESULTS: Three themes were evident: 1) Inclusive design was perceived as challenging, 2) Appreciation for the opportunity to learn about the perspectives of people with disabilities, and 3) Change of attitude toward inclusive design. Experiential learning had fostered reflection, changes in attitude and the realization that inclusive design, should begin at the start of the design process. CONCLUSIONS: For equitable access for all people to become reality, experiential learning, coupled with positive examples of inclusive design should be embedded in architectural education.

The Influence of Age, Sex and Body Mass Index on the Effectiveness of Brisk Walking for Obesity Management in Adults: A Systematic Review and Meta-Analysis.

BACKGROUND: Brisk walking is the most popular activity for obesity management for adults. We aimed to identify whether participant age, sex and body mass index (BMI) influenced the effectiveness of brisk walking. METHODS: A search of 9 databases was conducted for randomized controlled trials (RCTs). Two investigators selected RCTs reporting on change in body weight, BMI, waist circumference, fat mass, fat-free mass, and body fat percentage following a brisk walking intervention in obese adults. RESULTS: Of the 5072 studies screened, 22 met the eligibility criteria. The pooled mean differences were: weight loss, -2.13 kg; BMI, -0.96 kg/m2; waist circumference, -2.83 cm; fat mass, -2.59 kg; fat-free mass, 0.29 kg; and body fat percentage, -1.38%. Meta-regression of baseline BMI showed no effect on changes. CONCLUSIONS: Brisk walking can create a clinically significant reduction in body weight, BMI, waist circumference, and fat mass for obese men and women aged under 50 years. Obese women aged over 50 years can achieve modest losses, but gains in fat-free mass reduce overall change in body weight. Further research is required for men aged over 50 years and on the influence of BMI for all ages and sexes.

Leisure Participation Patterns of Children With Movement Impairments in New Zealand.

PURPOSE: To investigate the leisure participation patterns of children with movement impairments in New Zealand. METHODS: A cross-sectional survey was conducted with children with movement impairments aged 6 to 12 years using the Children's Assessment of Participation and Enjoyment questionnaire. Descriptive statistics were used to analyze the data. RESULTS: Children participated in an average of 57.3% of activities, with a greater number and frequency of recreational, social, and self-improvement activities as compared with skill-based and physical activities. Children performed nearly 50% of activities with family and 13% of activities with friends. Approximately 50% of activities were performed at home and 50% of activities were performed outside the home. CONCLUSIONS: Children with movement impairments participated in diverse leisure activities. However, reduced involvement in physical activities needs further investigation to identify the actual level of physical exertion, barriers faced, and how increased opportunities for regular physical activity could be instigated.

Evaluation of a Fatigue Self-Management Program for People with Multiple Sclerosis.

BACKGROUND: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS). The program "Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis" (MFML) was created in New Zealand because of the lack of a fatigue management program for people with MS in that country. This program aims to empower individuals with MS to manage their own symptoms of fatigue. The objective of this study was to evaluate the MFML fatigue self-management program. METHODS: Self-report questionnaires were used to measure impact of fatigue (5-item Modified Fatigue Impact Scale), self-efficacy (MS Self-efficacy Scale), and quality of life (12-item Short Form Health Status Survey [SF-12]) 1 month before (T1), at commencement of (T2) (to investigate the stability of questionnaire scores before the intervention), and at the end of (T3) the 6-week group-based program. Increased self-efficacy and quality of life scores and a decrease in reported impact of fatigue were the anticipated primary outcomes, with participants acting as their own controls. RESULTS: Twenty-five women (aged 37-63 years) participated. Stability of scores for all the questionnaires was evidenced between T1 and T2. After the intervention (T3), scores showed a significant improvement in self-efficacy and impact of fatigue, with large effect sizes, but no change in either the physical or mental component summary of the SF-12. CONCLUSIONS: Despite the small sample size, this study showed an organized approach to the management of fatigue for people living with MS, and its outcomes demonstrated benefits for participants.

Perceived Impact of a Self-Management Program for Fatigue in Multiple Sclerosis: A Qualitative Study.

BACKGROUND: Fatigue in multiple sclerosis (MS) is reported to be one of its most debilitating symptoms, affecting personal, family, and community participation. Despite a high incidence of MS in New Zealand, there was no cohesive approach to support people with MS to manage their fatigue. This prompted the development of Minimise Fatigue, Maximise Life: Creating Balance with Multiple Sclerosis (MFML), a group-based, 6-week fatigue self-management program. This study explored the perceived impact of MFML for participants who attended the program. METHODS: We undertook semistructured individual telephone interviews 1 (n = 23) and 3 (n = 11) months after delivery of the program. Data were analyzed for themes. RESULTS: Two themes emerged from the data: achieving behavior change to manage fatigue and whole of life effects. These themes represent participants' perceived benefits of the program. CONCLUSIONS: This study provides evidence that the MFML fatigue self-management program positively affected the lives of participants. The findings suggest that participants had begun to successfully develop and integrate self-management skills into their everyday lives. This affected the individual personally and also their participation in family and community life. This study adds to the current knowledge and understanding of the positive effect that delivery of a fatigue self-management intervention can have for people with MS.