Effects of an exercise intervention on participation reported by people with disabilities: A mixed methods randomized trial.

BACKGROUND: Despite a long history of research on the benefits of exercise for people with mobility impairments, little is known about how exercise affects participation in their daily activities. OBJECTIVE: This randomized mixed-methods study examined the effects of participating in a structured community-based exercise program on pain, depression, fatigue, exertion and participation in daily activities. METHOD: Study participants were recruited from a population-based sample of people who returned a survey (n = 800) and indicated they would be willing to participate in another study. The intervention group was randomly assigned to participate in a physical therapy evaluation and 30 exercise sessions within four months and the control group completed measures only. Ecological momentary assessment and a daily diary was used to evaluate treatment outcomes for the intervention relative to the control group on pain, depression, fatigue, exertion and participation in high exertion activities. We also interviewed a subset of intervention participants to solicit their lived experience from engaging in the exercise intervention. RESULTS: Exercise intervention participants reported 28% less pain and 19% less fatigue than control participants. They also reported engaging in 11% more bathing and grooming, 22% more household chores, and left their homes 13% more than control participants. These results were mirrored in qualitative interview results. CONCLUSIONS: Participating in an exercise program leads to less pain and fatigue and more participation in activities that require relatively high levels of exertion like bathing and leaving home.

Patient perspectives of ankle-foot orthoses for walking ability in peripheral artery disease: A qualitative study.

Calf claudication associated with peripheral artery disease results in limited walking ability and diminished quality of life. Ankle-foot orthoses (AFO) have been used to mitigate calf pain during community-based walking exercise, yet little is known about patients' perspectives of this novel device. The purpose of this qualitative study was to determine the personal impact AFO had on patients who used them. Ten patients with calf claudication who previously completed a 12-week unstructured community-based walking program supplemented by AFO participated in a semi-structured recorded focus group. After data saturation was achieved, transcripts were coded and analyzed, and 2 primary themes emerged from the focus groups: 1) positive functional impact of AFO on walking ability and quality of life and 2) self-selected AFO usage patterns. Six subthemes included 1) positive ambulatory changes from using AFO, 2) sustained ambulatory improvements without AFO, 3) positive psychosocial impact, 4) optimal conditions for AFO usage, 5) optimal ambulatory surfaces when using AFO, and 6) challenges with comorbidities. The AFO were influential in decreasing claudication symptoms, improving walking capacity, and enhancing participation in meaningful daily and recreational activities. This study explores experiential knowledge of patients with calf claudication describing AFO as an effective tool to enhance unstructured walking programs. Further trials are needed to optimize device design and effectiveness in varying walking environments.

A qualitative assessment of upper quarter dysfunction reported by physical therapists treated for breast cancer or treating breast cancer sequelae.

PURPOSE: As survival rates for breast cancer improve, long-term effects of treatment are receiving increasing attention, including upper quarter impairments and functional limitations. The purpose of this study was to assess, through qualitative means, the long-term effects of breast cancer treatment on upper quarter function as reported by those with expertise in upper quarter dysfunction. Participants were physical therapists who were either breast cancer survivors ("survivors") or those who specialized in treatment of individuals post-breast cancer ("treaters"). SUBJECTS AND METHODS: Three focus groups (two groups of survivors [n=16] and one group of treaters [n=10]) were convened to discuss their experiences with upper quarter dysfunction post-breast cancer. Qualitative research methods were used to collect and analyze the data, to extract themes, and to assure reliability and validity of the original and extracted data. RESULTS: Two themes emerged from the data and are supported by participant quotes. The first theme described the presence of upper quarter dysfunction that impacted body structure and function and resulted in activity/participation limitations. The second theme described the contextual factors that impacted the reported dysfunction, including access to comprehensive care, inadequate attention by health care providers, and a resulting need for self-advocacy. CONCLUSIONS: The study supports the problem of late effects from breast cancer treatment on upper quarter function and points out the need for better education for health care providers, increased long-term surveillance of survivors, and a more proactive model of health care delivery for this population.