Feasibility and Acceptability of a Physical Exercise Program Embedded Into the Daily Lives of Older Adults Living in Nursing Homes: A Pilot Feasibility Study.

The purpose of this study was to test the feasibility and acceptability of a staff-delivered physical exercise program embedded into the daily lives of older adults living in nursing homes. A randomized controlled pilot feasibility study was carried out, which included quantitative, qualitative, and economic assessments at baseline, 12 weeks, and 12 months. Two nursing homes (one intervention and one control) took part. The exercise program was carried out on 3 days per week for 12 weeks and consisted of a program of Morning Movement (walking and sit-to-stand exercises) and Activity Bursts. The results confirm that the intervention and study processes are largely acceptable and feasible to implement in the nursing home setting. Potential short-term improvements in physical mobility and quality of life were noticed as positive mean changes and supported by qualitative assessment. Future randomized controlled trials should consider using the 6-meter walk test and refining nursing home and participant eligibility criteria.

Mobilising people as assets for active ageing promotion: a multi-stakeholder perspective on peer volunteering initiatives.

BACKGROUND: Successful peer volunteering is central to many community-based, active ageing initiatives. This study synthesises the perspectives of a range of stakeholders involved in peer volunteering initiatives and provides recommendations as to how peer volunteers can be effectively mobilised as community assets. METHODS: An evidence synthesis of qualitative data from (a) the evaluation of ACE (Active, Connected, Engaged), a feasibility trial of a peer volunteering active ageing intervention, and (b) interviews with volunteers and managers of third sector organisations providing peer volunteering programmes. Data were analysed using directed content analysis. RESULTS: Ten managers, 22 volunteers and 20 ACE participants were interviewed. The analysis identified six main themes, 33 higher and 22 sub themes. Main themes were: (i) Motives, (ii) Benefits, (iii) Skills and Characteristics, (iv) Challenges, (v) Training Needs, (vi) Recruitment and Retention. Altruism, changes in life circumstances, opportunities to reconnect with the community and personal fulfilment were the main reasons for volunteering. Volunteering was described as being personally rewarding, an avenue to acquire new skills and knowledge, and an opportunity for increased social connections and physical activity. Good peer volunteers are committed, reliable, have a good sense of humour, good interpersonal skills and are able to relate to participants. When pairing volunteers with participants, shared interests and geographical proximity are important to consider. Clarity of role, level of time commitment, regular feedback, recognition of effort and strong networks for on-going support are important strategies to facilitate volunteer retention. CONCLUSIONS: The findings of this study support the value of peer volunteering as a strategy for mobilising community assets in promoting active ageing. To ensure success and longevity, these schemes require appropriate funding and efficient administrative support.

Physical Therapy Management of Nontraumatic Shoulder Problems Lacks High-Quality Clinical Practice Guidelines: A Systematic Review With Quality Assessment Using the AGREE II Checklist.

OBJECTIVES: To appraise the quality of clinical practice guidelines (CPGs) for physical therapy management of nontraumatic shoulder pain disorders. DESIGN: Systematic review of CPGs. LITERATURE SEARCH: Two reviewers independently conducted a search of 7 databases and 7 gray literature sources. STUDY SELECTION CRITERIA: We included systematically developed CPGs for physical therapy management of nontraumatic musculoskeletal conditions of the shoulder in adults that were available in full text in the English language. We excluded CPGs for physical therapy management of surgically treated shoulder pain disorders. DATA SYNTHESIS: Three reviewers independently rated the quality of included CPGs using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Data were compiled into tables that displayed AGREE II domain scores for each CPG and mean item scores across the CPGs. RESULTS: We included 9 CPGs. Five CPGs focused on rotator cuff disorders, 2 focused on frozen shoulder, and 2 covered a range of soft tissue shoulder diagnoses. Three CPGs were judged as high quality (all were 5 or more years old) and 6 were judged as low quality. The quality domains in which CPGs were rated highest were "scope and purpose" (all CPGs scored greater than 50% and 4 scored greater than 80%) and "clarity of presentation" (all CPGs scored greater than 50% and 7 scored greater than 80%). The domains in which CPGs were rated most poorly were "applicability" (6 CPGs scored 40% or less) and "editorial independence" (4 CPGs scored less than 40%). CONCLUSION: There were no high-quality, contemporary CPGs to guide physical therapy management of nontraumatic shoulder pain. J Orthop Sports Phys Ther 2021;51(2):63-71. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9397.

The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO.

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

Clinical effectiveness of non-surgical interventions for primary frozen shoulder: A systematic review.

OBJECTIVE: To update an existing systematic review of randomized clinical trials evaluating the clinical effectiveness of non-surgical management interventions for people with primary frozen shoulder in terms of pain, movement, self-reported function and disability, quality of life, recovery time, return to work and recreation, and adverse events. DATA SOURCES: Cochrane CENTRAL, SCI and MEDLINE, CENTRAL between 1 January 2010 and June 2017, plus reference lists of included trials and trial registers. Abstracts were independently screened by 2 reviewers and discussed. DATA EXTRACTION: Two reviewers evaluated eligibility. Data were extracted by one reviewer and checked by another. Two reviewers evaluated risk of bias. Meta-analyses were not appropriate. Narrative analyses were performed for trials evaluated as low risk of bias. RESULTS: Thirty trials were included, with the majority of studies evaluated as being at high risk of potential bias. Only 4 trials were evaluated as being at low risk of bias and this, plus the variety of participants included/excluded in trials and the variety of methods, interventions and outcomes used across the trials provided limited new evidence to inform the non-surgical management and treatment of people with frozen shoulder. CONCLUSION: Substantial evidence gaps remain for the non-surgical treatment of people with frozen shoulder.

Evaluation of a Companion Robot for Individuals With Dementia: Quantitative Findings of the MARIO Project in an Irish Residential Care Setting.

The current study focuses on the short-term effect of MARIO, a social robot, on quality of life, depression, and perceived social support in persons with dementia (PWD) and evaluates their acceptability of MARIO. Ten PWD in one nursing home took part in a 4-week pilot study, where each participant had up to 12 sessions with MARIO. Sessions comprised engagement in music, news, reminiscence, games, and calendar applications. Standardized questionnaires were administered before and after the 4-week period. Participants had a sustained interest in MARIO during their interactions and an acceptance of MARIO's appearance, sound, and applications. Consequently, participants spent more time socially engaged. No statistically significant differences were found in quality of life, depression, and perceived social support. PWD can engage with a social robot in a real-world nursing home. Future research should incorporate a larger sample and longer intervention period. [Journal of Gerontological Nursing, 45(7), 36-45.].

MARIO Project: Validation and Evidence of Service Robots for Older People with Dementia.

BACKGROUND: In the EU funded MARIO project, specific technological tools are adopted for the people living with dementia (PLWD). In the final stage of the project, a validation of the MARIO companion robot was performed from August to October 2017. OBJECTIVE: The aims of the present study are: 1) to illustrate the key results and evidence obtained in the final evaluation phase of the project across the three different pilot sites; 2) to assess the engagement dimensions of the PLWD who interacted with the MARIO robot; and 3) to assess the acceptability and efficacy of the MARIO companion robot on clinical, cognitive, neuropsychiatric, affective and social aspects, resilience, quality of life in PLWD, and burden level of the caregivers. METHODS: 38 people (M = 14; F = 24) with Alzheimer's disease were screened for eligibility and all were included. The following tests were administered Pre and Post interactions with MARIO: Observational Measurement of Engagement (OME), Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Frontal Assessment Battery (FAB), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia (CSDD), Multidimensional Scale of Perceived Social Support (MSPSS), 14-item Resilience Scale (RS-14), Quality of Life in Alzheimer's Disease (QOL-AD), Caregiver Burden Inventory (CBI), Tinetti Balance Assessment (TBA), and Comprehensive Geriatric Assessment (CGA) was carried out. RESULTS: In Post-MARIO interactions, significant improvements were observed in RS-14 (p = 0.020).Considering the age of the people, PLWD with 68-76 years perceived that they had major social support (MSPSS Total: p = 0.016) and friends to support them (MSPSS Fri: p = 0.014). Indeed, the younger people (55-67 years) were less depressed (CSDD: p = 0.033), and more resilient (RS-14: p = 0.003). The people aged 77-85 years perceived they had major family support (MSPSS Fam: p = 0.018). The participants were gender and education matched without any statistically significant difference. CONCLUSION: MARIO may be a useful tool in mitigating depression and loneliness, while enhancing social connectedness, resilience, and overall quality of life for people with dementia.

Feasibility of a physical activity programme embedded into the daily lives of older adults living in nursing homes: protocol for a randomised controlled pilot feasibility study.

BACKGROUND: Older adults living in nursing homes spend the majority of their time inactive. The associated levels of chronic disease place an increasing burden on healthcare systems. Physical activity (PA) interventions delivered through exercise classes may be resource-intensive and require specialist staff. The aim of this study is to explore the feasibility and acceptability of a PA programme embedded into the daily lives of older adults living in nursing homes and to examine the preliminary effects of this on physical mobility and quality of life. METHODS: A randomised controlled pilot feasibility study, including embedded qualitative and economic components will be carried out. Two randomly selected nursing homes will take part in the study; participants (n = 20) in one nursing home will receive a three-month PA intervention and participants (n = 20) in the other will be a usual care control. Nursing home staff will be provided with training and support to monitor participants PA programmes. Feasibility data will be collected on recruitment, randomisation, assessment and intervention procedures. Criteria for progression of the pilot feasibility study to a definitive trial will be specified. The Timed Up and Go test, Nottingham Health Profile, 10-Metre Walk test, the Investigating Choice Experiments for the Preferences of Older People Capability index and the Bangor Goal Setting Interview will be assessed at baseline, three-month and 12-month follow-up. Between-group and within-individual effects will be estimated using appropriate linear mixed models. Semi-structured interviews will be conducted with staff and participants of the intervention group within one month after the intervention to explore the feasibility and acceptability of the programme. A subset of control participants will be interviewed to describe usual care. Economic data will be collected to examine costs of the intervention in comparison with costs in the control group. DISCUSSION: The findings will facilitate refinement of the PA programme and development of a clear protocol for subsequent evaluation of the PA intervention in a definitive randomised controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03484715 . Registered on 30 March 2018.

Exploring patient experiences of participating in a group exercise class for the management of nonspecific shoulder pain.

OBJECTIVE: Recent evidence has demonstrated that group-based physiotherapy interventions for musculoskeletal pain can have similar clinical outcomes compared to one-to-one treatment. This study qualitatively explored the experiences of individuals who participated in a physiotherapist-led group exercise class for people with nonspecific shoulder pain (NSSP). METHODS: Semi-structured interviews were carried out with 23 people with NSSP, who had recently participated in a 6-week structured exercise class. All recorded verbal data were transcribed verbatim. Transcripts of interview data were verified by participants and analyzed using thematic analysis. RESULTS: The exercise class was positively evaluated by all participants. Four themes emerged from the data: (1) the participant's experiences of support, motivation, and learning from peers; (2) the preference for an exercise class compared to individual physiotherapy; (3) the physiotherapist as an educator and facilitator; and (4) beliefs about pain and exercise. CONCLUSION: Among those interviewed, the exercise class was described as providing an environment conducive to the development of relationships, friendships, humor and fun, gaining mastery of their exercises, and encouraging the transition toward self-management of their pain. For those who had previous experience of one-to-one physiotherapy, the exercise class was evaluated as the preferred mode of physiotherapy delivery. The findings of this study support a move away from traditional one-on-one physiotherapy sessions to the potentially more cost-effective group setting.

Cryotherapy or gradual reloading exercises in acute presentations of rotator cuff tendinopathy: a randomised controlled trial.

OBJECTIVES: Rotator cuff tendinopathies are the most common shoulder disorders. As persistent symptoms lasting more than 3 months have been shown to be a strong indicator of poor outcomes, it is important to have successful interventions in the acute stage. However, there is no evidence yet to guide clinical interventions in an acute pain context. The objective of this study was to compare the short-term effect of a 2-week gradual reloading exercises programme with the use of cryotherapy on symptoms and function for acute rotator cuff tendinopathy. METHODS: This simple-blind, randomised controlled trial included 44 participants with acute rotator cuff tendinopathy who were randomly allocated to either the exercises or cryotherapy group. Symptoms and functional limitations were evaluated at weeks 0, 2 and 6 using self-reported questionnaires (Disabilities of the Arm, Shoulder and Hand, Western Ontario Rotator Cuff, and Brief Pain Inventory), while acromiohumeral distance, shoulder strength and active range of motion were evaluated at weeks 0 and 2. RESULTS: Following interventions, both groups showed statistically significant improvements on symptoms and function at week 2 and week 6 compared with baseline. However, there was no significant group × time interaction. There was no time effect on acromiohumeral distance, shoulder strength and active range of motion, as well as no time × group interaction. CONCLUSION: The results showed a statistically significant improvement in symptoms and function in both groups, but there was no difference between the short-term effect of a cryotherapy based-approach and a gradual reloading exercises programme. TRIAL REGISTRATION NUMBER: NCT02813304.

Validation of the manual inclinometer and flexicurve for the measurement of thoracic kyphosis.

INTRODUCTION: Physiotherapists commonly use the manual inclinometer and Flexicurve for the clinical measurement of thoracic spinal posture. The aim of this study is to examine the concurrent validity of the Flexicurve and manual inclinometer in relation to the radiographic Cobb angle for the measurement of thoracic kyphosis. METHODS: Eleven subjects (seven males, four females) underwent a sagittal plane spinal radiograph. Immediately following the radiograph, a physiotherapist measured thoracic kyphosis using the Flexicurve and manual inclinometer before the subjects moved from position. Cobb angles were subsequently measured from the radiographs by an independent examiner. RESULTS: A strong correlation was demonstrated between both the Cobb angle and the Flexicurve angle (r = 0.96) and the Cobb angle and the manual inclinometer angle (r = 0.86). On observation of the Bland-Altman plots, the inclinometer showed good agreement with the Cobb angle (mean difference 4.8 ° ± 8.9 °). However, the Flexicurve angle was systematically smaller than the Cobb angle (mean difference 20.3 ° ± 6.1 °), which reduces its validity. CONCLUSION: The manual inclinometer is recommended as a valid instrument for measuring thoracic kyphosis, with good agreement with the gold standard. While the Flexicurve is highly correlated to the gold standard, they have poor agreement. Therefore, physiotherapists should take caution when interpreting its results.

An evaluation of two types of exercise classes, containing shoulder exercises or a combination of shoulder and thoracic exercises, for the treatment of nonspecific shoulder pain: A case series.

STUDY DESIGN: A case series was carried out. INTRODUCTION: There is a lack of evidence exploring the effectiveness of group exercise classes for people with nonspecific shoulder pain (NSSP). Also, there is a lack of research that measures potential reductions in thoracic kyphosis after exercise interventions in people with NSSP. PURPOSE OF THE STUDY: To observe changes in shoulder pain, disability, and thoracic kyphosis in 2 groups of people with NSSP, after 2 different types of group exercise classes. METHODS: People with NSSP received a 6-week block of exercises classes containing either shoulder exercises alone (shoulder group, n = 20) or a mixture of shoulder and thoracic extension exercises (thoracic group, n = 19). The Disabilities of the Arm, Shoulder and Hand questionnaire for disability and the Numeric Rating Scale for pain were measured at baseline, 6 weeks, and 6 months. Thoracic kyphosis was measured at baseline and 6 weeks using the manual inclinometer. RESULTS: Significant and clinically meaningful improvements in Numeric Rating Scale and Disabilities of the Arm, Shoulder and Hand were demonstrated in both groups at 6-week and 6-month follow-up (P < .001). Effect sizes ranged from 0.78-1.16 in the shoulder group and 0.85-1.88 in the thoracic group. Thoracic kyphosis did not change beyond measurement error in either group. DISCUSSION/CONCLUSION: Group exercise classes can improve shoulder pain and disability in people with NSSP. Resting thoracic kyphosis did not change after either exercise intervention, which suggests that the treatment effect was not due to a change in static thoracic spine posture.

Interacting with Dementia: The MARIO Approach.

MARIO is a companion robot that aims to help people with dementia (PWD) to battle isolation and loneliness by enabling them to stay socially active by providing a number of applications focused on hobbies (music, movies, etc), staying engaged with communities (reading headlines, reading local twitter feeds etc.) and staying connected with family and friends (telephoning them, reading their news from twitter, etc.). This paper presents the results from the initial trials of MARIO interacting with PWD involving a limited set of applications. It confirms some of the challenges hypothesized at the outset of the study and provides guidelines for future development work.

Investigating the Effect of Social Robot Embodiment.

The experiment described in this paper is an early assessment to identify if the embodiment of a verbal and visual user interaction system in a robot is more effective in people with dementia than when using the same system in a simple laptop. This study provides input for the robot's design.

Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review.

INTRODUCTION: Excessive thoracic kyphosis is considered a predisposing factor for shoulder pain, though there is uncertainty about the nature of the relationship between shoulder pain and thoracic spine posture. The aim of this systematic review was to investigate the relationship between thoracic kyphosis and shoulder pain, shoulder range of motion (ROM) and function. METHODS: Two reviewers independently searched eight electronic databases and identified relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using a previously validated tool (Ijaz et al., 2013). Data were synthesised using a level of evidence approach (van Tulder et al., 2003). RESULTS: Ten studies were included. Four studies were rated as low risk of bias, three at moderate risk of bias and three at high risk of bias. There is a moderate level of evidence of no significant difference in thoracic kyphosis between groups with and without shoulder pain. One study at high risk of bias demonstrated significantly greater thoracic kyphosis in people with shoulder pain (p < 0.05). There is a strong level of evidence that maximum shoulder ROM is greater in erect postures compared to slouched postures (p < 0.001), in people with and without shoulder pain. CONCLUSIONS: Thoracic kyphosis may not be an important contributor to the development of shoulder pain. While there is evidence that reducing thoracic kyphosis facilitates greater shoulder ROM, this is based on single-session studies whose long-term clinical relevance is unclear. Higher quality research is warranted to fully explore the role of thoracic posture in shoulder pain.

Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review.

BACKGROUND: A wide array of instruments are available for non-invasive thoracic kyphosis measurement. Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered. This systematic review reports on the reliability and validity of non-invasive methods for measuring thoracic kyphosis. METHODS: A systematic search of 11 electronic databases located studies assessing reliability and/or validity of non-invasive thoracic kyphosis measurement techniques. Two independent reviewers used a critical appraisal tool to assess the quality of retrieved studies. Data was extracted by the primary reviewer. The results were synthesized qualitatively using a level of evidence approach. RESULTS: 27 studies satisfied the eligibility criteria and were included in the review. The reliability, validity and both reliability and validity were investigated by sixteen, two and nine studies respectively. 17/27 studies were deemed to be of high quality. In total, 15 methods of thoracic kyphosis were evaluated in retrieved studies. All investigated methods showed high (ICC ≥ .7) to very high (ICC ≥ .9) levels of reliability. The validity of the methods ranged from low to very high. CONCLUSION: The strongest levels of evidence for reliability exists in support of the Debrunner kyphometer, Spinal Mouse and Flexicurve index, and for validity supports the arcometer and Flexicurve index. Further reliability and validity studies are required to strengthen the level of evidence for the remaining methods of measurement. This should be addressed by future research.

Intrarater and interrater reliability of the flexicurve index, flexicurve angle, and manual inclinometer for the measurement of thoracic kyphosis.

Objective. This study aimed to describe the interrater and intrarater reliability of the flexicurve index, flexicurve angle, and manual inclinometer in swimmers. A secondary objective was to determine the level of agreement between the inclinometer angle and the flexicurve angle and to provide an equation to approximate one angle from the other. Methods. Thirty swimmers participated. Thoracic kyphosis was measured using the flexicurve and the manual inclinometer. Intraclass correlation coefficient, 95% confidence interval, and standard error of measurement were computed. Results. The flexicurve angle and index showed excellent intrarater (ICC = 0.94) and good interrater (ICC = 0.86) reliability. The inclinometer demonstrated excellent intrarater (ICC = 0.92) and interrater (ICC = 0.90) reliability. The flexicurve angle was systematically smaller and correlated poorly with the inclinometer angle (R (2) = 0.384). The following equations can be used for approximate conversions: flexicurve angle = (0.275 × inclinometer angle) + 8.478; inclinometer angle = (1.396 × flexicurve angle) + 8.694. Conclusion. The inclinometer and flexicurve are both reliable instruments for thoracic kyphosis measurement in swimmers. Although the flexicurve and inclinometer angles are not directly comparable, the approximate conversion factors provided will permit translation of flexicurve angle to inclinometer angle and vice versa.

Industry experience in promoting weekly iron-folic acid supplementation in the Philippines.

After participating in a pilot project under a government-industry partnership to promote the adoption of weekly iron-folic acid supplementation among women of reproductive age in the Philippines in 1998, United Laboratories (UNILAB), the Philippines' largest private pharmaceutical company, decided in April 2002 to launch a weekly iron-folic acid supplement for pregnant and non-pregnant women under the brand name Femina. The business objective set for the Femina brand was to build the category of preventive iron-folic acid supplements in line with the Philippine Department of Health's advocacy on weekly supplementation as an alternate to daily dosing to reduce the prevalence of anemia in the country. The brand was supported with an integrated mix of traditional advertising media with complementary direct-to-consumer educational programs that aimed to create awareness of iron-deficiency anemia, its causes and effects, and the role of weekly intake of iron-folic acid in preventing the condition. Aggressive marketing support for 1 year was successful in creating awareness among the target women. Significant lessons derived from consumers identified opportunity areas that can be further addressed in developing advocacy programs on weekly iron supplementation implemented on a nationwide scale in the future.