Cardiac Rehabilitees' Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach.

BACKGROUND: Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees' perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation. OBJECTIVE: This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees' experiences and attitudes toward technology before 12 months of remote rehabilitation. METHODS: Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser's mode of the grounded theory approach. RESULTS: The result of the study was an "identifying e-usage" experience category, which refers to the rehabilitees' notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees' technology experience. These subcategories are "feeling outsider," "being uninterested," "reflecting benefit," and "enthusiastic using." All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation. CONCLUSIONS: The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education. TRIAL REGISTRATION: ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD).

Why is excessive sitting a health risk?

Increased epidemiological evidence over the past few years has shown excessive sitting to be a health risk even if recommendations for physical activity are fulfilled. Sitting is an independent health risk for two reasons: sitting and physical activity exhibit poor correlation, and an increase in physical activity does not contribute to all mechanisms underlying the health risks of sitting. During sitting, muscular passivity increases insulin resistance and influences the transport and oxidation of fatty acids in muscular tissue, and acute exercise is not sufficient to restore all changes. Accordingly, adequate everyday physical activity seems to be important for maintaining the signaling pathways affecting insulin sensitivity.

My Well-Being in My Own Hands: Experiences of Beneficial Recovery During Burnout Rehabilitation.

PURPOSE: To explore how burnout rehabilitation clients experienced their recovery from burnout and what they found beneficial in rehabilitation. SUBJECTS: Twelve clients whose burnout levels had declined during rehabilitation were interviewed at the end of the second period of the rehabilitation course. METHODS: Semi-structured interviews comprised the main material of the study and were analysed by content analysis. In addition, the Bergen Burnout Indicator (BBI-15) was used to measure the reduction in burnout levels. RESULTS: The analysis yielded a single overarching theme, My well-being in my own hands, and four categories. The overarching theme describes the overall process of recovery and the revelation experienced by clients that they are in charge of their own well-being. The process starts with Support from rehabilitation professionals, the client group and family or friends. The categories Awareness and Approval refer to specific changes in the attitude towards and recognition of one's needs and limits. The category Regained joy describes the culmination of the recovery process manifested in different spheres of life. CONCLUSIONS: The rehabilitation course proved particularly beneficial for individuals suffering from burnout. The accumulation of support, awareness and approval led to a revival of joy in life and greater perceived control over one's well-being.

Effects of a home-based physical rehabilitation program on physical disability after hip fracture: a randomized controlled trial.

OBJECTIVE: Fewer than half of the patients with hip fracture will regain the prefracture level of physical functioning. This secondary analysis of a randomized controlled trial investigated the effects of a multicomponent home-based rehabilitation program (ProMo) on physical disability after hip fracture. DESIGN: Randomized, controlled, parallel-group trial. SETTING: Rehabilitation in participants' homes; measurements in university-based laboratory and local hospital. PARTICIPANTS: Population-based clinical sample of community-dwelling people older than 60 years (n = 81) operated for hip fracture were randomized into intervention and control groups. INTERVENTION: The year-long intervention aimed at restoring mobility. It included evaluation and modification of environmental hazards, guidance for safe walking, pain management, home exercise, physical activity counseling, and standard care. MEASUREMENTS: Physical disability was assessed by a questionnaire at baseline, and 3, 6, and 12 months thereafter. Sum scores were computed for basic (ADLs) and instrumental activities of daily living (IADLs). A higher score indicated more difficulty. GEE models were constructed to analyze the effect of the intervention. RESULTS: In the intention-to-treat analysis, no intervention effect was observed for sum scores. For the single disability items, borderline significant positive effects were observed for preparing food and handling medication (interaction P = .061 and P = .061, respectively). In the per-protocol analysis, the mean differences between groups were -0.4 points (SE 0.5), -1.7 (0.7), and -1.2 (0.7) at 3, 6, and 12 months for ADLs and -1.0 (1.2), -3.2 (1.5), and -2.5 (1.4) for IADLs, correspondingly. CONCLUSION: The current analyses suggest that home-based rehabilitation may reduce disability among older people after hip fracture. The present results need to be confirmed in a study with larger sample size. Potentially a more task-oriented rehabilitation approach might gain more benefits. Current Controlled Trials (ISRCTN53680197).

Walking recovery after a hip fracture: a prospective follow-up study among community-dwelling over 60-year old men and women.

PURPOSE: Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. METHODS: A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. RESULTS: Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. CONCLUSIONS: A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation.

Physical dose of therapeutic exercises in institutional neck rehabilitation.

OBJECTIVE: To determine the intensity and volume of therapeutic exercises during a standard 13-day inpatient neck rehabilitation course in relation to overall physical activity in rehabilitation and everyday life. DESIGN: Cross-sectional study. METHODS: Subjects (n = 19; 16 women and 3 men; mean age 48.6 years, standard deviation (SD) 6.6) with chronic non-specific neck pain were recruited from two inpatient neck rehabilitation courses. Intensity and volume of therapeutic exercises and physical activity were measured in metabolic equivalents (METs) with an objective measurement device and all-time recall questionnaire. Maximum oxygen uptake was determined in METs (METc) by direct maximal cycle ergometer. RESULTS: Subjects' mean METc was 7.2 METs (SD 1.4) or 25.3 ml/kg/min (SD 4.8). Intensity of all therapeutic exercises was 1.9 METs or 27 %METc (SD 5.1) and volume 7.7 MET-hours/week. Intensity of specific neck and shoulder exercises was 2.0 METs or 28 %METc (SD 5.4) and volume 2.5 MET-hours/week. In addition, subjects were more active in everyday life than in inpatient rehabilitation. CONCLUSION: The therapeutic exercise dose failed to reach previously reported target values for pain relief. The dose of therapeutic exercises and confounding physical activity should be carefully controlled in pain rehabilitation programmes.

Muscle performance, work ability and physical functioning in middle-aged men.

BACKGROUND: Limited data exist on the associations between muscle performance and work ability measures in working age adults. AIMS: To evaluate how the results of simple muscle performance tests correlate with self-reported work ability and physical functioning in middle-aged men. METHODS: Muscle performance was measured with handgrip, sit-up, arch-up, squatting and lifting tests. The Physical Functioning scale and the Role Limitations due to Physical Health Problems scale of the RAND-36 health questionnaire were used to assess functioning and the Work Ability Index (WAI) questionnaire to assess perceived work ability in a subgroup of 51 subjects. RESULTS: A total of 104 men aged 45-55 years employed in physically active work participated. Muscle performance was weakly associated with WAI and functioning measures, accounting for 10% of the variance at most. Dynamic lifting test results for both arms correlated with WAI scores (right: r = 0.31, left: r = 0.34). Scores of the dynamic lifting test for both arms correlated with the Physical Functioning scores (right: r = 0.23, left: r = 0.28) and with the Role Limitations due to Physical Health Problems scores (right: r = 0.25, left: r = 0.28). Results of the squatting test were associated with the Physical Functioning scores (r = 0.24). CONCLUSIONS: The study failed to provide support for the use of muscle performance tests in work-related fitness evaluations in middle-aged men employed in physical jobs.

Burnout during a long-term rehabilitation: comparing low burnout, high burnout - benefited, and high burnout - not benefited trajectories.

To focus rehabilitation activities among burnout clients more effectively, it is important to investigate who benefits from burnout interventions. This study (N=85) aimed at identifying burnout trajectories in terms of benefit, that is, subgroups of clients who share similar mean levels and changes in burnout during a one-year rehabilitation intervention (17 days in total) with a six-month follow-up. After identifying the burnout trajectories, the relations of the trajectories with factors describing the clients, antecedents, and consequences of burnout during the one-year intervention were examined. Three burnout trajectories were identified by growth mixture modeling: (a) low burnout (n=39), (b) high burnout - benefited (n=29), and (c) high burnout - not benefited (n=17). Positive changes were detected in antecedents and consequences among the clients in the low burnout and high burnout - benefited trajectories. Recovery from burnout was associated with increased job resources and decreased job demands, as well as with increased job satisfaction and decreased depression. It seems that more precise targeting of rehabilitation is needed since the trajectories revealed not only clients with mild symptoms, but also clients who probably received this treatment too late.

Associations between work ability, health-related quality of life, physical activity and fitness among middle-aged men.

The Work ability of ageing work force is a matter of major concern in many countries. The aim of this study was to examine the relationship between perceived work ability and health-related quality of life (HRQoL), and to investigate their associations with age, physical activity and physical fitness in middle-aged men working in blue-collar occupations. The study population consisted of 196 middle-aged (aged 40-60 years) men (construction and industrial work) attending occupationally orientated early medical rehabilitation. They were mostly healthy having only symptoms of musculoskeletal or psychological strain. Perceived work ability was assessed with the work ability index (WAI) and HRQoL with the Rand, 36-item health survey (Rand-36). Information on physical activity was obtained with a structured questionnaire. Cardiorespiratory fitness was estimated with a submaximal exercise test on a cycle-ergometer. The WAI was significantly (p<0.001) associated with the total score of Rand-36, and with all its domains. Age, physical activity and cardiorespiratory fitness were neither associated with the WAI, nor did physical activity predict any of the dimensions of Rand-36. Cardiorespiratory fitness was associated with the physical functioning dimension of the Rand-36 whilst age was positively associated with the dimensions of the energy, emotional well being and social functioning of the Rand-36. The present study on middle-aged men showed a close relationship between perceived work ability and the HRQoL. It is suggested that the promotion of work ability may have beneficial effects on quality of life.

Are cardiorespiratory fitness and walking performance associated with self-reported quality of life and work ability?

OBJECTIVES: In Finland, testing cardiorespiratory fitness (VO2max) is popular in health promotion programs and work ability evaluations. The most common instruments used for this purpose are the submaximal cycle ergometer test, and the 2-km walking test. However, limited data exist on the associations between VO2max and wellbeing in working age adults. The aim of the study was to evaluate how the measured (cycle ergometer) and the estimated (walking test) VO2max and walking performance are associated with health-related quality of life and work ability. MATERIALS AND METHODS: The subjects were 104 middle-aged men workers (45-55 years old), mostly from the construction and manufacturing industries. VO2max was directly measured by a maximal exercise test on a cycle ergometer. The 2-km walking test parameters were the walking time, predicted VO2max, and fitness index. Health-related quality of life was assessed with the RAND-36 questionnaire which was further divided into physical dimensions (P-RAND-36) and mental dimensions (M-RAND-36). Perceived work ability was assessed with the work ability index (WAI) in a subgroup of 51 subjects. RESULTS: The 2-km walking test parameters significantly predicted the score on P-RAND-36 (r2=0.18, p=0.001), and correlated significantly with WAI. The directly measured VO2max was not associated with P-RAND-36, M-RAND-36 or WAI. CONCLUSIONS: The inexpensive 2-km walking test may be more useful when evaluating the quality of life and work ability, compared to the more expensive direct measurement of one's cardiorespiratory fitness in a laboratory.

Burnout patterns in rehabilitation: short-term changes in job conditions, personal resources, and health.

This longitudinal study reports the patterning of the burnout symptoms and the changes in employees' job conditions, personal resources, and psychological health 4 months after a rehabilitation intervention. The data were gathered by means of questionnaires before and after a rehabilitation period. Four patterns were identified: not burned out (n = 55), exhausted and cynical (n = 36), burned out (n = 26), and low professional efficacy (n = 18). These patterns differed in terms of job resources, personal resources, and depression. There were both positive and negative changes detected in participants' psychological health and job resources at the follow-up. The study shows the importance of identifying different burnout patterns in order to focus rehabilitation activities more effectively.