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Brazilian Journal of Physical Therapy Jun 2024Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for...
Embedded motivational interviewing combined with a smartphone application to increase physical activity in people with sub-acute low back pain: a cluster randomised controlled trial.
BACKGROUND
Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate.
OBJECTIVES
This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP.
METHODS
A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention.
RESULTS
There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app.
CONCLUSION
The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.
PubMed: 38943741
DOI: 10.1016/j.bjpt.2024.101091 -
International Journal of Law and... Jun 2024This article critically examines the proposed reforms to Irish mental health law the Mental Health Act 2001 (2001 Act). The article will provide background to the 2001...
This article critically examines the proposed reforms to Irish mental health law the Mental Health Act 2001 (2001 Act). The article will provide background to the 2001 Act and the lengthy law reform process, which has resulted in the publication of the Heads of Bill that propose significant amendments. The article assesses the suggested reforms, considering Ireland's 2018 ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD), which provides important context to the law reform process. The 2001 Act is the primary piece of legislation regulating mental health services and safeguarding the rights of persons subject to the legislation in Ireland. While passed in 2001, the legislation did not come into effect until 2006. The 2001 Act was seen as bringing Irish mental health law into compliance with international human rights law, in particular the European Convention on Human Rights (ECHR). However, Ireland's ratification of the CRPD has necessitated closer scrutiny of the legislation. This review has culminated in the publication of a Heads of Bill in July 2021 and pre-legislative scrutiny by the responsible parliamentary committee in 2022. The long title of the Heads of Bill explicitly states its goal of safeguarding individual autonomy and underscores its commitment to upholding and advancing the rights of people subject to the legislation. The analysis of the Heads of Bill addresses several key areas. These areas include a background to the long process of review, new guiding principles, the category of persons under the mental health legislation, mental health tribunals, consent to treatment, advance healthcare directives, provisions relating to children and young people, and independent advocacy. Based on this analysis of the Heads of Bill, recommendations are suggested which would strengthen respect for the human rights of persons subject to the legislation.
PubMed: 38943689
DOI: 10.1016/j.ijlp.2024.102004 -
Geriatrics & Gerontology International Jun 2024To identify factors associated with locomotive syndrome (LS) using medical questionnaire data and machine learning.
Identifying factors associated with locomotive syndrome using machine learning methods: The third survey of the research on osteoarthritis/osteoporosis against disability study.
AIM
To identify factors associated with locomotive syndrome (LS) using medical questionnaire data and machine learning.
METHODS
A total of 1575 participants underwent the LS risk tests from the third survey of the research on osteoarthritis/osteoporosis against disability study (ROAD) study. LS was defined as stage 1 or higher based on clinical decision limits of the Japanese Orthopaedic Association. A total of 1335 items of medical questionnaire data came from this study. The number of medical questionnaire items was reduced from 1335 to 331 in data cleaning. From the 331 items, identify factors associated with LS use by light gradient boosting machine-based recursive feature elimination with cross-validation. The performance of each set was evaluated using an average of seven performance metrics, including 95% confidence intervals, using a bootstrapping method. The smallest set of items is determined with the highest average of receiver operating characteristic area under the curve (ROC-AUC) under 20 items as association factors of LS. Additionally, the performance of the selected items was compared with the LS risk tests and Loco-check.
RESULTS
The nine items have the best average ROC-AUC under 20 items. The nine items show an average ROC-AUC of 0.858 (95% confidence interval 0.816-0.898). Age and back pain during walking were strongly associated with the prevalence of LS. The ROC-AUC of nine items is higher than that of existing questionnaire-based LS assessments, including the 25-question Geriatric Locomotor Scale and Loco-check.
CONCLUSIONS
The identified nine items could aid early LS detection, enhancing understanding and prevention. Geriatr Gerontol Int 2024; ••: ••-••.
PubMed: 38943538
DOI: 10.1111/ggi.14923 -
Disability and Rehabilitation.... Jun 2024There is a lack of literature examining the engagement in strength activities of people with disabilities (PWD) using and not using wearable devices. The objectives of...
There is a lack of literature examining the engagement in strength activities of people with disabilities (PWD) using and not using wearable devices. The objectives of the current study were to determine the prevalence of strength activity engagement among wearable device users with disabilities, and to compare strength activity engagement between wearable device users and non-users with and without disabilities. Wearable device users and non-users with and without disabilities from eight states of the CDC's 2017 Behavioral Risk Factor Surveillance were included in the analysis. Linear regression was used to examine the association between wearable device use and disability status and the interaction term for frequency of strength activity per week, while logistic regression was used to determine the association between the two variables and the interaction term for strength activity engagement and meeting strength activity guidelines. 7055 wearable device users and non-users with and without disabilities were included in the analysis. No interaction effects were found between wearable device use and disability status. In unadjusted logistic regressions, wearable device users were more likely to engage in strength activity (OR = 1.16, 95% CI [1.16, 2.20]) and meet strength activity guidelines (OR = 1.50, 95% CI [1.07, 2.09]), whereas PWDs were less likely to engage in strength activity (OR = 0.57, 95% CI [0.44, 0.75]) and meet strength activity guidelines (OR = 0.72, 95% CI [0.53, 0.98]). The use of wearable devices could lead to engagement in strength activity. However, further research is needed to determine its effectiveness in PWD.
PubMed: 38943532
DOI: 10.1080/17483107.2024.2373299 -
Health Promotion International Jun 2024Health literacy is a significant element of education and is inextricably linked to children's and adolescents' growth and prosperity. It is critical to monitor...
Health literacy is a significant element of education and is inextricably linked to children's and adolescents' growth and prosperity. It is critical to monitor students' health literacy on a nationwide scale and identify the factors that influence it in order to create policies that advance it. The purpose of this study was to determine the health literacy level of Greek secondary school students and to correlate it with possible determinants such as personal and family characteristics, social support and personal and/or family illness experiences. A representative sample of 2749 seventh-, ninth-, and tenth-grade students was involved. Results showed that a higher motivation to learn about health topics and having positive social interactions and support were strongly associated with a higher level of health literacy. Gender, high academic achievement, absence of learning disabilities, gender, preference for biology and informatics and primary source of health information were also found to influence the skills' level. In order to enhance health literacy, the Greek educational system should take measures to include health literacy skills development goals in their curricula.
Topics: Humans; Greece; Male; Health Literacy; Female; Adolescent; Students; Surveys and Questionnaires; Social Support; Motivation; Schools; Child; Sex Factors
PubMed: 38943524
DOI: 10.1093/heapro/daae063 -
Epilepsia Jun 2024This study was undertaken to analyze whether the rate of breakthrough seizures in patients taking antiseizure medication (ASM) who have been seizure-free for at least...
OBJECTIVE
This study was undertaken to analyze whether the rate of breakthrough seizures in patients taking antiseizure medication (ASM) who have been seizure-free for at least 12 months varies among different types and etiologies of epilepsy. Given the relative ease of achieving seizure freedom with ASM in patients with post-ischemic stroke epilepsy, we hypothesized that this etiology is associated with a reduced risk of breakthrough seizures.
METHODS
We defined a breakthrough seizure as an unprovoked seizure occurring while the patient was taking ASM after a period of at least 12 months without seizures. Data were analyzed retrospectively from a tertiary epilepsy outpatient clinic. Patients were eligible for inclusion if they either had a breakthrough seizure at any time or a seizure-free interval of at least 2 years. Our primary endpoint was rate of breakthrough seizures. We conducted univariable and multivariable analyses to identify variables associated with breakthrough seizures.
RESULTS
Of 521 patients (53% females, median age = 49 years) included, 29% had a breakthrough seizure, which occurred after a median seizure-free interval of 34 months (quartiles = 22, 62). When controlling for clinically relevant covariates, breakthrough seizures were associated with post-ischemic stroke epilepsy (odds ratio [OR] = .267, 95% confidence interval [CI] = .075-.946), genetic generalized epilepsy (OR = .559; 95% CI = .319-.978), intellectual disability (OR = 2.768, 95% CI = 1.271-6.031), and the number of ASMs previously and currently tried (OR = 1.203, 95% CI = 1.056-1.371). Of the 151 patients with breakthrough seizures, 34.3% did not reachieve terminal 12-month seizure freedom at the last visit.
SIGNIFICANCE
This is the first study to show an association between type and etiology of epilepsy and risk of breakthrough seizures. Our data suggest that epilepsies in which seizure freedom can be obtained more easily also exhibit a lower risk of breakthrough seizures. These findings may help to better counsel seizure-free patients on their further seizure prognosis.
PubMed: 38943516
DOI: 10.1111/epi.18048 -
Journal of Evaluation in Clinical... Jun 2024The Knowledge Translation (KT) Programme of a pan-Canadian strategic patient-oriented research network focused on brain-based developmental disabilities aimed to...
RATIONALE
The Knowledge Translation (KT) Programme of a pan-Canadian strategic patient-oriented research network focused on brain-based developmental disabilities aimed to mobilize knowledge relevant to the network members. The programme also promotes and studies integrated Knowledge Translation (iKT) approaches involving different interested parties, such as researchers, patient-partners and decision-makers, in all parts of the knowledge creation process.
AIMS AND OBJECTIVES
The objective of this study is to advance research programme evaluation methods through a realist evaluation of the process of implementing iKT activities.
METHODS
Realist process evaluation included: (1) development of initial programme theories (using the partnership synergy theory); (2) data collection and analysis; (3) synthesis and refinement of theories through engagement with literature; and (4) presentation of findings in context-mechanism-outcome (C-M-O) configurations. A range of project documentation records were reviewed for analysis, and three co-leads, a programme coordinator, and a senior research associate were consulted to contextualize the implementation process of relevant KT activities.
RESULTS
Based on the developed C-M-O configurations, we identified five key mechanisms of generating synergy in the iKT processes: (1) Visible shared leadership that embodies what iKT looks like; (2) Researchers' readiness for iKT; (3) Adaptation and flexible allocation of resources to emerging needs; (4) Power sharing to create practical and creative knowledge; and (5) Collective voice for potential transformative impacts at the policy level.
CONCLUSIONS
The current realist evaluation demonstrated how partnerships between researchers, patient-partners and other interested parties can synergistically generate new ways of thinking among all interested parties, actionable strategies to integrate users in research, and solutions to disseminate knowledge. In particular, we identified a pivotal role for patient-partners to act as equal decision-maker helps building and maintaining partnerships and consolidating KT strategies.
PubMed: 38943509
DOI: 10.1111/jep.14056 -
American Journal of Industrial Medicine Jun 2024In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the...
OBJECTIVES
In Italy, asbestos was used intensively until its ban in 1992, which was extended for asbestos cement factories until 1994. The aim of this study was to evaluate the dose-response between asbestos exposure and asbestosis mortality across a pool of Italian occupational cohorts, taking into account the presence of competing risks.
METHODS
Cohorts were followed for vital status and the cause of death was ascertained by a linkage with mortality registers. Cause-specific (CS) Cox-regression models were used to evaluate the dose-exposure relationship between asbestosis mortality and the time-dependent cumulative exposure index (CEI) to asbestos. Fine and Gray regression models were computed to assess the effect of competing risks of death.
RESULTS
The cohort included 12,963 asbestos cement workers. During the follow-up period (1960-2012), of a total of 6961 deaths, we observed 416 deaths attributed to asbestosis, 879 to lung cancer, 400 to primary pleural cancer, 135 to peritoneal cancer, and 1825 to diseases of the circulatory system. The CS model showed a strong association between CEI and asbestosis mortality. Dose-response models estimated an increasing trend in mortality even below a CEI of 25 ff/mL-years. Lung cancer and circulatory diseases were the main competing causes of death.
CONCLUSIONS
Asbestos exposure among Italian asbestos-cement workers has led to a very high number of deaths from asbestosis and asbestos-related diseases. The increasing risk trend associated with excess deaths, even at low exposure levels, suggests that the proposed limit values would not have been adequate to prevent disability and mortality from asbestosis.
PubMed: 38943482
DOI: 10.1002/ajim.23629 -
Journal of Back and Musculoskeletal... Jun 2024Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment...
BACKGROUND
Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area.
OBJECTIVE
To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain.
METHODS
The study involved 44 participants who were randomised into two different groups: the exercise group (n= 22) and the kinesio tape group (n= 22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants' ROM, pain evaluations and functional scales were evaluated with disability, and work functionality.
RESULTS
Neck pain severity decreased in both groups (p< 0.001 for each value), but there was no difference between the groups (p: 0.071). When disability scores were evaluated, improvement was noted in both groups (p: 0.001 for each value), but no statistically significant difference was found (p: 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p: 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p< 0.05).
CONCLUSION
KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance.
PubMed: 38943382
DOI: 10.3233/BMR-240001 -
Journal of Back and Musculoskeletal... Jun 2024During the last two decades, there has been a growing interest in spinal sagittal alignment. Most published studies have focused on the role of spinopelvic parameters in...
BACKGROUND
During the last two decades, there has been a growing interest in spinal sagittal alignment. Most published studies have focused on the role of spinopelvic parameters in patients with adult spinal deformity or in those with previous spinal fusion.
OBJECTIVE
The aim of this study was to explore possible association between disability related to back pain and spinopelvic parameters in the absence of coronal deformity or previous spinal surgery.
METHODS
In the setting of a larger study involving patients with low back pain (LBP), those without previous surgery or spinal deformity in the coronal plane were selected. A total of 52 patients (mean age 59 years, range 21-86, 23 men and 29 women) were found. The visual analogic scale (VAS) and Oswestry Disability Index questionnaire (ODI) were recorded. Surgimap software was used to measure the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and lumbar lordosis (LL). Statistical analysis was performed with SPSS Statistics software. Pearson or Spearman correlation were the test of choice depending on the specific variables.
RESULTS
A statistically significant association was found between SVA and ODI (r 0.59, p< 0.03). Increased pelvic tilt was also associated with more severe disability related to back pain (r 0.48, p< 0.03). PI-LL mismatch showed moderate association with disability and severity of back pain, although this association did not reach statistical significance (r 0.52, p< 0.08).
CONCLUSION
Our findings suggest that sagittal misalignment may be related with more severe disability and back pain in patients with minor or null deformity in the coronal plane.
PubMed: 38943379
DOI: 10.3233/BMR-230242