Clinical guideline: Multiple Sclerosis in adults

Citation: National Institute for Health and Care Excellence (2014). Clinical guideline: Multiple Sclerosis in adults. Retrieved from: https://www.nice.org.uk/guidance/cg186

Research Type: Guideline

Abstract: This guideline covers diagnosing and managing multiple sclerosis in people aged 18 and over. It aims to improve the quality of life for adults with multiple sclerosis by promoting symptom management, comprehensive reviews and effective relapse treatment. Click here to view the full guideline.

Adult stroke rehabilitation and recovery guidelines

Citation: American Health Association & American Stroke Association (2017). Adult stroke rehabilitation and recovery guidelines. Retrieved from: http://www.strokeassociation.org/STROKEORG/AboutStroke/Recovery-Healthcare-Professional-Resource-Page_UCM_496009_Article.jsp#.WrbKBpPwbgH

Research Type: Guideline

Abstract: Recommendations from the American Health Association & American Stroke Association on best clinical practices for adults recovering from stroke. Click here to view the full guidelines.

U.S. Department of Veterans Affairs and Department of Defense clinical practice guideline: Rehabilitation of lower limb amputation

Citation: U.S. Department of Veterans Affairs and Department of Defense (2017). U.S. Department of Veterans Affairs and Department of Defense clinical practice guideline: Rehabilitation of lower limb amputation. Retrieved from: https://www.healthquality.va.gov/guidelines/Rehab/amp/

Research Type: Guideline

Abstract: The guideline describes the critical decision points in the Rehabilitation of Lower Limb Amputation and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients with lower limb amputations. Click here to view full guideline.

U.S. Department of Veterans Affairs and Department of Defense clinical practice guideline: The management of upper extremity amputation rehabilitation

Citation: U.S. Department of Veterans Affairs and Department of Defense (2014). U.S. Department of Veterans Affairs and Department of Defense clinical practice guideline: The management of upper extremity amputation rehabilitation. Retrieved from: https://www.healthquality.va.gov/guidelines/Rehab/UEAR/

Research Type: Guideline

Abstract: This guideline is designed to address the key principles of rehabilitation and clinical care for patients with upper limb amputation. The overall goal of amputation rehabilitation is to optimize the patient’s health status, function, independence, and quality of life. Ongoing medical assessments and therapy interventions to address psychosocial, physical and functional limitations are necessary to achieve these desired end states. Click here to view the full guideline.

An effective leisure program for older people with diabetes

Citation: Middleton, R., Moxham, L., & Parrish, D. (2017). An effective leisure program for older people with diabetes. World Leisure Journal, 59(sup1), 30-37.

Research Type: Qualitative Research Design

Abstract: This paper will present findings from a research study, undertaken in Australia, to explore the meaning that older people with diabetes attribute to being involved in an exercise and health promotion leisure programme. A phenomenological approach was adopted to identify what participants perceived was meaningful to them about the experience of being involved in a leisure programme. Semi-structured interviews and a focus group were conducted with participants following the facilitation of a leisure intervention, which incorporated individualized physical activity and lifestyle education over a 12-week period. The primary goal of the intervention was to enhance the health and wellness of people with diabetes. A number of themes emerged from the analysis of participant interview and focus group transcripts. The overarching theme, and critical point of difference, identified in this research study, of effective leisure programmes for health and wellness purposes, is person-centeredness. This essence of meaning, person-centered programme efficacy is explored as a key to ensuring the effective design, promotion and delivery of leisure programmes for older people with diabetes. Since determination of an effective leisure programme can only be established by those involved, the expertise of the participants on their own journey is recognized throughout this presentation by privileging their voices and presenting their words, thereby allowing the findings to be contextualized through the lens of the participants. It is anticipated that exploration of these findings can lead to better understanding how participant engagement particularly of older people, in other health promotion leisure programmes can be enhanced. Link to publisher’s article.

Contextual facilitators and barriers of community reintegration among injured female military veterans: A qualitative study

Citation:Hawkins, B. & Crowe, B. (2018). Contextual facilitators and barriers of community reintegration among injured female military veterans:  A qualitative study. Archives of Physical Medicine and Rehabilitation, 99(2), S65-S71.

Research Type: Qualitative Research Design

Abstract: Objective: To understand the facilitators and barriers to community reintegration (CR) among injured female veterans. Design: Phenomenologic qualitative design. Setting: Community. Participants: Community-dwelling female veterans with physical and/or psychological injury (N=13). Interventions: None. Main Outcome Measures: None. Results: Conventional content analysis revealed 3 types of facilitators, including (1) strong social support, (2) impactful programs, and (3) protective personal beliefs. Six types of barriers included (1) inadequate services, (2) lack of access to services, (3) poor social support, (4) difficulty trusting others, (5) nonsupportive personal beliefs, and (6) injury factors. Multiple environmental and personal factors acted as facilitators and barriers to CR. Findings are relatively consistent with previous veteran and civilian community reintegration research that indicates the importance of health-related services, attitudes of others, and social support. However, women in this study reported being effected by many of these facilitators and barriers because of their sex. Conclusions: This study supports the need to foster social support among injured female veterans throughout the rehabilitation process to promote CR. Long-term social support can be gained by incorporating services (eg, adjunctive therapies, recreation, other social programming) into the rehabilitation repertoire to help with CR for all veterans, particularly women. Link to publisher’s article.

Traumatic brain injury severity, comorbidity, social support, family functioning, and community reintegration among veterans of the Afghanistan and Iraq wars

Citation: Pugh, M., Swan, Al, Carolson, K, Jaramillo, C., Eapen, B., Dillahunt-Aspillaga, C., Amuan, M., Delgado, R., McConnell, K., Finley, E., & Grafman, J. (2018). Traumatic brain injury severity, comorbidity, social support, family functioning, and community reintegration among veterans of the Afghanistan and Iraq wars. Archives of Physical Medicine and Rehabilitation, 99(2), S40-S49.

Research Type: Other Quantitative Research Design

Abstract: Objective: To examine the association between traumatic brain injury (TBI) severity; social, family, and community reintegration outcomes; and return to work status among post-9/11 veterans in Department of Veterans Affairs (VA) care. Design:  Retrospective observational cohort study. Setting: Mail/online survey fielded to a national sample of veterans. Participants: Sample of post-9/11 veterans with at least 3 years of VA care stratified according to TBI severity and comorbidities who completed and returned surveys (N=2023). Interventions: Not applicable. Main Outcome Measures: Deployment Risk and Resilience Inventory-2 family functioning and social supports subscales; Military to Civilian Questionnaire; and employment status.Results: Bivariate analyses revealed that veterans with every classification of TBI severity reported significantly more difficulty on social, family, and community reintegration outcomes than those with no TBI. In the fully adjusted model, veterans with unclassified and moderate/severe TBI reported significantly more difficulty with community reintegration and were less likely to be employed relative to those with no TBI; those with unclassified TBI also reported significantly more difficulty with family functioning. Veterans with mild TBI also reported significantly more difficulty with community reintegration. Conclusions: This study provides insight into long-term outcomes associated with TBI in post-9/11 veterans and suggests that exposure to TBI has a negative effect on social and family functioning, community reintegration, and return to work even after controlling for comorbidity, deployment experiences, and sociodemographic characteristics. Additional research is required to explicate what appears to be complex interactions among TBI severity, psychosocial well-being, combat exposures, and socioeconomic resources in this population. Link to publisher’s article

 

Physical fitness in people with posttraumatic stress disorder: A systematic review

Citation: Vancampfort, D., Stubbs, B., Richards, J., Ward, P., Firth, J., Schuch, F., & Rosenbaum, S. (2017). Physical fitness in people with posttraumatic stress disorder: A systematic review. Disability and Rehabilitation, 39(24), 2461-2467.

Research Type: Systematic Review

Abstract: Purpose: People with posttraumatic stress disorder (PTSD) have an increased risk of cardiovascular diseases (CVD). Physical fitness is a key modifiable risk factor for CVD and associated mortality. We reviewed the evidence-base regarding physical fitness in people with PTSD. Methods: Two independent reviewers searched PubMed, CINAHL, PsycARTICLES, PEDro, and SPORTDiscus from inception until May 2016 using the key words “fitness” OR “exercise” AND “posttraumatic stress disorder” OR “PTSD”. Results: In total, 5 studies involving 192 (44 female) individuals with PTSD met the inclusion criteria. Lower baseline physical fitness are associated with greater reductions in avoidance and hyperarousal symptoms, as well as with total, physical, and social symptoms of anxiety sensitivity. Rigorous data comparing physical fitness with age- and gender matched general population controls are currently lacking. Conclusions: The research field regarding physical fitness in people with PTSD is still in its infancy. Given the established relationships between physical fitness, morbidity and mortality in the general population and the current gaps in the PTSD literature, targets for future research include exploring: (a) whether people with PTSD are at risk of low physical fitness and therefore in need of intensified assessment, treatment and follow-up, (b) the relationships among physical fitness, overall health status, chronic disease risk reduction, disability, and mortality in individuals PTSD, (c) psychometric properties of submaximal physical fitness tests in PTSD, (d) physical fitness changes following physical activity in PTSD, and (e) optimal methods of integrating physical activity programs within current treatment models for PTSD. Implications for Rehabilitation:

 

  • People with PTSD should aim to achieve 150 minutes of moderate or 75 minutes vigorous physical activity per week while also engaging in resistance training exercises at least twice a week.
  • Health care professionals should assist people with PTSD to overcome barriers to physical activity such as physical pain, loss of energy, lack of interest and motivation, generalized fatigue and feelings of hyperarousal.

 

Link to publisher’s article.

Risk factors for falls in community stroke survivors: A systematic review and meta-analysis

Citation: Xu, T., Clemson, L., O’Loughin, K., Lannin, N., Dean, C., & Koh, G. (2018). Risk factors for falls in community stroke survivors: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 99(3), 563-573.

Research Type: Systematic Review

Abstract: Objective: To identify the risk factors for falls in community stroke survivors. Data Sources: A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted. Study Selection: Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis. Data Extraction: Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. Data Synthesis: Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68–7.10); reduced balance (OR, 3.87; 95% CI, 2.39–6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36–7.48); disability in self-care (OR, 2.30; 95% CI, 1.51–3.49); depression (OR, 2.11; 95% CI, 1.18–3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02–2.99); and history of fall (OR, 1.67; 95% CI, 1.03–2.72). A history of fall (OR, 4.19; 95% CI, 2.05–7.01) had a stronger association with recurrent fallers. Conclusions: This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional. Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. Link to publisher’s article.

Creating an inclusive leisure space: Strategies used to engage children with and without disabilities in the arts-mediated program Spiral Garden

Citation: Smart, E., Edwards, B., Kingsnorth, S., Sheffe, S., Curran, CJ., Pinto, M., Crossman, S., & King, G. (2018). Creating an inclusive leisure space: Strategies used to engage children with and without disabilities in the arts-mediated program Spiral Garden. Disability and Rehabilitation, 40(2), 199-207.

Research Type: Qualitative Research Design

Abstract: Purpose: This article describes how service providers use a set of practical strategies to create an inclusive leisure space in Spiral Garden, an arts-mediated outdoor summer day program for children with and without disabilities. Methods: This study was guided by an interpretive qualitative approach. Fourteen Spiral Garden service providers participated in semi-structured interviews. Nine had extensive experience with the program and had been present during key phases of program development spanning over a 26-year period and five were service providers during the summer of 2013. Transcript data were analyzed using inductive thematic analysis. Results: The analysis produced eight strategies organized under three larger categories that service providers perceived to be essential in creating an inclusive leisure space: (1) engaging children in collective experiences; (2) encouraging peer interactions and friendships; and (3) facilitating collaborative child-directed experiences. Conclusions: Service providers working across different inclusive settings can use findings from this study to contribute to program design and implementation. Presented strategies enable children to experience opportunities for spontaneous free play, individualized structured support, and meaningful social participation. Overall, service providers are encouraged to enhance supportive child and service provider relationships and reciprocal child and environment relationships in group-based programs. Implications for Rehabilitation:

  • Exploring and facilitating reciprocal relationships between children and their environment is essential to creating inclusive leisure spaces.
  • Transforming program intentions of meaningful social participation into practice requires learning about and affecting change in children’s individual social contexts.
  • Service providers can engage themselves as full participants in inclusive leisure spaces through playful negotiations, internal reflections, and artistic expressions.

Link to publisher’s article.