Journal of therapeutic horticulture 27.1 2017
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Published onAuthors of this article:. Background: Prolonged sedentary behavior is related to a number of risk factors for chronic diseases. Given the high prevalence of sedentary behavior in daily life, simple yet practical solutions for behavior change are needed to avoid detrimental health effects. Objective: The mobile app SedVis was developed based on the health action process approach. The app provides personal mobility pattern visualization for both physical activity and sedentary behavior and action planning for sedentary behavior change.
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About the Author s. The Author s. This is an Open Access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Comparative effectiveness research on wheelchairs available in low-resource areas is needed to enable effective use of limited funds. Mobility on commonly encountered rolling environments is a key aspect of function. High variation in capacity among wheelchair users can mask changes in mobility because of wheelchair design. A repeated measures protocol in which the participants use one type of wheelchair and then another minimises the impact of individual variation.
It measures the impact of different wheelchair types on physical performance in commonly encountered rolling environments and provides an opportunity for qualitative and quantitative participant response. This study sought to confirm the ability of the AWMT to discern differences in mobility because of wheelchair design. Method: Participants were wheelchair users at a boarding school for students with disabilities in a low-resource area.
Each participant completed timed tests on measured tracks on rough and smooth surfaces, in tight spaces and over curbs. Four types of wheelchairs designed for use in low-resource areas were included. Results: The protocol demonstrated the ability to discriminate changes in mobility of individuals because of wheelchair type.
Conclusion: Comparative effectiveness studies with this protocol can enable beneficial change. This is illustrated by design alterations by wheelchair manufacturers in response to results. Wheelchair users and family members have often placed highest priority on mobility and the psychosocial benefits that result from it Hosseini et al.
In fact, wheelchairs are provided specifically to those people who are unable to get around in their daily environment effectively by walking. Wheelchairs intended for use in low-resource areas should enable good mobility on commonly encountered rolling surfaces. Wheelchairs designed for use in the United States and Europe may not provide adequate mobility because of the differences in the environments of daily life.
In developed areas, populations spend more time indoors on smooth surfaces than they typically do in low-resource areas; therefore there is more need for rough terrain wheelchairs for low-resource areas Winter et al.
In contrast, wheelchair users in low-resource areas often spend considerable time outdoors where they and their wheelchairs encounter rough terrain, and where public transportation is difficult Blanford et al. In low-resource areas, living spaces such as houses and schools may be small and sometimes crowded; therefore, the ability to move a wheelchair through tight spaces is also crucial; building codes may not require ramps and other modifications that make wheelchair access easy; thus, coping with curbs is necessary Borg et al.
Wheelchair centre of gravity, caster and wheel sizes, wheelbase length and other design characteristics may impact the ease of movement in different rolling environments quite differently Cowan et al. Often, wheelchair availability in low-resource areas may limit the ability of therapists to ideally fit wheelchair users.
For example, active users may be put into a range of more or less ideally appropriate wheelchairs depending on what is available Gartz et al. The type of wheelchair provided often simply depends on which type is available when one is needed. Studies carried out in the environments where the wheelchairs are used are essential to provide feedback to maximise effective use of limited funds Jutai et al.
Variations among wheelchair users in skill and capability level can mask the negative impact of a poor wheelchair design. Unless a protocol is used in a repeated measures study design in which the user completes a test in one wheelchair and then another, the impact of wheelchair design on mobility may not be apparent Hoenig et al. Even in a repeated measures protocol, a strongly skilled wheelchair user may be able to roll in most environments in almost any wheelchair; therefore, the ability to discern the effect of different wheelchair designs requires high discriminatory validity.
Study design impacts discriminatory validity in several ways. Objectively measured data such as velocity may be considerably lower in one chair type than another when rolling on rough ground, but a study design which only uses a limited categorical response or completion score would indicate the task was completed successfully in both chairs. In addition, unlike categorical data, objectively measured data is often suitable for powerful parametric statistical tools such as analysis of variance ANOVA May ; Walpole et al.
Longer timed roll tests are also more likely than shorter tests to discern differences. A change in the ease of rolling which impacts energy cost is more evident as participants move into aerobic exercise about 2 min into a test Berne et al. Visual analogue scale VAS question format produces continuous data which has been considered suitable for parametric statistical analysis Philip ; Walpole et al. Discriminatory validity is enhanced by a mixed methods protocol which includes qualitative data, allowing wider scope of understanding and triangulation FieldingThe Quebec User Evaluation of Satisfaction with Assistive Technology obtains user feedback on their satisfaction with any assistive device Demers et al.
It can and has been used in comparative effectiveness studies assessing user satisfaction with assistive technology Deems-Dluhy et al. However, it is not a physical performance measure and does not supply information specific to wheelchair mobility. Questionnaires aimed at assessing individual capability and physical performance include Functional Independence Measure and the Barthel Index Kumar et al. The above measures are not primarily designed for use in repeated measures studies assessing differences in mobility because of wheelchair design.
Objective quantitative data on mobility have also been obtained in laboratory settings Askari et al. However, a laboratory setting does not perfectly mimic the conditions of daily use. It is important that effectiveness studies are also done in the environment where wheelchairs are used Jutai et al. There is a tension between every rolling environment that may be of interest, and keeping a protocol short, simple and usable.
Face validity is the logical subjective expectation that a protocol will test its target construct Jerosch-HeroldPerformance tests were of sufficient duration to include the transition to aerobic respiration Neto et al. Visual analogue scale responses and comments were solicited from participants, and exercise and resting heart rate were monitored using research grade heart rate monitors Crapo et al. This format was selected because VAS format is very likely to provide data suitable for parametric statistical analysis tools, and because each question includes an opportunity to write a comment providing qualitative explanatory information Funk et al.
Measurements of heart rate or oxygen consumption provide continuous objective data on the energy cost of movement Coutinho et al. Slowing down when encountering difficulty or awkwardness is the strategy that has enabled timed walk tests to be validated by measuring difficulty in ambulation Holland et al.
However, slowing down is not the only response to a greater difficulty in moving. Circadian rhythm, the cost of digestion, body temperature and other factors have a larger proportional impact on non-exercise heart rate than on exercise heart rate. Because PCI calculation includes non-exercise heart rate, these factors would likely impact PCI more than they would do the direct measurement of exercise heart rate Berne et al. The objective of this study was to obtain data that sheds light on the mobility provided by wheelchairs designed for low-resource areas as they roll on surfaces and in situations commonly encountered there.
Our hypothesis was that an updated version of the AWMP which used exercise heart rate instead of PCI would have the discriminatory validity to provide comparative effectiveness data on four types of wheelchairs commonly provided to wheelchair users with strong upper bodies at our study site. Specifically, we hypothesised that ANOVA results for velocity, heart rate and participant response VAS scores would indicate significant differences between wheelchair types.
Participant comments would shed light on the perceived reasons for ease or difficulty. Meaningful discriminatory validity would be confirmed by results which would enable wheelchair manufacturers to make responsive changes.
This study was conducted in partnership with an organisation that provides rehabilitation to students at a boarding school for students with disabilities in Kenya. The location included a primary and secondary school, and participants were drawn from both. Because students with disabilities in Kenya are often not able to attend local schools, some had begun school at an older age. This resulted in a wide age range in study participants.
Wheelchair users at the site regularly traverse paved and unpaved areas, curbs and tight spaces. A convenience sample of participants was recruited from wheelchair using students. Local therapists identified students of appropriate size and disability to use the study wheelchairs safely, and who had the ability to self-propel a manual wheelchair without stress on unpaved surfaces.
The second criterion was added with the presupposition that strong wheelchair users would provide more complete data sets for all tracks, and would therefore increase the statistical power of ANOVA analysis across tracks and wheelchairs.
Participation was voluntary, and participants could withdraw at any time or choose not to complete any task. The study utilised four wheelchair types intended for provision in low-resource areas.
All four types were commonly provided to wheelchair users with strong upper bodies at our study site, and were available at our study site. Additional information on characteristics of the wheelchair types such as dimensions, weight and so on is available through the manufactures whose websites are cited above.
Because AWMP is intended to provide real-world comparative effectiveness data, the wheelchairs were set up in the configuration most commonly used for active wheelchair users at our study site.
Photos of the four wheelchairs in the configurations used in this study are given in Figure 1. The width of the seat of the wheelchairs used in this study was the option closest to 33 cm for all chair types.
This was chosen because this width was suitable to a large group of wheelchair users at our study site. Broader comparison with other wheelchair options for active users at our study site was desired; therefore, MRT and WRR were also included.
However, there was no sufficient time to compare all four wheelchairs on all tracks; therefore, only the curb track, the most challenging, was chosen for use with all four wheelchairs. On arriving at the study location, researchers looked for areas appropriate to set up measured tracks incorporating rough, smooth, tight spaces and curbs. For each of the four rolling environments, a looped track was set up and measured using a survey wheel.
Rough and smooth tracks were to be of 6 min duration similar to the 6 min timed walk test. Curb and tight tracks were of 3 min duration because of greater difficulty of the curb track and repeated turns on the tight track. Curb and rough rolling environments were included partly to prevent a ceiling effect.
HKC and FG2 wheelchairs were used on the tight, rough and smooth surface tracks. All four wheelchair types were used on the curb track to provide a broader comparison for wheelchair function on that track. Each participant was asked to attempt to complete each track in each wheelchair utilised on that track. A low discrepancy shifting pattern of wheelchairs and rolling environments was used to avoid skewing of results by the order of testing. If the study wheelchair was not their own wheelchair type, participants were given a few minutes to accommodate to the wheelchair before testing began.
To avoid fatigue, data collection for different wheelchairs was done on different days, and participants were pushed between track locations. Distance travelled was measured by counting the number of times the loop was completed, and using a survey wheel to measure the length of the final incomplete loop. Velocity was calculated by dividing distance travelled by test time. After each track, participants were asked to rate the ease or difficulty of movement on a cm VAS and to provide a qualitative explanatory comment see Figure 2 for question format.
Participants wore PolarPro heart rate monitors and watches. Non-exercise heart rate was taken while the participants sat quietly for 5 min before testing began. Heart rate monitor data were downloaded to a computer, the time period after the first 2 min of each test was selected and the mean heart rate for that time period was calculated. If a proportion of participants withdrew from a test on a particular track, a chi-squared analysis of proportions test was calculated.
Qualitative comments were coded into categories using an open-ended conventional content analysis method in which the content of the comments guided the formation of categories. The number of comments for each category was counted across wheelchair types and tests. Participants over 18 years of age provided informed written consent.
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High-risk patients being underprescribed statins, study finds
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Tui Na for Chronic Nonspecific Low Back Pain: Protocol for a Systematic Review and Meta-analysis
Published onAuthors of this article:. Background: Chronic nonspecific low back pain CNLBP is one of the most common complex pain conditions, and it is strongly associated with high rates of disability. Even though several studies on Tui na for CNLBP have been reported, to our knowledge there has been no systematic review of the currently available publications.
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Methods: This retrospective, descriptive study was conducted at the Aga Khan University Hospital, Karachi, and comprised the medical records of all patients with the diagnosis of acute calculus cholecystitis who presented in and those who presented in after the implementation of Tokyo Guidelines. SPSS 19 was used for data analysis. The overall mean age wasConclusion: Implementation of Tokyo Guidelines not only greatly influenced but also standardised the choice of antibiotics in patients without compromising the infective and surgical outcomes. The choice and duration of antibiotics usually remain a contentious issue in this situation. Updated Tokyo Guidelines classified the patients with acute cholecystitis into three broad groups on the basis of severity of infection and provide recommendations for the antibiotic regimen and duration of therapy in each category.
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This article refers to the development of a Brief Psychotherapy modality in a hospital setting through the use of alchemical images. This article presents the fourth and last stage of this process, which refers to the application of RIME in women undergoing treatment for breast cancer with the possibility of a cure. This is a comparative exploratory and descriptive research that uses the quantitative and qualitative approaches. The main focus of this article is to present the qualitative results. Qualitative data were collected using recorded semi-structured interviews and graphical representations, prior to the 1st and after the 3rd RIME sessions. In summary, the results obtained showed that the RIME Intervention promoted empowerment for libido strengthening, as a constructive force, in women with breast cancer with the possibility of a cure. This article refers to the development of a Brief Psychotherapy modality entitled RIME in a hospital setting using alchemical images. RIME intervention Relaxamento, Imagens Mentais, Espiritualidade [Relaxation, Mental Images, Spirituality] has been developed for 17 years, and this study presents the last stage of its development process.
From research to application: supportive and therapeutic environments for Journal of Dementia Care. Nov-Dec ; vol. 25(6), pp. Abstract.
African Journal of Disability
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