Many people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a ...decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS.
Are biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS?
In this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment FGA, Activities-specific Balance Confidence scale ABC, self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls.
Only ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate.
While the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.
•Many people with chronic stroke have reduced walking balance and confidence.•Modulation of mediolateral foot placement may be an important balance strategy.•Paretic foot placement modulation was related to clinical balance measures.
BACKGROUND: Prolonged and chronic sedentary behavior (SB) contributes to negative health problems including cardiovascular and metabolic diseases. As SB time continues to increase in adults, there is ...an increasing trend towards breaking up SB over the course of the day. Research has shown that short bouts of exercise throughout the day can minimize the negative cardiovascular and metabolic effects seen from excessive SB. Therefore, current recommendations are to move more and sit less. Provided that any bout of physical activity provides health benefits, the current literature investigates breaking up prolonged SB with short bouts of exercise using various modes, durations, and intensities and have reported positive effects on metabolic health. PURPOSE: The purpose of this study was to determine the effects of combined arm and leg cycling (CALC) on glucose metabolism. We hypothesized that short bouts (1-min and 5-min) of CALC would decrease the 60-min blood glucose (BG) area under the curve (AUC) in a dose-dependent manner, when compared to control (CON). METHODS: Thirty participants between the ages of 18-35 were recruited and enrolled upon meeting inclusion criteria. A repeated measures design was used with participants completing baseline assessments and three experimental sessions: CON, a 1-min exercise bout (1M) and a 5-min exercise bout (5M). Experimental sessions were completed in a randomized order. During the exercise visits, participants performed CALC at a self-selected speed on an Assault™ Air bike for the respective exercise time. Participants completed a 60-min oral glucose tolerance test (OGTT) (75g glucose beverage) immediately after exercise. Capillary blood sampling was collected via finger sticks pre-exercise and every 15-min post-exercise. The CON trial followed the same experimental procedure; however, participants did not engage in any exercise. The primary analyses were a one-way repeated measures MANOVA to identify differences in BG at the individual time points between the trials and a two-way mixed ANOVA to identify differences in the AUC during the 60-min OGTT between gender and trial. A two-way mixed ANOVA was done as a secondary analysis to identify any differences to AUC between pre-diabetic and normoglycemic individuals. RESULTS: There were significant differences between the BG values when comparing the 5M and CON at 0-min (p=0.034), 15-min (p<0.001) and 30-min (p<0.001) and the 1M bout compared to CON at 30-min (p=0.017). The 5M and 1M bout were significantly different at 0-min only (p=0.045). There were significant differences in the total area under the curve (tAUC) between CON and the 5M bout (p=0.001). There were no significant differences in incremental area under the curve (iAUC) between the three trials. There were no significant differences in tAUC or iAUC between genders or glycemic status. CONCLUSION: Short bouts of CALC were able to significantly reduce BG values up to 30-min post-exercise and reduce the tAUC, compared to performing no exercise at all. This mode and duration of exercise may aid healthy, able-bodied individuals in achieving benefits to glucose metabolism. An increase in exercise duration may be necessary to see additional results in this population that extend further than 30-min post-exercise.
Purpose
To explore the reciprocal process of decisional conflict within the patient-physician dyad, and its relationship with patient general health and patient-perceived physician helpfulness. Among ...the subset of participants who were in a committed relationship, we examined the congruence in reciprocal processes between patient-spouse/caregiver and patient-physician dyads.
Methods
An online retrospective survey of cancer patients was conducted in the USA. The reciprocal process of decisional conflict within the patient-physician dyad was measured using the Decisional Conflict Scale (DCS). The Perception of Spousal Reciprocity Scale (POSRS) was used to measure reciprocity in the patient-spouse/caregiver dyad.
Results
The final analytic cohort consisted of 116 participants. The average age of participants was 58.4 years, the majority were female (66.7%), and the most common diagnosis was breast cancer (27.9%). Participants who perceived their physician as more helpful were more likely to report lower levels of decisional conflict on the DCS total scale and subscales (
r
range = 0.24–0.46,
p
< 0.05). Higher scores on the PSORS were associated with lower levels of decisional conflict (
r
= − 0.37,
p
< 0.01). Participants not in a relationship had higher levels of decisional conflict about their treatment decisions (
M
= 21.69) than participants in a relationship (
M
= 9.69,
t
(26.95) = − 2.26,
p
= 0.032).
Discussion
Physicians are an important resource for both the patient and caregiver during the cancer journey. Understanding reciprocal processes within the patient-physician relationship related to patient-centered care and including the caregiver in the medical decision-making process can decrease the threat of decisional conflict and subsequent adverse outcomes.
During walking in neurologically-intact controls, larger mediolateral pelvis displacements or velocities away from the stance foot are accompanied by wider steps. This relationship contributes to ...gait stabilization, as modulating step width based on pelvis motion (hereby termed a "mechanically-appropriate" step width) reduces the risk of lateral losses of balance. The relationship between pelvis displacement and step width is often weakened among people with chronic stroke (PwCS) for steps with the paretic leg. Our objective was to investigate the effects of a single exposure to a novel force-field on the modulation of paretic step width. This modulation was quantified as the partial correlation between paretic step width and pelvis displacement at the step's start (step start paretic ρdisp). Following 3-minutes of normal walking, participants were exposed to 5-minutes of either force-field assistance (n = 10; pushing the swing leg toward mechanically-appropriate step widths) or perturbations (n = 10: pushing the swing leg away from mechanically-appropriatestep widths). This period of assistance or perturbations was followed by a 1-minute catch period to identify after-effects, a sign of altered sensorimotor control. The effects of assistance were equivocal, without a significant direct effect or after-effect on step start paretic ρ disp . In contrast, perturbations directly reduced step start paretic ρ disp (p = 0.004), but were followed by a positive after-effect (p = 0.02). These results suggest that PwCS can strengthen the link between pelvis motion and paretic step width if exposed to a novel mechanical environment. Future work is needed to determine whether this effect is extended with repeated perturbation exposure.
Introduction
The patient–physician relationship is a critical component of patient‐centred health care. The patient–oncologist relationship is particularly important due to the uncertainties that ...surround treatment of cancer. The goal of the current review was to summarise current methodological approaches to studying the relationship between cancer patients and oncologists.
Methods
A systematic review using PsychInfo, Ebsco, PubMed and Google Scholar was performed using combinations and variations of the MESH terms: “relationship,” “doctor‐patient,” and “oncology.” The included studies explicitly measured the “relationship” as an independent or dependent variable. Data were extracted and analysed.
Results
The 13 studies included in the review were published from 2004 to 2018. There was little agreement between studies on the definition of the patient–oncologist relationship. Trust was most frequently measured, but methods varied. Most studies evaluated the patient perspective (n = 10). The few studies that considered the oncologist perspective did not measure their perception of the relationship.
Conclusions
The current review demonstrates that current approaches used to assess the patient–oncologist relationship are inconsistent. These differences may limit our understanding of patient needs in current research and practice. Future research should focus on the use of a relational lens as a theoretical framework to assess the patient–oncologist relationship.
Background: Incorporating physical activity (PA) has been a challenge for health care professionals working with anorexia nervosa (AN) patients. This has contributed to partial physical fitness ...(PFit) recovery that persists after weight restoration. Objective: This cross-sectional study aimed to examine the relationships between PA, sedentary behaviors, PFit, and quality of life (QoL) in a group of adolescents after hospitalization. Methods: QoL, PA, and sedentary behaviors were measured using the Health-Questionnaire Short-Form 36 (SF-36) and accelerometers, while PFit was assessed through cardiorespiratory fitness, body composition (anthropometry), and strength (six repetition maximum) tests in a total of 63 patients. Results: Light-PA (LPA), moderate-PA (MPA), moderate-to-vigorous-PA (MVPA), and relative sedentary time (%ST) did not meet the recommendations (p < 0.001). Only 22% of the patients met MVPA criteria, and ~82% exceeded %ST. SF-36 scores were lower than normative values except the physical component scale. Absolute cardiorespiratory fitness was reduced (p < 0.001) in 84% of the patients, and was positively associated to body weight, body mass index (BMI), circumferences, and muscle areas. Additional positive significant relationships were found between QoL, muscular strength, and body composition, and negative associations between vigorous-to-very vigorous PA and BMI, skinfolds, and percent body fat. Regression analyses revealed lower body strength as an explanatory factor for improved QoL (OR 1.03, 95%CI 1.00−1.07). Conclusions: PFit and QoL scores are poor after hospitalization. LPA, MPA, and MVPA do not meet recommendations. PFit management—with emphasis on improving muscular fitness—may be a valuable strategy for QoL improvement in AN after hospitalization.
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