Background: Balance is one of the risk factors for falls in older adults. The use of smartphone applications (apps) related to health (mHealth) is increasing and, while there is potential for apps to ...be used as a self-managed balance intervention, many healthcare providers are concerned about the content and credibility of mHealth apps overall.
Purpose: This study evaluates the quality of balance promoting apps and identifies strengths and areas of concern to assist healthcare providers in recommending these resources.
Materials and methods: Balance apps for the general public, offered on the iPhone Operating System (iOS) and Android platforms, were evaluated using the Mobile Application Rating Scale (MARS).
Results: Five iOS apps met the inclusion criteria. The mean scores for each of the domains in MARS were: Engagement (3.32), Information (3.7), Functionality (3.8), and Esthetics (3.8). Overall, one app (UStabilize) received a rating of 4.43 in MARS five-point scale, which was considered "good". Other apps in the review demonstrated acceptable quality.
Conclusions: The reviewed balance apps targeted to improve or maintain physical balance were of acceptable quality. Apps address many current issues older adults have to accessing rehabilitation services and, as such, may be particularly useful for this group. Future research should focus on assessing and comparing app efficacy. Development of balance apps for the Android platform is also necessary.
Implications for Rehabilitation
Given the availability and accessibility of various mHealth apps and the increasing mobile device usage among older adults, mobile apps are a promising avenue for delivering rehabilitation interventions, such as balance training, to older adults.
Smartphone apps exist for balance training but overall confidence in health apps within the healthcare community is low and rigorous evaluation is required.
A range of apps exist that demonstrate acceptable to good quality and stakeholders should work towards having these apps listed in credible mHealth clearinghouses.
Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need ...for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs.
Our study was informed by the Levesque et al.'s (2013) "conceptual framework of access to health care." We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed.
Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants' Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants' attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and 'normal' results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants.
With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.
Children with neurodevelopmental disorders (NDD) are at high risk for sleep problems, especially insomnia. It is currently not known whether behavioural sleep interventions developed for typically ...developing (TD) children are effective for children with NDD, and if interventions need to be modified for each diagnostic group. The aim of this systematic review was to identify and evaluate commonalities, trends in outcomes, and the methodological quality of parent-delivered behavioural sleep interventions for children with NDD, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Cerebral Palsy, and Fetal Alcohol Spectrum Disorder. Nine databases were searched. A total of 40 studies met eligibility criteria. The majority of studies were conducted with ASD and ADHD populations. Common sleep problems were evident across the NDD populations. The most frequently reported included bedtime resistance, night-waking, early morning awakening, and co-sleeping. The most common interventions used were implementation of healthy sleep practices, reinforcement, graduated extinction, and faded bedtime. All studies reported at least one behavioural treatment component as effective. Commonalities across NDD populations, as well as the TD population, for both sleep problems reported and behavioural interventions implemented, suggest the feasibility of developing a transdiagnostic behavioural sleep intervention suitable for children with a range of NDD.
People with chronic pain may seek rehabilitation to reduce pain and restore productivity and valued roles. Theoretically, a biopsychosocial approach makes rehabilitation more meaningful, however, the ...limited research on meaningful rehabilitation predominantly describes the perspective of therapists and researchers. The client's perspective of meaningfulness in rehabilitation is lacking.
To investigate the experience of meaningfulness in rehabilitation from the perspective of people with chronic pain.
Qualitative, semi-structured interviews were conducted with Australian adults who had chronic pain and recent experience of occupational therapy or physiotherapy. Sampling continued until thematic saturation occurred. Transcripts were coded and analyzed using theory-driven and data-driven thematic analysis.
Ten participants (four males; six females) were interviewed. Pain histories ranged from nine months to 20+ years, with conditions such as fibromyalgia or trauma. Three themes from a prior concept analysis were upheld, and a further three data-driven themes emerged. Results indicate that people with chronic pain seek a "genuine connection"; from a therapist who is "credible"; and can become a "guiding partner", and they find rehabilitation meaningful when it holds "personal value"; is "self-defined"; and relevant to their sense of "self-identity".
The genuine connection and guiding partnership with a credible therapist, that is sought by people with chronic pain, may be at odds with aspects of contemporary rehabilitation. Client-defined meaningfulness is an important construct to engage clients in treatment and improve work and other occupational outcomes for people with chronic pain.
The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite ...its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study's aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients.
Interpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant's choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit.
Four conditions were identified as necessary for establishing a therapeutic relationship:
,
,
, and
. These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed.
These conditions of engagement are needed for physiotherapist and patient to "be" in a therapeutic relationship. Although communication skills are important for advancing therapists' relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.
In 2020–2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and ...to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.
Wrist actigraphy is a form of objective sleep measurement that has gained a central role in sleep research and clinical settings. Guidelines for actigraphy recommend placing the monitor on the ...non-dominant wrist, however, this potentially will be the most involved limb for someone with Parkinson disease, and so alternative placement would be preferred. To-date, there is little published about sleep actigraphy use in Parkinson disease (PD). This study examines the degree of sleep actigraphy score variation in persons with PD when monitors are placed simultaneously on all four limbs. In this study, four participants wore a sleep actigraph on each limb for seven nights. Data from the four actigraphs was compared within each participant to determine the degree of consistency. We found that all of the participants' sleep efficiency and total sleep time scores were higher in the lower limb than upper limb. There was no notable difference in sleep variables between the dominant arm and non-dominant arm. We concluded that simultaneous actigraphy measurement did not notably vary between dominant and non-dominant arms. However, a discrepancy was seen between upper limbs and lower limbs actigraph scores. Further study is warranted to develop guidelines for sleep actigraphy use in this population.
Excessive daytime sleepiness (EDS) is highly prevalent among medical students and can have serious negative outcomes for both students and their patients. Little is known about the magnitude and ...predictors of EDS among medical college students. A meta-regression analysis was conducted to achieve these two targets. A systematic search was performed for English-language studies that reported the prevalence of EDS among medical students using the Epworth sleepiness scale (ESS), age, sex, sleep duration and sleep quality as predictive variables. A total of nine observational studies (K = 9, N = 2587) were included in the analyses. Meta-regression analyses were performed using mean age (years), sex (proportion of male subjects), sleep duration (hours/night) and sleep quality index score (continuous scale) as moderators for EDS—with the prevalence of EDS as an outcome variable. An interaction term of sleep duration X sleep quality was created to assess if these two variables simultaneously influenced the outcome variable. Utilizing the ESS, the pooled prevalence of EDS among medical students was 34.6% (95% Confidence Interval (CI) 18.3–50.9%). Meta-regression models of age, sex, sleep duration and sleep quality alone revealed poor predictive capabilities. Meta-regression models of sleep duration–sleep quality interaction revealed results with high statistical significance. The findings from this review contribute supporting evidence for the relationship between sleep duration and sleep quality scores (i.e., sleep duration X sleep quality score) in predicting EDS in medical students.
Purpose Chronic pain is a complex biopsychosocial experience, and rehabilitation helps people to manage pain, and restore valued life roles. Evidence suggests that more positive outcomes occur when ...clients perceive their rehabilitation to be meaningful. People with chronic pain describe rehabilitation as personally-meaningful when they develop a genuine connection with a credible therapist who they see as a guiding partner, and when rehabilitation holds personal value, is self-defined, and relevant to their sense of self-identity. This paper presents a qualitative study of therapists’ experience using an e-learning package on patient-defined, personally-meaningful rehabilitation. Methods A qualitative descriptive design was used to explore rehabilitation therapists’ experience of a prototype evidence-informed, online resource developed on the basis of eLearning and web-design principles. Semi-structured interviews and focus groups were conducted with a purposive sample of occupational therapists and physiotherapists, and inductive coding and thematic analysis of transcripts was completed. Findings Twenty-four therapists (12 occupational therapists, 12 physiotherapists) participated, representing a mix of gender and experience (early career; experienced; and specialist). Four themes and 12 sub-themes emerged from the analysis. The resource delivered a positive user experience, which added (translational) value to enhance learning, and participants were highly positive about the future potential of the resource to translate chronic pain rehabilitation research for early career, experienced, and specialist rehabilitation therapists. Conclusion Results suggest that the disparate learning needs of rehabilitation therapists from diverse professional backgrounds and experience, may be addressed through the one resource. Participant feedback provides evidence that the resource fits with current models of learning and behaviour change. This study demonstrates the importance of basing online resources on eLearning and web-design principles to translate complex biopsychosocial chronic pain rehabilitation research for rehabilitation therapists.
Objective
The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep ...changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents’ and children’s needs to support sleep during the pandemic.
Methods
Eighty-five Canadian parents with children aged 4–14 years participated in this explanatory sequential, mixed-methods study using an online survey of children’s and parents’ sleep, with a subset of 16 parents, selected based on changes in their children’s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial.
Results
While some parents perceived their child’s sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child’s sleep had worsened (40.0%, n = 34). Parents attributed children’s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children’s and parents’ sleep.
Conclusions
The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children’s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.
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