West Park Healthcare Centre

There is limited evidence comparing center and home-based sit-to-stand (STS) tests in individuals with chronic respiratory disease (CRD). This study aimed to estimate the level of agreement and performance differences among center-based, remotely supervised, and self-administered STS tests in individuals with CRD. A repeated-measures design was used to compare the 30-s and 1-min STS across 3 test conditions. The sample size was one of convenience and included subjectswith CRD from an out-patient pulmonary rehabilitation program in Toronto, Canada. Bland-Altman analysis was used to estimate STS agreement across conditions, reporting mean difference and 95% limits of agreement (LoA). Analysis of variance was used to estimate differences in STS performance across conditions, controlling for testing order. Secondary measures included indicators of safety and acceptability of the remotely supervised and self-administered conditions. All analyses were completed using Stata/BE 17.0 with a significance level of P ≤ .05. Twenty-seven participants (mean age 69.4 ± 11.8 years, 52% female) completed STS testing in all 3 conditions. Bland-Altman plots revealed limited bias across all comparisons (mean difference < 1 repetition). LoA illustrated individual variation across comparisons for the 30-s STS (LoA -3.4 to 4.1) and 1-min STS (LoA: -7.4 to 8.6). Analysis of variance models indicated no effect of test condition on either 30-s STS (P = .12) or 1-min STS (P = .33). There was an observed order effect for the 30-s STS (P = .005) and 1-min STS (P = .005). There were no serious adverse events for remotely supervised and self-administered tests. The majority (≥80%)of participants found the instructions clear, and felt safe and confident while performing the remotely supervised and self-administered STS. Performance on the 30-s and 1-min STS did not differ across test conditions. Remotely supervised and self-administered tests may be safe and acceptable.

Maintaining pulmonary rehabilitation (PR) benefits in people with COPD is challenging due to the difficulties in sustaining a physically active lifestyle. The PICk UP programme (<ext-link>NCT04223362</ext-link>), a personalised community-based physical activity (PA) intervention, proved effectiveness in preventing PA decline six months post-PR. This qualitative study explored how the behavioural change techniques (BCTs) in the PICk UP intervention supported sustained PA engagement. Pre- and post-intervention semi-structured focus groups were conducted with the PICk UP participants. Reflexive thematic analysis was applied, following the “capability, opportunity, motivation, behaviour” (COM-B) framework. We included 15 individuals with COPD (14male, 70±8yrs, FEV157.1±18.1%pp). Participants identified 12 BCTs within the intervention: information about health, feedback on behaviour/ outcome, verbal persuasion, PA habit formation, restructuring of the physical/social environment, action plan, goal setting, problem solving, commitment and social support. These BCTs were categorised into 5 intervention types (education, persuasion, training, environmental restructuring and enablement), which addressed the 6 components that influence behaviour (Figure 1). Collectively, they empowered participants to maintain PA following PR. This study highlights the critical role of targeted BCTs in supporting long-term PA maintenance in individuals with COPD following PR. <fig><object-id>erj;66/suppl_69/PA2792/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

There is limited published guidance available to help less experienced practitioners assess and manage shoulder conditions, including spasticity, after acquired central nervous system (CNS) lesions. To address this gap, 11 spasticity and dystonia experts convened in a 2023 meeting to build on existing guidance, provide consensus on best treatment practice, and develop expert recommendations to guide the diagnosis and treatment of complications of shoulder conditions following CNS lesions. Presentations by each expert on diagnosis and management were followed by discussion; consensus on assessment and treatment practices was identified and recommendations developed. The expert panel recommended an assessment approach structured using the following components: patient history, including interpretation of reported symptoms; observation of postures and pain responses; clinical examination with targeted tests for specific signs; diagnostic tests; and assessment of upper limb impairment, activity limitations, and participation restrictions. This assessment process and the recommended measures recognize the importance of identifying shoulder involvement in upper limb spasticity as part of the diagnostic process in shoulder conditions following CNS lesions. These recommendations provide a practical approach to diagnosis and treatment for clinicians who are less experienced in evaluating and treating such conditions, simplifying otherwise complicated clinical scenarios.

Diabetes-related lower limb amputation (LLA) is a leading cause of disability globally, impacting individuals' physical and mental health, and ultimately their quality of life. Physical activity can reduce risk of chronic disease and mortality while improving quality of life. However, people with LLA often have reduced balance and walking ability resulting in sedentary behaviour. We co-created a physical activity intervention, IMproving Physical Activity through Coaching and Technology following Lower Limb Loss (IMPACT-L3), to support physical activity behaviour change in people with dysvasular LLA. To date, no studies have assessed a peer-led physical activity behaviour change intervention for people with LLA. Prior to launching a large trial, a pilot study is required to assess feasibility and optimize design of a future trial. This pilot study is a parallel group randomized controlled trial (RCT) with an embedded qualitative component. The intervention group will have access to once-weekly virtual peer coaching sessions with a peer trained in brief action planning; web-based physical activity modules; and a wearable activity monitor for 8 weeks. The control group will continue usual care and be offered the intervention at the end of the follow-up period. Data on feasibility will be collected including assessment of process, resource, management and treatment indicators. The proposed primary outcomes will be measured at baseline, post-intervention and one month later: total physical activity counts per day measured by the ActiGraphTM activity monitor and self-efficacy measured by the Self-efficacy for Exercise scale. Secondary measures include patient reported outcome measures of physical activity, mobility, depression, social participation, balance confidence and quality of life. Semi-structured interviews will explore feasibility and acceptability of the intervention to participants and peers. This study will inform the design of a definitive RCT to determine the effectiveness of a peer-led physical activity intervention for people with dysvascular LLA.

BACKGROUND:Individuals with lower extremity amputations (LEA) often face high rates of depression and anxiety that hinder their rehabilitation and post-discharge coping. Group therapy is a clinically and cost-effective way to address these mental health challenges, but evidence for its use with LEA inpatients is limited.OBJECTIVE:To determine the feasibility of a psychosocial group therapy intervention for individuals with dysvascular LEA undergoing inpatient rehabilitation.METHODOLOGY:This randomized controlled trial randomly assigned dysvascular LEA rehabilitation inpatients into a supportive-expressive group therapy (SEGT) or a treatment as usual (TAU) group. The SEGT intervention, a form of group therapy adapted from outpatient medical settings, consisted of six one-hour sessions held twice weekly over a three-week period. Participants completed baseline, exit and three-month surveys assessing the study's secondary outcomes of SEGT effectiveness on depression, anxiety, coping, body image, health, and community participation. The main outcomes assessed recruitment, survey completion, treatment adherence, and participant retention rates. Interviews and a focus group were completed to obtain feedback on the intervention.FINDINGS:Twenty-five participants were recruited, with 12 randomly assigned to the SEGT group, and 13 to the TAU group. The average number of sessions attended by SEGT participants was 3.9 (SD = 2.1). The survey completion rates for all participants were 84% (21/25) for the baseline assessment, 64% (18/25) for discharge, and 44% (11/25) for the three-month follow-up. The SEGT group showed a significant improvement in anxiety and depression scores (p = 0.02). SEGT was well-received by participants and staff.CONCLUSION:The findings suggest a larger pragmatic SEGT trial is feasible, despite a small sample size and implementation challenges during the COVID-19 pandemic, given this study achieved moderate rates of recruitment, retention, and survey completion. Several critical insights were gained on how to optimize an inpatient group therapy intervention for dysvascular LEA populations in rehabilitative settings.

BackgroundAt least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.MethodsA systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The β-coefficients were normalised to assess relative impact.ResultsOur search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised β-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).ConclusionsThis study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.PROSPERO registration numberCRD42023476939.

ObjectiveMetabolic syndrome (MetS) is a cluster of factors that increase the risk of cardiovascular disease and type 2 diabetes. It is highly prevalent among patients with Chronic Obstructive Pulmonary Disease (COPD). This systematic review and meta-analysis assessed MetS prevalence in COPD patients, focusing on variations by gender, diagnostic criteria, and disease severity.MethodsWe systematically searched MEDLINE, Embase, Scopus, and CINAHL. Two reviewers independently extracted data using a standardized form, and study quality was assessed with the Joanna Briggs Institute checklist. Prevalence rates, with 95% confidence intervals (CI), were calculated using a random-effects model. Subgroup analyses by sex, COPD severity, and MetS components were conducted.ResultsForty-two studies, including 54,278 COPD patients, were analyzed. Overall, the prevalence of MetS was 37% (95% CI: 30.6-43.8%; I2 = 99.03%, p < 0.001). Prevalence was 48% (95% CI 38.1 to 57.5) in males and 43% (95% CI 38.3 to 48.8) in females. Among studies using the Alberti definition, the pooled prevalence was 46% (95% CI 35.6 to 56.3). Patients with GOLD stage II showed a prevalence of 44% (95% CI 37.3 to 50.4). The most common MetS components were Hypertension 58% (95% CI 47.2 to 68.0) and increased waist circumference 51% (95% CI 37.1 to 64.6).ConclusionMetS is highly prevalent among COPD patients. Standardized diagnostic criteria are needed, and early detection with integrated care is recommended.