1,721,050 research outputs found
Exploring the usefulness of real-time digitally supported fatigue monitoring for fatigue management: perspectives from Occupational Therapists and Brain Injury Survivors
No full textFatigue persists after acquired brain injury (ABI) requires long-term self-management. Self-monitoring supports self-management and informs the use of fatigue management strategies. Using ecological momentary assessment (EMA) to monitor fatigue offers a data driven approach to managing fatigue. Aims: to explore the usefulness of self-monitoring fatigue in real-time, using EMA to support self-management, from the perspective of people with ABI and occupational therapists.Methods: people with ABI participated in EMA monitoring by wearing a Fitbit and completing six surveys a day on their phone for six days. Think aloud and semi-structured interviews elicited views on self-monitoring and the data generated. Transcripts were analysed using reflexive thematic analysis.Results: four themes were developed from people with ABI (n=9): 1) Attending to experience, 2) making sense of data, 3) the relationship between fatigue and activity, 4) Implications for daily life. Three themes from occupational therapists (n=5): 1) Challenges of using of data, 2) Perceived benefits of Self-monitoring , 3) viewing data in relation to their understanding of fatigue. Conclusion: data generated in real-time challenged perspectives on fatigue and fatigue management. These insights may help people with ABI and their clinicians to plan personalised strategies for fatigue management and evaluate its impact on daily living. <br/
Experiences of fatigue in daily life of people with acquired brain injury: a qualitative study
No full textPurpose: To develop an in-depth understanding of how survivors of acquired brain injury (ABI) experience fatigue and how fatigue affects everyday life. Materials and methods: We conducted semi-structured in-depth interviews with 16 adults with ABI fatigue, recruited from support groups in south east UK. Interviews were analysed using the frameworks method. Results: We developed four themes: experiencing fatigue in the context of everyday activities, struggling to make sense of fatigue, coping with fatigue, and adjusting social participation in the context of fatigue. Fatigue was comprised of mental, physical, generalised, and motivational fatigue. Balancing fatigue against participation in daily activities was influenced by coping strategies and social support. Opportunities to socialize or participate in meaningful activities provided incentives for participants to push through their fatigue. Conclusions: This study highlights complex interactions that potentially mitigate the impact of fatigue on everyday life. Educational and self-management approaches to fatigue need to account for different types of fatigue in the contexts of an individual’s daily activity. Assessment of fatigue should capture inthe-moment experiences of different types of fatigue and activity. Social support and participation in meaningful activities may help individuals to break the negative cycle of fatigue and inactivity<br/
Exploring the usability of a smartphone application to monitor fatigue and activity for people with acquired brain injury
No full textBackground: fatigue after acquired brain injury (ABI) leads to detrimental changes in ABI survivors’ daily activities and participation. There is a need capture individual’s experience of fatigue as it happens, to better support self-management of fatigue.Study aims: to investigate the usability of a real-time tracker of fatigue and activity (using ecological momentary assessment delivered by a smartphone application) and the feasibility of capturing activity and environmental factors using phone sensors.Methods: participants wore an activity monitor and completed up to eight surveys a day on a smartphone app, for six days, completed the system usability scale (SUS) and were interviewed on their views of using the app. Interview transcripts were analysed using qualitative content analysis. Agreement between data from the phone’s sensors and the activity monitor was analysed using Kappa statistics. Results: seven participants completed between 11 and 58 surveys. Mean score on the SUS indicated good perceived usability of the app. Phone sensors did not reliably capture physical activity or background noise. Participants found the app easy to use and perceived self-monitoring to help their understanding of fatigue. A fatigue-tracking app may be acceptable to ABI survivors and has potential to aid self-management of fatigue.<br/
Factors associated with participation in life situations for adults with stroke: a systematic review
Full text linkObjectives: To identify biopsychosocial factors associated with participation outcomes for adults with stroke and to investigate factors associated with participation at different time points post stroke. Data sources: Medline, CINAHL, AMED, PyschINFO and Web of Science were systematically searched using key words “stroke”, “participation” and “outcomes” and their synonyms on 15th May 2017. Study selection: Observational studies reporting on biopsychosocial factors and participation outcomes for community dwelling adults with stroke were selected. Studies were eligible for inclusion if participation outcomes were measured using indices that mapped to the participation domain of the ICF. Intervention studies were excluded. A second reviewer checked all studies against eligibility criteria at each stage. Data extraction: Data were extracted on any statistically determined association between biopsychosocial factors and participation outcomes. Data synthesis: The proportion of studies reporting significant associations with variables were classified according to the ICF. The exact binomial test was used to determine the probability that the proportion of studies reporting significant associations was due to chance alone. Qualitative descriptive summaries of each study allowed consideration of interactions between variables and changes in participation over time points. Conclusions: Whilst depressive symptoms, cognitive functioning and mobility were found to have the strongest associations with participation, we found that other frequently occurring factors (such as fatigue and environmental factors) were less extensively considered. The diversity of outcome measures encountered within the review highlight the need for a consensus on a core set of outcome measures to evaluate long term participation in life situations after stroke
Merritt High School hockey team
No full textAllan Collett, Johnny Cassidy, Norm Bruster, Ronald Clifford, Paul Britton, Wilfred Carrington, Lincon Meeker, Jim Nesbit, Pat Boyel
Tracking individual disease-trajectory of patients with neuromuscular disorders (Duchenne muscular dystrophy and spinal muscular atrophy)
Full text linkNeuromuscular diseases represent a diverse group of complex genetic disorders. In conditions such as Duchenne muscular dystrophy (DMD) and Spinal muscular atrophy (SMA), progressive motor impairment limiting activities of daily life is a common and central clinical feature. Over the last 15 years, the emergence of clinical trials and the approval of new therapies have transformed the disease landscape. A consistent theme across these conditions is the reliance on motor clinical outcome measures, which play a crucial role in guiding treatment decisions and assessing research outcomes. The development of disease-specific outcome measures, along with the use of wearable technologies to monitor motor function, has expanded
the possibilities for evaluation. Quantifying progressive motor decline is key to supporting prognosis and informing both care decisions and clinical trial endpoints. However, selecting appropriate and fit-for-purpose outcome measures is essential to ensure accurate interpretation of findings.
This thesis critically examined three publications, all focused on motor outcome measures. The first explores the use of a wearable device that records gait in an uncontrolled environment for use in clinical trials. The second identifies prognostic factors from a longitudinal natural history study in DMD. The third highlights the value of incorporating patient-reported outcome
measures alongside motor assessments. Guided by the International Classification of Functioning (ICF) framework, this work aims to critically assess motor outcome measures to enhance our understanding of disease progression tracking in DMD and SMA.
The analysis concludes that no single motor outcome measure can fully capture disease progression or treatment effects, underscoring the need to combine multiple tools alongside consideration of statistical analysis in the context of rare diseases.
It also highlights that defining “meaningful change” depends on context and rater type, making stakeholder involvement essential for ensuring clinical relevance and advancing patient-centred care
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Central and peripheral fatigue in response to the acute and chronic metabolic demand: implications for exercise tolerance
Full text linkFatigue and the associated exercise limitation has wide reaching human performance and health implications, however the mechanisms are poorly understood. Muscle fatigue during exercise originates from a combination of peripheral and central processes, and their interaction, which are influenced by exercise-induced metabolic stress. Developments in non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS), have allowed for measurement of central nervous system (CNS) processes alongside measurements of muscle performance and metabolic disturbances, but there are few studies to do so during locomotor exercise. Furthermore, although endurance training is a potent enhancer of exercise tolerance, the effect of training on fatigue mechanisms and the limiting factors to exercise tolerance is poorly understood. The aim of this thesis is to examine the central and peripheral contributions to fatigue in response to the exercise-induced metabolic demand before and after training in order to better understand the integrated physiology of fatigue as well as the mechanisms contributing to fatigue resistance and exercise tolerance.
Study 1 examined the within- and between-day reliability of a number of motor nerve stimulation and single- and paired-pulse TMS (ppTMS) techniques that examine aspects of neuromuscular and corticospinal function which have been implicated in fatigue. The results confirmed that measures of neuromuscular and corticospinal function demonstrate good reliability and provide the first evidence that ppTMS can be reliably measured in a functional locomotor muscle of the knee extensors, however the stimulation parameters should be considered in order to optimise reliability and minimise variability. Study 2 investigated the relationships between corticospinal and neuromuscular function with exercise capacity in order to better understand the peripheral and central factors underpinning exercise tolerance. This study revealed a number of neuromuscular and motor cortical properties related to submaximal and maximal exercise capacity which could be indicative of central fatigue resistance. Study 3 examined the central and peripheral contributions to fatigue resulting from non-exhaustive and exhaustive exercise of high and low metabolic stress in order to better understand the integration between peripheral and central mechanisms and how they contribute to exhaustion. This study revealed that high metabolic stress accelerates the development of peripheral and central fatigue, however central fatigue was similar at exhaustion, suggesting this is an important mechanism in exercise termination. Additionally, a number of disturbances in cortical cell function were identified in a manner dependent on the exercise-induced metabolic strain. Study 4 examined the effect of endurance training on high-intensity exercise tolerance and the associated central and peripheral fatigue mechanisms. High-intensity interval training, but not work-matched moderate-intensity continuous endurance training, increased tolerance of exercise that elicited the same metabolic demand as pre-training. Better exercise tolerance was accompanied by a greater tolerance of peripheral fatigue and ischaemic muscle pain, and attenuated central fatigue. These studies provide novel insight to the central and peripheral contributions to fatigue and exercise tolerance, and the associated adaptations to exercise training
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Physical Activity of Adults with Intellectual Disabilities: Feasibility and validity of measuring physical activity and physical activity intention and their relationship to the spectrum of Adults with Intellectual Disabilities
Full text linkIn comparison to the wider population people with intellectual disabilities (ID) experience higher rates of morbidity and mortality associated with inactive lifestyles, however little is known about the pattern of their physical activity (PA). To address the inadequacies that currently exist around PA and those with ID, we need to better understand their PA levels to identify those who are inactive and the related factors. The four-part studies in this thesis aimed to establish PA levels of adults with intellectual disabilities (awID) across the spectrum. It also aimed to investigate the readiness to change PA behaviour in this population. The first study, a systematic review of evidence for PA levels among awID found that in 15 eligible studies, comprising 3159 subjects, only 9% achieved PA guidelines. ID severity, living in care, gender, and age were independently significantly correlated with PA levels, the strongest predictor being ID severity (Beta 0.63, p<0.001). These findings were limited in context; none objectively measured PA in people with profound ID. This informed the second feasibility study, investigating assessment of PA across the spectrum using wrist-worn, 7-day accelerometers and the short form of the International Physical Activity Questionnaire (IPAQ-s). This revealed the difficulty in recruiting subjects across the full spectrum, and a difference in response rates between homes (16%) and residential-homes (4%): χ2 (1) = 7.7, p <0.05. Nonetheless, 20 participants were recruited, and both PA measures were used across the ID spectrum, including in those with profound ID (n=5). The third study investigated concurrent validity between the two PA measures; suggesting a substantial agreement between the accelerometer and IPAQ-s (k= 0.6, n = 16, p < .05) in identifying active participants, and a significant positive correlation between the sedentary time by the IPAQ-s and accelerometer (r = 0.50, n = 17, p = 0.04). This has implications both clinically and in the research environment as the study showed for the first time that the IPAQ-s could be used effectively to identify those that are active and measure sedentary behaviour across ID spectrum.
In the final study, PA levels measured across the spectrum using the IPAQ-s suggested low PA (39% active) and high sedentary behaviour (82% sedentary >3 hours/day) among awID (n=82). Multiple linear regression revealed that high ID severity is a significant predictor of low PA (Beta -0.28, p<0.05) and high sedentary behaviour (Beta 0.41, p<0.001). To investigate readiness to change PA behaviour in this group, the author developed a single-item PA intention measure (SPAIM). The construct validity and test-retest reliability of the SPAIM were examined, and the relationship between PA intention and PA levels. The SPAIM was a reliable measure of the PA intention, with a strong, positive correlation between first and repeated measure (rs =0.78, n=35, p<0.001). Additionally, linear regression revealed that PA intention significantly predicts daily sedentary hours (Beta -0.34, p<0.01).
This research showed that it is possible to measure PA levels across the ID spectrum, but the choice of measure is a major factor. It also highlighted a need for better engagement with carers and residential-home managers, to improve research participation by those with severe to profound ID. Moreover, although only a minority of participants were active, the majority had a positive PA intention. The amount of time spent being sedentary is the only variable related to PA intention. Overall, the evidence suggests that intervention studies aimed at reducing sedentary behaviour are urgently needed in this group. The sedentary hours/day could be a primary target for public health efforts in this population
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