BSc (Hons) Physiotherapy

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7262

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Intra- and inter- reliability of an inertia-based motion analysis system: testing shoulder function in healthy, young adults
(Queen Margaret University, 2016)
Objective: To assess intra- and inter-rater reliability of an inertia-based motion analysis system (Xsens-MTw), used by untrained operators to measure range of movement at the shoulder, in order to determine whether inertial systems are a consistent objective measure for shoulder movements in physiotherapy practice. Design: Flexion, Abduction, External Rotation and Internal Rotation movements at the glenohumeral joint were measured with two sensors, strapped to the arm above the elbow and wrist. Participants: 15 asymptomatic subjects with a mean age of 23 (standard deviation 2.1) years. Results: Good reliability and low standard error was found for Abduction; both intra-rater (ICC (r)= 0.90, SEM = 4.5º) and inter-rater (r= 0.94, SEM= 3.6º). External Rotation reliability was similar with good intra-rater (r= 0.92, SEM= 12.9º) and inter-rater (r= 0.90, SEM= 13.3º), but the SEM was greater. Flexion movements had moderate reliability (r= 0.58, SEM= 7.5º for intra-rater; r= 0.61, SEM= 6.5º for inter-rater). Internal Rotation movements (measured via a movement combining more than one dimension) also had moderate reliability, intra-rater (r= 0.79, SEM= 52.8º) and inter-rater (r= 0.68, SEM= 59.2º), but the SEM was much greater for these movements. Conclusion: This inertia-based motion analysis system has moderate to high intra- and inter-rater reliability when measuring simple movements at the shoulder, but more complex movements are not as reliable between operators. Based on the findings from this study, Xsens-MTw has the potential to be used as a quantifying measure of range of movement at the shoulder in physiotherapy practice.
The current and future physiotherapy workforce is not ready for the increased use of technology in practice: an observational study using the Technology Readiness Index.
(Queen Margaret University, 2016)
Questions: 1. Is the current and future physiotherapy workforce ready for the increased use of technology in practice? 2. Does the technology readiness differ between 4th year physiotherapy students and qualified physiotherapists? 3. Does the number of years of experience affect the technology readiness of physiotherapists? Design: Observational study using the Technology Readiness Index (TRI). Outcome measures: Respondents rated their agreement with each statement on a 5-point Likert scale, overall TRI scores and individual category averages were analysed. Participants: 205 respondents including 4th year physiotherapy students and qualified physiotherapists. Results: Mean overall TRI score was neutral (3.16 (0.52)). No statistically significant differences were found regarding the overall TRI score across the sample. Students and newly qualified physiotherapists showed statistically significantly higher innovativeness than highly experienced physiotherapists. Discomfort was statistically significantly more in highly experienced physiotherapists than newly qualified physiotherapists. Students showed statistically significantly more insecurity than qualified physiotherapists as a whole group and specifically more than experienced physiotherapists. Conclusion: The neutral overall TRI score suggests that respondents are not ready for the increased use of technology in practice. Individual category analysis has provided insight into the attitudes of the current and future physiotherapy workforce to inform curriculum changes and training needs. Students and newly qualified staff scoring highly in the innovativeness category indicates that universities are preparing students and graduates well with regards to this aspect. The insecurity shown by students and discomfort shown by highly experienced staff are additional points to consider when planning university curriculum and staff training.
An investigation of Physical Activity levels in Asthmatic Children: A Service Evaluation Study
(Queen Margaret University, 2016)
Objective: To investigate the physical activity levels in asthmatic children in relation to asthma control and body mass index (BMI). Design: A service evaluation study. Participants: 21 boys and 16 girls between the ages of 5 and 14 were recruited from The Royal Hospital for Sick Children (Edinburgh) asthma clinic following recent exacerbation of their condition. Participants were excluded if they suffered from any other health conditions or physical disabilities which may have affected their ability to exercise. Main Outcome Measures: The Physical Activity Questionnaire for Children (PAQ-C) was administered to participants along with the Asthma Control Test (ACT) to assess asthma severity and control. BMI in relation to age and sex was also calculated for each child. Results: Only weak correlations were evident between variables. The results suggest that children with poor asthma control and high BMI participate in less physical activity, whilst those with a higher BMI were shown to have better asthma control. In addition, physical activity levels appeared lower in older children. Conclusion: It can be concluded that physical activity participation is generally low in this population, indicating a need for intervention. Although significant results were not achieved, this study provides a basis for further research in the field.
An exploration of orthopaedic physiotherapists' experiences with the use of outcome measures in practice: A qualitative study
(Queen Margaret University, 2016)
Objective: Explore orthopaedic physiotherapists' views and experiences with the use of outcome measures (OMs) in practice and investigate whether OMs influence orthopaedic physiotherapists' clinical decision-making. Design: Qualitative, phenomenological design Participants: Six HCPC registered orthopaedic physiotherapists working in NHS Scotland (in-patient and out-patient). All participants were female, with a median age of 43 years (Range 25-59) and a median duration of experience in orthopaedic physiotherapy of 8 years (Range 0.42-22) Methods: Individual, semi-structured interviews over the phone, lasting approximately 40 minutes. Results: Two a priori themes were confirmed and four themes emerged from the data; 1. Awareness and understanding of OMs. 2. Physiotherapists' views towards using OMs. 3. How physiotherapists select OMs to use in practice. 4. How OMs are used in practice (a priori). 5. Barriers towards using OMs (a priori). 6. Factors influencing the future use of OMs. Conclusion: Orthopaedic physiotherapists use OMs to support clinical decision-making and justify the effectiveness of physiotherapy interventions. OMs used in practice were selected based on validity and practicality of use. Lack of time, lack of knowledge and measures being inappropriate for patients were identified as main barriers towards using OMs in orthopaedic practice. Easy accessible OM databases with information and active educational strategies, combined with increased support from managers were suggested to increase use of OMs in orthopaedic practice.
Exploring differences in technology readiness in the workplace between highly expe-rienced physiotherapists and 4th year physiotherapy students using Technology Readiness Index: a cohort study.
(Queen Margaret University, 2016)
Question: Are 4th year physiotherapy students more technological ready than highly experienced physiotherapists who have been in the workplace for 20 years or over? Is technological readiness related to age? Design: observational cohort design. Participants: eighty-five eligible participants, 29 (34.1%) 4th year students and 56 (65.8%) highly experienced physiotherapists completed the survey. Intervention: Participants completed either a paper or online questionnaire of the technological readiness index (TRI). The questionnaire consists of 16-item with its questions focusing primarily on technology readiness within the workplace. The TRI consists of four main themes: innovativeness, optimism, discomfort and insecurity. Results: No statistical difference in overall TRI scores was found between 4th year physiotherapy students and highly experienced physiotherapists (95% CI, p= 0.095). 4th year physiotherapy students scored significantly higher in the innovative (95% CI, p = 0.019) and insecurity (95% CI, p= 0.02) domain respectively. No correlational relationship was found between overall TRI score and age. Conclusion: Overall, both groups indicated a 'neutral' belief and TRI score toward the use of technology in the workplace. Closer analyses of individual themes, showed that 4th year physiotherapy students may be more innovative at the prospect of using technology in the workplace to contribute to clinical practice, yet they show higher levels of insecurity compared to the highly experienced physiotherapists. The results may be of interest to both universities and physiotherapy managers in providing the right training and support to facilitate the adoption of technology in the workplace.
Factors affecting exercise participation in adolescents with cerebral palsy: a quantitative secondary data analysis
(Queen Margaret University, 2016)
Questions: What types of structured exercise activities do adolescents with cerebral palsy (CP) take part in? What levels of impairment do individuals who take part in these activities have? How is the level of exercise participation impacted by motor function or gender? What are the barriers and facilitators towards participation in exercise activities? Design: This was a secondary data analysis study of a quantitative self-report survey. Participants: 16 adolescents with CP aged 11-15 (median 13.5) including 9 males and 7 females who were under the care of a physiotherapist in the Edinburgh Lothian area. Results: A variety of activity types were reported; swimming/hydrotherapy followed by race running were the most frequent. Males took part in more hours of exercise activities than females. The ambulatory group partook in more exercise than non-ambulatory group. A significant negative correlation was found between motor function and activity participation. A range of barriers and facilitators were identified; the most frequent barrier was being physically unable to do the activity and the most frequent facilitator was parental encouragement to partake in activity. Conclusions: Physical activity should be promoted in adolescents with CP, particularly in females and those with more severe motor impairments. Knowledge of the types of activities individuals are involved in, as well as the factors influencing exercise participation, may help therapists in promoting exercise to their patients and inform service improvement.
The activPAL as a measure of physical activity and sedentary behaviour in people with Parkinson's Disease: a validity study
(Queen Margaret University, 2016)
Purpose To establish the criterion validity of the activPAL activity monitor in measuring sedentary behaviour (sitting/lying) and physical activity (standing/walking) in people with Parkinson's Disease, using direct observation as the criterion measure. Design A cross-sectional observational study, evaluating the criterion validity of the activPAL in a laboratory setting. Participants 12 individuals with a Parkinson's Disease diagnosis and Hoehn and Yahr Disease Severity Classification of ≤ 3 who could walk five minutes independently or with an aid. Methods Participants wore one activPAL monitor and completed a test protocol involving 3 modules: body-postures, activities of daily living and indoor/outdoor walking. Each trial was video-recorded where the camera was synchronised with the activPAL. Researchers classified the time spent in different postures and compared it to the activPAL output. Results Using the Bland and Altman method, the activPAL appeared to over-estimate sedentary behaviour compared to direct observation. Mean difference for module 1 was -35.6s (limits of agreement -75.3s to 4.1s) and for module 2 -16.5s (limits of agreement -29.4s to -3.6s). When measuring physical activity, in module 1, the activPAL slightly underestimated compared to direct observation. Mean difference of 2.3s (limits of agreement -21.1 to 25.7s). Modules 2 and 3 had better agreement. Mean differences of -0.2s and -0.1s with limits of agreement of -16.9s to 16.5s and -1.2s to 1.01s, respectively. Conclusion The activPAL may be a valid measure of physical activity and sedentary behaviour in people with Parkinson's Disease however, further research is needed to build-on and strengthen these findings.
Impact of a primary care lymphoedema service on cellulitis: audit and evaluation of economic implications in relation to diagnosis and history of cancer treatment.
(Queen Margaret University, 2016)
Question: what is the impact of a primary care lymphoedema service on cellulitis in relation to diagnosis and history of cancer? Design: A quantitative service evaluation with a retrospective, before and after study design. Participants: A total of 268 participants, taking part in the Lothian Primary Lymphoedema Service having experienced at least one episode of cellulitis. Intervention: Normal individualised treatment for lymphoedema including advice, education, exercises, manual therapy, compression therapy, psychosocial support, diet advice or and referral to weight management. Outcome measures: Limb Volume Pre- and Post-Treatment, measured using the tape measure method. Results: The 90 participants without a cancer diagnosis had a significantly higher pre-treatment limb volume (10195.06 ml (SD 4623.599) than the 42 participants with a previous cancer diagnosis (7922.18 ml (SD 5282.502) (95% CI 483.115 to 4062.465) .The groups did not differ significantly in their response to treatment. Participants with primary lymphoedema correlate negatively with a medium strength relationship for change in limb volume (Rp-bs= -.297) (95% CI -496 to 109). No other diagnosis had a statistically significant correlation with change in limb volume following treatment. Conclusion: Patient diagnosis and history of cancer affects their final outcome from the service. All secondary diagnoses correlate positively, if not significantly, with change in limb volume. Both cancer and non-cancer groups respond equally well to treatment. Patients with a cancer history have a significantly lower limb volume both entering the service and following treatment. Further longitudinal studies are required to investigate the effect diagnosis and early access to treatment have on patient outcome.
Stroke survivor's perceptions of 'In-Reach' and community exercise programmes: A qualitative focus group study
(Queen Margaret University, 2016)
Question: What are the experiences and perceptions of community-dwelling stroke survivors regarding the hospital-based In-Reach service and community based classes? Design: Secondary analysis of qualitative study data collected by focus group. Participants: Six people post stroke were enrolled in a hospital-based In-Reach project and participated in a focus group interview. Results: Focus group (FG) data were closely similar and four main themes emerged: quality of life post stroke, motivation, support, and service satisfaction. The In-Reach service and community classes were described overall as positive, with ascribed benefits in everyday activity, ability to resume previously valued activities leading to increase in active participation in life. All participants voiced a need for ongoing exercise sessions to maintain new found abilities. Patient-tailored or group exercise programmes, peer support and Leisure Centre location were all important determinants in exercise uptake. Several barriers to physical activity were identified, however they did not have an impact on participants' motivation to participate in an exercise programme. People with positive beliefs about their capabilities demonstrated improved feelings of control, self-efficacy and engagement in physical activity (PA). Conclusion: Participants reported a positive impact on function and participation in life post-stroke. The opportunity for regular exercise started soon after the stroke event with peer and professional support in a suitable venue. Exercise and healthier behaviour appear to be important determinants for enhanced recovery in the long term. This study indicates a need for further examination of the long-term impact of the exercise programme.
Exploring the variability of technological readiness in qualified physiotherapists in relation to length of qualification, age and gender using the Technological Readiness Index (TRI): a prospective cohort study.
(Queen Margaret University, 2016)
Questions: Do physiotherapist's attitudes towards technology vary due to different lengths of qualification? Do physiotherapist's attitudes towards technology vary due to gender? Do physiotherapist's attitudes towards technology vary due to age? Design: A prospective cohort study. Participants: 171 physiotherapists over the age of 18 from NHS Lothian. Intervention: Participants completed the 16 item Technology Readiness Index questionnaire. Non-identifiable demographic data was collected first; which included, gender, age, and years since qualification. Outcome measures: Technology Readiness Index (TRI) questionnaire. Results: It was found that there was no statistically significant differences in attitudes across different lengths of qualification, age, or gender. Although differences were not statistically significant, differences in mean TRI scores were found in relation to different lengths of qualification, age and gender. Differences were also found between scores of different domains, relating to years since qualification, with a statistically significant difference found regarding innovativeness. Conclusion: Physiotherapists qualified for less than 1 year had the lowest TRI scores, and those qualified for 2-5 years were found to have the highest. Males had a higher TRI score than females and physiotherapists aged 20-29 had higher TRI scores than those aged 50+. Findings shown may provide a basis for potential changes regarding technology training and education within NHS Lothian and also within university curricula.
A preliminary study evaluating the concurrent validity of a waist worn and a wrist worn ActiGraph - during free-living activities in people with Parkinson's disease over a seven day period.
(Queen Margaret University, 2016)
Background: Parkinson's disease (PD) is one of the most prevalent neurological conditions within the aging population. One of the symptoms of PD is the decline in physical activity and an increase in sedentary behaviour. It is essential to monitor activity within this population as exercise is recognised to slow the process of the disease. Therefore it is essential to have valid tools to measure sedentary behaviour within this population. Objective: Establish the concurrent validity between an ActiGraph worn on the waist and worn on the wrist. Participants: 9 participants were recruited (7 males and 2 females). All had a confirmed diagnosis of Parkinson's, a Hoehn and Yahr rating of 3 or less and an MMSE of 28 or above. Methods: Participants wore two ActiGraphs, one on their non-dominant wrist and one on their left hip for 7 days during free living. Data collected from the devices was analysed and comparisons were made between the sedentary time recorded on the waist and on the wrist. Results: There was a strong correlation between the devices (0.7 and 0.72), daily sedentary and weekly sedentary behaviour respectively. However the bias between the devices was considerably high at 24.43, 24.96 respectively. Conclusion: Further research is needed to conclude the concurrent validity between the devices. The wrist worn device needs more testing to test appropriateness for this population. Therefore, at present it could be suggested to wear the waist worn ActiGraph when evaluating sedentary behaviour within this population.
An exploration of the activPAL™ activity monitor in measurement of sedentary and physical activity patterns in people with mild to moderate Parkinson’s disease: A validation study.
(Queen Margaret University, 2016)
Background Measurement of physical activity (PA) and sedentary behaviour (SB) may facilitate individually-tailored interventions aimed at modifying the progression of Parkinson’s disease (PD) symptoms. Accelerometry is suggested as a practical and objective measurement tool. Aim This study aims to investigate the validity of the activPAL in measuring PA and SB in people with mild to moderate PD with direct observation (DO) as the criterion measure. Design Cross-sectional, DO, validation study. Methods Eight men and two women (mean age 69 ± 7.3) with mild to moderate PD (median Hoehn and Yahr 1.5, IQR 1-2) were recruited. Wearing an activPAL, they completed a controlled module consisting of 3-minute periods in different postures and a “free-living” module consisting of four randomly selected ADLs. The trial was captured on a video-camera and the time spent in different postures was classified. This was aligned and compared with the activPAL output data. Results The activPAL has a low percentage error for SB in both modules (9.11% and 3.37%) and a higher percentage error for PA (-15.1% and -19.63%). There was no statistically significant correlation between the activPAL and DO in module 1 (r=0.68, p=0.03 and r=0.55, p=0.098), however, high correlation in module 2 (r=0.94, p<0.001 and r=0.99, p<0.001). Wide limits of agreement (LOA) (range -112.6s – 106s) were demonstrated between the activPAL and DO throughout the whole test. Conclusion The activPAL overestimated SB and underestimated PA. Wide LOA may be considered clinically unacceptable. Further research is warranted to validate the activPAL before its use in practice.
Is the medication given to children with acute asthma exacerbation, in Scotland, effective on improving physiological markers? A Quantitative secondary data analysis
(Queen Margaret University, 2016)
Purpose: To investigate the effectiveness of hospital based treatment for children admitted to hospital with acute asthma exacerbation and the adherence to hospital's discharge criteria. Design: A quantitative secondary data analysis of within and between group comparisons to evaluate practice implementation. Participants: Medical notes from 34 children aged 5-14 admitted with acute asthma at the Royal Hospital for Sick Children (RHSC), in Scotland, during November 2014. Methods: Medical notes were divided in two groups (n=28 and n=6) according to the medication received while in hospital. Means of admission and discharge values for the outcomes were compared. Outcome measures: Primary: Heart rate (HR), respiratory rate (RR), temperature, oxygen saturation (SaO2), and Peak expiratory flow (PEF) values. Secondary: Hospital's discharge criteria (inhaler dose=4 hourly, SaO2>92, temp <38). Results: The treatment given in both groups was effective in increasing SaO2 and reducing temperature, RR and HR values; First group: HR (95%CI: -38.09 to -17.48), RR (Z= -3.751, p<0.0001), temperature (95%CI: -0.7816 to -0.09693) and Sao2 (95%CI: -1.254 to3.460); Second group: HR (95%CI: -47.84 to -18.16), RR (95%CI: -16.03 to -4.637), temperature (95%CI: -2.554 to 0.053) and SaO2 (95%CI: -2.366 to7.366). Discharge criteria were met in 33 out of 34 patients (97%). Conclusion: The hospital adhered to recommendations made in previous audit and medication prevalence abides by the current evidence in the literature. The hospital failed to provide PEF records, which is essential for screening asthma severity. Further research is necessary to explain the increased number of asthma related admissions, investigate the lack of PEF records and investigate literature inconsistencies regarding the use of ipratropium in children with acute asthma.
Researching the current Barriers and Facilitators Influencing Participation in Exercise within an Adolescent, Cerebral Palsy Population: An Exploratory, Secondary Analysis Study.
(Queen Margaret University, 2016)
Research Questions: 1. What are the main barriers and facilitators to exercise identified by UK adolescent Cerebral Palsy populations? 2. What differences does the educational environment attended by adolescent Cerebral Palsy populations have on why or why not physical activity is carried out? Design: An exploratory, secondary analysis study using data collated from a previously conducted, self-reported questionnaire. Participants: 16 adolescents with Cerebral Palsy, (male: 9, female: 7), aged 11-18 years, (mean = 13.4, SD = 1.41) recruited with severity of disability GMFCS I -V (median III, IQR = 1.00). Results: Adolescents reported numerous barriers and facilitators which affected their participation in physicalactivities. It was found that barriers caused by the limiting physical and cognitive effects of Cerebral Palsy provided the highest barrier for the population. Facilitators to activity were broad and focused mainly on the positive intrinsic effects of exercise felt by the adolescents. School settings provided wide ranging results.
Do ActiGraph™ activity monitors measure sedentary behaviour in people with Parkinson's disease; a concurrent validity study.
(Queen Margaret University, 2016)
Background: Parkinson's disease is a degenerative neurological disease that affects approximately 127,000 people within the UK. The common side effects of slowness of movement, rigidity and tremor along with tiredness and depression can lead to people with Parkinson's disease (pwPD) leading a less active lifestyle. Inactivity in pwPD has been shown to have a negative effect on the motor decline and it is therefore important to have a valid means of monitoring sedentary activity in pwPD. Objective: to investigate the concurrent validity of ActiGraph™ GT3X hip and wrist monitors in pwPD. Participants: 9 participants (7 male, 2 female) with early stage PD (Hoehn & Yahr ≤3) `(MMSE ≥24) recruited from the Parkinson's UK Group. Methods: 9 pwPD wore the ActiGraph™ GT3X hip and wrist monitors for 7 days noting the time worn and removed on a simple diary log. The monitor's data were then downloaded into ActiLife V6.12.0 with their diary logs to remove non-wear time to give total sedentary activity per day (minutes). Results: Daily: spearman correlation (rs=0.872, n=9, p= 0.002). Bland-altman upper limits of agreement are 353.33 and the lower is 73.44. Bias is 213.39 minutes (±71.4). Mean daily: pearson correlation (rs=0.872, n=9, p= 0.002). Bland-altman upper limits of agreement are 353.33, lower 73.44. Bias is 213.39 minutes (±71.4). Conclusion: the ActiGraph™ GT3X hip and wrist monitors are not concurrently valid when measuring sedentary behaviour of pwPD with the hip location registering higher sedentary activity in comparison to the wrist.
Physiotherapy intervention reduces incidence of cellulitis and antibiotic use in patients with lymphoedema: A service evaluation.
(Queen Margaret University, 2016)
Objectives Lymphoedema is a chronic, progressive condition which results in significant management problems for both patients and clinicians. The main physical complications that is commonly seen in patients with lymphoedema is the development of cellulitis. This paper aims to investigate any potential treatment benefits of the service with a focus on cellulitis. The Lothian Primary Care Lymphoedema Service (LPCLS) was audited in relation to: a) Lymphoedema-related information b) Cellulitis-related information (precipitating factors, signs and symptoms experienced) c) Incidence of cellulitis d) Antibiotic usage and type e) Treatments received by patients within the LPCLS Design An observational, retrospective audit of all patients (n=315) entering the LPCLS since 2009, who had more than one previous episode of cellulitis prior to entering the service, is presented in this paper. Intervention All patients received a combination of: educational leaflets/videos, self-lymphatic drainage, manual lymphatic drainage, multilayer lymphoedema bandaging, exercise, hosiery and skincare. Treatment was administered through facilitation of patient self-management and community care/in-clinic appointments. Outcome measures Incidence of cellulitis and antibiotic treatment were used as outcome measures to evaluate the effectiveness of the service. Results The results suggest that there was a significant decrease in incidence of cellulitis and the use of oral and IV (intravenous) antibiotics.
Experiences of an In-Reach Service Promoting Physical Activity in the Community: A qualitative Study of People with Stroke
(Queen Margaret University, 2016)
Question: What are the experiences of the participants attending an In-Reach service (IRS) post stroke and how does this enhance physical activity in their local communities? Design: A qualitative focus group was conducted by two senior researchers in order to identify and explore the participants' experiences of the IRS. Verbatim transcripts were thematically analysed by a group of student researchers. Participants: Six participants with stroke who had attended the IRS took part; 3 male and 3 female, average age 64.3 (range 35-86); time post stroke 2-7 months. Results: Data from the focus group revealed three main themes: support, empowerment and activity. Positive feedback from the exercise instructor and peers motivated participants to engage in physical activity. Particular weight was given to the importance of individually tailored activities based on participants' targets. The participants agreed that physical activity had a positive impact after their stroke on activity and participation in their daily lives. Conclusion: Although the focus group aimed to explore the participants' experiences of the IRS, the discussion also related to their experiences of community-based activity. The support provided and the accessible leisure centres were perceived as facilitators for exercising. The IRS may have contributed to their uptake of exercise in the community. The findings support the idea that activity and participation should be facilitated as close as possible to peoples' lives. In order to fully assess the importance of physical activity more comprehensive data of service users and service providers experiences of the IRS is needed.
The activPAL™ and Actigraph activity monitors show a low level of agreement in measuring sedentary behaviour in people with Parkinson's disease: a 7-day validation study
(Queen Margaret University, 2016)
Background People with Parkinson's disease (pwPD) have high levels of sedentary behaviours (SB) which are associated with adverse health-outcomes. Validated instruments are required to objectively quantify SB, establish dose-response relationships and SB intervention strategies. Aims To investigate the concurrent validity of the activPAL™ and ActiGraph activity-monitors in pwPD during 7-days of free-living. Methods 9 pwPD completed a 7-day period of free-living while concurrently wearing the activPAL™ and ActiGraph activity-monitors and completed a wear-time diary. activPAL™ SB was determined from total sit/ly time per day. ActiGraph SB was calculated using an activity-count cut-points of vertical-axis<100cpm (AG100) and vector-magnitude<200cpm (AG200). Descriptive statistics, correlations and agreement were compared for average SB/day and an individual-day basis. Results Participants recorded 13.2 hours/day of wear-time. Average SB/day for the activPAL™ was 519 minutes (SD 72). The AG100 reported 133 minutes (SD 40) greater and AG200 reported 43 minutes (SD 40) greater. Very strong, positive correlations were found between all activPAL™ and ActiGraph comparison (r=0.84-0.93, p<0.01). Bland-Altman plots showed large mean differences (AG100 bias 133 minutes and AG200 bias 43). 95% Limits of agreement were >2.5 hours/day for both AG100 and AG200. Conclusion The concurrent validity between the ActivPAL™ and ActiGraph is low, characterised by noticeable differences in reported SB/day and large levels of variation of greater than 2.5 hours per day. Results suggest that the activity-monitors are not interchangeable and SB values reported are not directly comparable. Different cut-points show a large influence on the ActiGraph reported SB therefore further investigation is needed for pwPD.
A 10 metre 6-minute walk test can not be used as an appropriate alternative to the standardised 30 metre 6-minute walk test: an inter- test reproducibility study
(Queen Margaret University, 2016)
Question: Does a 10-metre 6 minute walk test (6MWT) show acceptable agreement to the standardised 30-metre 6MWT, to be used as an appropriate alternative? Design: A within participant, inter-test reproducibility design Setting: Sports Hall, Queen Margaret University. Participants: 25 healthy participants, between 18 and 24 years, were recruited from the Queen Margaret University student population. Intervention: Participants attended for one session in which they were required to perform one 10m 6MWT and one 30m 6MWT. The 6MWTs were performed in accordance with the standardised American Thoracic Society guidelines. Total distance walked, number of laps, heart rate, Borg rate of perceived exertion and anthropometric data was recorded under strict experimental conditions. Outcome Measures: 6-minute walk distance in metres (6MWD). Results: Moderate inter-test reproducibility was found between the 10m 6MWT and the 30m, with an ICC score of 0.584 (95% CI of -0.53-0.879). Bland and Altman analysis produced a range of 94.12 m between 95% limits, showing moderate agreement. All of the participants walked further in the 30m 6MWT trial with a mean increase 13.18% (65.88 m) in 6MWD. Conclusion: The 10m 6MWT appears to have moderate agreement to the 30m 6MWT, however, when the results are considered with minimal detectable change values, this agreement can not be considered acceptable. The 10m 6MWT can not be interchanged with the standardised 30m 6MWT in clinical practice. It is recommended that further research, looking at the agreement between the 10m 6MWT and the 30m 6MWT, using more clinical populations and larger sample sizes.
Compliance with guidelines for discharge and follow up care at a paediatric hospital: a service evaluation.
(Queen Margaret University, 2016)
Question: Does the discharge care and follow-up plan in a paediatric asthma hospital adhere to national guidelines? Design: A service evaluation. Participants: There were 33 children aged 5-14 years admitted to the Royal Hospital for Sick Children due to an exacerbation of asthma during the month of November 2014. The data required for this service evaluation was taken from the case notes of these children during November 2014. Only children aged between 5-14 years were included in the project. Outcome measures: A template of indicators for discharge and follow-up care was designed to measure adherence to the recommendations in the British Thoracic Society (BTS) audit (2013) and national SIGN guideline 141 (2014), with the current discharge and follow-up care delivered at the Royal Hospital for Sick Children. Patients admitted were classed as either new patients or readmission patients. The relationship between these two groups was evaluated using a two sample t-test for comparing proportions. Results: There were 76 patients admitted and 43 excluded due to inclusion criteria. Of the 33 patients who met the inclusion criteria 33% (n=11) were readmissions. Only 61% (n=20) of patients' received an asthma weaning plan. Follow-up was frequently utilised with 91% (n=30) of patients given some form of follow-up. There was no documentation of education or symptom score. Evidence of inhaler technique was anecdotal. Conclusion: This service evaluation highlighted a significant gap between the actual discharge care delivered and that recommended in the guidelines. The follow-up plan was adequate but the care could be improved to make it more structured and optimal for the patient.