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Physical therapy on trial: the rationale, organization, and impact of a mock trial on physical therapy students' attitudes toward and confidence in research.

A learning activity, debate with a mock trial format, provides opportunities for physical therapy students to develop skill and confidence in learning to evaluate research critically, to formulate opinions regarding the credibility of the available evidence for a therapeutic approach to patient care, and to substantiate their choice of treatments with persuasive arguments and analytic rebuttals. The purposes of this study were to (1) describe the mock trial learning activity within a professional physical therapy curriculum and (2) determine whether the mock trial positively influenced students' attitudes toward research and confidence in their ability to interpret and apply research findings to clinical practice. A structured questionnaire was distributed to the 48 students at key points during the academic program to measure the overall effects of the physical therapy curriculum and the specific effects of the mock trial learning activity. There was an increase (p < 0.05) in the students' confidence in their ability to interpret and apply research after participating in the mock trial. The overall responses to the modified Attitudes-to-Research scale indicated that the physical therapy students generally held positive and optimistic attitudes toward research. These attitudes were maintained over the entire experience within the curriculum. If attitudes predict behavior, these future practitioners are more likely to be physical therapists who critically appraise and use evidence to determine practice.

Adult↗

[Physical education for spina bifida children in special schools for the physically handicapped (primary school)].

With a rate of 0.5-1/1,000 of the total number of births in West Germany, spina bifida is next to cerebral paresis one of the most frequent congenital defects. Altogether, fifty places in special schools are needed per one million of inhabitants for spina bifida children. The loss of physical unctions is comparable to that in the case of paraplegia. The variety of medical and psychological problems makes the cooperation of highly different branches of study indispensible in a rehabilitation team (neurosurgeon, neuropediatrician, urologist, orthopaedist, pediatrician, educator, social worker, physical therapist). Each team member must be informed about the complete rehabilitation plan. These children's shortage of environmental experience is mainly due to their backwardness as regards motoric development, which cannot be recovered by means of individual physical therapy alone. On the other hand, additional, specifically selected and organised physical education makes possible the necessary mobility and social experiences. By giving the children exercises suitable for their ages it is hoped to achieve a late maturation and stabilization of the personality. In choosing the exercises it is first of all necessary to go back to the so-called fundamental activities like climbing, hanging by one's hands, sliding, pushing oneself up off the ground, swinging or throwing and catching, before going on to wheel-chair sports. Wheel-chair sport promises a varied selection for group exercises (games) and for everyday use. Using the wheel-chair as sports equipment, it is possible for persons with other types of locomotive handicaps to be integrated into the group. For physical education in special schools the pupils whould be arranged into groups according to their ability in order to keep the groups as homogenous and the children's chances as equal as possible. The most important teaching criteria are in this case: the creation of a happy atmosphere, a high degree of clarity, the fulfilment of individual inclinations, the encouragement of independence, the development of community life and the fulfilment of everyday tasks. In swimming, the spina bifida child differs from the normal child in his greater initial fear and in the existence of contractions, a scoliosis, hyperlordosis or -kyphosis due to the resultant instability of the water. Because of this, specifically oriented swim- and work-aids must be used. The didactic procedure is then the same as in the case of normal children. After the child's familiarity with and safety in the water is assured, one can proceed to individual swimming techniques and in a few cases to sport swimming. Bacteriological examination of the water did not yield any results which could cause objection on the grounds of hygiene.

Child↗

[The effect of physical training on physical, mental and social conditions in drug and/or alcohol addicts].

The physical, mental and social conditions of eight drug and alcohol addicts were examined prior to and after a period of three months with systemical physical training. The condition improved significantly during training. The circulatory reaction to stress remained unchanged before and after training but the resting levels for pulse and blood pressure were lower after training. Prior to training, a significant correlation was observed between the excretion of adrenalin in the urine and the anxiety level and this was not observed after training. The anxiety level measured by a STAI test decreased during the period of training whereas the excretion of adrenalin in the urine was not altered significantly and remained within the normal range. The patients were followed-up for approximately 18 months after discharge from hospital. During this period, the result of the physical stress and a hiking holiday which was included in the treatment were discussed before discharge. None of the patients continued the physical training after discharge from hospital despite encouragement to do so. The group gradually disintegrated and two years after the conclusion of the training, five patients had resumed the addiction. This investigation suggests that physical training may be of significance in the treatment of addicts but continued contact with the therapist is of decisive significance.

Adult↗

Effect of training on physical capacity and physical strain in persons with tetraplegia.

The effects of quad rugby training on physical capacity and physical strain during standardized activities of daily living were investigated in 9 trained (A) and 5 untrained quad rugby players (B), and 7 inactive persons with tetraplegia (C) at 0, 3 and 6 months after the start of a quad rugby training program (1.5h.wk[-1]). Physical capacity was measured as maximal isometric strength, peak power output (POpeak) and peak oxygen uptake (VO2peak) on a stationary wheelchair ergometer. Physical strain was expressed as a percentage of heart-rate reserve. No measurable training effects could be observed for POpeak, VO2peak and physical strain. A significant rise in maximal isometric strength was found in group B after 3 and 6 months of training, whereas no significant changes were found in groups A and C. The results suggest that a higher training frequency and/or intensity may be needed to gain significant training effects for POpeak and VO2peak.

Activities of Daily Living↗

Physical morbidity in elderly psychiatric inpatients: prevalence and possible relations between the major mental disorders and physical illness.

BACKGROUND: This study examines the prevalence of physical morbidity in elderly psychiatric inpatients and the possible relationships between major psychiatric disorders (organic mental disorders, schizophrenic and mood disorders) and physical illnesses. The clinical implications of such relationships are discussed. METHOD: Data were obtained from two old age psychiatry wards over a six month period. Seventy-nine subjects were studied and information was obtained from their medical files. Demographic characteristics, psychiatric diagnosis, number of physical illnesses and number of body systems affected were collected. Analysis of variance (ANOVA) was used to compare the psychiatric groups on continuous outcome data and chi(2) test to compare psychiatric groups on categorical data. RESULTS: Seventy-five per cent of subjects had at least one physical illness. The number of medical illnesses was independent from the psychiatric disorder. Subjects with mood disorders, and especially depression, were more likely to suffer from hypertension, diabetes and cardiovascular illnesses than subjects with schizophrenic or organic disorders. Subjects with organic disorders had the lowest prevalence of endocrine disease and diabetes. CONCLUSIONS: It was concluded the link between mood disorders (depression), cardiovascular diseases and hypertension could be of a 'cause/effect' type or are the results of a survivor effect. The high prevalence of physical morbidity has implications for training and continuing professional development of those in Old Age Psychiatry Services. It should also be taken into consideration when the location of services is being decided.

Aged↗

Physical activity among breast cancer survivors: regular exercisers vs participants in a physical activity intervention.

BACKGROUND: Secondary prevention is of great importance in the cancer survivor population, given the substantial medical risks survivors face. Consequently, researchers have begun developing interventions that target behavioral risk factors, such as sedentary lifestyle, among survivors. This study represents a novel approach for evaluating the efficacy of a physical activity intervention for breast cancer survivors. METHODS: Repeated measures analyses were used to compare a group of previously sedentary breast cancer survivors offered a physical activity intervention (n=43) with a group of regularly active survivors (n=40). These two groups were compared on select behavioral and psychosocial measures associated with physical activity. RESULTS: Results indicated significant time x group effects on the following: behavioral processes of change, minutes of moderate-intensity activity/week, and time to complete the one-mile walk test (a measure of fitness). There was also a borderline significant interaction for self-efficacy. Contrasts indicated that, for each interaction, previously sedentary and regularly active survivors differed at baseline, but were not significantly different postintervention. CONCLUSIONS: Thus, after completing a 12-week physical activity intervention, previously sedentary breast cancer survivors became similar to regularly active survivors on select behavioral and psychosocial measures associated with physical activity.

Adult↗

Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians.

BACKGROUND: Participation in regular moderate or vigorous physical activity substantially reduces risk for all-cause and cardiovascular-disease mortality and confers other health benefits. Efforts to decrease the population prevalence of inactivity will have a greater impact if they are tailored to the needs and preferences of the community. METHODS: In the Pilot Survey of the Fitness of Australians, a questionnaire was administered to a randomly selected sample of 2,298 adults and included questions on the preferred sources of assistance or support to become physically active, preferred activities, and barriers to regular participation. The responses of those who were identified as insufficiently physically active (n = 1,232; 53.6%) were examined for men and women separately and for those aged 18 to 39, 40 to 59, and 60 to 78 years. RESULTS: The most-preferred activity was walking (38 and 68% of the youngest and oldest age groups, respectively). The most frequently cited barriers to more-regular participation in the youngest age group were insufficient time, lack of motivation and child care responsibilities. Among those aged 60 to 78 years, injury or poor health were the most frequently cited barriers to activity. The most-preferred source of advice or assistance changed with age: more than 50% of the oldest age group wanted advice from a health professional (compared with 22% of the youngest group) and the opportunity to exercise with a group was the most preferred source of support for the youngest age group. CONCLUSIONS: The physical activity-related attributes of men and women and of younger and older age groups described in this study may be used to provide more relevant and appealing options for those who might otherwise be missed by "one-size-fits-all" physical activity promotion strategies.

Adult↗

The use of pedometer and actometer in studying daily physical activity in man. Part II: validity of pedometer and actometer measuring the daily physical activity.

The validity of the pedometer and actometer for estimating the daily physical activity was evaluated by means of an observation study. The physical activity in a classroom of 11 pupils of a kindergarten was assessed by means of a pedometer, actometer and by observation. Besides this an activity questionnaire was completed by the infant-quide. On basis of the individual observation it is clear that the infant-guide can give valuable information about the activity of the children at school. The results of the pedometer attached to the waist and the actometers attached to the ankle were significantly correlated with the results of the observation method. The wrist actometer showed a smaller but still significant correlation with the other variables. Implications of this findings are discussed in regard toward the physical activity. The pedometer results point out that when the percentage of intense activity is high the pedometer tends to underestimate the level of activity. The actometer results indicate that such a motion recorder gives a reliable estimation of activity in children. The findings are discussed in terms of the practical applications of the actometer in the research of daily physical activity and the physical rehabilitation treatment of certain diseases.

Activities of Daily Living↗

[Physical activity and health. Evidence for the health benefits of different physical activity promotion concepts].

Recent years have been marked by increased efforts of public health to pro mote physical activity. Concepts used for the promotion of physical activity range from the prescription of exercise to advice for "active living". The article compares existing evidence for the health benefits of the concepts of physical activity, health-enhancing physical activity, exercise and the German concept of "health sport". Furthermore, existing evidence for different promotion strategies for physical activity on the individual and population level are presented and discussed. Referring to the situation in Germany, the article intends to support current discussions regarding the development of health sport programs and initiatives to promote active living.

Exercise↗

Alcohol and violence: comparison of the psychosocial correlates of adolescent involvement in alcohol-related physical fighting versus other physical fighting.

This study examined the demographic and psychosocial correlates of alcohol-related physical fighting and other physical fighting to determine if the predictors for aggressive behaviors are similar or different when alcohol is involved. Analyses were based on the National Longitudinal Study of Adolescent Health which is a nationally representative school based sample of adolescents in grades 7 through 12 (N=18,924). The current analyses were restricted to current drinkers who could be grouped into three categories of involvement in physical fights (n=8866): no fighting; fighting not related to alcohol use; fighting related to alcohol use. Regression models were computed using a backward-elimination procedure. Overall, 38% of adolescent drinkers reported fighting, including 12% who reported alcohol-related fighting and 26% who reported other physical fighting. Non-Hispanic African-American adolescents were most likely to report other physical fighting (37.1%) but they were least likely to report alcohol-related fighting (8.2%). The correlates of alcohol-related fighting differed by age and race/ethnicity. Moreover, since the correlates of alcohol-related fighting pertain mostly to the frequency and quantity of alcohol use and to having alcohol-related problems, prevention efforts that seek to reduce alcohol use or delay alcohol use initiation may also reduce alcohol-related fighting.

Adolescent↗

Physical training in Syndrome X: physical training counteracts deconditioning and pain in Syndrome X.

OBJECTIVES: The aim of this study was to evaluate the effects of exercise training and body-awareness training in female patients with Syndrome X. BACKGROUND: Patients with Syndrome X, defined as effort-induced angina pectoris, a positive exercise test and a normal coronary angiogram, suffer from a chronic pain disorder. We hypothesized that this disorder results in physical deconditioning with decreased exertional pain threshold. METHODS: Twenty-six patients were randomly assigned to two training groups (A, B) and a control group (C). Group A (n = 8) started, after baseline measurements, with eight weeks of body-awareness training followed by eight weeks of exercise training on a bicycle ergometer three times a week for 30 min at an intensity of 50% of peak work rate. Group B (n = 8) performed only eight weeks of exercise training. Group C (n = 10) acted as controls without any intervention whatsoever. The effects on exercise performance, hormonal secretion, vascular function, adenosine sensitivity and quality of life were evaluated. RESULTS: Body-awareness training did not change the pain response. The two training groups did not differ in effects of exercise training. Exercise capacity before training was below the gender- and age-matched reference range and improved by 34% with training to a level not different from the reference range. Onset of pain was delayed by 100% from 3 +/- 2 to 6 +/- 3 min (p < 0.05) while maximum pain did not change. Thus the pain-response-to-exercise curve was shifted to the right. Syndrome X patients showed a hypersensitivity to low-dose adenosine infusion compared to healthy age- and gender-matched controls (p < 0.0001) that did not change with exercise training. Endothelium-dependent blood flow increase was at baseline within reference range and tended to increase (p < 0.06) following training. In Group A the concentration of cortisol in urine decreased by 53% after body-awareness training (p < 0.05), and this change from baseline remained after physical exercise training (p < 0.05). A similar decrease occurred with only exercise training (Group B). CONCLUSIONS: Physical deconditioning with lower exertional threshold for pain is a prominent feature in Syndrome X. Physical training in Syndrome X results in an increased exercise capacity with lesser anginal pain. We suggest physical training as an effective treatment in Syndrome X.

Exercise Therapy↗

How to promote physical activity through individual counseling--a proposal for a practical model of counseling on health-related physical activity.

A model was developed to aid practical decision making in the counseling of health-related physical activity. The development was based on the following concepts and theories: (1) A wide concept of physical activity; (2) A logical sequence of the practitioner's work steps; (3) Personal aspect of the client; (4) The client's stages of adoption; (5) Determinants of physical activity; (6) Selected educational concepts; (7) Selected strategies of planned maintenance. The model provides the practitioner the main work steps of counseling to follow and detailed lists of potential factors in each step to be taken into account for effective counseling on health-related physical activity. An illustrative case history is given on the model's application. The model is shown to incorporate central behavioral strategies shown useful in promoting adherence to physical activity.

Adult↗

Patients who present physical symptoms in the absence of physical pathology: a challenge to existing models of doctor-patient interaction.

Many patients seek physical treatment for physical symptoms in the absence of physical pathology and incur symptomatic interventions that are ineffective, costly and iatrogenic. It is therefore important to understand how decisions to provide physical intervention can arise in consultations in the absence of physical pathology. Existing models of doctor-patient communication are ill-suited to understanding these consultations. A series of studies has provided the components of an alternative approach that is based on understanding consultation from the patients' perspective. Specifically, these studies have delineated: sources of patients' perception of their authority over doctors; what patients seek by consulting their doctors; and ways that patients use their authority to influence doctors to provide what they seek. Patients' authority reflects primarily their own sensory and infallible knowledge of symptoms. Their influence derives from descriptions of subjective symptoms and from additional strategies including descriptions of the psychosocial effects of symptoms, catastrophising and requesting treatment. This analysis suggests directions for future research and medical training.

Attitude of Health Personnel↗

Developing a reliable audit instrument to measure the physical environment for physical activity.

BACKGROUND: The physical environment plays an important role in influencing participation in physical activity, although which factors of the physical environment have the greatest effect on patterns of activity remain to be determined. We describe the development of a comprehensive instrument to measure the physical environmental factors that may influence walking and cycling in local neighborhoods and report on its reliability. METHODS: Following consultation with experts from a variety of fields and a literature search, we developed a Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument and used it to collect data over a total of 1987 kilometers of roads in metropolitan Perth, Western Australia. The audit instrument is available from the first author on request. Additional environmental information was collected using desktop methods and geographic information systems (GIS) technology. We assessed inter- and intra-rater reliability of the instrument among the 16 observers who collected the data. RESULTS: The observers reported that the audit instrument was easy to use. Both inter- and intra-rater reliability of the environmental scan instrument were generally high. CONCLUSIONS: Our instrument provides a reliable, practical, and easy-to-use method for collecting detailed "street-level" data on physical environmental factors that are potential influences on walking in local neighborhoods.

Bicycling↗

Physical function in patients with cancer: psychometric characteristics and clinical usefulness of a physical performance test battery.

This study investigated the psychometric properties of a battery of physical performance tests, characterized physical function in patients with cancer referred for rehabilitation, and provided normative standards against which to compare disease progression and/or future treatment effectiveness. A total of 109 patients with cancer (55 women and 54 men) and 105 control subjects (66 women and 39 men) participated. Subjects completed self-report questionnaires regarding pain, physical function, and fatigue, and also performed nine physical performance tests: the time taken to complete various tasks (picking up coins, tying a belt, reaching up, putting on a sock, standing from sitting, a 50-foot fast walk, a 50-foot walk at preferred speed), the distance walked in 6 minutes, and the distance reached forward while standing were measured. Inter-tester and test-retest reliability was good to excellent for all tests (ICC(11) 0.69 to 0.99). Known group analyses controlling for age were significant (P < 0.001) for all physical performance tests. Control subjects significantly and systematically outperformed those with cancer by a factor of two or three. Examination of the correlation matrices showed relatively low correlations between performance and external measures (r = 0.01 to 0.45). In contrast, correlations among performance measures were generally in the range of r = 0.25 to 0.85. Correlations between self-report of function and performance of functional tests were moderate, suggesting that the two methods of measuring function are complementary and both should be used for assessment and as outcome measures.

Adult↗

An update of recent evidence of the relationship between objective and self-report measures of the physical environment and physical activity behaviours.

The physical environment has the potential to influence the physical behaviours of large numbers of people; hence creating supportive environments has the potential to increase physical activity (PA). During the last decade, there has been growing interest in how the physical environment shapes PA behaviour. This area of research is important given that levels of PA participation are declining globally. Literature was reviewed that examined the association between physical environmental attributes and PA behaviours. The environmental attributes were grouped into four categories based on a conceptual framework of environmental factors that might influence PA and included functionality, safety, aesthetics and destinations. Positive associations were found between both perceived and objectively measured environmental factors and PA behaviour. The availability, accessibility and convenience of destinations and facilities, as well as the general functionality of the neighbourhood (eg, the presence of sidewalks, traffic conditions) and aesthetics were positively associated with various levels of PA. The review highlights the need for future studies: to examine behaviour-specific environmental attributes, to collect objectively-measured environmental data and to include both objective and perceived environmental data in the same studies, and to adopt prospective study designs to allow causal relationships to be established.

Environment↗

The heterogeneous group for chronically physically ill and physically healthy but emotionally disturbed children and adolescents.

The homogeneous group has been the most common form of group therapy for chronically physically ill children and adolescents. The goals of these groups have included the provision of peer support, adaptation to the realities of physical illness, and acceptance of and cooperation with the medical management of the disease. The refinement of the theory of developmental ego psychology suggests that the heterogeneous group has potential for aiding the emotional maturation of the chronically physically ill. This paper presents examples of groups of latency-age children, early adolescents, and middle adolescents that included chronically physically ill with physically healthy peers. The groups were planned under the assumption that despite external differences, children and adolescents of a similar age identify with peers in terms of normal age-specific developmental needs and conflicts.

Adolescent↗

Assessing perceived physical environmental variables that may influence physical activity.

The present study evaluated a measure of perceived physical environments that may influence physical activity. Forty-three self-report items were used to assess environmental variables at homes, in neighborhoods, or on frequently traveled routes. The presence of facilitators of (e.g., equipment, programs, attractive surroundings) and barriers to (e.g., high crime) physical activity was assessed. In 110 college students, test-retest reliabilities were .89 for the home equipment scale, .68 for the neighborhood scale, and .80 for the convenient facilities scale. Home equipment and convenient facilities scales were correlated with self-reported physical activity. In multiple regression analyses, the only significant association, after adjusting for neighborhood socioeconomic status, was home equipment with strength exercise. Further research is needed to identify other environmental characteristics that may influence physical activity.

Adult↗