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This study investigated the immediate effects of auditory feedback training on gait performance and kinematics in 19 healthy young adults, focusing on bilateral changes, despite unilateral training. Baseline and post-training kinematic measurements, as well as the feedback training were performed on a treadmill with a constant velocity. Significant improvements were seen in step length (trained: 590.7 mm to 611.1 mm, 95%CI [7.609, 24.373]; untrained: 591.1 mm to 628.7 mm, 95%CI [10.698, 30.835]), toe clearance (trained: 13.9 mm to 16.5 mm, 95%CI [1.284, 3.503]; untrained: 11.8 mm to 13.7 mm, 95%CI [1.763, 3.612]), ankle dorsiflexion angle at terminal stance (trained: 8.3 deg to 10.5 deg, 95%CI [1.092, 3.319]; untrained: 9.2 deg to 12.0 deg, 95%CI [1.676, 3.573]), hip flexion angular velocity, (trained: −126.5 deg/s to −131.0 deg/s, 95%CI [−9.054, −2.623]; untrained: −130.2 deg/s to −135.3 deg/s, 95%CI [−10.536, −1.675]), ankle angular velocity at terminal stance (trained: −344.7 deg/s to −359.1 deg/s, 95%CI [−47.540, −14.924]; untrained: −340.3 deg/s to −376.9 deg/s, 95%CI [−37.280, −13.166s]), and gastrocnemius EMG activity (trained: 0.60 to 0.66, 95%CI [0.014, 0.258]; untrained: 0.55 to 0.65, 95%CI [0.049, 0.214]). These findings demonstrate the efficacy of auditory feedback training in enhancing key gait parameters, highlighting the bilateral benefits from unilateral training.

Advancements in remote gait analysis technologies enable efficient, cost-effective, and personalized real-time assessments at home. This study aims to contribute evidence as to the comparability of gait quality metrics of three methods of remote gait assessment in individuals with Parkinson’s disease (PD): (1) observation, (2) a wearable sensor, and (3) pose estimation. A cross-sectional, multiple case series study was conducted remotely. Twenty participants submitted videos performing a modified TUG test with the Heel2ToeTM wearable. Each video was analysed by six raters using the checklist specific to PD developed for this study and the MediaPipe Pose Landmarker task estimation library. The observational ratings agreed with the Heel2ToeTM on detecting heel strike 64% of the time and 28.5% of the time on detecting push-off. The difference in the ranks of paired observations based on the Wilcoxon signed rank sum test between the pairs of methods compared was significant for all parameters, except for push-off when estimates from MediaPipe were compared to the ratings from the Observational Checklist, W = 86 (p = 0.498). A combination of digital technologies for remote gait analysis, such as wearable sensors and pose estimation, can detect subtle nuances in gait impairments that may be overlooked by the human eye.

Loneliness has been shown to be a predictor of poor health and early mortality in the general population. Older men living with human immunodeficiency virus (HIV) are at heightened risk of experiencing loneliness. Here, we aim to describe the lived experience of loneliness in older men living with HIV and identify targets for intervention. We used grounded theory with a theoretical framework of narrative phenomenology to focus data collection and analysis on significant experiences related to loneliness. Based on individual narrative interviews with 10 older men living with HIV, experiences of loneliness related to “multiple losses,” “being invisible” and “hiding out” as emergent themes. Participants also described living with loneliness by “finding meaning,” “creating social experiences,” “pursuing interests and things to ‘live for’” and attending events in which “everyone is welcome.” The discussion situates experiences of loneliness within the accumulation of losses and stigmas over time and how the participants strategies for living with loneliness could inform interventions to reduce loneliness in older men living with HIV at individual and societal levels.

Background Anticholinergic drugs are commonly prescribed, especially to older adults. Anticholinergic burden scales (ABS) have been used to evaluate the cumulative effects of multiple anticholinergics. However, studies have shown inconsistent results regarding the association between anticholinergic burden assessed with ABS and adverse clinical outcomes such as cognitive impairment, functional decline, and frailty. This review aims to identify gaps in research on the development, validation, and evaluation of ABS, and provide recommendations for future studies. Method A comprehensive search of five databases (MEDLINE, Embase, PsychInfo, CINAHL, CENTRAL) was conducted for relevant studies published from inception until 25 May 2023. Two reviewers screened for eligibility and assessed the quality of studies using different tools based on the study design and stage of the review framework. Research evidence was evaluated, and gaps were identified and grouped into evidence, knowledge, and methodological gaps, using evidence tables to summarize data. Results Several evidence, knowledge, and methodological gaps in existing development, validation, and evaluation studies of ABS were identified. There is no universally accepted scale, and there is a need to define a clinically relevant threshold for measuring total anticholinergic burden. The current evidence has limitations, underrepresenting low- and middle-income countries, younger individuals, and populations with cognitive disabilities. The impact of anticholinergic burden on frailty is also understudied. Existing evaluation studies provide limited evidence on the benefit of reducing anticholinergic burden on clinical outcomes or the safety of anticholinergic deprescribing. There is also uncertainty regarding optimal reduction, clinically significant anticholinergic burden thresholds, and cost effectiveness. Conclusions Future research recommendations to bridge knowledge gaps include developing a risk assessment framework, refining ABS scales, establishing a standardized consensus scale, and creating a longitudinal measure of cumulative anticholinergic risk. Strategies to minimize bias, consider frailty, and promote multidisciplinary and multinational collaborations are also necessary to improve patient outcomes.

Occupational therapists (OTs) and physiotherapists (PTs) are expected to provide evidence-based services to individuals living with disabilities. Despite the emphasis on evidence-based practice (EBP) by professional entry-level programs and professional bodies, little is known about their EBP competencies upon entry to practice and over time or what factors impact EBP use. The aim of the study was to measure and understand how EBP evolves over the first three years after graduation among Canadian OTs and PTs, and how individual and organizational factors impact the continuous use of EBP. A longitudinal, mixed methods sequential explanatory study. We administered a survey questionnaire measuring six EBP constructs (knowledge, attitudes, confidence, resources, use of EBP and evidence-based activities) annually, followed by focus group discussions with a subset of survey participants. We performed group-based trajectory modeling to identify trajectories of EBP over time, and a content analysis of qualitative data guided by the Theoretical Domains Framework. Of 1700 graduates in 2016-2017, 257 (response rate = 15%) responded at baseline (T0) (i.e., at graduation), and 83 (retention rate = 32%), 75 (retention rate = 29%), and 74 (retention rate = 29%) participated at time point 1 (T1: one year into practice), time point 2 (T2: two years into practice, and time point 3 (T3: three years into practice) respectively. Group-based trajectory modeling showed four unique group trajectories for the use of EBP. Over 64% of participants (two trajectories) showed a decline in the use of EBP over time. Fifteen practitioners (7 OTs and 8 PTs) participated in the focus group discussions. Personal and peer experiences, client needs and expectations, and availability of resources were perceived to influence EBP the most. Though a decline in EBP may be concerning, it is unclear if this decline is clinically meaningful and whether professional expertise can offset such declines. Stakeholder-concerted efforts towards the common goal of promoting EBP in education, practice and policy are needed.

Although the principal goal of hip fracture management is a return to the pre-event functional level, most survivors fail to regain their former levels of autonomy. One of the most effective strategies to mitigate the fracture's consequences is therapeutic exercise. The purpose of this study was to review and quantify the reported effects of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures. The Cochrane libraries, PubMed, CINAHL, PEDro, and EMBASE were searched to April 2012. All randomized controlled trials comparing extended exercise programs with usual care for community-dwelling people after hip fracture were included in the review. Two reviewers conducted each step independently. The data from the included studies were summarized, and pooled estimates were calculated for 11 functional outcomes. Thirteen trials were included in the review and 11 in the meta-analysis. The extended exercise program showed modest effect sizes (ESs), which reached significance, under random theory, for knee extension strength for the affected and nonaffected sides (ES=0.47, 95% confidence interval [CI]=0.27-0.66, and ES=0.45, 95% CI=0.16-0.74, respectively), balance (ES=0.32, 95% CI=0.15-0.49), physical performance-based tests (ES=0.53, 95% CI=0.27-0.78), Timed \"Up & Go\" Test (ES=0.83, 95% CI=0.28-1.4), and fast gait speed (ES=0.42, 95% CI=0.11-0.73). Effects on normal gait speed, Six-Minute Walk Test, activities of daily living and instrumental activities of daily living, and physical function subscale of the 36-Item Short-Form Health Survey (SF-36-PF) did not reach significance. Community-based programs had larger ESs compared with home-based programs. To the authors' knowledge, this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study the cost-effectiveness of extended programs.

Background Health services planning and mechanism-focused research would benefit from a clearer picture of symptoms, impact, and personal priorities in post-COVID-19 syndrome (PCS). This study aimed to provide estimates of the symptom, function, and quality of life (QOL) impact of PCS. Methods People living in Quebec, aged ≥ 18, were eligible for the Québec Action for/pour le Post-COVID (QAPC) study if they had symptoms lasting more than 4 weeks post-acute SARS-CoV-2 infection, with or without a positive COVID-19 test. Recruitment was through conventional and social media between September 2022 and December, 31, 2023. Standardized and individualized questionnaires, in French or English, were accessed through an online portal. We report cross-sectional results from the baseline visit. Results Individuals ( n =535) spontaneously reported symptoms attributable to an average of 4.5 organ systems. Fatigue was most frequent. Effects on function and quality of life were moderate to severe and had already persisted for a year or more in the majority. Personal intervention priorities included fatigue and post-exercise malaise (PEM), cognitive symptoms, shortness of breath, and impaired taste and smell. Except for PEM, women and men did not differ importantly on measures of PCS impact, while older age was associated with lower impact. Conclusion Symptom clusters defined a range of severity, with fatigue a pervasive symptom at all levels of severity. Participants in this study are likely to be representative of those seeking health care for post-COVID-19 symptoms in Canada and the results can inform next steps for clinical, research, and health services planning.

We outline different health outcomes and describe how multiple perspectives can be harnessed to optimize accuracy of key data collected about patients with chronic conditions. The terms health status, health-related quality of life, and quality of life are often used interchangeably without recognizing that they have different meanings, as are the terms used to refer to the different components of function. Although the advantages and limitations of existing frameworks and perspectives are largely understood, greater precision is needed when using health outcome terminology and identifying optimal sources of information. A refinement of the current taxonomy is proposed to distinguish between patient-reported outcomes and self-report outcomes and expand the concept of clinically reported outcomes to include those assessed by performance and emerging technologies. Health outcomes yield important information that can be used to improve the lives of many people. Now is the time to “talk the talk” as part of larger coordinated efforts within and across countries to identify and measure what matters most in health.

Background The objective of this systematic review was to summarize and evaluate evidence about the effectiveness of knowledge translation (KT) interventions to improve the uptake and application of clinical practice guidelines and best practices for a wide range of musculoskeletal (MSK) disorders and health care professionals. Methods A search for relevant randomized controlled trials (RCTs) published in English was conducted in MEDLINE (Ovid interface), EMBASE, CINAHL, and CENTRAL (Cochrane library). Two independent reviewers selected studies, assessed risk of bias, and extracted data. All MSK disorders were included except MSK injuries, fractures, trauma, or inflammatory disorders. Results A total of 7904 citations yielded 11 eligible RCTs. The targeted MSK disorders included: low back pain ( n  = 5), neck pain ( n  = 2), whiplash (1), spinal disorders ( n  = 1), and osteoarthritis of the hip and knee (n = 2). Studies primarily involved physiotherapists, chiropractors, and a mix of physiotherapists, chiropractors and osteopaths. Results were reported using effect sizes (Cohen’s d ). Interactive educational meetings were the most commonly used KT strategy. For professional outcomes, 3 studies using single - component interventions had a small effect ( d ranges from 0.14 to 0.28) and 7 studies used multifaceted interventions (3 were effective ( d ranges from 0.824 to 2.27). For patient outcomes, 4 studies were ineffective ( d ranges from 0.06 to 0.31). The majority of the included RCTs had moderate-to-high risk of bias. About half of the studies used theory-based interventions, but the elements of the interventions and theoretical frameworks were often poorly described. Furthermore, there were no comparable outcome measures to evaluate the impact of the interventions on a similar scale. Conclusions The findings suggested that multifaceted educational KT interventions appear to be effective for improving professional outcomes, although effects were inconsistent. The KT strategies were generally not effective on patient outcomes. In general, studies were of low quality, interventions were poorly described, and only half had theoretical underpinning. Researchers are encouraged to use validated professional and patient outcomes.

While HIV-associated neurocognitive impairment remains common despite the widespread use of combined antiretroviral therapy (cART), there have been relatively few studies investigating the trajectories of neurocognitive change in longitudinal NeuroAIDS studies. To estimate the magnitude and pattern of neurocognitive change over the first 3 years of follow-up using Group-Based Trajectory Analysis (GBTA) applied to participants in the longitudinal arm of the CHARTER cohort. The study population consisted of 701 CHARTER participants who underwent neuropsychological (NP) testing on at least 2 occasions. Raw test scores on 15 NP measures were modeled using GBTA. Each trajectory was categorized as stable, improved or declined, according to two different criteria for change (whether the magnitude of the estimated change at 36 months differed ≥ 0.5 standard deviations from baseline value or changed by > the standard error of measurement estimated at times 1 and 2). Individuals who declined on one or more NP measures were categorized as decliners. Overall, 111 individuals (15.8%) declined on at least one NP test over 36 months, with the vast majority showing decline on a single NP test (93/111-83.8%). The posterior probability of group assignment was high in most participants (71%) after only 2 sessions, and in the overwhelming majority of those with 3+ sessions. Heterogeneity of trajectories was the norm rather than the exception. Individuals who declined had, on average, worse baseline NP performance on every test, were older, had a longer duration of HIV infection and more follow-up sessions. The present study identified heterogeneous trajectories over 3 years across 15 NP raw test scores using GBTA. Cognitive decline was observed in only a small subset of this study cohort. Decliners had demographics and HIV characteristics that have been previously associated with cognitive decline, suggesting clinical validity for the method.