Background Adults ageing with a disability need lifelong access to health services to meet their changing needs. This study aimed to explore in depth the experience and impact of health service access to address mobility change in adults ageing with cerebral palsy (CP). Method Semistructured interviews were conducted. Qualitative analysis and identification of themes were undertaken on resultant transcripts. Results Six community-living adults (35-52 years) with CP, at levels II and III of the Gross Motor Function Classification System -Extended & Revised (GMFCS-E&R), participated. All described adult-onset mobility decline and had experienced recent falls. Emergent themes explored the accessibility, nature, and type of health service available, comparisons to paediatric experience, and themes related to frustration, perceived control, and self-advocacy. Conclusion Adults with CP report variability in the access to and matching of health service provided with self-perceptions of service type and need to address mobility decline. Adults with CP describe frustration regarding their experiences and may seek opportunities to increase self-advocacy regarding available health and support services.
A customised balance programme is feasible and safe for ambulant adults with cerebral palsy. Small effects from balance training in selected outcomes occurred. Study replication with at least 38 participants per group to confirm efficacy is warranted.
Background Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. Objective The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. Methods Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. Results A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. Conclusions The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. Trial Registration PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168
BACKGROUND People living with chronic health conditions need support to manage risk factors such as physical inactivity and poor diet. Access to websites providing health information may be an efficient and effective way to manage chronic disease. OBJECTIVE To determine whether having access to self-directed websites improves physical activity levels and/or diet quality in people living with chronic health conditions. Secondary aims are to evaluate effectiveness of self-directed websites on self-efficacy and quality of life and to compare self-directed websites to websites with additional supports (e.g., tailored interventions or interventions supported by a health care professional). METHODS This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, CINAHL and PEDro databases were searched from earliest available until February 2023. Randomized controlled trials (RCTs) evaluating effectiveness of self-directed websites on levels of physical activity and/or diet quality in adults with a chronic health condition were included. If included trials reported on quality of life and/or self-efficacy, these data were also extracted. Two independent reviewers completed data extraction. Risk of bias of included trials was assessed using the Physiotherapy Evidence Database Scale. The overall certainty of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. For outcomes where values were presented as the same unit of measure, data were pooled for meta-analysis to yield an overall mean difference (MD). A standardized mean difference (SMD) was calculated for pooled data where different units were used for the same outcome. Where data of trials could not be included in a pooled analysis, individual trial data were described. RESULTS Twenty-nine trials (n= 6418 participants) were included for analysis. There was moderate certainty evidence that access to self-directed websites increased levels of moderate-to-vigorous physical activity (mean difference [MD], 39 minutes/week; 95% CI, [18.60 – 58.47]), quality of life (SMD 0.36, 95% CI [0.12 to 0.59]) and self-efficacy (SMD 0.26, 95% CI [0.05 to 0.48]) and high certainty evidence for reduction in processed meat consumption (MD, 1.1 portions per week, 95% CI [0.70 to 1.58]) when compared with usual care. No differences were detected for other measures of diet quality. There was no added benefit of providing additional support to website access when compared with self-directed websites. CONCLUSIONS Access to self-directed websites can improve physical activity levels, quality of life and self-efficacy. It can also reduce processed meat consumption in people living with chronic health conditions when compared with usual care. Our findings support the development and implementation of disease specific self-directed websites to facilitate long term risk factor management related to physical activity and diet quality for people living with chronic health conditions. CLINICALTRIAL PROSPERO (CRD42021283168)
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