ObjectiveTo examine the overall effectiveness of interventions for reducing adult sedentary behaviour and to directly compare environmental, behavioural and multicomponent interventions.DesignIntervention systematic review with meta-analysis.Data sourcesOvid PsycINFO, Ovid MEDLINE, EBSCOHost CINAHL, EBSCOHost SPORTDiscus and PubMed were searched from inception to 26 July 2017.Eligibility criteriaTrials including randomised controlled trials, quasi-randomised, cluster-randomised, parallel group, prepost, factorial and crossover trials where the primary aim was to change the sedentary behaviour of healthy adults assessed by self-report (eg, questionnaires, logs) or objective measures (eg, accelerometry).ResultsThirty-eight trials of 5983 participants published between 2003 and 2017 were included in the qualitative synthesis; 35 studies were included in the quantitative analysis (meta-analysis). The pooled effect was a significant reduction in daily sitting time of −30.37 min/day (95% CI −40.86 to −19.89) favouring the intervention group. Reductions in sitting time were similar between workplace (−29.96 min/day; 95% CI −44.05 to –15.87) and other settings (−30.47 min/day; 95% CI −44.68 to –16.26), which included community, domestic and recreational environments. Environmental interventions had the largest reduction in daily sitting time (−40.59 min/day; 95% CI −61.65 to –19.53), followed by multicomponent (−35.53 min/day; 95% CI −57.27 to –13.79) and behavioural (−23.87 min/day; 95% CI −37.24 to –10.49) interventions.ConclusionInterventions targeting adult sedentary behaviour reduced daily sitting time by an average of 30 min/day, which was likely clinically meaningful.

BackgroundDesigning appropriate studies for evaluating complex interventions, such as electronic health solutions to support integrated care, remains a methodological challenge. With the many moving parts of complex interventions, it is not always clear how program activities are connected to anticipated and unanticipated outcomes. Exploratory trials can be used to uncover determinants (or mechanisms) to inform content theory that underpins complex interventions before designing a full evaluation plan.ObjectiveA multimethod exploratory trial of the electronic patient-reported outcome (ePRO) tool was conducted to uncover contexts, processes and outcome variables, and the mechanisms that link these variables before full-scale evaluation. ePRO is a mobile app and portal designed to support goal-oriented care in interdisciplinary primary health care practices (clinical-level integration). This paper offers evaluation findings and methodological insight on how to use exploratory trial data to identify relevant context, process, and outcome variables, as well as central (necessary to achieving outcomes) versus peripheral (less critical and potentially context dependent) mechanisms at play.MethodsThe 4-month trial was conducted in 2 primary health care practices in Toronto, Canada. The patients were randomized into control and intervention groups and compared pre and post on quality of life and activation outcome measures. Semistructured interviews were conducted with providers and patients in the intervention group. Narrative analysis was used to uncover dominant mechanisms that inform the intervention’s content theory (how context and process variables are linked to outcomes).ResultsOverall, 7 providers, 1 administrator, and 16 patients (7-control, 9-intervention) participated in the study. This study uncovered many complex and nuanced context, process, and outcome variables at play in the intervention. Narrative analysis of patient and provider interviews revealed dominant story lines that help to tease apart central and peripheral mechanisms driving the intervention. Provider and patient story lines centered around fitting the new intervention into everyday work and life of patients and providers and meaningfulness of the intervention. These themes were moderated by patient-provider relationships going into and throughout the intervention, their comfort with technology, and the research process.ConclusionsIdentifying dominant story lines using narrative analysis helps to identify the most relevant context and process variables likely to influence study outcomes. Normalization process theory emerges as a useful theory to uncover underlying mechanisms because of its emphasis on the social production and normalization of technological, processual, and social aspects of work; all found to be critical to our intervention. The number of complex, overlapping influencing variables suggests that complex interventions such as ePRO require us to pay careful attention to central versus peripheral mechanisms that will influence s...

BackgroundOlder adults with type 2 diabetes (DM2) are at increased risk of falling due to complications including: diabetic peripheral neuropathy, diabetic retinopathy, autonomic neuropathy and diabetic foot ulcers. The purpose of this study was to determine the test-retest reliability, internal consistency, construct validity and to perform factor analysis of a new falls Risk Perception Questionnaire (RPQ) in older community-dwelling adults with DM2.MethodsA prospective cohort of 30 community-dwelling older adults, ≥ 55 years, with DM2 was assembled. At baseline, perceived risk of falling, fear of falling and physical activity were measured. At time 2 (T2), at least 2 days later, perceived risk of falling was assessed again to determine the test-retest reliability of the RPQ. At time 3 (T3), approximately six weeks later, and time 4 (T4), at least 2 days after T3, perceived risk of falling was assessed by phone to determine the test-retest reliability of the RPQ when administered by phone.ResultsThe RPQ demonstrated excellent test-retest reliability when delivered in person (ICC = 0.78, 95% Confidence Interval, CI: 0.59–0.89) and by phone (ICC = 0.82, 95% CI: 0.65–0.91), good internal consistency (α = 0.78) and adequate construct validity (r = 0.52, 95% CI: 0.20–0.74, p = 0.003) in older adults with DM2.ConclusionGiven the good psychometric properties in this sample of persons with Diabetes, the RPQ has the potential to be used in clinical practice as a risk assessment and fall prevention tool. However, further testing needs to be done using a larger sample.

Background: Survivors of cancer who are considered “hard to reach” have less engagement in survivorship programming and lower overall health status, well-being, quality of life, and survival. These include individuals who live in rural areas. There is a need to determine the availability, characteristics, feasibility, and effectiveness of exercise programs for individuals with cancer living in rural settings. Purpose: To conduct a scoping review describing the current literature on available exercise programming for survivors of cancer who live in rural or remote settings. Methods: Data Sources: Six databases were searched for studies. Study Selection: 105 abstracts were identified through literature searches; 84 studies remained for title and abstract screening after duplicates were removed. Thirty-three articles were included in full-text review. Data Extraction: Data related to participant characteristics, intervention characteristics, study design, and outcomes were extracted from full texts. Data Synthesis: Descriptive quantitative summaries are provided for result variables, and a narrative analysis was performed. Discussion and Limitations: Thirteen articles were selected for data extraction. The majority of interventions were phone-based walking programs for survivors of breast cancer. The interventions described were held in only 2 countries. The most common outcomes assessed were physical activity level, quality of life, and anxiety/depression. Conclusion: This scoping review highlighted the lack of accessible exercise programs for this subset of hard-to-reach survivors of cancer. This review found that there are few exercise programs accessible for survivors living in rural and remote areas, suggesting one reason for low engagement in physical activity and highlighting the need to devise novel means to implement exercise interventions for this population.

Interventions to reduce falling in older adults with type 2 diabetes mellitus should focus on reducing lower extremity pain, reducing body weight and managing comorbid conditions. Implications for Rehabilitation    Diabetes mellitus:   • Older adults with type 2 diabetes mellitus (DM2) have a higher risk for falling than older adults without.   • Older adults with DM2 are more likely to suffer serious injuries when they fall.   • Comprehensive risk factor identification is necessary for rehabilitation professionals to accurately determine whether their clients are at risk for falling.   • Rehabilitation professionals also need to tailor interventions based on the client's risk factors in order to effectively reduce falls and fall-related injuries.

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