This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.
Purpose: To investigate feasibility and effectiveness of an individually-directed, group strength-training programme on knee muscle strength after stroke.Method: Ten volunteers (62 ± 11 years, mean ± SD), 6-12 months after first-ever unilateral stroke, walking independently with or without aids were recruited. Using an A1-B-A2 design, 3 sets of baseline measures were taken at 2 weekly intervals; volunteers then attended twice weekly sessions of low intensity progressive strengthening exercises and were assessed after each series of 8 sessions to a maximum of 24 sessions; post training, measures were repeated after 4-6 weeks.Measures included isometric and concentric knee extensor muscle strength and 10m walking velocity.Results: Strength of knee extensor muscles was improved after training (ANOVA, p<0.05). On cessation of training, isometric strength increased by 58 ± 19% and concentric strength at 30º/s by 51 ± 14%; walking velocity quickened from 0.47 ± 0.06 ms -1 to 0.57 ± 0.08 ms -1 (t=-3.31, p<0.01). These gains were maintained 4-6 weeks after completion of training.Conclusions: These findings support the use of low intensity strength training after stroke and confirm published evidence. It was feasible for one therapist to deliver the training programmes for 4-6 participants at a time; an important feature when resources are limited.
BackgroundOver the last 20 years, there have been marked improvements in the availability of effective medications for rheumatic conditions such as gout, osteoporosis and rheumatoid arthritis (RA), which have led to a reduction in disease flares and the risk of re-fracture in osteoporosis, and the slowing of disease progression in RA. However, medication adherence remains suboptimal, as treatment regimens can be complex and difficult to continue long term. Many trials have been conducted to improve adherence to medication. Core domains, which are the outcomes of most relevance to patients and clinicians, are a pivotal component of any trial. These core domains should be measured consistently, so that all relevant trials can be combined in systematic reviews and meta-analyses to reach conclusions that are more valid. Failure to do this severely limits the potential for trial-based evidence to inform decisions on how to support medication adherence. The Outcome Measures in Rheumatology (OMERACT) – Interventions for Medication Adherence study by the OMERACT-Adherence Group aims to develop a core domain set for interventions that aim to support medication adherence in rheumatology.Methods/designThis OMERACT-Adherence study has five phases: (1) a systematic review to identify outcome domains that have been reported in interventions focused on supporting medication adherence in rheumatology; (2) semi-structured stakeholder interviews with patients and caregivers to determine their views on the core domains; (3) focus groups using the nominal group technique with patients and caregivers to identify and rank domains that are relevant to them, including the reasons for their choices; (4) an international three-round modified Delphi survey involving patients with diverse rheumatic conditions, caregivers, health professionals, researchers and other stakeholders to develop a preliminary core domain set; and (5) a stakeholder workshop with OMERACT members to review, vote on and reach a consensus on the core domain set for interventions to support medication adherence in rheumatology.DiscussionEstablishing a core domain set to be reported in all intervention studies undertaken to support patients with medication adherence will enhance the relevance and the impact of these results and improve the lives of people with rheumatic conditions.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2565-z) contains supplementary material, which is available to authorized users.
Objective This study aimed to identify and prioritize factors important to patients and caregivers with regard to medication adherence in gout, osteoporosis (OP), and rheumatoid arthritis (RA) and to describe the reasons for their decisions. Methods Patients with gout, OP, and RA and their caregivers, purposively sampled from 5 rheumatology clinics in Australia, identified and ranked factors that they considered important for medication adherence using nominal group technique and discussed their decisions. An importance score (IS; scale 0–1) was calculated, and qualitative data were analyzed thematically. Results From 14 focus groups, 82 participants (67 patients and 15 caregivers) identified 49 factors. The top 5 factors based on the ranking of all participants were trust in doctor (IS 0.46), medication effectiveness (IS 0.31), doctor’s knowledge (IS 0.25), side effects (IS 0.23), and medication‐taking routine (IS 0.13). The order of the ranking varied by participant groupings, with patients ranking “trust in doctor” the highest, while caregivers ranked “side effects” the highest. The 5 themes reflecting the reasons for factors influencing adherence were as follows: motivation and certainty in supportive individualized care; living well and restoring function; fear of toxicity and cumulative harm; seeking control and involvement; and unnecessarily difficult and inaccessible. Conclusion Factors related to the doctor, medication properties, and patients’ medication knowledge and routine were important for adherence. Strengthening doctor–patient trust and partnership, managing side effects, and empowering patients with knowledge and skills for taking medication could enhance medication adherence in patients with rheumatic conditions.
Objective Non-adherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. Methods We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with pre-specified extraction and analysis protocols. Results Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains) and adherence-related factors (e.g. medication knowledge) (32 domains). We subdivided adherence into three phases: initiation (n=13 studies, 25%); implementation (n=32, 60%); persistence (n=27, 51%); phase unclear (n=20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were: medication adverse events (n=24, 45%); disease activity (n=11, 21%); bone turnover markers/physical function/quality of life (each n=10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were: medication beliefs (n=8, 15%); illness perception/medication satisfaction/satisfaction with medication information (each n=5, 9%); condition knowledge/medication knowledge/trust in doctor (each n=3, 6%). Conclusion The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.
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