Background/Objective Exercise-based rehabilitation is a conservative management approach for individuals with low back pain. However, adherence rates for conservative management are often low and the reasons for this are not well described. The objective of this study was to evaluate predictors of adherence and patient-reported reasons for non-adherence after ceasing a supervised exercise-based rehabilitation program in individuals with low back pain. Design Retrospective observational study. Methods Data was retrospectively analyzed from 5 rehabilitation clinics utilizing a standardized exercise-based rehabilitation program. Baseline demographics, diagnosis and symptom specific features, visit number, and discontinuation profiles were quantified for 2,243 patients who underwent the program. Results Forty-three percent (43%) of participants were adherent to the program, with the majority (31.7%) discontinuing treatment prior to completion due to logistic and accessibility issues. Another 13.2% discontinued prior to the prescribed duration due to clinically significant improvements in pain and/or disability without formal discharge evaluation, whereas 8.3% did not continue due to lack of improvement. Finally, 6.0% were discharged for related and unrelated medical reasons including surgery. Individuals diagnosed with disc pathology were most likely to be adherent to the program. Limitations This study was a retrospective chart review with missing data for some variables. Future studies with a prospective design would increase quality of evidence. Conclusions The majority of individuals prescribed an in-clinic exercise-based rehabilitation program are non-adherent. Patient diagnosis was the most important predictor of adherence. For those who were not adherent, important barriers include personal issues, insufficient insurance authorization and lack of geographic accessibility.
The most important finding of the current study was that iontophoresis of acetazolamide did not significantly decrease sweat rate during exercise in the heat. Such results suggest that in past studies it was systemic dehydration, and not CA inhibition at the level of the sweat gland, that caused the reported decreased sweat rate.
Following heat illness, a return to activity may require passing a heat tolerance test (HTT). However, there are several logistical limitations to the widespread use of the HTT. Thus, it would be advantageous to develop a test that could be conducted in a thermoneutral (~22°C) environment to predict heat tolerance status. The purpose of the current study was to determine the sensitivity and specificity of using the criteria of a heart rate (HR) ≥130 bpm following 30 min of thermoneutral exercise in detecting heat-intolerant and heat-tolerant individuals. Material and Methods: Sixty-five subjects visited the lab on 3 separate days. The first visit consisted of completing a maximal oxygen uptake (VO 2 max ) test to assess cardiovascular fitness. For lab visits 2 and 3, subjects randomly completed a 2-hour walking treadmill test in either a hot (40°C, 40% relative humidity [RH]) or thermoneutral (22°C, 40% RH) environment. Results: Forty-eight subjects were classified as heat-intolerant and 17 subjects as heat-tolerant. Using the criterion of a HR ≥130 bpm at 30 min of exercise in the thermoneutral environment, specificity (54%) and sensitivity (100%) of passing the HTT was calculated. Secondary analysis using multiple regression revealed 3 significant variables for predicting ending HR during the HTT. They were: 1) absolute VO 2 max (l/min), 2) age, and 3) HR at 30 min of exercise during thermoneutral exercise. Conclusions: Exercise in a thermoneutral environment had a positive predictive value of 100%, thus, if a subject has a HR ≥130 bpm at 30 min of exercise in a thermoneutral environment, they are very likely to fail a subsequent 2-hour HTT in the heat and be classified as heat-intolerant. Therefore, prior screening has the potential to save time and money, along with providing safety to a heat-intolerant subject.
The purpose of the current study was twofold. First, it was to determine the intra‐subject variability of sweat rate per gland for a given skin location during exercise in the heat. Second, it was to determine the relative importance of intrinsic vs. extrinsic factors as the source of the intra‐subject variability in sweat rate per gland. Sweat rate of individual eccrine glands on the forearm was measured following pilocarpine iontophoresis and during exercise in the heat. In five subjects during exercise in the heat the measured sweat rate for individual forearm eccrine glands (n= 500) ranged from 0.5 nL/gland/min to 16 nL/gland/min, or over a 30‐fold difference. The mean ± SD intra‐subject coefficient of variation in sweat rate per gland was 36±5% and 49±10% (p = 0.008) following pilocarpine iontophoresis and during exercise in the heat, respectively. Such results suggest that intrinsic factors (i.e., sweat gland size and cholinergic sensitivity) contribute approximately three times more than extrinsic factors (i.e., sweat gland nerve fiber density and threshold amplitude) towards explaining the large intra‐subject variability in sweat rate per gland seen during exercise in the heat.
Active videogames (AVG) are an appealing form of physical activity for many adults; however, hardware for AVG typically lack accessibility and limits options for individuals with disabilities. Adapted AVGs have been shown to be more usable than off the shelf videogame controllers. PURPOSE: To evaluate the usability, enjoyment, and perceived exertion of an adapted touchpad (TPA) AVG controller among adults with a mobility limitation. METHODS: As part of a larger ongoing study assessing the usability of adapted videogame hardware, 9 adults with a limitation (post-stroke, spinal cord injury, amputation), 38 to 73 years of age, played 4 videogames for 5 min each by moving, leaning, and reaching for a series of (TPA) placed around them. After each videogame, participants reported their enjoyment using a visual analog scale (0 to 100mm) and physical exertion using the OMNI 0 to 10 perceived exertion scale. The usability of the TPA system was assessed by having participants complete a System Usability Scale (SUS) after gameplay. The SUS scores were computed according to the scale's rubric with a score of >68 considered above average. At the end of each visit, participants were interviewed, and members of the research team recorded their own observations for future revision of the system. Quantitative data are reported as mean (SD). RESULTS: All participants were able to successfully play the 4 videogames. Six participants (n=6) played seated in a chair, 1 seated in their wheelchair, and 2 standing. The participants reported above average usability for the TPA with an SUS of 71 ± 25. Participants reported moderate enjoyment (60 ± 30mm) and perceived exertion of moderate intensity (4.8 ± 2.3). The participants considered the TPA as "something new to keep alert", "a lot of fun", and "entertaining"; however, the researchers discovered several areas of improvement for future TPA iterations. CONCLUSION: Adults with mobility limitations were able to use the early prototype TPA system. Participants reported above average usability, moderate enjoyment, and perceived exertion of the TPA system. The TPA will be revised based on participant input and researcher observation.
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