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This research explored the facilitators and barriers to physical activity engagement for people of Pacific Island heritage. From an experiential constructionist position, we inductively applied thematic analysis to data collected via individual fully transcribed semi-interviews. Participants were five academics or tutors of Pacific Island descent interested in physical activity for Pacific peoples. The themes developed were: Centrality of community, Physical activity is something you do and It depends on the ‘environment’. Centrality of community was a prominent theme that spoke to the high value placed on collectivism and communitarianism by Pacific communities, which may limit individual choices of physical activity participation. Such collective principles may, however, facilitate physical activity through collective responsibility for all to engage in health endeavours. Optimal facilitators of physical activity may be (i) mobilising a community response to participation in physical activity by motivating through improved understanding of the health benefits of physical activity for the community as a whole, (ii) a response role-modelled and championed by community leaders (such as church leaders) and (iii) choosing activity programmes that are group- and community-based, fun and social occasions. Approaches that target the individual, both in health benefits and individually based activities, may be less successful.

The impact of stroke is lifelong; affecting independence and quality of life. Stroke survivors need support to manage their recovery. The Bridges stroke self-management approach (Bridges) empowers stroke survivors and facilitates self-management within usual rehabilitation. We implemented Bridges into a New Zealand stroke service, aiming to identify context-specific delivery factors and long-term sustainability strategies. Using a case study design, data were collected from multiple sources, including meeting and training notes, researcher observations, workshop evaluations, and in-depth semi-structured interviews (n = 7). Data were compared for congruency or disparity, and integrated to develop a comprehensive case description. Overall, 69 health professionals were trained. Collectively, the data found Bridges to be conceptually acceptable and contextually appropriate, raising awareness of self-management support across the service. Identified key factors that would assist with the implementation of this new intervention, including the need for time and sustained support for staff; an initial small, contained inter-professional team; ongoing communication to staff by managers about their expectations and endorsement of the intervention; and staff “champions”, requiring training, resources, and managerial support. Whilst staff may value Bridges, they needed time and the opportunity to develop knowledge, skills, and self-efficacy to support patient self-management.

Non-motor symptoms, namely cognitive and affective domain function, may impact the physical functioning and perceived health status of people with Parkinson’s disease (PD). The aim of this cross-sectional observational study was to explore the relationship between the severity of non-motor symptoms (cognitive and affective) and physical function in individuals with PD living in the community. The outcome measures were completed in 19 participants diagnosed with PD, with or without affective symptoms and cognitive impairments. The main constructs included in the bivariate statistical analyses were: self-reported non-motor experiences of daily living (Movement Disorder Society – Unified Parkinson’s Disease Rating Scale [MDS-UPDRS] Part I); self-reported motor experiences of daily living (MDS-UPDRS Part II); clinician-rated impression of motor symptoms (MDS-UPDRS Part III); motor fluctuations (MDS-UPDRS Part IV); self-reported anxiety and depression symptoms (Hospital Anxiety and Depression Rating Scale [HADS] – a total score comprising sub-scores for “anxiety” [HADS-A] and “depression” [HADS-D]); global cognitive function (Montreal Cognitive Assessment [MoCA]); functional gait and balance performance (Dynamic Gait Index [DGI]); and perceived quality of life (European Quality of Life – Visual Analogue Scale [EQ-VAS]). Significant positive correlations (p ≤ 0.05) were observed between the MDS-UPDRS Part II and MDS-UPDRS Part I (p < 0.01), HADS, HADS-A, and HADS-D (p < 0.05). The Hoehn and Yahr (H & Y) scale was the only variable to significantly correlate with the DGI (p < 0.01). Cont...

Introduction: Evaluation of curriculum is essential to its development. Typically, curriculum evaluations are conducted by end-of-course questionnaires, often resulting in a lengthy delay in implementing improvements that no longer affect the students who completed the evaluation. This study investigated a continuous real-time curricula feedback model as a novel method more appropriate for simultaneous evaluation and improvement of our integrated physiotherapy courses than typical end-of-course evaluation.Methods: A mixed methods design involving concurrent qualitative (focus group interviews, anonymous comments in a “suggestion” box, qualitative survey comments) and quantitative (survey) approaches was used to regularly collect staff (n = 20) and students’ (n = 127) perceptions of a full-year course. Quantitative data were analysed descriptively, and qualitative responses were collated and categorised. The analysed data were fed back to staff and students in the form of a feedback report sent out via email after each module. The report incorporated a summary of the results and the changes to be actioned within the next module.Results: We found the new model to be helpful and liked by both staff and students. Students liked that they could see change as a result of their feedback. Staff felt it should be used in conjunction with the typical end-of-course evaluation, although they found the periodic student feedback reports helpful.Conclusions: The continuous feedback model, although it does not eliminate the need for a formal end-of-year quantitative evaluation, did provide useful qualitative information, a safe environment for student feedback and the opportunity to correct issues in the curriculum as they arise.

Objectives Individuals self-manage chronic illnesses daily with episodic support provided by healthcare professionals. Learning about supporting self-management should be part of healthcare professional student programme curricular and training. However, little is known about the perceptions and attitudes students hold about supporting patient self-management and whether support for self-management is implemented on clinical placement. Methods A mixed method approach explored students’ perceptions and attitudes to supporting patient self-management via e-survey and semi-structured interviews. Results Survey data (n = 96; 11 programmes) were analysed descriptively and interviews thematically (n = 10; F = 9; aged 19–34 years; 8 programmes). Survey data suggested participants had a positive attitude towards, and were confident in providing support for self-management, but did not implement it frequently in clinical environments. One main theme “ Self-management support is puzzling” identified the uncertainty around what students thought their role was or how to enact support within the patient interaction. A smaller theme “Self-management support is valuable” showed participants were open to learning more about how to support patient self-management. Discussion We suggest more explicit and frequent learning opportunities need to be provided for healthcare professional students to learn how to support patient self-management, with particular emphasis on involving family and incorporating self-management tools within the patient encounter.

Children’s health and wellness are influenced by a wide range of biological, psychological or social factors with a rising number of children requiring supportive healthcare. Family-centred care is considered best practice paediatric healthcare; however, processes and actions are not well explored in the literature. This research aimed to synthesise the evidence on the processes of implementation of family-centred care for children with biopsychosocial support needs and identify outcome measures used in the studies. A scoping search across Cinahl, Medline, Web of Science, Scopus, Psyc INFO, Embase and Education Research Complete for English language publications published between 2005 and 14 October 2020 was conducted. A total of 42 studies met the inclusion criteria: a focus on the processes of implementation of family-centred care for children aged 0–21 years with biopsychosocial needs. Diversity in the implementation of interventions of family-centred care was evident due to heterogeneity in study populations, methodology and reporting. Health condition or impairment focused outcome measures were found to be standard with a paucity of outcomes measuring participation or activity. Theoretical and practical elements of implementing interventions were identified as novel and key attributes of family-centred care and contributed to a new standardised framework for the processes of implementation of family-centred care. Future research should address whether mapping family-centred care to the International Classification of Function model helps families and health professionals identify meaningful participation and activity outcomes, which in turn may guide the processes of implementation of family-centred care interventions.

ObjectivesTo examine context-specific delivery factors, facilitators and barriers to implementation of the Diabetes Community Exercise and Education Programme (DCEP) for adults with type 2 diabetes (T2D) using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework.DesignA qualitative evaluation embedded within the DCEP pragmatic randomised controlled trial. Data collected via focus groups and interviews and analysed thematically.SettingCommunity-based in two cities (Dunedin and Invercargill) in the lower south island of New Zealand.ParticipantsSeventeen adults diagnosed with T2D attending DCEP and 14 healthcare professionals involved in DCEP delivery.InterventionDCEP is a twice weekly session of exercise and education over 12 weeks, followed by a twice weekly ongoing exercise class.ResultsWhile our reach target was met (sample size, ethnic representation), the randomisation process potentially deterred Māori and Pasifika from participating. The reach of DCEP may be extended through the use of several strategies: promotion of self-referral, primary healthcare organisation ownership and community champions. DCEP was considered effective based on perceived benefit. The social and welcoming environment created relationships and connections. People felt comfortable attending DCEP and empowered to learn. Key to implementation and adoption was the building of trusting relationships with local health providers and communities. This takes time and care and cannot be rushed. Training of staff and optimising communication needed further attention. To maintain DCEP, delivery close to where people live and a generic approach catering for people with multiple chronic conditions may be required.ConclusionsFor success, lifestyle programmes such as DCEP, need time and diligence to build and maintain networks and trust. Beyond frontline delivery staff and target populations, relationships should extend to local healthcare organisations and communities. Access and ongoing attendance are enabled by healthcare professionals practicing in a nuanced person-centred manner; this, plus high staff turnover, necessitates ongoing training.Trial registration numberACTRN12617001624370.

Objectives: To explore healthcare professionals’ views on, and attitudes, towards recommending online resources for persistent pain self-management. Methods: This study was the qualitative phase of a two-phase mixed method study. Thirty-one New Zealand health professionals involved in the management of persistent pain were interviewed via focus groups and individual interviews. Data were analysed using the general inductive approach. Results: The major themes were as follows: (1) risks and limits of online information outweigh benefits, (2) a blended model, of online resources with healthcare professional support, could work, (3) only trustworthy resources can be recommended, (4) need for personalisation and (5) perceived barriers to adoption. Conclusion: Online resources were perceived as a useful adjunct to support pain self-management; however, due to potential risks of misinterpretation and misinformation, healthcare professionals proposed a ‘blended model’ where curated online resources introduced during face-to-face consultations could be used to support self-management. Participants needed ‘trustworthy online resources’ that provide evidence-based, updated information that is personalised to clients’ health literacy and cultural beliefs. Practice implications: Training for healthcare professionals on critical appraisal of online resources or curation of evidence-based online resources could increase recommendation of online resources to support pain self-management as an adjunct to in-person care.

Background The number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation. Objective To investigate whether ACTIV improved physical function compared with usual care. Methods This 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants’ homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control. Results A total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up. Conclusions ACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.

To explore the impacts of the 2020 New Zealand COVID-19 lockdown on peer-led Steady as You Go (SAYGO) fall prevention exercise classes and members, and to develop recommendations for mitigating impacts during future lockdowns.Semi-structured phone interviews were conducted with 20 SAYGO program participants and managers following the first COVID-19 lockdown in New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using the General Inductive Approach.Participants were between 67 and 88 years of age, predominantly female (90%) and NZ European (80%), with one participant identifying as NZ Māori. Three themes were constructed from the analysis: Personal Function and Well-Being, Class Functioning and Logistics, and Future Strategies for Classes During Prospective Lockdowns. Participants used a range of strategies to stay connected with each other and continue the SAYGO exercises at home. Most participants and peer-leaders reported that they maintained physical function during lockdown, although some had feelings of psychological distress and social isolation. Contact systems and resource distribution varied substantially between groups. Classes resumed post-lockdown with only minor modifications and slightly decreased attendance.Overall, members of this peer-led model of fall prevention classes demonstrated resilience during the COVID-19 lockdown, despite some challenges. We propose three recommendations to address the challenges of maintaining existing peer-led exercise classes in the context of prospective lockdowns: (1) develop a comprehensive contact detail register and plans for each group; (2) delivery of modified exercise classes remotely over lockdown; and (3) implementation of a nationwide IT education and resource program for older adults.

Current research explores the patient and healthcare professional role in self-management; however, it is unclear what healthcare students are taught about supporting self-management as part of the...

Background and Objectives: People with dementia are critically dependent on their carers when accessing and utilizing health care. To inform health care development and delivery, we aimed to explore carers’ perceptions of their role in caring for a family member with dementia and to identify carers’ skills and attributes and factors impacting on care. Research Design and Methods: We used semistructured interviews to collect data from 25 carers supporting older adults with dementia. Data were thematically analyzed and the paradigm model was used to guide theory development. Results: “Constructing normalcy” was central to all carers did, impacted by stage of life and relationship status and driven by a holistic focus on their care-recipient’s quality of life. Goals guiding care were: keeping the peace; facilitating participation, happiness and independence; and ensuring safety. Enablers included: social contact; knowledge; and quality social services. Barriers included health and legal issues; symptoms of dementia; and reduced knowledge. These goals kept the peace and reduced stress for the cared-for person, but often at the cost of unrelenting responsibility and loss of carers’ original roles. Discussion and Implications: As carers are so critical to the access and uptake of health care of those with dementia, health professionals and services need to support carers in their quest to construct normalcy. Our findings provide guidance to assist in ensuring appropriate support and understanding of carers work in order to optimize dementia health care delivery.

To explore kaiāwhina (Māori community health workers) perspectives on supporting whānau Māori with chronic pain, and to understand their views on the use of online resources for pain management.A Māori-centred, qualitative design using focus groups as the primary data collection method. Analysis using the general inductive approach.Thirteen kaiāwhina working in the Greater Wellington region took part in the focus groups. Four key themes were identified: (1) treatment of chronic pain in primary health relies exclusively on medication, (2) health literacy approaches to pain management are urgently required, (3) Māori have significant unmet need for culturally responsive pain management, and (4) the availability of, and referral practices to, specialist pain services are inadequate for Māori communities.Current chronic pain management was predominantly biomedical, and educational strategies lack health literacy approaches. Primary health services exclude traditional Māori methods of treating chronic pain and do not focus on whānau wellbeing. The lack of referral for Māori to specialist services highlights the existing health inequities for Māori. Developing new initiatives (both in-person and online) to address chronic pain management for Māori must be Māori-led and co-designed with whānau to result in holistic solutions for Māori.

The use of telehealth has increased since the COVID-19 pandemic; however, the lack of reliable and valid tools to measure balance and gait remotely makes assessing these outcomes difficult. Thus, we investigated whether balance and gait measures used in clinical practice are reliable and valid when assessed remotely through telehealth.In this pilot study, we investigated 15 healthy older adults who performed validated tests: Timed Up and Go simple, dual cognitive and motor tasks; Berg Balance Scale; Functional Gait Assessment and Dynamic Gait Index. The tests were assessed on two dates: (i) face-to-face, (ii) and remotely, via videoconference between 7 and 14 days after the initial assessment. Participants also undertook the Physiological Profile Assessment (PPA) to assess their risk of falling. Reliability was measured using intraclass correlation (ICC) two-way mixed with absolute agreement to contrast the score of the assessments undertaken face-to-face and remotely in real-time and recorded. We also assessed inter-rater reliability. Criterion validity was measured using Pearson correlation between the tests that were undertaken remotely and PPA.All tests showed good reliability between face-to-face and real-time telehealth (ICC = 0.79-0.87) and face-to-face and recorded telehealth (ICC = 0.78-0.88) assessments and good to excellent inter-rater reliability (ICC = 0.80-1.00). Correlation between the tests and PPA were significantly (p 0.05) moderate for real-time (r = -0.68-0.64) and recorded (r = -0.69-0.71) telehealth assessments.The good reliability between face-to-face and remote measurements together with moderate validity of these measures to assess fall risk suggest that health professionals could use these measures to evaluate the balance and gait of healthy older adults remotely.

INTRODUCTION Pacific populations in New Zealand are aging, but little is known in the health-care environment about their experiences with cognitive impairment. AIM The aim was to explore the needs of Pacific peoples affected by age-related cognitive decline from the perspectives of health-care providers. METHODS Six health-care service providers from organisations focused on Pacific patients were interviewed to determine services available to aged Pacific peoples, access, and whether they met Pacific people’s needs. RESULTS Three areas of concern were identified by all participants: access to services; getting a diagnosis; and communication and language. Many experienced a lack of information and poor access to services. Diagnosis of cognitive impairment was frequently made difficult by inconsistent access to general practitioners in lower socio-economic areas. Communication was hindered by poor access to information in Pacific languages. DISCUSSION Common themes noted by all participating health-care providers indicated the needs of aged Pacific people experiencing cognitive decline were often not being met.

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77–84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0–64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002), both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4–25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6–1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Background Participatory approaches to developing health interventions with end-users are recommended to improve uptake and use. We aimed to explore the experiences of co-designing an online-delivered pain management programme (iSelf-help) for people with persistent pain. Methods A modified participatory action research (PAR) framework was used to co-design contents and delivery of iSelf-help. The PAR team included: (1) a patient advisory group consisting of people living with persistent pain (n = 8), (2) pain management service clinicians (n = 2), (3) health researchers (n = 3), (4) digital health experts (n = 2), (5) a health literacy expert, and (6) two Māori health researchers and our community partner who led the cultural appropriateness of iSelf-help for Māori (the Indigenous population of New Zealand). The iSelf-help co-design processes and activities of the ‘PAR’ team is reported in another paper. In this paper, all PAR team members were invited to share their experiences of the co-design process. Individual interviews were held with 12 PAR team members. Interview transcripts were analysed using the General Inductive Approach. Results Five common themes were identified from the interviews: (1) Shared understanding and values of the co-design process, (2) Mismatched expectations with content creation, (3) Flexibility to share power and decision making, (4) Common thread of knowledge, and (5) Shared determination. Sustaining these themes was an overarching theme of “A coalition of the willing”. Conclusions PAR team members valued the shared determination and responsibility to co-design iSelf-help. They also acknowledged the complexities and challenges during the process related to mismatched expectations, power sharing and establishing a common thread of knowledge. Successful co-design requires a shared commitment and responsibility as a coalition to meet the aspirations of end-users, within the boundaries of time and budget. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00275-0., Plain English summary Persistent non-cancer pain affects one in five people globally. Māori (the Indigenous population of New Zealand) experience a higher persistent pain prevalence than non-Māori. People living with persistent pain in New Zealand experience significant challenges in accessing specialised pain services, such as long-waiting times for referral, delays in getting a persistent pain diagnosis, lack of specialised health professionals in pain management and services that do not provide culturally responsive care. In an increasingly digital world, one way of addressing such access barriers is to provide pain services remotely. Using a participatory action research (PAR) framework, we co-designed an online version of an existing hospital-based pain management programme. The PAR ‘team’ included patients living with persistent pain, who have previously completed the pain management programme and other stakeholders including pain management clinicians, health researchers, technology design experts, and a health literacy expert. The PAR ‘team’ also included two Māori researchers, and our Māori community partner who led the cultural adaptation process of the online programme with Māori community members living with persistent pain. We invited all the PAR team members asking their experiences of co-designing an online pain management programme (iSelf-help) that is culturally adapted for Māori. Our results from interviewing 12 PAR team members suggest the shared values and determination to co-design the online programme enabled team members’ journey as a coalition to be successful, however, along the way, the process was complex and challenging at times both within and between the various teams. The key factors that caused such complexity were the mismatched expectations and understandings of the project, negotiating power sharing between the various teams and establishing a common thread of knowledge. We conclude that successful co-design requires a shared commitment and responsibility as a coalition to meet the aspirations of end-users, within the limits of time and budget. Supplementary Information The online version contains supplementary material available at 10.1186/s40900-021-00275-0.

Purpose Online health resources (websites, apps and social media) may be an adjunct to provide self-management support for people with persistent or chronic pain. Endorsement of online health resources by health care providers is crucial for uptake by end-users. The aim of this study was to investigate the current practices of New Zealand (NZ) health care providers in recommending online resources for persistent pain management, and to identify what factors predict health care providers' recommendations and to explore the common concerns. Methods An online survey of NZ health care providers (ie, chiropractors, general practitioners, nurses, occupational therapists, osteopaths, physiotherapists, psychologists, specialist consultants, and social workers) involved in the management of persistent pain was conducted. The recruitment strategy was tailored to each occupation via occupation-specific professional organizations, and by approaching multidisciplinary professional organizations. Results Data from 213 health care providers were used in the final analysis. Most of the health care providers were physiotherapists (n=71), followed by chiropractors (n=39) and general practitioners (n=31). Fifty three percent (111/210) of health care providers reported currently recommending online resources. A multivariate logistic regression model showed that specialist interest in treating pain (OR=3.84; 95% CI: 1.66, 8.87; P=0.002), and level of confidence in recommending online resources (OR=1.05; CI: 1.04, 1.07; P

Background/Aims Many people with intellectual disability fall frequently. Understanding fall prevention intervention characteristics will assist efficacy trials to target appropriate people. An exploration of two exercise-based fall prevention interventions is reported, focusing on viability and acceptability. Methods A multiple case study of adults with intellectual disability completing either the group Otago Exercise Programme or the Prevention of Falls for Adults with Intellectual Disability intervention was performed. Integrated data sources were used: semi-structured interviews with participants and support workers, observations, attendance/adherence, falls, adverse events and balance measures. Results In total, seven adults with varying intellectual disability levels participated. Overall, three themes enabled understanding of suitability of people to each intervention: suitability of the exercises; role of the environment; and benefits to participants. Conclusions Educating adults with intellectual disability and their support workers of the importance of regular exercise is key to participation. Both programmes required high levels of support and prioritisation to ensure exercises occurred and were carried out safely.

Background Decreased physical ability of individuals with a dysvascular amputation when compared with non-dysvascular counterpart may impact on their ability to participate in regular physical activity and concomitant quality of life. Objective To compare physical activity, quality of life (QoL), and perceptions towards exercise between individuals with dysvascular and individuals with non-dysvascular amputation. Methods A random sample of individuals identified from the New Zealand Artificial Limb Service database, aged 18 years and over, with a unilateral below-knee amputation due to a dysvascular condition (n = 61) and trauma (n = 116) completed the self-reported survey. Main constructs measured were: self-reported physical activity levels (MET-hours/day); quality of life (EuroQoL); perceptions towards exercise (Exercise Barriers and Benefits Scale [EBBS]); mobility capability (Locomotor Capability Index [LCI]) and a customized screening questionnaire. Results Significant differences (p ≤ 0.05) were observed between dysvascular and non-dysvascular groups for total MET-hours/day [13.2 ± 12.7; 27.0 ± 23.2], LCI [36.3 ± 17.7; 49.9 ± 13.7], EuroQoL [72.1 ± 21.7; 80.9 ± 19.3] and EBBS [78.5 ± 10.3; 85.0 ± 14.3]. Cause of amputation, age, experience with the prosthesis, presence of co-morbidities and LCI were significant (p ≤ 0.008) correlates (simple linear regression) of MET-hours/day. Age was the only significant correlate in multivariable model with 0.43 MET-hours/day [F (5,161) = 9.28; p Conclusion Physical activity levels and quality of life of individuals with dysvascular amputation were lower when compared with non-dysvascular amputation. Person-centred behavioural interventions to increase physical activity levels are needed to decrease the risk for developing long-term co-morbidities and to lessen the effects of co-morbidities already present in this population.

Background Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown. Aims To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults. Methods A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group. Discussion This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation. Trial registration Australian and New Zealand Clinical Trials Registry number—ACTRN12614000827639.

Background: Regular engagement in exercise or physical activity is a key evidence-based recommendation in the self-management of type 2 diabetes (T2D). The Diabetes Community Exercise Programme (DCEP) is an exercise and educational programme aimed at supporting adults living with T2D to take control of their health and to live well with T2D. It was specifically developed to enhance the self-efficacy of people to engage in exercise for a long term and is underpinned by the spirit of motivational interviewing. This study explores what DCEP attendees and health care professionals (HCPs) who deliver the programme perceived DCEP to be and what motivated attendance. Such insights further the knowledge of how people with T2D can be supported to engage in exercise or physical activity programmes.Method: This qualitative study used open-ended interviews of 17 DCEP attendees and 12 HCPs delivering DCEP. Interviews occurred at the completion of the initial twice-a-week, 12-week duration part of the programme and prior to attendees starting with a twice-weekly maintenance exercise class, which forms the second part of the programme. Interviews were audio-recorded, transcribed verbatim and analysed with the General Inductive Approach.Results: The two themes constructed from the analysis were person-centred care and attention to logistics and administration. Person-centred care comprised four subthemes: monitoring, individualised exercise within a sociable group setting, flexible education and discussion, and HCP training, and these components appeared to support attendees to engage in exercise. The second theme spoke about the processes, that was either present or that should be included, that enabled DCEP delivery, such as appropriate venues, flexible approaches to time of day and the requirement of good administrative support.Conclusion: The Diabetes Community Exercise Programme did motivate people with T2D to engage in exercise. Important to this was the emphasis on a person-centred approach that focussed on the health status monitoring and educational and social aspects of the programme, which in turn facilitated exercise engagement. Knowledgeable HCPs who require training in the delivery of person-centred care to tailor the exercise and education to the individual is imperative. Equally important are optimal exercise environments and well-trained administrative support.

Background Engagement in physical activity during the initial months following coronary artery bypass graft (CABG) surgery is important in order to improve health, quality of life and functional outcomes. There are, however, many potential barriers to physical activity engagement during the recovery period. No review studies have focused on barriers and facilitators to engagement in physical activity during the early stages of recovery following CABG surgery. Objective To explore the factors that influence engagement in physical activity during the first three months following CABG surgery. Methods Four electronic databases were searched. Extracted data from selected studies were synthesised using the Joanna Briggs Institute convergent integrated approach. Results Nineteen studies met the inclusion criteria. Four main themes that influenced engagement were identified: sociodemographic variables; physical symptoms; psychosocial factors; and environmental factors. More barriers were identified than facilitating factors. Psychosocial factors were the most commonly reported barriers in the literature. Conclusions The findings of this review provide insights into factors that inhibit and facilitate engagement in physical activity following CABG surgery. Further research specifically exploring factors that influence engagement, especially facilitators, is required.

Stroke can cause lifelong disability and participatory limitations. Stroke survivors thus manage their recovery long term. Health professionals can support self-management, tailoring this support to be culturally appropriate. This study explored the unique culture and ethnicity specific experiences of Indian people living in New Zealand with stroke, focussing on self-management and facilitators and challenges to recovery.Eight individuals with stroke took part in semi-structured interviews. Data were analysed using the General Inductive Approach.Four themes were identified: (1) helping myself, in any way that I can, (2) family and support, (3) social connections, and (4) ethnicity was not a barrier.All participants felt well looked after within the New Zealand healthcare context but highlighted the need for long term support. Self-management strategies participants considered important included changes to their diet, acceptance by oneself and society, returning to work, the role of family, and the use of technology and social media. Health professionals should consider these factors when providing self-management support to individuals of Indian ethnicity.IMPLICATIONS FOR REHABILITATIONAdvice and help around diet, lifestyle, and return to work were important priorities identified by our Indian stroke survivor participants.Our Indian stroke survivor participants requested more long-term specialist support and stroke information.Although the family willingly take increased responsibility for the wellbeing of the individual with stroke, it is not a substitute for professional input which needs to be tailored and offered proactively.

Considering the important role that paid support workers play in care of older people with dementia, it is vital that researchers and relevant organisations understand the factors that lead to them feeling valued for the work that they do, and the consequences of such valuing (or lack thereof). The current study employed semi-structured interviews to understand the individual experiences of 15 support workers based both in residential care homes and private homes. The General Inductive Approach was used to analyse the interview transcriptions and to develop a conceptual model that describes the conditions that lead to support workers feeling valued for the work that they do. This model consists of organisational or individual strategies, the context in which support work takes place, and various interactions, actions and intervening conditions that facilitate or prevent support workers feeling valued. A significant finding in this research was the role of interpersonal relationships and interactions which underlie all other aspects of the conceptual model developed here. By understanding the importance of how employers, families of older adults with dementia and peers interact with support workers, we may promote not only the quality of work that support workers deliver, but also the wellbeing of the support workers themselves.

PURPOSE Optimal community reintegration is a key rehabilitation outcome post-stroke. This concept has been investigated in many countries but not qualitatively in New Zealand. We explored perceptions about community reintegration of stroke survivors living in southern New Zealand. METHOD Qualitative interviews were used to collect data. Recruitment was via local stroke clubs, inviting adult stroke survivors (stroke duration > six months, any severity or type) living in the lower South Island. Data were analysed using the General Inductive Approach. RESULTS Eight stroke survivors (two female, six males; age range 50-80 years, mean 66 years (SD = 12); mean time since stroke 6.5 (SD = 4) years) participated. Participants' perceptions of what is integral to reintegration into their community were shaped by four themes, namely: (1) personal relationships, (2) re-establishing normality (old and new), (3) purpose in life, and (4) independence. CONCLUSIONS Stroke survivors in New Zealand hold many similar perceptions about optimal community reintegration with those living elsewhere. Key to successful community reintegration, irrespective of geography, culture and ethnicity, appears to be involvement in meaningful activities, and reduced reliance on others whilst maintaining or developing good social relationships. These fundamental components are then contextually nuanced by what is meaningful and important to the individual.IMPLICATIONS FOR REHABILITATIONOptimal community reintegration post-stroke is arguably the key goal of rehabilitation, and thus should be enabled and measured.To optimise community reintegration post-stroke, rehabilitation should focus on enabling stroke survivors' social relationships, independent community mobility, and engagement in meaningful activities.Optimal community reintegration post-stroke is however contextual. Rehabilitation professionals must understand what each patient considers successful community reintegration to be for them and tailor their rehabilitation accordingly.

Purpose: The purpose of this study was to determine the use and value of the Physiotherapy eSkills Training Online resource during work-integrated learning in naïve physiotherapy students. Method: A mixed methods study design was used. Participants: Forty-four final year physiotherapy students participating in neurological work-integrated learning units of study participated in this study. Intervention: Students had access to the Physiotherapy eSkills Training Online resource during their 6-week neurological work-integrated learning unit of study, which includes video footage and written information about 25 practical skills related to the physiotherapy management of stroke. Outcome Measures: Use of the Physiotherapy eSkills Training Online resource was examined by recording the number of hits on the resource, the number of students who accessed it, the number of times each student accessed it, and the time it was accessed. Students’ perception of the value of the resource was explored through semi-structured interviews. Results: There were 46 hits on the resource, by 13 (30%) students during the neurological work-integrated learning unit of study. Ten students accessed the resource twice or more. Double the number of hits occurred outside of work hours compared with during work hours. Qualitative analysis revealed five themes regarding the low usage of the resource by students: content of the resource; learning style; learning behavior and expectations; technical issues; and practical issues. Conclusion: Use of the resource was low, with only a small number of students using the resource on a few occasions. Value of the resource could not be clearly established.

Falls in older persons are prevalent and costly for the individual and the health system. Falls prevention guidelines have been developed from best evidence to minimise falls in older persons. Aim To synthesise the literature on falls prevention strategies used by community dwelling older persons and/or their informal carers and to compare the commonly adopted strategies with those recommended by falls prevention guidelines. Data sources Health sciences databases for full text articles published in English plus reference list searching of included articles. Review method An integrative review approach. Studies were included if they identified fall prevention management strategies used by community dwelling older adults and/or their informal carers. Quality appraisal was undertaken using appropriate Joanna Briggs Institute critical appraisal tools. Information relevant to the aim of the review were extracted and coded into categories then inductively sorted into sub-themes and themes. Results Of the seventeen studies included in the review, eleven identified older adults' falls prevention strategies, two investigated fall prevention strategies used by carers, and four explored perspectives of older persons together with their carers, representing the perspectives of an estimated 501 older persons and 102 carers. Strategies used by older adults arose because of self-awareness about their changing physical ability, and advice and support mainly from family or friends. Carer fall prevention strategy was predominantly around protection of the older adult from falling by discouraging independence. Conclusions The fall self-management strategies adopted by older adults and their carers to prevent falls, in the main, do not align with international best practice fall prevention guidelines.

Background and Purpose— Feasibility of utilizing the Stroke Riskometer App (App) to improve stroke awareness and modify stroke risk behaviors was assessed to inform a full randomized controlled trial. Methods— A parallel, open-label, 2-arm prospective, proof-of-concept pilot randomized controlled trial. Participants were randomized to usual care/control or App intervention group and assessed at baseline, 3, and 6 months. The App measures stroke risk and provides information on management of risk factors. Participants were aged >19 years with at least 2 modifiable stroke risk factors identified, no prior stroke, and owned a smartphone. Results— Fifty participants (24 control, 26 App) were recruited from 148 eligible participants. Retention in the trial was 87%. Mean cardiovascular health (Life’s Simple 7) improved by 0.36 (95% CI, −2.10 to 1.38) in the App group compared with 0.01 (95% CI, −1.34 to 1.32) in controls ( P =0.6733). Conclusions— These findings support a full randomized controlled trial to test the effectiveness of the Stroke Riskometer for primary stroke prevention. Clinical Trial Registration— URL: www.anzctr.org.au . Unique Identifier: ACTRN12616000376448.

Many studies have demonstrated that exercise and physical activity can reduce symptoms, increase cardiopulmonary health and improve quality of life for people with multiple sclerosis (pwMS) [1–14]....

Summary Background Obesity is a progressive global phenomenon that is disparately prevalent amongst Indigenous populations. While there is a growing body of literature investigating the extrinsic contributors to obesity, there is a lack of evidence to elucidate intrinsic drivers in the context of an Indigenous population. Methods Qualitative research theory, inclusive of Indigenous knowledge systems, was applied to the narratives of 15 Indigenous (Māori) people aged between 18 and 65 to contextualise their understandings of obesity. Results Thematic analysis of the interview data revealed four intrinsic determinants for obesity expression that specifically relate to Indigenous peoples: (1) relationships and social connectedness; (2) holistic health including spiritual beliefs and cultural practices (Indigenous worldview); (3) historical trauma and the impacts of colonisation; and (4) the biomedical model of caloric restriction, diet and exercise were culturally insensitive, non-relatable, and were not significant drivers for engagement in healthier lifestyles. Discussion and conclusions Similar to non-Indigenous populations, Indigenous understandings of obesity are multi-factorial. What was unique about the findings of this study were insights into the importance of relational aspects and connectedness to each other and the environment, as determinants for obesity expression. This suggests that the current individualistic approaches of western medicine to obesity management are not culturally aligned with Indigenous peoples ways of being. Adopting an ontology of connectedness may represent a more culturally centred approach, and help build epistemological resilience to mitigate rising obesity incidence in Indigenous populations.

New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke.We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals.The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted.Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.

We conducted a mixed method study to explore the environmetal factors affecting leisure participation of children with movement impairments aged six to 12 years in Aotearoa/New Zealand. Families of children with movement impairments completed the “Craig’s Hospital Inventory of Environmental Factors for Children-Parent Version” questionnaire and in-depth individual interviews of children, along with their parents or guardian, were undertaken. Fifty-nine families participated in the survey, with 22 of these also participating in the interview. We used descriptive statistics for quantitative data and the general inductive approach to analyse the qualitative data. The findings of each were then integrated. We found a mismatch between a child’s ability and existing leisure activity opportunities/choices at various settings. Restrictions to participation included non-inclusive school-based physical education programmes, limited tailoring of community-based programmes and inaccessible neighbourhood environments. To maximise the leisure activity opportunities in Aotearoa/New Zealand, concerted efforts are required by health professionals, including physiotherapists, schools, disability organisations and policymakers, to create and offer adaptive and/or inclusive leisure activity programmes to children of all ages and abilities at their school, community and local neighbourhood.