Now showing 1 - 10 of 14
  • Publication
    Fit for life after cancer: Does exercise timing matter?
    Objectives: To assess the effects of a single exercise session per week for 6 weeks on quality of life (QoL), fatigue and exercise participation in male and female cancer survivors with follow-up at 6 months. A secondary aim was to identify if the timing of exercise delivery determined its effect. Methods: An exploratory prospective cohort study design was implemented. Twenty-five patients undergoing or who had completed cancer treatment (11 active treatment; 14 completed treatment) undertook exercise and educational sessions (Fit for Life) 1×/week. The Brief Fatigue Inventory (BFI), the European Organisation for Research and Treatment of Cancer QoL C-30 (EORTC QLQ C-30) and the Godin Leisure Time Exercise Questionnaire (GLTEQ) were used to assess fatigue, QoL and exercise levels, respectively. Participants were evaluated before and after the intervention, and after 6 months. Results: There was a significant group × time interaction for the GLTEQ at 6 months post in favour of exercising during active treatment (p=0.01). No other group × time interactions were observed across the EORTC QLQ C-30 or BFI. There was a significant main effect for time for EORTC QLQ C-30 Global with a significant increase observed between pre and 6 months post. Conclusions: Exercise 1×/week delivered during treatment may impact on long-term exercise participation in adult cancer survivors. This lower volume programme may improve QoL, but has minimal effect on fatigue suggesting an insufficient exercise dosage to impact this variable. This study generates interesting proof of concept results and may be helpful in the development of larger randomised controlled trials.
      233Scopus© Citations 3
  • Publication
    Self-directed home-based neuromuscular electrical stimulation (NMES) in patients with advanced cancer and poor performance status: a feasibility study
    Purpose: Concurrent neuromuscular electrical stimulation (NMES) involving sub-tetanic low frequency and tetanic high frequency which targets aerobic and muscular fitness is a potential alternative to conventional exercise in cancer rehabilitation. However, its safety and feasibility in patients with advanced cancer are unknown. The aim of this feasibility study was to determine safety and feasibility and evaluate changes in functional and health-related quality of life (HR-QoL) outcomes in individuals with advanced cancer and poor performance status after concurrent NMES. These results should help inform the design of future studies. Methods: Participants with advanced cancer and poor performance status (Eastern Cooperative Oncology Group scale ≥ 2) (n = 18) were recruited. The intervention included a novel NMES intervention implemented over a 4-week period. Functional exercise capacity, lower limb muscle endurance and HR-QoL were measured by 6-min walk test (6MWT), 30-s sit-to-stand (30STS) and European Organization for Research and Treatment quality of life questionnaire core-30 (EORTC QLQ C30) pre and post-intervention. Participants unable to complete the 6-min walk test completed the timed up and go test. Participant experience and the impact of the intervention on daily life were investigated through semi-structured interviews. Results: Ten of 18 participants completed the intervention. No adverse events were reported. Seven of 8 participants improved 6MWT performance (2 of 2 improved timed up and go), 8 of 10 participants improved 30STS and 8 of 10 participants improved Global quality of life. Perceived benefits included improved mobility and muscle strength. Conclusions: Neuromuscular electrical stimulation appears safe and feasible in advanced cancer and may improve physical and HR-QoL outcomes. Future prospective trials are warranted to confirm these findings prior to clinical implementation in an advanced cancer setting.
      138Scopus© Citations 3
  • Publication
    Design considerations for the development of neuromuscular electrical stimulation (NMES) exercise in cancer rehabilitation
    Aim: The aim of this narrative review is to explore design considerations for effective neuromuscular electrical stimulation exercise prescription in cancer rehabilitation, with simultaneous consideration for fundamental principles of exercise training and the current state of the art in neuromuscular electrical stimulation technologies and application methodologies. Method: Narrative review. Results: First, we consider the key neuromuscular electrical stimulation exercise design considerations, with a focus on training objectives and individual training requirements and constraints for individuals with cancer. Here, we contend that concurrent, low and high frequency neuromuscular electrical stimulation exercise, individually prescribed and progressed may be optimal for enhancing physical function. Second, we review the appropriate literature to identify the most appropriate stimulation parameters (pulse frequency, intensity, duration and duty cycle) to deliver effective neuromuscular electrical stimulation in cancer rehabilitation. Conclusions: We propose an informed and innovative neuromuscular electrical stimulation exercise intervention design and provide practical information for clinicians and practitioners who may work with and implement neuromuscular electrical stimulation exercise in cancer.Implications for rehabilitation Neuromuscular electrical stimulation is an emerging technology in cancer rehabilitation to help provide an aerobic and muscle strengthening exercise stimulus. Neuromuscular electrical stimulation may help improve aerobic exercise capacity, muscle strength and augment quality of life. Current prescription in cancer lacks adherence to the fundamental principles of exercise training, which may negatively affect adherence.
      221Scopus© Citations 4
  • Publication
    Interventions for behaviour change and self-management in stroke secondary prevention: Protocol for an overview of reviews
    Background: Stroke secondary prevention guidelines recommend medication prescription and adherence, active education and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positive behaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour change and self-management interventions. A growing number of systematic reviews have addressed complex interventions in stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makes the mechanism/s that affect positive change difficult to identify or replicate clinically. Adopting a two-phase approach, this overview will firstly comprehensively summarise systematic reviews in this area and secondly identify and synthesise primary studies in these reviews which provide person-centred, theoretically informed interventions for stroke secondary prevention. Methods: An overview of reviews will be conducted using a systematic search strategy across the Cochrane Database of Systematic Reviews, PubMed and Epistomonikas. Inclusion criteria: systematic reviews where the population comprises individuals post-stroke or TIA and where data relating to person-centred risk reduction are synthesised for evidence of efficacy when compared to standard care or no intervention. Primary outcomes of interest include mortality, recurrent stroke and other cardiovascular events. In phase 1, two reviewers will independently (1) assess the eligibility of identified reviews for inclusion; (2) rate the quality of included reviews using the ROBIS tool; (3) identify unique primary studies and overlap between reviews; (4) summarise the published evidence supporting person-centred behavioural change and self-management interventions in stroke secondary prevention and (5) identify evidence gaps in this field. In phase 2, two independent reviewers will (1) examine person-centred, primary studies in each review using the Template for Intervention Description and Replication (TIDieR checklist), itemising, where present, theoretical frameworks underpinning interventions; (2) group studies employing theoretically informed interventions by the intervention delivered and by the outcomes reported (3) apply GRADE quality of evidence for each intervention by outcome/s identified from theoretically informed primary studies. Disagreement between reviewers at each process stage will be discussed and a third reviewer consulted. Discussion: This overview will comprehensively bring together the best available evidence supporting person-centred, stroke secondary prevention strategies in an accessible format, identifying current knowledge gaps.
      148Scopus© Citations 10
  • Publication
    Neuromuscular Electrical Stimulation (NMES) in the Management of Glioblastoma Multiforme
    Background and Purpose: Glioblastoma multiforme (GBM) is associated with debilitating physical and psychosocial side effects. Voluntary exercise recommended as an adjunct therapy is often limited by physical and neurological impairments. The potential effect of aerobic and muscle-strengthening neuromuscular electrical stimulation (termed concurrent NMES) exercise (4 weeks, 2-5 times/week, 30 minutes to 1 hour) delivered to the lower limbs in patients with GBM has not been examined. This case study explores the effect of a short-term concurrent NMES intervention progressing to NMES and supervised voluntary exercise (aerobic and resistance training) over a 10-week period in a patient with GBM undergoing adjuvant treatment. Case Description: The case was a 61-year-old man with GBM who had completed radiotherapy treatment (40 Gy) and was undergoing adjuvant chemotherapy. Eastern Cooperative Oncology Group level was 3. Assessments were conducted at baseline, and at weeks 4 and 10 of the intervention. Outcomes included 30-second sit-to-stand (30STS), Timed Up and Go (TUG), European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and Godin Leisure Time Questionnaire. Outcomes: The intervention was well tolerated, with more than 70% NMES exercise adherence over 10 weeks and progression to combined NMES and voluntary exercise at week 5. No adverse events were reported. Despite self-reported increases in fatigue levels, clinically meaningful improvements were observed at weeks 4 and 10 for 30STS, TUG, and physical quality of life (QoL). Self-report physical activity levels increased at week 10. Discussion: In this first clinical case report, a 10-week NMES/voluntary exercise intervention led to improvements in physical and QoL outcomes. This initial evidence suggests NMES exercise is safe and feasible and may act as a bridge to voluntary exercise. NMES demonstrated promise as an effective supportive intervention in the management of GBM. Future clinical trials are required to expand on these initial findings.
  • Publication
    An internet-delivered cognitive behavioural therapy pain management programme for spinal cord injury pain: A randomized controlled trial
    Background: Chronic pain is common after spinal cord injury (SCI) and dedicated SCI cognitive behavioural therapy pain management programmes (CBT-PMPs) have a growing evidence base to support their uptake clinically. The development of internet-delivered treatment options may overcome barriers to the access and uptake of centre-based programmes. This study examines such an approach on quality of lie (QoL), pain, mood and sleep. Methods: Adults with SCI pain (>3 months) were recruited and randomly assigned to the intervention or control group. The intervention comprised a six module CBT-PMP delivered once weekly. A blinded assessor determined changes in self-reported outcome measures post-intervention and at 3 months. Linear mixed models and effect sizes based on changes between groups were reported. Significance was set p < 0.05. Results: The recruitment rate was 32% (intervention n = 35, control n = 34), and the drop-out rate at 3 months was 26%. On average, participants accessed three (SD 2.1) of six modules. While no difference in QoL was reported, a significant group*time interaction was found for NRS of current pain (χ2 = 8.22, p = 0.016), worst pain (χ2 = 11.20, p = 0.004), and Brief Pain Inventory (interference) (χ2 = 6.924, p = 0.031). Moderate to large effect sizes favouring the intervention were demonstrated at each time point for the pain metrics (Cohen's d: 0.38–0.84). At 3-month follow-up, 48% of the intervention group rated themselves improved or very much improved (p < 0.05). Conclusions: This study demonstrates the potential of an internet-delivered SCI specific CBT-PMP in reporting significant statistical and clinical benefit in pain intensity and interference. Strategies to improve engagement are needed.
      266Scopus© Citations 18
  • Publication
    Neuropathic pain prevalence following spinal cord injury: A systematic review and meta-analysis
    Following spinal cord injury (SCI), chronic pain is a common secondary complication with neuropathic pain (NP) cited as one of the most distressing and debilitating conditions leading to poor quality of life, depression and sleep disturbances. Neuropathic pain presenting at or below the level of injury is largely refractory to current pharmacological and physical treatments. No consensus on the prevalence of NP post SCI currently exists, hence this systematic review was undertaken. The review comprised three phases: a methodological assessment of databases [PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and Physiotherapy Evidence Database (PEDro)] identifying potential papers and screening for inclusion criteria by two independent reviewers; data extraction; and finally rating of internal validity and strength of the evidence, using a published valid and reliable scale. Meta‐analysis estimated pooled point prevalence rates using a random effects model. In total, 17 studies involving 2529 patients were included in the review. Overall point prevalence rates for NP were established at 53% (38.58–67.47); 19% (13.26–26.39) for at‐level NP and 27% (19.89–34.61) for below‐level NP, with high heterogeneity noted (I2 = 84–93%). Prevalence rates for NP following SCI are high. Future studies should include established definitions, classification systems and assessment tools for NP at defined time points post SCI to follow the trajectory of this problem across the lifespan and include indices of sleep, mood and interference to allow for appropriate, optimal and timely NP management for each patient.
      308Scopus© Citations 190
  • Publication
    Pain profiles in a community dwelling population following spinal cord injury: a national survey
    (Taylor & Francis, 2019-03-04) ; ;
    Context: While as many as 60% of patients with spinal cord injury (SCI) develop chronic pain, limited data currently exists on the prevalence and profile of pain post-SCI in community dwelling populations. Study Design: A cross-sectional population survey. Setting: Primary care. Participants: Community dwelling adults with SCI. Methods: Following ethical approval members registered to a national SCI database (n=1,574) were surveyed. The survey included demographic and SCI characteristics items, the International Spinal Cord Injury Pain Basic Data Set (version 1) the Douleur Neuropathique 4 questionnaire (interview) and questions relating to health care utilisation. Data were entered into the Statistical Package for the Social Sciences (version 20) Significance was set P < 0.05 for between group comparisons. Results: In total 643 (41%) surveys were returned with 458 (71%) respondents experiencing pain in the previous week. Neuropathic pain (NP) was indicated in 236 (37%) of responses and nociceptive pain in 206 (32%) Common treatments for pain included medications n=347 (76%) massage n=133 (29%) and heat n=115 (25%). Respondents with NP reported higher pain intensities and increased healthcare service utilisation (P= < 0.001) when compared to those with nociceptive pain presentations. A higher proportion of females than males reported pain (P = 0.003) and NP (P = 0.001) and those unemployed presented with greater NP profiles compared with those in education or employment (P = 0.006). Conclusion: Pain, in particular NP post SCI interferes with daily life, increases health service utilisation and remains refractory to current management strategies. Increased availability of multi-disciplinary pain management and further research into management strategies is warranted.
      146Scopus© Citations 7
  • Publication
    Quality of life after spinal cord injury: The impact of pain
    Pain is a common complication after spinal cord injury (SCI). A mixture of nociceptive and neuropathic pain (NP) can present. Limited studies have investigated the impact of different pain phenotypes on quality of life (QoL) post-SCI. Methods: Members registered to a national support group for those with SCIs were surveyed (n = 1574). The survey comprised questions relating to demographics and SCI characteristics, The Douleur Neuropathique 4 (DN4) (interview), the International SCI Pain Basic Data Set recording the worst pain and the World Health Organisation Quality of Life BREF (WHOQOL-BREF). An ANCOVA model with post hoc analysis explored between group factors of pain type and intensity of pain categories on QoL, controlling for additional confounding variables. Significance was set p < 0.05. A linear regression explored whether pain intensity, type or interference best predicted QoL. Results: The response rate was 41% (n = 643), 70% (n = 447) were male. The mean age of respondents was 52 years (SD 14.2) and mean time from SCI was 17 years (SD 12.4). In the previous week, 71% (n = 458) experienced pain, 37% (n = 236) of which had NP as defined in the study. Respondents experiencing NP demonstrated significantly poorer QoL than those without pain (p < 0.001) or nociceptive pain (p < 0.05). Those reporting high pain intensity had significantly lower QoL than those with moderate or no pain (p < 0.001). Pain interference consistently and best-predicted domains of QoL (p < 0.001). Conclusion: High-intensity pain and NP negatively impacts QoL post-SCI. However pain interference more than intensity or type best explains the variance in QoL reported. Significance: Neuropathic pain type and severe pain intensities negatively impact QoL after SCI. Pain interference items better predict reported QoL than either pain type or intensity, suggesting better pain management strategies are warranted.
      600Scopus© Citations 36
  • Publication
    Wearable Absolute 6 DOF Exercise Training System for Post Stroke Rehabilitation
    (Dublin City University, 2010-09-02) ; ;
    This paper introduces a multidisciplinary research effort to design an interactive, real time system to assist rehabilitation of stroke patients. The proposed system aims to help stroke survivors with limited mobility to relearn lost skills and regain maximal functional independence. The system assesses the quality of exercise being performed and provides advisory feedback to the patient in order to enable task specific training and correct motor relearning. The system uses a novel, ambulatory and wearable 6 Degree of Freedom (DOF) motion capture system composed of miniature ultrasonic and inertial sensors. The system captures the 3D kinematic parameters of the subject¿s movement while performing exercise, enabling tele-medicine applications or subsequent review by clinical experts. The paper presents the architecture of the aforementioned system and results from early stages of the research.