Supervised Exercise Therapy using Mobile Health Technology in Patients with Peripheral Arterial Disease: Randomized Controlled Pilot Trial. (Preprint)

BACKGROUND Mobile interventions are intended to digitally nurse complex health care needs in chronic diseases, but they are mainly targeted at general health improvement and neglect disease-specific requirements. Therefore, we designed TrackPAD, a smartphone app to support supervised exercise training (SET) in patients with peripheral arterial disease (PAD). OBJECTIVE The aim of the present pilot study was to evaluate suitability, feasibility, and the impact on a prognosis relevant outcome measure for patients with PAD, the 6-minutes walking test, by using TrackPAD. METHODS Twenty-nine participants with symptomatic PAD were randomized. The study group (n=19) received usual care with additional use of TrackPAD. The control group (n=20) only received usual care. RESULTS The study group improved their 6-minutes walking distance, while the control group decreased their mean distance after 3 months of follow-up (83±72.2 vs. -38.8±53.7 m; p<0.01). The PAD-related quality of life improved significantly in terms of ‘symptom perception’ and ‘limitations in physical functioning’. Users’ feed-back showed increased motivation and a changed attitude to perform SET, while raising the educational background. CONCLUSIONS Besides the rating as a valued support tool by the user group, the mobile intervention TrackPAD was linked to an improvement in prognosis relevant outcome measure combined with an enhanced disease coping. CLINICALTRIAL International Registered Report Identifier (IRRID): DERR1-10.2196/13651

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care

For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s). The surgical goals were to provide opening of the fingers and thumb, wrist stability and, if required, to release muscles around the elbow and shoulder. We used the Carer Burden Score as a relevant outcome measure. Preoperatively and 3 months postoperatively, the carer rated the degree of difficulty in cleaning the palm, cutting the fingernails, cleaning the axilla and dressing the upper body on a 5-point Likert scale. Surgery significantly improved the ease of care, which has implications not only for the patient but also for carers and associated health costs. Level of evidence: IV

The Spanish-Version of the Subjective Vitality Scale: Psychometric Properties and Evidence of Validity

The Subjective Vitality Scale (SVS) assess the subjective experience of being full of energy and alive, a clinically relevant outcome measure of positive psychological well-being. The purpose of this paper was to translate the 7-item SVS into Spanish and examine its psychometric properties. In Study 1 (n = 790 adolescents) and Study 2 (n = 130 athletes) reliability and exploratory factor analysis (EFA) were carried out. In Study 1 and Study 3 (n = 197 dancers) evidence of validity of inferences based on SVS scores estimating relationships with other variables (life satisfaction, global self-esteem and emotional and physical exhaustion) was obtained. In Study 2 invariance across time was tested. Finally in Study 3, the factorial structure was cross-validated using confirmatory factor analysis (CFA). Results of EFA showed a one-factor solution. CFA also supported a unidimensional factor structure for the Spanish 6-item SVS (RMSEA = .050 (90% CI = .00, .080); NNFI = .993; CFI = .996). Reliability analysis indicated a strong internal consistency in all study samples (α ranged from .82 to .89). Further, results from multi-sample analysis supported the replicability of SVS factor structure across time. Finally, the SVS scores showed the expected correlations patterns (all them significant, p < .01) with the measured outcomes. In conclusion, the Spanish version of the SVS demonstrated adequate psychometric properties, indicating that the scale can be confidently used to measure the experience of possessing energy and aliveness; furthermore, differences across time can be meaningfully carried out.

Quality of Life after Critical Illness

The demand for critical care is on the rise and is expected to grow significantly in coming decades. Health-related quality of life (HRQoL) is a relevant outcome measure for patients recovering from critical illness. This chapter addresses several key questions about HRQoL, namely: Why measure HRQoL in critically ill patients? What do we mean with HRQoL? Which HRQoL instruments are being used? How to estimate HRQoL before ICU admission, and what is the impact of critical illness on HRQoL, particularly in the elderly? This chapter also addresses the phenomenon of response shift in survivors of critical illness related to their perceived HRQoL. It is argued that HRQoL measures for physical and psychological factors, functional status, and social interactions should be incorporated as standard quality indicators of ICU performance. These measurements will provide further insight on long-term post-ICU recovery and might be used to evaluate and track the utility of follow-up clinics after hospital discharge.