An online functional assessment experience in individuals over 65+ during Covid 19 pandemics: physiotherapist opinion & participant opinion

Funding Acknowledgements Type of funding sources: None. Background The quarantine during COVID-19 pandemic affects the clinical visits of elderly people. Since, telehealth gained importance, it is essential to adapt routine visits to the tele-assessment for elderly people especially in high risk factor for both functional impairment and fall risks. Our aim was to present our online assessment experiences in the elderly who underwent particular home quarantine during COVID-19 pandemics. Method: Thirty-three participants aged 65-85 (mean = 71.33 ± 5.35/years, 20 women, 13 men) those never attended an online assessment before were invited to a video-conference based assessment session. It was advised that a relative of the participant or caregiver must attend the online assessment session and follow the instructions of the physiotherapist. The assessments were conducted in the following sequence over seven main topics that are important in terms of functionality in the elderly: (1) physical activity were questioned using International Physical Activity Questionnaire-Short Form, (2) the functional performance were tested with 30 seconds Sit-to-Stand test (SST), (3) participation to the daily living activities with KATZ Index, (4) coronavirus anxiety with Coronavirus Anxiety Scale (CAS), (5) fear of falling with Falls Efficacy Scale, (6) the balance and mobility with Timed-Up and Go test (TUG) in a 3-meter corridor, and (7) frailty with Clinical Frailty Scale. The assessments were done by six physiotherapists (one PhD, 2 MSc, and 3 BSc). The opinions of the participants and physiotherapists regarding their experiences were noted. Result: All participants were finished the assessment and not reported adverse events. The mean of all outcomes showed in Table 1. The mean assessment time was 23.26 ±6.89 minutes. The bad internet connection reported in only one session. Seven of the participants (21.2%) mentioned that SST or TUG were somewhat effortful despite their short duration. The physiotherapists also reported that ensuring an appropriate testing environment for the sit to stand test and Timed-Up and Go test were not always possible. In addition, the sit-to stand test Two of the participants (6 %) were felt discomfort from the questions of CAS. Twenty-one (63.6 %) online assessment were rated as "good" while 12 (36.4 %) were rated as "fair" by the relative of the participant or caregiver in terms of preparing the tools (chair etc.) and testing environment. No problem reported by both therapists and participants related to the questions of IPAQ-SF, CFS, KATZ or FES. Conclusion: This study indicated that an online tele-assessment session is safe and applicable in elderly who underwent home quarantine during COVID-19 pandemic. It was observed that an application of survey based assessments were easier than functional assessments. The results of this study offer an exemplary tele-assessment session for elderly people. Future studies may focus the consistency of the tele-assessment and clinic based assessment results.

‘Relearning How to Think’: A Brief Online Intervention to Modify Biased Interpretations in Emotional Disorders. Study Protocol for a Randomised Controlled Trial

Background: Cognitive biases seem to play an important role in the development and maintenance of emotional disorders such as depression and anxiety. Novel procedures, known as Cognitive Bias Modification (CBM), aim to reduce these dysfunctional information processing modes. This study develops a brief online intervention program to modify biased interpretations in depression and anxiety, overcoming some methodological issues that have been addressed in previous literature. Methods: Volunteer participants will be recruited via social media, posters and universities. They will be randomly assigned to an experimental group or a waiting list control group. Both groups will attend two assessment sessions at the lab. The assessments will consist of questionnaires measuring cognitive and emotional variables as well as three experimental tasks to measure cognitive biases (i.e., attention, memory and interpretation). After the first assessment session, only participants in the experimental group will receive a link to follow the four-sessions program at home. All participants will receive, via email, follow-up questionnaires two weeks and three months after the second assessment session.Discussion: This study will test an online program potentially beneficial to modify cognitive variables in disorders such as depression and anxiety. Several limitations of previous CBM procedures are addressed and the impact of the program both on cognitive performance and clinical symptoms will be explored.Trial registration: This trial was prospectively registered on June 17, 2019 with the ClinicalTrials.gov NCT03987477

Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home

Background Although evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients’ health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized. Methods Secondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period. Results Only 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 ( P = .001) or 8 or more hours of DSMES ( P = .022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES. Conclusion Referral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians’ decisions on whether to refer or not refer patients to DSMES are key for future studies.

Vocabulary Learning and Assessment: A Commentary on Four Studies for JALT Vocabulary SIG

Four papers by Chie Ogawa, Haidee Thomson, Michael Holsworthm and Darrell Wilkinson were presented in the Vocabulary Learning and Assessment session at the Eighth Annual Japan Association for Language Teaching (JALT) Vocabulary Special Interest Group (SIG) Symposium, at the University of Niigata, Japan, in May 2020. The papers raised methodological questions, proposed approaches to assessing spoken and written word knowledge and fluency, and presented some experimental findings. It is my pleasure to discuss these papers in terms of the ideas proposed by the four researchers, their implementation and potential future directions.

Combined Exercise Modulates Cortisol, Testosterone, and Immunoglobulin A Levels in Individuals Living With HIV/AIDS

Background: Combined exercise (CE) has been recommended for individuals living with HIV/AIDS (ILWHA) under antiretroviral therapy. However, depending on the intensity and duration, physical exercise may occasionally increase inflammatory parameters and reduce immunological responses that if not reversed, cause health injury specifically in this population. Information about immunological and hormonal responses after CE in ILWHA has not been completely elucidated. Therefore, the aim is to verify the acute effects of CE on cortisol, testosterone, immunoglobulin A, and pro-inflammatory and anti-inflammatory cytokines over 24 hours in ILWHA. Methods: Noninfected individuals and ILWHA undergone 5 sessions of CE prior to the acute assessment session. Seventy-two hours after the last session, the subjects were submitted to one session of CE (aerobic exercise: 25 min at 60–70% reserve heart rate and resistance exercise: 3 sets of 15 maximum repetitions of 6 exercises). Saliva samples were collected before, immediately, 6 and 24 hours after CE. Results: CE reduced cortisol (6 h: 2.54 [0.58] vs 0.65 [0.22] pg·mL−1; P = .02), increased testosterone (all moments) and immunoglobulin A levels (24 h: 255.3 [44.7] vs 349.2 [41.9] μm·mL−1; P = .01) without significant difference in cytokines levels in ILWHA. Conclusion: CE modulates cortisol, testosterone, and immunoglobulin A levels without the change in immunological parameters in ILWHA.

An Optoelectronic System for Measuring the Range of Motion in Healthy Volunteers: A Cross-Sectional Study

Background and Objectives: Within the clinical evaluation of multiple pathologies of the lower limb, the measurement of range of motion (ROM) of its joints is fundamental. To this end, there are various tools, from the goniometer as a reference to more recent devices such as inclinometry-based applications, photo capture applications, or motion capture systems. This study aimed to assess the validity, intra-rater, and inter-rater reliability of the VeloFlex system (VS), which is a new camera-based tool designed for tracking joint trajectories and measuring joint ROM. Materials and Methods: Thirty-five healthy volunteers (16 females; aged 18–61 years) participated in this study. All participants were assessed on two separate occasions, one week apart. During the first assessment session, measurements were obtained using a goniometer and the VS, whereas, in the second session, only the VS was used. In each assessment session, nine active movements were examined. For each movement, three trials were tested, and the mean of these three measures was used for analysis. To evaluate the concurrent validity and agreement, the Pearson correlation coefficient (r) and Bland-Altmann plots were used. Intra-rater and inter-rater reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Results: Both devices showed excellent correlations for all movements (r ranged from 0.992 to 0.999). The intra-rater reliability of the VS was excellent (ICC ranged from 0.93 to 0.99), SEMs ranged from 0.53% to 2.61% and the MDC ranged from 0.68° to 3.26°. The inter-rater reliability of the VS was also excellent (ICC ranged from 0.88 to 0.98), SEMs ranged from 0.81% to 4.76% and the MDC ranged from 2.27° to 4.42°. Conclusions: The VS is a valid and reliable tool for the measurement of ROM of lower limb joints in healthy subjects.