Objective: To explore the main barriers to and facilitators of physical activity in young adults with childhood-onset physical disabilities. Design: Qualitative study using focus groups. Participants: Sixteen persons (12 men and 4 women) aged 22.4 (standard deviation 3.4) years, of whom 50% were wheelchair-dependent, participated in the study. Eight were diagnosed with myelomeningocele, 4 with cerebral palsy, 2 with acquired brain injury and 2 with rheumatoid arthritis. Methods: Three focus group sessions of 1.5 h were conducted using a semi-structured question route to assess perceived barriers to and facilitators of physical activity. Tape recordings were transcribed verbatim and content analysed. According to the Physical Activity for People with a Physical Disability model, barriers and facilitators were subdivided into personal factors and environmental factors. Results: Participants reported several barriers related to attitude and motivation. In addition, lack of energy, existing injury or fear of developing injuries or complications, limited physical activity facilities, and lack of information and knowledge, appeared to be barriers to physical activity. Fun and social contacts were mentioned as facilitators of engaging in physical activity, as well as improved health and fitness. Conclusion: Young adults with childhood-onset physical disabilities perceived various personal and environmental factors as barriers to or facilitators of physical activity. These should be taken into account when developing interventions to promote physical activity in this population. into adulthood (1-3). As a consequence, healthcare is shifting from disability prevention towards health promotion, in order to prevent secondary conditions and to ensure a healthy adult life (4). Secondary conditions affecting people with physical disabilities include osteoporosis, decreased balance, reduced muscle strength and endurance, reduced aerobic fitness, increased spasticity, overweight, hypertension and depression. With increasing age, lifestyle-related diseases, such as diabetes mellitus and cardiovascular diseases, may also be of concern. Encouraging physical activity (PA) is important for health promotion, and is assumed to have positive effects on secondary conditions, and on functional independence, social integration, and life satisfaction (5, 6).Previous studies in adolescents and young adults with MMC and CP showed low levels of PA and low aerobic fitness, compared with able-bodied people of the same age (7-9). In order to develop programmes to promote PA in people with childhood-onset physical disabilities, it is important to understand the factors that determine PA behaviour in this population (10, 11). To describe factors associated with PA in people with a physical disability, van der Ploeg et al. (12) proposed the Physical Activity for People with a Disability (PAD) model (Fig. 1). The model uses the International Classification of Functioning, Disability and Health (ICF) as its starting point. The ICF model describes th...
This study aims to evaluate and predict outcome as part of routine quality assessment of an inpatient stroke rehabilitation programme. By relating functional outcome to patient characteristics, including variables from the quality of life domain, we aim to find a set of variables that can be useful for prognosis, stratification and programme improvement. Data were collected, before and after rehabilitation, from a prospective quality registration database. Included were 250 patients in inpatient stroke rehabilitation after sustaining a first or recurrent ischemic or haemorrhagic stroke. Functional status was measured with the Barthel Index and the Academic Medical Centre Linear Disability Score. Health-related quality of life (HrQoL) was measured with the COOP/WONCA and the Nottingham Health Profile. Significant improvements were found on all outcome measures. A lower functional admission score, older age, more severe stroke, more pain and more negative emotional reactions on admission were found to be independent predictors of a lower outcome score, explaining 39.5% of its variance. Subjective (HrQoL) factors such as negative emotion and pain have an adverse effect on outcome of stroke rehabilitation, in addition to stroke severity, age and functional status at admission. These factors need to be taken into account in screening, clinical decision making and treatment design.
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