A Quality Improvement Project on Agitation Management in the Emergency Department.

Introduction: Agitation is common in the emergency department. When agitation is not detected early, patients can become aggressive and violent, potentially leading to restraint use and subsequent injury. The goals of the project were early detection and management of patient agitation, reduction of restraint use in the emergency department, and determination of the usability of the Behavioral Activity Rating Scale.

The Feasibility and Impact of the EMOVE Intervention on Self-efficacy and Outcome Expectations for Exercise in Epilepsy.

The purpose of this pilot study was to evaluate the feasibility of the self-efficacy based Epilepsy-Motivate and Outcome Expectations for Vigorous Exercise (EMOVE) intervention and report on the preliminary efficacy of this intervention aimed at improving exercise behaviors in adults with epilepsy. Methods: A single-group, repeated-measures design was used in 30 outpatients. Data were collected at baseline and 12 weeks after the intervention.

Automated Fall Detection Technology in Inpatient Geriatric Psychiatry: Nurses' Perceptions and Lessons Learned.

ABSTRACTHospitalized older adults are at high risk of falling. The HELPER system is a ceiling-mounted fall detection system that sends an alert to a smartphone when a fall is detected. This article describes the performance of the HELPER system, which was pilot tested in a geriatric mental health hospital.

Reliability and Validity of the Self-Efficacy for Exercise in Epilepsy and the Outcome Expectations for Exercise in Epilepsy Scales.

Purpose: The purpose of this study was to test the psychometric properties of the revised Self-Efficacy for Exercise With Epilepsy (SEE-E) and Outcome Expectations for Exercise with Epilepsy (OEE-E) when used with people with epilepsy.

Methods: The SEE-E and OEE-E were given in face-to-face interviews to 26 persons with epilepsy in an epilepsy clinic.

Results: There was some evidence of validity based on Rasch analysis INFIT and OUTFIT statistics.

Implementation of the Agitated Behavior Scale in the Electronic Health Record.

Purpose: The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital.

Design: A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling.

Methods: The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale.

Clinimetric properties of a novel feedback device for assessing gait parameters in stroke survivors.

Introduction: Community-dwelling stroke survivors tend to become less physically active over time. There is no 'gold standard' to measure walking activity in this population. Assessment of walking activity generally involves subjective or observer-rated instruments.

The impact of PRAISEDD on adherence and initiation of heart health behaviors in senior housing.

Objective: Building on prior theoretical work and research, we developed a community-based intervention, People Reducing Risk And Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD), a three-phase program which was implemented in 2009. The purpose of this study was to report on Phase III, the Inoculation Phase, of the PRAISEDD program and explore participant experiences.

Design And Sample: This was a descriptive, qualitative study focused on exploring participation in heart healthy PRAISEDD classes.

People reducing risk and improving strength through exercise, diet, and drug adherence (PRAISEDD): a case report on long-term single site adoption.

African-American and low-income older adults have heightened risk for cardiovascular disease (CVD). Culturally and socially congruent community-based programs can promote risk-reduction behaviors, including physical activity (PA), and can demonstrate durability. The purpose was to increase lifestyle PA and promote self-management of CVD risk factors in a sample of at-risk older adults and to sustain a PA program within low-income housing.

Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery.

Stroke survivors are at high risk for cardiovascular mortality which can be in part mitigated by increasing physical activity. Self-efficacy for exercise is known to play a role in adoption of exercise behaviors. This study examines self-reported psychological outcomes in a group of 64 stroke survivors randomized to either a 6-month treadmill training program or a stretching program.

Exercise intervention research in stroke: optimizing outcomes through treatment fidelity.

Background: Demonstrating the treatment fidelity of an intervention is a key methodological requirement of any trial testing the impact of the intervention.

Purpose: The purpose of this report was to serve as a model for evaluating treatment fidelity in stroke exercise intervention studies and to provide evidence for treatment fidelity in the Exercise Training for Hemiparetic Stroke Intervention Development Study.

Methods: Treatment fidelity was evaluated based on study design, training of interventionists, and delivery and receipt of the intervention.

Pilot testing of the PRAISEDD intervention among African American and low-income older adults.

Background And Research Objective: The incidence of cardiovascular disease (CVD) is particularly high among African American (AA) older adults, and these individuals are least likely to have access to CVD prevention activities. The purpose of this study was to test the feasibility of People Reducing Risk and Improving Strength through Exercise, Diet and Drug Adherence (PRAISEDD), which is geared at increasing adherence to CVD prevention behaviors among AA and low-income older adults.

Methods: This feasibility study was conducted in a senior housing site, using a single-group repeated-measures design and testing physical activity, diet, medication adherence beliefs and behaviors, and blood pressure at baseline and after a 12-week intervention period.

Progressive adaptive physical activity in stroke improves balance, gait, and fitness: preliminary results.

Purpose: We conducted a non-controlled pilot intervention study in stroke survivors to examine the efficacy of low-intensity adaptive physical activity to increase balance, improve walking function, and increase cardiovascular fitness and to determine whether improvements were carried over into activity profiles in home and community.

Method: Adaptive physical activity sessions were conducted 3 times/week for 6 months. The main outcomes were Berg Balance Scale, Dynamic Gait Index, 6-Minute Walk Test, cardiovascular fitness (VO2 peak), Falls Efficacy Scale, and 5-day Step Activity Monitoring.

Motivators for treadmill exercise after stroke.

Purpose: The purpose of this qualitative study was to explore factors that motivated older adults with ischemic stroke to engage in a task-oriented treadmill aerobic exercise (T-AEX) intervention study.

Method: Participants included community-dwelling individuals post stroke with mild-to-moderate hemiparetic gait deficits who completed a 6-month T-AEX study. A total of 29 participants attended focus groups or individual telephone interviews.

Inflated perceptions of physical activity after stroke: pairing self-report with physiologic measures.

Background: Self-report measures of physical activity have well-known drawbacks, and physiologic measures alone do not account for behavioral variables important in the perception and performance of physical activity. Therefore, we considered multiple measures to quantify physical activity in community-dwelling men and women with chronic stroke.

Methods: This analysis included data from a volunteer sample of 87 individuals at least 6 months poststroke.

Ambulatory activity intensity profiles, fitness, and fatigue in chronic stroke.

Purpose: The purpose of this study was to describe household and community ambulatory activity profiles and their relationship to fatigue and cardiovascular fitness in a sample of men and women with chronic hemiparetic stroke.

Method: We quantified community-based ambulatory activity profiles in terms of step counts and intensity, along with cardiovascular fitness and fatigue severity, in a convenience sample of 79 men and women with chronic hemiparetic stroke.

Results: As captured by daily step activity monitoring, participants demonstrated extremely low step counts (1389 +/- 797 steps/day), and almost no step activity at high intensity (78 +/- 168 steps/day at a rate of >or=30 steps/ minute).

Confidentiality challenges and good clinical practices in human subjects research: striking a balance.

The Health Insurance Portability and Accountability Act (HIPPA) has been fully implemented in clinical practice and research settings. Although subject confidentiality has always been a concern, clinical researchers must now take extra care to attend to the mandates of privacy while also minding good clinical practice guidelines. Unanticipated conflicts may arise as a result of these dual priorities.

Cardiovascular risk in survivors of stroke.

Background: Stroke survivors are at significant risk for recurrent stroke and cardiovascular disease. Inadequately managed modifiable risk factors increase the threat of recurrent stroke, development of new comorbidities, and double the risk of premature mortality. The purpose of this study was to determine the prevalence of modifiable cardiovascular risk factors in stroke survivors who completed a research screening evaluation for entry into exercise rehabilitation studies.

Stroke prevention and management in older adults.

Stroke is the third leading cause of death and a foremost cause of serious, long-term disability in the United States. As cardiovascular and metabolic disease incidence rises with age, older people are more likely to experience strokes. Age is the single most important risk factor for stroke.

Fatigue after stroke: relationship to mobility, fitness, ambulatory activity, social support, and falls efficacy.

Fatigue is common and persistent in stroke survivors, yet it is not known how mobility deficits, fitness, or other factors, such as social support, relate to fatigue severity, or whether subjective fatigue contributes to reduced ambulatory activity. The severity of fatigue in a sample of 53 community-dwelling subjects with chronic hemiparetic stroke was examined, and relationships among fatigue and mobility deficit severity, cardiovascular-metabolic fitness, ambulatory activity, social support, and self-efficacy for falls were identified. Measures included the Fatigue Severity Scale, timed 10-meter walks, the Berg Balance Scale, submaximal and peak VO2, total daily step activity derived from microprocessor-linked Step Activity Monitors, the Medical Outcomes Study Social Support Survey, and the Falls Efficacy Scale.

Reduced ambulatory activity after stroke: the role of balance, gait, and cardiovascular fitness.

Objectives: To determine ambulatory activity in a sample of community-dwelling people with chronic hemiparetic stroke and to examine whether deficits in balance and gait and cardiovascular and metabolic fitness are key determinants of ambulatory activity levels.

Design: Descriptive correlational.

Setting: Home and community.

Steps after stroke: capturing ambulatory recovery.

Background And Purpose: Nearly two thirds of stroke survivors have deficits impairing ambulatory recovery. Conventional mobility outcome measures such as timed walks and functional independence measure (FIM) do not quantify free-living ambulatory behavior. This study compared step activity monitoring (SAM) with established instruments to assess ambulatory recovery across the outpatient subacute stroke rehabilitation phase.

Fatigue and stroke.

Under disabling conditions such as stroke, fatigue may worsen other symptoms and impede full participation in a rehabilitation program. The functional improvement needed to regain mobility and independence may be impacted significantly by fatigue. This article explores the symptom of fatigue and its relation to stroke from a rehabilitation perspective.