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Contextual experiences of Maltese stroke survivors during their rehabilitation journey : an interpretative phenomenological study using status passage theory

2026-03-04T13:17:17Z

Title: Contextual experiences of Maltese stroke survivors during their rehabilitation journey : an interpretative phenomenological study using status passage theory Abstract: Introduction: The adjustment period of stroke survivors can be very individualised, as they experience the changes in their lives during rehabilitation, and also when discharged into the community. Understanding the meaning behind stroke survivors’ lived experience of rehabilitation during this process is crucial. On discharge back home, reintegration into the relationships and roles within their familial and societal networks is important to explore, as it is the expression of the status of the ‘stroke patient’ as a person, within their individual cultural context. Exploring contextual lived experience of persons following stroke is therefore essential in the implementation of person-centred care. Methodology: This study aimed to explore Maltese stroke survivors’ lived experience following rehabilitation, on discharge to the community. Participants were interviewed 3 months, 6 months, and 9 months following discharge into the community. Interviews were audiotaped and transcribed verbatim. Interpretative Phenomenological Analysis (IPA) was used to analyse the findings. A specific theory, Status Passage Theory (SPT), was also used in a second analysis of these transcribed interviews to deepen the exploration of the lived experience of stroke survivors during the rehabilitation process. This analysis was done using the five properties of SPT: Reversibility, Desirability, Temporality, Shaping of Status Passage and Multiplicity. Findings: Group Experiential Themes (GETs) constructed from the IPA included the engagement and understanding of rehabilitation during their in-patient stay, limited active participation in the discharge process from the rehabilitation hospital into the community, the meaning of home and family for the Maltese stroke survivor, the diversity of levels of health literacy within participants, and the influence of Maltese familial networks on stroke survivors’ experiences. A matrix constructed from the codes generated from the analysis using SPT indicated that they were aligned with the GETs. The GETs were also displayed in a matrix using a ‘best-fit’ framework approach method, and this matrix showed that they did fit in the five properties of Status Passage, in more than one property of this theory. In this way, this alignment of the properties of the SPT brought out different aspects of the GETs constructed within the IPA, not only at a static point in time, but related to periods of transition across time. It also indicated how some aspects of the GETs constructed from the IPA were influential in the shaping of the status passage of the participants, as stroke survivors during the rehabilitation process. Conclusion: The findings in this study highlighted specific aspects related to active participation, knowledge and understanding required for the contextual management of Maltese stroke survivors within Maltese healthcare systems and within the Maltese sociocultural context. Stroke survivors within this context may benefit from an increase in shared clinical decision-making in the management of their healthcare, including the discharge process, with assistance where necessary. The support of familial networks appears to be a crucial component of their process of recovery whilst back in the community. This vital component may need to be supplemented by the involvement of health care professionals in stroke survivors where this social capital and cohesion are not present, to enable discharge into the community. This individualised approach is an important component of person-centred care. Description: Ph.D.(Melit.)

Barriers and motivators to gym attendance by older persons

2024-12-17T09:14:06Z

Title: Barriers and motivators to gym attendance by older persons Abstract: Introduction: The importance of, and awareness towards healthy ageing and active ageing are major points of discussion in view of the increase in average longevity across the globe, and Malta is no exception. Improving physical fitness dimensions may play a role in active ageing. The barriers and motivators to physical activity within the older population have been largely studied, much more than to the specific context of gym attendance. Therefore, the aim of this study was to explore the attitudes of community-dwelling older persons (≥ 65 years) towards gym attendance with the purpose of providing the evidence to support policy makers and entrepreneurs to promote workout spaces that are specifically designed for and intended to the needs of older persons. Method: A multi-method case study approach was adopted, consisting of data collected via an online survey in a first phase, followed by data collected from interviews in a second phase. Both the survey questionnaire and the interview guide were developed by the research team. Data in Phase 1 was collected through the social media platform Facebook. Participants for Phase 2 – the interview phase, were approached following their self declared interest to participate in this phase. Analysis was carried out using descriptive and inferential methods for the findings from Phase 1; framework analysis was used to interpret the findings from Phase 2 using the socio-ecological framework and social determinants of health as a basis for discussion and interpretation. Findings/ results: 177 community-dwelling older persons participated in Phase 1. 12 participants participated in Phase 2. The key findings from the first phase are that the likelihood of attending a gym is greater amongst the young old (65-69 years), those living with a spouse/partner, those living in the Northern Harbour District, as well as those with higher education levels. Conversely, the likelihood of not attending a gym is greater for the older old (≥80 years), those living with children, those living in the Southern Harbour district or Gozo and Comino District, and those with lower educational levels. Barriers and motivators were also analysed through a 1-5 Likert scale, with 1 representing the least and 5 representing the greatest. In the order of greatest to lowest barriers to attending a gym, the top five barriers were cost (3.12), lack of age-appropriate programs (3.07), lack of willpower (3.01), poor health (2.98), and lack of positive attitude (2.80). The greatest five motivators were good health (4.18), physical functioning benefits (3.95), physical benefits (3.92), improved well-being (3.89), and health benefits (3.87). A trend was also observed between genders, where females experienced greater barriers when compared to males. Individual factors such as perceived health limitations and perceived negative mental health were found to be more likely to act as a barrier to gym attendance than social factors, whilst social factors such as economic support and good neighbourhood and built environment were more likely to motivate older persons to attending a gym. Conclusion: Whilst most older persons understand the benefits of gym attendance, this attendance is dependent on a number of factors that may impact a decision to pursue such goals. For policy makers and entrepreneurs knowing what hinders and/ or motivates older persons to attending a gym may serve to focus on reducing the barriers and promoting motivators amongst older persons in pursuit of national and global goals linked to active and healthy ageing. Description: M.Sc.(Melit.)

Effects of neuromuscular electrical nerve stimulation on quadriceps muscle strength and endurance in patients with chronic obstructive pulmonary disease

2024-12-17T09:13:25Z

Title: Effects of neuromuscular electrical nerve stimulation on quadriceps muscle strength and endurance in patients with chronic obstructive pulmonary disease Abstract: Introduction: Neuromuscular Electric Nerve Stimulation (NMES) is a modality that is gaining interest as part of the management of participants with Chronic Obstructive Pulmonary Disease (COPD). Given the increased knowledge of how the muscle changes structurally as the respiratory condition deteriorates, treatment options are being investigated to help maintain and improve strength and endurance in patients who are limited due to poor exercise tolerance and increased dyspnoea and cannot part-take in rehabilitation. Method: Using a randomised control trial design, 33 participants who required admission to hospital due to an Acute Exacerbation of COPD, with a moderate to severe classification based on the MRC score, were recruited and randomly allocated to an experimental or control group. Quadriceps strength, endurance, COPD Assessment Test Score (CAT Score), 1-minute Sit-to-Stand test (1MSTS), Borg Dyspnoea Scale (BDS) and Rectus Femoris width and thickness were assessed at baseline and on completion of the intervention upon discharge from hospital on all participants. The experimental group received 30 minutes of NMES stimulation on the quadriceps muscles daily throughout their hospitalisation stay, over and above the usual physiotherapy treatment provided to all participants by physiotherapists in the ward. The control group received only Physiotherapy treatment provided in the ward. All outcome measures were repeated prior to discharge. Results: Statistically significant improvements in quadriceps strength (left and right; P < 0.001), quadriceps endurance (left: P < 0.027, right: P < 0.015), Rectus Femoris Cross-sectional Area (left: P < 0.012, right: P < 0.003), Rectus Femoris Thickness (left and right: P < 0.001), Rectus Femoris Width on the right side (P = 0.017) and BDS (P = 0.027) were reported in the experimental group. In contrast, statistically significant declines in mean values for the left and right Rectus Femoris width were registered for the control group (left P = 0.006, right: P< 0.001). The only outcomes which resulted in statistically significant improvements for both groups included the CAT Score (P < 0.001) and the 1MSTS test (P < 0.001); however, a higher mean percentage change in both tests was noted for the experimental group. Conclusions: 30 minutes of daily NMES during a period of hospitalisation due to an AECOPD in moderate to severe participants resulted in significant improvements in all outcome measures for the experimental group. Therefore, NMES can be utilised as an adjunct to the already provided physiotherapy treatments offered to maintain and improve quadriceps strength, endurance and muscle structure, improve the impact of COPD on patients and increase exercise tolerance. Description: M.Sc.(Melit.)

The use of immersive virtual reality to reduce risk of falls in community-dwelling older adults : a feasibility study

2024-12-17T09:07:08Z

Title: The use of immersive virtual reality to reduce risk of falls in community-dwelling older adults : a feasibility study Abstract: Falls represent a significant challenge to healthy ageing, emphasising the importance of fall prevention interventions. Physiotherapy interventions, including balance exercises and muscle strengthening, are commonly used to address fall risk. The use of immersive virtual reality (IVR) exergaming offers a contemporary approach to complement traditional physiotherapy interventions. This study aimed to explore the feasibility of IVR as an innovative intervention for local physiotherapists to reduce fall risk among older individuals, thereby promoting social inclusion. Using a mixed method experimental design, with an embedded model in two phases, the research initially employed a quasi-experimental one-group pre-test post-test design to quantitatively assess the effectiveness of IVR intervention, as indicated by changes in Timed Up and Go (TUG) and Berg Balance Scale (BBS) scores. Seven participants who were at risk of falls were recruited and underwent the intervention which included 12 sessions of IVR exergaming. Thematic analysis was conducted based on descriptive phenomenological insights from individual semi-structured interviews. A statistically significant improvement in TUG and BBS scores was observed, indicating that the IVR sessions were potentially effective in reducing the risk of falls. A thematic network was constructed to categorise the interview findings, resulting in the identification of the overarching Global Theme centred on Physiotherapy and IVR. It was observed that IVR has the potential to reduce risk of falls and thus serve as a complementary tool for existing falls risk strategies. Furthermore, this study was able to identify promoters and barriers to feasibility, offering insights for future implementation studies in this domain. Furthermore, this study was able to identify promoters and barriers to feasibility, offering insights for future implementation studies in this domain. Description: M.Sc.(Melit.)