The Relationship between Self-Efficacy,Functional Exercise Capacity and Physical Activity in People with COPD: A Systematic Review and Meta-Analyses

Abstract

The purpose of this study was to investigate the strength of the relationships between self-efficacy and (i) functional exercise capacity and (ii) physical activity in chronic obstructive pulmonary disease (COPD), and whether self-efficacy assessment type (i.e., COPD symptoms, exercise-task, exercise-barrier, general, falls) and physical activity assessment type (i.e., self-report vs. objective) are moderators. A systematic search of COPD and self-efficacy concepts was conducted using eight databases from inception to 23 January 2019. Studies were included if they provided correlation coefficients of the relationship between self-efficacy and functional exercise capacity or physical activity, were conducted in adults diagnosed with COPD, and were published in English-language journals. A total of 14 correlation coefficients were included in the self-efficacy and functional exercise capacity meta-analysis, and 16 in the self-efficacy and physical activity meta-analysis. Data were screened, reviewed, and extracted independently by two reviewers, with discrepancies resolved by a third reviewer. Stronger self-efficacy was associated with better functional exercise capacity (weighted r?=?0.38, 95%CI [0.25, 0.50]), and greater physical activity (weighted r?=?0.25, 95%CI [0.17, 0.34]). Exercise-task self-efficacy had the strongest relationship to functional exercise capacity (weighted r?=?0.64, 95% CI [0.51, 0.73]). For physical activity, the type of self-efficacy most strongly related was inconclusive. In COPD, self-efficacy has a relationship to functional exercise capacity and physical activity, the strength of which is influenced by the choice of self-efficacy measure. An understanding of these relationships will assist clinicians in selecting the self-efficacy measure most closely related to the outcome of interest.     

Multimorbidity and functional impairment–bidirectional interplay,synergistic effects and common pathways

This review discusses the interplay between multimorbidity (i.e. co‐occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians’ fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug–drug and drug–disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age‐related health deterioration; this review provides an overview of knowledge gaps and future directions.     

对构建德智体美劳全面发展的新医科人才体系的思考

通过分析"新医科"发展趋势以及目前我国医疗供给侧改革的内在需求与人的全面发展之间的紧密联系,提出立德树人、以智启人、以体育人、以美成人、以劳塑人是"新医科"对医学人才培养的主要途径。在此要求之下,医学高等院校应适应全民健康的目标和社会保健服务的需求,坚持本科教育服务地方经济社会的理念,加强大健康教育与全面素质教育,着力培养符合社会需要的、全面发展的新医科人才。     

系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的对年轻患者肩关节脱位进行系统的康复治疗,以检验系统康复疗法疗效优于单纯固定的假设。方法根据所采用的治疗方法,将43例40岁以下的急性肩关节脱位患者分成实验组23例,对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果实验组复发率为17%(4/23),对照组复发率为45%(9/20),两组复发率比较差异有显著性意义(χ2=3.866,P<0.05);随访结果显示肩关节ASES评分实验组为90.9±4.87,对照组为75.4±4.94,两组差异有非常显著性意义(t=9.94,P=2.99×10-12<0.01)。结论肩关节脱位年轻患者进行系统的康复锻炼,可以提高患肩的稳定性。     

Physical laws of cholesterol gallstone fragmentation

Efficient fragmentation is the most important prerequisite for successful treatment of gallstones by extracorporeally induced shock waves. No data are available on the amount of energy necessary for stone disintegration and on the threshold energy below which no further fragmentation occurs. We therefore performed an in vitro investigation on human cholesterol gallstones to elucidate physical laws governing shock-wave lithotripsy. First, the focal pressure of the lithotripter was measured to calculate the energy traversing a stone. Second, 96 gallstones from 16 gall bladders were analysed with respect to physicochemical composition, radiological features and ultrasound before fragmentation was performed. Energy for stone disintegration was constant within each stone family but varied between 4.6 J mL^?1 and 36.8 J mL^?1 in different families. This energy correlated linearly with stone volume. None of the radiological and physicochemical factors revealed a clear-cut correlation of the different energies necessary for similar stone disintegration. The threshold energy differed between 0.26 mJ and 1.04 mJ per pulse. In conclusion, stone volume was the best parameter predicting stone fragmentation. However, in cholesterol stones with a similar composition the required energy per volume varies considerably together with the threshold energy. Radiological and ultrasound parameters appear to be of minor importance in explaining these differences.     

银杏竹鼠肌肉成分对小鼠智力、体力的影响

目的：观察银杏竹鼠肌肉成分对小鼠智力体力的影响。方法：小鼠随机分为七组，通过喂饲银杏竹鼠肌肉干粉连续一个月，用小鼠低温游泳存活时间实验，耐缺氧实验及跳台和记忆获得障碍实验分别记录低温游泳存活时间，缺氧存活时间及第一次错误潜伏期和跳台错误次数。结果：各竹肉组小鼠与普通饲料（ＮＳ）组，普肉组，护宝液组比较，均可明显延长小鼠低温游泳存活时间和缺氧存活时间（Ｐ＜０．０５），与洋参丸组相当（Ｐ＞０．０５），竹肉大／超组小鼠跳台错误次数均减少（Ｐ＜０．０５），竹肉超组小鼠第一次错误潜伏期延长（Ｐ＜０．０５），竹肉大组小鼠第一次错误潜伏期有延长趋势，但无统计学意义。结论：口服银杏竹鼠肌肉成分可增强小鼠学习记忆能力，增强小鼠体质，提高小鼠生活质量。这一结果也提示银杏竹鼠肌肉成分很有可能成为极有应用前景和开发前景的保健食品。     

人机工程学工作分析方法在体力劳动负荷评价中的应用

对鞍钢耐火厂、炼钢厂22个工种分别进行体力劳动负荷的人机工程学分析及劳动强度测定。调查表明,两种方法所得结果基本一致,但人机工程学分析方法简便,易于基层单位推广应用。     

Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Background and Purpose . Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. Method . A single‐subject experimental study design with ABAA phases was used, and two patients with relapsing–remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self‐report measures and interviews were used. Results . After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as ‘much improved’. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). Conclusion . The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS. Copyright © 2006 John Wiley & Sons, Ltd.