Gagnon I1, Schiffman C1, Lawson J1, Pham J2, Fougeres C1, Burstein B3, Agostino H4
1McGill University, Physical Therapy, Montreal, Canada, 2McGill University, Occupational Therapy, Montreal, Canada, 3McGill University, Pediatric Emergency Medicine, Montreal, Canada, 4McGill University, Adolescent Medicine, Montreal, Canada
Background: Restrictive Eating Disorders (REDs) such as Anorexia Nervosa, commonly lead to altered mood, reduced bone density, bradycardia or hypotension. In extreme cases, patients with REDs may be hospitalized in a medical ward because of vital sign instability, a condition that is potentially life-threatening. The standard of care provided to patients hospitalized for vital sign instability typically consists of strict bed rest and refeeding. However, a recent systematic review suggests that strict bed rest may not be the optimal approach, and that some level of physical activity may be a potential alternative intervention with has less negative side effects than bed rest and refeeding alone. However, there remains a gap regarding the characteristics of an optimal rehabilitation m for this population.
Purpose: Design an innovative and theoretically sound physiotherapy rehabilitation intervention for adolescents with REDs hospitalized for vital sign instability aimed at minimizing side effects linked to extended bed rest.
Methods: A multi-step process steps was involved so that the intervention could be based on solid theoretical grounds and empirical evidence. A systematic review of the literature was first completed and served to co-construct the logic model or intervention theory as well as a detailed description of the intervention with the Adolescent Medicine Care Team. The logic model was then submitted for validation to leading experts in the field by means of an iterative process through electronic consultation as well as through an in-person meeting. Together the information obtained from the literature review and from the expert consultation provided sound theoretical and conceptual background for the new intervention.
Results: The developed physiotherapy intervention consists in a daily 2-station circuit program involving
1) Weight bearing activities (jumping);
2) Breathing activities (yoga);
3) Balance activities (yoga);
4) Low intensity aerobic exercise (walking); or
5) Low level resistance exercises; to be performed twice per day for a maximum of 20 minutes per day.
The activities are to be performed in variable combinations over the duration of the hospitalization. The final intervention description and logic model was then presented and finalized, as well as prepared for a pilot implementation study, planned as a subsequent step of this research program.
Conclusion(s): A Physiotherapy rehabilitation intervention for adolescents with REDs hospitalized for vital sign instability was developed with a multi-phase and interdisciplinary process. There was consensus among experts that this program could theoretically be feasible and safe for the population, although a formal empirical implementation evaluation is ongoing.
Implications: Physiotherapy interventions for adolescents with REDs hospitalized for vital sign instability do not currently exist. As exercise specialists, physiotherapists are well positioned to become integral part of the care team for this population and continue to develop this emerging role for the profession. Our study provided novel information about the addition of a supervised and low intensity PA program in this population, setting the stage for further research in this area and improved outcomes for patients.
Keywords: Pediatrics, Physical Activity, Mental Health
Funding acknowledgements: School of Physical and Occupational Therapy, McGill University, and the Research Institute of the McGill University Health Center
Purpose: Design an innovative and theoretically sound physiotherapy rehabilitation intervention for adolescents with REDs hospitalized for vital sign instability aimed at minimizing side effects linked to extended bed rest.
Methods: A multi-step process steps was involved so that the intervention could be based on solid theoretical grounds and empirical evidence. A systematic review of the literature was first completed and served to co-construct the logic model or intervention theory as well as a detailed description of the intervention with the Adolescent Medicine Care Team. The logic model was then submitted for validation to leading experts in the field by means of an iterative process through electronic consultation as well as through an in-person meeting. Together the information obtained from the literature review and from the expert consultation provided sound theoretical and conceptual background for the new intervention.
Results: The developed physiotherapy intervention consists in a daily 2-station circuit program involving
1) Weight bearing activities (jumping);
2) Breathing activities (yoga);
3) Balance activities (yoga);
4) Low intensity aerobic exercise (walking); or
5) Low level resistance exercises; to be performed twice per day for a maximum of 20 minutes per day.
The activities are to be performed in variable combinations over the duration of the hospitalization. The final intervention description and logic model was then presented and finalized, as well as prepared for a pilot implementation study, planned as a subsequent step of this research program.
Conclusion(s): A Physiotherapy rehabilitation intervention for adolescents with REDs hospitalized for vital sign instability was developed with a multi-phase and interdisciplinary process. There was consensus among experts that this program could theoretically be feasible and safe for the population, although a formal empirical implementation evaluation is ongoing.
Implications: Physiotherapy interventions for adolescents with REDs hospitalized for vital sign instability do not currently exist. As exercise specialists, physiotherapists are well positioned to become integral part of the care team for this population and continue to develop this emerging role for the profession. Our study provided novel information about the addition of a supervised and low intensity PA program in this population, setting the stage for further research in this area and improved outcomes for patients.
Keywords: Pediatrics, Physical Activity, Mental Health
Funding acknowledgements: School of Physical and Occupational Therapy, McGill University, and the Research Institute of the McGill University Health Center
Topic: Mental health; Paediatrics; Service delivery/emerging roles
Ethics approval required: Yes
Institution: McGill University Health Center
Ethics committee: Pediatric Committee
Ethics number: 2017-4709
All authors, affiliations and abstracts have been published as submitted.
