The Psychosocial Consequences of Sports Participation for Individuals with Severe Mental Illness: A Metasynthesis Review

The purpose of the current metasynthesis review was to explore the psychosocial benefits of sport and psychosocial factors which impact on sports participation for individuals with severe mental illness. AMED, CINAHL Plus, Medline, EMBASE, ProQuest Nursing & Allied Health Source, and Science Citation Index were searched from inception until January 2014. Articles included use qualitative methods to examine the psychosocial effects of sports participation in people with severe mental illness. Methodological quality was assessed using the Consolidated Criteria for Reporting Qualitative Studies and a case study tool. Included studies were analysed within a metasynthesis approach. Eight articles involving 56 patients met the inclusion criteria. The results identified the broader and direct psychosocial benefits of sport. Sport provided a ?normal? environment and interactions that were not associated with an individual?s mental illness. Sport provided individuals with a sense of meaning, purpose, belonging, identity, and achievement. Other findings are discussed. Direct psychosocial benefits are a consequence of sports participation for the vast majority of individuals with severe mental illness. Further to this, sports participation was associated with a reduction in social isolation and an increase in social confidence, autonomy, and independence

A pragmatic randomised controlled trial of healing therapy in a gastroenterology outpatient setting

Introduction: To determine the benefits of healing therapy (spiritual healing) as an adjunct to conventional management in irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Methods: 200 outpatients with IBS or IBD were randomised to either conventional treatment (control) or conventional plus five sessions of healing therapy (intervention). After 12 weeks controls also had healing therapy. Outcomes used were, the Measure Yourself Medical Outcomes Profile (MYMOP). IBS-QOL, IBDQ, and symptom measures. Results: There was a significant improvement in the MYMOP score at week 6 (p < 0.001) which was maintained to week 12 (p < 0.001) and 24 (p < 0.001). Improvements in MYMOP were significantly greater in the intervention group at both 6 (p < 0.001) and 12 weeks (p < 0.001) with effect sizes of 0.7 (95% CI: 0.4–1.1) and 0.8 (95% CI: 0.4–1.2). Condition-specific data for IBS showed that most QoL dimensions had a significant minimum 10-point score improvement at 6 and 12 weeks. The overall score improvement was 12.9 units at week 6 (p < 0.001), 12.4 units at week 12 (p < 0.001) and 13.8 units at week 24 (p < 0.001). In IBD there was also similar score improvement, but only up to week 12 were there associations of improved social and bowel functions (p < 0.001, respectively). Between group differences were identified for QoL scores in IBS at both week 6 (p < 0.001) and 12 (p < 0.001) but only for week 12 (p < 0.001) in the IBD group. Conclusions: The addition of healing therapy to conventional treatment was associated with improvement in symptoms and QoL in IBS, and to a lesser extent in IBD

Patient journey following lumbar spinal fusion surgery (LSFS): protocol for a multicentre qualitative analysis of the patient rehabilitation experience (FuJourn)

INTRODUCTION: There has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years, with costs of £26 million to the UK National Health Service annually. Patient dissatisfaction with outcome and persistent pain and disability incurs further costs. Three trials provide low-quality evidence for the role of physiotherapy. Our UK surveys investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. This study will explore the perceptions of patients who undergo LSFS to inform precision rehabilitation. METHODS AND ANALYSIS: A qualitative study, using interpretive phenomenological analysis, will recruit a purposive sample (n=40) to ensure patterns of similarity and difference in their journeys can be explored. In-depth semistructured interviews will be undertaken following discharge from hospital and at 12 months postsurgery. Patients' preoperative and postoperative experiences, underlying attitudes and beliefs towards the surgical intervention, facilitators and barriers to recovery, adherence to advice and physiotherapy, experiences of rehabilitation and return to normal function/activity/work will be explored. A 12-month patient diary will provide real time access to patient data, capturing a weekly record of life as lived, including symptoms, medication, experiences of stages of recovery, rehabilitation adherence, healthcare professional appointments, attitudes, their feelings and experiences throughout their journey. Data will be analysed in a number of stages in accordance with interpretive phenomenological analysis, supported using NVivo software. Analysis of the first interviews and patient diaries will afford a rich density of data to build an overall understanding of the patients' lived experiences, informing the 12-month interview. Strategies (eg, reflexivity) will ensure trustworthiness. ETHICS AND DISSEMINATION: The study has ethical approval (IRAS 223283). Findings will ensure that patient-driven data inform precision rehabilitation by understanding the patient journey. Findings will be disseminated through peer-reviewed journals and conferences

Aggregate Games: Computations and Applications

Existing computational game theory studies consider compact representations of games that capture agent interaction in real-world environments and examine computation aspects of computing equilibrium concepts to analyze or predict agent behavior. One of the most well-studied representations that capture many commonly studied real-world environments is aggregate games. Aggregate games, first systematically studied by Nobel laureate Reinhard Selten, have various applications in modeling the decision-making interdependence of agents, where each agent’s utility function depends on their own actions and the aggregations or summarizations of the actions of all agents. These applications include Cournot oligopoly competition, public good contribution, and voting, where an agent’s action (e.g., goods to produce) depends only on the aggregation of all other agents’ actions (e.g., total goods produced). For the first part of this thesis, we extend aggregate games to model two new complementary non-cooperative game-theoretic scenarios capturing certain aspects of real-world characteristics that are not known to be modeled by aggregate games previously. For the first scenario, we introduce (collaborative) public project contribution games with thresholds, where each agent determines which projects to contribute to and each project\u27s success depends on the total contribution exceeding their threshold. The thresholds model project failure from insufficient contributions not modeled by prior work. The second scenario examines (competitive) multi-dimensional congestion games, where each agent determines which resources to use and the cost of using each resource depending on its total demands in multiple dimensions. These games are a recent extension of the popular congestion games. For these two games and their variants, we examine the open computational complexity of determining and computing Nash Equilibria (NE), a fundamental solution concept in game theory, and related problems. For the second part of this thesis, we consider aggregate games and examine open computational questions on NE and strong NE, which extends NE for agent coalitions, utilizing insights from the first part of this thesis. We also demonstrate how aggregate game computational results (e.g., algorithms for NE and strong NE) are applicable to several popular games. Advisor: Hau Cha

Social constructivist meta-ethnography -:A Framework Construction

Objective: The objective of this review was to establish a modified meta-ethnography framework by integrating the traditional phases with methods from social constructivist grounded theory. The modified version was required to identify methods which can ensure analytic generalisability and honour critical inquiry. Method: A narrative synthesis review was undertaken using 4 electronic databases. Articles were located that described the methods and methodologies of meta-ethnography and social constructivist grounded theory. A synthesis was undertaken which integrated the methods of social constructivist grounded theory. Results: The meta-ethnography was undertaken in 5 phases: (1) The positionality of the researcher and the area of interest identified. (2) Identifying what is relevant. (3) Reading the included studies and determining how studies are related. (4) The iterative process of idea generation required for theory generation. And (5) Expression of the theory, model, or process. Conclusion: The current review has been able to create a social constructivist meta-ethnographic framework for reviewing empirical qualitative research. This framework will support the development of a substantive theory (a theory in one area) which can be used then to consider its application in other areas. This approach will help create new lines of research and aid the explanation of problems in other areas.<br/

Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach

Background People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the meta-ethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients’ need and expectations. Methods This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will be performed by two reviewers. Data will be extracted by one reviewer, tabled, and checked for accuracy by the second reviewer. The meta-ethnography approach by Noblit and Hare [1] will be used to synthesise the data. Discussion This systematic review is expected to provide new insights into the experience of community-based group physical activity initiation for adults who have a serious mental illness to inform person-centred improvements to the management of serious mental illness through physical activity. Registration The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017059948 (registration number CRD42017059948). Keywords Serious mental illness - Physical activity - Community - Social support - Exercise - Sport - Adults - Patient experience - Qualitative research - Meta-ethnography - Systematic revie

A thematic synthesis considering the factors which influence multiple sclerosis related fatigue during physical activity

The purpose of this study is to consider the factors that influence fatigue related to physical activity in patients with multiple sclerosis (PwMS) and to identify the necessary adaptations undertaken by patients to remain active. A review using a thematic synthesis methodology situated within a subtle realist paradigm was undertaken. The review was completed in three stages: 1) search of relevant studies; 2) critical appraisal of literature; and 3) thematic synthesis. Nineteen studies met the inclusion criteria. This included a total of 263 participants of whom 243 were PwMS (159 females, 70 males and 14 unknown). The aggregated mean age was 53.3 years and aggregated mean time living with MS post diagnosis 11.3 years. Following critical appraisal, no articles were excluded. Three major themes were identified: (1) fatigue-related consequences, (2) exercise related barriers affecting fatigue, and (3) factors that make fatigue bearable for MS individuals. The thematic synthesis identified the cycle of activity and inactivity as a result of fatigue perception. Exercise experience, professional and social support, as well as the necessary adaptation of a training programme empower PwMS to adopt a more active coping strategy and enjoy the benefits of exercise. Clinicians could consider the implementation of a suitable, individualised exercise programme to reduce PwMS&rsquo;s stress during physical activities

Factors which influence risk taking and the evolution of social-identity in stroke narratives:a thematic synthesis

Background: The disruption of a stroke can impact an individual&rsquo;s sense of social identity. A comprehensive review is required to understand the factors and processes that influence changes in social identity following a stroke. Aims: To undertake a review of literature to discover a process of social identity evolution for people with stroke and identify the factors which influence it. Methods: A meta-ethnographic approach to review was undertaken and a subtle realist viewpoint was assumed. Studies were included if they documented experiences and perceptions relating to stroke. Eight electronic databases were searched from January 2009 until January 2019. Quality assessment and synthesis techniques were applied. Findings: Out of the 18 papers included, a total of 251 (141/251, 56% male, 109/251, 43% female, 1/251, 0.4% undisclosed) individuals were included within the synthesis. The evolution of social-identity model was developed and identified with five key stages to represent a process that individuals with stroke can experience. Factors which influence the process were identified and direct implications for clinical practice are given. Conclusion: This review has highlighted the major themes within the evolution of social identity and management strategies for risk taking to achieve a desired future. Further research is required to consider how these findings may be tested in clinical practice