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Results | PMC10803506 | |||
Participants | HT | DOUBLE VISION | Twenty surgeons were recruited for this study from September to December 2021. One surgeon was excluded from the analysis due to double vision with the HT loupes. The demographics of the 19 included participants are shown in Demographics of participants. | PMC10803506 |
Muscle activity of the cervical erector spinae, upper trapezius, and lumbar erector spinae | HT | MVE | From the surgeons’ own loupes to LT loupes and HT loupes, the 50th percentile of the muscle activity of the right CES decreased significantly in all three tasks [%MVE, median (IQR)]: PT [own, 9.5 (8.2–11.5); LT, 8.2 (6.8–10.1); HT 6.5 (5.1–7.6); own vs. LT, Muscle activity (50th percentile; %MVE) of the right CES of the 19 participants during three simulated surgical tasks compared among the surgeons’ own surgical loupes, the low-tilt loupes, and the high-tilt loupes. For each box, the middle line represents the median value; the upper and lower edges of the box denote the upper and lower quartiles; the upper edge and lower edge of the whiskers denote the nonoutlier maximum and minimum; and outliers are marked with +. Significant differences are indicated with | PMC10803506 |
Subjective evaluation | bad posture, HT | DOUBLE VISION | Most participants preferred LT loupes (5 for own; 11 for LT; 2 for HT; 1 for own or LT depending on the surgery case; 1 for “own loupes for now or HT if double vision can be fixed”). For the LT loupes, nine participants stated that they liked the visual functions of the loupes because of their good spatial orientation (Regarding the HT loupes, five participants mentioned feeling “relaxed/relieved” in the neck. Six participants stated that the HT loupes had good visual functions, including clear vision (Regarding their own loupes, four participants stated that they were used to their own loupes and that they fit well. While four participants expressed that their own loupes caused them to have a bad posture, three mentioned that their own loupes were old and needed visual adjustment. | PMC10803506 |
Performance of surgeons | HT | The task completion time [seconds, median (IQR)] was significantly longer when using the HT loupes in the PT compared to the surgeons’ own loupes and the LT loupes [own, 45 (41–49); LT, 46 (42–53); HT 57 (44–62); LT vs. HT, Task completion time of three simulated surgical tasks of the 19 participants compared among the surgeons’ own surgical loupes, the low-tilt loupes, and the high-tilt loupes. For each box, the middle line represents the median value; the upper and lower edges of the box denote the upper and lower quartiles; the upper edge and lower edge of the whiskers denote the nonoutlier maximum and minimum; and outliers are marked with +. Significant differences are indicated with | PMC10803506 | |
Discussion | angulation, head or neck flexion, HT, neck/shoulder pain | The main results of this randomized crossover study were that using prismatic loupes (compared to traditional loupes) reduced two ergonomic risk factors – head inclination and neck muscle activity –without increasing surgical errors. However, in two of three tasks, the completion time was prolonged when using HT loupes.To our best knowledge, this is currently the largest performed study that focuses on the effects of prismatic loupes use among surgeons. There was a significant reduction in head inclination when using the two prismatic loupes compared to traditional loupes. This is an important finding since the forward head inclination likely is a primary contributor to the high frequency of neck/shoulder pain among surgeons. An angulation of 15° in the prism of the LT loupes resulted in a 13°–14° reduction in the group median of the 50th percentile head inclination, while a 48° angulation in the prism of the HT loupes reduced the head inclination by 22°–26°. While factors such as eye rolling and frame angle also influence the impact of loupes on head inclination, the results consistently show a trend: increased angulation in the prism of the surgical loupes correlates with greater head inclination.A few studies have reported that the usage of prismatic glasses can reduce head or neck flexion among dental workers, with an angulation angle of 5° in the prism leading to a reduction of 6.5° in the 50th percentile head inclination (This study also found that in comparison to that with the use of nonprismatic loupes, the neck muscle activity significantly decreased on both sides when using prismatic loupes, with a 0–23% reduction in the group median of the 50th percentile muscle activity for the LT loupes and a 32–42% reduction for the HT loupes. This reduction was smaller than in a previous study (~40% reduction in the group mean of the 10th percentile), which used loupes with a 90-degree angulation for a simulated dental task (Regarding surgical performance, no significant difference in surgical errors was found between the nonprismatic loupes and the LT and HT prismatic loupes. However, it took the participants longer to complete the activities in two of the three simulated tasks with the HT loupes than with the nonprismatic loupes and LT loupes, though the practice session provided for all participants before the trials were short. Another finding was that the upper arms were slightly more static when the surgeons used the HT loupes than the others. In the previous study by Smith et al. (Reduced physical workload is related to reduced risks of developing MSDs (It is important to note that factors other than angulation in the prism should also be considered when choosing or designing prismatic loupes. The higher angulation can lead to significantly lower head forward inclination angles, but the user experience of such loupes might, on the other hand, be worse than those with slightly lower angulation. This is revealed by the results that LT loupes were preferred by most surgeons in this study, while HT loupes were less preferred. The comfort, e.g., “lightweight and fit,” visual quality, and the presence of glasses around the loupe for side vision during surgery were important factors contributing to the surgeons’ preference for LT prismatic loupes in addition to the resultant neck posture. For the future design of prismatic surgical loupes, finding the most suitable angulation for different types of surgeries is worth further studying. | PMC10803506 | |
Limitations | One limitation is that due to one drop-out and missing data caused by lost contact of electrodes, a perfect balance between groups of the original study design was not achieved, especially for the EMG data. Two of the four missing data sets for EMG regarded LES, and they were related to the two prismatic loupes. However, most measured variables were not impacted by the missing data, and the amount of missing data comprised only a small portion of the total amount of data. Previous studies ( | PMC10803506 | ||
Conclusion | peripheral vision, angulation, HT | BENDING | Compared to traditional loupes, this study shows that both evaluated prismatic loupes can significantly reduce neck muscle activity and forward head bending in surgical tasks, with no significant difference in surgical errors. Nevertheless, using the HT prismatic loupes prolonged the task completion times, but this was only after a short training period. LT loupes were preferred by a majority of the surgeons in this study. The significant results from this study are in favor of the usage of prismatic loupes in reducing the surgeon’s workload. Future studies are needed to investigate the extent to which prismatic loupes may decrease physical workloads and reduce musculoskeletal discomfort among surgeons in the operating room and over the long term. In addition, the design of prismatic surgical loupes should consider multiple factors, including not only the prism angulation but also factors such as magnification, peripheral vision, and comfort to suit surgeons’ needs for different types of surgeries. | PMC10803506 |
Data availability statement | The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. | PMC10803506 | ||
Ethics statement | The studies involving humans were approved by The Regional Ethics Review Board in Stockholm. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. | PMC10803506 | ||
Author contributions | XF: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Visualization, Writing – original draft, Writing – review & editing. LY: Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing. NY: Data curation, Writing – review & editing. IK: Data curation, Writing – review & editing. MK: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Writing – review & editing. MF: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Writing – review & editing.We thank AFA Insurance for funding this project and all the surgeons for their time and active participation in this study. We also thank suppliers of the surgical loupes from whom we bought the loupes for their technical support in producing, installing, and adjusting loupes for the participants. | PMC10803506 | ||
Conflict of interest | The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. | PMC10803506 | ||
Publisher’s note | All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. | PMC10803506 | ||
Supplementary material | The Supplementary material for this article can be found online at: Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file. | PMC10803506 | ||
References | PMC10803506 | |||
Background | degenerative disease, TMJ-OA, pain | TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS | Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease and manifests itself with pain and limitation of movement in the jaws. Arthrocentesis alone or in combination with intraarticular injections is one of the most commonly used treatment methods in these patients. The aim of the study is to examine the effectiveness of arthrocentesis plus tenoxicam injection and to compare it with arthrocentesis alone in patients with TMJ-OA. | PMC9996841 |
Methods | pain | Thirty patients with TMJ-OA who were treated randomly with either arthrocentesis plus tenoxicam injection (TX group) or arthrocentesis alone (control group) were examined. Maximum mouth opening (MMO), visual analog scale (VAS) pain values, and joint sounds were the outcome variables, which were evaluated at pre-treatment and at 1, 4, 12, and 24 weeks after treatment. Statistical significance was set at | PMC9996841 | |
Results | Pain | The gender distribution and mean age were not significantly different between the two groups. Pain values ( | PMC9996841 | |
Conclusions | pain | Arthrocentesis plus tenoxicam injection showed no better outcomes in terms of MMO, pain, and joint sounds compared with arthrocentesis alone in patients with TMJ-OA. | PMC9996841 | |
Trial registration | MAY, OSTEOARTHRITIS | Injection of Tenoxicam Versus Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis, NCT05497570. Registered 11 May 2022.Retrospectively registered, | PMC9996841 | |
Keywords | PMC9996841 | |||
Background | degenerative disease, increases mouth, Osteoarthritis, pain | RHEUMATOID ARTHRITIS, DEGENERATION, OSTEOARTHRITIS, JOINT DISEASES, HAND OSTEOARTHRITIS | Osteoarthritis is the degeneration and gradual deterioration of the cartilage in a joint. It is a chronic, progressive, degenerative disease that causes loss of function, pain, and discomfort [Arthrocentesis alone or in combination with intraarticular injections is highly effective in the treatment of TMJ-OA. It reduces pain, increases mouth opening, and improves jaw movements [Tenoxicam is an NSAID that is used systemically or locally in joint diseases such as acute or chronic inflammatory rheumatoid arthritis and osteoarthritis [ | PMC9996841 |
Methods | PMC9996841 | |||
Study population | TMJ-OA, malignant disease | TEMPOROMANDIBULAR DISORDERS, SYSTEMIC DISEASE, NEUROLOGICAL DISEASE, TMJ, MAY, MALIGNANT DISEASE | This randomized, single- blinded, prospective study was conducted with patients who were seen at the maxillofacial surgery clinic of the Faculty of Dentistry of Adıyaman University between May 2019 and November 2021. The included patients were diagnosed with TMJ-OA through clinical and radiological examinations based on the Diagnostic Criteria for Temporomandibular Disorders (axis I group I b). The study protocol was approved by the Turkey Republic Adıyaman University Clinical Research Ethics Committee on 22/01/2019 (approval number 2019/1–2), and all patients signed an informed consent form. The study was conducted in full accordance with the Declaration of Helsinki.The study was planned with 38 patients, but 8 patients were excluded because they did not attend follow-up visits. The inclusion criteria were patients who were diagnosed with TMJ-OA clinically and radiologically, 18 years of age and older, and sufficient clinical data at baseline and follow-up. Patients were excluded from the study if they had uncontrolled systemic disease, neurological disease, previous TMJ surgery, malignant disease in the head and neck region, or did not come to follow-up visits. The appropriate sample size was computed with a significance level of 0.05 and power of 80% to detect a clinically meaningful difference of 4 mm in the interincisal opening. The power analysis indicated that 11 patients were needed in each group. | PMC9996841 |
Surgical procedure | incisors, pain | CREPITUS | The patients were randomly separated into two groups by simple randomization method by computer. No conservative treatment was applied before arthrocentesis. Only arthrocentesis was given to patients in the control group (n:14), while the TX group (n:16) received both arthrocentesis and a 2-ml injection of tenoxicam (Oksamen-L, Mustafa Nevzat İlaç Sanayi, Istanbul, Turkey) to the temporomandibular joint (Fig. Arthrocentesis procedurePreoperative measurements and arthrocentesis procedures were performed by the same surgeon (GYY). All patients were irrigated with approximately 100 ml of Ringer’s lactate. In the control group, no additional injections were given, but in the TX group, 2 ml(20 mg) of tenoxicam was injected intraarticularly following arthrocentesis. A drug containing paracetamol was prescribed to relieve post-procedure pain. A soft diet was recommended to the patients. Physical therapy, occlusal splint or other preventive treatments were not applied during the follow-up period. The form in which the data of the patients is processed is given in Fig. A patient form samplePatients were followed for 6 months. The outcome variables were pain scores on a visual analog scale (VAS), VAS joint sounds (crepitus sounds), and maximum mouth opening (MMO), which were measured at baseline, one week, one month, three months, and six months after the arthrocentesis. To measure the VAS value, a 10-cm-long numbered line was created. The patient chose a point on the line, the corresponding value was measured with a ruler, and a score was given. MMO was gauged between the incisal edges of the maxillar and mandibular central incisors. Outcome variables were evaluated postoperatively by the surgeon (AK), who was unaware of the treatment procedures for all patients. | PMC9996841 |
Statistical analysis | The data were examined with the software package IBM SPSS Statistics Version 22. The normal distribution of the data was examined with the Shapiro Wilk test. An independent t test was used for the discrepancy among groups for variables with normal distribution, and a Mann Whitley U test was used for the discrepancy among groups for variables that did not show a normal distribution. A chi-squared analysis was implemented to study the relationship between the groups for the nominal variables. In the intragroup comparison, Friedman's two-way ANOVA was used for at least two dependent variables that did not show a normal distribution in their analyses. Variables that differed were examined using pairwise comparison tests if significant differences emerged. Statistical significance was set at | PMC9996841 | ||
Results | PMC9996841 | |||
Study population | The study included 30 patients (24 women and 6 men) who were diagnosed with TMJ-OA. The ages of the participants ranged from 22 to 64 years with an average age of 41.96 ± 11.50 years. The patients were separated into two groups. Of the 14 patients in the control group, 12 were female and 2 were male, and the mean age was 43.35 ± 11.10 years. Of the 16 patients in the TX group, 12 were female and 4 were male, and their average age was 40.75 ± 12.06 years. The gender distribution (Comparison of age and sex between groupsn: sample size; P: significance | PMC9996841 | ||
Discussion | TMJ, Arthrocentesis, osteoarthritis, pain | OSTEOARTHRITIS, TMJ | Arthrocentesis is a symptom-focused treatment for internal derangement of the TMJ. It reduces pain, increases jaw movements and mouth opening, and eliminates inflammatory products and tissue disruptors [Tenoxicam is a potent analgesic and anti-inflammatory agent with a half-life of 60–80 h [Colbert et al. [A few studies have examined intra-articular administration of tenoxicam in patients with internal TMJ derangement [Another study compared intra-articular tenoxicam and sodium hyaluronate in the treatment of internal TMJ derangement and found that there was no statistical difference in recovery [In the present study, the TX group did not have better results than the control group. There was a significant improvement in the parameters of MMO, VAS pain values, and joint-noise values in both groups, but there was no significant difference between the groups. There was no significant difference in both groups in terms of MMO and pain in the first week after the procedure. In the 4th week, there was a significant improvement in MMO in only the control group, while significant improvement was found in both groups at the 12th and 24th weeks. In terms of pain, significant improvement was found in both groups at the 4, 12, and 24 weeks.This study has some limitations. Although the sample size was computed by power analysis, it was limited because only patients with osteoarthritis were included. Another limitation is that the patient follow-up period was 6 months. To our knowledge, this is the first study to evaluate the efficacy of tenoxicam in patients with TMJ-OA. | PMC9996841 |
Conclusions | pain | The results of this study indicate that arthrocentesis plus tenoxicam injection does not produce better results in terms of MMO, pain, and joint sounds in patients with TMJ-OA. Arthrocentesis alone and arthrocentesis plus tenoxicam injection showed similar effects and can be used safely in patients with TMJ-OA. | PMC9996841 | |
Acknowledgements | Not applicable. | PMC9996841 | ||
Authors’ contributions | ZB carried out the research and participated in drafting the manuscript. GYY made the arthrocentesis procedures and AK participated in collecting data. MK and GSK participated in the statistical analysis. All authors read and approved the final manuscript. | PMC9996841 | ||
Funding | No funding. | PMC9996841 | ||
Availability of data and materials | All data generated or analyzed during this study are included in this article. | PMC9996841 | ||
Declarations | PMC9996841 | |||
Ethics approval and consent to participate | The study protocol was certified by the Ethics Committee of Adıyaman University (Ethical Number 2019/1–2) All participants informed consent volunteered to participate in the study. | PMC9996841 | ||
Consent for publication | Written informed consent for publication of their clinical images was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal. | PMC9996841 | ||
Competing interests | The authors declare that they have no competing interests. | PMC9996841 | ||
References | PMC9996841 | |||
Background | Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs. | PMC10375749 | ||
Methods | sarcopenia | SARCOPENIA, RECRUITMENT | This was a pre-post mixed-methods study. Older adults aged ≥ 65 years attending community social clubs who provided written consent and were not actively participating in exercise classes took part in the feasibility study. Older adults, volunteers, and staff were interviewed to determine the acceptability of the intervention. The intervention was a once weekly volunteer-led online group seated strength exercises using resistance bands. The duration of the intervention was 6 months. The primary outcome measures were the feasibility of the intervention (determined by the number of volunteers recruited, trained, and retained, participant recruitment and intervention adherence) and its acceptability to key stakeholders. Secondary outcome measures included physical activity levels (Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire), modified Barthel Index, Health-related quality of life (EQ-5D-5L), frailty (PRISMA-7) and sarcopenia (SARC-F), at baseline and 6 months. | PMC10375749 |
Results | SECONDARY | Nineteen volunteers were recruited, 15 (78.9%) completed training and 9 (47.3%) were retained after 1 year (mean age 68 years). Thirty older adults (mean age 77 years, 27 female) participated, attending 54% (IQR 37–67) of exercise sessions. Participants had no significant changes in secondary outcome measures, with a trend towards improvement in physical activity levels (physical activity in minutes per week at baseline was 1770 min, and 1909 min at six months, | PMC10375749 | |
Conclusions | Trained volunteers can safely deliver online group exercise for community-dwelling older adults which was acceptable to older adults, volunteers, and club staff. | PMC10375749 | ||
Trials registration | NCT04672200. | PMC10375749 | ||
Keywords | PMC10375749 | |||
Introduction | Physical activity (PA) has multiple benefits for older adults, including reducing falls risk [There is increasing evidence on the role of trained volunteers in delivering interventions to promote increased PA among older adults. The Hospital Elder Life Programme [The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased PA. Digital technology has the potential of improving accessibility and promoting a wider engagement of older adults in physical activity interventions [The specific aims of the study were:To determine the feasibility of recruiting, training, and retaining volunteers to deliver online group exercises for older adults attending community social clubsTo explore the acceptability of the proposed intervention to older adults, volunteers, and club staffTo explore barriers and facilitators to the implementation of the intervention | PMC10375749 | ||
Methods | PMC10375749 | |||
Study design | This was a pre-post mixed methods study. Triangulation of quantitative and qualitative data was performed to explore the feasibility and acceptability of this intervention. Trials registration on ClinicalTrials.gov: NCT04672200 (17/12/2020). | PMC10375749 | ||
Volunteer recruitment and training | RECRUITMENT | A detailed description of volunteer recruitment and training has been published in our protocol paper [ | PMC10375749 | |
Participant recruitment | Older adults aged ≥ 65 years who attended community social clubs ( | PMC10375749 | ||
Intervention | The intervention consisted of a once weekly volunteer-led online group exercise, for a duration of 30 min per session. The seated exercises focused on strengthening upper and lower limbs with the use of resistance bands and enhancing whole body range of motion and flexibility. Volunteers were trained to progress the exercises by encouraging participants to increase repetitions, increase the resistance by using a band with higher resistance and gently improve range of motion. For an in-depth description of the intervention, including how public contributors supported the development of this study including the intervention, please refer to our protocol paper [ | PMC10375749 | ||
Primary outcome measures | The feasibility of implementing the intervention was determined by:The number of volunteers recruited, trained, and retainedThe number of older adults recruitedThe number of physical activity sessions delivered, and proportion completed by participants (adherence)The acceptability of the intervention, including barriers and facilitators, were determined through semi-structured interviews with older adults, their family members, volunteers, and club staff. Participants were selected by purposive sampling to ensure a wide range of views regarding the implementation of the intervention, including male and female participants, different clubs, and a representative age range. Interviews were conducted by SJM within the first 2 months and towards the end of the study (6 months) to ensure participants views were captured during the earlier stages of the intervention, and when the groups were well established. The interview schedules were underpinned by normalisation process theory (NPT) [ | PMC10375749 | ||
Secondary outcome measures | Frailty, Sarcopenia | SECONDARY, SARCOPENIA | The secondary outcome measures were:Physical activity levels measured using the Community Health Model Activities Programme for Seniors (CHAMPS) questionnaire [Activities of daily living measure using the modified Barthel Index [Health-related quality of life (EQ-5D-5L) [Sarcopenia measure using the Strength, Assistance with walking, Rising from chair, Climbing stars and Falls (SARC-F) questionnaire [Frailty measure using the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA-7) screening tool [The cost of training a volunteer. This was estimated through calculating resource expenses for each volunteer, including provision of training booklets and exercise equipment, and costing the trainers time to conduct training, fidelity checks, and volunteer support meetings.All outcome measures were recorded at baseline and repeated at 6 months. A descriptor for each of the outcome measures applied is available in our published protocol. Data collection was performed by a post-doctoral researcher (SJM) who is trained in administering these assessments. | PMC10375749 |
Adverse events | accidents, injuries | ADVERSE EVENTS, ADVERSE EVENT | Any injuries or symptoms developed directly as a result of the exercises were recorded as an adverse event. Volunteers were trained to document any adverse events. All adverse events were reported to the research team. The clubs also have established procedures for responding to incidents and accidents including access to emergency contacts of participants. | PMC10375749 |
Analysis | Baseline characteristics of participants were reported as mean (SD) or median (interquartile range (IQR)) for continuous variables and number (percentage) for categorical variables. Descriptive statistics were used to analyse the number of volunteers and participants recruited, the number of volunteers trained and retained, and participants’ adherence to the intervention. Secondary outcome measures recorded at baseline were compared at 6 months using t-tests or Wilcoxon signed rank tests depending on the normal distribution of data. Statistical significance was considered when Interviews were transcribed verbatim and analysed using reflexive thematic analysis [ | PMC10375749 | ||
Ethics | This study received ethical approval from the University of Southampton Faculty of Medicine Ethics Committee and Research Integrity and Governance committee (ID: 52 967.A1). The study steering committee had oversight of study processes and research personnel were trained in Good Clinical Practice. Data was anonymised and stored on a password protected University database and handled in line with the Data Protection Act 2018 to maintain confidentiality. | PMC10375749 | ||
Results | PMC10375749 | |||
Feasibility of the volunteer training programme | CORONAVIRUS | Nineteen volunteers were recruited, 15 completed training and 9 volunteers (47.3%) were retained at the end of the study. Four volunteers withdrew before training due to beliefs that they were unsuitable for the role, including lack of time to commit, and poor confidence in their skills to deliver exercise. Six volunteers withdrew after training because of: ill health (1), work commitments (1), concerns regarding the safety of online exercise (2), and reduced commitment to the volunteer role with the return of normal activities after the Coronavirus pandemic 2019 (COVID-19) lockdown (2).All volunteers completed 3 online group training sessions, 60–90 min, with 1 trainer (SJM), and additional online one-to-one training depending on competence and confidence (33% of volunteers). In total, each volunteer completed a median of 2.7 h (interquartile range [IQR] 2.7–3.3) of training. The trainer (SJM) was a qualified and experienced exercise practitioner. Volunteers were mainly female (78%), mean age 68 (± 6.3) years (age range 59 – 77 years), retired (67%), with previous volunteering experience (78%), but no experience delivering exercise (78%). The trainer (SJM) visited clubs to support volunteers, conducted fidelity checks, and organised 5 volunteer group support meetings. | PMC10375749 | |
Feasibility of delivering the exercise intervention | injury or ill | Seven community social clubs, comprising 62 members, were approached through online visits from the study team and encouragement from club staff. Thirty-four older adults were recruited, and 30 were retained at the end of the study. Reasons for withdrawal were unrelated injury or ill health (3), and one participant stopped attending the club. Participants were mainly female (90%) living at home without formal care (Table Overall, volunteers delivered 184 group weekly exercise sessions (127 online; 57 in-person) March 2021 to April 2022. There was considerable variability in the number of sessions delivered per volunteer (range 11–67; median 35.0 [IQR 20.0–37.0]) related to time of enrolment, availability of volunteer time, and number of clubs led per volunteer. Over a 6-month data collection period, comprising 1 volunteer-led session per week, participants’ attendance ranged from 4.17–100% (median 54.17% [IQR 37.5–77.1]). Twenty-six participants completed the intervention online (median 54.17% [IQR 42.71–66.67]), 1 participant transferred from online to in-person post lockdown, and 3 participants attended only in-person sessions (median 83.33% [IQR 60.42–85.42]). | PMC10375749 | |
Secondary outcome measures | Light PA increased 90 min per week (Secondary outcome dataMetabolic equivalent; | PMC10375749 | ||
Acceptability of the intervention | arthritis | ARTHRITIS | Seven volunteers (aged 57–83 years; 6 female), eight older adults participating in the exercise intervention (aged 68–82 years; 8 female), one family member (aged 67 years; female), and four staff members were interviewed. Results are presented under the main domains of NPT, including implementation contexts, mechanisms, and outcomes (Fig. Acceptability of the interventionThe main themes and subthemes influencing the acceptability of the intervention, including quotations‘I suppose the fact that it's seated, and other people feel a lot more comfortable with that, they feel they're not going to be asked to do press ups or jump up and down or anything… But the fact that it's seated, the fact that it is relatively easy and the fact that you can stop if you feel uncomfortable, I think helps’. (Volunteer)‘I think the exercises are for people who are older, like more 75 to 80 plus. I think it would be nice if we could have exercises for the newly retired 60 plus to 75, because they are fitter, and they are losing their mobility. So, it’s finding the middle ground. What we’re doing at the moment is very much helping the less abled, but we need something a bit more lively.’ (Staff)‘I used to go to a gym with a lot of young people, you feel a bit threatened when you go into that environment. Because you know that you are flabby and not as fit as some of them, and some people in the gyms that I've been to you think, “goodness me what are they gonna think of me?” So, if you've not exercised for a long time or not exercise regularly, you can feel a bit put off by the culture of “keep fit”.’ (Volunteer)‘I think if you’re not active you seize up a bit, the joints seize up. I mean, I’ve got a bit of arthritis in my knee, and I find it better when I’m exercising more. It gives out on me now and again, but if I keep exercising regularly it doesn’t seem to happen, and it’s not painful.’ (Participant)‘I think an external instructor would be better because they know, I mean after all, (name) is just somebody who volunteered out of the goodness of her heart, to do the best she can. She does it as well as she can, but that’s not the same as somebody who knows about the exercises.’ (Member)‘Someone coming in (instructor) might have expectations about us that we are not sure about’ (Member)‘I feel as if I’m an amateur delivering them (exercise). I feel as if I’m doing my best, I’m doing the exercises and people are following along, but I don’t feel 100% competent because I can’t remember all the exercises, and which muscles they’re exercising.’ (Volunteer)‘I think we feel they (volunteers) are just one of us; they’re not an outsider coming in and therefore we’re relaxed with them… we are already friends, we are not self-conscious when they are around’ (Member)‘I find my body is more flexible. Because I know when I reach up in my kitchen cupboards, I can do it easier now I’ve been doing the exercises.’ (Member)‘Seeing people online, now that we are doing Zoom, makes you feel, “hey that’s great there’s another person here!” We can talk.. see other people… I do think that seeing other people is a very important part of well-being.’ (Volunteer) | PMC10375749 |
Implementation contexts | PMC10375749 | |||
Adaptations to COVID-19 restrictions | infection | INFECTION | Government restrictions during the pandemic reduced participants’ social interactions and created a sense of isolation. Fear of infection altered daily activity choices and behaviours, such as reduced confidence to leave the house. Subsequently, many participants experienced reductions in their normal PA routine and the pandemic accelerated organisational change at the clubs, including expansion of club activities, and provision of online options and remote support to club members. The intervention created an opportunity to exercise during social isolation and replaced participants’ normal PA routines. | PMC10375749 |
The existing social structures of the organisation | ’ | The characteristics of the social clubs impacted the reach of the intervention. For instance, most participants were widowed women and there was a lack of male older adults, impacting diversity. The organisation’s ethos and objectives, to enhance members’ mental health and well-being was consistent with the underlying principles of the intervention, improving acceptability from key stakeholders, including club managers and staff. | PMC10375749 | |
Compatibility with existing work practices and negotiation of intervention fit | Incorporation of exercise challenged some of the participants’ normal sedentary routines and preferred activities, such as the expectation of attending the club to have ‘a chat with friends and listen to a talk’ (Volunteer). To prevent interference with other social activities a shorter exercise duration was introduced (30 min).The organisation’s budget restricted funds for a professional exercise instructor, therefore, the volunteer-led intervention was compatible with the organisation’s working practice, in which, ‘the aim is for the Clubs to be run by volunteers, with staff support.’ (Staff). Subsequently, volunteer-led exercise was implemented on a regular basis compared to expensive one-off implementation of external instructor support. | PMC10375749 | ||
Implementation mechanisms | PMC10375749 | |||
Coherence | PMC10375749 | |||
The intervention suited changes in perceived capabilities with age, but for those more able the intervention was not challenging enough | OVER EXERTION | Reduced functional capacity with age altered perceived capabilities for PA and increased perceptions of harm, including participants’ worry regarding over exertion, discomfort, and injury. Older adults who felt vulnerable and unable to cope with exercise were embarrassed showing this vulnerability to others during activity. The chair exercise suited lower fitness levels and individuals who were unfamiliar or felt more vulnerable during PA. Participants described the exercise as comfortable and safe, ‘they’re quite good exercises because they’re not over taxing’ (Member). Fitter participants found the exercises too easy and would have preferred more challenging and energetic forms of exercise. Staff perceived the intervention as more appropriate for their oldest old members and thought their newly retired members would prefer more challenging and ‘lively’ exercise. | PMC10375749 | |
PA meaning influenced the perceived value of the intervention | ’ | Each participant had their own sense of meaning and value attached to PA, which influenced intervention coherence. PA meaning was influenced by a range of factors, including PA knowledge, familiarity and history of PA, the opportunities afforded by the environment, and wider social culture. For instance, some older adults had perceptions that they did not belong in a traditional ‘keep fit’ culture, where they often felt ‘threatened’ in a gym environment.Most participants recognised the benefits of PA and were motivated to participate in the intervention to improve fitness, manage chronic health conditions, prevent deterioration with ageing, improve well-being, and enhance functional ability and activities of daily living. For instance, a participant described PA as important in maintaining her joint health and improving self-esteem. | PMC10375749 | |
Personal development and helping others motivated volunteering | Volunteers were enthusiastic to support member’s health and well-being and were motivated to volunteer to overcome feelings of loneliness, combat negative body image stereotypes and have a sense of purpose through contributing specific skills at the club. | PMC10375749 | ||
Cognitive participation | PMC10375749 | |||
Level of understanding in intervention processes influenced engagement | RECRUITMENT | Overall, a good rationale to the project was provided. Volunteer recruitment was influenced by the clarity of the volunteer role and the training received. Club visits from health professionals piqued participant interest and understanding. | PMC10375749 | |
Training resources impacted intervention functioning | Training content was valued by volunteers, ‘I think the training, the information, and the support we’ve been given has been really good.’ (Volunteer). Volunteers’ also felt the training enhanced their confidence and competence to deliver the exercise. The booklets and videos provided a resource to practice at home and most volunteers referred to the booklets to prompt them during the sessions. | PMC10375749 | ||
Tensions between provision of instructor expertise and fear of unrealistic expectations | Perceptions regarding professional exercise instructors influenced participants’ commitment and engagement with the volunteer-led intervention. Some participants preferred the expertise of a qualified instructor, especially those who wanted specialist support for health conditions. However, participants also expressed feeling self-conscious exercising with qualified instructors and perceived that they may have unrealistic exercise expectations through a lack of empathy for older people, particularly in the capabilities of older people to perform certain exercises or achieve certain goals. Comparatively, the exercise volunteers at the social clubs were a similar age and ability, which enhanced participant motivation and confidence (detailed in the | PMC10375749 | ||
Collective action | PMC10375749 | |||
Volunteers’ performance and competency delivering exercise | The volunteers demonstrated competency when delivering the exercise intervention including guiding participants’ exercise technique, learning pacing, effectively setting up devices for online demonstrations, and implementing safety considerations. Members seemed satisfied with the volunteer’s exercise delivery, ‘I think (name) did a really good job, she got the hang of it, and got us all doing them properly so, it was good. I don’t think we needed a professional.’ (Member).Nevertheless, they were not qualified instructors and there was a limit to their knowledge and to what they could deliver. One volunteer was concerned about her competence to meet vulnerable older adult’s needs and described how she felt like an ‘amateur’.The members regarded the volunteers as positive and relatable role models, due to their similar age and abilities. The volunteers had a strong rapport with the group, which helped to create a fun atmosphere in which the exercise was delivered in a relaxed and non-judgmental way. Learning from peers created a positive vicarious experience for participants, bolstering their confidence and engagement with the exercise routine. Volunteers brought their own skill sets and style to the exercise role. Two volunteers sharing the role facilitated delivery through reducing pressure on volunteers and bolstering confidence through peer support. | PMC10375749 | ||
Co-ordination and assistance provided by staff | RECRUITMENT | Staff were key in the smooth running of the intervention. They effectively organised the social clubs, including helping with volunteer recruitment, integrating new volunteers into the social groups, and facilitating club safety. Effective communication between staff and trainers was essential to provide a bridge between trainers and volunteers. | PMC10375749 | |
The supportive group atmosphere aided implementation | Exercising in a group helped reduce isolation and motivated engagement with the intervention. Social connections were important to participants, in which the group created a sense of belonging, moral support and a shared experience. | PMC10375749 | ||
The online modality presented new challenges to overcome | ’d | Older adults familiar with online technology were more likely to engage with the intervention compared to individuals with a fear and lack of knowledge. The clubs had lower numbers attending the online groups, which impacted the reach of the intervention. Nevertheless, the organisation loaned devices to improve member access and they provided learning and support (digital coaching) to resolve any technical issues, helping older adults to upskill, as illustrated by this staff member:‘Her face when she finally could see people… It did take us several days, a lot of hours on the phone, but when she suddenly popped up on that screen and she realised she’d done it, it was just amazing. So, it’s pushed people so far out of their comfort zone.’ (Staff).Inevitably there were technical difficulties experienced during online exercise, such as difficulties connecting, and poor sound, or picture quality. Staff assisted participants online, putting volunteers on ‘spotlight’ to improve visibility of demonstrations and setting up the online meetings. Family members also supported older adults with technology use. However, the volunteers felt that delivering the exercise online compromised interaction and coaching due to the inability to clearly see the group (e.g., small screens, poor set up of camera positioning). This created some safety concerns. To reduce injury risk and to follow the organisation’s insurance policy, the exercises were completed seated. However, strict safety guidance limited the effectiveness of exercise for individuals who required more challenging standing movements, particularly participants who wanted to improve balance. | PMC10375749 | |
Reflexive monitoring | PMC10375749 | |||
Ongoing communication and training support | To encourage and support volunteers, trainers provided regular communication in the form of phone calls, emails, and club visits, which made volunteers feel ‘valued’ and gave the opportunity for feedback and continued learning. Regular volunteer meetings allowed shared experiences with peer feedback and support. Moreover, fidelity checks conducted by the research team facilitated volunteer development:‘It was good to have like the one to one, sort of examination …somebody watching you to make sure that you knew what you were doing before you started.’ (Volunteer). | PMC10375749 | ||
Adaptations to the intervention in response to feedback | Listening and responding to feedback from regular communication with volunteers, participants, and staff was essential to improve the acceptability of the intervention. Feedback was appraised and resulted in several changes to the intervention. Additional warm up and cool down exercises were added, and resistance bands were introduced to improve strength and interest and to progress the exercises. | PMC10375749 | ||
Suggested future modifications | ’ | EVENT, RECRUITMENT | Participants suggested exercise variety could keep the intervention ‘fresh’ and enhance enjoyment. Some volunteers disliked the label ‘exercise volunteer’ due to negative fitness stereotypes and preferred an emphasis on ‘mobility’, which they thought would attract more volunteers to the role. Volunteer recruitment was essential for intervention functioning, which participants suggested could be improved by providing an exercise taster, inclusion of a monthly newsletter, and hosting a volunteer event to show appreciation and thanks. To enable embedding of the intervention and provision of support moving forward, staff wanted ongoing links with the University. | PMC10375749 |
Implementation outcomes | PMC10375749 | |||
Varied level of engagement and participation in the exercise | RECRUITMENT | Engagement in the intervention varied. While most members were keen to participate, some felt indifferent, or preferred not to exercise. Overall, the intervention became an integrated routine at the start of the club, and some members completed the exercise in their own time. Staff commented that inclusion of the intervention could help retain and attract new members and volunteers to the organisation:‘I think for recruitment, actually saying “if you’re interested in exercise training, we could provide that”. It’s a hook for members so it would probably be a hook for volunteers as well.’ (Staff). | PMC10375749 | |
Feelings of improved health and fitness | ’ mood | The exercises introduced new types of movement and participants described improved strength, posture, balance, mobility, and flexibility. Moreover, the social connections from the group exercise enhanced well-being and improved participants’ mood. | PMC10375749 | |
Helping others helped themselves | The exercise role provided volunteers with a sense of belonging which helped improve well-being. Volunteering enhanced personal growth and development, such as increasing leadership skills. The role gave volunteers a sense of purpose and self-esteem, as well as increasing their own PA levels. | PMC10375749 | ||
Discussion | It was feasible and safe to deliver a volunteer-led online exercise intervention in social clubs for community-dwelling older adults. The intervention was acceptable to staff, volunteers, and older adults. Volunteers were positive and relatable role models who developed a non-judgmental group atmosphere. The group environment, social connections, and sense of togetherness motivated participation. A key to success was the digital coaching and support to upskill older adults’ technological knowledge and improve access and confidence to engage with the intervention online. Volunteer retention rate was at 47.3% at the end of the study period which is in line with the usual retention rates for volunteer-based interventions [This study adds to a burgeoning evidence-base suggesting that with proper training, volunteers can take on more direct roles in supporting older adults’ PA [This feasibility study demonstrated encouraging trends in PA levels and subjective reports regarding enhanced health and fitness, but these preliminary findings need to be confirmed in a larger controlled trial. Importantly, the intervention provided opportunity for participants to exercise during the pandemic, a time when older adults experienced significant restrictions to activities of daily living with subsequent deconditioning and reductions in health-related quality of life [Most volunteers were aged over 60 years with similar ability levels to the groups they were leading, and some of them also experienced their own health problems. As such the volunteers became relatable role models in which they provided a positive vicarious experience for club members, increasing their confidence (i.e., self-efficacy to exercise) and encouraging them to join in the exercise sessions. Exercise self-efficacy refers to the participants’ beliefs in their capabilities to exercise, and can influence choice to participate, level of effort exerted, and perseverance in the face of difficulties [A key influence on the success of the intervention was participants’ digital literacy and their ability to access the online exercise. Older adults are more likely to experience barriers in the use of digital tools, such as poor prior experience with technology, and cybersecurity concerns [A motivating factor to learn how to use the online platform was to continue socialising, and the sense of belonging and trust established in the social groups. Hence, the group nature of the intervention was important. Similarly, a range of studies have pinpointed group exercise and social connection as a strong motivator to exercise in later life and a principal influence on exercise adherence [Robust collaborations with the host organisation, including valuable input from staff, volunteers and participants was a strength of this study. A mixed methods approach allowed rich in-depth qualitative exploration and understanding of implementation processes, while quantitative measures revealed the impact of the intervention on physical activity and health outcomes. A further strength was the use of NPT, which provided a set of conceptual tools to support understanding and evaluation of the adoption, implementation, and sustainment of the intervention, and considered the complexity of the beliefs, behaviours, artefacts, and practices that played out over time and between settings [ | PMC10375749 | ||
Limitations | The study was conducted during the COVID-19 pandemic and changes in social distancing rules resulted in a change of how the intervention was delivered towards the end of the trial period. Club members were very keen to return to face-to-face meeting following a prolonged period of social restrictions and therefore the intervention was moved from online to face to face for 2 clubs towards the end of the intervention. Meeting face-to-face may have introduced bias to the study as it may have enhanced its effects but as no changes were made to the exercises including the duration and frequency of the intervention, the effects are likely to me minimal. This study does not have a control group but as the main aim of the study was to determine the feasibility and acceptability of the intervention, key findings to be explored in this study could be achieved without having a controlled group. Another limitation of this study was the low adherence rates to the online exercise intervention at 54%. However, this appears to correlate with existing online physical activity intervention adherence rates which ranges from 43–90% [ | PMC10375749 | ||
Acknowledgements | The authors would like to thank the volunteers and Brendoncare staff members for their support with the study. | PMC10375749 | ||
Authors’ contributions | HCR, SA, and SL designed the study and SL led the development of the study protocol. SL led the delivery of the study. SJM delivered the volunteer training and conducted the data collection and analysis for this study. KI supported with the data analysis process. All authors contributed to the preparation of the manuscript. | PMC10375749 | ||
Funding | ARC | The National Institute for Health Research (NIHR) funded this research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. SL, SJM, KI and HCR received support from the NIHR Applied Research Collaboration (ARC) Wessex and the University of Southampton. HCR received support from the NIHR Southampton Biomedical Research Centre. SL is funded by the NIHR Advanced Fellowship scheme. SA is funded by Brendoncare and EC is funded by Southern Health NHS FT. | PMC10375749 | |
Availability of data and materials | The datasets used and/or analysed during the current study are available in the PURE repository of the University of Southampton and will be made available from the corresponding author on reasonable request. | PMC10375749 | ||
Declarations | PMC10375749 | |||
Ethics approval and consent to participate | This study received ethical approval from the University of Southampton Faculty of Medicine Ethics Committee and Research Integrity and Governance committee (ID: 52 967.A1) and the study was conducted in accordance with the relevant guidelines and regulations. Informed consent was obtained from all research participants. | PMC10375749 | ||
Consent for publication | Not applicable. | PMC10375749 | ||
Competing interests | The authors declare no competing interests. | PMC10375749 | ||
References | PMC10375749 | |||
Key Points | PMC10233424 | |||
Question | death | BRONCHOPULMONARY DYSPLASIA (BPD) | Does risk of bronchopulmonary dysplasia (BPD) or death modify the effect of hydrocortisone in extremely preterm infants? | PMC10233424 |
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