Physical Environmental Factors Research Articles

Environmental impact on clinical and anthropometric indicators of patients with face injury in a state of acute traumatic stress

The environment affects the health of a patient with a maxillofacial injury if it provokes acute traumatic stress and is a stressor, which leads to physiological adaptive reactions. Physiological reactions initiate the patient over the influence on chronically stressful physical and social environmental factors, e.g., because of alcohol consumption. Physiological reaction to acute traumatic stress can accumulate and lead to excessive influence on neurons, endocrine and immune mediators, leading to persistent negative patient health with facial trauma, affecting the hypothalamus, pituitary, adrenal cortex, sympathetic nervous and immune systems with subsequent consequences for the human peripheral system. Negative health consequences for a patient with a maxillofacial injury include: the influence of height, weight, systolic and diastolic blood pressure, which is associated with cardiovascular disease, stroke, loss of physical and cognitive functioning. Acute traumatic stress negatively affects chronic diseases by affecting the metabolic system, including high total cholesterol, high lipoprotein density, overweight, and elevated glucose levels. These metabolic parameters are associated with an increased risk of patient mortality, increased cardiovascular risk, and worsening of functions cognitive, namely, a decrease in memory, mental capacity for work, perceiving of information, processing, and analysis of information, memorizing, and keeping, which is the result of environmental influences. The aim is to investigate the relationship between the environment of the metropolis and the clinical and anthropometric parameters of patients with facial trauma in a state of acute traumatic stress. The authors considered the hypothesis that the relationship was mediated by acute traumatic stress and the patient’s state of health.

Assessment of global habitat suitability and risk of ocean green tides

Green tides, which are widespread problems, are harmful issues that affect the protection of ocean ecosystems and natural resources. Scientific assessment and prevention of the green tides are essential for sustainable planning and the utilization of maritime traffic, tourism, and industry. However, the suitable or risk habitats and their dominant factors of green tides from global perspective are unknown. Here, this study proposed a novel framework to show the habitat suitability and risk of ocean green tides by considering marine environmental factors (i.e., sea surface temperature, sea surface salinity, solar irradiance, chlorophyll-a concentration, and sea surface wind). Through global remote sensing images and marine environmental factor data, this study found that (1) suitable and at-risk green tides areas are located in the north and south temperate zones; (2) marine physical factors are expected to weaken the green tide risk globally and enhance the green tide risk in coastal areas; (3) the green tides in the North Atlantic Ocean and the West Pacific Ocean are dominated by environmental factors and physical factors, respectively; and (4) when reducing carbon to promote sustainability, more potentially suitable green tide areas may appear at high latitudes. The results demonstrate the at-risk location and future trend of green tides, which are helpful for sustainable planning of ocean ecosystems.

Zooplankton community of Bakreswar reservoir: Assessment and visualization of distribution pattern using self-organizing maps

Self-organizing maps, otherwise known as Kohonen-maps, are one form of unsupervised artificial neural networks that can produce two-dimensional plots from multidimensional data. This tool is especially useful in community pattern analyses and has been previously used in spatial pattern analysis with different perspectives. The present study aims to find zooplankton's community pattern in the Bakreswar reservoir ecosystem. Bakreswar reservoir is a freshwater ecosystem in the Birbhum district of West Bengal, India. The reservoir is primarily used to supply freshwater to the Bakreswar thermal power plant. However, the local villages around the reservoir depend on it for drinking water and fishing sustenance. The data used in this study was collected over two years from three different stations. Thus, in addition to describing the spatial pattern of community distribution of zooplankton groups, the temporal variation was also studied. It is observed in the study that the four major groups of zooplankton – Copepoda, Cladocera, Ostracoda, and Rotifera – react differently to the different environmental attributes. Primarily directed by the physical environmental factors, the effect of the chemical factors on the patterning is also evident from the study. Copepods are the dominant group in the system, closely followed by cladocerans and rotifers. But this observation changes at different stations and throughout the study period. The temperature profiles of the reservoir primarily direct the occurrence of ostracods and rotifers, whereas cladocerans and copepods are inclined more towards a chemical factor directive. Rotifers are dominant in the monsoon, whereas the post-monsoon and winter seasons show an increased presence of copepods and cladocerans. The overall observation that the reservoir's water quality is good, and the trophic structure is healthy is in accordance with previous studies as well.

How do people feel while walking in the city? Using walking-triggered e-diaries to investigate the association of social interaction and environmental greenness during everyday life walking.

BackgroundLight to moderate physical activity, which includes walking, is associated with positive effects on physical and mental health. However, concerning mental health, social and physical environmental factors are likely to play an important role in this association. This study investigates person-place interactions between environmental characteristics (greenness, social interaction) and momentary affective states during walking episodes. A within-subject design is implemented, in which affective states and environmental characteristics are assessed while participants are walking outside.MethodsOn smartphones, coupled with a motion sensor (move3), e-diaries were triggered as soon as people walked 100 m outside. E-diaries assessed momentary affective states (valence, calmness, energetic arousal), and social interaction (walking alone; seeing other people while walking; interacting with other people; walking with a known person) between 6 am and 10 pm over nine days. The percentage of greenness was determined afterward from recorded GPS and GIS data. Demographics were collected in advance via an online questionnaire. Multilevel models were calculated with R for 46 individuals (age = 41.2, ± 13.2; 52% female).ResultsAffective state dimension energetic arousal showed a significant association with social interaction and greenness, i.e., participants rated energetic arousal lower when walking alone, and if there was less greenness vs. when interacting shortly with someone while walking (β = 0.13, p = 0.02), and being in situations with more greenness (β = 0.08, p = 0.02). Furthermore, associations with social interaction and greenness were found for dimension calmness: walking together with someone was associated with higher calmness (β = 0.16, p = 0.02), and the higher the proportion of surrounding greenness during a walk, the higher calmness was rated, i.e., participants were calmer (β = 0.09, p = 0.01). Significant associations with valence were not present.ConclusionThe findings indicate that the affective states varied significantly due to different social and physical environmental factors. In the future, the importance of environmental factors should be further investigated, e.g., by assessing environmental factors right in situations contrary to a subsequent imputation. Within-subject designs, and in particular triggered assessments with the addition of GPS, can aid in developing interventions for health-promoting urban environments.

Use of gradient boosting machine for exposome-wide analyses: application for pharmaceutical risk factors for amyotrophic lateral sclerosis

Background Accumulating evidence suggests that human health is affected by a complex set of exposures, including to environmental toxicants, dietary constituents, psychosocial stressors, and physical factors. Capturing the complexity of the whole exposome is pivotal for advancing etiological knowledge, yet standard statistical methods, as well as recent developments for mixtures analysis, are limited to considering only a modest number of exposures and interactions while often also making the implicit assumption that the exposures are continuous. Machine learning approaches could offer benefits in these very high-dimensional settings. Method Using gradient boosted decision trees coupled with Bayesian model optimization and a nested cross-validation design, we describe an approach for outcome prediction based on a mixture of exposures, and for identification of specific culprit factors within the mixture that consistently drive the association while allowing for synergistic or antagonistic interactions between the predictors. While this flexible approach is applicable to many settings, we used it to evaluate the association between patients’ history of medication use and risk of amyotrophic lateral sclerosis (ALS), as a steppingstone for integrating additional exposures and in a setting that largely avoids exposure measurement errors that further complicate many toxicant mixtures. Results Of nearly 800 binary predictors, we identified 7 medication classes that were consistently associated with ALS risk across independently trained models. Interactions between medication groups did not substantially affect the risk. Prediction accuracy was consistent, but low due to the lack of information on other etiological risk factors for ALS. Summary The described methodology allows to predict the overall effect of a mixture and to identify specific culprit factors in very high dimensional settings and when both continuous and categorical exposures are of interest. While causal interpretation of purely predictive models should generally be avoided, the repeated sampling of the dataset has interesting causal inference implications.

Physical Therapist Telehealth Delivery at 1Year Into COVID-19.

ObjectiveThe purpose of this study was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and to identify factors that influence physical therapists’ delivery of telehealth in an urban academic medical center.MethodsElectronic medical record data were extracted within the dates of interest (March 22, 2021 to May 15, 2021), the proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs >1 session). Qualitative data also were collected from physical therapists via semi-structured interviews, and a directed content analysis was conducted, informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model, to identify factors influencing telehealth delivery.ResultsTelehealth was used for 3793 of 8038 (47.2%) physical therapy sessions, and 1028 unique patients had at least 2 physical therapy sessions (without telehealth: 6.6% [n = 68], telehealth once: 39.1% [n = 402], telehealth more than once: 54.3% [n = 558]). Patients without telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients with telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Capabilities that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. Factors external to physical therapists—including the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives—also influenced telehealth delivery. Finally, patient needs and telehealth as a beneficial tool guided physical therapist intention to use telehealth.ConclusionSustained telehealth utilization outcomes 1 year into the COVID-19 pandemic and an interaction among physical therapist, patient, and environmental factors support the long-term potential of telehealth physical therapy in an urban academic medical center.

A qualitative study of food choice behaviors among college students with food allergies in the US

PurposeThis study explored how food allergies have affected food-related behaviors and quality of life of college students with food allergies and identified factors influencing food choice decisions among this group of individuals.Design/methodology/approachOne-on-one interviews were conducted with 26 college students with self-reported or clinically diagnosed food allergies, recruited from two universities located in the southern region of the United States. The participants were asked a series of questions based on a semi-structured discussion guide. Each interview lasted about 30 min; all interviews were audio-recorded and transcribed verbatim. The transcriptions were coded independently by three researchers, and themes were identified.FindingsFood allergies affected the participants' food-related behaviors, including eating, food preparation and shopping, as well as some aspects of their quality of life. Individual factors, such as mood, other diseases, cultural background and sensory properties, also influenced food choices. Friends and families were the two most important social influencers of food choices. Regarding physical environmental factors, cost, convenience, value and variety were considered important in selecting food. However, the participants' food choices were less influenced by food advertisements and social media. Additionally, experiences and complex cuisines were also key factors in making food choices.Research limitations/implicationsTheoretically, this qualitative study applied a food choice decision framework in the context of college students with food allergies. Practical recommendations are provided, particularly to campus dining facilities, to fulfill the needs of college students with food allergies.Originality/valueThis study advanced the understanding of the complexity of food choice decision-making among college students with food allergies. A path diagram specific to food choice among college students with food allergies was developed based on the results of this study. This study also highlighted that food allergy management would involve various behavioral changes and revealed that the food choices are influenced by a wide range of factors.

ENVIRONMENTAL IMPACT ANALYSIS FOR HEALING MENTAL HEALTH PATIENT

Background : Mental health is a condition in which individuals can develop physically, mentally, spiritually, and socially so that they are aware of their abilities, can cope with pressure, work productively and are able to contribute to their community. According to the Indonesian Ministry of Health (2016), there are around 35 million people affected by depression, 60 million people affected by bipolar, 21 million affected by schizophrenia, and 47.5 million affected by dementia, psychosocial, religious, cultural and environmental. Several factors that affect mental health are social life, such as the family environment, school/work, and the social environment in general. Patients with mental health disorders have a calm tendency to be in a safe and comfortable environment. The physical environment for mental health patients is a safe and comfortable environment prepared to provide social impact for people with mental health conditions in hospitals. Facilities that must be prepared to support the healing environment process include privacy, social support, and a positive impact on the environment. This writing employs a literature review method related to the topic Environmental Impact Analysis for healing mental health patients. There are 14 journals used in this writing. The purpose of this paper is to analyze the environment that has an impact on the process of treating and healing patients with mental health disorders. Method : This study uses a literature review method related to the topic Environmental Impact Analysis for healing mental health patients . Literature review has an important role in making a scientific paper or essay, because it can provide ideas and goals about the research topic to be carried out which is about how the environmental impact for healing mental health patients. Conclusion : The social environment can be a source of mental health disorders, if not managed properly, as well as physical environmental factors. A well-managed social and physical environment can support healing . Health facilities as role models should apply the concept of a social environment and physical environment that supports and impacts on patient healing.

Smart Biophilic Framework to Improve Productivity of Existing Office Buildings in Egypt

We spend most of our lives indoors. For the majority of us, the time is spent at work, often in buildings that were not designed to facilitate well-being or any natural elements. Yet we prefer to be around fresh air, greenery and natural elements. Architects have improved the places we live and work, but they have paid little attention to physiological needs. ''Smart Biophilic design'' could be a tool for a more relaxed workplace, where nature is brought into the environment either physically or digitally, to relieve stress and improve an individual's well-being by bringing the outside in. Consequently, this study proposes a framework for developing the existing office buildings in Egypt into smart biophilic ones. Such a development will serve the society by improving productivity of employees which will lead to more financial revenues to companies as well as an improvement to the economy of the country. The study used a quantitative method to develop the framework, by applying a questionnaire to arrange the smart biophilic systems/materials according to specific criteria, then analyzing the questionnaire results to reach an action plan of arranged smart biophilic systems/materials as inputs to formulate existing workplaces framework. The results demonstrated a positive correlation between the physical environmental factors and productivity. Hence, this study recommends smart biophilic developments to the existing office buildings in Egypt to maintain healthy, highly efficient, and cost-saving productive buildings.

35168 SkinTracker: A novel smartphone app enabling remote clinical research in dermatology

A highly visual practice, dermatology as a field has significant potential to use emerging technology such as mobile applications for research and patient-centered mapping of the disease process. The UCSF team is working to create SkinTracker, a mobile application for patients with skin disease to remotely participate in clinical trials and research studies. The initial iteration of the application focuses on atopic dermatitis. The application includes an enrollment and consent module, validated surveys including the Patient Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Numerical Rating Scale (NRS) for itch, link to a wearable device that collects biometric data, a voice diary, and a patient-directed photography module to facilitate physician evaluation of disease. Also included is the ability to report medication use, adverse events, and the ability to chat with the study team. The patient information is available to the research team on a secure online website, where researchers can assess patient photographs to perform Eczema Area and Severity Index (EASI) scoring, note important patient observations from the voice diary, and view quantitative data from both patient surveys and health measures like physical activity, sleep, and environmental factors. We believe this application and website will facilitate patient interest and participation in research, continue research despite in-person restrictions placed during the COVID-19 pandemic, and allow enrollment of more diverse patients for clinical studies who would otherwise be less likely to participate in research due to time or financial constraints.

Modifying International Classification of Functioning, Disability, and Health (ICF) to Guide Development of Environmental Interventions for Transfer Performance by Individuals with Disabilities and Their Caregivers

To improve ICF’s utility in guiding design decisions about physical environmental interventions forindividuals with activity limitations and their caregivers, a more robust approach is needed to classify, describe, and measure the task-relevant environmental characteristics that create demands on activity performance. The purpose of this paper is to demonstrate one possible approach, through examination of physical environmental influences that impact caregiver-assisted toilet transfer performance by older adults and their caregivers. By applying the Modified Dyadic ICF in our analysis of caregiver-assisted transfers, we make suggestions for conceptualization of physical environmental factors in the ICF. This work suggests that physical environmental influences in dyadic activity performance are highly dynamic, oftentimes reciprocal, and task-specific. The proposed approach appears to be a feasible method to reveal areas of suboptimal environmental interaction during activity performance, which can be remedied by future environmental design interventions. Future research is needed on additional activities to validate the generalizability of this approach.

Tinjauan Faktor-Faktor Penyebab Terjadinya Kerusakan Dokumen Rekam Medis Rawat Inap Di Rumah Sakit Putri Hijau Medan

Medical Record is a file containing records and documents regarding patient identity, examination, treatment, actions and other services for patients at health care facilities. The factors that affect archive damage can be divided into two, namely intrinsic factors which are the cause of damage originating from the archive object itself, for example the quality of paper and the influence of ink. extrinsic factors are the causes of damage that come from external factors of archive objects, such as physical, biological and chemical environmental factors. cross-sectional approach, that is, each research subject is only observed once and measurements are made on the status of the character or variable of the subject at the time of examination. Intrinsic factors which include paper, ink and adhesive with the amount of damage to medical record documents caused by ink with a total of 89 (29.5%). Extrinsic factors include physical, biological and chemical factors with 72 (23.9%) damage caused by fungi. The conclusion is that the biggest damage is caused by intrinsic factors, namely chemical damage as many as 89 (29.5%) medical record documents

Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo.

Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail.

Progress in research of chronic obstructive pulmonary disease and risk factors

Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable chronic airway disease characterized by persistent airflow restriction and associated respiratory symptoms. COPD is the main cause of morbidity and mortality of chronic diseases and one of the top three causes of death in the world. The prevalence of COPD among provinces in China are at a high levels for years. The prevalence of COPD varies from country to country, region to region, and population to population, and the incidence and development of COPD are influenced by multi risk factors, including individual genetic factors, age, sex, body mass index, abdominal obesity and physical activity and environment factors, such as smoking, indoor and outdoor air pollution, and occupational exposure.

FAKTOR YANG MEMPENGARUHI KEJADIAN ISPA PADA BALITA


 
 
 
 ABSTRACT 
 Acute Respiratory Infection (ARI) is a contributor to high morbidity and mortality rates in children under five every year in developing countries, including Indonesia. The cause of the incidence of ARI in toddlers is due to individual factors (age, immunization status, gender, birth weight, exclusive breastfeeding and nutritional status), physical environmental factors (type of walls, temperature, humidity and density of housing, fuel for cooking) and behavioral factors. family members who smoke in the house. The purpose of the study was to analyze the incidence of ARI in children under five at the Cinta Kasih Hospital (CK) Tzu Chi Cengkareng-West Jakarta. Descriptive quantitative research design with a cross sectional approach and using retrospective data from medical record data. The research sample was 100 children under five ARI with random sampling technique. The results of the study explained that the majority of children under five who experienced ARI had an age of <25 months as much as 55%, 52% poor nutritional status, 53% complete immunization, 47% mild ARI incidence in toddlers at Tsu Chi Hospital. Statistical analysis using the Kendall Tau-b statistical test, explained that there was a relationship between birth weight under five (p value = 0.004), nutritional status (p value = 0.000), exclusive breastfeeding (p value = 0.002) and immunization (p value = 0.024) with the incidence of ARI at Tsu Chi Hospital. The conclusion is that it is better for families, especially mothers, it is important to maintain their health during pregnancy to prevent babies from being born LBW, the correct feeding of infants and children is to give exclusive breastfeeding and then complementary foods (ASI) to make the nutritional status of toddlers good, compliance with immunizations
 
 
 

Incorporating local health education priorities in HealthLAB: Learnings from very remote Australia.

It is well-established that health education and promotion programs work best when they have been tailored to meet local contextual needs. In thisbrief report we describe a health education program and how it identified and incorporated local priorities into its delivery in two remote Aboriginal communities in the "Top End" of the Northern Territory. During the first visit to each community team members met with local stakeholders and ran an inaugural HealthLAB session. Fieldnotes were taken during or directly after each interaction. At the end of each day team members debriefed regarding their fieldnotes. After both trips had been completed, priority areas were extracted from fieldnotes and synthesised. Although some health priorities were congruent across all groups, Community Members and Childcare staff tended to identify practical solutions while School and Clinic staff were focused on the clinical outcome. Community Members were particularly focused on the wider social and systemic factors impacting health. In response to the need for practical support, HealthLAB modified their health education packages to upskill mothers and sports coaches to provide brief health education sessions to local children and young people. SO WHAT?: It is recognised that many health promotion programs focus on individual behaviours without creating supportive environments. While it was out of scope for HealthLAB to address physical environmental factors, by building local capacity and knowledge to deliver health education, the program can contribute to a healthier and supportive social environment.

Physical environmental impacts on atherosclerotic cardiovascular disease: A review

Background and Aims : Introduction: The prevalence of atherosclerotic cardiovascular disease (ACD) is alarming worldwide. In order to develop effective and timely strategies to minimize the impacts caused by ACD such as physical and psychological health of patients, financial burden due to healthcare expenses of patients and that to the society, it brings our attention on exploring the factors that prevent or lead to ACD for decades. Among all the factors, physical environmental factors is suggested to positively or negatively impacting prevalence of ACD.

Sistematic Review: Mathematics Model Epidemiology of Dengue Fever

Dengue Hemorrhagic Fever (DHF) is a disease caused by an arbovirus that enters the human body through the Aedes aegypti mosquito. Dengue Hemorrhagic Fever is characterized by symptoms, headache; reddish skin that looks like measles; and muscle and joint pain. The spread of dengue hemorrhagic fever (DHF) globally has tended to be higher in the last 50 years, thus giving rise to ideas for systematic prevention. Many factors cause this dengue fever, climate factors, weather, residential density, and other factors. The Epidemiological Model of DHF can provide a pattern of prevention against dengue outbreaks so that this problem can be modeled mathematically and through the stability of the equilibrium point, the dynamics or behavior of the model can be determined. The spread of DHF can be suppressed by providing control in the form of vaccines, eradication with insecticides and treatment. This review article aims to provide a systematic description of the causative factors, a mathematical model of DHF with an epidemiological approach. To get the right model related to the SIR epidemiological mathematical model and its modifications which can be an alternative solution to describe and analyze the model mathematically. The methodology used is to systematically search for journals and articles from August 2021 to April 2022. This is done by accessing electronic journal portals such as: Elsevier, Springer, ResearchGate, google scholar, Scient direct and so on. Other references also use national journals and information on the Ministry of Health's website. The results of a review of factors that cause dengue fever are physical environmental factors that have a significant influence on rainfall and air temperature. Mathematical models with Optimal Control can be used as an alternative to mathematical analysis which is expected to help solutions to reduce the spread of dengue fever. The recommendation given is to investigate the disease-causing factors from the chemical aspect related to the chemical effect in water that influences the growth of mosquito larvae in water which can indirectly affect DHF disease and involves these parameters in mathematical models and optimal control.

An efficient enhanced medicinal leaf image production using Adaptive Gamma Correction Weighting Distribution (AGCWD) algorithm with guided filter

The quality of an image is always degraded by the random variation called noise which is included in the contrast, intensity and other properties like brightness. Noise is added with an image during the digital image transmission. The image sensors are always affected by the normal physical environment factors like temperature, scanner dust particles and the parametric characteristics of the lens and the camera. Noise removal is important in the image transmission because any interference in the transmission channel can include noise into it. A medicinal plant leaf needs to be disease free for a harmless medicine production. It becomes a necessity for a method to produce a more contrast enhanced image with the efficient noise removal mechanism. The paper proposes a combinational approach of an Adaptive Gamma Correction Weighting Distribution (AGCWD) which mainly serves to enhance the contrast of the image and the Noise removal mechanism which is performed by a guided filter. The proposed method evaluated various performance metrics like Mean square error (MSE), Image enhancement factor (IEF), Peak Signal to noise Ratio (PSNR) And Mean Absolute Error (MAE). The evaluation of the proposed system gave more better performance results than while using the existent Bilateral filter.

Relationships Among Environmental Variables, Physical Capacity, Balance Self-Efficacy, and Real-World Walking Activity Post-Stroke

Background: Social and physical environmental factors affect real-world walking activity in individuals with stroke. However, environmental factors are often non-modifiable, presenting a challenge for clinicians working with individuals with stroke whose real-world walking is limited due to environmental barriers. Objective: The purpose of this work was to test a model hypothesizing the relationships among environmental factors (specifically, living situation and area deprivation), modifiable factors, and real-world walking activity to understand opportunities for intervention. We hypothesized that balance self-efficacy would mediate the relationship between the environment and real-world walking and that physical capacity would moderate this mediation. Methods: This was a cross-sectional study of 282 individuals with chronic (≥6 months) stroke. We tested the indirect effect to determine if mediation was present. Multiple group structural equation modeling was used to test if physical capacity moderated this mediation. A χ2 difference test was used to compare the moderation model against the null (no moderation) model. Results: Balance self-efficacy mediated the relationship between area deprivation and real-world walking (indirect effect: β = −0.04, P = .04). Both the moderation and null models fit the data equally well statistically (χ2(5) = 6.9, P = .23). We therefore accepted the simpler (null) model and concluded that the mediation was not moderated. Conclusions: Targeting balance self-efficacy may be an effective approach to improving real-world walking in persons with stroke who experience barriers within the physical environment. A stroke survivor’s physical capacity may not impact this approach. Future work should consider utilizing more specific measures of the social and physical environment to better understand their influences on real-world walking activity in individuals with stroke. However, the results of this work provide excellent targets for future longitudinal studies targeting real-world walking activity in stroke.