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      Development and validation of a new tool to measure the facilitators, barriers and preferences to exercise in people with osteoporosis


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          Despite the widely known benefits of exercise and physical activity, adherence rates to these activities are poor. Understanding exercise facilitators, barriers, and preferences may provide an opportunity to personalize exercise prescription and improve adherence. The purpose of this study was to develop the Personalized Exercise Questionnaire (PEQ) to identify these facilitators, barriers, and preferences to exercise in people with osteoporosis.


          This study comprises two phases, instrument design and judgmental evidence. A panel of 42 experts was used to validate the instrument through quantitative (content validity) and qualitative (cognitive interviewing) methods. Content Validity Index (CVI) is the most commonly used method to calculate content validity quantitatively. There are two kinds of CVI: Item-CVI (I-CVI) and Scale-level CVI (S-CVI).


          Preliminary versions of this tool showed high content validity of individual items (I-CVI range: 0.50 to 1.00) and moderate to high overall content validity of the PEQ (S-CVI/UA = 0.63; S-CVI/Ave = 0.91). Through qualitative methods, items were improved until saturation was achieved. The tool consists of 6 domains and 38 questions. The 6 domains are: 1) support network; 2) access; 3) goals; 4) preferences; 5) feedback and tracking; and 6) barriers. There are 35 categorical questions and 3 open-ended items.


          Using an iterative approach, the development and evaluation of the PEQ demonstrated high item-content validity for assessing the facilitators, barriers, and preferences to exercise in people with osteoporosis. Upon further validation it is expected that this measure might be used to develop more client-centered exercise programs, and potentially improve adherence.

          Electronic supplementary material

          The online version of this article (10.1186/s12891-017-1914-5) contains supplementary material, which is available to authorized users.

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          Most cited references22

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          Development and psychometric evaluation of the exercise benefits/barriers scale.

          Initial psychometric evaluation of an instrument to measure perceived benefits of exercise and perceived barriers to exercise was based on the responses of 650 adults and included item analysis, factor analysis, and reliability measures. Factor analysis yielded nine factors, five benefits and four barriers, which explained 64.9% of the variance in the 43-item instrument. Second order factor analysis resulted in a two-factor solution, one a benefits factor and the other a barriers factor. The standardized Cronbach's alpha reliability coefficients were: .952 for the total scale, .953 for the benefits scale, and .886 for the barriers scale. Use of the instrument in research involving perceptions of the benefits of exercise and the barriers to exercise appears warranted.
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            Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials.

            Exercise can reduce falls and fall-related fractures in healthy individuals; however, evidence for individuals with low BMD is limited. The results from this systematic review indicate that exercise interventions for individuals with low BMD to reduce falls and fractures should include balance, muscle strengthening, and weight-bearing exercises. The purpose of this systematic review was to investigate which exercise interventions are effective in individuals with low bone mineral density (BMD; osteopenia or osteoporosis) in reducing (1) falls and fractures and (2) risk factors for falls and fractures. Databases were searched for relevant studies between 1996 and June 2008. Methodological quality was assessed with the Jadad score and the PEDro scale. Of the 1,369 publications found, 23 met the inclusion criteria. Five additional articles were included after checking reference lists and searching author's names and related articles. Interventions with balance exercises reduced falls or fall-related fractures and improved balance in the majority of the studies. Muscle strengthening exercises were effective in improving lower extremity strength and back extensor strength; however, not all RCT's reported positive effects. Bone strength was improved by weight-bearing aerobic exercise with or without muscle strengthening exercise when the duration of the intervention was at least a year. Exercise can reduce falls, fall-related fractures, and several risk factors for falls in individuals with low BMD. Exercise interventions for patients with osteoporosis should include weight-bearing activities, balance exercise, and strengthening exercises to reduce fall and fracture risk.
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              Design a questionnaire.

              The design of questionnaires is a craft which has been badly neglected by the medical profession. A questionnaire should be appropriate, intelligible, unambiguous, unbiased, capable of coping with all possible responses, satisfactorily coded, piloted, and ethical. The key steps in designing a questionnaire are to: decide what data you need, select items for inclusion, design the individual questions, compose the wording, design the layout and presentation, think about coding, prepare the first draft and pretest, pilot, and evaluate the form, and perform the survey. Despite the apparently complicated nature of the task, theoretical knowledge is no substitute for practical experience.

                Author and article information

                (905)-865-7426 , rodrigib@mcmaster.ca , ibrodrig@uwaterloo.ca
                (905)-529-1317 , jd.adachi@sympatico.ca
                (905)-527-1317 , beattik@mcmaster.ca
                (519)-646-6100 , jmacderm@uwo.ca
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                19 December 2017
                19 December 2017
                : 18
                : 540
                [1 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, McMaster University School of Rehabilitation Science, ; 1400 Main Street Wm, IAHS 308, Hamilton, ON L8S 4K1 Canada
                [2 ]ISNI 0000 0000 8644 1405, GRID grid.46078.3d, Department of Kinesiology, , Waterloo University, ; 200 University Ave W, BMH 1100A/1102, Waterloo, ON N2L 3G1 Canada
                [3 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Department of Medicine, , McMaster University, ; 25 Charlton Ave. E Room 501, Hamilton, ON L8N 1Y2 Canada
                [4 ]ISNI 0000 0001 0742 7355, GRID grid.416721.7, St. Joseph’s Healthcare Hamilton, ; 25 Charlton Ave. E Room 501, Ontario, Hamilton L8N 1Y2 Canada
                [5 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Department of Medicine, , McMaster University, ; 25 Charlton Ave. E Room 501, Hamilton, ON L8N 1Y2 Canada
                [6 ]Hand and Upper Limb Center Clinical Research Lab, 930 Richmond, St. London, ON N6A 3J4 Canada
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 16 June 2017
                : 14 December 2017
                Funded by: FundRef http://dx.doi.org/10.13039/501100007202, CIHR Skin Research Training Centre;
                Award ID: FRN 122070
                Award Recipient :
                Research Article
                Custom metadata
                © The Author(s) 2017

                osteoporosis,facilitators,barriers,exercise,physical activity,questionnaire,checklist,survey,content validity,instrument development


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