bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of the evidence of two interventions for self-care with stroke patients
Authors: Haslam Toni-Marie , Beaulieu Karen
Published: May 2014

Current healthcare demands the use of evidence-based practise (EBP) through national standards, such as National Service Frameworks (Department of Health, 2004) and as part of professional registration (Health Professions Council (HPC), 2004) when justifying treatment. This study, completed as undergraduate research, compared the evidence base for functional and remedial intervention in self-care rehabilitation for stroke patients in order to establish the most effective treatment.

A literature review searched electronic databases and identified 11 articles, which covered ten different interventions within the functional and remedial approaches. Literature was critiqued using Taylor's (2000) tool for EBP in occupational therapy. Themes were identified through critique, and evidence for both treatment approaches was compared and contrasted.

The results were inconclusive, forming tentative suggestions rather than conclusive evidence on which to base interventions. Functional intervention was favoured, as this had the strongest evidence-base. Evidence supported and rejected interventions in both approaches, highlighting the need to research specific interventions as part of EBP, rather than treatment approaches. Results also highlighted lack of rigour in current research.

There is a need to develop outcome measures that go beyond physical and cognitive improvement to establish occupational outcomes in addition to further research.
A study into the employment trends of individuals treated at a spinal cord injury centre
Authors: Hills Lynne , Cullen Emma
Published: May 2014

This study was undertaken to identify the employment status of individuals before and after spinal cord injury (SCI), the factors influencing return to work and the reasons why return to previous employment status were difficult, delayed or not achieved. The study identified when individuals were ready to address return to employment issues as well as the resources that may be required to support return to work.

Postal questionnaires were sent to 242 individuals, aged 16 years and above, who were admitted to the Stanmore spinal cord injury centre (SCIC) with acute, traumatic SCI between 1998 and 2003. Forty-two percent of respondents returned to paid employment however, only 26% actually remained in employment. Reasons for non-return to or cessation of employment were primarily related to respondents' health, access to transport and training. Twenty-five percent of respondents described themselves as long-term sick, particularly those with cervical injuries.

Physical intensity of work activities altered after injury. For those returning to paid employment, family and employer support was reported to be most commonly available and beneficial . Those respondents who had more structured support schemes had found them beneficial. Approximately half of respondents stated they were ready to address return to work during their admission.

Findings suggest that vocational advice and education should be available following a SCI, particularly for those with a cervical injury or those working in heavy or strenuous jobs before injury.
The conventional care of therapists as acute stroke specialists: A case study
Authors: Hubbard Isobel , Parsons Mark
Published: May 2014

There has been an increase in the number of stroke units in Australia owing to evidence proving their clinical effectiveness. This study aimed to explore the conventional care provided by an occupational therapist and physiotherapist employed in the acute stroke unit of an Australian hospital and then compare the findings to national stroke guidelines.

Mixed methodologies were used in a case study format. Results showed that conventional care was based primarily on an efficient initial investigative process which occurred in a work place under pressure. Other findings highlighted patient-centered care and hypothesis-driven clinical reasoning. The study revealed that, in general, the conventional care provided by the two therapists met the national stroke guidelines.

This case study has explored the use of combined methodologies for studying complex packages of care and has also provided a basis on which to propose a model of practice.
The efficacy of community-based rehabilitation programmes for adults with TBI
Authors: Evans Lizzie , Brewis Claire
Published: May 2014

Aims: The aim of this systematic review was to investigate the factors that infl uence the efficacy of community-based rehabilitation programmes in improving the quality of life and daily functioning of adults with severe traumatic brain injury.

Methods: A systematic review of the literature was conducted. In keeping with the principles of best evidence synthesis, the findings from the studies were analysed according to their methodological quality.

Findings: Eleven studies were included in the review; synthesis of these studies revealed that the outcomes of community rehabilitation programmes are mediated by a complex interaction between programme characteristics, participant characteristics and the methods used to assess outcomes. Variations in study methodology and quality further impact the extent to which treatment effectiveness can be demonstrated. There was evidence to support the use of telephone counselling nd interdisciplinary team rehabilitation. There was moderate strength evidence indicating the psychosocial benefits of engaging in group rehabilitation programme

Conclusions: Outcome measures designed specifically for use with traumatic brain injury clients in community settings need to be validated. The clinical and cost benefits of telephone counselling, peer support groups and interdisciplinary team rehabilitation programmes warrant further research.
Goal setting and outcome measurement in a wheelchair service: A client-centred approach
Authors: Pimentel Sue
Published: May 2014

Aims: There is increasing recognition of the need for a client-centred approach to health-care provision, which takes into account how people live with their health condition in all domains of life. This study aimed to explore assessment practices for clients requiring standard wheelchairs in one wheelchair service in the UK, and develop a framework for setting client-centred goals and measuring outcomes that uses this approach.

Methods: An action research approach was adopted within the normal parameters of the wheelchair service. A brief review of relevant literature was undertaken, and an assessment and prescription form incorporating client-centred goals was then developed and implemented. Outcomes were collected from clients using a telephone questionnaire. A focus group was used to elicit the views, beliefs and working practices of therapists.

Findings: The data gave an insight into the type of functional mobility goals that clients set. Goal setting was an unfamiliar concept for most clients, and therapists stated that they needed to guide them through the process. Formulating goals at the start of the assessment process helped both therapist and client focus on the outcomes the client wanted to achieve.

Conclusions: This project demonstrates how a conceptual change to services can be achieved. The process for setting client-centred goals and measuring outcomes was quick to implement and has orked effectively in practice; crucially by ensuring clients' own goals are achieved.
Health instruments itching for a Rasch
Authors: de Morton Natalie , Keating Jenny
Published: May 2014

The Rasch model is a probabilistic mathematical model that is based on item response theory. It was developed by Danish mathematician Georg Rasch (Rasch, 1960) in the field of education and its use has increased exponentially in health over the past decade. The Rasch model can be employed to develop new instruments or to assess and/or refine existing instruments. It offers a sophisticated method for investigating the dimensionality of items on an assessment instrument (i.e. the extent to which items capture information about a common underlying construct), whether the instrument total score provides interval or ordinal level measurement and the relative difficulty of each of the instrument items.
Pressure ulcers and deep tissue injury in wheelchair users: A bioengineering perspective
Authors: Agam L , Gefen A
Published: May 2014

Wheelchair users are highly susceptible to deep tissue injury. Interface pressures are unlikely to predict this, and an alternative assessment approach is needed that can easily monitor internal mechanical stresses and deformations.

This review aims to provide clinicians with a comprehensive perspective of the biomechanical aspects of pressure ulceration in wheelchair users.
The role of patient education in the rehabilitation of people with spinal cord injuries
Authors: Williams Sue
Published: May 2014

Individuals with newly acquired spinal cord injuries need to be educated to manage the consequences of their neurological impairment and disability. However, to enable individuals with long-term conditions to manage their own care, they need to be provided with more than simply information about their condition. Critical to independence and self-management are empowerment and self-efficacy. As part of the process of rehabilitation, patient education programmes need to incorporate teaching strategies that develop these key skills to facilitate a successful outcome of rehabilitation for the patient.

This article will explore these strategies, and the theories behind them, from a nursing perspective; highlighting how the rehabilitation professional can use these to improve patient outcomes.
Smart Homes: Intelligent buildings
Authors: I Swann Julie
Published: May 2014

Throughout the world advances in technology have enabled the development of products and systems to improve the quality of our lives. Many modern appliances are sensor-operated or remote-controlled, and many items originally designed for the general market have enhanced the lives of people who have problems coping with the complexities of life or physical management of their environment.

Telecare products and the advent of smart technology incorporated into smart homes enables some people who would otherwise have struggled in their own homes to continue to live in the community safely, with the support of good social care networks.

This article describes smart homes and outlines some of the constituent telecare products and monitoring systems that can be set according to the needs of the household. Case scenarios are provided that demonstrate how levels of independence can be enhanced, particularly for people with disabilities and cognitive impairment. The future of the smart home, and the therapist's role with clients who have or require this type of housing is discussed.
Prevention and management of aggression in mental health: An interdisciplinary discussion
Authors: Stubbs Brendon , Dickens Geoff
Published: May 2014

Aims

Health-care professionals working in mental health settings are at risk of encountering violent and aggressive behaviour from patients, which can have a detrimental effect on their physical, psychological, emotional and spiritual well-being. Prevention and management of aggression and violence is therefore a priority. However, unlike their nursing colleagues, allied health professionals are not routinely taught such strategies in their pre-registration training.

Methods

This article describes and critically explores violence prevention and management strategies under three headings: psychological, physical and pharmacological interventions. This is intended as a discussion article to introduce and update allied health-care professions in this area, assist them in identifying their own training needs, and allow them to have a greater role in multidisciplinary planning and discussion relating to aggression and violence in mental health settings.

Conclusions

Focused and consistent training during pre-registration programmes, particularly in psychological interventions to de-escalate potentially violent scenarios could benefi t allied health professionals who go on to work in mental health settings. Future research should address the effi cacy of all types of interventions aimed at reducing aggression.
Assessing student nurses' clinical skills: The ethical competence of mentors
Authors: Gopee Neil
Published: May 2014

Aims

Various issues related to assessment of student nurses’ clinical skills have been documented in the literature. The assessment of these skills is performed by designated qualifi ed health-care professionals, referred to here as mentors. Research suggests that during clinical placements, some mentors may be signing students’ practice competencies as pass without full evidence of their competence. If the student is not competent in those skills, they could unknowingly harm patients, which amounts to unethical practice on the part of the mentor.

Content

This article describes the reasons for exploring ethical practice in relation to assessments of clinical skills. It examines what ethical practice and ethical competence are, the importance of detecting student underachievement early, and the support available to mentors for resolving problems with assessment of clinical skills.

Discussion and Conclusions

It is suggested that education for ethical competence should be more emphatically incorporated in the educational preparation programmes for mentors and similar roles.
A study of perceived facilitators to physical activity in neurological conditions
Authors: Elsworth Charlotte , Dawes Helen , Sackley Catherine , Soundy Andrew , Howells Ken , Wade Derick , Hilton-Jones David , Freebody Jane , Izadi Hooshang
Published: May 2014

Aims

The study aimed to determine the opinions of individuals with neurological conditions on factors facilitating their physical activity participation.

Methods

Four condition-specific focus groups (muscular dystrophy, multiple sclerosis, motor neurone disease and Parkinson's disease) were run with a total of 24 people. Themes that emerged were used to create an eight-item self-completed questionnaire, which explored barriers to participation, preferred activities and support networks. A cross-sectional survey was then conducted using this questionnaire with individuals with a range of neurological conditions.

Findings

Three themes categories emerged from the focus groups: ‘opinions of physical activity’, ‘barriers to physical activity’, and ‘factors that would encourage increased physical activity involvement’. Of the 115 distributed questionnaires, 80 (70%) responses were received. Swimming, stretching and walking were the three most popular activities. The most common barriers were embarrassment, perceived lack of condition-specific knowledge of the fitness professionals about neurological disease and the impact of that on exercise advice. Facilitators were use of specific groupbased exercise sessions and the presence of specifically trained staff.

Conclusions

People with neurological conditions enjoy participating in physical activity but reported several barriers that prevent their participation in exercise. Respondents identified barriers and facilitators in functional, psychological and environmental domains. It is important that healthcare professionals and fitness professionals identify and remove these barriers to promote greater participation in exercise among people with neurological conditions.
Establishing a Health Qigong protocol for rehabilitation of patients with COPD
Authors: Ng Bobby HP , Tsang Hector WH
Published: May 2014

Aims

This two-phased pilot study intended to validate the potential therapeutic values and applicability of a Health Qigong protocol as an alternative home exercise programme for patients suffering from chronic obstructive pulmonary diseases (COPD), and test its safety before proceeding to a randomized controlled trial.

Methods

Eight experts in the area of pulmonary rehabilitation and traditional Chinese medicine were recruited to evaluate the Health Qigong protocol using a questionnaire specifically designed for the purpose. The safety of this protocol was then tested among eight participants with COPD in a field test. Safety indicators included physiological parameters, including pulse, blood pressure, oxygen saturation, as well as perceived symptoms.

Results

All experts recognized that there were potential benefits of the Health Qigong protocol, and made suggestions as to how the protocol could be revised for COPD patients. No serious adverse event was reported in the field test.

Conclusions

The Health Qigong protocol is safe when applied to patients with COPD and has potential to be used an adjunct intervention in rehabilitation of COPD. The results support progression to the randomized controlled trial.
An exploratory study of physiotherapy telephone assessment
Authors: Turner Diane
Published: May 2014

Aims

The popular adoption of self referral to physiotherapy across the United Kingdom has increased the use of the telephone as a means of accessing the service. This relies on the physiotherapist's ability to make an accurate diagnosis, leading to an appropriate management decision and thus facilitating the best possible outcome for the patient. This study examined the agreement between telephone and face-to-face management of musculoskeletal conditions and assessed the accuracy of diagnosis over the telephone.

Methods

55 patients with musculoskeletal conditions were assessed over the telephone and then face to face. Patients were assigned to either a physiotherapist with less than 2 years of experience (n=33) or to a physiotherapist with over 4 years of experience (n=22). The physiotherapist on the telephone and the physiotherapist in the department made independent diagnoses (clinical impression) and management decisions. Inter-examiner agreement between the telephone and face-to-face management decisions was measured (Kappa coefficient values), and the Fisher's Exact test was used to measure agreement between the provisional telephone diagnosis and the final department diagnosis.

Findings

Kappa values showed poor agreement for junior staff for the management decision (64% agreement; κ-value of 0.27) and fair to good agreement for experienced staff (91% agreement; κ-value of 0.70). Agreement on diagnosis was good and there was not a significant difference between the junior staff (85%) and experienced staff (91%) (Fisher's Exact test 0.30).

Conclusions

Findings indicate that diagnosis over the telephone appears to be comparable with face-to-face diagnosis. However, management of musculoskeletal conditions by telephone, particularly by less experienced members of staff, was found to compare less favourably with face-to-face management. Given the growth of telephone assessment in physiotherapy, it is suggested that further research is required to explore its ability to provide an effective and efficient service.
Developing high performing employment services for people with mental illness
Authors: Browne Deborah J , Stephenson Adel , Wright Jules , Waghorn Geoffrey
Published: May 2014

Aims

This analysis examined employment outcomes achieved by a supported employment service in Hawke's Bay, New Zealand. The evaluation aimed to identify opportunities and challenges for ongoing service development, and to demonstrate how other employment services can use these methods and benchmarks in service development.

Methods

Service performance over 4 years was examined on multiple levels, and compared with outcomes recently reported by published international controlled trials with high fidelity to evidence-based practice in supported employment.

Findings

As a segregated supported employment service, there were no formal arrangements to coordinate employment services with local mental health services. Despite this limitation, the service was high performing on a range of employment outcome variables.

Conclusions

With challenging economic times ahead, this analysis provides a timely framework for allied health professionals, supported employment and vocational rehabilitation service providers, to review their operations in comparison to established evidence-based practices and international performance benchmarks.
Sample size and power calculations made simple
Authors: McCrum-Gardner Evie
Published: May 2014

Background

Sample size estimation is an important concern for researchers as guidelines must be adhered to for ethics committees, grant applications and publications. Studies may be underpowered (too few participants) or overpowered (too many participants) so it is important to achieve the correct balance.

Content

The process of sample size calculations, including relevant definitions, is explained and clear examples for different study designs are provided for illustration. A range of software packages and websites are discussed and evaluated.

Conclusions

The information regarding sample sizes and statistical programs should be useful for researchers in order to perform sample size calculations for research projects.
A qualitative study of work participation in early rheumatoid arthritis
Authors: Codd Yvonne , Stapleton Tadhg , Veale Douglas J , FitzGerald Oliver , Bresnihan Barry
Published: May 2014

Aims

This article details a qualitative study aiming to explore the impact of rheumatoid arthritis (RA) on participation in paid work during the first two years after diagnosis.

Methods

In-depth semi-structured interviews using the Model of Human Occupation Worker Role Interview were used to explore the impact of a diagnosis of RA on the participant's lived experience, the meaning of work from the participant's point of view, and whether there was any change in perception or attitude towards work and work ability since diagnosis. Qualitative methods were felt to be appropriate to capture the lived experience of participation and engagement in work. Interviews were conducted on entry to the study and were repeated at six-month follow-up. Transcripts from the interviews were subjected to interpretative phenomenological analysis.

Findings

Ten individuals with RA in paid employment participated in the study. The mean age was 38 years. The mean duration from diagnosis was 14.2 months. Participants identified work-specific changes and external lifestyle alterations made early in the disease trajectory to support maintenance of the worker role. The personal meaning of work and the importance of the worker role in shaping self-identity emerged as an important factor in determining work participation. Qualitative factors influenced the type and extent of changes made to work and determined the impact of RA on work. These findings suggest that from early in the disease course RA influences the individual's normal lifestyle and work participation.

Conclusions

Qualitative assessment of work participation demonstrated that paid work was affected in the early phase of RA. Work intervention needs to shift to encompass such factors which influence maintenance of the worker role.
Will occupational science facilitate or divide the practice of occupational therapy?
Authors: Pollard Nick , Sakellariou Dikaios , Lawson-Porter Anne
Published: May 2014

Background

Prompted by a study day at last year's European Network of Occupational Therapists in Higher Education conference, this article explores the relationship between occupational therapy and occupational science in the context of the future development of the profession.

Content

The authors consider some of the challenges currently being expressed within occupational therapy, particularly the move to define the profession in terms of its ‘origins in social transformation’, and the difficulties arising from its position in relation to a biomedical hierarchy.

Conclusions

The authors conclude that occupational science may have much to offer but this underpinning knowledge base is not without additional challenges for a profession which is concerned with aspects of doing.
Pain intensity, self-efficacy and physical performance in patients with chronic low back pain
Authors: Adegoke BOA , Ezeukwu AO
Published: May 2014

Aim

This article describes a study investigating the relationship between pain intensity, self-efficacy and physical performance in patients with chronic low back pain (CLBP) receiving physiotherapy at selected hospitals in Nigeria.

Methods

One hundred and forty-two patients (86 female, 56 male) recruited from the out-patient units of the physiotherapy departments of the University of Nigeria Teaching Hospital and the National Orthopaedic Hospital, Enugu participated in the study. The pain intensity in the low back, self-efficacy and physical performance of patients with CLBP were assessed using the Box Numerical Scale, Chronic Pain Self-Efficacy Scale and Back Performance Scale respectively.

Results

The participants were aged 48.05 ± 12.66 years (range 21–65). There was no significant correlation (r=0.051; P=0.548) between pain intensity and physical performance, but significant negative correlations were obtained between self-efficacy domain scores and physical performance (r values range from -0.239 to -0.414; P values range from 0.000 to 0.004). Self-efficacy for physical function was the only self-efficacy subscale/domain that had no significant correlation (r=0.030; P=0.719) with pain intensity.

Conclusions

An increase in self-efficacy was significantly related to improvement in the physical performance of patients with CLBP, or vice versa. Only the self-efficacy domain of physical function was not significantly related with pain intensity. Recommendations were made for the incorporation of assessment of pain self-efficacy levels in the management of CLBP patients, as well as for the development of strategies to improve it clinically.
Additive effect of interferential therapy over pelvic floor exercises
Authors: Patil Shubhangi P , Nagrale Amit V , Ganvir Shyam D
Published: May 2014

Aim

Genuine stress urinary incontinence (GSI) is a common, disruptive and potentially disabling condition in which involuntary loss of urine occurs as a result of stress, and in the absence of involuntary detrusor contractions. The purpose of this trial was to investigate the additive effect of interferential therapy over pelvic floor exercises alone, in the management of genuine stress urinary incontinence.

Methods

One hundred and two women suffering from GSI were randomized into one of two 4-week physical therapy programmes. Fifty two women had interferential therapy (IFT) as well as doing set pelvic floor exercises (PFM), while 50 women did the pelvic floor exercises, without any undergoing other treatment. The relevant treatment/exercises were done three times a week for 4 weeks, totalling 12 treatment sessions. The outcomes of interest, including one hour pad test, frequency volume chart, quality of life questionnaire and a visual analogue score for incontinence were collected at baseline, 1-week, 2-weeks, 3-weeks and 4-weeks after initiation of therapy.

Results

The results revealed significant (p<0.05) improvement for all outcome measures in each group. Significantly (p<0.05) greater improvements were detected in the group which combined pelvic floor exercises with IFT.

Conclusions

The findings of the present study indicate a potential benefit to including IFT with pelvic floor exercises when treating GSI.
Physiotherapy and ergonomics for a work-related musculoskeletal disorder
Authors: Chetty Laran
Published: May 2014

Aims

The purpose of this case was to report on the physiotherapy and ergonomic roles for a workrelated musculoskeletal disorder.

Methods

A 29-year old male employee presented complaining of neck and right upper trapezius pain following prolonged periods at his workstation.

Findings

Following intervention, positive changes were noted in outcome measures such as pain, work status and activities of daily living.

Conclusion

Physiotherapy intervention combined with ergonomic consideration was beneficial in addressing the work-related musculoskeletal disorder.
Soleus stretch reflex in subjects with cerebrovascular accident
Authors: Agostinucci James , Lyons Haleigh
Published: May 2014

Aims

The conclusion that circumferential pressure decreases reflex activity in subjects with neuromuscular disorders including cerebrovascular accidents has recently come under scrutiny due to the methods used to analyze its effects. Thus far, studies used to determine circumferential pressure's efficacy on motor neuron reflex excitability have mainly used the H-reflex technique on resting muscle. The purpose of this study was to investigate the effect that circumferential pressure has on the soleus stretch reflex (SSR) when superimposed onto a voluntary ramp movement in patients with cerebrovascular accident (CVA).

Methods

Thirteen patients with CVA volunteered for this study. SSR's were investigated before, during and after the application of pressure to the calf. Twenty-five SSR's were recorded and averaged for each experimental phase. Peak to peak amplitudes were measured and then normalized for comparisons. Reflex latencies were also measured. Friedman Repeated Measures Analysis of Variance on Ranks were used to analyze the differences in SSR latency and amplitude from baseline values.

Findings

Patients with CVA showed a decrease of 35% (P<0.006) in SSR mean amplitude. Postpressure values and latencies were not significantly different from baseline values.

Conclusions

The results show circumferential pressure has an inhibitory effect on spinal cord muscular reflexes for patients with CVA and may be used as a supplement to other treatments in temporarily reducing spinal cord reflex related muscle activity associated with a neurological dysfunction
Participatory research. Part 2: practical considerations
Authors: Northway Ruth
Published: May 2014

Background

Participatory research can make heavy demands upon both the researcher and the community with whom they work. Nonetheless it can also be a very rewarding process for all involved, and lead to real changes. It is thus important that a number of issues are considered and addressed, both before the research commences, and during the life of the research project.

Content

This paper explores five key areas – participatory, ethical, financial, time and personal considerations. In each instance, the personal experience of the author, as well as wider literature is used to explore the practical issues which need to be identified and managed.

Conclusions

While not all research will be participatory, consideration of these issues should assist readers in developing participatory research studies, and can inform other types of research.
Highly satisfied or eager to please? Assessing satisfaction among allied health outpatients
Authors: Harding Katherine E , Taylor Nicholas F
Published: May 2014

Aims

This article details a study into measuring patient satisfaction among patients attending acute outpatient physiotherapy and occupational therapy services at a large metropolitan health service.

Methods

Patients were invited to complete an anonymous written survey incorporating the MedRisk Instrument for Patient Satisfaction with Physical Therapy Care (MRPS), and two open questions regarding positive and negative aspects of their experience.

Findings

One-hundred and sixty-five responses were received. Respondents reported themselves to be very satisfied with the service they received with an overall satisfaction rating of 4.8 out of 5 on the MRPS. Almost half of patient comments on positive aspects of care concerned factors relating to personal interactions. Issues related to waiting areas featured most highly in suggestions for improvement.

Conclusions

Although the high rates of satisfaction were encouraging, they are consistent with previous findings that research of this type tends to result in high rates of reported satisfaction, and is subject to various forms of bias. The responses to the open questions were, perhaps, more informative, reinforcing previous findings that interpersonal interactions and short waiting times are important to satisfaction, and that improving waiting areas and communicating delays may be simple measures that could improve the patient experience.
The influence of two rehabilitation protocols in upper-limb function of stroke patients
Authors: Rosa Marlene , Vasconcelos Olga , Marques Alda
Published: May 2014

Aims

A significant decrease in upper-limb functionality occurs after stroke. There are two different approaches to the upper-limb rehabilitation of stroke patients: unilateral and bilateral protocols. The main aim of this study was to assess the differences in the functionality of the hemiparetic upper-limb between individuals with chronic hemiparesis submitted to a unilateral protocol and those submitted to a bilateral protocol.

Methods

Eight individuals with stroke and chronic hemiparesis were recruited and randomly assigned to one of two groups (four participants in each group). All participants were observed over a period of six weeks, and were evaluated at four different moments of the intervention protocol using the Fulg-Meyer Assessment Scale (FM) (Fulg-Meyer et al, 1975) and the Purdue Pegboard (PP) (Tiffin, 1948). The statistical procedures included percentage evolution and descriptive analysis for each participant.

Findings

The findings suggest that the unilateral protocol provides better results, when compared with the bilateral protocol.

Conclusions

This study suggests that unilateral protocols are at least as effective as bilateral protocols for hemiparetic upper-limb rehabilitation.
Facilitating independence in personal activities of daily living after a severe traumatic brain injury
Authors: Kelly Fiona , Nikopoulos Christos K
Published: May 2014

Aims

This study examined the effectiveness of two components of a treatment programme typically used by occupational therapists (OTs) in personal activities of daily living (PADL) rehabilitation.

Methods

A multiple baseline probe design across PADL tasks was used, one which is particularly suited to the examination of the effects of complex interventions on skill performance. The subjects were two male adults with severe brain injuries and cognitive impairments who were in the acute stages of recovery. The OT treatment program consisted of a combination of errorless learning and strategy training approaches. The impact of the program was measured by the number of steps completed independently in each of these tasks, the level and type of assistance required, and by administering the UK Functional Independence Measure and the Assessment of Motor and Process Skills.

Findings

Errorless learning and strategy training, as used within an OT programme, was demonstrated to be effective in reducing the amount of assistance both participants required to complete the targeted PADL tasks. Further, there was evidence of generalization of training effects among trained and untrained activities.

Conclusions

Selecting and combining treatment techniques based on detailed assessment of functional performance is an area of high clinical importance but with limited research; the current study stands as an attempt towards that direction.
Patient/carer perceptions of disability in motor neurone disease and carer coping
Authors: Ng Louisa , Kee Kirk , Amatya Bhasker , Khan Fary
Published: May 2014

Aims: To compare patient- and carer-reported disability in motor neurone disease (MND) using the International Classification of Functioning, Disability and Health (ICF); and to describe carer burden, psychological coping, and quality of life.

Methods: A prospective cross-sectional survey of MND patients (n=44) and carers (n=37). Their MND-related problems were linked with ICF categories (second level) using open-ended questionnaires and ‘linkage rules’. Standardized assessments measured carer psychological coping (depression/anxiety/ stress), strain/burden, quality of life (QoL), and coping strategies.

Findings: MND patients were older than their carers (mean age 61, carers 57) there were more male patients than carers (66%, carers 27%). Most carers were spouses/partners (89%). MND patients identified 70 ICF categories whereas carers identified 8: body function 15 (carers 0); body structure 5 (carers 0); activities and participation 40 (carers 6); environmental factors 10 (carers 2). Main ICF categories in activities and participation linked by patients and carers were general tasks and demands, mobility, self-care, community, social and civic life. Environmental factors included support and relationships, services, systems and policies. Carer psychological coping and burden were significant, but self-reported QoL for carers was good, possibly related to use of problem-focused coping strategies.

Conclusions: ICF adequately incorporates perspectives of MND patients and carers, which may enable development of a ‘core set’ (ICF categories selected by experts that list issues in impairment, disability, participation, and environmental factors that need to be addressed in multidisciplinary care settings) to optimize care. Reduction in carer burden will optimize outcomes for MND carers and patients.
Energy expenditure of dressing in patients with stroke
Authors: Singh Anupa , Stewart Aimee , Franzsen Denise
Published: May 2014

Aims: The primary aim of this study was to compare the energy expended and time taken in dressing the upper and lower body of 23 subjects who had survived a stroke within the previous 18 months, with a control group of subjects at risk from stroke. Secondary aims were to establish a relationship between energy costs and motor impairment, and the relationship between the energy expenditure and the subjects’ perceived level of exertion.

Methods: Measurement of the energy expenditure and time taken to dress was done by means of a triaxial accelerometer. The accelerometer was used to convert total caloric expenditure (in kilocalories) to metabolic equivalents (METs) allowing comparability of the energy costs in the physical activity undertaken. The degree of motor impairment present in the limbs was also documented. Parametric data were analyzed using t-tests to establish if a difference between the two groups existed for age, height, gender, and energy expenditure. A linear regression was performed to determine a relationship between variables such as energy expenditure, time, and weight. An ANOVA was used to establish variances between the groups.

Findings: Results indicated that significantly more energy was expended in dressing the upper body in the experimental group (P<0.05). No significant differences were found in the energy expenditure in dressing the lower limbs. Subjects with stroke took four times longer to dress than controls. Despite having active movement, stroke survivors were not able to translate this into the functional task of dressing. There was a linear relationship between the energy expenditure and perception of difficulty indicating a significant relationship between these variables.

Conclusions: Recommendations include an increased awareness of therapists to understand the elevated energy expenditure in routine activities of daily living (ADL) tasks such as dressing in patients with a neurological disorder in order to re-engage them into ADL.
Can playing pre-recorded music at mealtimes reduce the symptoms of agitation for people with dementia?
Authors: Johnson Rachel , Taylor Clare
Published: May 2014

This article aims to explore the evidence that playing pre-recorded relaxing music at mealtimes can reduce the symptoms of agitation in people with dementia. Seven studies were identified which exclusively studied this concept in institutional settings. 4 summary of the studies, alongside a review of the theory base, suggests that use of appropriate relaxing music can help to decrease aggressive behaviours in some clients. However, it must be remembered that preference for music is personal and must be assessed on an individual level.
Platelet-rich plasma therapy as a first-line treatment for severe Achilles tendon tear: a case report
Authors: Sampson Steven , Aufiero Danielle , Meng Michael , Bledin Anthony , Gillette Terry , Zall Mona
Published: May 2014

Steven Sampson, Danielle Aufiero, Michael Meng, Anthony Bledin, Terry Gillette, Mona Zall

Background: This case report evaluates non-surgical ultrasound-guided injection of platelet-rich plasma (PRP) in a sports medicine setting, as a first-line treatment to repair a severely torn Achilles tendon of a 71-year-old male. Diagnosis was made through clinical examination and imaging, and follow-up data was collected at 6 and 24 weeks post-injection.

Content: At 6 weeks post-injection, autologous PRP resulted in a substantial reduction of the Achilles torn fibres, with only minor focal tear evident on musculoskeletal ultrasound. At 24 weeks post-injection, the tear was completely resolved on MRI and the patient returned to full functional activity.

Conclusions: Currently there is limited data, with mixed results, regarding PRP treatment for Achilles tendinopathy, and limited reports of using PRP in humans within the first few weeks of injury. This case report demonstrates success of early PRP therapy to repair a severe Achilles tendon tear, from both radiological and functional perspectives. However, larger controlled trials using follow up MRI and sonographic imaging are needed to determine if early PRP treatment post tendon injury would be a safe and effective alternative to accelerate healing.
Indicators facilitating research-based practice in allied health profession departments
Authors: Thomas Lois , Roddam Hazel , Baker Paula , French Beverley , Burton Christopher
Published: May 2014

Lois Thomas, Hazel Roddam, Paula Baker, Beverley French, Christopher Burton

Background: The implementation of research in practice is influenced not only by individual clinicians, but the organisational context in which they operate. Strategies aimed at increasing research use therefore need to incorporate a wider range of factors, rather than solely focusing on achieving change in individual practitioners.

Content: This article presents findings relating to the identification of organisational factors facilitating research-based practice in allied health profession (AHP) departments. Fifty eight AHP clinicians and operational managers from nine teams participated in the study, representing four National Health Service organisations. Participants completed the benchmarking survey tool in their teams and were asked to provide examples of elements within their organisation which facilitated research-based practice in relation to 17 benchmarks of departmental context.

Conclusions: The AHPs in this study provided a rich variety of indicators facilitating research-based practice in their organisations. There was some evidence of strategies in place to facilitate this at an organisational level but little evidence of collaboration across professional boundaries.
Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): a multi-centre investigation of clinical utility
Authors: Rowland Tennille , Gustafsson Louise , Turpin Merrill , Henderson Robert , Read Stephen
Published: May 2014

Aims:

Assessment of upper limb ability is a common focus of the occupational therapist in acute stroke. Chedoke Arm and Hand Activity Inventory - 9 (CAHAI-9) is an activity based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to investigate the clinical utility of CAHAI-9 in an acute stroke setting.

Methods:

Thirty-two occupational therapist participants from eight hospitals completed 100 CAHAI-9 assessments, on 92 patients with stroke, over six months. Occupational therapists completed questionnaires regarding the clinical utility of CAHAI-9.

Findings:

The mean patient age was 69 years and mean CAHAI-9 score was 39/63. The mean administration time was 16 minutes. Eighty-three percent of therapists indicated they would use CAHAI-9 again. Eight-seven percent agreed CAHAI-9 was useful for patients with mild and moderate (91%) upper limb deficits however only 25% agreed for severe deficits.

Conclusions:

The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment in acute stroke, with therapists indicating they would use CAHAI-9 again. However, further investigation of the scoring issues may be warranted before CAHAI-9 is ready for clinical use in Australian acute care settings.
Early Stroke Discharge Team: a participatory evaluation
Authors: Moule Pam , Young Pat , Glogowska Margaret , Weare Jayne
Published: May 2014

Aims:

International evaluation of Early Stroke Discharge (ESD) has concentrated on measuring the impact of service provision. This research aimed to address the question, ‘How did the ESD team members and external stakeholders experience the service implementation process?’

Methods:

Between October 2009 and February 2010, six team members and four external stakeholders were interviewed as part of a participatory evaluation. Interviews were used to explore the experiences of the process of inception and implementation of the team. Transcripts were subjected to thematic analysis.

Findings:

Five themes related to the experiences of the introduction of the ESD team: Setting up the team; team working experience; team within the context of other services and professionals; effectiveness in achieving aims; learning for the future. Within the themes issues relating to funding, leadership, team management and working were highlighted.

Conclusions:

It is clear that at the inception of a new ESD service it is crucial to engage all stakeholders in the development of the service, and review the interface with existing care provision. Decisions regarding the management and leadership of the team and professionals within it are also required, and should be guided by an understanding of the patient care pathway. While specific to the UK, this article provides information that is relevant internationally.
Effects of glossopharyngeal breathing on voice in cervical spinal cord injuries
Authors: Johansson Kerstin M , Nygren-Bonnier Malin , Klefbeck Brita , Schalling Ellika
Published: May 2014

Aims: Glossopharyngeal Pistoning for Lung Insufflation (GI, also called glossopharyngeal breathing) is a method to increase vital capacity (VC) when respiratory muscle function is limited. The authors’ aims were to evaluate the effects of GI on voice and speech in people with cervical spinal cord injury (CSCI), and to document specific instantaneous effects of GI on voice and speech.

Methods: Seven individuals with CSCI performed ten GI-cycles four days weekly for eight weeks. Intervention outcomes included spirometry, registration of the subglottal air pressure (PS), audio recording of speech and self-ratings with the Swedish version of the Voice Handicap Index (Sw-VHI). VC, PS and sound pressure level (SPL) were also registered with GI.

Findings: Main changes pre/post intervention: Median SPL for syllable repetition increased 7.1 dB (P=0.046) and for loud reading 4.1 dB (P=0.018). Median phonatory instability decreased to 1.2% (P=0.046), median phrase length (words per breath) increased from 9.5 to 12.8 (P=0.004). Four participants pre and three post intervention scored >20 on Sw-VHI. With GI median VC increased 0.6 litres, median SPL for habitual voice increased 4.6 dB (P=0.030), for loud voice 7.2 dB (P=0.030) and median PS for loud voice increased 4.5 cm H2O (P=0.024).

Conclusions: The results indicate some positive effects of GI on voice/speech and thus may support the implementation of GI in clinical practice.