bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges and responses in providing palliative care for people living with HIV/AIDS
Authors: Huang Yu-Te
Published: May 2014

HIV/AIDS has become a chronic and manageable disease owing to the remarkable advancement in medication, and it is now suggested that a palliative approach should be integrated into the trajectory of the disease to alleviate patients' psychosocial distress and optimally improve their quality of life. This article synthesises a body of literature to highlight several clinical and systematic challenges that should be addressed in implementing a palliative approach to care for HIV/AIDS patients. They involve pain and symptom management, health-care providers' perceptions of HIV/AIDS, patients' beliefs about palliative care, variability in informal care resources, socioeconomic and demographic determinants of palliative care, and difficulties in evaluating the effectiveness of palliative care. To inform current practice in the palliative care domain, responses to the identified challenges are discussed. A disease stage-specific model is also presented to respond to the prolonged course of HIV/AIDS.
The perspectives of bereaved family members on their experiences of support in palliative care
Authors: Lundberg Tina , Olsson Mariann , Fürst Carl Johan
Published: May 2014

Aim: To explore family members’ supportive interactions in palliative care and the emotional experiences that they associate with these interactions. Methods: Qualitative individual interviews were performed with bereaved family members recruited from an urban palliative care service in Sweden. The interviews were analysed using inductive qualitative content analysis. Results: Five categories of supportive interactions with staff members were linked with emotional consequences: informational support, supportive encounters, professional focus of staff, a supportive environment, and bereavement support. Having a dialogue with family members nurtured certainty and security, supportive encounters gave a warm and comforting feeling, and bereavement support contributed to feelings of strength. Environmental factors contributed to dignity. Conclusion: Supportive interactions with staff and within a home-like environment help to build resilience if tailored to the family member's own needs.
Setting up a new evidence-based hospice-at-home service in England
Authors: Butler Claire , Holdsworth Laura
Published: May 2014

A hospice service in south east England determined to develop a new hospice-at-home service to enable greater patient choice and facilitate patients dying at home, which is often a patient's preferred place. As a first step, a literature review was commissioned to establish the evidence base to inform the design of the new service. A range of research had been reported on hospice-at-home services, but the service configurations evaluated in these studies and the context in which they operated had not been described in detail. This paper briefly summarises the results of the literature review and then describes the new service that was established, including the setting and context. Experiences with the service in terms of activity, acceptability, and problems are described. The aim is to assist providers and commissioners seeking to establish or develop similar services and to help them predict the likely impact of such services.
Exploring the advance care planning needs of moderately to severely ill people with COPD
Authors: Nguyen Marilyse , Chamber-Evans Jane , Joubert Alexandre , Drouin Isabelle , Ouellet Isabelle
Published: May 2014

Background: There is no clear consensus on how to approach advance care planning (ACP) with people with chronic obstructive pulmonary disease (COPD).

Aim: This study aimed to explore the perceived ACP needs of people with COPD and to investigate the usefulness of a DVD in meeting these needs.

Methods: A qualitative descriptive design was used. Twelve people with moderate to severe COPD were interviewed in an outpatient clinic.

Results: From the themes elicited, a mental model was created to demonstrate how the participants engaged in a process of mental work to accept their own mortality and subsequently engage in ACP.

Conclusions: Health professionals should not rely solely on illness severity to initiate ACP. Rather, patients from different illness categories should be approached, but with sensitivity to their emotional cues. Participants who were receptive to end-of-life issues enjoyed the DVD. The DVD is a good medium to facilitate discussion, but would be more effective if patients were screened for readiness prior to viewing.
Integrating palliative care in lung cancer: an early feasibility study
Authors: Johnston Bridget , Buchanan Deans , Papadopoulou Constantina , Sandeman Gillian , Lord Hannah
Published: May 2014

Aim:

The aim of this preliminary study was to evaluate the feasibility of conducting an effectiveness trial of early access to palliative care services for people with lung cancer through use of an integrated outpatient model.

Methods:

Newly diagnosed patients with lung cancer receiving palliative-intent treatment or best supportive care treatment were recruited over a 5-month period from one out-patient clinic in Scotland. Patients were offered a clinical review appointment with a palliative medicine consultant at two time points: baseline and 12 weeks later. Prior to each appointment patients completed three outcome measures addressing symptom severity, wellbeing, and health-care needs. One-to-one interviews were also conducted to explore patients’ experiences of being involved in the study.

Results:

Three patients participated in the study. The main reasons for low recruitment were patients’ deteriorating condition and unwillingness to undertake extra hospital visits. However, qualitative data indicated that the participants found this extra layer of supportive care useful in identifying and managing their needs, as well as enabling future planning.

Conclusion:

Further testing is needed to ascertain the feasibility of conducting a trial of integrating early access to palliative care services into routine practice for people with lung cancer.
Iranian nurses’ perceptions of palliative care for patients with cancer pain
Authors: Seyedfatemi Naimeh , Borimnejad Leili , Hamooleh Marjan Mardani , Tahmasebi Mamak
Published: May 2014

Aim:

The purpose of this study was to identify Iranian nurses’ perceptions of palliative care for patients with cancer pain.

Methods:

The study took a qualitative approach. Semi-structured interviews were held with 15 nurses with Bachelor's degrees working in three teaching hospitals in Iran. Transcripts of the interviews underwent content analysis, and categories were extracted from the material.

Findings:

The findings came under two main categories: management of physical pain and psychological empowerment. Management of physical pain had two subcategories: the importance of communication, and pain palliation using drugs. Psychological empowerment also had two subcategories: supportive behaviour and distress reduction.

Conclusion:

The sample felt that palliative care for patients with cancer pain must include psychological empowerment, support, and communication as well as physical pain relief.
An overview of hospice and palliative care nursing models and theories
Authors: Dobrina Raffaella , Tenze Maja , Palese Alvisa
Published: May 2014

Current literature reports that nurses are the members of the health-care team who have the most contact with patients facing a life-threatening illness. The multidisciplinary palliative care approach means that hospice and palliative care nurses require a consistent theoretical foundation in order to be confident of and able to explain their role. The aim of this paper is to describe existing palliative care and hospice nursing models and theories and to identify their core concepts. Literature published between 2002 and 2012 on such models was reviewed and subjected to content analysis. Ten core concepts were identified that fell into three categories: patient, nurse, and therapeutic relationship. The themes and values identified in the end-of-life nursing models and theories are congruent with palliative care best practices based on a patient-centred and an interdisciplinary teamwork approach. In developing a therapeutic relationship with patients, nurses have a ‘privileged’ experience that may lead to existential growth and job satisfaction.
Research roundup
Authors: Nicholson Craig
Published: May 2014

Brief synopses of a selection of recently published research articles of relevance to palliative care.
Reconstructing occupation after HIV infection: Lessons from women's experiences
Authors: Opacich Karin J
Published: May 2014

For the majority of human immunodeficiency virus (HIV) positive women in the United States, social and economic circumstances limit options for meaningful occupation and access to relevant healthrelated services. Quality of life is highly contingent upon the extent to which individuals can fulfil their life plans. This triangulated study explored relationships among HIV and acquired immunodeficiency syndrome (AIDS) status, engagement in meaningful occupations, services associated with AIDS-related health care and self-reported quality of life for HIV positive women. Survey data from the Multidimensional Quality of Life Questionnaire for People with HIV was collected, along with numeric health indicators and narrative from two semi-structured interviews addressing occupation and health.

In total, 15 women representing three cohorts along the illness trajectory of HIV and AIDS were recruited from an urban health-care facility designed to provide AIDS-related services. Most of the women in the study relayed a protracted process of learning to live with HIV and several of the women viewed HIV infection as an event that led to enhanced quality of life. The need for comprehensive health and support services was evident in every case, regardless of health status.
The hidden role of the occupational therapist in the management of continence
Authors: Supyk Jo-Anne , Vickerman Julie
Published: May 2014

This article describes a collaborative project, ‘PromoCon Education and Integration’, between PromoCon and the University of Salford. A national survey questioned occupational therapists on their opinions as to whether they had a role in continence care for people with disabilities. Is the promotion of continence part of an occupational therapist's role?

The results of the survey were analysed and findings highlighted a need for additional training in continence management, but were not explicit as to the types of training needed. A series of structured focus groups explored these findings further to identify that the majority of therapists relied heavily on self-teaching to develop specialist skills within continence management and there was definite support for the inclusion of continence care issues in occupational therapy undergraduate programmes. Therapists felt that delivering education at an undergraduate level would ensure that all newly qualified therapists have the knowledge they require to include assessment offunctional continence within their remit, thereby meeting the functional and psychosocial needs of individuals with continence problems.
Ageism and attitudes to ageing: implications for health-care students
Authors: Mandy Anne
Published: May 2014

As economic and political development continues, mortality rates in middle and later life fall because of better living conditions and better health care. Death rates are falling because people are fitter and because ill and disabled people are being kept alive for longer.
Best Research for Best Health: New patient-focused NHS strategy
Authors: Scullion Philip
Published: May 2014

Most therapists would subscribe to the view that research should lead to better health. Yet in 1995, it was claimed that ‘most medical research in Britain bore little relationship to the needs of the NHS’ (Smith, 1995).
Context of change in community mental health occupational therapy: Part two
Authors: Harrison Deborah
Published: May 2014

This is the second part of a report on a study that used focused ethnography to explore an occupational therapist's role in a community mental health team. Following collaborative data analysis, it was found that the context of change was an important influence on the occupational therapist. The practitioner was trying to develop her role as a mental health worker and an occupational therapist in a multiprofessional team. The team was working within a changing organization, with little opportunity to explore the impact of change.

It is recommended that further development of professional roles is a collaborative endeavour, involving all professions and the service users. Institutional ethnography is identified for future research, so that the relationships and influences throughout the entire mental health-care system can be explored. The effect of organizational change on the working lives of health-care professionals needs to be acknowledged and actively managed.
Clinical reasoning processes in physiotherapists' assessment of unilateral neglect: Part one
Authors: Plummer Prudence , Morris Meg E , Denisenko Sonia , Dunai Judith
Published: May 2014

Although unilateral neglect (ULN) is a complex neurological syndrome comprising several behavioural patterns, physiotherapists do not always differentiate between the different types of neglect when performing neurological assessments. This study explored the clinical decision-making processes used by physiotherapists when assessing ULN after stroke. In total, 14 neurological physiotherapists in Victoria, Australia, participated in the study. They observed a 27-min videotape of an experienced therapist assessing a stroke patient with left ULN. At predetermined intervals, the videotape was paused and participants recorded their thoughts pertaining to the patient at that time. At the completion of the videotape, physiotherapists were asked questions in relation to their clinical decisions. They were also instructed to classify the behaviour of the patient using a glossary of diagnoses.

This article provides background to the study and details the methods used. Results and discussion will be presented in part two, in the following issue.
Understanding how to use outcome measures
Authors: Bannigan Katrina
Published: May 2014

Therapists are becoming increasingly interested in using outcome measures to evaluate their practice (Henstock, 2004; Gorman, 2005). This is because ‘all health-care practitioners are under pressure to demonstrate the added value of the service they provide’ (Chartered Society of Physiotherapists, 2001).
Special seating considerations for the child with a spinal cord injury
Authors: Krey Christin H
Published: May 2014

Although wheelchair and seating set-up for the paediatric population is a specialty itself, the child who has sustained a spinal cord injury has several distinct orthopaedic needs that must be addressed; specifically, the issues of neuromuscular scoliosis and hip subluxation. These two factors, as well as the biomechanics and kinematics of wheelchair propulsion, will be discussed.

This article reviews current published research regarding orthopaedic needs in paediatric spinal cord injury, wheelchair pushrim biomechanics in adults with spinal cord injury and clinical experience. It concludes that preventative measures such as proper seating, positioning and wheelchair set-up should be taken early on to decrease the chance of, or at least slow the rate of development of a scoliotic curve, hip subluxation or an upper extremity over-use injury.
Assessment of the RPE as a measure of cardiovascular fitness in patients with low back pain
Authors: Finucane Laura , Fiddler Helen , Lindfield Helen
Published: May 2014

Improving cardiovascular fitness is recognized as an important aspect in the rehabilitation of patients with chronic low back pain. The improvement of cardiovascular fitness relies on an individual exercising at a certain intensity. The Rating of Perceived Exertion (RPE) has been widely accepted as a way to monitor exercise intensity.

This study aimed to determine the criterion validity and the test–retest reliability of the RPE in patients with chronic low back pain. In total, 30 subjects with chronic low back pain performed two identical submaximal graded cycle ergometer tests. Heart rate and oxygen consumption were recorded continuously using the Metamax oxygen analyser. Subjects reported RPE scores every minute.

Strong correlations were found between the RPE and heart rate and RPE and oxygen consumption. The reliability of the RPE was examined using the Bland and Altman 95% limits of agreement statistical test. There were wide limits of agreement, with subjects' scores varying as much as four points between tests. The findings demonstrated that the RPE is a valid measure to monitor exercise intensity in those patients with chronic low back pain. However, its repeatability is questionable.
Physiotherapists' and podiatrists' views on the effectiveness of treatments for plantar fasciitis
Authors: Brown Joan
Published: May 2014

Little is known about the effectiveness of numerous conservative treatments given for plantar fasciitis. Randomized controlled trials are needed, but researchers need guidance in choosing treatments most likely to be found effective.

This study aimed to develop such guidance by analysing physiotherapists' and podiatrists' views on the effectiveness of treatments commonly given by them for plantar fasciitis. A postal self-completed questionnaire survey of Kent, Surrey and Sussex NHS physiotherapists (n=104) and podiatrists (n=62) was undertaken to guide research in future randomized controlled trials. Treatments were rated for recommendation by using four tools: treatments used, treatments not used, total treatment effectiveness scores and total outcome opinion scores. The author concludes that taping is the only treatment recommended for randomized controlled trials.
The Naidex 2005 exhibition: A preview
Authors: Franklin Zoë
Published: May 2014

The seminar programme for the UK disability and rehabilitation exhibition, Naidex 2005, has now been announced. Naidex 2005, which returns to Birmingham's National Exhibition Centre on May 24–26, has a full and comprehensive list of high-profile speakers designed to provide an insight into a wide range of subjects. Delegates attending the seminars will be provided with an attendance certificate, which they can count towards their continuing professional development (CPD) training.
The College of Occupational Therapists' Annual Conference and Exhibition: A preview
Authors: Richards Sheelagh
Published: May 2014

The College of Occupational Therapists' (COT) 29th Annual Conference and Exhibition will be held at Eastbourne on 21–24 June. The conference provides an opportunity for occupational therapists to develop their skills, share ideas, challenge the opinions of colleagues and appraise their own thinking, while at the exhibition, major suppliers such as Stannah Stairlifts, Invacare and Arjo will be displaying their latest products for carers, people with a disability and health- and social-care professionals.
A pictorial scale of pain intensity (SPIN) for patients with communication impairments
Authors: Turner-Stokes Lynne , Jackson Diana , Horn Sandra , Kersten Paula
Published: May 2014

Patients with impaired communication often have difficulty describing symptoms such as pain, which hinders both clinical treatment and research. The objective of this study was to develop and characterize a step-by-step process for introducing a new pictorial scale of pain intensity (SPIN) to stroke patients with communication deficits undergoing rehabilitation.

To exemplify the process, this article describes a single patient with profound aphasia and right-sided hemiplegia, who was thought to have severe pain in his affected shoulder, probably associated with neuropathic pain.

A method of presenting the SPIN, based on a total communication approach, was established and serial pain ratings made by the patient were found to be consistent with independent clinical records. The SPIN appears to have potential as a method for quantifying pain severity in people with limited communication. Further evaluation is needed in a larger sample of patients.
Healthcare rationing: Goodwill to all?
Authors: Rugg Sue
Published: May 2014

Having survived the time of ‘mists and mellow fruitfulness’ (Knowles, 1997) we're now galloping rapidly towards the ‘goodwill to all’ time of the year. Actually, this year, there seem to be distinct shades of ‘no room at the inn’ about things. I know it's seasonal, but not having enough to go around is no joke. It seems that rationing, whatever you call it, is everywhere in healthcare these days.
An exploration of walking activity among older psychiatric inpatients
Authors: Stubbs Brendon , Cooper-Evans Mia-Samantha , Durran Marianne , Montenegro Jose Miguel
Published: May 2014

Physical activity can lead to a longer life expectancy and is associated with preserved independence and quality of life (QOL). The health consequences of being physically inactive for older adults include depression, decreased mobility and decreased QOL. Despite this, recent observational studies of older adults' activity levels have highlighted that older adults in care are remaining sedentary.

The aim of the study was to audit the walking activity levels of 53 older adult psychiatric in-patients before and after a health promotion activity which advocated the benefits of walking. Each patient wore a pedometer for three consecutive days. At baseline, only 21% (11/53) were walking the daily amount recommended for older adults. After the intervention this increased to 32%, (15/47) although a total of 33 (70%) patients increased the amount of daily walking (P = 0.002).

This study identified that most older adults in the sample did not walk enough to gain the health benefi ts associated with walking. However, there was an encouraging increase in the amount of walking older adults did following some health promotion activity, which warrants further investigation.
Cardiorespiratory physiotherapy in clinical placement: Students' perceptions
Authors: Bennett Rosalie , Hartberg Olaf
Published: May 2014

This study aimed to explore possible links between clinical experience in cardiorespiratory physiotherapy and the potential for career choice within that specialty. The perceptions of a purposive sample of physiotherapy students were explored using a self-administered questionnaire, which was constructed to produce in-depth data.

Analysis showed that students' perceptions of cardiorespiratory physiotherapy correlated significantly to the degree of experience gained. However, experience was gained both within and outside specialty-specific areas and students were using cardiorespiratory skills in a number of clinical areas and settings.

Students with the greatest level of experience within cardiorespiratory patient management were more likely to consider future employment within this specialty. Among the influencing factors was the attitude of clinical educators to the specialty. These findings may have implications for future practice and the recruitment of physiotherapists in to this specialty.
The Canadian Occupational Performance Measure: Use in an independent living centre
Authors: Chatfield Jean , Beckett Dawn
Published: May 2014

This audit explores the use of the Canadian Occupational Performance Measure (COPM) in an independent living centre (ILC) in the UK. Although the COPM is widely used in a variety of situations, the audit setting is currently the only ILC in the UK using this outcome measure. It is used in this setting to prove the effectiveness of occupational therapy in order to secure ongoing funding for the ILC.

The audit took place over two years and examined results obtained with the COPM during this period. The findings of the audit were then compared to the findings and analyses of a pilot study carried out by Law et al (1994), which tested the use of the COPM as an outcome measure.

The audits highlights the effective use of COPM within this setting, recognizing its challenges and limitations, particularly when used by students and junior staff. It is suggested that this measure can be adopted by other organizations for the purpose of securing funding as well as to prove the value of occupational therapy in similar settings.
Establishing an effective quantity of physiotherapy after stroke: A discussion
Authors: Purton Judy , Golledge Janet
Published: May 2014

Physiotherapy is a well-established part of stroke rehabilitation and the UK National Clinical Guidelines for Stroke recommend that patients should have as much therapy as is appropriate to their needs. However there is no conclusive evidence of a definitive amount of treatment that is effective.

This discussion paper seeks to explore four trends that appear to be emerging from current research on intensity of physiotherapy treatment, namely quantity of treatment, type of interventions used, influence of levels of impairment and lastly, responsiveness of different body parts for recovery.

The authors suggest that further research is needed to investigate some key issues. First of all, research should investigate whether the amount of traditional physiotherapy alone should be increased or if additional treatment should be focused on functional tasks and repetition, as advocated within neuroplasticity literature. Further investigation could also explore whether more intensive treatment is beneficial to all patients or only those with specific types of impairment and activity limitation. To reflect this concept, the possibility of establishing more careful matching of patients to treatments should be explored. Finally, it should be determined whether particular contributions to recovery, e.g. lower limb function, are more responsive to intensive treatment than others, e.g hand function.
Family therapy and neuro-rehabilitation: Forging a link
Authors: Bowen Ceri
Published: May 2014

Family therapy—otherwise known as systemic therapy—is based on a holistic understanding of the impact of illness or injury on the family. The overall aim of family therapy is to draw on family strengths and highlight examples of positive coping in the face of adversity.

Family therapy is often delivered in a high-tech ‘open’ clinic setting, in contrast to the majority of rehabilitation efforts which take place behind closed doors, either in acute medical settings, rehabilitation establishments or in the family home. In neuro-rehabilitation there are further difficulties relating to the actual injuries themselves; particularly the impact of reduced mobility, and poor memory and concentration. Together, this can make family therapy a challenging approach.

Yet in spite of its challenging nature, there is a growing exploration of links between rehabilitation and family therapy services, particularly in the UK. This new development is based on a belief that rehabilitation should involve a model for supporting families that is flexibly applied, with extra support for the injured party to allow their full participation. This paper outlines the issues and makes the claim for special interest groups to develop the initiative further.
Physical interventions for managing aggression in mental health: Should physiotherapists be involved?
Authors: Stubbs Brendon , Knight Caroline , Yorston Graeme
Published: May 2014

Dealing with challenging and aggressive patients has been an accepted routine part of psychiatric practice throughout its history. There has been growing concern about the level of violence on psychiatric wards in recent years. Physical intervention is a technique employed by staff to manage an aggressor, the use of which is highly emotive.

There is a paucity of evidence to support its effectiveness. Up to 29% of able bodied staff are injured when applying the techniques in training, which is a passive process. Physical intervention is employed throughout psychiatric services, including those where patients may have physical disability such as in older adults and traumatic brain injury. Clearly a blanket approach employing techniques for able-bodied individuals is not acceptable in such populations.

This article reviews the relevant literature on physical intervention in mental health, and discusses a new potential role of the physiotherapist in assessing aggressive individuals with physical impairments suitability for restraint techniques. This is based on practice at a leading independent psychiatric hospital in the United Kingdom.
Measuring occupational performance and client priorities in the community: The COPM
Authors: Roberts AEK , James A , Drew J , Moreton S , Thompson R , Dickson M
Published: May 2014

The primary aim of this study was to examine changes in clients' occupational performance and satisfaction with their performance within a community trust setting, using the Canadian Occupational Performance Measure (COPM). Given the rapid throughput of clients and the pressure of limited resources, the authors postulated that occupational therapy interventions were focusing on clients' self-care needs as a matter of priority for clients to be independent at home. Therefore, at a time when services are seeking to be increasingly client-focused, the authors' secondary aim was to explore whether self-care needs were also the clients' highest priorities.

Fourteen occupational therapists and 62 clients took part in the study. The therapists used the COPM to assess the client; the clients completed the COPM at initial interview and at the end of the intervention. Inferential statistics were then used to ascertain any change over the intervention period.

The findings showed a statistically significant change in clients' occupational performance and satisfaction with their performance, in all settings, following occupational therapy. There were notable differences in occupational performance goals between men and women, in that a higher percentage of self-care goals were identified by the men. Self-care goals were the most frequently cited goals in all of the settings.
Are explanatory randomized controlled trials feasible in rehabilitation?
Authors: Rassafiani Mehdi , Copley Jodie , Kuipers Kathy , Sahaf Robab
Published: May 2014

Randomized controlled trials (RCTs) investigate causal relationships and are considered to provide the best evidence of intervention efficacy in health care (Roland and Torgerson, 1998). To ensure valid and reliable results, a RCT should include specific criteria such as a clearly defined participant group and intervention, adequate sample size, randomization, allocation concealment, baseline reporting, prescriber/assessor and participant blinding, appropriate outcome measures, and consideration of the intention-to-treat principle (Morrow, 2008). While RCTs may be considered an appropriate methodology to answer some clinical questions in the field of rehabilitation, it is not typically possible to satisfy all RCT criteria in most rehabilitation settings. In particular, blinding, and defining both the intervention and the participant group are difficult criteria to implement in this field (Halm et al, 2002; Boutron et al, 2007).
An occupational therapy income-generation group for HIV-positive women in Uganda: Part 2
Authors: Kamba Moses , Rugg Sue
Published: May 2014

Little is known of the occupational therapy interventions available to occupational therapy clients living with the human immunodeficiency virus (HIV) in the developing world. Part 1 of this article outlined the background literature in this area. Part 2 details a small, interview-based study of ten HIV-positive Ugandan women taking part in such an intervention; an occupational therapy incomegeneration group. The study sought to identify reasons for falling attendance at the group.

The study findings reflect both the challenges of being HIV-positive, and the factors influencing women's participation in the group. The women attributed a range of social, emotional and practical benefits to group attendance, relating these to social support and empowerment, as well as opportunities to go beyond the home environment, learn new skills and earn money. The negative aspects of group attendance cited were all interpersonal in nature, relating to conflict with participants' peers and group leaders.

This study discusses these findings, and their implications for occupational therapy, concluding that the profession has much to offer clients and that this should be explored further.
Sternal instability during arm elevation observed as dynamic, multiplanar separation
Authors: El-Ansary Doa , Adams Roger , Waddington Gordon
Published: May 2014

Aims

The purpose of this study was to describe and measure the motion of the sternal edges in a single case with sternal instability, a complication that can follow a sternotomy for cardiac surgery.

Methods

Using proprietary ultrasonography system software, and with a modification whereby the ultrasound unit head was attached to a microphone stand in order to maintain optimal contact with the chest of the seated subject, imaging was performed in the transverse plane during a series of three repeated unilateral arm elevation movements.

Findings

Ultrasonography showed that the sternal separation was in both the transverse (10–17.5 mm) and sagittal (3.5–18.2 mm) planes during arm elevation.

Conclusions

Such multiplanar separation of the sternal edges in inoperable sternal instability may explain the degree of discomfort experienced by patients with sternal non-union. Future research on sternal closure methods and the effects of activity and exercise on the healing sternum could lead to new clinical guidelines, which might reduce this discomfort.
Investigating physiotherapy and occupational therapy students' outcome effectiveness
Authors: Rone-Adams Shari , Nof Leah , Hart Dennis L , Sandro Colleen R , Wang Ying-Chih
Published: May 2014

Aims

Research has looked at the differences between outcomes of patients treated by novice vs expert therapists, but to date research has not looked at differences in outcomes of patients treated by students and therapists. The purpose of this pilot study was to determine if there was a difference in functional status, treatment visits or treatment duration of patients treated by student therapists compared to patients treated by occupational therapists and physiotherapists.

Methods

This retrospective study used secondary analysis of the Focus on Therapeutic Outcomes (FOTO), Inc. database, which is used within one outpatient rehabilitation hospital in Ohio, USA. The database contains patient data on functional status measures, number of visits and treatment duration, and comparisons were made in these three areas between patients treated by therapists and therapy students.

Findings

Data suggested patients treated by therapists tended to have fewer visits (10.8 visits for students, 9.1 visits for therapists), shorter treatment duration (37.6 days for students, 27.2 days for therapists), and greater improvement of functional status compared to patients treated by students.

Conclusion

The trends in the data suggesting that students used more visits and treated with less improvement in functional status warrants further discussion and investigation. Findings contribute to the ongoing discussion about the need to be efficient and effective, which is consistent within the healthcare industry, while at the same time making sure that students have quality educational experiences.
Causes of delayed discharge following joint replacement surgery
Authors: Williams Geraint
Published: May 2014

Aims

After developing an increased awareness of the issues which delay timely discharge, the author conducted a retrospective case note analysis to establish causes and discuss potential solutions for delays at the elective primary arthroplasty unit at Wirral University Teaching Hospital NHS Trust.

Methods

A total of 189 patients who underwent total hip or total knee replacements during 2007 were identifi ed. Case notes were scrutinized for causes of failure to achieve target inpatient stay of 5 days or fewer.

Findings

Rehabilitation factors were the primary cause of delayed discharge in 66 of the 110 patients who failed to achieve target inpatient stay. Post-operative complications were the second most common reason for extended stay, resulting in 21 delays. Organizational, administrative and occupational therapy factors were the source of the remaining 23 delays.

Conclusions

The arthroplasty unit at Wirral University Teaching Hospital NHS Trust provides a comprehensive postoperative rehabilitation service. Factors which affect the speed of rehabilitation are comprehensive and the process by which it takes place cannot be addressed in isolation. Physiotherapy services are functioning at a premium, and further reductions in stay may only be possible by shifting the emphasis away from quality and redefining the functional rehabilitation requirements for safe discharge. Reducing inpatient times in this situation may not be desirable and could compromise the basic principles of what joint replacement aims to achieve.
Handy skills – partnership working in practice
Authors: Cannon Ben , Williams Sally , Woolcomb Rachel
Published: May 2014

Background

Disabled Adults' Resource Team (DART) was established in 1999 to meet the ongoing health and therapy needs of adults of working age who have an ongoing physical impairment. DART works to a person centred social model, on goal focused episodes of intervention taking into account each service user's individual circumstances. DART therapists work together in an interdisciplinary manner to enable service users to achieve their goals.

Content

This article details how partnership working between a service user with cerebral palsy and his therapists has enabled him to gain the use of his right arm. It identifies the range of treatment modalities that were used and explores how important it is for therapy to remain functionally relevant to the individual.

Conclusions

By interspersing the service user's own report of the experience of therapy with the therapists' perspective, a person centred approach is demonstrated.
Research – a tool to empower or disrupt? The effects of research on those involved
Authors: White Margaret , Smith Judy
Published: May 2014

Background

Research in clinical practice without attachment to a major academic institution can be fraught with difficulties. This article aims to explore some of the difficulties that can be encountered when carrying out research, using the example of a project aiming to use clinical practice to develop more relevant and realistic multidisciplinary outcome measures for the rehabilitation population. In this example, with patient and staff involvement, the reliability study successfully developed the Care Dependency Scale into such a tool.

Contents

This article does not present the results of the research, which will be presented separately; rather it describes the story of the research project, outlining both the challenges and benefits that transpired as a consequence of staff being involved in research in a small multidisciplinary rehabilitation centre.

Conclusions

While such research can present many challenges, endeavouring to overcome these can have positive outcomes for both staff and patients. In this case, participating in research proved to be a tool to empower both staff and patients and promoted changes in the Centre. Potential researchers should not be put off their investigations simply because they are not affiliated with an academic institution.
Allied health professional's views on palliative care for people with advanced Parkinson's disease
Authors: Waldron Mary , Kernohan W George , Hasson Felicity , Foster Susan , Cochrane Barbara , Payne Cathy
Published: May 2014

Mary Waldron, W George Kernohan, Felicity Hasson, Susan Foster, Barbara Cochrane, Cathy Payne

Aims: Allied health professionals (AHPs) have a key role in the delivery of palliative care through rehabilitation. However, evidence suggests that rehabilitation remains an area of neglect in palliative care. This study explores the views of allied health professionals in delivering rehabilitation in palliative care to people with Parkinson's disease.

Methods: Twelve allied health professionals, from both generalist and specialist settings, who had experience of working with people with advanced Parkinson's disease and/or palliative care took part in interviews and/or focus groups.

Findings: Participants viewed palliative care as holistic care, however, the rehabilitation care they provided was impeded by a number of personal and organisational barriers, and negative perceptions. Misconceptions as to the value of rehabilitation in the palliative stage and a lack of training resulted in uncertainty as to when and how it could be introduced. While the importance of early referral to AHP rehabilitation services was highlighted, organisational and administrative barriers prevented many people from accessing such care.

Conclusions: Many health professionals have a role in palliative rehabilitation, but barriers prevent early referral and ongoing access to such services. There is a need to educate professionals in the principles of palliative rehabilitation, combined with providing targeted resources to promote shared care and responsibility.
A clinical pathway for management of fractured ankles can be used to identify course of recovery and resource use
Authors: Page Carolyn , Brock Kim , Black Susan
Published: May 2014

Carolyn Page, Kim Brock, Susan Black

Aims: This article describes a study investigating the use of a clinical pathway for the management of fractured ankles and seeking to identify the usual course of recovery for patients treated according to the pathway for both conservative and surgical management.

Methods: The study was a prospective, observational cohort study The participants were 63 patients who had sustained a fractured ankle and could weight bear The outcome measures were the Ankle Lunge Test (ALT), Lower Extremity Functional Scale, swelling, and 10m walk test.

Findings: Compliance in documenting key items of assessment on the pathway ranged between 52% and 91%. Adherence to recommended interventions was above 60% for most recommendations.

The number of weeks attending physiotherapy had a mean of 6.6 (SD 3.3). There was a correlation of r = 0.44 between ALT at week 1 and week of discharge (p > 0.01), with those having poor ALT results more likely to have prolonged treatment. The surgically treated group had a significantly poorer ALT at week one (p < 0.01), continued to make slower recovery at week three (p < 0.001) and, overall, had a significantly longer period of physiotherapy.

Conclusions: A structured clinical pathway for fractured ankles is an effective and efficient way to collect data on this population and has the capacity to detect patients that fail to progress as normal.
How Students with Low Level Subjective Wellbeing Perceive the Impact of the Environment on Occupational Behaviour
Authors: Yazdani Farzaneh
Published: May 2014

Aims: This article describes a study exploring what students with a low level of subjective wellbeing and satisfaction with life perceive as the impact of the environment on their occupational behaviour in the Arabic Muslim context in Jordan. The study explored the way students explain their occupational adaptation - their dissatisfaction with environmental demands and supports and its relation to their occupational behaviour.

Methods: A qualitative approach was used with a purposive sample of ten students who had been assigned as having a low level of subjective wellbeing and satisfaction with life. An in-depth interview, guided by the concepts of the Model of Human Occupation (MOHO), was carried out with these students to explore the cultural specifics of their environment.

Findings: Many students perceive their problems to be mostly related to the discrepancy between their own established values, and the new demands of a less traditional lifestyle. A student's environment has a significant impact on the way they identify with values.

Conclusions: The outcomes of the study will help counsellors understand the atmosphere of student life in the Arab Muslim context, as well as contexts with a similar perspective. It also emphasizes the importance of validating environmental elements which impact on students’ occupational behaviour in different cultures.
Review of the use of standardized patients in speech-language pathology clinical education
Authors: Zraick Richard I.
Published: May 2014

Allied health programmes worldwide have reported increasing difficulty in finding sufficient traditional clinical placements for students within the workplace. As a result, some programmes are taking alternative approaches to clinical training. One such approach is to use standardized patients. A standardized patient is an individual trained to portray a specific clinical case in a highly consistent and measurable manner. The use of standardized patients in speech-language pathology clinical education has been limited. The purpose of this paper is to describe the use of standardized patients and objective structured clinical examinations (OSCEs) to train and assess students in speech-language pathology. The limited literature on the use of standardized patients and OSCEs in speech-language pathology is reviewed, and a call is made for further research into the use of standardized patients and OSCEs for clinical education and assessment.
Effect of physical exercise-movement strategies programme on mobility, falls, and quality of life in Parkinson's disease
Authors: Georgy Ehab , Barsnley Susan , Chellappa Rajesh
Published: May 2014

Background: Parkinson's disease (PD) is an incurable, progressive neurodegenerative disorder that gradually results in accumulating disability. Evidence suggests that specific interventions, for example, physical exercise and movement strategy training, can improve some of the PD-associated problems and enhance quality of life. The aim of this paper is to demonstrate the effect of a tailored rehabilitation programme, comprising of a combination of exercise therapy and movement strategy training, on falls risk, mobility, and quality of life in people with PD.

Methods: A prospective longitudinal design, with 1- and 2-year follow-up, was conducted, where fifteen people with idiopathic PD and average age of 76.1 years attended weekly, then biweekly 90-minute rehabilitation sessions that focused on exercise therapy and movement strategy training. Outcome measures were assessed at baseline and at 1- and 2-year, which included self-reported number of falls, Freezing of Gait Questionnaire, Tinetti falls assessment tool, and Parkinson's Disease Questionnaire (PDQ-39).

Results: At 1-year, a significant improvement was identified in gait freezing and Tinetti scores, as well as a statistically significant reduction in the number of falls and falls risk. Several aspects of the PDQ-39 have also improved. Some of the effects continued to exist through year two, but the improvement has not been consistent compared to year one.

Conclusion: A combination of regular exercise and movement strategy training has the potential for reducing falls risk, and improving mobility (less gait freezing) and quality of life of people with PD.