bluuebunny/crossref_metadata_2025 huggingface dataset:
Physiotherapy for chronic rhinosinusitis: The use of continuous ultrasound
Authors: Nakhostin Ansari Noureddin , Naghdi Soofia , Farhadi Mohammad
Published: May 2014

Chronic rhinosinusitis (CRS) is the most common chronic disease in the field of ear, nose and throat and is often very difficult to treat. The aim of this pilot study was to determine the effects of continuous ultrasound (US) on CRS. In a randomized, single-blind, placebo-controlled study, 20 patients were treated with either continuous US (n = 10) or mock-US (n = 10), 3 days a week for 10 treatment sessions.

All patients improved after treatment with US. Excellent and good improvements were observed in nine patients. Between-group comparisons of ‘percent improvement’ showed a significantly higher improvement in the US group than in the control group. The total scores of rhinosinusitis symptoms were significantly improved after treatment in both the groups. At one-month follow-up, eight patients in the US group reported no recurrence of the disease and the CRS had recurred in all patients of the control group.

This trial demonstrates that continuous US may be an effective tool in the treatment of patients with CRS, although further study is needed.
Physiotherapists' perceptions of problematic musculoskeletal soft tissue disorders
Authors: Poltawski Leon , Watson Tim , Byrne Geraldine
Published: May 2014

Aims: Many common musculoskeletal disorders are resistant to existing management strategies, causing long-term pain and disability. While arthritic and spinal problems have been prioritized for research, several soft tissue disorders may be equally burdensome for individuals and difficult to treat successfully. Identifying those that are least responsive to treatment may help focus the limited resources available for research and treatment provision. This study aimed to rank the most problematic disorders, and identify contributory factors, to inform the debate on research and service priorities in the management of musculoskeletal disorders.

Methods: The views of practising physiotherapists on the most problematic soft tissue disorders were sought using a postal questionnaire survey and telephone interviews. The questionnaire was sent to 193 experienced musculoskeletal physiotherapists working in National Health Service and private clinics in south-east England.

Findings: The response rate was 48%. The top three problematic disorders were identified as frozen shoulder, plantar fasciitis and tennis elbow. Subsequent interviews with 20 respondents indicated that inadequate differential diagnosis, triaging and differences in therapeutic practice may account for some of the observed variation in outcomes.

Conclusions: A greater focus on these particular disorders and issues by both clinicians and the research community is warranted.
Qualitative research: Part three - Methods
Authors: Nicholls David
Published: May 2014

Background: There are still many practitioners, academics and researchers who are bemused by the principles and practices of qualitative research. In the third and final article in this three part series, I look at sampling in qualitative studies, methods of data collection and analysis.

Content: Building on the previous two articles, I highlight the importance of rigour and explore some of the different criteria used by researchers to demonstrate that their research is trustworthy. I include a brief discussion of some of the more recent trends in mixed-method or post-positivist research.

Conclusions: Qualitative research is different in many ways to quantitative, and it cannot be approached with the same mind-set. It seeks to explore different aspects to quantitative research, focusing on the individual experience, rather than conclusions that can be drawn from large groups. Because of these differences, the two approaches to research should not be seen as alternatives, but complementary.
Predictors of fitness improvements in phase III cardiac rehabilitation exercise
Authors: McKee Gabrielle
Published: May 2014

This study aimed to determine if age, gender, body mass index and pre-programme fitness were predictors of fitness improvements in phase III cardiac rehabilitation programmes. The main objective was to propose how this information could be used to further tailor exercise intervention to individual needs.

A sample of 119 patients were included in this single site, practice-based, longitudinal observational investigation of patients before and after attending a structured cardiac rehabilitation programme. Patient fitness was measured both before and after participation in a phase III cardiac rehabilitation programme, using a Bruce protocol sub-maximal exercise stress test.

Significant increases in fitness occurred after participation in the cardiac rehabilitation programme. The factor that significantly influenced pre-programme fitness was age. The factors that significantly influenced fitness improvements were pre-programme fitness and gender, with the least fit participants and males improving fitness most. Findings suggest potential methods of further individualizing the exercise component of cardiac rehabilitation and highlight areas for further exploration.
Reliability of hand function testing instruments in patients with muscular dystrophies
Authors: Aldehag Anna S , Jonsson Hans , Littorin Susanne , Ansved Tor
Published: May 2014

Aims

Welander distal myopathy (WDM) and myotonic dystrophy type 1 (DM1) are conditions characterized by gradually impaired hand function. Measurement of hand function is therefore important in therapy for patients. However, to date reliability of common hand function test instruments for these patients has not been evaluated. The aim of the study was to test intra-rater reliability (test-retest) of the hand function testing instruments: the Grippit®, Grip Ability Test (GAT), hand-held myometer (Microfet2TM) and Purdue Pegboard in patients with WDM and DM1. In addition, inter-rater reliability of these instruments was tested in DM1 patients.

Methods

For test-retest, the two patient groups (16 patients in each group) were tested on 2 consecutive weeks, on the same day of the week and at the same time of day. During the second week, the DM1 patients were randomly tested either before or after retest for inter-rater reliability.

Results

Mainly good–very good (intra-class correlation coefficient≥0.61) intra-rater and inter-rater reliability were found in three out of four instruments tested: the Purdue Pegboard, Grippit and the hand-held myometer for both WDM and DM1 patients.

Conclusions

The instruments are thus considered reliable for evaluating hand function in patients with WDM and DM1. However, the GAT and pinch grip measured with the Grippit® need to be interpreted with caution, as the reliability of these instruments varied from fair to good.
Caregiver stress in traumatic brain injury
Authors: Blake Holly
Published: May 2014

Aims

Many patients experience physical, behavioural, cognitive and emotional problems following traumatic brain injury (TBI). They may require continuing care for many years, most of which is provided by informal caregivers, such as spouses, parents, or other family members. The caregiving role is associated with a range of adverse effects including anxiety, depression, poor physical health and lowered quality of life. This article explores issues around caregiver stress; highlighting interventions for this group and areas for further research.

Methods

Literature exploring the impact of caregiving, its influencing and alleviating factors and interventions for caregivers of people with TBI is discussed, with brief critical analysis of key studies.

Findings

Research suggests that caregiver characteristics, coping strategies, their appraisal of the situation and social networks may be associated with the amount of distress experienced. Many caregivers have unmet needs such as respite care and information provision on TBI. Providing information may help to alleviate strain. Community-based family therapies providing education, support and counselling can help to decrease distress and improve aspects of family functioning, although evidence for these is lacking.

Conclusions

There is a need for more well-designed, controlled studies evaluating the impact of interventions to alleviate caregiver strain.
Qualitative research: Part three – Methods
Authors: Nicholls David
Published: May 2014

Background

There are still many practitioners, academics and researchers who are bemused by the principles and practices of qualitative research. In the third and final article in this three part series, I look at sampling in qualitative studies, methods of data collection and analysis.

Content

Building on the previous two articles, I highlight the importance of rigour and explore some of the different criteria used by researchers to demonstrate that their research is trustworthy. I include a brief discussion of some of the more recent trends in mixed-method or post-positivist research.

Conclusions:

Qualitative research is different in many ways to quantitative, and it cannot be approached with the same mind-set. It seeks to explore different aspects to quantitative research, focusing on the individual experience, rather than conclusions that can be drawn from large groups. Because of these differences, the two approaches to research should not be seen as alternatives, but complementary.
Evaluating inpatient satisfaction with a physiotherapy service: A rehabilitation centre survey
Authors: Stiller Kathy , Cains Grace , Drury Craig
Published: May 2014

Aims

Patient satisfaction is an important consideration in rehabilitation and the measurement of health-care outcomes. The purpose of this observational study was to determine inpatients' levels of satisfaction with a physiotherapy service at one rehabilitation centre in South Australia.

Methods

One-hundred-and-six of 122 eligible inpatients completed a purpose-designed survey. Analyses were predominantly descriptive in nature.

Findings

High degrees of satisfaction with the physiotherapy service were reported, including with the overall standard of the physiotherapy service, the interpersonal skills of the physiotherapy staff and the facility itself. Responses were not significantly influenced by demographic characteristics.

Conclusion

These findings promote confidence that a high standard of physiotherapy is provided to inpatients at the rehabilitation centre studied. The survey was relatively straightforward to conduct in practice and has, importantly, identified areas where the service can be improved.
Phase III cardiac rehabilitation after CABG: Combined aerobic and strengthening exercise protocols
Authors: Moghadam Behrooz Attarbashi , Tavakol Kamran , Hadian Mohammad Reza , Bagheri Hossein , Jalaei Shohreh
Published: May 2014

Aims

Little is known of the short-term effects of combined aerobic and strengthening exercises—as components of phase III cardiac rehabilitation— in patients of Middle Eastern origin who have undergone coronary artery bypass grafting (CABG). This study aimed to assess the efficacy of exercise protocols used during phase III cardiac rehabilitation of patients from Iran who had undergone this procedure.

Methods

The study compared the effect of combined aerobic and strengthening exercises vs aerobics alone on the functional capacity, muscle strength, serum lipids and blood pressure of 88 patients, 4-5 weeks after CABG. A control group performed aerobics while three experimental groups performed combined aerobic and strengthening exercises, 5 days a week over 5 weeks. The functional capacity, muscle strength and serum lipids were determined at baseline and specific time points during the study. Heart rate and blood pressure were measured before and after each session.

Findings

The combined exercise protocols improved the functional capacity and muscle strength to a significantly greater extent than the aerobic protocol. Serum total cholesterol, low-density lipoproteins and triglyceride levels decreased insignificantly, however, the high-density lipoproteins level increased significantly in all groups. Systolic blood pressure declined insignificantly but the diastolic blood pressure remained unchanged in all groups.

Conclusions

The results suggest that the combined exercises were superior to the aerobics alone for positive changes in patients’ functional capacity and muscle strength, with effects lasting up to follow-up.
The reliability of identifying bronchial breathing by auscultation
Authors: Morrow Brenda , Angus Lauren , Greenhough Dale , Hansen Ashleigh , McGregor Gina , Olivier Odette , Shillington Lucy , Van der Horn Paula , Argent Andrew
Published: May 2014

Aims

This study was carried out to determine the intra- and inter-rater reliability of identifying bronchial breathing by auscultation, and the effect of education on the ability to identify bronchial breathing.

Methods

Eighteen children admitted to a tertiary paediatric hospital underwent auscultation and recording of 20 breath sounds using an electronic stethoscope. Breath sounds were independently assessed before and after educational intervention. Intra- and inter-rater reliability were calculated using free-marginal Kappa statistics.

Findings

Ten raters (six physiotherapists; four paediatricians), were included. Inter-rater reliability had a Kappa value of 0.3 whilst intra-rater reliability ranged from -0.01 to 0.6. Sensitivity increased from 58% to 75% following education, with no change in specificity. Physiotherapists' test scores increased from 76.7 (± 9.3%) to 80.8 (± 5.8%) while the paediatricians' scores decreased from 66.3 (± 4.8%) to 60.0 (± 4.1%) following education (P = 0.038). After education, total test scores improved more in newly qualified professionals than those qualified for over five years (P = 0.01).

Conclusion

Auscultation of bronchial breath sounds is unreliable in infants and young children and is therefore not a valid outcome measure for clinical studies.
Knowledge brokering as an intervention in paediatric rehabilitation practice
Authors: Glegg Stephanie
Published: May 2014

Introduction

Knowledge brokering is an emerging intervention to promote research use in clinical practice. By targeting identified barriers, clinician knowledge brokers have the potential to facilitate evidence-based practice for their peers, while accounting for contextual factors that influence this process. Few accounts in the literature describe the process of implementing a knowledge brokering system, or the specific activities and roles carried out by knowledge brokers in an enabling capacity.

Content

The aim of this article is to present the theoretical basis for knowledge brokering, and to describe a model used by a brain injury team within a paediatric health care centre.

Conclusions

Knowledge broker facilitation enabled the compilation and creation of useful resources to assist team members in incorporating evidence into practice. It also yielded increased awareness of, and access to, available research, as well as evidence syntheses on clinical topics of relevance to the group. Clinicians may be well suited to perform this enabling role. An increased emphasis on mentoring and community building to support knowledge brokers and on structured evaluation of knowledge broker activities is recommended.
The use of skill mix in home-care occupational therapy with patients with bathing difficulties
Authors: Guay Manon , Dubois Marie-France , Desrosiers Johanne , Robitaille Judith , Charest Joëlle
Published: May 2014

Aims

Occupational therapists working in Canada have to deal with a shortage of human resources. In the case of bathing-equipment recommendations, a proposed solution, albeit controversial, is to use skill mix. The purpose of this article is to describe the use of skill mix in home-care occupational therapy in Quebec,Canada, with patients with bathing diffi culties.

Methods

All provincial Health and Social Services Centres (N = 95) were contacted by phone and surveyed on their setting and use of skill mix.

Findings

Findings: The participation rate was 91%, with results indicating that 89% of the protocols for determining the need for technical assistance with bathing in home-care services involve skill mix. Generally, occupational therapists collaborate with physical therapists or with home-health aides; substitution occurs by task assignment. Clinical occupational therapists provide informal training, lasting 1–40 hours (mean of 8 hours), and have developed 63 ‘in-house’ tools to assist those involved in the task.

Conclusions

This article provides a portrait of the use of skill mix in home-care occupational therapy in Quebec with clients with bathing diffi culties, looking at a proposed solution to human resource shortages, a problem experienced worldwide.
How well do pain scales correlate with each other and with the Oswestry Disability Questionnaire?
Authors: Solomon D , Roopchand-Martin S
Published: May 2014

D Solomon, S Roopchand-Martin

Aims: This article describes a study aiming to determine the correlation between pain ratings obtained with the Numerical Rating Scale (NRS) and the Visual Analogue Scale (VAS) in patients with chronic low back pain in Trinidad, and to determine the correlation between pain and disability in the same population.

Methods: The VAS, NRS and Oswestry Disability Questionnaire (ODQ) were administered to forty-two consecutive patients with chronic low back pain in Trinidad. Spearman's rho was calculated for pairs of variables at an a level of 0.01.

Findings: A high correlation was found between the numerical rating scale and the visual analogue scale (r = 0.822, p < 0.0001). Significant low to moderate correlations were found between the two pain scales and disability, r = 0.577, p < 0.0001, and r = 0.616, p < 0.0001 for the NRS and the VAS respectively.

Conclusions: The strong correlation between the VAS and NRS indicates that either instrument can be used in the Trinidadian population; however, the low to moderate correlation between pain and disability speaks to the importance of evaluating both pain intensity and disability in this population and not simply using information from one to make inferences about the other.
Knowledge and perception of physiotherapy by final year students of various health care professions
Authors: Varghese Benjamin , Rengaramanujam Kanagaraj , Swaminathan Narasimman , Vishal Kavita , Romer Mellisa
Published: May 2014

Background/objectives: Interaction between various disciplines of medicine within a health care team is becoming recognised more and more as an effective method of improving the delivery of health care services. Members of the health care team need to understand and respect each other's professional abilities, in order to achieve interdisciplinary teamwork. This study was designed to evaluate the perception of the physiotherapy profession by the final year students of various health care professions and also to find out the extent of their knowledge of physiotherapy services.

Materials/methods: A total of 1008 final year students of various health care professions in Dakshina Kannada participated in the survey. They were recruited from 13 nursing colleges, 4 medical colleges, 2 ayurvedic, and 1 homoeopathic college. The participants were required to fill a 22 item self-administered 3-page questionnaire, which contained both closed and open-ended questions

Result: This study demonstrated that 53.1% of the respondents had good perception of physiotherapy. Also, 88.8% of the respondents demonstrated lack of knowledge of physiotherapy.

Conclusion: The findings suggest that health care students need more information about physiotherapy services. Future studies would benefit the profession if they evaluate the outcomes of strategies designed to increase the awareness of physiotherapy among health care students.
Cancer in the workplace: evaluation of a resource to help those affected by cancer, return to work in the UK
Authors: Lydon Anne , Hughes Sean
Published: May 2014

Background: As the detection of, and treatments for cancer improve, more people are living with the disease. For many, getting back to paid work represents a return to normality and financial security. Recently there have been changes in British legislation relating to employment and equality, notably the Equality Act (2010) .

Content: The cancer charity, Macmillan Cancer Support and the Scottish Centre for Healthy Working Lives developed a resource, a DVD and booklet, to raise employers' awareness to issues experienced by cancer patients. This paper will look at the evaluation of this resource, and of its potential benefit to help those involved in the rehabilitation of cancer patients. The evaluators took a qualitative approach, using data from discussions with the producer of the resource, and the opinions of those who would use it. In the evaluation, 21 representatives from human resource and occupational health departments of small private companies, charity organisations, NHS and governmental departments attended one of four focus group meetings. Most participants noted that bringing the subject of ‘cancer in the workplace’ ‘out into the public domain’ was a positive attribute of both the DVD and booklet.

Conclusion: This paper explores the potential benefit of an educational resource. Based on the recommendations from this evaluation, changes have been made and are widely available to the general public via the Macmillan Cancer Support website.
Pedometer accuracy in slow-walking older adults
Authors: Martin Jessica B. , Krc Katarina M. , Mitchell Emily A. , Eng Janice J. , Noble Jeremy W.
Published: May 2014

Aim:

The purpose of this study was to determine pedometer accuracy during slow overground walking in older adults (mean age=63.6 years).

Method:

A total of 18 participants (6 males, 12 females) wore 5 different brands of pedometers over 3 pre-set cadences that elicited walking speeds between 0.3 and 0.9 m/s and one self-selected cadence over 80 meters of indoor track.

Results:

Pedometer accuracy decreased with slower walking speeds with mean percent errors across all devices combined of 56%, 40%, 19%, and 9% at cadences of 50, 66, and 80 steps/min, and self selected cadence, respectively. Percent error ranged from 45.3% for Omron HJ105 to 66.9% for Yamax Digiwalker 200. Due to the high level of error across the slowest cadences of all 5 devices, the use of pedometers to monitor step counts in healthy older adults with slower gait speeds is problematic.

Conclusions:

Further research is required to develop pedometer mechanisms that accurately measure steps at slower walking speeds.
Understanding the common interrater reliability measures
Authors: Lim Sok Mui , Palethorpe Natasha , Rodger Sylvia
Published: May 2014

Health and rehabilitation professionals use a range of outcome instruments to evaluate the effectiveness of their interventions. In order to be evidenced-based practitioners, we need to understand the psychometric properties of these instruments and to be able to interpret the statistics used to test their psychometric properties. This paper focuses on inter-rater reliability. Different statistical methods for computing inter-rater reliability can be classified into one of three categories: consensus estimates, consistency estimates, and measurement estimates. The common statistical methods such as Kappa, intraclass correlation and Many-Facets Rasch Model are described along with the advantages and disadvantages of each approach. For each category of estimates, one paper has been chosen from the therapy and rehabilitation literature to illustrate the use of a number of commonly utilised inter-rater reliability measures. It is hoped that this overview will provide practitioners, students and/or new researchers with a ready reference of key measurements used for determining inter-rater reliability.
Mandatory continuing professional development in South Africa: Rehabilitation therapists' perspective
Authors: Maharaj Sonill Sooknunan
Published: May 2014

Aims:

In 2007, Health Professions Council of South Africa (HPCSA) introduced mandatory continuing professional development (CPD), which enables therapists to acquire new knowledge and skills to improve patient care. To remain registered, therapists must meet CPD standards by formal HPCSA audits; however, latest figures revealed a compliance rate of 35% due to non-attendance of CPD activities. This study reviewed the experiences of therapists to identify barriers and obtain suggestions to improve attendance.

Methodology:

This cross-sectional descriptive study used a questionnaire with closed and open questions to explore the aims from a sample of 138 rehabilitation therapists, comprising speech and language therapists (9%), occupational therapists (21%) and physiotherapists (70%), attending an ethics workshop.

Results:

Eighty five (62%) supported CPD and 97 (71%) supported compulsory ethics. Short 1 to 3 day courses, mini-congresses and journal club activities were the most frequently-attended events. Barriers to CPD were: time, cost of courses, cost of travel due to geographical distance, staff shortages, lack of employee support, and multi-disciplinary or inappropriate courses. Suggestions for improving attendance were: introducing state subsidised and corporate sponsorships, increased in-service journal club activities, tele- and video-conferences, on-line presentations, and profession-specific courses.

Conclusion:

Therapists support mandatory CPD, but stakeholders must take cognisance of the barriers and suggestions to improve CPD attendance and compliance.
Critical triangulation of a movement test, questionnaires, and observational assessment for children with DCD
Authors: Doderer Larissa , Miyahara Motohide
Published: May 2014

Aims:

Standardised assessment tools for developmental coordination disorder (DCD) do not always seem to agree with each other, which causes problems in making clinical and research decisions. This case study research aims to first determine whether or not three standardised assessment tools converge on diagnostic categories of DCD and, second, examine how useful observational assessment is to understanding the intervention process and the outcomes for selected children who exhibited discrepancies between the standard assessment tools.

Methods:

Based on the case formulation approach, a 7-week individual intervention program was developed for seven children who had delayed motor development and did not meet the DSM diagnostic exclusion criteria for DCD. The observational assessment of this 7-week, weekly intervention was documented, and a motor performance test and two questionnaires were administered before and after the intervention program. The authors examined the consistency and the discrepancies between the assessment tools regarding diagnostic status by employing methodological triangulation of the observational assessment, the movement test and the questionnaires.

Results:

The three standardised assessment tools agreed on the DCD categories of four out of the seven children both before and after the intervention. The standardised assessment tools produced discrepant results in the DCD categories of four children. Insights gained from the observational assessment could explain some of the reasons behind the discrepancies.

Conclusions:

Clinicians and researchers need to recognise discrepancies between different standardised assessment tools, not as errors, but as reflections of multiple aspects of motor development. Critical triangulation serves this purpose. Observational assessment can be useful to reconcile the discrepancy between standardised assessment tools and to make an ultimate clinical judgement for the diagnosis of DCD.
Further validation of the Danish version of the McGill Ingestive Skills Assessment (MISA-DK): Rasch analysis
Authors: Hansen Tina
Published: May 2014

Background/aims

The McGill Ingestive Skill Assessment (MISA) for measuring dysphagic patients' functional performance during meals has been previously translated into Danish — the Danish McGill Ingestive Skill Assessment (MISA-DK) and this translated version validated. However, issues about the construct validity of the scale had been raised. Therefore, this study aims to further validate and revise the MISA-DK using Rasch analysis.

Methods

An extended Rasch analysis was performed on data from a former MISA-DK validation study, which resulted in revisions to the scale. The revised MISA-DK was then tested using 102 videorecordings of geriatric patients' ingestive skill performance, and the data from the scale were examined using a second Rasch analysis.

Results

Initially, two of the six proposed subscales of the original MISA-DK failed to fit the Rasch model, and were removed. It was also necessary to revise one item due to differential item functioning and to develop additional items as its reliability was too low. A second Rasch analysis of the revised MISA-DK with four subscales showed fit to the Rasch model after adjusting local item dependence throughout the scale.

Conclusion

A revised MISA-DK demonstrated satisfactory construct validity when measured by the Rasch model. As local item dependence appeared to be a feature of the scale, the application of more complex Rasch models is warranted for further validation.
Is time spent using constraint induced movement therapy an appropriate measure of dose? A critical literature review
Authors: Abdullahi Auwal
Published: May 2014

Background/aims

Constraint induced movement therapy (CIMT) is used for upper limb rehabilitation following stroke. Evidence for its effectiveness has been reported on several outcomes, such as neurophysiological, behavioural and kinematic. The main components of CIMT are constraint of the unaffected limb and massed task practice with the affected limb for specific durations of time.

Methods

Five databases and four recent systematic reviews were systematically searched. Studies of CIMT using duration in hours of time spent practising tasks and those using repetition of task practice as measures of dose were critically analysed.

Results

Most studies of CIMT use task practice duration in hours as the measure of dose. However, this way of determining dose seems arbitrary as dose is conceived differently in different studies. One randomised controlled trial considered only the time spent practising tasks per session as task practice dose. A recent systematic review considered all factors of task practice duration (in hours per session, number of days per week and number of weeks practising task) as the task practice dose. Studies of neuroplasticity and motor learning in stroke reported that they are dependent upon number of repetitions of tasks practice. This number of repetitions is in the region of 300 and above; and this can provide an appropriate or even accurate measure of dose of tasks practice.

Conclusion

While these findings can have immediate implications for clinical practice and can be easily adopted by the clinicians, more research needs to be undertaken using randomised controlled trial designs to establish a robust and sound evidence base.
Reliability of an assessment of deep neck flexor muscle endurance test: A cross-sectional study
Authors: Painkra Jai Prakash , Kumar Suraj , Anwer Shahnawaz , Kumar Ratnesh , Nezamuddin Mohammad , Equebal Ameed
Published: May 2014

Background:

Deep neck flexor (DNF) muscles assist in stabilising the cervical spine during gross neck movements. Patients with neck pain often exhibit reduced deep neck flexor muscle endurance.

Aims:

This study's primary purpose was to determine the inter-rater and intra-rater reliability of measurements obtained using a simple clinical test of DNF muscle endurance in a healthy Indian population. The secondary purpose was to determine and compare the average hold time for deep neck flexor muscle endurance in healthy male and female participants, to add to the body of knowledge around deep neck flexor muscle endurance testing.

Methods:

In this cross-sectional study, 60 participants (30 male, 30 female) were evaluated using a deep neck flexor endurance test, which involved them lifting their head while maintaining their craniocervical region in a flexed position. Deep neck flexor endurance was measured by two physiotherapists. Each tester measured the DNF hold time of each participant twice, and there was a 5-minute rest between trials.

Results:

Inter-rater reliability was moderate to good (ICC = 0.69–0.88) and intra-rater reliability was good to excellent (ICC = 0.82–0.93). Neck flexor endurance time was significantly greater in males (mean = 63.73 seconds; SD = 20.27 seconds) than females (mean = 38.43 seconds, SD = 11.71 seconds, (F = 72.89, P<0.001).

Conclusion:

The results suggest that healthy males have greater deep neck flexor endurance than females. This is the first normative data available that reports on deep neck flexor endurance in healthy Indian adults.
How restless legs can be calmed
Authors: Chaudhuri Ray
Published: May 2014

An urge to move the limbs is more than just an annoyance.
Top technology
Authors: Walker Wendy
Published: May 2014

Advances in home monitoring can reduce home visits and surgery appointments, and give patients more control over their conditions.
An introduction to acupuncture
Authors: Richardson Marion
Published: May 2014

As interest in alternative therapies continues to grow, Marion Richardson begins our occasional series on complementary medicine by looking at the tradition and modern use of acupuncture
Febrile convulsions
Authors: Sprague Debra
Published: May 2014

Continuing our series on common conditions in primary care, Debra Sprague examines febrile convulsions. She looks at possible causes, treatment options, what to tell parents and when to refer children
Coping with infantile colic
Authors: Brown Harry
Published: May 2014

Parents with a colicky baby will benefit from a supportive approach and a thorough investigation to exclude other causes.
Diagnosing bacterial
Authors: Brown Mary
Published: May 2014

Bacterial vaginosis is a common cause of abnormal vaginal discharge, writes Mary Brown.
Recognising obstructive sleep apnoea
Authors: Mullins Rebecca
Published: May 2014

Practitioners need a greater awareness of obstructive sleep apnoea, says Rebecca Mullins
Skin problems due to insulin use
Authors: Miles Pat , Kerr David , Richardson Tristan
Published: May 2014

Various conditions brought on by insulin use in diabetes.
Practical prescribing - Molly Courtenay helps resolve everyday issues for nurse prescribers
Authors: Courtenay Molly
Published: May 2014

Q: I am a diabetes specialist nurse and dose-adjust insulin for my patients under a Patient Group Direction (PGD). Is this acceptable? My manager wants me to do a prescribing course, but I don't want to do this due to the amount of study required.
Identifying memory loss disorders
Authors: Larner Andrew
Published: May 2014

Red-flag signs can help to identify pathological causes of forgetfulness, says Dr Andrew Larner.
Teamworking and the law
Authors: Parker Sue
Published: May 2014

Working in teams raises some specific medico-legal issues.
Combating the threat of West Nile virus
Authors: Hill Barry
Published: May 2014

West Nile virus can prove fatal. Barry Hill examines its potential threat to the UK.
Multiple sclerosis
Authors: Brennan Kathryn , Overell James
Published: May 2014

Epidemiology, aetiology, diagnosis and treatment.
Self-management in asthma
Authors: McIntosh Iain B
Published: May 2014

The DoH is encouraging patient self-care. Dr Iain McIntosh examines the issues involved.
Countering obesity in Scotland
Authors: Griffiths Julie
Published: May 2014

After being rolled-out in England and Wales, Counterweight has been adopted in Scotland.
Case Study - Poisoning misdiagnosed as allergy
Authors: Radcliffe Michael
Published: May 2014

A suspected case of fish allergy is not all that it seems. Dr Michael Radcliffe explains.
Diabetes - Helping young people to manage their diabetes
Authors: Wild Sarah
Published: May 2014

Interactive, educational workshops are teaching children and teenagers to understand the dietary management of childhood diabetes
Pain management - Recognising and treating neuropathic pain
Authors: Morris David
Published: May 2014

It is reasonable to begin with simple analgesia for neuropathic pain, but other agents are usually needed.
The rising tide of alcohol problems
Authors: Bostock Jenny
Published: May 2014

A sensitive approach to patient assessment can help to identify those at risk of alcohol-related health problems, says Jenny Bostock.
Update on obesity management
Authors: Haslam David
Published: May 2014

Independent Nurse: Obesity is a physical sign of underlying pathology and should be managed accordingly.
Spotting the signs of oral cancer
Authors: Hamilton William
Published: May 2014

Early diagnosis in oral cancer remains the exception.
Why breastfeeding is important
Authors: Dodds Rosie
Published: May 2014

Breastfeeding can help to reduce health inequalities in the UK.
Case study - Initiating insulin in type-2 diabetes
Authors: Page Renee
Published: May 2014

A move from oral therapy to insulin needs to be tailored carefully to individual patient need.
Prescribing steroids
Authors: Brown Harry
Published: May 2014

Many conditions can benefit from steroids, but long-term therapy raises the risk of side-effects, writes Dr Harry Brown.
Practical prescribing - PGDs
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Dealing with ketoacidosis
Authors: Ahmed Jalil , Malik Rayaz A
Published: May 2014

Prompt diagnosis and referral are essential. Dr Jalil Ahmed and Professor Rayaz Malik explain.
Helping women make the emotional transition to motherhood
Authors: Bertram Lynn
Published: May 2014

In the first of two articles, Lynn Bertram explains how therapeutic group work can help reduce postnatal depression.
Practical prescribing - The Mantoux test for TB
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Clinical Focus - Thyrotoxicosis
Authors: Kohler Sibylle , Wass John AH
Published: May 2014

Epidemiology, diagnosis, management and prognosis.
First steps in depression management
Authors: Rogers Melanie
Published: May 2014

Patients with depression will have both physical and psychological symptoms. Melanie Rogers explains.
Winning the battle against stress in primary care
Authors: Koch Hugh
Published: May 2014

Taking active steps to combat stress can help nurses cope with the pressures of work.
Developing telehealth as a tool in primary care
Authors: Griffiths Julie
Published: May 2014

Scottish pilots are trialling remote monitoring of patients with long-term conditions.
Reducing CVD risk
Authors: Cornforth Amber
Published: May 2014

The advantages of early diagnosis of hypertension and diabetes and aggressive risk factor management are clear.
Understanding attention deficit hyperactivity disorder
Authors: Kirby Amanda
Published: May 2014

ADHD can overlap with other developmental disorders.
Medical management of erectile dysfunction
Authors: Morris David
Published: May 2014

Several pharmacological options are available for men with erectile problems.
Malaria
Authors: Easmon Charlie
Published: May 2014

Epidemiology, diagnosis, management and future developments
Managing lipid markers for atherosclerosis
Authors: Menown Ian
Published: May 2014

Clinical imaging trials have assessed the impact lipid management has on atherosclerosis. Dr Ian Menown explains.
Managing DVT in primary care
Authors: Stephens Liam
Published: May 2014

DVT can be safely and effectively managed in primary care, writes Liam Stephens.
Parental concerns relating to asthma
Authors: Duncan Debbie
Published: May 2014

Parents of children with asthma may have a range of concerns that need to be addressed, writes Debbie Duncan.
Spotting the signs of pneumothorax
Authors: Kochhar Suneeta
Published: May 2014

It is important to recognise pneumothorax, say Dr Suneeta Kochhar and Dr Paul Cornelius.
Seizing the opportunity for smoking cessation
Authors: Croghan Emma
Published: May 2014

A deeper understanding of smoking behaviour may improve quit rates, writes Emma Croghan.
The benefits of reflective writing
Authors: Cornforth Paul
Published: May 2014

Reflecting on both negative and positive incidents can improve clinical practice.
Management of cardiac arrhythmia
Authors: Griffiths Angela , Meldrum Nicola
Published: May 2014

People with arrhythmias need prompt referral for specialist advice.
Practical prescribing - Prescribing after a telephone consultation
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Assessing alcohol misuse in young people
Authors: Kaner Eileen , McGovern Ruth
Published: May 2014

A greater awareness of problem drinking is needed.
Identifying Parkinson's disease
Authors: Warburton Louise
Published: May 2014

Other conditions that mimic Parkinson's disease can make diagnosis tricky.
Bringing entrepreneurship to urgent care
Authors: Lepper Joe
Published: May 2014

A nurse-led social enterprise is providing emergency and rapid response cover in London.
Women's health - Advising on contraceptive alternatives to the Pill
Authors: Cruse Alison
Published: May 2014

Women should be given advice on the full range of contraceptive options available to them.
Tackling threadworms
Authors: Stevenson Jane
Published: May 2014

Hygiene measures are important to break the cycle of infection, writes Jane Stevenson.
Clinical Focus - Open angle glaucoma
Authors: Vafidis Gilli , Levin Samantha
Published: May 2014

Glaucoma is the world's most significant cause of preventable, irreversible blindness. In the UK it accounts for 10-15 per cent of registrations for sight impairment and 500,000 people live with the disease.
Monitoring child growth
Authors: Dodds Rosie
Published: May 2014

New WHO child growth charts have been adopted in the UK, covering the period from birth to four years. Rosie Dodds explains.
Practical prescribing - Repeat prescriptions
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issue for nurse prescribers
The role of chaperones in health
Authors: Edwards Marilyn
Published: May 2014

Patients have the right to request a chaperone when with a health professional.
PVL-associated S aureus infection
Authors: Duncan Debbie
Published: May 2014

With community-acquired cases on the rise overseas, it is important for nurses to know how to screen for and treat this infection, Debbie Duncan argues
Managing weight in adolescence
Authors: Pryke Rachel
Published: May 2014

Parental support can help adolescents manage their weight.
Managing Parkinson's disease in primary care
Authors: Robinson Gina
Published: May 2014

Primary and secondary care can work together to ensure that patients with Parkinson's disease receive optimal care.
Clinical focus - Back pain: acute/sub-acute
Authors: Ritchie Mark
Published: May 2014

The first in a two-part clinical review of lower back pain.
Case study - Self-monitoring blood glucose
Authors: Cornforth Amber
Published: May 2014

Step-by-step tuition with written advice is key.
Contraindications to the COC
Authors: Gupta Geetika
Published: May 2014

The results of a practice audit highlight the need for regular review.
Becoming a freelance nurse
Authors: Cornforth Paul
Published: May 2014

Becoming self-employed is a viable option for primary care nurses, writes Paul Cornforth.
The role and regulation of healthcare assistants
Authors: Lepper Joe
Published: May 2014

The lack of clarity about the HCA role must change.
Practical prescribing - CPD for nurse prescribers
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Microcytic anaemia
Authors: Barroso Ana Filipa
Published: May 2014

Contributed by Dr Ana Filipa Barroso, research fellow in obstetric haematology at Barts and the London NHS Trust.
Moderate acne: a case study
Authors: Van Onselen Julie
Published: May 2014

Helping patients to manage acne requires a sensitive approach and an understanding of its severity and cause.
Understanding the risks of osteoporosis
Authors: Pryke Rachel
Published: May 2014

Prevention measures for osteoporosis should begin in childhood.
Practical prescribing - Prescribing in a hospital setting
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Help to protect home nursing
Authors: Bradby Matthew
Published: May 2014

Nurses can take practical actions to support a new campaign, writes Matthew Bradby
Diagnosing the cause of vaginal discharge
Authors: Feder Angie
Published: May 2014

The cause of abnormal vaginal discharge can be infective or non-infective. Angie Feder advises on how to reach a diagnosis.
Practical prescribing - Vaccinating using a Patient Specific Direction
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Diagnosing the ‘missing millions'
Authors: Barr Fiona
Published: May 2014

The COPD strategy will be nurse-led, focusing on prevention and undiagnosed patients.
Raised ferritin
Authors: Galloway Mike
Published: May 2014

Contributed by Dr Mike Galloway consultant haemotologist, Sunderland Royal Hospital
Support networks for community matrons
Authors: Lillyman Sue , Saxon Ann
Published: May 2014

Reflective practice helps professional development.
Meeting the health needs of children
Authors: Lepper Joe
Published: May 2014

Health professionals must work closely with children's centres.
The role of compression bandaging in oedema
Authors: Muldoon Jeanette
Published: May 2014

High compression bandaging remains the gold standard for treating venous disease and chronic oedema, Jeanette Muldoon writes
Using violence risk markers
Authors: Frith Sue
Published: May 2014

New guidance brings clarity and consistency to recording incidences of violence.
Supporting the development of future clinical leaders
Authors: Carnall Ruth
Published: May 2014

The development of high-quality clinical leaders for the NHS will not occur by accident.
Providing a community rheumatology service
Authors: Archer Alison
Published: May 2014

An innovative nurse-led service for patients with inflammatory arthritis is providing specialist care in a community setting.
Keeping safe in the sun
Authors: Anguita Maria
Published: May 2014

Although being outdoors and enjoying sunshine is part of a healthy lifestyle, the public needs to be aware of the risks of overexposure.
The assessment of stable heart failure
Authors: Thackwray Jane , Walton Anita
Published: May 2014

Assessing medical and cardiac history, comorbidities, signs and symptoms is essential for effective care.
Implants as a safe contraceptive option
Authors: Rogers Melanie
Published: May 2014

Bad press surrounding Implanon should not deter women from choosing its successor, Nexplanon, as their contraceptive option.
Psychological aspects of erectile dysfunction
Authors: Pete Ian
Published: May 2014

Both physical and psychological factors can cause erectile difficulties. History-taking is important for effective treatment and care, argues Professor Ian Peate
Cystic fibrosis: the nurse specialist's role
Authors: Madge Su , Dack Kamilla , Peres Alan
Published: May 2014

Multidisciplinary teams, particularly clinical nurse specialists, play a key role in supporting patients to reach their potential.
OSA and diabetes
Authors: Sweeting Helen
Published: May 2014

Practice nurses can assess and treat obstructive sleep apnoea as a co-morbidity of type-2 diabetes.
Ankylosing spondylitis
Authors: Watkins Jean
Published: May 2014

Ankylosing spondylitis is an inflammatory disease of the spine that leads to pain and irreversible disability.

The most common presentation is lower back pain and stiffness.

Current treatments aim to reduce inflammation and joint destruction.

Ankylosing spondylitis should be considered in patients presenting with lower back pain.
Intermittent claudication
Authors: Palfeyman Simon , Fenwick Nikki , Trender Hazel
Published: May 2014

Nurses should be alert to the signs of intermittent claudication to prevent it progressing to CVD.