bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospice nurses' perceptions of caring for patients with a non-malignant diagnosis: a single-site case study
Authors: Balasubramanian Sundar , Read Sue
Published: May 2014

In the early stages of its development in the UK, palliative care focused almost exclusively on the care of patients with cancer, with efforts concentrated on relieving distressing physical symptoms in the last few weeks of life—often referred to as terminal care. It is increasingly expanding to include non-malignant conditions, but is still predominantly accessed by cancer patients. This paper presents findings from a small-scale qualitative study into nurses' experiences of providing hospice care for patients with a non-malignant diagnosis. Two focus groups were conducted with nurses in one established UK hospice. The results highlight the importance of timely educational preparation, the need for proactive thinking regarding the shifting medical profiles of health care in the UK, and the need for hospice managers to critically consider existing infrastructures (including supervision and support) in anticipation of diverse patient populations. The paper also reiterates that collaboration remains the key to effective support.
Promoting health and wellbeing at the end of life: the contribution of care pathways
Authors: Allen Michael , Watts Tessa
Published: May 2014

Enhancing end-of-life care (EoLC) is a core component of international governments’ health policies. Across the globe, nurses make significant contributions to EoLC and, at this delicate time, have the power to positively influence the health and wellbeing of those facing death. Indeed, health promotion is a core component of the nurse’s role. Originating in the UK, EoLC pathways have been adopted around the world. Their broad aim is to optimise the quality of the dying process, enabling people to ‘die well’ across care settings. This paper examines EoLC pathways in terms of promoting health and wellbeing in this discrete stage of the dying trajectory. Concepts of health and health promotion are described briefly and the idea of health-promoting palliative care and its association with a good death examined. The ensuing discussion relates to two EoLC documents. While acknowledging that much has been achieved it is argued that, despite the potential for promoting health and wellbeing, a professionally led, biomedical approach predominates, and in terms of promoting health and wellbeing at the end of life there is a pressing need for proactive advance care planning at an earlier point in the illness trajectory.
A profile of hospice-at-home physiotherapy for community-dwelling palliative care patients
Authors: Cobbe Sinead , Nugent Kathy , Slattery Sinead , Lynch Margaret , Real Shirley
Published: May 2014

Aim: To profile a specialised palliative care physiotherapy service to community-dwelling patients. Design: Retrospective audit. Setting: Milford Care Centre, Limerick, Ireland. Participants: Patients referred to hospice-at-home physiotherapy during September 2010–February 2011. Outcome measure: Edmonton Functional Assessment Tool (EFAT-2). Results: 165 patients were referred, of whom 90% had cancer. Nurses referred 120 (73%). Referrals appeared to be increased by the presence of physiotherapists in the nursing bases. No asssessment was conducted for 55 referrals (33%), mainly owing to clinical deterioration. The remaining 110 patients were assessed, with 47 (43%) being contacted within 2 days of referral (mean 4 days, standard deviation 4.2, range 0–21 days). Physical function ranged from 0–18 (median 7, mode 4) on the EFAT-2 scale. The most commonly used treatments were exercises and advice/education. Conclusion: Referrals to the at-home physiotherapy service are heavily dependent on nurses and their understanding of the physiotherapy role. Patients tended to be relatively high functioning and tolerated numerous interventions.
Politics and palliative care: Chile
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Outcomes of a nurse-delivered psychosocial intervention for weight- and eating-related distress in family carers of patients with advanced cancer
Authors: Hopkinson Jane B , Fenlon Deborah R , Foster Claire L
Published: May 2014

Background: International expert consensus is that psychosocial intervention is likely to help advanced cancer patients and their family carers affected by weight loss and poor appetite. Purpose: To investigate the potential for a psychosocial intervention, the Macmillan Approach to Weight and Eating (MAWE), to mitigate weight- and eating-related distress in carers of patients with advanced cancer. Method: A controlled before and after study was conducted with carers of advanced cancer patients living in the community in the South of England in 2006–7. It used mixed methods to compare carers exposed to MAWE (n=12) with a control group (n=14). Results: Weight- and eating-related distress improved in carers exposed to MAWE. Qualitative analysis found that MAWE may help carers by providing information, reassurance, and support for self-management. Conclusion: This preliminary study of MAWE suggests that it provides benefits as a supportive intervention. Further testing is warranted using a more robust experimental design.
Politics and palliative care: Myanmar
Authors: Smyth Dion
Published: May 2014

Dion Smyth's review of the internet for palliative nursing
Gait aid use by ambulatory older people in a residential setting: a descriptive exploration
Authors: Watson SC , Chipchase LS , Mackintosh SF
Published: May 2014

The aim of this study was to describe the use of gait aids by ambulatory older people in a residential care setting. A cross-sectional exploration generating both qualitative and quantitative data was undertaken in a South Australian low-care population (n = 31). Demographic data were collected via case note review. Type of aid, mode of use and reasons for gait aid use were investigated via a structured face-to-face interview.

Results identified four discrete groups of gait aid users in this population: those who used no aid (n = 5), those who used a stick only (n = 7), those who used a frame only (n = 13) and those who used both a stick and a frame (n = 6). In total, 31% of gait aids were self-prescribed and 33% of frames were used inappropriately. A vast range of psychosocial and behavioural factors was described by subjects to influence gait aid type and use. These findings suggest that self-prescription by older people may indicate alternative underlying needs that may be better met by therapeutic interventions other than gait aid prescription.
Preparing patients to self-manage faecal continence following spinal cord injury
Authors: Pryor Julie , Jannings Wendy
Published: May 2014

Spinal cord injury is catastrophic and there is much to learn for the injured person. During inpatient rehabilitation in Australia, it is the responsibility of the nurse to teach the patient to care for him or herself. One of the components of this self-care is the management of the patient's newly acquired neurogenic bowel. However, readiness and motivation to learn about this may be missing or weak, and non-adjustment to the injury may initially impair the patient's learning.

Astute assessment is therefore needed to determine the person's learning ability. As a result, the bowel management programme can be adjusted accordingly to either meet the needs of a self-directed learner or a dependent learner. Whichever the case, well designed education materials will facilitate patient learning and the transfer of education from inpatient to community settings. This article highlights the complexity of preparing patients with spinal cord injury for the self-management of faecal continence.
Physiotherapy for people with Parkinson's disease in the UK: an exploration of practice
Authors: Ashburn Ann , Jones Diana , Plant Rowena , Lövgreen Brenda , Kinnear Elizabeth , Handford Felicity , Loader Sue
Published: May 2014

The aim of this study of physiotherapy in Parkinson's disease was to identify current baseline activity and opinion on best practice to inform a model for future evaluations. The two-phase study comprised a Delphi survey of specialist physiotherapists (n=49) followed by case studies of best practice sites (n=9), involving interviews with professionals (n=29) and patients (n=30) and a documentary analysis of patients' notes. There was strong consensus that physiotherapy was optimized within a multidisciplinary context, that treatment (which was eclectic in nature) aimed to maximize functional ability and that outcome should be assessed at this level. Patients and carers were able to identify physical, psychological and social benefits of physiotherapy.

This study was a first step in a coordinated drive to link research to practice. The subsequent development and review of Guidelines for Physiotherapy Practice in Parkinson's Disease will inform the current National Institute for Clinical Excellence Parkinson's disease guidelines exercise.
Driving after stroke: A study of recollection of advice and compliance with guidelines
Authors: Johnston J , Chaudhuri M Datta , Stocks SJ , Dey P
Published: May 2014

Following a stroke, patients may have deficits that affect their ability to drive. The Royal College of Physicians recommend that health professionals provide advice to promote adherence to Driver and Vehicle Licensing Agency (DVLA) guidelines.

The authors surveyed 46 participants who had had a stroke at least 1year ago to determine whether they received and complied with current advice. When compared to those who did not receive advice, those who did were significantly more likely to obtain medical permission before driving, but there were no significant differences in the frequency with which they complied with other recommendations. Many who notified the DVLA benefited from an assessment. Driving status and advice should be recorded in medical records and hospital staff should emphasize the positive benefits that may follow assessments and compliance with current guidance.
Horsemastership part 1: Therapeutic components and link to occupational therapy
Authors: Lee Young Rhona
Published: May 2014

Since mythology, the horse has been referred to as a healer and a helper of humans. Yet, it is only within the past 50 years that the horse has truly been recognized as having therapeutic value. Horsemastership, a generic term defined as ‘the care, maintenance and use of the horse in all pleasure and commercial activities’, has potential to be used as a therapeutic medium. Indeed, horsemastership is successfully used as a therapeutic medium for young adults (16–25 year olds) with additional needs at the Fortune Centre of Riding Therapy, a residential specialist college based in the New Forest. Despite this, however, the existing literature to support this specialist area is minimal.

The first part of this article takes a comprehensive view of horsemastership by discussing all the distinct aspects that can be used as a treatment medium for people with additional needs. The skills and knowledge of the occupational therapist are also applied to highlight the potential involvement and role that the occupational therapy profession has to offer in this field.
Assessment for and provision of positioning equipment for children with motor impairments
Authors: Hong Chia Swee
Published: May 2014

Posture is a dynamic process that underpins movement and function. Appropriate positioning for children with a motor impairment, such as cerebral palsy, is essential. Careful assessment is needed to ensure the provision of the most appropriate piece of equipment to enable correct positioning.

This article considers some of the factors that may cause postural control problems and their functional implications. It explores the basic process involved in assessing a child for appropriate equipment and provides an overview of the latest equipment on the market to enable supine, side lying, prone, sitting and standing positions.
A comparison of Finnish and British rehabilitation curricula
Authors: Lukkarinen Hannele , Lahtinen Mari
Published: May 2014

The purpose of this research was to assess a Finnish and a British curriculum of rehabilitation by means of benchmarking. The following aspects were assessed: the basic purpose of education; the qualifications provided by the educational programme; the objectives of education; the curricular model; the study modules and their contents; the coursework practices; and the evaluation and development of the curriculum.

According to a comparative assessment, the Finnish and British curricula had the same underlying starting point: in both countries, rehabilitation is regarded a societally topical and multidisciplinary issue that is addressed in the educational programme. The studies are based on different systems of credit units and scores, but after a standardization of scoring, the programmes are mutually comparable and roughly correspond to each other

There is, however, a significant difference in the two curricula: the structure of the study modules. Finnish study modules are practical-based and focus on the experiences of different individuals, groups of patients and health professionals. The education focuses on rehabilitation issues and aims to enhance students' awareness of and competence in certain target areas of practice. The British study modules are more research-based; the focus is on the scientific approach and the ways to produce knowledge. The British curriculum risks ignoring practical issues surrounding individual patients and therapists, but its focus on research-based practice means that practice is logically and consistently structured. The Finnish curriculum focuses on issues surrounding therapists and patients but risks becoming fragmented, as rehabilitation can be studied from many different scientific perspectives.
Teaching evidence-based practice: A survey of UK's higher education provision
Authors: Dewey A , Dean T , Ward D , Harris J
Published: May 2014

Evidence-based practice (EBP) ensures that clinical health management decisions are based on valid, reliable and relevant evidence determined by sound research and evaluation. It is a key element of both the clinical governance and clinical effectiveness agendas. Clearly, there is a need to provide adequate educational and professional attributes to meet this increasing demand.

The aim of this research was to identify and map all UK postgraduate courses that focus on EBP within health- and social-care services. Electronic searching of internet databases and all UK postgraduate electronic prospectuses using the broad term ‘evidence based’ was undertaken. Course details and prospectuses were obtained and reviewed, where available.

In total, 12 postgraduate courses were identified. These could be broadly categorized into two distinct groups: five courses focused on health-care sciences designed for multidisciplinary health professionals and seven targeted clinical specialities. UK universities therefore provide relatively few courses in EBP. Two models of EBP education appear to be developing, which either specifically target EBP as a separate component of the curriculum or integrate into existing subjects. Further evaluation is needed to determine the relative merits of each.
A 1-year study of gait characteristics in diabetes: The impact of rosiglitazone
Authors: Petrofsky Jerrold , Lee Scott , Cuneo Maria , Dial Russell , Sanchez Marty , Kwan Sam
Published: May 2014

Fifty subjects diagnosed with type 2 diabetes and 30 subjects with no history of diabetes (controls) were examined to assess their gait characteristics during the initiation of gait, gait in a linear path and during turns. Gait characteristics were measured by pressure sensors in the shoes, accelerometers on the knees and the electromyogram from the medial gastrocnemius and tibialis anterior muscles.

Thirty subjects with diabetes (D1) and 20 control subjects (C) were followed for a period of 1year to see if gait changed over that period, especially in the diabetic population. Twenty additional subjects with diabetes (D2) were placed on the insulin sensitizer rosiglitazone (RSG) – a drug known to also improve vascular endothelial function – and were also followed for 1year.

The results showed that D1 had more unsteadiness in their gait; they walked more slowly and with more circumduction (lateral movement during the swing phase) than did C. D1 also showed greater muscle use and co-contraction of agonist and antagonist pairs of muscle during gait when compared to controls. While the controls showed no difference in gait over the year, D1 showed deterioration in gait and D2 showed improved gait over the 1year. Thus, diabetes seems to continually deteriorate gait unless a drug like RSG is given. When RSG was administered for 1year, the velocity of gait, circumduction and muscle use was increased to near that of the age-matched controls.
The community rehabilitation unit in Leeds: A resource for people with long-term conditions
Authors: O'Connor Rory J , Best Meriel , Chamberlain M Anne
Published: May 2014

Community rehabilitation is a well established and valuable part of the service response to the needs of people with long-term conditions. The authors explored the value of a Leeds-based community rehabilitation programme, before more formal evaluation, through two case reports of people living with long-term neurological conditions.

Interventions were delivered not only in patients' homes and an outpatient rehabilitation department, but also in a facility where patients can stay overnight and access 24-hour nursing support and daily therapy input. This facility is not present in many parts of the country. Two women with a range of impairments received complex multidisciplinary interventions, incorporating repeated systematic analyses of problems by various combinations of professionals, with treatment delivered over several consecutive days across several rehabilitation disciplines. The particular benefit of the short period of focused inpatient treatment, where sustained interventions are given simultaneously by staff with complementary skills to enhance an individual’s function and maximize the gains provided by other parts of the service, is highlighted.

These cases illustrate how a range of interventions, including short inpatient admissions, can be provided in a community setting to enhance participation.
The music therapy assessment tool for low awareness states
Authors: Daveson BA , Magee WL , Crewe L , Beaumont G , Kenealy P
Published: May 2014

Many existing assessment tools for patients in low awareness states involve language functioning capabilities. Information regarding the construction and validity of a new assessment tool that relies on music, called the Music Therapy Assessment Tool for Low Awareness States (i.e. MATLAS), is presented in this paper.

A total of nine assessments, involving eight patients, were examined. Results from the investigation of scores from three tools: the MATLAS, the Sensory Modality Assessment and Rehabilitation Technique (SMART), and the Wessex Head Injury Matrix Main Scale (WHIM)), as administered by multidisciplinary staff, were analysed, and the MATLAS was found to have good validity with these measures.

While limitations involved in this work prevent conclusions about the validity of the MATLAS being drawn, they support the need for further research, and indicate that MATLAS may be a valid tool to assist with multidisciplinary assessment of such patients.
Emotional intelligence training in adjustment to physical disability and illness
Authors: McKenna Jacqui
Published: May 2014

Reactions to chronic illness and disability include experience of negative emotions, and these are linked to poor psychosocial adaptation and disability-related stress. The individual's cognitive appraisal of the disability infl uences both emotional response to and management of self, therefore managing these emotions will be central to the rehabilitation process.

Emotional intelligence describes the ability to understand, perceive, use, and manage the emotions of self and others. This article explores the concept and suggests how the occupational therapist can enable the emotional adjustment of an individual coping with physical disability or illness through emotional intelligence training. It is suggested that the training and facilitation of emotional intelligence abilities can be developed in an effective therapeutic relationship and by engagement in specifi c therapeutic activities in an occupational therapy programme. Research into application of emotional intelligence training in occupational therapy is suggested to explore these ideas further.
Testing of the short self-efficacy and outcome expectations
Authors: Resnick Barbara , Shaughnessy Marianne , Whitall Jill , Michael Kathleen , Nahm Eun Shim , Orwig Denise , Kopunek Sue , Macko Richard
Published: May 2014

The purpose of this study was to test the reliability and validity of the short outcome expectations for exercise (SOEE) and short self-efficacy expectations for exercise (SSEE) scales in a sample of adults recruited into two exercise intervention studies for patients post stroke. A total of 157 individuals, 90 males (56%) and 67 females (43%) with an average age of 63.7 (SD=12.3) years participated in the study.

There was evidence of internal consistency for both scales based on alpha coefficients and Rasch Model testing estimates of person and item separability, evidence of test re-test reliability with no change in scores over a 6-week period, and some support of reliability based on R2 estimates. There was evidence of validity of the measures based on confirmatory factor analysis using structural equation modeling and Rasch measurement model testing, and convergent validity testing. There was some evidence of convergent validity based on a statistically significant relationship between selfefficacy and outcome expectations, and both of these measures with physical health status.

The study provided some preliminary evidence for the reliability and validity of the SSEE and SOEE when used with adult stroke patients, and suggested revisions for subsequent use of these measures are provided.
Circuit class therapy versus one-to-one therapy sessions
Authors: English Coralie
Published: May 2014

Physiotherapists and occupational therapists have long believed that one-to-one therapy sessions are essential for individuals recovering from stroke. Is it time for this belief to be challenged?
Inclusive design of tools for daily living
Authors: Swann Julie
Published: May 2014

All humans, irrespective of their age or environment, use tools to facilitate daily living tasks. Humans are not the only species to use tools, and the use of tools to assist those with disabilities is not a modern day concept. However, the development of new materials, mass production, transportation, technology and communication has helped to develop a wide range of assistive equipment for people with disabilities.

This article examines the history of assistive equipment and how the concept of inclusive design has contributed to its development. It then explains why society should encourage the development of more inclusive design features and how therapists can be involved in this process.
The JCM Moonlite Sleep System: Assisting in the provision of 24-hour postural support
Authors: Collins Fiona
Published: May 2014

Children and adults with mobility problems often suffer with contraction of unused muscles, which can consequently pose a risk to joint stability. Both contraction and joint instability can be extremely painful, leading to among other issues, poor quality of sleep. Although seating provision attempts to maintain appropriate posture during the day, suitable equipment provision must also be considered for the night. Sleep systems aim to provide appropriate support, promote postural symmetry and increase quality of sleep.

This article discusses the Moonlite Sleep System, manufactured by JCM. It describes the features and benefits of the system and summarizes client feedback to date.
The Bercow Report: Meeting children's speech, language and communication needs in the UK
Authors: Rogers Rosalind
Published: May 2014

Speech and language therapists (SLTs) in the UK were asking this question in the winter of 2007. John Bercow is the Conservative party champion for better speech, language and communication services in the House of Commons. His importance to SLTs was that he had been selected to lead a high-level review of services for children and young people with speech, language and communication needs (SLCN) in England. This had been commissioned by both the Department of Health (DH) and the Department for Children, Schools and Families (DCSF). Therefore there was a real opportunity to have infl uence at the highest level, where traditionally there has been a lack of shared understanding between these departments. This has previously led to separate policies, divergent practices and priorities for resources, which has created tension for SLTs who—;although normally employed by health services—;wish to work in partnership with teachers to facilitate children’s access to the curriculum.
Help-seeking for medically unexplained hearing difficulties: A qualitative study
Authors: Pryce Helen , Wainwright David
Published: May 2014

Aims

Up to 10% of audiology patients report diffi culties hearing speech in noise even though clinical investigation reveals normal hearing thresholds, in other words, no evidence of physical pathology. The diagnostic category applied to these patients is known as King-Kopetzky Syndrome (KKS). This study aimed to gather descriptions of patients' experiences of the clinical encounter involving their KKS diagnosis and analyse the themes of help-seeking, as part of a larger study into the process of coping with medically unexplained hearing diffi culties.

Method

A qualitative approach was employed, comprising unstructured interviews in the homes of 25 patients who had attended audiology services (and received a diagnosis of KKS) in Bath and Cardiff. Thematic analysis of transcripts was undertaken, infl uenced by grounded theory techniques.

Findings

Informants characterized the clinical encounter as either negative or positive. Negative consultations were those in which patients' illness claims were dismissed and as such not validated. Positive encounters were typifi ed by the provision of meaningful information that reconciled clinical information with the patients' experiences of hearing loss.

Conclusion

Successful management of medically unexplained illnesses requires the adoption of a patient-centred approach, rather than focusing on the absence of observable pathology
Occupational therapy research: Where do we take it from here?
Authors: Bonsaksen Tore , Brown Ted , Voigt-Radloff Sebastian
Published: May 2014

The 8th European Congress in Occupational Therapy took place in Hamburg, Germany, in May 2008. In addition to the many varied lectures and workshops in diverse fields of occupational therapy (OT) practice, the congress provided opportunities to reflect on the context of OT research in Europe. One such opportunity was provided in a workshop organized by van Nes et al (van Nes et al, 2008). Following this, topics generated from the congress workshop were discussed further, to initiate a debate concerning future OT research (Brown et al, 2008; unpublished work). Here, the authors who were involved in this workshop outline a possible direction for future OT research efforts.
Baby boomers' use and perception of recommended assistive technology
Authors: Steel Dianne M , Gray Marion A
Published: May 2014

Aims

The aim of this study was to enhance the understanding of the baby boom generation's use and perception of recommended assistive technology.

Methods

A mixed quantitative and qualitative research design was employed, primarily based on a phenomenological framework. Literature was reviewed to provide an overview of the factors found to influence the use of assistive technology. Twelve patients (born 1946-1965 inclusive) from a regional Australian public hospital, who were recommended assistive technology upon discharge, were administered questionnaires. Semi-structured interviews were undertaken with four participants.

Findings

Eight participants followed recommendations to hire/purchase assistive technology. All of the participants who obtained recommended assistive technology stated they ‘used’ it. Cost was identified as influencing non-use.

Conclusions

There was some variation from the literature in factors that influenced use, highlighting the importance of further examination of baby boomers and assistive technology use. The importance of choice and the diversity of opinion shown within this study group reinforces the need for a focus on patient-centred practice and acknowledgement of individual needs in the prescription of assistive technology.
The availability and use of allied health care in care homes in the Midlands, UK
Authors: Sackley C , Hoppitt T , Cardoso K , Levin S
Published: May 2014

Aims

A review by an international charity for older people, Help the Aged, suggested that older people living in care homes in the UK do not receive the appropriate levels of access to health professionals. The authors aimed to establish the access to and use of services provided by allied health professions to care homes in Oxfordshire and Warwickshire.

Methods

A postal survey with telephone follow up of the use of and access to allied health-care services in 121 Oxfordshire and Warwickshire care homes was conducted using an established questionnaire.

Findings

The majority of homes reported using a chiropodist (91%), an optician (86%), hearing services (63%) and a physiotherapist (65%). Less than half of the homes reported using an occupational therapist (41%), a dietician (44%) or a speech and language therapist (39%). A third used an alternative therapist (35%) and a similar number (35%) a social activities organizer. There was inconsistency in the sources of funding and the reasons for referral, particularly regarding occupational therapy and the provision of aids and adaptations.

Conclusions

The expertise of allied health-care professions available in UK hospital and domiciliary National Health Service (NHS) settings is not evident or accessible in the care home setting unless funded privately. When taking into account the high levels of impairments in these settings, access would appear to be contrary to the UK National Service Framework for Older People, which suggests that the NHS will provide a universal service for all based on clinical need, not ability to pay.
Bilateral movement therapy post-stroke: underlying mechanisms and review
Authors: Tabak Rachel , Plummer-D'Amato Prudence
Published: May 2014

Aims

Up to 66% of individuals with stroke never regain functional use of their upper extremities. Bilateral movement training (BMT) is a task-specific rehabilitation technique that has recently been investigated for its influence on upper extremity recovery in individuals post-stroke. BMT is thought to affect the hemiparetic upper extremity by a phenomenon referred to as cross education, or the cross transfer effect.

Methods

This article reviews the theoretical accounts underlying the cross transfer effect and explain the means by which BMT may facilitate recovery of function in the hemiparetic arm. The current research evidence supporting the use of BMT as a therapeutic approach to stroke rehabilitation is discussed, and implications for clinical practice and recommendations for further research are presented.

Findings

Evidence is emerging that BMT improves impairments and function in people with hemiparesis after stroke. The main limitations of existing research on BMT include small sample sizes, varying initial impairment levels, and lack of control groups.

Conclusions

Future research needs to establish which individuals are most likely to benefi tfrom BMT, as well as the optimal dose of BMT, and whether BMT can be used as an adjunct to existing rehabilitation approaches for upper extremity rehabilitation.
Length of stay in an Australian stroke rehabilitation unit: a pilot study
Authors: Roberts Kate , Stiller Kathy , Harling Rachel
Published: May 2014

Aims

Length of stay (LOS) is an important consideration in rehabilitation, and it can be adversely affected by delayed discharge. The purpose of this prospective study was to document LOS, frequency of discharge delay, reasons for discharge delay and its impact on LOS.

Methods

Ninety-eight inpatients in a stroke rehabilitation unit were included in the study.

Findings

Sixty (61%) patients had a LOS that exceeded the Australasian Rehabilitation Outcomes Centre (AROC) benchmark LOS according to the Australian National Sub-acute and Non-acute Patient classification system. Twenty-five (26%) patients had delayed discharge resulting in a total delay of 886 days, with most of these related to delays in the provision of community services. When patients with discharge delay were factored out of analyses, LOS was still longer than AROC benchmark figures for 39 (57%) of the 69 patients without discharge delay.

Conclusions

The LOSs of the majority of patients included in this study were longer than the AROC benchmark figures, even when patients with discharge delay were factored out. Initiatives to address this problem include the implementation of a proactive computerized tool that will provide target LOSs and enable reasons for excessive LOS to be more closely examined.
Heterotopic ossification following cardiac arrest and hypoxic brain damage
Authors: Mackiewicz-Milewska Magdalena , Jung Stanislaw , Lach-Inszczak Sabina , Borland Steve , Szymku Iwona , Cieski Jakub , Cisowaka Adamiak Magorzata , Hagner Wojciech , Lasek Wladislaw
Published: May 2014

Aims

Heterotopic bone can cause restriction of movement when deposited in the soft tissues around joints. Neurogenic heterotopic ossification may follow brain injury. This article describes research into the incidence of heterotopic ossification after brain injury, and its impact on rehabilitation.

Methods

Thirty-nine patients who were admitted to the rehabilitation unit of University Hospital Bydgoszcz, Poland, after hypoxic brain injury due to cardiac arrest, were examined.

Findings

Six patients were identified as having developed heterotopic bone around one or more joints causing limitation of movement and delay in the rehabilitation process.

Conclusions

Heterotopic ossification occurs in up to 15% of patients following hypoxic brain injury. The development of the condition may often be missed clinically, and can hinder rehabilitation.
Social support and subjective health complaints in occupational rehabilitation
Authors: Øyeflaten Irene , M Gabriele Jeanne , B Fisher Edwin , R Eriksen Hege
Published: May 2014

Aims

The objective of this study was to examine differences in the social support rehabilitation patients received from rehabilitation staff and from support providers outside rehabilitation, and to examine the relationships between social support and the patients' reports of subjective health complaints (SHC).

Methods

A total of 131 patients (68% female, mean age 45 years) participating in a 4-week, inpatient, occupational rehabilitation programme were included. All patients completed questionnaires on demographic variables, SHC, and social support (Social Support Inventory, SSI) received from rehabilitation staff and from support providers outside rehabilitation. The factor structure of the Norwegian version of SSI was analysed identifying two factors; directive and nondirective social support.

Findings

Patients reported significantly more support from rehabilitation staff than from support providers outside rehabilitation, and they reported significantly more nondirective support compared to directive support. High directive support from providers outside rehabilitation was associated with more subjective health complaints.

Conclusions

Fully understanding the role of social support in health and well being will require attention not only to the source of support but also to its characteristics and nature, such as whether it is nondirective or directive.
An HIV mentorship programme for rehabilitation professionals: lessons learned from a pilot initiative
Authors: Solomon Patricia , O'Brien Kelly , Hard Julie , Worthington Catherine , Zack Elisse
Published: May 2014

Aims:

This article describes a pilot programme aiming to identify the strengths and challenges associated with a human immunodeficiency virus (HIV) mentorship programme for rehabilitation professionals.

Methods:

This unique pilot programme incorporated elements of problem-based learning, interprofessionalism and multiple mentoring models. A group of five physiotherapy mentees met initially with three clinician mentors, and three mentors who were persons living with HIV, for a one day workshop to develop relationships, identify learning needs and engage in learning through discussion of case scenarios. Subsequently they met formally every month via teleconference, over a five-month period, followed by a final one-day workshop. Qualitative evaluation included interviews and focus group methodology. Transcripts from these were analyzed through qualitative content analyses.

Findings:

Participants viewed the mentorship programme positively, in particular the networks they were able to establish, and learning from the mentors living with HIV. However, barriers to participation were related to scheduling and lack of support to devote time to the programme from the mentees' clinical managers. Other challenges related to the mentees' limited opportunities to implement new knowledge, and to difficulties in engaging in informal mentorship activities.

Conclusions:

Lessons learned from this pilot programme are of value to those interested in developing HIV-related mentorship experiences for rehabilitation health professionals or for those in other emerging areas of practice.
A study of perceived factors affecting patients' participation in outpatient stroke physiotherapy exercise in Nigeria
Authors: Olaleye Omowunmi , Suddick Kitty
Published: May 2014

Background/Aims: Stroke results in a range of disabilities, activities and restrictions which have been shown to benefit from physiotherapy rehabilitation and exercise. However there are numerous factors that prevent stroke patients from participating in their exercise programmes. The aim of this study was to explore the factors that were perceived to affect people with stroke in Nigeria in participating in their outpatient physiotherapy exercise.

Methods: Semi-structured interviews were used to explore the topic. The interviews were transcribed and analyzed using thematic analysis. Eight male participants with stroke who were attending outpatient stroke physiotherapy in Nigeria were recruited in December 2009.

Findings: The factors that were perceived to affect the participants' participation in their outpatient physiotherapy programme encompassed three dimensions: the internal and personal, the relational and experiential, and external factors. These dimensions were interconnected with the internal and personal factors being central to the participants' participation.

Conclusions: This study has provided an insight into the factors that were important for a small group of Nigerian men post-stroke who were receiving out-patient stroke physiotherapy. This can lead to further research that could assist in informing the development of clinical practice and services.
Comparing the effects of rhythmic auditory cueing and visual cueing in acute hemiparetic stroke
Authors: Chouhan Swati , Kumar Sanjiv
Published: May 2014

Introduction:

Every individual requires proper upper limb functions as well as proper walking balance to meet day-to-day demands. Some of the most common problems faced after stroke are balance problems, which, in turn affect the recovery of activities of daily living (ADL), mobility, and lead to an increased risk of falls. In addition, about 80% of all stroke survivors have an upper limb paresis immediately after stroke affecting gross motor and fine motor problems.

Objective:

To evaluate the effectiveness of rhythmic auditory stimulation and conventional treatment on gross motor, fine motor activities, and walking imbalance; to evaluate the effectiveness of visual cues and conventional treatment on gross motor, fine motor activities, and walking imbalance; and to compare the effectiveness of rhythmic auditory stimulation and visual cueing with conventional treatment on gross motor, fine motor activities, and walking imbalance.

Methodology:

Design-a randomised controlled trial of 45 participants in acute stage were recruited. The subjects selected for the study were randomly allocated using sealed envelopes into three groups Group A-rhythmic auditory stimulation and conventional treatment, Group B-visual cueing and conventional treatment, Group C-conventional treatment.

Outcome measures:

Dynamic gait index and upper extremity Fugl Meyer motor score.

Result:

After one month of therapy a comparison of the groups showed a statistically significant improvement in all three groups independently (P=<0.05 in Group A, B, and C). On comparing post scores between the groups, a statistically significant difference was found between group A and C, and group B and C data (P=<0.05).

Conclusion:

Both the therapies were effective for gross motor, fine motor, and gait imbalance in acute hemiparetic stroke.
Falls risk factors and healthcare use in patients with a low-trauma wrist fracture attending a physiotherapy clinic
Authors: O'Reilly Ciara , Keogan Fiona , Breen Roisin , Moore Alan , Horgan N Frances
Published: May 2014

Background:

Falls continue to be the most common cause of injury for those aged over 65 years of age. The aim of this study was to characterise multifactorial falls risk factors in participants who had sustained a low-trauma wrist fracture and identify their healthcare use.

Methods:

This was a case-control, observational study, incorporating a comprehensive multifactorial falls assessment on 41 consecutive adults between 55 and 80 years who sustained a low-trauma wrist fracture and were compared to 41 age-matched healthy controls. The assessments included falls history, balance, footwear, vision, lower-limb strength, cognition, self-efficacy and environmental hazards.

Results:

The mean age of the wrist fracture group was 67.3 (SD ± 7.0) and that of the age-matched controls was 68.5 (SD ± 5.7). There were statistically significant differences between the wrist fracture participants and the control participants in: the Timed Up and Go test (TUG) (P<0.002); the Modified Clinical Test of Sensory Integration and balance (M-CTSIB) (P<0.001); knee flexor strength (right: p<0.006, left: P<0.019); and cognition (P<0.009). There were higher levels of healthcare demands and medical interventions (referral to GP P<0.001; geriatrician P<0.04) and for further physiotherapy (P<0.001) for the participants following a low-trauma wrist fracture.

Conclusions:

The findings of this study highlight the need for a targeted falls prevention screening tool and intervention programmes for patients over 55 years of age who sustain a low-trauma wrist fracture.
Cervical disc herniation: Is the regression flawed by age? A case report
Authors: Di Ciaccio Emanuele , Polastri Massimiliano , Gasbarrini Alessandro
Published: May 2014

Introduction/aim:

Spontaneous regression of the herniated disc in the cervical tract is rare, and conservative treatment should be considered as a therapeutic option. This case study aims to describe the course of the recovery from cervical disc herniation (CDH) within a conservative care pathway using global postural reeducation (GPR).

Methods:

A 74-year-old Caucasian woman with a body mass index of 20.3 was diagnosed with CDH. She had a 4-month history of neck-arm burning pain and short-term dizziness. The treatment goals for the patient were: relief of her neck-arm pain; reduction of the dizziness; improvement in neck flexion and extension range of motion. The first treatment using GPR started 4 months after symptom onset and treatment was provided in an outpatient setting by the same physiotherapist each time. Eight, 1 hour therapeutic sessions were carried out weekly. The chosen exercises were: frog on the ground with upper limbs in abduction, and frog on the ground with upper limbs in adduction.

Results:

Two months after treatment initiation, neither flexion nor extension were painful, and the patient was able to perform movements that the symptoms previously compromised.

Conclusions:

This study is the first to describe the treatment of CDH in an older patient and the study raised two additional questions for further studies necessary to determine the effectiveness of GPR in this context. First, was the resolution described in this case report linked to a natural course? Second, is GPR effective for the treatment of CDH?
Diagnosis and management of tinnitus to help patients cope
Authors: Wareing Michael
Published: May 2014

Tinnitus is a common presenting symptom that can cause significant distress.
Forum boosts community links
Authors: Wild Sarah
Published: May 2014

Establishing a parents' forum can help build good relations in hard-to-reach communities.
Contemporary issues in the clinical management of HIV
Authors: Miles Kevin
Published: May 2014

HIV is now seen as a chronic condition needing long-term management. Kevin Miles surveys the issues involved in HIV care
An introduction to sleep disorders
Authors: King Martin
Published: May 2014

Problems with sleep dramatically affect health and may warrant structured care.
Recognising hearing loss in primary care
Authors: Mills Linda , Bartrop Pauline
Published: May 2014

Many factors can lead to hearing loss.
How to negotiate a pay rise
Authors: Applebee Kathie
Published: May 2014

Prepare your case before approaching your employer about a pay rise, and treat it as an objective request.
Case Study: Post-travel diarrhoea
Authors: Townend Mike
Published: May 2014

Gastrointestinal upsets are common in returning travellers.
Indoor allergies and strategies to reduce the allergen load
Authors: Brydon Mary J
Published: May 2014

This week is Indoor Allergy Week. Simple steps to reduce allergens in the home can help your patients.
How to negotiate a career break
Authors: Applebee Kathie
Published: May 2014

Career breaks can benefit both workers as well as employers, but must be planned with care.
The case for childhood pneumococcal vaccine
Authors: Polak Monika
Published: May 2014

Childhood vaccination against pneumococcal disease may benefit all.
How to tackle child continence
Authors: Welford Heather
Published: May 2014

A child's toilet problems may be very distressing, but nurses can offer help.
Renal services in primary care
Authors: White Caroline
Published: May 2014

Primary care workers are often unaware of renal disease.
Where do we stand with HRT?
Authors: Andrews Gilly
Published: May 2014

Confusion around HRT remains. Gilly Andrews outlines the benefits, risks and remaining uncertainties
Super-sized surgeries
Authors: Andalo Debbie
Published: May 2014

New style surgeries with a diverse range of services under one roof offer nurses integrated working in state-of-the-art premises.
Putting drugs on report
Authors: Raine June
Published: May 2014

Reporting adverse drug reactions can help to identify emerging medical safety issues.
Essentials of cluster headache
Authors: Kernick David
Published: May 2014

Careful diagnosis is vital in caring for patients who suffer cluster headaches.
Making the QOF work for patients
Authors: Wild Sarah
Published: May 2014

PMS practices may need to create bespoke quality frameworks.
Why teams and why now?
Authors: Jelphs Kim
Published: May 2014

In the first of a two-part series on teamwork, Kim Jelphs looks at how collaborative working can benefit nurses and improve patient care
Could heart surgery cure migraine?
Authors: Polak Monika
Published: May 2014

Dr Peter Wilmshurst, co-primary investigator for the MIST trial.
Networking pays dividends
Authors: Wells Sally
Published: May 2014

Practice nurse forums can prevent professional isolation and allow nurses to influence local strategy.