bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring outcomes of care in older people following a comprehensive assessment
Authors: Nancarrow Susan A 
Published: May 2014

The Australian Capital Territory (ACT) community health service successfully introduced a single point of entry and single assessment process for its community health services at the same time as the ACT government moved to outcomes-based funding. This article discusses an attempt to measure the outcomes of the single assessment process, which was part of a larger study to explore the practicalities of routine outcomes measurement in clinical practice. The aim was to investigate whether it is possible to introduce routine outcome measures for an assessment and complex intervention. A quasi-experimental design was developed, which involved the 3-month follow-up of all patients who underwent an assessment during a single month. Outcome measures included the Dartmouth Primary Care Cooperative Information Project (COOP) charts and achievement of patient goals. While the quantifiable outcomes improved slightly across some domains, one third of the participants developed new needs over the 3-month follow-up period. While the Dartmouth COOP charts were easy to use in this setting, rates of adherence to the tool were low, and the tool provided less valuable information than simply asking the clients whether they had achieved their goals. As a result of the project, the service introduced routine 3-month telephone follow-up to ascertain changes in health-care needs and the achievement of client goals. This study highlights the dynamic nature of older people’s needs and the need for ongoing monitoring and care, rather than a snap-shot assessment of outcomes, and makes recommendations for services attempting to introduce a comprehensive assessment process.
Clinical reasoning processes in physiotherapists' assessment of unilateral neglect: Part two
Authors: Plummer Prudence , Morris Meg E , Denisenko Sonia , Dunai Judith 
Published: May 2014

Physiotherapists do not always differentiate between the different types of unilateral neglect (ULN) when performing neurological assessments. This study explored the clinical decision-making processes used by 14 Australian neurological physiotherapists when assessing ULN after stroke. The method and background to this study was detailed in part one. Briefly, participants observed a videotape of an experienced therapist assessing a stroke patient with left ULN. The videotape was paused at intervals and participants recorded their thoughts pertaining to the patient at that time. Afterwards, physiotherapists were asked questions in relation to their clinical decisions and were instructed to classify the behaviour of the patient using a glossary of diagnoses. The findings revealed that physiotherapists used both hypothetico-deductive and pattern recognition models of clinical reasoning. Hypotheses concerning neglect were generated early in the assessment. Only a small number of physiotherapists were able to refine their neglect-related hypotheses in light of new information. Types of neglect were rarely considered in the decision-making process. Neglect behaviour was more precisely characterized when therapists were provided with the glossary. Although relevant cues were obtained for neglect-related hypothesis formation, a lack of specialized knowledge may limit the ability of physiotherapists to make detailed characterizations of neglect behaviour. A glossary comprising definitions of the different types of neglect improved the ability of clinicians to accurately characterize neglect behaviour, suggesting that education may enhance diagnostic reasoning ability of physiotherapists in the assessment of ULN.
Thinking outside the bed: Managing interface pressure
Authors: Norton Linda , Rappl Laurie , Sibbald Gary 
Published: May 2014

Bed rest has often been prescribed as a treatment for pressure ulcers. However, clients have expressed difficulty complying with this. It is clear that bed rest can cause a number of complications, including muscle atrophy, urinary tract infections, pulmonary emboli and decreased cardiac reserve, while there is no compelling evidence that bed rest is effective in the treatment of pressure ulcers. The long list of potential complications has highlighted a number of issues, including whether or not bed rest is an effective treatment and the difference between compliance, adherence and coherence. A comprehensive assessment will guide the choice of managing interface pressure. To address these issues, this article will provide an overview of the wound healing paradigm, explore whether or not bed rest is an effective treatment for pressure ulcers and examine alternatives for managing pressure throughout the client’s activities of daily living.
Horsemastership part 3: International perspectives of its therapeutic value
Authors: Young Rhona Lee , Bracher Maggie 
Published: May 2014

In previous opinion articles written by the authors, it has been proposed that horsemastership is an effective medium for therapy and education for young adults with additional needs. However, the existing research to support this proposal is informal and limited. Therefore, the first author carried out an international piece of research into the value of horsemastership to this group of people. A questionnaire using both quantitative and qualitative methods was completed by 21 professionals of various disciplines and countries who used horsemastership for therapeutic and educational purposes. This article gives a brief description of the methodology, including justification for the design selected, and discusses the relevance and implications of the results of this study. To pull together the three articles written by the authors, a final conclusion on the value of horsemastership to people with additional needs is drawn.
Assisting people with disabilities to bathe and shower
Authors: Swann Julie 
Published: May 2014

Some people with disabilities require advice, assisitive equipment or adaptations to their homes in order to be able to wash their bodies. A wide range of bathing and showering aids and specialist baths and showers is available to help with this personal care activity and it is important for occupational therapists to know what equipment is available so they can help service users to make an informed choice. This article explores some of the bathing and showering equipment currently available. It emphasizes the importance of empowering individuals to make the right choice for themselves. The key to providing a good service is to ensure that advice provided follows an appropriate assessment that takes into account individual needs.
Treating lower limb vascular claudication using community-based exercise rehabilitation
Authors: Abbassian Ali , Khan Aamir Z , Poulter Edward , Ransome Roseann , Thomas Paul R 
Published: May 2014

‘Claudication’ refers to pain experienced in the legs that is brought on by exertion, caused by relative ischaemia of the muscle. Exercise is effective in improving vascular claudication pain and walking distance. Despite this, community-based exercise rehabilitation programmes that are directly available to GPs are almost unknown in the UK. In this pilot study, the authors assess the practicalities of setting up such a programme and evaluate its efficacy. Patients with stable claudication for whom exercise was not contraindicated were enrolled into a twice-weekly exercise programme for up to 8 months (n=20). This was supervised by one of the authors with experience in exercise rehabilitation. Outcome measures included the Six-Minute Walk Test (6MWT) and the Short-Form-36 (SF-36) questionnaire. The average walking distance as measured by the 6MWT increased by 16.3% (P=0.001). There was also a 23.5% increase in the average score of the physical functioning domain of the SF-36 (P=0.007). Community-based exercise rehabilitation for lower limb claudication is safe and effective, with high compliance and attendance rates. Walking distances increase both objectively and subjectively. Patients also become more able to cope with claudication pain and show improvements in their physical function. If these programmes are available to primary care groups, the majority of patients can be managed in the community, reducing the workload of consultant-based hospital services.
Availability and use of patient handling sliding devices
Authors: Gallagher Paula , Flynn Claire , Dockrell Sara 
Published: May 2014

Although some research has been carried out on patient handling aids, there is a lack of studies focusing on sliding devices. This questionnaire survey investigated the availability, use and criteria for use of sliding devices, along with training received. Sliding devices were available to the majority of respondents (88%) and 81% of these respondents who had these devices available for use actually used them. Only 26% of respondents had specific criteria on which their decision to use a sliding device was based. Most (92%) respondents had received training in the use of sliding devices. Safety in the use of this equipment gives rise to some concern, as some respondents had never received training but were using the sliding devices. Because of their wide availability, further research into the use of sliding devices by nurses and other health professionals is required.
Expert physiotherapists' clinical decision-making in acute care. Part two
Authors: Prentice CE , Chipchase L 
Published: May 2014

The evaluation of patients' functional outcome and mobility status is of critical importance to all physiotherapists, including those practising in acute care. However, the difficulty in attributing aspects of improvement to physiotherapy intervention has made outcome measurement a complex process. Furthermore, a general literature search failed to identify an immediately appropriate evaluative outcome measure to guide physiotherapists' reasoning or monitor patients' in the acute care setting. Without adequate instruments to measure intervention efficacy for clinical and research purposes, it is difficult to implement evidence-based practice. Part two of this article series presents findings on outcome measurement derived from the focused ethnography in-depth interview methodology described in part one. Recommendations to improve physiotherapists' functional outcome evaluation in acute care are discussed. The use of individualized/patient-specific measures of either items of impairment or activity limitation are suggested, as scored from the physiotherapists' perspective.
Bathing and showering equipment: A product guide
Authors: Fernandes Tanya 
Published: May 2014

Bathing should be seen as a pleasant and relaxing experience for all those concerned. This should not be any different for a child with a disability. Bathing and showering equipment tailored to meet the specific need of the child and the extent of the disability can ease the burden on the carer and encourage the independence of the child. This article explores the range of assistive products available on the market and the factors that need to be taken into consideration before purchasing such equipment.
A dynamic and comprehensive practice model of paediatric feeding practice
Authors: Fayed Nora , Berall Glenn , Dix Louise , Judd Peter 
Published: May 2014

Feeding impairment is a complex problem impacting the health, development, and the nutritional status of many individuals in the paediatric population. Prevalence rates of feeding impairment span a wide range between 30–80% of children with neurological diagnoses (Field et al, 2003; Schwartz, 2003). Conversely there is sparse practice information available to guide professionals working on feeding teams on how to function effectively to deal with the problem. This report will provide a procedural example of a practice model that incorporates a dynamic team approach and comprehensive service delivery. The model is based on an innovative practice-driven feeding assessment procedure that integrates medical and rehabilitative perspectives. Discussion of the advantages, disadvantages, and future directions for the model will also be presented.
The role of the occupational therapist in attention deficit hyperactivity disorder:
Authors: Young Rhona Lee 
Published: May 2014

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that can significantly interfere with all aspects of occupational performance, i.e. the interaction of the individual's mental, physical, sociocultural and spiritual skill components within an environment (Hagedorn, 2000). Given that ADHD can have a significant impact on individuals' overall function, occupational therapy (OT) input should have a primary role in the assessment and intervention for ADHD. This article gives a descriptive account of the author's experience of undertaking a specialist OT post for the Scottish Borders ADHD service. The benefits gained from having specialist OT input in the service are highlighted and approaches used by the OT in the assessment and intervention for ADHD are discussed.
Telecare: Looking to the future
Authors: Swann Julie I 
Published: May 2014

A new age is emerging with regard to the type and range of care services being delivered. An explosion of technological advances, creatively applied to health and social care provision, can enhance the lives of people of all ages. With an increasing ageing population, the benefits of these developments could lead to better outcomes for people as well as being more affordable than the traditional models of care. These advances, however, do open up new ethical challenges that must be addressed. This article will explore the opportunities and challenges involved in using telecare in today's health-care climate and provide examples of the types of products available.
Rehabilitation in mental health: A context for health professionals
Authors: Kennard Jerry 
Published: May 2014

The factors that cause or generate social exclusion are complex and multi-faceted. Research into social xclusion does not include rigorously controlled studies, but embraces qualitative, quantitative and mostly descriptive methods from the best quality material available to provide a narrative review that is both systematic and transparent. As part of their Breaking the Cycle series, a review of literature confi ned to the last decade was commissioned by the Social Exclusion Unit (SEU) via the Offi ce of the Deputy Prime Minister. Nine domains of social exclusion were included in the subsequent report, one of which was health. The health domain was itself sub-categorized into six areas, one of which was mental health. This article reflects further on details submitted to the SEU, relating mental health to healthy living. The focus is on mental health promotion and the relationship between physical exercise and mental health. The article looks at public perception of mental health and its impact, and the evidence for physical activity in improving mental health outcomes. Health professionals may interpret the issues within their own remit for rehabilitation and research. The key point summary aims to provide a platform for further discussion and possible action.
The HydroTilt Armchair: Meeting complex seating requirements
Authors: Collins Fiona 
Published: May 2014

This article explores the difficulties encountered by people with seating needs, whose requirements cannot be met by more conventional armchairs. Such people often have limited ability to remain independently seated within the chair and also are at high risk of developing pressure damage. This paper discusses the features of the HydroTilt armchair and provides case examples which demonstrate the different situations in which the chair may be used.
A survey to e xplore the negative social evaluation of patients by physiotherapists
Authors: Housley Georgie , Thomson Diane 
Published: May 2014

There is a paucity in the physiotherapy literature about the specific characteristics and circumstances which lead to the negative social evaluation of patients as 'problems'. The aim of this survey was to explore further the 'problem patient' categories defined by Thomson (2000) in a group of physiotherapists in four London NHS hospitals. Results showed that the majority of problem patient categories were generalizable to a wider population of therapists although the agreement was relatively weak. Patients with multiple healthcare and psychosocial needs were seen the most often and 15 out of the 17 categories were seen regularly. The lack of extremes of opinion suggests these physiotherapists are reluctant to label patients negatively. The differences between the junior grades (juniors and senior IIs) and senior grades (senior I and above) suggested that inexperience and lack of time management skills underpinned the juniors' understanding of problem patients. The context, daily practice and the type of patients seen reflected the disparity between the clinical settings. A biopsychosocial approach in which patients are enabled to contribute their perspective to increase and possibly change the therapists' understanding are crucial to the management of problem patients.
Investigating joint kinematics during a hoist-assisted sit-to-stand activity
Authors: Bilboe Jade , Healey Kathryn , Busse Monica E 
Published: May 2014

Assisting individuals to stand up from a chair, or sit-to-stand (STS), is a physically demanding task restricted by manual handling regulations. If a hoist was able to produce a normal STS movement pattern this would offer a safe option for both therapist and patient, satisfying both therapeutic and manual handling criteria. Twenty-two healthy subjects participated in the study. Each subject completed STS with and without hoist assistance. Two hoists were used: the Sara 3000 and the Encore. The STS movements were captured on digital camera and the knee and trunk angles were calculated at point of seat-off for unassisted STS, Sara 3000 STS and Encore STS. Data were analysed using a repeated measures ANOVA. Trunk angles during STS using both hoists were found to be different (P < 0.001) from that seen during normal STS. Knee angles measured when using the Sara 3000 hoist were different to those seen during unassisted (or normal) STS; however, knee angles at seat-off for the Encore hoist were similar to those seen during normal STS. This study analysed the movement patterns re-created by two hoists used in the clinical setting. Results showed that the Encore hoist is effective at re-creating normal knee angles at seat-off during the STS transfer, however, neither hoist is able to encourage the required normal trunk angle for independent STS.
Case study evaluation of body weight-supported treadmill training for parkinsonian gait
Authors: Evans Elizabeth , Cook David 
Published: May 2014

Parkinsonian gait is characterized by kinetic and kinematic anomalies such as reduced push-off and reduced walking velocity. It is evident that any improvement to gait is likely to result in concomitant improvement in aspects of everyday life that require whole body ambulation. Consequently, the aim of this study was to quantify, biomechanically, the potential of body weight-supported treadmill training (BWSTT) in eliciting a shift toward a more normal pattern of gait for individuals with Parkinson's disease. A single-subject intervention-based research design was adopted. Kinetic, kinematic and spatiotemporal data were captured via the simultaneous use of a Kistler force platform and an automated video-based motion analysis system. The emphasis of the BWSTT intervention was to provide stimulus to the extensor load receptors of the lower extremities through the unloading and reloading of body weight, characterized through kinetic and kinematic profiles (Dietz, 1997). The findings of the study revealed significant enhancement—relative to ‘normal’ gait—of parkinsonian gait following BWSTT, which was reflected in observed normalization across measured spatiotemporal, kinematic, and kinetic parameters. As such, BWSTT may be a viable method of implementing sustained improvement to parkinsonian gait, although further large-scale research is needed.
A survey of dysphagia screening practices across England and Wales
Authors: Head Kathryn , Weeks Keith , Stroud Alison , Coll Anne Marie 
Published: May 2014

Screening of acute stroke patients for signs of dysphagia (swallowing impairment) is recommended within 24hours of hospitalization owing to increased risk of morbidity and mortality. Speech and language therapists (SLTs) are the lead health professionals responsible for assessment of dysphagia. However, increasing demand for assessment and the relative dearth of SLTs in the NHS has resulted in delays in assessment of up to 6days. Subsequently there is a drive for nurses to perform this screening process using a validated screening method and tool. This paper centres on the exploratory phase of a three-stage programme of research, designed to develop and evaluate a bedside dysphagia screening tool for use by registered nurses. Here the authors focus on a review of the salient professional literature and the findings of a survey of current dysphagia screening practices employed by nurses across 52 NHS trusts in England and Wales.
An occupational therapy income-generation group for HIV-positive women in Uganda: Part 1
Authors: Kamba Moses , Rugg Sue 
Published: May 2014

Little is known of the occupational therapy interventions available to occupational therapy clients living with the human immunodeficiency virus (HIV) in the developing world. This two-part series explores one group of female clients’ views of taking part in such an intervention; an occupational therapy income-generation group. In this, the first part of the article, the authors outline the relevant background literature, exploring research on support group attendance, social support for HIV-positive people and the value of income-generation activities for women in developing countries. This material shows that people with chronic health conditions, especially those from potentially stigmatised groups, can obtain much-valued practical, psychological, social and economic support from therapeutic group attendance. This suggests that occupational therapy has much to offer this potential client group. The authors used this material to underpin a small qualitative study of ten HIV-positive Ugandan women taking part in an occupational therapy income-generation group. The methods used in this study, its findings and implications are detailed in part two of this article.
Home-based rehabilitation for people with stroke: An evaluation of efficacy
Authors: Bader Tara 
Published: May 2014

Stroke affects approximately 150,000 people each year in England and approximately 15 million people each year worldwide. Post-stroke rehabilitation aims to reduce morbidity and improve quality of life for affected individuals. It can be provided in both the hospital and home setting, as patients can be discharged early on home-based rehabilitation schemes. This article evaluates the current evidence for the effectiveness of home-based rehabilitation and discusses how further research should guide practice in this area. Evidence suggests that home-based rehabilitation can not only improve quality of life for the patient, including physical and emotional outcomes, but it also has the potential to offer better support for the carer than hospital-based rehabilitation. Home-based rehabilitation also has the benefit of reducing length of time spent in hospital which may be a preferable option for patients. However, the cost-effectiveness of home-based rehabilitation remains unclear. Future research should investigate specific types of home-based rehabilitation, assessing outcomes of quality of life, impact on the carer, length of hospital stay and cost.