A condensed wheelchair skills training ‘bootcamp’ improves students’ self-efficacy for assessing,training, spotting,and documenting manual and power wheelchair skills

Abstract

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.

Methods: In a pre-post design, students in their final year of an entry-to-practice master of occupational therapy program completed a two-day manual (6.5?h) and power (6.5?h) wheelchair skills bootcamp. Outcomes for self-efficacy (in assessing, training, spotting and documenting manual and power wheelchair skills; primary) and capacity (manual and power wheelchair skills; secondary) were collected at baseline and immediately after the bootcamp.

Results: Participants (n?=?44) were 27.3?±?4.3?years of age (41 female). Most students (81.8%) reported little previous experience using manual and power wheelchairs at baseline. Students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills improved by between 28.4% and 35.3%, representing a change from ‘somewhat confident’ to ‘fairly confident’. Students’ manual and power wheelchair skills capacity increased by 47.2% and 37.1% respectively.

Conclusions: Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity; thus may provide an option for integrating wheelchair skills training into the curriculum of time-intensive programs.

• Implications for rehabiliation

• A two-day condensed wheelchair skills training workshop improves occupational therapy

• students’ self-efficacy for assessing, training, spotting and documenting power and

• manual wheelchair skills.

• A two-day condensed wheelchair skills training workshop improves occupational

• therapy students’ power and manual wheelchair skills.

• Self-efficacy is an indicator of future behaviours. Therefore, improving students’ selfefficacy

• for assessing training and documenting wheelchair skills may influence their future practice.

     

Oxygen uptake on-kinetics during six-minute walk test predicts short-term outcomes after off-pump coronary artery bypass surgery

Abstract

Purpose: We aimed to investigate the ability of oxygen uptake kinetics to predict short-term outcomes after off-pump coronary artery bypass grafting.

Methods: Fifty-two patients aged 60.9?±?7.8 years waiting for off-pump coronary artery bypass surgery were evaluated. The 6-min walk test distance was performed pre-operatively, while simultaneously using a portable cardiopulmonary testing device. The transition of oxygen uptake kinetics from rest to exercise was recorded to calculate oxygen uptake kinetics fitting a monoexponential regression model. Oxygen uptake at steady state, constant time, and mean response time corrected by work rate were analysed. Short-term clinical outcomes were evaluated during the early post-operative of off-pump coronary artery bypass surgery.

Results: Multivariate analysis showed body mass index, surgery time, and mean response time corrected by work rate as independent predictors for short-term outcomes. The optimal mean response time corrected by work rate cut-off to estimate short-term clinical outcomes was 1.51?×?10^?3?min²/ml. Patients with slower mean response time corrected by work rate demonstrated higher rates of hypertension, diabetes, EuroSCOREII, left ventricular dysfunction, and impaired 6-min walk test parameters. The per cent-predicted distance threshold of 66% in the pre-operative was associated with delayed oxygen uptake kinetics.

Conclusions: Pre-operative oxygen uptake kinetics during 6-min walk test predicts short-term clinical outcomes after off-pump coronary artery bypass surgery. From a clinically applicable perspective, a threshold of 66% of pre-operative predicted 6-min walk test distance indicated slower kinetics, which leads to longer intensive care unit and post-surgery hospital length of stay.

• Implications for rehabilitation

• Coronary artery bypass grafting is a treatment aimed to improve expectancy of life and prevent disability due to the disease progression;

• The use of pre-operative submaximal functional capacity test enabled the identification of patients with high risk of complications, where patients with delayed oxygen uptake kinetics exhibited worse short-term outcomes;

• Our findings suggest the importance of the rehabilitation in the pre-operative in order to “pre-habilitate” the patients to the surgical procedure;

• Faster oxygen uptake on-kinetics could be achieved by improving the oxidative capacity of muscles and cardiovascular conditioning through rehabilitation, adding better results following cardiac surgery.

Trial registration: ClinicalTrials.gov identifier: NCT02758600.     

Glycaemic efficacy and safety of linagliptin for the management of non-cardiac surgery patients with type 2 diabetes in a real-world setting: Lina-Surg study

Introduction: The use of dipeptidyl peptidase-4 inhibitors in hospitalized patients is an area of active research. We aimed to compare the efficacy and the safety of the basal-bolus insulin regimen versus linagliptin-basal insulin in non-critically ill non-cardiac surgery patients in a real-world setting.

Methods: We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240?mg/dL, and no at-home injectable treatments who were treated with basal-bolus (n?=?347) or linagliptin-basal (n?=?190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed.

Results: After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission (p?=?.162), number of patients with a mean blood glucose 100–140?mg/dL (p?=?.163) and > 200?mg/dL (p?=?.199), and treatment failures (p?=?.395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both p?<?.001). Patients on linagliptin-basal insulin had fewer hypoglycaemic events (blood glucose < 70?mg/dL) (p?<?.001).

Conclusion: For type 2 diabetes surgery patients with mild to moderate hyperglycaemia without pre-hospitalization injectable therapies, linagliptin-basal insulin was an effective, safe alternative with fewer hypoglycaemic events in real-world practice.

• Key messages

• Treatment with basal-bolus insulin regimens is the standard of care for non-critically ill hospitalized patients with type 2 diabetes.

• A differentiated treatment protocol that takes into account glycaemic control and clinical factors should be implemented in the hospital setting.

• Linagliptin-basal insulin is an effective, safe alternative with fewer hypoglycaemic events during the hospitalization of non-critically ill non-cardiac surgery patients with T2D in real-world practice.

     

Associations of serum sclerostin with bone mineral density,markers of bone metabolism and thalassaemia characteristics in adult patients with transfusion-dependent beta-thalassaemia

Abstract

Aim of the study: To assess serum sclerostin in transfusion-dependent beta-thalassaemia patients versus healthy controls and to examine its associations with bone mineral density, bone metabolism markers and beta thalassaemia alterations.

Material and methods: Sixty-two transfusion-dependent beta-thalassaemia (TDßT) patients and 30 healthy controls were evaluated for serum sclerostin, osteocalcin, beta-cross laps, osteoprotegerin and serum level of receptor activator of nuclear factor kappa-Β ligand (sRANKL). Bone mineral density was measured at the lumbar spine and femoral neck. Thalassaemia characteristics were collected from the patients’ medical records.

Results: A significantly higher sclerostin level (median 565.50?pmol/L) was observed in the transfusion-dependent beta-thalassaemia patients vs. the healthy controls (median 48.65?pmol/L, p?<?.001). Sclerostin showed significant associations with the Z-scores at the lumbar spine and femoral neck, osteocalcin, beta-cross laps, osteoprotegerin, sRANKL, pretransfusion haemoglobin, liver iron concentration and female gonadal state. Significantly higher levels of sclerostin were observed in splenectomized TDßT patients and in those with fragility fractures. Age, sex, body mass index, disease severity, serum ferritin, cardiac T2* and male gonadal state did not show significant associations with sclerostin.

Conclusion: Sclerostin may play a role in the bone pathophysiology of beta-thalassaemia patients and could serve as a marker of severe osteoporosis.

• KEY MЕSSAGES

• Serum sclerostin is more than 10-fold higher in adult patients with transfusion-dependent beta-thalassaemia compared to healthy controls.

• Serum sclerostin is negatively associated with bone mineral density and the bone synthesis markers and positively with the bone resorption indices.

• Serum sclerostin is significantly associated with pre-transfusion haemoglobin, liver iron concentration, splenectomy status and fragility fracture events in adult patients with transfusion-dependent beta-thalassaemia.

• Serum sclerostin could serve as a marker of severe osteoporosis in beta-thalassaemia patients.

     

Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an acute coronary syndrome event

Abstract

Background: Acute coronary syndrome (ACS) patients are widely treated with long-term beta-blocker therapy after cardiac event. Especially for low-risk patients, the benefits of beta-blockers on survival and the optimal therapy duration remain unclear. We investigated the effect of adherence to beta-blockers on long-term survival of ACS patients.

Methods and results: A total of 1855 consecutive ACS patients who underwent angiography and survived 30?days after were followed for a median of 8.6?years. During follow-up, 30.1% (n?=?558) of patients died. Adherence was assessed as yearly periods covered by medication purchases and investigated as a dynamic time-dependent variable in Cox proportional hazards models. In a univariable model, non-adherence to beta-blockers was associated with higher all-cause mortality (Hazard ratio [HR] 2.99, 95% confidence interval [CI] 2.50?3.57; p?<?.001). Results were similar in multivariable models on both overall survival (HR 1.84, 95% CI 1.51?2.24; p?<?.001) and on 1-year landmark survival (HR 1.74, 95% CI 1.41?2.14; p?<?.001). In subgroup analyses, the increase in all-cause mortality was consistent among low-risk patients (HR 1.60, 95% CI 1.16?2.21; p?=?.004).

Conclusion: Poor adherence to beta-blockers is associated with increased long-term mortality among ACS patients. Even low-risk patients seem to benefit from long-term beta-blocker therapy.

• Key messages

• Adherence to secondary prevention medications diminishes drastically over the years after an ACS event.

• Non-adherence to β-blockers is associated with increased long-term mortality of ACS patients, and the effect on survival extends beyond the first year after an ACS event.

• Our follow-up was exceptionally lengthy with median follow-up period of 8.6 years.

     

The prevalence and prognostic significance of interatrial block in the general population

Abstract

Introduction: Partial and advanced interatrial block (IAB) in the electrocardiographic (ECG) represents inter-atrial conduction delay. IAB is associated with atrial fibrillation (AF) and stroke in the general population.

Material and methods: A representative sample of Finnish subjects (n?=?6354) aged over 30?years (mean: 52.2?years, standard deviation: 14.6) underwent a health examination including a 12-lead ECG. Five different IAB groups based on automatic measurements were compared to normal P waves using multivariate-adjusted Cox proportional hazard model. Follow-up lasted up to 15?years.

Results: The prevalence of advanced and partial IAB was 1.0% and 9.7%, respectively. In the multivariate model, both advanced (hazard ratio (HR): 1.63 (95% confidence interval (CI): 1.00?2.65)) and partial IAB (HR: 1.39 (1.09?1.77)) were associated with increased risk of AF. Advanced IAB was associated with increased risk of stroke or transient ischaemic attack (TIA) independently of associated AF (HR: 2.22 (1.20?4.13)). Partial IAB was also associated with increased risk of being diagnosed with coronary heart disease (HR: 1.26 (1.01?1.58)).

Discussion: IAB is a rather frequent finding in the general population. IAB is a risk factor for AF and is associated with an increased risk of stroke or TIA independently of associated AF.

• Key messages

• Both partial and advanced interatrial block are associated with increased risk of atrial fibrillation in the general population.

• Advanced interatrial block is an independent risk factor for stroke and transient ischaemic attack.

• The clinical significance of interatrial block is dependent on the subtype classification.

     

Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial

Abstract

Purpose: Knee ligamentous trauma and the following pain is one of the most prevalent athletic injuries. Transcutaneous electrical nerve stimulation is one of the conservative approaches in controlling pain which is low cost, noninvasive, and safe with low complications. Our purpose was to study whether transcutaneous electrical nerve stimulation (TENS) could help athletes perform better during the first phase of rehabilitation (0–4?weeks) after anterior cruciate ligament (ACL) reconstruction surgery and until the follow-up.

Methods: This randomized single blind (exercise instructor and assessor) clinical trial was performed on 70 male athletes, undergone ACL surgery. After the surgery, patients were randomly divided into two groups: the first group received semi-supervised exercise plus high-frequency TENSTENS for 35?min a day and the second group only performed exercises. Treatment duration continued for 20 sessions, 4?weeks. The visual analog scale (VAS) score (100?mm), International Knee Documentation Committee (IKDC) questionnaire and knee flexion Range of motion (ROM) were evaluated for all patients after the surgery (before commencing the rehabilitation program), after 4?weeks and 14?weeks from the surgery.

Results: Mixed ANOVA was used to explore the interaction effects of time and group on outcome measures and post hoc additional tests were performed on the data. The VAS, IKDC questionnaire score and knee flexion ROM increased in both groups over time, but the amount of improvement did not differ between the two groups, implying no additional improvement in the group receiving TENS along with exercises.

Conclusion: The findings of the present trial shows that adding TENS to a specific protocol of semi-supervised exercise in the first phase of rehabilitation after ACL reconstruction is not efficient on improving knee function and pain more than exercise alone.

• Implications for Rehabilitation

• Injury to the anterior cruciate ligament of the knee is a common injury specifically in athletes.

• Incorporating effective pain relieving strategies during the post anterior cruciate ligament reconstruction surgery rehabilitation could lead to improvement in regaining the range of motion and function of the knee which is of crucial importance after the surgery.

• Applying transcutaneous electrical nerve stimulation alongside a specific protocol of semi-supervised exercise in the first phase of rehabilitation after anterior cruciate ligament reconstruction did not have any additional effect to exercise alone.

     

Functional changes through the usage of 3D-printed transitional prostheses in children

Introduction: There is limited knowledge on the use of 3?D-printed transitional prostheses, as they relate to changes in function and strength. Therefore, the purpose of this study was to identify functional and strength changes after usage of 3?D-printed transitional prostheses for multiple weeks for children with upper-limb differences.

Materials and methods: Gross manual dexterity was assessed using the Box and Block Test and wrist strength was measured using a dynamometer. This testing was conducted before and after a period of 24?±?2.61 weeks of using a 3?D-printed transitional prosthesis. The 11 children (five girls and six boys; 3–15 years of age) who participated in the study, were fitted with a 3?D-printed transitional partial hand (n?=?9) or an arm (n?=?2) prosthesis.

Results: Separate two-way repeated measures ANOVAs were performed to analyze function and strength data. There was a significant hand by time interaction for function, but not for strength.

Conclusion and relevance to the study of disability and rehabilitation: The increase in manual gross dexterity suggests that the Cyborg Beast 2 3?D-printed prosthesis can be used as a transitional device to improve function in children with traumatic or congenital upper-limb differences.

• Implications for Rehabilitation

• Children’s prosthetic needs are complex due to their small size, rapid growth, and psychosocial development.

• Advancements in computer-aided design and additive manufacturing offer the possibility of designing and printing transitional prostheses at a very low cost, but there is limited knowledge on the function of this type of devices.

• The use of 3D printed transitional prostheses may improve manual gross dexterity in children after several weeks of using it.

     

Development of a scoring tool (BLARt score) to predict functional outcome in lower limb amputees

Purpose: To develop a valid preoperative scoring tool that predicts the probability of walking with a prosthetic limb after major lower limb amputation.

Methods: A retrospective review of 338 patients who had undergone lower limb amputation was conducted to identify characteristics that affected the success of rehabilitation with a prosthetic limb. These data were used to devise an assessment tool (the BLARt score), which was then tested and validated in 199 patients planned to undergo lower limb amputation in two UK regional centers. Functional rehabilitation outcomes were recorded at 12?months after surgery using the SIGAM mobility grading.

Results: No patient with a BLARt score?≥13 achieved good functional outcome (defined as independent mobility, SIGAM grade E or F) and only 6 patients with a BLARt score?≥17 achieved any functional outcome (defined as any ability to walk unaided, SIGAM grade C or greater).

Conclusions: In the patient cohorts studied, the BLARt assessment tool was a strong predictor of whether or not patients would be able to walk with a prosthetic limb after surgery. It is simple to administer and could be useful in clinical practice to inform expectations for patients and clinicians.

• Implications for rehabilitation

• Patients undergoing lower limb amputation face major physical and psychological challenges after surgery that have a considerable impact on rehabilitation and their ability to walk independently.

• Many amputees are unable to walk with a prosthetic limb, but there are no validated tools to predict this before surgery.

• The BLARt is a potentially valuable measure that can predict the likelihood of being unable to walk after amputation.

• It is simple to use and could be useful to inform patients’ and clinicians’ expectations before surgery.

     

Effects of preventive home visits on health-related quality-of-life and mortality in home-dwelling older adults

Objective: We explored the effectiveness of preventive home visits on the health-related quality-of-life (HRQoL) and mortality among independently community-dwelling older adults.

Design: A randomised controlled trial.

Subjects: Independently home-dwelling older adults 75 years and older, consisting of 211 in the intervention and 211 in the control group.

Setting: Hyvinkää town municipality, Finland.

Main outcome measures: We used the change in HRQoL measured by the 15D scale as our primary outcome. Mortality at two years was retrieved from central registers.

Results: At the one-year time point, the HRQoL according to the 15D scores deteriorated in the control group, whereas we found no change in the intervention group. The difference between the 15D score changes between the groups was ?0.015 (95% CI ?0.029 to ?0.0016; p?=?0.028, adjusted for age, sex, and baseline value). At the two-year time point as the visits ended, that difference diminished. There was no difference in mortality between the groups during the 24-month follow-up.

Conclusion: Preventive home visits implemented by a multidisciplinary team with CGA appear to help slow down the decline in HRQoL among older adults, although the effect diminishes when the visits end.

• Key points

• We are exploring preventive home visits as means to support the health-related quality-of-life (HRQoL) of home-dwelling older adults

• Multiprofessional preventive home visits in this intervention study helped to maintain the HRQoL when measured using 15D

• The effects on HRQoL diminished when the intervention ended, so could further benefits be attained with a longer intervention?The clinical trial registration number: ACTRN12616001411437

     

Postpericardiotomy syndrome after cardiac surgery

Abstract

Postpericardiotomy syndrome (PPS) is a well-known complication after cardiac surgery. The syndrome results in prolonged hospital stay, readmissions, and invasive interventions. Previous studies have reported inconsistent results concerning the incidence and risk factors for PPS due to the differences in the applied diagnostic criteria, study designs, patient populations, and procedure types. In recent prospective studies the reported incidences have been between 21 and 29% in adult cardiac surgery patients. However, it has been stated that most of the included diagnoses in the aforementioned studies would be clinically irrelevant. This challenges the specificity and usability of the currently recommended diagnostic criteria for PPS. Moreover, recent evidence suggests that PPS requiring invasive intervention such as the evacuation of pleural and/or pericardial effusion is associated with increased mortality. In the present review, we summarise the existing literature concerning the incidence, clinical features, diagnostic criteria, risk factors, management, and prognosis of PPS. We also propose novel approaches regarding to the definition and diagnosis of PPS.

1. Key messages:

2. Current diagnostic criteria of PPS should be reconsidered, and the analyses should be divided into subgroups according to the severity of the syndrome to achieve more clinically applicable and meaningful results in the future studies.

3. In contrast with the previous presumption, severe PPS – defined as PPS requiring invasive interventions – was recently found to be associated with higher all-cause mortality during the first two years after cardiac surgery. The association with an increased mortality supports the use of relatively aggressive prophylactic methods to prevent PPS.

4. The risk factors clearly increasing the occurrence of PPS are younger age, pleural incision, and valve and ascending aortic procedures when compared to CABG.

     

Validation of assistive technology on psychoactive substances for visually impaired people

Purpose: To validate the assistive technology “Drugs: reflection for prevention” to be used with visually impaired people.

Method: Quantitative and quasi-experimental study, contrasting knowledge before and after the use of the assistive technology with 140 visually impaired people in institutes and associations for people with visual impairment. A questionnaire with identification data, a pre-test, a post-test and a questionnaire to assess the assistive technology were applied. Data were described through means and standard deviations, and analyses included the McNemar test, the exact binomial distribution test, and the intraclass correlation coefficient.

Results: Participants were male (65.7%), 84.3% were blind, aged 37.1?years on average and with schooling of 10.1?years on average. There were more correct answers in the post-test (p?<.001). The attributes of the assistive technology were considered adequate: objectives, access, clarity, structure and presentation, relevance and efficacy, and interactivity (p?<.001).

Conclusions: The assistive technology “Drugs: reflection for prevention” was considered valid and reliable to inform visually impaired people about psychoactive substance abuse.

• Implications for rehabilitation

• Created new tool for prevention substance abuse that can be accessed easily.

• Improved information about substance psychoactive for users of the assistive technology.

• Improved quality of life for its users.

     

Does change in isolated lumbar extensor muscle function correlate with good clinical outcome? A secondary analysis of data on change in isolated lumbar extension strength,pain, and disability in chronic low back pain

Purpose: Secondary analysis of data from studies utilising isolated lumbar extension exercise interventions for correlations among changes in isolated lumbar extension strength, pain, and disability.

Materials and methods: Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention?≥?four?weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as “met” or “not met” based on minimal clinically important changes and between groups comparisons conducted.

Results: Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r?=??0.391 to ?0.539, all p?<?0.001). Isolated lumbar extension strength and Oswestry Disability Index pooled analysis showed significant weak correlations (r?=??0.349 to ?0.470, all p?<?0.001). For pain and disability, isolated lumbar extension strength changes were greater for those “met” compared with those “not met” (p?<?0.001–0.008).

Conclusions: Improvements in isolated lumbar extension strength may be related to positive and meaningful clinical outcomes. As many other performance outcomes and clinical outcomes are not related, isolated lumbar extension strength change may be a mechanism of action affecting symptom improvement.

• Implications for Rehabilitation

• Chronic low back pain is often associated with deconditioning of the lumbar extensor musculature.

• Isolated lumbar extension exercise has been shown to condition this musculature and also reduce pain and disability.

• This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability.

• Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.

     

Effects of bilateral swing-away grab bars on the biomechanics of stand-to-sit and sit-to-stand toilet transfers

Purpose: Kinetic characteristics of transfers to and from a toilet performed using bilateral grab bars are not fully quantified to inform grab bar design and configuration. The purpose of this study was to (1) determine effects of bilateral swing-away grab bars on peaks of ankle, knee and hip joint moments during grab bar assisted stand-to-sit and sit-to-stand transfers; and (2) determine effects of three different heights and widths of swing-away grab bars on the same kinetic characteristics.

Methods: Healthy subjects (N?=?11, age 25–58?years) performed stand-to-sit and sit-to-stand transfers with and without grab bars. In transfers with grab bars, 9 grab bar configurations were tested by varying their height from the floor (0.787?m, 0.813?m, 0.838?m; 31″–33″) and width, the distance of each grab bar from the toilet’s centerline (0.330?m, 0.356?m, 0.381?m; 13″–15″). Motion capture, force plate and inverse dynamics analysis were used to determine lower limb joint moments.

Results: The use of bilateral grab bars generally reduced the peak magnitude of extension moments at lower limb joints during stand-to-sit and sit-to-stand transfers (p?Conclusion: The obtained results suggest that the studied ranges of grab bar configurations reduce moment demands on the leg joints and thus decrease difficulty and required lower limb muscle effort to perform the transfers.

• Implications for Rehabilitation

• Maximizing the benefits of assistive technology in the built environment requires a careful assessment of their spatial and configurational dimensions, especially in respect to the needs and abilities of the intended users.

• Examining the kinetic characteristics of transfers to and from a toilet using the swing-away grab bars is useful for informing grab bar design and configuration recommendations for assisted living and skilled nursing facilities.

• Our findings suggest that the swing-away grab bars located at certain ranges are a reasonable alternative to the grab bars mandated by the current Americans with Disabilities Act (ADA) Accessibility Guidelines.

• Future research investigating the effects of grab bars on transfer performance should consider additional factors, such as a wider range of abilities and transfer methods of the users.

     

Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

Abstract

Objective: To explore how patients, that had experienced harm in primary care, and how primary providers and practice managers understood reasons for harm and possibilities to reduce risk of harm.

Design: Inductive qualitative analysis of structured questionnaires with free text answers.

Setting: Primary health care in Sweden.

Patients/subjects: Patients (n?=?22) who had experienced preventable harm in primary health care, and primary care providers and practice managers, including 15 physicians, 20 nurses and 24 practice managers.

Main outcome measures: Categories and overarching themes from the qualitative analysis.

Results: The three categories identified as important for safety were continuity of care, communication and competence. With flaws in these, risks were thought to be greater and if these were strengthened the risks could be reduced. The overarching theme for the patient was the experience of being neglected, like not having been properly examined. The overarching theme for primary care providers and practice managers was lack of continuity of care.

Conclusion: Primary care providers, practice managers and patients understood the risks and how to reduce the risks of patient safety problems as related to three main categories: continuity of care, communication and competence. Future work towards a safer primary health care could therefore benefit from focusing on these areas.

• Key points

• Current awareness:

• ??Patients and primary care providers are rather untapped sources of knowledge regarding patient safety in primary health care.

• Main statements:

• ??Patients understood the risk of harm as stemming from that they were not properly examined.

• ??Primary care providers understood the risk of harm to a great extent as stemming from poor continuity of care.

• ??Patients, primary care providers and practice managers believed continuity, communication and competence play an important role in reducing risks.

     

Practices and views of occupational therapists in Nova Scotia regarding wheelchair-skills training for clients and their caregivers: an online survey

Abstract

Purpose: To determine the extent to which Occupational Therapists (OTs) in Nova Scotia (NS) conduct wheelchair skills training, the nature of training and the OTs’ perceptions on training.

Materials and methods: Anonymous online survey.

Results: We received 110 responses from OTs living in NS and involved in direct patient care, 96 (93%) of whom reported helping clients obtain manual wheelchairs. Of the OTs who responded to the question “…do you typically provide wheelchair-skills training…?”, 40 (43.5%) answered “Yes, usually” for clients and 40 (46.0%) for caregivers. The median duration of training sessions for clients and caregivers was 30 and 20?min; the median number of sessions was 2 and 1. Regarding the importance of training, 65 (73.9%) OTs answered “Very important” and 22 (25%) “Somewhat important” for clients and 55 (64.0%) answered “Very important” and 29 (33.7%) “Somewhat important” for caregivers. About one-third of OTs considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Trainers were significantly more likely than non-trainers to consider wheelchair skills training as important (p?=?.0003 for clients and p?=?.0039 for caregivers) and to consider themselves adequately prepared for the trainer role (p?=?.002 for clients and .003 for caregivers).

Conclusions: Only a minority of NS OTs usually provide wheelchair-skills training for clients or their caregivers and the training provided is minimal, despite a majority who consider such training to be important. Only about one-third of OTs feel prepared for the training role.

• Implications for rehabilitation

• Only a minority of Occupational Therapists (OTs) in Nova Scotia, Canada usually provide wheelchair-skills training for clients or their caregivers.

• The training that is provided is minimal.

• A majority of OTs consider such training to be important.

• Only about one-third of OTs feel prepared for the training role.

     

Do parents and children agree on rating a child’s HRQOL? A systematic review and Meta-analysis of comparisons between children with attention deficit hyperactivity disorder and children with typical development using the PedsQLTM

Purpose: This meta-analysis was conducted to assess differences in a child’s health-related quality of life (HRQOL) as reported by the child and their parents using the Pediatric Quality of Life Inventory^TM, and the effects in both children with attention deficit hyperactivity disorder (ADHD) and those with typical development.

Methods: Eight studies encompassing 16 independent groups met the inclusion criteria and were combined and compared in this meta-analysis. Fixed effect analysis was applied in the subgroup analysis to compare differences between children with ADHD and those with typical development.

Results: Small to moderate magnitudes of parent-child discrepancies were found in the ratings of the children’s HRQOL both in those with ADHD (g?=??0.23 [?0.33, ?0.13], p?<?0.001, physical HRQOL; g?=??0.60 [?0.71, ?0.48], p?<?0.001, psychosocial HRQOL) and in those with typical development (g?=??0.27 [?0.31, ?0.23], p?<?0.001, physical HRQOL; g?=??0.29 [?0.33, ?0.25], p?<?0.001, psychosocial HRQOL) except for emotional HRQOL in children with typical development (g?=?0.003 [?0.04, 0.04], p?=?0.90). The parent-child discrepancy in rating the child’s psychosocial HRQOL was significantly larger in the children with ADHD than in those with typical development.

Conclusions and implications: This meta-analysis suggests that a child’s HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports. Parent-child discrepancies, especially in psychosocial HRQOL, and sources of discrepancy need to be addressed when assessing the child’s HRQOL and planning interventions in children with ADHD.

• Implications for Rehabilitation

• Parents reported a significantly worse health-related quality of life of their children than both the children with attention deficit hyperactivity disorder and those with typical development.

• A child’s health-related quality of life needs to be assessed both by parent proxy and self-reports of the children.

• Children with attention deficit hyperactivity disorder and those with typical development differed significantly in parent-child discrepancy in child’s psychosocial health-related quality of life, but not in physical health-related quality of life.

• Parent-child discrepancies, especially in psychosocial health-related quality of life, and sources of discrepancy (e.g., child, parent or family characteristics) need to be addressed when assessing the child’s health-related quality of life and planning interventions in children with attention deficit hyperactivity disorder.

     

Body composition and its association with physical performance,quality of life,and clinical indictors in Charcot-Marie-Tooth disease: a pilot study

Aim: To investigate whether the amount and distribution of lean body mass and fat mass is associated with disease severity in adults with Charcot-Marie Tooth.

Methods: Ten participants (age 46?±?13?y, height 1.7?±?0.1?m, and body mass 77?±?17?kg) with Charcot-Marie Tooth disease were involved in this study. Participants were evaluated for quality of life, falls efficacy, balance, mobility, muscle strength, and power. Body composition was measured using dual energy x-ray absorptiometry. Statistical analyses were conducted on subsets of all participants.

Results: Better static balance was associated with higher lean body mass of the lower leg (r?=?0.73, p?=?0.03), while superior leg press strength and power was associated with greater lean body mass of the leg and lower leg (r?≥?0.80, p?≤?0.01). Faster habitual walking speed and enhanced quality of life was associated with lower fat mass of several regions.

Conclusion: Our study seems to suggest that assessing of body composition could assist with monitoring of disease progression in people with Charcot-Marie Tooth; however these findings need to be substantiated in a larger cohort.

• Implications for Rehabilitation

• Higher lean body mass and lower fat mass of the legs is associated with better physical performances in people with Charcot-Marie-Tooth disease.

• Lower fat mass is related to greater quality of life and reduced clinical symptoms in people with Charcot-Marie-Tooth disease.

• Optimising favorable body composition profiles (higher lean body mass and lower fat mass) in people with Charcot-Marie-Tooth disease may be highly clinically relevant.

     

Psychosocial issues need more attention in COPD self-management education

Abstract

Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients’ self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.

Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.

Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n?=?29) and nine out of 160 health centres in Finland.

Subjects: 83 doctors and 162 nurses.

Main outcome measures: The respondents’ answers on how regularly they included the contents regarded as essential for COPD patients’ self-management in their education of COPD patients.

Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n?=?70) was more systematic than the education provided by the other nurses (n?=?84).

Conclusion: Healthcare professionals’ continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients’ ability to cope with the disease.

• KEY POINTS

• Issues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.

• Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.

• The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education.