Does additional weekend and holiday physiotherapy benefit geriatric patients with hip fracture? — A case-historical control study

Objective:To evaluate the new service model of additional weekend and holiday physiotherapy (PT) by comparing functional outcomes and hospital length of stay between a group of geriatric patients with hip fracture receiving daily PT training and a group of geriatric patients with hip fracture receiving weekdays PT training.Methods:A retrospective case-historical control chart review was conducted and a total of 355 patients were identified. Between-group comparisons were done on functional outcomes including Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Modified Barthel Index (MBI) and process outcome in terms of length of stay (LOS) in hospitals.Results:With similar characteristics, patients who received weekend and holiday PT training had a significant higher percentage of MFAC Category III and a significant lower percentage of MFAC Category II (p=0.015) and significant higher MBI scores (mean±standard deviation, median; Study group: 47.4±19.6 points, 51 points; Control group: 43.0±20.0 points, 43 points; p=0.042) upon admission to rehabilitation hospital. A similar trend in EMS scores (Study group: 8.2±5.5 points, 7 points; Control group: 8.4±6.1 points, 6 points; p=0.998) and MBI scores (Study group: 63.0±23.4 points, 68 points; Control group: 61.2±26.1 points, 64 points; p=0.743) were observed upon discharge from the rehabilitation hospital. The average LOS in acute hospitals remained static (Study group: 7.7±3.9 days, 7 days; Control group: 7.4±5.0 days, 6 days; p=0.192). The average LOS in rehabilitation hospital (Study group: 20.0±5.5 days, 20 days; Control group: 24.3±9.9 days, 23 days; p<0.001) and total in-patient LOS (Study group: 26.7±6.4 days, 26 days; Control group: 30.7±11.2 days, 28 days; p<0.001) were significantly reduced. A higher percentage of days having PT training during hospitalization in rehabilitation hospital was shown with the implementation of new service (Study group: 89.1%; Control group: 65.9%, p<0.001).Conclusion:Additional weekend and holiday PT training in post-operative acute and rehabilitation hospitalization benefits geriatric patients with hip fracture in terms of improved training efficiency, where hospital LOS was shortened with more PT sessions, without any significant impacts on functional outcome.     

Lumbopelvic sagittal standing posture associations with anthropometry,physical activity levels and trunk muscle endurance in healthy adults

Background:Various factors, inherited and acquired, are associated with habitual spinal postures.Objective:The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.Methods:In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2–22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.Results:LC and SS angles correlated significantly (r=0.80, p<0.001). Statistically significant differences for both LC (p=0.023) and SS (p=0.013) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC (r=−0.27, p=0.004); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant (r=−0.17, p=0.08). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC–SS) in standing and the participants’ body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.Conclusion:The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.     

The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study

Background/Objective:To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.Methods:Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.Results:Intraclass correlation coefficient for inter-rater reliability was excellent (ICC=0.999, 95% confidence interval=0.996–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: ICC=0.996, 95% confidence interval (CI)=0.812–1.000; R2: ICC=1.000, 95% CI=0.994–1.000; R3: ICC=1.000, 95% CI=0.998–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption (r=0.315, p=0.023; r=0.309, p=0.026).Conclusion:This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.     

The influence of low-intensity resistance training combined with neuromuscular electrical stimulation on autonomic activity in healthy adults: A randomized controlled cross-over trial

Background:Low-intensity resistance training (RT) combined with neuromuscular electrical stimulation (NMES) is one method of exercise to improve the deterioration of physical function. However, it is unclear whether low-intensity RT combined with NMES (RT + NMES) can be safely implemented.Objective:This study aimed to examine the influence of low-intensity RT + NMES on autonomic activity and cardiovascular responses in healthy adults.Methods:This study was an open-label, randomized controlled cross-over trial. The exercise intensity of isometric knee extension RT was set to 40% of the maximum voluntary contraction (peak torque). NMES was adjusted to a biphasic asymmetrical waveform with the frequency maintained at 50 Hz and a phase duration of 300 μs. The difference in the change in autonomic activity and cardiovascular responses was compared by assessing heart rate variability, blood pressure, and heart rate during RT and RT+NMES.Results:Twenty healthy male college students (mean age 21.0±0.6 years) participated in this study. The ratio of low- and high-frequency components of heart rate variability, systolic blood pressure, and heart rate increased during exercise in the RT and RT+NMES sessions (P<0.05). There were no significant differences in autonomic activity and cardiovascular responses throughout the sessions during RT and RT+NMES.Conclusion:In conclusion, our results demonstrated that low-intensity RT+NMES was safe and did not induce excessive autonomic and cardiovascular responses in healthy adults.     

Ambulatory chest physiotherapy in mild-to-moderate acute bronchiolitis in children under two years of age — A randomized control trial

Objective:The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis.Methods:Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15.Results:There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); p-value=0.005, in the control and intervention groups, respectively], with a mean difference (95% CI) of −0.9 (−1.6 to −0.3).Conclusion:Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT04260919","term_id":"NCT04260919"}}NCT04260919.     

Cross-cultural adaptation of the Pain Catastrophizing Scale in Greek clinical population

Background:Catastrophizing is an important psychological construct in mediating the behavioral response toward pain.Objective:The purpose of this study is to examine the psychometric properties of the Pain Catastrophizing Scale (PCS) in Greek clinical population.Methods:The scale was administered in 376 patients with chronic cervical and lumbar pain. Test–retest reliability, internal consistency (Cronbach α) and concurrent validity were assessed. Exploratory (EFA) and Confirmatory Factor Analysis (CFA) were used to test the factorial validity of the hypothesized three factor structure.Results:The PCS factors suggested high levels of test–retest reliability, whereas Cronbachs’ α values were acceptable. The EFA yielded a three-factor solution and indicated a marginal fit to the data. CFA procedures indicated a rather acceptable fit to the data. The concurrent validity of the instrument was confirmed.Conclusion:PCS seems to be a reliable and valid instrument in Greek patients with chronic cervical and lumbar pain.     

Indian (Marathi) version of the Shoulder Pain and Disability Index (SPADI): Translation and validation in patients with adhesive capsulitis

Background:The Shoulder Pain and Disability Index (SPADI) is the most commonly used self-administered questionnaire which is a valid and reliable instrument to assess the proportion of pain and disability in shoulder disorders. There is no evidence of SPADI questionnaire being translated into regional Indian language (Marathi).Objective:This study aims to translate and culturally adapt and validate the Marathi version of the SPADI questionnaire. This was done as per the AAOS outcomes committee guidelines.Methods:Cross-cultural adaptation and psychometric testing of SPADI was done in the Outpatient Physiotherapy Department of Tertiary Care Hospital, Ahmednagar, India.Results:The internal consistency was assessed by calculating Cronbach alpha value for the pain score (0.908), disability score (0.959), and total SPADI (0.969) which were all high. The Test–retest reliability was assessed using the intraclass correlation coefficient (ICC) values for the pain score (0.993), disability score (0.997), and total SPADI (0.997) which showed excellent reliability. The criterion validity was assessed using Pearson correlation coefficient. In Males, weak to strong negative correlation was observed except for shoulder extension and in females, moderate negative correlation was observed between baseline shoulder range of motion and initial total SPADI scores and individual pain and disability except for shoulder internal rotation. The internal consistency of the Marathi SPADI (Cronbach’s alpha >0.99) was higher than the original English version. The reliability of the total Marathi SPADI and its subscale (Intraclass correlation coefficient >0.90) were found to be higher than that of the English SPADI and were consistent with the German, Brazilian, Slovene and Greek versions.Conclusion:The translated and culturally adapted Marathi version of the SPADI questionnaire is a reliable and valid tool for the assessment of pain and disability in Marathi population.     

The effectiveness of stretching for infants with congenital muscular torticollis

Introduction: Congenital muscular torticollis (CMT) is a neck deformity that involves unilateral shortening of the sternocleidomastoid (SCM). Conservative physiotherapy management of CMT is primarily focused on stretching the affected SCM. However, there is limited research evidence on the use of stretching to improve the extensibility of SCM in infants with CMT.

Aim: To investigate the effectiveness of stretching for infants with CMT.

Method: A systematic search of AMED, CINAHL, MEDLINE, EMBASE, Physiotherapy Evidence Database (PEDro) and Cochrane Library was conducted during the period 2011–2018.

Results: Seven articles that met eligibility criteria were reviewed out of a total number of 415 articles that were screened; two articles were randomised control trials and five were cohort studies. The studies typically reported statistically significant benefits of stretching for the restoration of cervical range of movement and SCM thickness (p < 0.05). Appraisal of the studies revealed varied quality.

Conclusion: The results suggest that stretching is an effective treatment intervention for the management of infants with CMT and early physiotherapy referral can lead to decreased treatment duration. However, due to a variation in study quality; additional high-quality research is needed to help formulate more robust conclusions.     

Instrument-assisted soft tissue mobilization and proprioceptive neuromuscular facilitation techniques improve hamstring flexibility better than static stretching alone: a randomized clinical trial

Objectives: Tight hamstrings contribute to inefficiency of movement and increased risk for injury. Static stretching is the most common intervention for this problem, but the use of alternatives like instrument-assisted soft tissue mobilization (IASTM) and proprioceptive neuromuscular facilitation (PNF) is increasing among clinicians. This study examined two prospective studies with the common aim of demonstrating the effectiveness of IASTM or PNF over static stretching for improving hamstring tightness.

Methods: Nondisabled adults were recruited on a university campus. IASTM study: N = 17 (11 males and 6 females). PNF study: N = 23 (7 males and 16 females). Hip flexion range of motion was measured with a passive straight leg raise (for IASTM) or active straight leg raise (for PNF) before and after stretching. Participants performed a self-static stretch on one leg and received the alternative intervention on the contralateral leg. The two studies were analyzed separately for reliability indices and significant differences between interventions.

Results: Hip flexion measures showed good reliability in both studies (intraclass correlation coefficient = 0.97) with a minimal detectable change of <4.26. Both studies showed significant interactions between time and intervention (p < 0.05). Follow-up analyses revealed PNF and IASTM interventions resulted in greater increases in hip flexion range than static stretching.

Discussion: These findings demonstrate the effectiveness of PNF and IASTM techniques over static stretching for hamstring flexibility. These interventions provide more efficient alternatives for improving flexibility in the clinic, allowing greater progress in a shorter period of time than an equivalent static stretching program.

Level of Evidence: 1b.     

In-vivo mechanical characterization of coronary atherosclerotic plaques in living swine using intravascular laser speckle imaging

The ability to evaluate the viscoelastic properties of coronary arteries is crucial for identifying mechanically unstable atherosclerotic plaques. Here, we demonstrate for the first time in living swine, the capability of intravascular laser speckle imaging (ILSI) to measure an index of coronary plaque viscoelasticity, τ, using a human coronary to swine xenograft model. Cardiac motion effects are evaluated by comparing the EKG-non-gated τ¯NG, and EKG-gated τ¯G among different plaque types. Results show that both τ¯NG and τ¯G are significantly lower in necrotic-core plaques compared with stable lesions. Discrete-point pullback measurements demonstrate the capability of ILSI for rapid mechanical characterization of coronary segments under physiological conditions, in-vivo.     

The lived experience of Joint Hypermobility and Ehlers-Danlos Syndromes: a systematic review and thematic synthesis

Background: Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome (EDS) are heritable connective tissue disorders characterised by joint instability, pain, anxiety, depression and poor quality of life. However, peoples’ lived experiences are not well understood.

Objective: To understand the lived experiences of people with JHS and EDS.

Methods: A systematic review was conducted using PRISMA guidelines. Critical appraisal and a thematic synthesis of participants’ lived experiences were conducted. Eight online databases were searched from 1990 to February 2018: AMED, CINAHL, EMBASE, MEDLINE, PubMed, PsychINFO, SPORTDiscus and the Cochrane Library. Eligibility criteria were: (1) People with either JHS or EDS, clearly distinguished from generalised joint laxity; (2) Qualitative studies, or mixed qualitative and quantitative studies with qualitative data reported independently and (3) Published in English.

Results: A total of nine studies were included. Five main themes were identified: (1) Lack of professional understanding; (2) Restricted life; (3) Social stigma; (4) Trying to ‘keep up’ and (5) Gaining control. The implications of these results are explored.

Conclusions: Further qualitative research is required to examine the impact of JHS/EDS on a wider range of participants and in greater depth.     

Burn care and rehabilitation in Australia: health professionals’ perspectives

Objective: To understand health professionals’ perspectives of burn care and rehabilitation.

Design: Qualitative and semi-structured interviews.

Setting: Australian burn and rehabilitation units.

Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.

Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.

Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.

• Implications for rehabilitation

• Burn care and rehabilitation remains a complex and challenging area of care.

• Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.

• Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

     

Diagnosing depression in primary care: a Rasch analysis of the Major Depression Inventory

Objective: This study aimed to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients.

Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.

Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.

Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.

Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.

Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.

Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.

• Key points

• The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.

• This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system

• The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.

• Minor problems with measurement structure should be addressed in future revisions of the MDI.

     

Noise Levels in an Acute Psychiatric Unit: An Exploratory Observational Study

Background: Noise is an important aspect of the ward atmosphere climate – the combination of the architectural solutions, organizational features, the psychological traits of the operators and their interactions, and the patients’ characteristics. Despite its importance noise levels have been less analyzed than other aspects of the ward atmosphere climate.

Aim: In this study the aim is to identify the sources of noise and the sound pressure level in an acute psychiatric ward, and secondly to ascertain whether this is perceived by inpatients as disturbing.

Method: The sound pressure levels were measured during three nonconsecutive mornings, three afternoons, and three nights. A questionnaire was administered to ascertain patients’ opinions about the noise in the ward.

Results: The average noise level in the ward was 62.5?dB(A)eq in the morning, 55.8 in the afternoon, and 51.5 at night. A total of 23 patients took part in the study: 65.2% of this sample did not perceive the noise in the ward as disturbing.

Conclusion: In a psychiatric ward, the main source of noise is the verbal communication, and acoustic pressure also derived from care activities based around relationships. Other sources of noise perceived as disturbing came from the opening and closing of doors and the entry doorbell. Adopting relational and architectural-structural measures could reduce the sound pressure, with a view to further improving the ambience in the ward.     

Diagnostic accuracy and validity of three manual examination tests to identify alar ligament lesions: results of a blinded case-control study

Introduction: Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.

Method: A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.

Results: The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.

Discussion: Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.     

Expert opinion on the use of biological therapy in non-infectious uveitis

Introduction: Conventional immunosuppressive drugs, anti-TNF alpha treatments and biotherapies are increasingly being used in non-infectious uveitis.

Areas covered: The present work was led by a multidisciplinary panel of experts, including internal medicine specialists, rheumatologists and ophthalmologists, and proposes an extensive review on the use of biological agents in non-infectious uveitis.

Expert opinion: In case of dependency to steroids or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or biological therapies such as anti-TNF alpha treatments (adalimumab, infliximab) can be used to achieve and maintain disease quiescence. Interferon is an efficient immunomodulatory drug that can be proposed as second-line therapy in specific indications (eg. refractory macular edema, sight-threatening Behçet’s uveitis). Other biologics, especially tocilizumab, are showing promising results.

Local treatments (steroids, sirolimus etc.) can be used as adjuvant therapies in case of unilateral relapse. Therapeutic response must always be evaluated by clinical examination and appropriate ancillary investigations.