Does the Feldenkrais Method make a difference? An investigation into the use of outcome measurement tools for evaluating changes in clients

Evidence-based practice confirms the need for outcome measures. Feldenkrais Method practitioners struggle to use such tools because of the broad range of applications of the Feldenkrais Method and the difficulty identifying suitable measurement tools. A pre/post-test design was used to investigate the use of three outcome measurement tools [Patient-specific Functional Scale (PSFS), Pain Outcome Profile (POP) and Short Form12v2 Health questionnaire (SF12v2)] for clients experiencing problems performing everyday functional tasks who attended Feldenkrais sessions. Eleven Feldenkrais practitioners submitted data on 48 clients. Changes were detected in the clients’ ability to perform everyday tasks (PSFS improved 3.8 points, p < 0.001), levels of pain decreased (POP improved in current pain p = 0.001, physical index p < 0.001 and affective index p = 0.001) and quality of life improved significantly in six of the eight SF12v2 domains. These three tools have been found to be suitable for detecting changes in client function before and after a series of Feldenkrais sessions.     

Swallowing and Voice Outcomes in Patients Hospitalized With COVID-19: An Observational Cohort Study

ObjectiveTo evaluate the presentations and outcomes of inpatients with coronavirus disease 2019 (COVID-19) presenting with dysphonia and dysphagia to investigate trends and inform potential pathways for ongoing care.DesignObservational cohort study.SettingAn inner-city National Health Service Hospital Trust in London, United Kingdom.ParticipantsAll adult inpatients hospitalized with COVID-19 (N=164) who were referred to Speech and Language Therapy (SLT) for voice and/or swallowing assessment for 2 months starting in April 2020.InterventionsSLT assessment, advice, and therapy for dysphonia and dysphagia.Main Outcome MeasuresEvidence of delirium, neurologic presentation, intubation, tracheostomy, and proning history were collected, along with type of SLT provided and discharge outcomes. Therapy outcome measures were recorded for swallowing and tracheostomy pre- and post-SLT intervention and Grade Roughness Breathiness Asthenia Strain Scale for voice.ResultsPatients (N=164; 104 men) aged 56.8±16.7 years were included. Half (52.4%) had a tracheostomy, 78.7% had been intubated (mean, 15±6.6d), 13.4% had new neurologic impairment, and 69.5% were delirious. Individualized compensatory strategies were trialed in all and direct exercises with 11%. Baseline assessments showed marked impairments in dysphagia and voice, but there was significant improvement in all during the study (P<.0001). On average, patients started some oral intake 2 days after initial SLT assessment (interquartile range [IQR], 0-8) and were eating and drinking normally on discharge, but 29.3% (n=29) of those with dysphagia and 56.1% (n=37) of those with dysphonia remained impaired at hospital discharge. A total of 70.9% tracheostomized patients were decannulated, and the median time to decannulation was 19 days (IQR, 16-27). Among the 164 patients, 37.3% completed SLT input while inpatients, 23.5% were transferred to another hospital, 17.1% had voice, and 7.8% required community follow-up for dysphagia.ConclusionsInpatients with COVID-19 present with significant impairments of voice and swallowing, justifying responsive SLT. Prolonged intubations and tracheostomies were the norm, and a minority had new neurologic presentations. Patients typically improved with assessment that enabled treatment with individualized compensatory strategies. Services preparing for COVID-19 should target resources for tracheostomy weaning and to enable responsive management of dysphagia and dysphonia with robust referral pathways.     

The nurse specialist as main care-provider for patients with type 2 diabetes in a primary care setting: effects on patient outcomes

A solution to safeguard high quality diabetes care may be to allocate care to the nurse specialist. By using a one group pretest-posttest design with additional comparisons, this study evaluated effects on patient outcomes of a shared care model with the diabetes nurse as main care-provider for patients with type 2 diabetes in a primary care setting. The shared care model resulted in an improved glycaemic control, additional consultations and other outcomes being equivalent to diabetes care before introduction, with the general practitioner as main care-provider. Assignment of care for patients with type 2 diabetes to nurse specialists seems to be justified.     

A Randomised Controlled Study of the Outcome of Hydrotherapy for Subjects with Low Back or Back and Leg Pain

Background and purpose:

Exercise is frequently selected by physiotherapists to treat patients with low back pain (LBP) or with back and leg pain. Anecdotally a particular form of exercise, group hydrotherapy, is widely accepted as a beneficial and cost-effective method of management. This study was designed to investigate the claimed benefits of group hydrotherapy for subjects with chronic low back pain (CLBP) and back and leg pain.

Subjects:

A total of 109 adults with LBP or back and leg pain of more than three months duration were randomly assigned to either a hydrotherapy (experimental) or control (delayed hydrotherapy) group; 95 subjects completed the study.

Methods:

Before and after the four-week‘intervention period’ the following measures were recorded for all subjects in both groups: the ranges of active lumbar flexion and extension and of passive straight leg raise; the levels of lower limb strength, reflex responses, light touch sensation, functional disability using the Oswestry Low Back Pain Disability Questionnaire, and pain using the McGill Pain Questionnaire. All measurements were made and recorded by an experienced physiotherapist unaware of the group assignment of subjects.

Results:

Analysis with chi-square showed a statistically significant greater number of subjects in the experimental group improved in their function and fewer deteriorated. Subjects whose condition improved on the other measures were typically in the experimental group, while those whose condition deteriorated were typically in the control group.

Conclusion and discussion:

The findings offer qualified support to anecdotal evidence that group hydrotherapy can benefit subjects with CLBP or back and leg pain.     

预防医学本科毕业生应对突发生物性公共卫生事件核心能力评价指标体系构建

目的　构建一套预防医学本科毕业生应对突发生物性公共卫生事件核心能力评价指标体系。方法　采用深入访谈和小组讨论等研究方法确定核心能力结构,并运用德尔菲法进行2轮专家咨询。以21位专家对该体系的咨询结果为依据,最终确定指标体系及其权重。采用Excel和SPSS 21.0软件进行数据整理和统计分析。结果　专家咨询的积极系数大于80%,权威系数大于0.7,均值为0.906。最终确定的指标体系由4个一级指标、10个二级指标、39个三级指标构成。结论　该评价指标体系可为探索提高毕业生核心能力的有效途径提供参考依据。     

The association of peri‐operative scores,including frailty,with outcomes after unscheduled surgery

Postoperative hospital stay is longer for frail, older patients, who are more likely to experience prolonged postoperative morbidity and reduced long‐term survival. We recorded in‐hospital mortality, morbidity and length of stay for 164 patients aged at least 65 years after unscheduled surgery. We evaluated pre‐operative frailty with the 7‐point Clinical Frailty Scale: 81 patients were ‘not vulnerable’ (frailty score 1–3) and 83 were ‘vulnerable or frail’ (frailty score 4), with mean (SD) ages of 74.7 (7.5) years vs. 79.4 (8.3) years, respectively, p < 0.001. Within 30 postoperative days 8/164 (5%) patients died, all with frailty scores 4, p = 0.007. Postoperative morbidity was less frequent in patients categorised as ‘not vulnerable’ on four out of the six days it was measured (days 3, 5, 8, 14, 23, 28). Median (IQR [range]) postoperative stay was 9 (6–18 [2–221]) days for patients with frailty scores 1–3, and 22 (12–33 [2–270]) days for patients with score 4, p < 0.001. Four variables independently associated with hospital discharge, hazard ratio (95%CI): E‐POSSUM, 0.74 (0.60–0.92), p = 0.007; ASA 2, 0.35 (0.13–0.98), p = 0.046, ASA 3, 0.17 (0.06–0.47), p = 0.001 and ASA 4/5, 0.08 (0.02–0.28), p < 0.001; operative severity ‘major +’, 0.69 (0.41–1.08), p = 0.10 and the Surgical Outcome Risk Tool, 7.75 (0.81–74.40), p = 0.08.     

远程医疗服务质量存在的问题及改进策略

通过文献查阅分析、实践调研及专家访谈,构建适合我国当前远程医疗服务模式的服务质量评价指标体系,选取具有代表性的150家医院的远程医疗服务站点进行服务质量评价,对目前远程医疗服务存在的问题进行总结、分析、归纳,进而提出远程医疗服务质量改进策略。