Use of Different Bath Grab Bar Configurations Following a Balance Perturbation

ABSTRACT

Although commonly prescribed, little research exists on bath grab bars. This study examined the use of bath grab bars following an experimentally induced balance perturbation, the influence of the task on grab bar use, and the influence of balance loss on acceptance of grab bars. A mixed design documented the use of four different grab bar configurations: (a) no bars, (b) vertical/horizontal combination, (c) L-shaped bar, and (d) vertical/angled combination following balance loss. Eighty adults were randomly assigned to three groups. Each group tried the “no bar” configuration and one of the other grab bar configurations. In 25% of the trials for each configuration, balance perturbation was induced. Older adults used grab bars 59.4% of time to regain balance, compared to 13.6% for younger adults. The vertical bar on the side wall was favored by both groups of participants during both bathtub entry and exit. To promote safety in the home, existing building codes must be revised to recommend minimally a vertical grab bar on the side wall. Additional bars may be needed to ensure safety during stand-to-sit and sit-to-stand phases of bath transfers. Initiatives must be taken to decrease the prejudice associated with grab bars.     

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.

     

Do active assist transfer devices improve transfer safety for patients and caregivers in hospital and community settings? A scoping review

Abstract

Background: Safe patient handling practices reduce injury risk for healthcare workers (HCW) and patients, but may conflict with goals of rehabilitation and person-centred care by minimizing (a) active participation in transfers and (b) autonomy and dignity while using mechanical lifts. Active assist transfer devices (AATDs) have potential to address both safety and support needs for appropriate clients.

Purpose: What is the scope and nature of the evidence to support the use of AATD for improving transfer safety for patients and caregivers in both hospital and community settings?

Methods: Scoping review of peer-reviewed and Gray literature, using systematic search strategies and multiple reviewers for identifying papers and extracting data.

Findings: Twenty-nine peer-reviewed publications, and 12 other documents (policy, technical) were included in the review. Half focused on HCW safety in the hospital setting, with only seven addressing patient safety in the community. Generally, literature was of low quality, with no controlled trials to support the benefit of this equipment, and often represented a nursing care perspective. However, positive outcomes reported included safety, satisfaction, and equipment utilization.

Implications: There is a need for rigorous research on use of AATDs in the community comparing rehabilitation outcomes across other forms of transfer equipment. Other important targets include injury risk for family caregivers, and potential to support early discharge. At present, utilization of AATDs within the rehabilitation field will continue to rely on best judgement of the care team. Implementation of AATDs should be considered a compelling target for practice-based research and quality improvements.

• Implications for rehabilitation

• The use of active assist transfer devices is associated with their availability in the in-patient hospital setting.

• The use of active assist transfer devices is associated with positive patient experience, such as increased patient satisfaction and dignity. Improved patient adherence and cooperation with healthcare workers during mobilization and rehabilitation may follow.

• Most current evidence is focused on caregiver safety outcomes and is in support of decreased injury rates with increased active assist transfer device use. There is a limited amount of evidence focusing on the rehabilitation outcomes with active assist transfer device use.

• With current evidence, the use of AATDs should be used at the discretion of the care team.

     

Upper-limb biomechanical analysis of wheelchair transfer techniques in two toilet configurations

BackgroundUsing proper technique is important for minimizing upper limb kinetics during wheelchair transfers. The objective of the study was to 1) evaluate the transfer techniques used during toilet transfers and 2) determine the impact of technique on upper limb joint loading for two different toilet configurations.MethodsTwenty-six manual wheelchair users (23 men and 3 women) performed transfers in a side and front wheelchair-toilet orientation while their habitual transfer techniques were evaluated using the Transfer Assessment Instrument. A motion analysis system and force sensors were used to record biomechanical data during the transfers.FindingsMore than 20% of the participants failed to complete five transfer skills in the side setup compared to three skills in the front setup. Higher quality skills overall were associated with lower peak forces and moments in both toilet configurations (−0.68 < r < −0.40, p < 0.05). In the side setup, participants who properly placed their hands in a stable position and used proper leading handgrips had lower shoulder resultant joint forces and moments than participants who did not perform these skills correctly (p ≤ 0.04). In the front setup, positioning the wheelchair within three inches of the transfer target was associated with reduced peak trailing forces and moments across all three upper limb joints (p = 0.02).InterpretationTransfer skills training, making toilet seats level with the wheelchair seat, positioning the wheelchair closer to the toilet and mounting grab bars in a more ideal location for persons who do sitting pivot transfers may facilitate better quality toilet transfers.     

Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton

Aim: The main objectives of this study were to quantify clients’ satisfaction and perception upon completion of a locomotor training program with an overground robotic exoskeleton.

Methods: A group of 14 wheelchair users with a spinal cord injury, who finished a 6–8-week locomotor training program with the robotic exoskeleton (18 training sessions), were invited to complete a web-based electronic questionnaire. This questionnaire encompassed 41 statements organized around seven key domains: overall satisfaction related to the training program, satisfaction related to the overground robotic exoskeleton, satisfaction related to the program attributes, perceived learnability, perceived health benefits and risks and perceived motivation to engage in physical activity. Each statement was rated using a visual analogue scale ranging from “0?=?totally disagree” to “100?=?completely agree”.

Results: Overall, respondents unanimously considered themselves satisfied with the locomotor training program with the robotic exoskeleton (95.7?±?0.7%) and provided positive feedback about the robotic exoskeleton itself (82.3?±?6.9%), the attributes of the locomotor training program (84.5?±?6.9%) and their ability to learn to perform sit–stand transfers and walk with the robotic exoskeleton (79.6?±?17%). Respondents perceived some health benefits (67.9?±?16.7%) and have reported no fear of developing secondary complications or of potential risk for themselves linked to the use of the robotic exoskeleton (16.7?±?8.2%). At the end of the program, respondents felt motivated to engage in a regular physical activity program (91.3?±?0.1%).

Conclusion: This study provides new insights on satisfaction and perceptions of wheelchair users while also confirming the relevance to continue to improve such technologies, and informing the development of future clinical trials.

• Implications for Rehabilitation

• All long-term manual wheelchair users with a spinal cord injury who participated in the study are unanimously satisfied upon completion of a 6–8-week locomotor training program with the robotic exoskeleton and would recommend the program to their peers.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study offered positive feedback about the robotic exoskeleton itself and feel it is easy to learn to perform sit–stand transfers and walk with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study predominantly perceived improvements in their overall health status, upper limb strength and endurance as well as in their sleep and psychological well-being upon completion of a 6–8-week locomotor training program with the robotic exoskeleton.

• All long-term manual wheelchair users with a spinal cord injury who participated in the study unanimously felt motivated to engage in a regular physical activity program adapted to their condition and most of them do plan to continue to participate in moderate-to-strenuous physical exercise.

• Additional research on clients’ perspectives, especially satisfaction with the overground exoskeleton and locomotor training program attributes, is needed.

     

Use of different bath grab bar configurations following a balance perturbation

Although commonly prescribed, little research exists on bath grab bars. This study examined the use of bath grab bars following an experimentally induced balance perturbation, the influence of the task on grab bar use, and the influence of balance loss on acceptance of grab bars. A mixed design documented the use of four different grab bar configurations: (a) no bars, (b) vertical/horizontal combination, (c) L-shaped bar, and (d) vertical/angled combination following balance loss. Eighty adults were randomly assigned to three groups. Each group tried the "no bar" configuration and one of the other grab bar configurations. In 25% of the trials for each configuration, balance perturbation was induced. Older adults used grab bars 59.4% of time to regain balance, compared to 13.6% for younger adults. The vertical bar on the side wall was favored by both groups of participants during both bathtub entry and exit. To promote safety in the home, existing building codes must be revised to recommend minimally a vertical grab bar on the side wall. Additional bars may be needed to ensure safety during stand-to-sit and sit-to-stand phases of bath transfers. Initiatives must be taken to decrease the prejudice associated with grab bars.     

Effects of Kinesio taping in rectus femoris activity and sit-to-stand movement in children with unilateral cerebral palsy: placebo-controlled,repeated-measure design

Background: Although it has been commonly used in rehabilitation sets, there is a lack of studies verifying the effects of Kinesio taping to improve functionality in children with Cerebral Palsy (CP). This information would promote evidence-based practice.

Purpose: To verify the effects of Kinesio taping in the performance of sit-to-stand movement in children with unilateral CP.

Methods and materials: A blinded, single placebo-controlled and repeated-measure design. The setting was the rehabilitation clinic of the university and care facilities. A total of 11 children from 6 to 12 years of age (mean: 10.5 years; standard deviation: 2.8 years) and classified as levels I and II by the Gross Motor Function Classification System were included. Kinesio taping was applied over the rectus femoris of the affected limb. Three taping conditions were used: Kinesio taping, without Kinesio taping and placebo. Three seat heights were used: neutral (100%), lowered (80%), and elevated (120%). Muscle activity (electromyography) and trunk and lower limb alignment (kinematics) were evaluated as body structures and function measures. The time required to perform sit-to-stand was used as a functionality measure. Mixed analysis of variation (ANOVA) measured angular variables of the hip, knee, ankle, and rectus femoris activity. Repeated ANOVA measured angular variables of trunk and pelvis and total duration. Significance was accepted for values of p?≤?0.05.

Results: Kinesio taping increased rectus femoris activity, decreased peak flexion of the trunk, knee, hip, and ankle, and increased trunk extension in the end of sit-to-stand when compared with without Kinesio taping and placebo. Total duration was decreased with lower effect sizes.

Conclusions: Immediate application of Kinesio taping modified body structures and function measures during sit-to-stand in children with unilateral CP, but it did not alter functionality.

• Implications for Rehabilitation

• Evidence-based practice about the use of Kinesio taping in Cerebral Palsy.

• Knowledge about alternative rehabilitation techniques in Cerebral Palsy.

• Knowledge about sensory stimulation in Cerebral Palsy.

• Effectiveness of Kinesio taping in muscle activation.

     

Design of a modular wheelchair with posture transformation capabilities from sitting to standing

Abstract

A significant part of world’s population is handicap, with majority suffering from lower body disabilities – the body waist down is paralysed or weak. In many of such cases, upper body of the affected person was found to be deemed fit and was able to perform all tasks, if feasible. Being able to transform posture from sitting to standing position independently, helps perform routine jobs with ease, increases employment prospects and improves blood circulation to name a few. Most of the existing wheelchair designs are expensive because of the electrical and electronics involved requiring added maintenance, or contain a variety of subsystems thus decreasing reliability. The objective is to further increase the posture transformation capabilities in terms of cost, user effort, maintenance and life. The modular wheelchair allows the user to use his/her own energy and bodyweight to shift from sitting to standing position and back, in single smooth movement with zero dependency on electrical/electronic parts. Detailed design of links, mechanisms and load calculations were performed as per standard requirements. Prototype of the proposed design was also made and successfully tested for all its design features and capabilities as per the design standards and conditions of physically challenged people.

• Implications for rehabilitation

• Five bar link mechanism helps to reduce manual effort.

• There is no dependency on auxiliary power source.

• It is a low cost rehabilitation solution with increased posture transformation capabilities.

• Increased body movements will help to increase self-confidence of disabled person.

• Easy sitting and standing capabilities will improve overall bodily functions and remove psychological barriers.

     

Development of an unpowered ankle exoskeleton for walking assist

Abstract

Aim: Assistive technologies traditionally rely on either powered actuation or passive structures to provide increased strength, support or the ability to perform specific functions. At one end of the spectrum are powered exoskeletons, which significantly increase a user’s strength, but require powerful actuators, complex control systems and heavy power sources. At the other end are orthoses, which are generally unpowered and light in weight, relying on the mechanical properties of passive mechanical elements. Ideally, assistive technologies should combine the benefits of both systems and enhance human motion while remaining lightweight and efficient. This paper presents the development of a lightweight unpowered ankle exoskeleton that relies on the spring-like properties of a Pneumatic Artificial Muscle, which is inflated and sealed.

Methods: This flexible air-spring is used to harness gait energy and compliment the human ankle torque at push-off. To mechanically validate the proposed exoskeleton design, a prototype was fabricated and experimentally tested.

Results: Unlike other existing devices, the proposed unpowered exoskeleton was able to store a significant amount of energy and release it all at once. The timing mechanism worked as intended and triggered the release of 115?N?m of torque when the ankle reached a pre-determined angle.

Conclusion: Overall, the device demonstrated the ability to provide significant contribution to the ankle torque, timed to release precisely at the push-off phase of the gait cycle.

• Implications for Rehabilitation

• The currently proposed ankle exoskeleton makes use of an unpowered, fully mechanical system to provide walking assistance to users by providing additional torque to the ankle joint.

• The newly developed assistive device is devised as a solution for persons struggling with mobility issues, and can be used both as a means for rehabilitation or as a permanent assistive devices for patients struggling with long-term disabilities.

• The device also has potential to be used as a performance enhancing device for ablebodied users by reducing muscle fatigue during extended physical exertion.

     

Motor learning from virtual reality to natural environments in individuals with Duchenne muscular dystrophy

Purpose: To examine whether performance improvements in the virtual environment generalize to the natural environment. Study design: we had 64 individuals, 32 of which were individuals with DMD and 32 were typically developing individuals. Methods: The groups practiced two coincidence timing tasks. In the more tangible button-press task, the individuals were required to ‘intercept’ a falling virtual object at the moment it reached the interception point by pressing a key on the computer. In the more abstract task, they were instructed to ‘intercept’ the virtual object by making a hand movement in a virtual environment using a webcam. Results and Conclusions: For individuals with DMD, conducting a coincidence timing task in a virtual environment facilitated transfer to the real environment. However, we emphasize that a task practiced in a virtual environment should have higher rates of difficulties than a task practiced in a real environment.

• IMPLICATIONS FOR REHABILITATION

• Virtual environments can be used to promote improved performance in ?real-world? environments.

• Virtual environments offer the opportunity to create paradigms similar ?real-life? tasks, however task complexity and difficulty levels can be manipulated, graded and enhanced to increase likelihood of success in transfer of learning and performance.

• Individuals with DMD, in particular, showed immediate performance benefits after using virtual reality

     

Understanding independent wheelchair transfers. Perspectives from stakeholders

Abstract

Purpose: Transferring to and from the wheelchair is among the most important routine tasks for many wheelchair users. Transfers are also greatly affected by many personal and external factors. The purpose of this study is to investigate personal experiences, needs and concerns of wheelchair users in relation to wheelchair transfers performed in their everyday lives.

Methods: A series of focus groups and interviews were carried out with 11 wheelchair users and 4 occupational therapists. Data were analysed using a hybrid deductive and inductive approach of thematic analysis.

Results: The seven themes identified emphasize the importance and complexity of wheelchair transfers. Transfers were described as gateways to independence that grant access to life opportunities, and community participation. Nonetheless, transferring skills are difficult to acquire and the concept of correct technique, although really important, is often poorly defined. Wheelchair transfers can be further complicated by the characteristics of the individual, the presence of upper limb pain, fear of falling or the characteristics of the environment. Despite the importance of transfer training to improve safety and reduce the risk of overload injuries, only a few people receive dedicated advice from health professionals. Currently available assistive technologies were perceived as only partially successful in providing support to wheelchair users during the execution of transfers, especially when environmental constraints make the transfer more challenging.

Conclusion: Due to their multifactorial nature, creating effective solutions to improve any aspect of wheelchair transfers will require a collaborative effort from users, clinicians, designers and other professionals.

• Implications for rehabilitation

• The ability to transfer independently is extremely important for many wheelchair users and can affect not only their personal and social lives, but also the way they perceive themselves and are perceived by others.

• The use of a correct transferring technique plays an important role in reducing the effort required to complete a transfer and decreases the risk factors for both falls and upper limb injury development. Unfortunately, few wheelchair users have access to in-person training to develop transferring skills. The remaining people rely on a combination of peer observation, personal research and simple trial and error to figure out the movement strategies that better suit their needs.

• Currently available assistive technologies are perceived by wheelchair users as only partially successful in providing support during the execution of transfers. Transfer boards and other devices are often described as only useful for basic transfers and for individuals with reduced, but still sufficient, upper limb function.

     

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.

     

Psychometric properties of field-based anaerobic capacity tests in children with Developmental Coordination Disorder

Background: Assessment of anaerobic capacity in children with Developmental Coordination Disorder (DCD) is essential for treatment planning. However, available field-based measures have no established validity and reliability in this population.

Purpose: To examine the psychometric properties of selected field-based anaerobic capacity tests in children with and without DCD.

Methods: School-aged children (6–16 years) with and without DCD participated in the study. The children completed the shuttle run sub-item of the Bruninks-Oseretsky test of motor proficiency-second edition, the 10?×?5 m sprint tests (straight and slalom) and the muscle power sprint test (MPST).

Results: The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and 10?×?5?m sprint tests possess good construct validity and test–retest reliability in children with DCD. The 10?×?5?m sprint test-slalom was found to be the most responsive test among children with DCD. However, the MPST was less reliable in children with DCD compared to their typically developing peers, leading to a very large Smallest Detectable Difference.

Conclusions: The findings suggest that the selected anaerobic capacity measures have sound psychometric properties among children with DCD with the exception of the MPST. Clinicians working on children with DCD could use these tests in their practice, especially in situations where logistical resources are limited.

• Implications for Rehabilitation

• Field-based anaerobic capacity tests are suitable measures for assessing anaerobic capacity in children with Developmental Coordination Disorder, particularly in situations where laboratory assessments are not feasible.

• The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and the 10?×?5 sprint tests (straight and slalom) have good construct validity in this population.

• The 10?×?5 sprint test (slalom) is the most sensitive anaerobic capacity test among children with Developmental Coordination Disorder.

     

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.

     

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.

     

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

     

An exploration of the experiences of Brazilian hemiplegic manual wheelchair users

Abstract

Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs.

Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users.

Results: The results identified 4?key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision.

Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment.

• Implication for rehabilitation

• Adding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment.

• The importance of involving the user in decisions made about wheelchair provision.

• Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.