Reliability of visual inspection and palpation to assess relative flexibility of the shoulder

IntroductionMovement compensations during internal rotation of the shoulder can provoke pain. Reliably observing and measuring compensations in the shoulder using visual and palpatory methods can result in more efficacious treatments of shoulder pathology. Despite this, the reliability of these measures and the relationship between them is unknown.MethodsBilateral shoulders of 33 Doctor of Physical Therapy (DPT) students were measured. Two third-year DPT student examiners used visual inspection and physical palpation to identify the first signs of internal rotation (IR) passive stiffness. Measurements were taken and recorded by a third examiner using the GetMyROM (Version 1.1) iPhone application.ResultsGood intra-rater reliability for both examiners was identified for physical palpation (ICC = 0.896, 95% CI = 0.830, 0.936, ICC = 0.901, 95% CI = 0.839, 0.939) and visual inspection (ICC = 0.813, 95% CI = 0.699, 0.884, ICC = 0.782, 95% CI = 0.667, 0.880). Moderate interrater reliability was found between the examiners for physical palpation (ICC = 0.681, 95% CI = 0.479, 0.797) while poor interrater reliability was found between examiners for visual inspection (ICC = 0.481, 95% CI = 0.234, 0.648). The correlation between physical palpation and visual inspection indicated moderate reliability for both examiners (r = 0.815, p = 0.01, r = 0.832, p = 0.01).ConclusionThe findings of this research study indicate that both physical palpation and visual inspection are reliable methods for measuring relative flexibility of shoulder IR when performed by the same examiner. However, the reliability for both methods decreases when performed by different examiners. Additionally, a strong correlation was found between both measures.     

Effectiveness of dry needling techniques in patients with knee osteoarthritis: A systematic review and meta-analysis

BackgroundDry needling has been found to be effective in various myofascial pain syndromes and musculoskeletal conditions. However, there is a need to evaluate the effects of dry needling techniques in patients with knee osteoarthritis. Hence, the objective of this systematic review was to identify and critically review the evidence on the short-term and long-term effects of dry needling techniques in patients with knee osteoarthritis.MethodsDatabases such as Pubmed, Cochrane library, and Scopus were searched from their inception to July 2019 for randomized controlled trials using dry needling as an active intervention against control/sham/placebo treatment in patients with knee osteoarthritis. The quality of the selected studies was analyzed using Cochrane tool for assessment of risk of bias.ResultsOut of 247 studies, 9 studies were included in the review. The qualitative synthesis for myofascial trigger point dry needling showed contradictory results. The mean difference for periosteal stimulation was significant on pain and function immediately post-treatment (p < 0.00001). The mean difference for intramuscular electrical stimulation on pain was significant (p = 0.03), but marked heterogeneity was found among the studies.ConclusionGood quality studies on myofascial trigger point needling and intramuscular electrical stimulation are required to evaluate their effects in patients with knee osteoarthritis. The review demonstrates a moderate-quality evidence on the short-term effect of periosteal stimulation technique on pain and function in knee osteoarthritis. Future studies comparing the effects of various techniques of dry needling with different dosages and long-term follow up need to be conducted.     

Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques

ObjectiveThe purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation.MethodsTwenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ² test were used to identify the factors associated with the error and inaccuracy of palpation.ResultsAccuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = –0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region.ConclusionThe palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.     

The Stiffness Comparison Test: A pilot study to determine inter-individual differences in palpatory skill related to gender,age, and occupation-related experience

BackgroundManual palpation is a core skill in physical examination. Assessing elastic properties such as tissue stiffness has the potential for being an important diagnostics tool in the detection of cancer and other diseases.ObjectiveThe study describes the newly developed Stiffness Comparison Test (SCT). The aim of our study was to test the SCT as a tool to detect interindividual differences in palpation skill related to gender, age and occupational experience.MethodsWe used eight pairs of polyuterhane gel pads with the stiffness difference decreasing from the first to the last pair. Test subjects were asked to palpate each pair and determine stiffness differences.ParticipantsWe recruited 25 osteopaths, 48 other manual therapists and 50 participants from other non-manual professions.ResultsAs hypothesized there was no significant difference in SCT performance between the sexes (t(121) = 0.288, p = .774). To investigate if an age-related decline would have an effect on palpation skill, we carried out a linear regression. As hypothesized, the model did not predict any significant associations (F(1, 121) = 2.733, b = −0.149, p = .101, R² = 0.022). To compare the effect of occupational groups on SCT performance a one-way ANOVA was conducted. There were no statistically significant differences between group means (F(2, 120) = 0.598, p = .552).ConclusionsThe SCT can be used as simple and affordable tool for assessment, teaching and training in all disciplines of manual medicine. Further refinements of the tool are suggested to advance its discrimination power.     

The Effect of Gluteus Medius Dry Needling on Pain and Physical Function of Non-athlete women with Unilateral Patellofemoral Pain Syndrome: A Double-Blind Randomized Clinical Trial

BackgroundOne of the most common knee problems is patellofemoral pain syndrome (PFPS).It is of great importance to pay attention to the muscles of the hip area in people with PFPS, especially to the presence of trigger points within the gluteus medius (GM). Accordingly, using therapeutic interventions to eliminate trigger points is required. Therefore, the aim of the present study was to evaluate the effect of GM active trigger point dry needling (TrP-DN) on pain and physical function of non-athlete women with unilateral PFPS.Methods29 young non-athlete women aged between 17 and 40 years old with unilateral PFPS were randomly divided into two groups of experimental (n = 15) and control (n = 14) through the simple and convenience sampling method. Both groups received conventional physiotherapy twice a week up to 6 sessions. The experimental group also received GM active TrP-DN once a week for 3 sessions in addition to the conventional physiotherapy. Pain intensity and physical function of women with PFPS were measured in both groups in three stages of before, immediately after and one week after performing the treatment sessions.FindingsThe six-session physiotherapy treatment led to a significant reduction in pain intensity as well as an improvement in physical function in both groups (p < 0.001). In addition, the intergroup comparison showed a significant improvement in physical function of the experimental group after one week from the GM active TrP-DN, compared to the control group (p = 0.048).ConclusionThe present study indicated that conventional physiotherapy with or without GM active TrP-DN can reduce pain and improve physical function in non-athlete women with unilateral PFPS. This study also revealed that conventional physiotherapy combined with dry needling can lead to further reduction in pain and a greater improvement in physical function of this group of patients.     

Accuracy of Palpation Procedures for Locating the C1 Transverse Process and Masseter Muscle as Confirmed by Computed Tomography Images

ObjectiveThe purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy.MethodsThis was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient.ResultsThe right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r = .219; 95% confidence interval, 0.018-0.403; P = .033).ConclusionPalpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles.     

Short-term effects of dry needling at a spinal and peripheral site on functional outcome measures,strength, and proprioception among individuals with a lateral ankle sprain

BackgroundThe purpose of the study was to compare the effects of spinal and peripheral dry needling with peripheral dry needling alone, in addition to a strength and proprioception home exercise program, on pain, balance, strength, proprioception, and functional limitations among individuals with a history of a lateral ankle sprain.MethodsThe study design is a single-blinded, repeated measures randomized clinical trial. Thirty-four participants, aged 18–50, with a history of a lateral ankle sprain within the last twelve months were randomly assigned into a peripheral dry needling (PDN) group or a spinal and peripheral dry needling (SPDN) group. Outcome measures included a pain assessment, strength testing, Modified Clinical Test of Sensory Integration and Balance, physical performance on hop tests, Cumberland Ankle Instability Tool and the Foot and Ankle Disability Index assessed at baseline, one week, and at four to six weeks.ResultsThe mixed model ANOVAs showed significant side by time interaction (p < 0.05) for inverter/dorsiflexion strength and significant improvements in side, time, and side by time (p < 0.05) for the CAIT.ConclusionTrigger point dry needling demonstrated short-term improvements in strength of the inverters/dorsiflexors and the CAIT scores on the involved side at one week and at four to six weeks irrespective of a PDN or SPDN approach.DiscussionThese results suggest that improvements in strength and function can be achieved with PDN without additional needling at the corresponding spinal level.     

Use of unstable exercises in periscapular muscle activity: A systematic review and meta-analysis of electromyographic studies

BackgroundThe use of unstable surfaces has been proposed to increase the neuromuscular demand. This strategy has been adopted to generate an increase in the activity of periscapular muscles due to its role in the stabilization of the scapula. However, the influence of this instability on the EMG activity remains uncertain. The aim of this study was to analyze the effects of using unstable surfaces on the EMG activity of the periscapular muscles.MethodsA comprehensive search in the PubMed, EMBASE, SCIELO, Web of Science, SCOPUS, Cochrane and LILACS databases was undertaken from their year of inception up to December 2019. Studies which directly investigated the EMG activity of periscapular muscles in healthy individuals while performing exercises for the upper limbs in stable and unstable conditions.ResultsA total of 33 studies which evaluated a total of 678 healthy individuals were found according to the eligibility criteria. A meta-analysis identified that the EMG activity of the upper trapezius showed a trivial increase with the insertion of the unstable surface (P = 0.04; SMD = 0.14 [95%CI 0.00, 0.27]). No significant effects were observed on the middle trapezius (P = 0.10) and lower trapezius (P = 0.25). A decrease of the anterior serratus EMG activity with a small effect size was observed by implementing an unstable surface (P = 0.01; SMD = −0.21 [95%CI -0.36, −0.05]).ConclusionThe use of unstable surfaces generated a trivial increase in the upper trapezius activity, and a slight decrease in the anterior serratus activity. No effect was observed on the middle and lower trapezius.     

Do patients with low back pain and central sensitization have differences in physical fitness?

IntroductionLow back pain is one of the main musculoskeletal complaints, and may be associated with central sensitization (CS). The physical capacity of patients with low back pain and CS is not very clear.MethodsA cross-sectional study, with 92 patients divided into two groups according to their risk of CS. The patient's physical capacity ability was assessed using 6-min walking test (6MWT); timed up and go test (TUG); sit-to-stand test (STS); and trunk flexor, extensor and side-bridge endurance tests. In addition, participants completed questionnaires regarding disability, kinesiophobia, catastrophization and quality of life.ResultsThe group with a higher risk of CS had worst performance in the 6MWT (U = 1248; p < 0.001), STS (t(83) = 3.63; p < 0.001) and TUG (t(83) = −4.46; p < 0.001). Similarly, endurance in the right (U = 1453,5; p = 0,002) and left (U = 1467; p = 0,003) side-bridge tests, and the trunk extensor test (U = 1546; p = 0,003) was worse. Disability (U = 1272; p < 0.001), physical capacity kinesiophobia (t(83) = -2.21; p = 0.03) work kinesiophobia (U = 1452; p < 0.001), and pain catastrophization (t(77.57) = -5.03; p < 0.001), were also higher in the group with a higher risk of CS. Quality of life indicators were worse in the higher risk group for all domains of the EQ-5D-3L: Mobility (X²(1) = 12.92; p < 0.001), self-care (X²(1) = 16,3; p = 0,012), usual activities (X²(2) = 14.14; p = 0.001), pain (X²(2) = 27.79; p < 0.001), anxiety and depression (X²(2) = 15.05; p = 0.001).ConclusionPatients with low back pain and higher risks of CS appear to show lower performance in physical capacity tests, higher rates of disability, kinesiophobia, pain catastrophization, and lower quality of life compared to those with lower risks of CS.     

The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis

BackgroundDespite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited.ObjectivesThis study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors.MethodsWe analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life.ResultsThe participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = ?0.48, p < 0.001), unemployment (β = ?0.19, p < 0.001), low income (β = ?0.11, p = 0.004), older age (β = ?0.08, p = 0.039), and cognitive impairment (β = ?0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = ?0.49, p < 0.001) and cognitive impairment (β = ?0.14, p = 0.005) and low income (β = ?0.09, p = 0.014) predicted mental component summary scores.ConclusionsThe participants reported poor physical and mental health–related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.     

Analgesic efficacy of the serratus anterior plane block in rib fractures pain: A randomized controlled trial

BackgroundSerratus anterior plane block (SAPB) was evaluated that in patients with the complaint of rib fracture pain in terms of total analgesic consumption and pain scores.MethodSixty patients with rib fracture and NRS (Numeric Rating Scala) pain scores equal or greater than four were included in randomized controlled study. Patients were randomized to perform SAPB or control group. Primary outcome was total tramadol consumption in 24 h. Secondary outcomes were NRS scores (after Patient Controlled Analgesia (PCA) application 30 min, first, second, 4 th, 6 th, 12 th, 24 th hour), peripheral oxygen saturation (first and 24 th hour after PCA application), chronic pain. and complications.ResultsThe total tramadol consumption significantly lower in group S (p = 0.02). NRS scores after 30 min, 1 h, 2 h, 4 h, 6 h, 12 h, and 24 h were significantly lower in group S than in group C (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.002, p = 0.026). The total number of patients who reported of chronic pain at rest and during effort was significantly lower in group SAPB than in group C (p = 0.006). Nine patients in group C were reported of pain, four of whom had pain at rest and five had pain during effort. One patient in group S was reported of pain during effort.ConclusionThis study demonstrated that SAPB, as part of multimodal analgesia in pain management due to rib fractures, is safe and effective in reducing acute pain.     

Cardiorespiratory and metabolic demand of the 6-minute pegboard and ring test in healthy young adults

ObjectiveTo determine the cardiorespiratory and metabolic demand of the Six-Minute Pegboard and Ring Test (6PBRT) in healthy young adults and its association with maximal arm cycle ergometer test (arm CET).MethodsVolunteers were randomized to performed the 6PBRT test or arm CET. The second test was performed after 48 h. Oxygen consumption (VO₂), heart rate (HR), dyspnea and upper limb fatigue were assessed during the tests. Demographic data, body composition, level of physical activity, arm strength and endurance were also evaluated.ResultsDuring 6PBRT, VO₂ values increased from 5.8 to 11.1 mL kg⁻¹.min⁻¹ (p < 0.001). VO_2peak, HR _Mean and HR_max at 6PBRT were 47.2% and close to 65% respectively of those achieved during the arm CET. There was a positive correlation between the score on 6PBRT and VO_2mean and VO_2peak achieved at arm CET (r = 0.268; p = 0.003 and r = 0.247; p = 0.046 respectively). No correlation was found between the HR_mean, HR_peak, level of physical activity or strength with 6PBRT (p > 0.05). Handgrip endurance had a positive correlation with score on 6PBRT (r = 0.237; p = 0.054). Body Mass Index, body fat and fat mass were negatively correlated with the score on 6PBRT (r = 0.301; p = 0.014, 0.329; p = 0.007 and r = 0.427; p = 0.001).ConclusionsThe 6PBRT test showed a moderate cardiorespiratory and metabolic demand in healthy individuals in comparison of arm CET. BMI, body fat and fat mass correlated with the score on 6PBRT.     

Inter-professional agreement of ultrasound-based diagnoses in patients with shoulder pain between physical therapists and radiologists in the Netherlands

Study designReliability study.ObjectivesThe aim of this study was to evaluate the interrater-reliability of the interpretation of diagnostic ultrasound in patients with shoulder pain between physical therapists and radiologists.BackgroundAlthough physical therapists in The Netherlands increasingly use diagnostic ultrasound in clinical practice, there is no evidence available on its reliability.MethodsA cohort study included patients with shoulder pain from primary care physiotherapy. Patients followed the usual diagnostic pathway of which diagnostic ultrasound could be a part. Patients that received diagnostic ultrasound also visited a radiologist within one week for a second one. Patients and radiologists were blinded for the diagnostic ultrasound diagnosis of the physical therapists. Agreement was assessed using Cohen's kappa statistics. Subgroup analysis was performed on education and experience.ResultsA total of 65 patients were enrolled and 13 physical therapists and 9 radiologists performed diagnostic ultrasound. We found substantial agreement (0.63 K) between physical therapists and radiologists on the assessment of full thickness tears. The overall kappa of all four diagnostic categories was 0.36, indicating fair agreement. The more experienced and highly trained physical therapists showed moderate agreement (0.43 K) compared to only slight agreement (0.17 and 0.09 K) from the less experienced and trained physical therapists with radiologists.ConclusionThe reliability between physical therapists and radiologist on diagnostic ultrasound of shoulder patients in primary care is borderline substantial (Kappa = 0.63) for full thickness tears only. This level of reliability is relatively low when compared with the high reliability between radiologists. More experience and training of physical therapists may increase the reliability of diagnostic ultrasound.     

Are the thorax Computed Tomography findings of ICU patients diagnosed with COVID-19 pneumonia related to the duration of hospital stay and mortality?

IntroductionQuantitative thorax Computed Tomography (CT) is used to determine the severity of COVID-19 pneumonia. With a new approach, quantitative thoracic CT is to contribute to the triage of patients with severe COVID-19 pneumonia in the ICU and to evaluate its relation with mortality by taking into account the vaccination status.MethodsFifty-six patients who had a diagnosis of COVID-19 pneumonia confirmed in the adult ICU were evaluated retrospectively. To evaluate the degree of parenchymal involvement, the quantitative CT “craniocaudal diameter of the thorax/craniocaudal largest lesion diameter (CCDT/CCDL)” ratio and semi-quantitative total CT severity scores (TCTSS) (0:0%; 1:1–25%; 2:26–50%; 3:51–75% and 4:76–100%) were calculated. Both methods were analyzed with comparative ROC curves for predicting mortality. The effects of vaccines on thorax CT findings and laboratory parameters were also investigated.ResultsThe sensitivities and specificities were found to be 72.5%, 75.61%, and 80%, 73.33% when CCDT/CCDL and TCTSS cutoff value was taken <1.4, and >9, respectively, to predict mortality in COVID-19 pneumonia (Area Under the Curve = AUC = 0.797 and 0.752). Both methods predicted mortality well and no statistical differences were detected between them (p = 0.3618). In vaccinated patients, CRP was higher (p = 0.045), and LDH and ferritin were lower (p = 0.049, p = 0.004). The number of lobes involved was lower in the vaccinated group (p = 0.001).ConclusionsThe quantitative CT score (CCDT/CCDL) may play as important a role as TCTSS in diagnosing COVID-19 pneumonia, determining the severity of the disease, and predicting the related mortality. COVID-19 vaccines may affect laboratory parameters and cause less pneumonia on thoracic CT than in unvaccinated individuals.     

Interrelationships among workload,illness severity,and function on return to work following acute respiratory distress syndrome

BackgroundInability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS).ObjectivesThe aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS.MethodsWe conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses.ResultsAmong 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: ?0.51 to ?0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (?0.32 to ?0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months.ConclusionsRTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients’ physical, psychological, and interpersonal function.     

Long Thoracic Neuropathy Resulting From First Rib Palpation

Abstract

Injury to the long thoracic nerve and subsequent scapular winging are serious conditions that create significant impairments. This case study describes an entrylevel physical therapy student who sustained a long thoracic neuropathy after another student palpated her first rib in a supervised lab that focused on palpation of the upper quarter. The student did not regain full active range of motion until more than four months after the injury, and one year later, she still reports mild, residual shoulder girdle weakness. The long thoracic nerveís unique position, tethered over the first rib, and its superficial location in the supraclavicular fossa make it susceptible to compression injury. Therefore, it is recommended that clinicians use extreme caution when palpating in the supraclavicular fossa. Preferably, clinicians should palpate the first rib along its posterior shaft or anteriorly on the costal cartilage of the first rib, avoiding the supraclavicular fossa all together.     

Does the use of BariBoard™ improve adequacy of chest compressions in morbid obesity? A pilot study using a simulation model

BackgroundObesity is a growing health problem worldwide. Morbid obesity has been associated with significant barriers to effective thoracic cage compression during cardiopulmonary resuscitation.ObjectiveThe BariBoard? purports to improve adequacy of chest compressions in morbidly obese patients. This study uses a simulation model to evaluate this.MethodsThis was a prospective blinded randomised-controlled crossover pilot trial using a simulation model of obesity. Participants, recruited from hospital departments and prehospital services, performed 2 minutes of continuous compressions on mannequins modified to emulate a morbidly obese patient. Participants were randomised by coin toss to a sequence of either control/intervention or intervention/control, with the BariBoard? in the intervention arm. Accelerometers measured chest wall movement during compressions. The primary endpoint was a composite measure of compression adequacy (rate, depth, and recoil). Secondary endpoints comprised the individual components of the composite outcome, as both dichotomous outcomes (adequate vs. inadequate) and continuous variables. All endpoints were adjusted for potential confounders.ResultsOf 205 participants recruited, 201 were analysed. There was a significant difference in the primary outcome between the control and intervention arms (13.4% vs. 4.5%, respectively, p = 0.001) and between the control and intervention arms for the secondary endpoints of adequate compression depth (31.3% vs. 15.9%, p < 0.001) and recoil (63.7% vs. 41.3%, p < 0.001). After adjustment for confounders and interactions, there was no difference in overall efficacy (odds ratio: 0.62, 95% confidence interval: 0.20–1.90, p = 0.40).ConclusionThis pilot study describes the successful assessment of a device using a simulation model of obesity. Within these constraints and after adjustment for confounders, use of the BariBoard ? did not improve efficacy of chest compressions.     

The effect of physical restraint on neurovascular complications in intensive care units

BackgroundTo reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate.ObjectivesThe objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate.MethodsA prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary.ResultsRedness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications.ConclusionsThe duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey.     

Reported practices related to,and capability to provide,first-line knee osteoarthritis treatments: a survey of 1064 Australian physical therapists

BackgroundPhysical therapists play a key role in providing first-line knee osteoarthritis treatments, including patient education and exercise therapy.ObjectivesDescribe Australian physical therapists’ awareness of guidelines; reported practices; and beliefs about capability, opportunity, motivation, and evidence.MethodsAn online cross-sectional survey was completed by physical therapists prior to attending the Good Living with osteoArthritis from Denmark (GLA:D®) Australia training courses (March 2017 to December 2019). The survey instrument was developed by an expert panel and was informed by the Theoretical Domains Framework.Results1064 physical therapists from all Australian states and territories participated. 11% (n = 121) could name an accepted guideline, 98% agreed it was their job to deliver patient education and exercise therapy, and 92% agreed this would optimise outcomes. Most reported providing strength exercise (99%), written exercise instructions (95%), treatment goal discussion (88%), and physical activity advice (83%) all or most of the time. Fewer provided aerobic exercise (66%), neuromuscular exercise (54%), and weight management discussion (56%) all or most of the time. Approximately one quarter (23–24%) believed they did not have the skills, knowledge, or confidence to provide education and exercise therapy recommended by guidelines, and just 48% agreed they had been trained to do so.ConclusionAustralian physical therapists treating knee osteoarthritis typically provide strength-based home exercise with written instructions, alongside goal setting and physical activity advice. Just one in nine could name a guideline. Education and training activities are needed to support physical therapists to access, read and implement guidelines, especially for aerobic and neuromuscular exercise, and weight management.