Virtual Reality-Enhanced Partial Body Weight-Supported Treadmill Training Poststroke: Feasibility and Effectiveness in 6 Subjects

Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

Objective

To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke.

Design

A before-after comparison of a single group with BWSTT intervention.

Setting

University research laboratory.

Participants

A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study.

Intervention

Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback.

Main Outcome Measures

Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed.

Results

One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s.

Conclusions

A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.     

Within-day repeatability of the endurance shuttle walk test

Objective

To determine the need for a practice walk for the endurance shuttle walk test (ESWT) following the performance of two incremental shuttle walk tests (ISWTs) - one practice and one test - on the same day.

Design

Retrospective data analysis of shuttle walk test measurements. All participants had performed two ISWTs and two ESWTs at a single visit, prior to commencing pulmonary rehabilitation.

Setting

Outpatient physiotherapy department of a university hospital.

Participants

Forty-four patients (33 males, 11 females) with a primary diagnosis of chronic obstructive pulmonary disease, referred for routine pulmonary rehabilitation.

Measurements

Shuttle walk test distance and time, Borg breathlessness score, heart rate and pulsed oxygen saturation.

Results

The mean age of the group was 67.6 years [standard deviation (SD) 9.0] and mean forced expiratory volume in 1 second was 37% predicted (SD 13). The mean times walked during ESWTs 1 and 2 were 195 and 207 seconds (SD 115 and 138), respectively. Using the analysis recommended by Bland and Altman, the mean of the individual differences (d) between Tests 1 and 2 was 12 seconds, with limits of agreement from −88 to +112 seconds.

Conclusion

A practice endurance shuttle walk is unnecessary following performance of ISWTs on the same day.     

Psychometric Properties of the Community Integration Questionnaire Adjusted for People With Aphasia

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia.

Objectives

To describe the feasibility of the Community Integration Questionnaire (CIQ) adjusted for use in people with aphasia and to report its psychometric properties in people with aphasia (internal consistency, factor analysis, test-retest reliability, convergent validity).

Design

A cross-sectional, interview-based psychometric study. Test-retest reliability was evaluated in 20 people (minimal to severe aphasia) by 2 different interviewers within a 2-week period.

Setting

Community.

Participants

In total 490 stroke survivors with (minimal to severe) aphasia were approached, of which 165 (34%) participants returned the answering letter. Participants (N=150) agreed to take part and were interviewed using a structured interview format.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire (CIQ), Frenchay Aphasia Screening Test, Barthel Index, Dartmouth Coop Functional Health Assessment Charts (COOP)-World Organisation of Family Doctors (WONCA) Charts, Life Satisfaction Questionnaire.

Results

A total of 150 stroke survivors with aphasia completed the CIQ adjusted for people with aphasia. The CIQ adjusted for people with aphasia was a feasible instrument. Results showed good internal consistency for the CIQ total (standardized Cronbach α=.75), excellent test-retest reliability (intraclass correlation coefficient=.96), moderate correlations with the Barthel Index, the COOP-WONCA, and the Life Satisfaction Questionnaire with regard to construct validity. Significant relations were found with regard to age and aphasia severity.

Conclusions

The CIQ adjusted for people with aphasia seems to be an adequate instrument to assess participation in people with aphasia.     

Are physiotherapy students adequately prepared to successfully gain employment?

Objectives

To explore the preparedness of final-year physiotherapy students for their progression into employment, and identify what universities can do to facilitate a smooth transition.

Design

A single-cohort study, utilising a qualitative design incorporating a survey followed by transcribed and coded semi-structured interviews.

Setting

Interviews were held in the Placement and Careers Centre at Brunel University, London.

Participants

Sixty final-year full- and part-time students participated in the survey, and 12 final-year full- and part-time students participated in the semi-structured interviews.

Methods

Sixty students completed a questionnaire which explored their preparedness for employment. Questions related to the current job situation, the application process and the student's ideal first post. Responses from the questionnaire were analysed and discussed further through a digitally recorded interview. Twelve students were interviewed by an experienced interviewer from a non-physiotherapy background.

Results

Students felt unprepared for employment. Forty-seven per cent wanted a rotational post, but 26% would only spend 6 months and 39% would only spend 1 year looking for a job. Seventy-one percent would change career and 99% would work abroad if they were unable to secure a post in the UK. Most importantly, students could not identify transferable skills required by potential employers; only 25% cited effective communications, and 10% cited flexible working as a transferable skill. Self-management skills (e.g. prioritisation, time management and documentation) were not perceived as essential for employment.

Conclusions

The job market requires physiotherapy graduates to possess transferable skills which can be applied to any situation. Many are integral to the profession and the undergraduate curriculum; however, analysis and assimilation of these skills cannot be assumed. Universities should reflect on their curriculum delivery to produce graduates who meet employers’ expectations and make a smooth transition into the workplace.     

The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: A parallel randomised single-blind clinical trial

Objectives

To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme.

Design

A parallel randomised single-blind clinical trial.

Participants

Fifty patients aged 65 years or over with knee osteoarthritis.

Interventions

The study group (n = 25) was given a group education programme once a week for 4 weeks, followed by a self-executed home-based exercise programme. The controls (n = 25) were given a brief course in short-wave diathermy treatment.

Main outcome measures

Patients were assessed before the intervention, after the intervention (4 weeks) and again 8 weeks later (follow-up) using the Western Ontario McMaster Osteoarthritis Index (WOMAC), the repeated sit-to-stand test and the get-up-and-go test.

Results

At 4 weeks, there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score; for example, the WOMAC total score was reduced by a mean of 9.5 points [95% confidence interval (CI) −12.3 to −6.7]. However, at follow-up, patients in the study group demonstrated continued improvement in the get-up-and-go test and the WOMAC total, pain and disability scores, but no such improvement was noted among the controls. This difference was significant; for example, the difference in mean WOMAC total score between the groups was −9.0 points (95%CI −14.5 to −3.4).

Conclusion

A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction. Further study is required to determine if this positive effect can be maintained over a longer period.     

Do smokers with chronic obstructive pulmonary disease report their smoking status reliably? A comparison of self-report and bio-chemical validation

Background

Chronic obstructive pulmonary disease (COPD) is predominantly caused by cigarette smoking and is considered a worldwide preventable chronic illness. Smoking cessation is considered the primary intervention for disease management and nurses should play a major role in assisting patients to stop smoking. Currently there is a lack of professional consensus on how cessation interventions should be evaluated. The vast array of biochemical markers reported in the literature can be confusing and can make the comparisons of results difficult.

Objective

To validate self-report data on smoking with exhaled carbon monoxide in patients with chronic obstructive pulmonary disease over twelve months.

Design

We performed a secondary analysis of a previously published randomized controlled trial evaluating nursing interventions to assist respiratory patients to stop smoking.

Setting

Northern Ireland's Regional Respiratory Centre.

Participants

A total of 91 cigarette smokers attending secondary care for the treatment for COPD participated in the study.

Method

Self-reported smoking status and cigarettes smoked per day were compared to exhaled carbon monoxide readings at baseline, 2, 3, 6, 9 and 12 months. The cut-off value of ≤10 ppm was used to identify non-smokers. The p-values are based on Pearson's correlation coefficient and Kappa Coefficient as appropriate.

Results

Findings suggest self-reported smoking status and cigarette consumption amongst patients with chronic obstructive pulmonary disease was highly consistent with exhaled carbon monoxide results (p = 0.001-0.003).

Conclusion

The majority of patients with chronic obstructive pulmonary disease reliably report their cigarette consumption.     

Fewer adverse events as a result of the SAFE or SORRY? programme in hospitals and nursing homes. part i: primary outcome of a cluster randomised trial

Background

Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously.

Objective

This study aimed to test the effect of the SAFE or SORRY? programme on the incidence of three adverse events (pressure ulcers, urinary tract infections and falls). This paper describes Part I of the study: the effect on the incidence of adverse events.

Design

A cluster randomised trial was conducted between September 2006 and November 2008. After a three-month baseline period the intervention was implemented followed by a nine-month follow-up period.

Settings

Ten wards from four hospitals and ten wards from six nursing homes were stratified for institute and ward type and then randomised to intervention or usual care group.

Participants

During baseline and follow-up, patients (≥18 years) with an expected length of stay of at least five days, were asked to participate.

Methods

The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for the three adverse events. A multifaceted implementation strategy was used for the implementation: education, patient involvement and feedback on process and outcome indicators. The usual care group continued care as usual. Data were collected on the incidence of adverse events and a Poisson regression model was used to estimate the rate ratio of the adverse events between the intervention and the usual care group at follow-up.

Results

At follow-up, 2201 hospital patients with 3358 patient weeks and 392 nursing home patients with 5799 patient weeks were observed. Poisson regression analyses showed a rate ratio for the development of an adverse event in favour of the intervention group of 0.57 (95% CI: 0.34-0.95) and 0.67 (95% CI: 0.48-0.99) for hospital patients and nursing home patients respectively.

Conclusion

This study showed that implementing multiple guidelines simultaneously is possible, which is promising. Patients in the intervention groups developed 43% and 33% fewer adverse events compared to the usual care groups in hospitals and nursing homes respectively. Even so, more research is necessary to underline these results.

Trial registration

clinicaltrials.gov, number NCT00365430.     

Feasibility of motor capability training at home in children with acquired brain injury

Objectives

Acquired brain injury (ABI) requires an extended recovery time and residual signs may be observed years after discharge. Supervised home-based motor training may present a viable option for continuing treatment of adult patients, but little information is available on home-based treatment in children. This study assessed the feasibility of home practice in children with ABI (1 or more years post-trauma). The efficacy of the programme was also evaluated.

Design

A non-randomised, self-control study with control and intervention periods.

Setting

Home-based exercise programme.

Participants

Nineteen children (mean age 12.5 ± 3.1 years).

Interventions

A 4-week daily training programme of step-up and sit-stand-sit exercises.

Main outcome measures

Feasibility was assessed by the number of participants who completed the programme. Efficacy was evaluated at different stages using 10-metre walking and 2-minute walking tests, and the balance subitems of the Bruininks-Oseretsky Test of Motor Proficiency. An energy expenditure index was calculated for walking. Performance scores were used to assess balance.

Results

Nine participants completed the study. The mean number of training sessions was 22 ± 8 of the 30 sessions originally scheduled. Major differences were noted between the experimental stages. Walking speed, endurance and balance improved significantly during the intervention period.

Conclusions

Continuing exercising at home may be a feasible and efficient option for a considerable proportion of ABI children who are compliant with a simple but challenging exercise programme. A randomised controlled trial with a larger sample is now required.     

Peripheral vascular changes after home-based passive leg cycle exercise training in people with paraplegia: a pilot study

Ballaz L, Fusco N, Crétual A, Langella B, Brissot R. Peripheral vascular changes after home-based passive leg cycle exercise training in people with paraplegia: a pilot study.

Objective

To determine the hemodynamic adaptations after home-based passive leg cycle exercise training in person with paraplegia.

Design

A randomized controlled trial (small cohort).

Setting

University department of physical medicine and rehabilitation.

Participants

A volunteer sample of people with paraplegia (N=17).

Intervention

Subjects within the experimental group performed 36 passive cycling sessions at home.

Main Outcome Measures

Before and after training, we measured heart rate and maximal and minimal femoral artery blood flow velocity at rest and immediately after a 10-minute session of passive cycling by using a quantitative duplex Doppler ultrasound. For each condition, we calculated the mean blood flow velocity and velocity index (VI), used as an indicator of peripheral resistance.

Results

At rest, after training, mean blood flow velocity (P=.08) and VI did not differ significantly in the experimental group compared with the pretraining values (nonparametric analysis). However, in this group, the postexercise mean blood flow velocity and VI are respectively increased and decreased after training (P<.05) compared with the pretraining values. No changes were noted in the control group.

Conclusions

Six weeks of home-based passive cycling training have no significant effect on the rest hemodynamic values but increase the hemodynamic response to acute passive cycling exercise.     

Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?

Introduction

In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment. The aim of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity.

Methods

Data were prospectively recorded in our MECU database and we reviewed all cases of opioid overdose between 1994 and 2003. The MECU database was cross-referenced with the Central Personal Registry. For patients who died within 48 h of MECU contact we reviewed the forensic autopsy reports to establish whether rebound opioid toxicity was likely.

Results

We found 4762 cases of acute opioid overdose. In 3245 cases positive identification was obtained. Over this ten year period fourteen patients who were released on-scene after having been treated with naloxone died within 48 h, but only in 3 of these we found a rebound opioid toxicity to be the likely cause of death, corresponding to 0.13% of those 2241 released on scene who were identified.

Conclusion

Prehospital discharge-on-scene after naloxone treatment is associated with a low risk of death due to rebound toxicity.     

Hyperbaric oxygen treatment induces platelet aggregation and protein release, without altering expression of activation molecules

Objectives

To investigate the effect of hyperbaric oxygen (HBO) on platelet physiology.

Design and methods

Human platelets were exposed to HBO (97.7% O₂, balance CO₂ at 2.2 ata) or control (CON; 5% CO₂, balance air at 1 ata) for 90 min, and analyzed for aggregation, protein release, NO production, and activation.

Results

HBO induced 29.8 ± 3.0% of platelets to aggregate compared with CON (5.5 ± 0.9%). Proteins observed to be released in greater abundance from HBO- compared with CON-treated platelets included 14-3-3 zeta and α-2-macroglobulin. Release of NO by platelets was unaffected following exposure to HBO, as was platelet activation as measured by surface expression of PECAM-1, CD62P and the activated form of α_IIBβ_IIIa.

Conclusions

Exposure to HBO induces both platelet aggregation and protein release. Further study will better define the precise mechanisms and effects of HBO on platelet activation.     

Changes in Dynamic Trunk/Head Stability and Functional Reach After Hippotherapy

Shurtleff TL, Standeven JW, Engsberg JR. Changes in dynamic trunk/head stability and functional reach after hippotherapy.

Objectives

To determine if hippotherapy (therapy using a horse) improves head/trunk stability and upper extremity (UE) reaching/targeting in children with spastic diplegia cerebral palsy (SDCP).

Design

Pre-postoperative follow-up with a 12-week intervention and 12-week washout period after intervention.

Setting

A human performance laboratory with 6 camera video motion capture systems for testing.

Participants

Eleven children (age 5-13y, average 8y) with SDCP, 8 children (age 5-13y, average 8y) without disabilities.

Intervention

Hippotherapy intervention performed at 3 therapeutic horseback riding centers.

Main Outcome Measures

Video motion capture using surface markers collecting data at 60Hz, a mechanical barrel to challenge trunk and head stability, and functional reach/targeting test on static surface.

Results

Significant changes with large effect sizes in head/trunk stability and reaching/targeting, elapsed time, and efficiency (reach/path ratio) after 12 weeks of hippotherapy intervention. Changes were retained after a 12-week washout period.

Conclusions

Hippotherapy improves trunk/head stability and UE reaching/targeting. These skills form the foundation for many functional tasks. Changes are maintained after the intervention ceases providing a skill foundation for functional tasks that may also enhance occupational performance and participation.     

Evaluation of consultation training in hypertension care

Background

Nurses in hypertension care play an important role in minimising the risk factors for cardiovascular diseases, but this care can be improved.

Aim

To evaluate the content of nurses' consultations with hypertensive patients before and after consultation training.

Methods

Nineteen nurses from a randomised study of nurse-led hypertension clinics at health centres received three days of residential training in patient-centred counselling and cardiovascular prevention. To assess the result, two consultations with hypertensive patients in clinical practice before and after the training were audio-recorded. Content analysis was used for the analysis.

Results

Diet and exercise were the most frequent topics in the consultations both before and after the training. Discussions about alcohol and the patient's responsibility for treatment increased after the training. The time spent talking about various issues, other health problems, history and appointment scheduling decreased in the consultations after the training.

Conclusion

After the consultation training, the nurses succeeded in emphasising important issues for risk factor control to a greater extent.     

Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health

Objective

To provide an example of how goals of physiotherapy interventions and their typical patterns can be described using the International Classification of Functioning, Disability and Health (ICF).

Design

Cross-sectional study.

Setting

Acute hospital.

Participants

One hundred patients with neurological, musculoskeletal or cardiopulmonary conditions requiring physiotherapy interventions in University Hospital Zurich between January 2003 and October 2003.

Main outcome measures

The case record form consisted of two parts: a standardised questionnaire for functioning and health of the patient; and a standardised record form for physiotherapy interventions. Both parts were based on the ICF.

Results

The mean age of the subjects was 58.2 years (standard deviation 15.9), the median age was 60.5 years and 44% were female. The most frequent intervention goals in patients with neurological conditions were: muscle power functions; muscle tone functions; control of voluntary movement functions; changing basic body position; maintaining a body position; and transferring oneself. The most frequent intervention goals for cardiopulmonary patients were: functions of the cardiovascular system; and respiration functions. The most frequent intervention goals in patients with musculoskeletal conditions were: sensation of pain; stability of joint functions; muscle power functions; muscle tone functions; and muscle endurance functions.

Conclusion

By using the ICF as a framework and linguistic support, intervention goals can serve as standardised documentation for physiotherapy interventions, their evaluation and planning.     

Personal Bankruptcy After Traumatic Brain or Spinal Cord Injury: The Role of Medical Debt

Relyea-Chew A, Hollingworth W, Chan L, Comstock BA, Overstreet KA, Jarvik JG. Personal bankruptcy after traumatic brain or spinal cord injury: the role of medical debt.

Objective

To estimate the prevalence of medical debt among traumatic brain injury (TBI) and spinal cord injury (SCI) patients who discharged their debts through bankruptcy.

Design

A cross-sectional comparison of bankruptcy filings of injured versus randomly selected bankruptcy petitioners.

Setting

Patients hospitalized with SCI or TBI (1996-2002) and personal bankruptcy petitioners (2001-2004) in western Washington State.

Participants

Subjects (N=186) who filed for bankruptcy, comprised of 93 patients with previous SCI or TBI and 93 randomly selected bankruptcy petitioners.

Interventions

Not applicable.

Main Outcome Measures

Medical and nonmedical debt, assets, income, expenses, and employment recorded in the bankruptcy petition.

Results

Five percent of randomly selected petitioners and 26% of petitioners with TBI or SCI had substantial medical debt (debt that accounted for more than 20% of all unsecured debts). SCI and TBI petitioners had fewer assets and were more likely to be receiving government income assistance at the time of bankruptcy than controls. SCI and TBI patients with a higher blood alcohol content at injury were more likely to have substantial medical debts (odds ratio=2.70; 95% confidence interval, 1.04-7.00).

Conclusions

Medical debt plays an important role in some bankruptcies after TBI or SCI. We discuss policy options for reducing financial distress after serious injury.     

The effect of ice stimulation on sensory loss in chronic stroke patients—a feasibility study

Objectives

Ice stimulation has often been used in sensory bombardment programmes after stroke. This feasibility study explored the effects of ice as a single stimulus on disturbed wrist position sense, sensation of light touch and temperature discrimination of the affected hand.

Design

A multiple baseline single case study design across subjects.

Setting

Physiotherapy department at the Royal Star and Garter Home.

Participants

Four patients following cerebrovascular accident with left hemiparesis.

Methods

Eight baseline measurements were collected over a minimum of 8 days. The intervention phase was started for the first, second, third and fourth subjects staggered on the 8th, 11th, 13th and 15th days of the study, respectively.

Intervention

The intervention phase involved daily short, repeated ice-water immersions of each subject's affected hand.

Main outcome measure

Repeated measurements of wrist position sense, sensation of light touch and temperature discrimination.

Results

Visual and statistical analysis indicated that changes of wrist position error were neither significant nor consistent across subjects. Results for sensation of light touch were inconclusive: one subject improved and two subjects showed deterioration. Temperature discrimination of warm stimuli improved in one subject.

Conclusion

These observations suggest that ice-water immersions of the affected hand did not improve wrist position sense in three chronic stroke patients. Further exploration of the effects of ice stimulation on disturbed sensation of light touch and temperature after stroke is justified.     

Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada

Dickey L, Kagan A, Lindsay MP, Fang J, Rowland A, Black S. Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada.

Objectives

To determine the incidence rate of inpatient stroke-induced aphasia in Ontario, Canada, and to examine the demographic and clinical characteristics for stroke patients with and without aphasia.

Design

Age- and sex-specific incidence rates for aphasia in Ontario were calculated using the Ontario Stroke Audit. In addition, data collected from the Registry of the Canadian Stroke Network (RCSN) were used to determine the demographic and clinical characteristics for stroke patients with and without aphasia.

Setting

All hospitals and regional stroke centers in Ontario, Canada.

Participants

The Ontario Stroke Audit is a representative weighted sample of more than 3000 stroke inpatients admitted to emergency departments in all hospitals in Ontario within the 2004/2005 fiscal year. RCSN data included a cohort of more than 15,000 consecutive patients presenting with stroke at 12 regional stroke centers in Ontario from 2003 to 2007.

Interventions

Not applicable.

Main Outcome Measures

Presence of aphasic symptoms on admission to hospital and at discharge, age and sex, stroke type and severity, severity of disability, services received in hospital, length of stay, and discharge destination.

Results

Thirty-five percent (1131/3207) of adult patients admitted with a diagnosis of stroke in the province of Ontario during the 2004 to 2005 Ontario Stroke Audit had symptoms of aphasia at the time of discharge. This amounts to an incidence rate of 60 per 100,000 persons per year. Risk of aphasia increased significantly with age. In comparison with nonaphasic stroke patients, patients with aphasia were older, presented with more severe strokes on admission, had more severe disability, and were more frequently discharged to long-term care and/or rehabilitation (unadjusted results). Adjusting for stroke severity, age, sex, comorbidity, and stroke subtype, the presence of aphasia was found to be an independent predictor of longer hospital stays, increased use of rehabilitation services, and higher rates of thrombolytic therapy.

Conclusions

A significant number of people with stroke experience aphasia, with advancing age associated with a higher risk. The profile and patterns for stroke patients with aphasia differed significantly from those who did not experience aphasia as a residual disability after stroke, particularly in relation to service usage. Given the personal and system cost associated with aphasia, best practices in the area of stroke should include recommendations on how to best serve this population throughout the clinical pathway.     

An intervention for reducing secondary traumatization and improving professional self-efficacy in well baby clinic nurses following war and terror: a random control group trial

Background

Due to the terror and war-related situation in Israel, well baby clinic nurses dealing with a large number of traumatized and highly distressed infants, toddlers and their parents have become overwhelmed.

Objectives

(1) Assess the level of secondary traumatization, including lack of compassion satisfaction, burnout and compassion fatigue of well baby clinic nurses living under chronic threat of war and terror. (2) Assess the efficacy of an intervention aimed at providing well baby clinic nurses with psycho-educational knowledge pertaining to stress and trauma in infants, young children and parents. This intervention provides the nurses with screening tools for identifying children and parents at risk of developing stress-related problems and equips them with stress management techniques.

Design

Quasi-random control trial.

Setting

The intervention took place in Israel, in war (North) and terror (South) affected areas.

Participants

Ninety well baby clinic nurses from the most war and terror affected areas in Israel were approached, 42 were randomly assigned the experimental intervention and 38 served as a waiting list group.

Methods

The intervention was comprised of 12 weekly 6-h sessions. Each session included theoretical knowledge, experiential exercises based on the nurses’ work or personal life experience, and the learning of skills accompanied by homework assignments. Participants were assessed on self-report measures of secondary traumatization, professional self-efficacy, hope, sense of mastery and self-esteem before and after the intervention.

Results

(1) Well baby clinic nurses were found to have elevated secondary traumatization levels. (2) Compared to the waiting list group, the intervention group improved significantly on the professional self-efficacy measure as well as reducing the level of secondary traumatization. Furthermore, improvement on all secondary traumatization measures covaried with the improvement on the professional self-efficacy assessments. Based on additional informal reports, the improvement was observed to be clinically significant.

Conclusions

Training of medical personnel who work with traumatized children and their families and who may also be under the threat of war and terror is essential to both improving their professional functioning, as well as reducing the vulnerability to secondary traumatization.     

Weight Lifting in Patients With Lower-Extremity Lymphedema Secondary to Cancer: A Pilot and Feasibility Study

Katz E, Dugan NL, Cohn JC, Chu C, Smith RG, Schmitz KH. Weight lifting in patients with lower-extremity lymphedema secondary to cancer: a pilot and feasibility study.

Objective

To assess the feasibility of recruiting and retaining cancer survivors with lower-limb lymphedema into an exercise intervention study. To develop preliminary estimates regarding the safety and efficacy of this intervention. We hypothesized that progressive weight training would not exacerbate leg swelling and that the intervention would improve functional mobility and quality of life.

Design

Before-after pilot study with a duration of 5 months.

Setting

University of Pennsylvania.

Participants

Cancer survivors with a known diagnosis of lower-limb lymphedema (N=10) were directly referred by University of Pennsylvania clinicians. All 10 participants completed the study.

Intervention

Twice weekly slowly progressive weight lifting, supervised for 2 months, unsupervised for 3 months.

Main Outcome Measures

The primary outcome was interlimb volume differences as measured by optoelectronic perometry. Additional outcome measures included safety (adverse events), muscle strength, objective physical function, and quality of life.

Results

Interlimb volume differences were 44.4% and 45.3% at baseline and 5 months, respectively (pre-post comparison, P=.70). There were 2 unexpected incident cases of cellulitis within the first 2 months. Both resolved with oral antibiotics and complete decongestive therapy by 5 months. Bench and leg press strength increased by 47% and 27% over 5 months (P=.001 and P=.07, respectively). Distance walked in 6 minutes increased by 7% in 5 months (P=.01). No improvement was noted in self-reported quality of life.

Conclusions

Recruitment of patients with lower-limb-lymphedema into an exercise program is feasible. Despite some indications that the intervention may be safe (eg, a lack of clinically significant interlimb volume increases over 5mo), the unexpected finding of 2 cellulitic infections among the 10 participants suggests additional study is required before concluding that patients with lower-extremity lymphedema can safely perform weight lifting.