The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis – a pilot study

Objective: When walking with an advanced reciprocating gait orthosis (ARGO), ankle and knee joint motion is restricted which causes an un-cosmetic gait compared to normal walking. The purpose of this study was to develop and evaluate a rocker modification for use with the ARGO in order to improve hip joint kinematics, walking speed, step length and cadence. Method: Spinal cord injury patients (n?=?4) with thoracic-level injury participated in this study, and walked with a standard ARGO and one which was also adapted with a rocker sole in a randomized order. Results: Mean walking speed and step length were both significantly increased by volunteer SCI subjects when ambulating using the ARGO adapted with a rocker sole compared to the standard ARGO. Cadence was not significantly affected, but swing time was significantly reduced and mean hip flexion and extension were both significantly increased when walking with the adapted ARGO. Conclusion: The rocker sole modification produced an increase in walking speed and step length, and improved sagittal plane hip joint kinematics when ambulating using an ARGO. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard unmodified version.

• Implications for Rehabilitation

• The ARGO adapted with a rocker sole could be used by spinal cord injury patients.

• A major advantage of the walking with the ARGO adapted with a rocker sole was increased of walking speed and step length, and improvement of the sagittal plane hip joint kinematics.

• The findings of this study would appear to provide useful data for rehabilitation teams who utilize orthoses to walk and rehabilitate SCI subjects. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard un-modified version.

     

Audio recordings of mindfulness-based stress reduction training to improve cancer patients’ mood and quality of life—a pilot feasibility study

Purpose  

Mindfulness-based stress reduction (MBSR), typically taught in eight weekly classes, helps patients cope with illness, including cancer. Current research is almost exclusively based on post-treatment class attendance. Research suggests that short courses and alternative delivery techniques may also be beneficial. This pilot study assessed whether it would be feasible for cancer patients receiving chemotherapy to listen to MBSR audio recordings individually during treatment and at home and evaluate whether the intervention shows preliminary evidence of efficacy to improve patients’ mood and quality of life (QoL).     

Measuring leprosy-related stigma – a pilot study to validate a toolkit of instruments

Purpose.?Stigma negatively affects the quality of life of leprosy-affected people. Instruments are needed to assess levels of stigma and to monitor and evaluate stigma reduction interventions. We conducted a validation study of such instruments in Tamil Nadu and West Bengal, India.

Methods.?Four instruments were tested in a ‘Community Based Rehabilitation’ (CBR) setting, the Participation Scale, Internalised Scale of Mental Illness (ISMI) adapted for leprosy-affected persons, Explanatory Model Interview Catalogue (EMIC) for leprosy-affected and non-affected persons and the General Self-Efficacy (GSE) Scale. We evaluated the following components of validity, construct validity, internal consistency, test–retest reproducibility and reliability to distinguish between groups. Construct validity was tested by correlating instrument scores and by triangulating quantitative and qualitative findings. Reliability was evaluated by comparing levels of stigma among people affected by leprosy and community controls, and among affected people living in CBR project areas and those in non-CBR areas.

Results.?For the Participation, ISMI and EMIC scores significant differences were observed between those affected by leprosy and those not affected (p?=?0.0001), and between affected persons in the CBR and Control group (p?<?0.05). The internal consistency of the instruments measured with Cronbach's α ranged from 0.83 to 0.96 and was very good for all instruments. Test–retest reproducibility coefficients were 0.80 for the Participation score, 0.70 for the EMIC score, 0.62 for the ISMI score and 0.50 for the GSE score.

Conclusion.?The construct validity of all instruments was confirmed. The Participation and EMIC Scales met all validity criteria, but test–retest reproducibility of the ISMI and GSE Scales needs further evaluation with a shorter test–retest interval and longer training and additional adaptations for the latter.     

Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study

Objectives: The term ‘cephalalgiaphobia’ was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term ‘cervico-cephalalgiaphobia’; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy.

Methods: A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n?=?56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥?60%.

Results: The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of ‘often/always’ was substantial for the indicators, ‘Short-term positive results in previous manual physical therapeutic treatment’, ‘Shorter interval between treatment sessions’, ‘Fear of “locked facet joints” of the neck’, ‘More frequent manipulation’, and ‘Fear of increase in headaches’. Coverage was also substantial for ‘never’ regarding ‘Long-term positive results in previous manual physical therapeutic treatment’. ‘Confirmation of “locked facet joints” of the cervical spine by MPT as a cause for increase of CEH’ scored ‘often/always’ in all patients. Coverage for ‘Increased use of medication with insufficient effect’ was substantial, scoring as ‘sometimes’ in 39 (84.8%) patients.

Discussion: Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.     

Health literacy in patients with intermittent claudication in relation to clinical characteristics,demographics, self-efficacy and quality of life – A cross-sectional study

BackgroundIntermittent claudication requires treatment with secondary prevention to reduce disease progression and the risk of cardiovascular events and to improve quality of life. Health literacy and self-efficacy are important preconditions for the health behaviour changes necessary for adhering to secondary prevention.AimEvaluate health literacy in patients with intermittent claudication regarding clinical characteristics, demographics, self-efficacy and quality of life.MethodsA cross-sectional study evaluating health literacy, self-efficacy and quality of life using questionnaires. Patients with intermittent claudication from vascular units in the south of Sweden were included.ResultsIn total, 158 patients were included, of which, 52.5% reported “inadequate” (0-8 points) or “problematic” (9-12 points) health literacy with no differences between men and women. A significant higher proportion of patients living alone reported “inadequate” or “problematic” health literacy than “sufficient” (13-16 points) health literacy. Patients with “sufficient” health literacy reported significantly higher self-efficacy and quality of life and were more physically active than patients with “inadequate” or “problematic” health literacy. Also, patients with a university degree reported a significantly higher ability to “access” (seek, find and obtain) and “understand” (comprehend the accessed) information relevant to health.ConclusionThe majority of patients with intermittent claudication have “inadequate” or “problematic” health literacy. Also, an “inadequate” or “problematic” health literacy level is more common among patients living alone, and education level appears to be more important when “accessing” and “understanding” information relevant to health. This illuminates the importance of not only the patients’ health literacy but also demographics when planning for secondary prevention.     

Effects of patient – clinician disagreement in occupational low back pain: A pilot study

Purpose.?To determine (1) patient?–?physical therapist and patient?–?physician agreement on clinical management of LBP, (2) patient perception of agreement between physical therapist and physician, (3) association between agreement and outcome (return to work, self-perceived disability).

Method.?Thirty-five workers compensated for LBP responded to a telephone interview within 1 week of referral to physical therapy. They were asked about agreement with the physical therapist and the physician regarding the clinical management of their LBP and whether they thought the physical therapist was providing the treatment the physician would have thought appropriate. They completed a second interview upon returning to work or after 3 months. They answered questionnaires on self-perceived disability, psychological distress, coping strategies, and job satisfaction at both baseline and follow-up.

Results.?Nearly all patients (97.1%) agreed with the physical therapist and all believed the physical therapist was providing the treatment the physician would have thought appropriate. The 10 (28.6%) patients who disagreed with their physician on medical management of their LBP were less satisfied with the medical care (P?=?0.05), technical quality of the visit (P?=?0.01), and catastrophized more about their pain (P?=?0.03) than those who agreed. Disagreement was not associated with greater time off-work or greater self-perceived disability.

Conclusion.?Patients who disagreed with their physician were less satisfied with their medical management, and catastrophized more about their pain than those who agreed, but disagreement was not associated with chronicity or disability. Studies with larger sample sizes should investigate the role of other factors, such as patient expectations, in the transition to chronicity.     

A qualitative study of older people’s experience of living with neurogenic claudication to inform the development of a physiotherapy intervention

Purpose: The aim of this study was to explore older people’s experiences of living with neurogenic claudication (NC), their preferences for physiotherapy treatment provision and associated outcomes in order to inform an intervention to be tested in a clinical trial.

Method: Patients with a diagnosis of NC and/or lumbar spinal stenosis were recruited through a UK NHS tertiary care center. Semi-structured interviews and self-report questionnaires were used to obtain data. A thematic analysis was conducted.

Results: 15 participants were recruited; half were classed as frail older adults. Pain and the threat of pain was a prominent feature of participants’ experience of NC. This led to a loss of engagement in meaningful activities and sense of self. Discourses of ageing influenced experiences as well as treatment preferences, particularly the acceptability of walking aids. A combination of one-to-one and group setting for treatment was preferred. Outcome preferences related to re-engagement in meaningful activities and pain reduction. Limitations relate to generalisability of the findings for NC patients not under physiotherapy treatment.

Conclusion: We have obtained important findings about older people’s experiences of living with NC and preferences for physiotherapy treatment and outcomes. These will be incorporated into an evidence-based intervention and evaluated in a randomized controlled trial.

• Implications for rehabilitation

• Older people living with NC want to get back to meaningful activities and learn how to live with the threat of pain.

• Allied health professionals (AHPs) should be sensitive to the complex and ambiguous ways in which older people live with ageing and age-related decline.

• AHPs are in a position to support patients’ successful transition to the use of walking aids thereby reducing stigmatizing effects and increasing activity.

• AHPs should consider a mixture of one-to-one and group classes to enable rehabilitation for older NC patients.

     

Comparative cost analysis of inpatient integrative medicine—Results of a pilot study

BackgroundCosts of integrative treatment alone and in comparison with other treatment approaches have scarcely been reported in the past. This study presents results of a comparative cost analysis of an inpatient integrative medicine treatment costs.MethodsData from 2006 for inpatients referred to a Department of Integrative Medicine in Germany were used. Case-related treatment costs were calculated, and transformed into Casemix-Indices and revenues per DRG. Costs were compared between departments at the same hospital and between different hospitals using univariate statistics and Chi-Square tests.ResultsIn total 1253 inpatients (81.4% female, 61.1 ± 14.4 years) were included in the current analysis. Most patients were treated for diseases of the musculoskeletal system (57.2%), followed by diseases of the digestive system (11.4%), and diseases of the nervous system (10.4%). The department received an additional payment for most of the patients (88.0%), which led to an effective appreciation of 10.8% per case compared to the standardized Casemix-Index. In-house comparisons with other departments found the department in close vicinity to the departments of Internal medicine with regards to CMI and mean revenue, however the Patient Clinical Complexity Level was significantly lower in the Integrative medicine department. The interhospital comparison revealed comparable Casemix-Index and DRG-revenue, however the additional payment increased the mean revenue significantly.ConclusionModern integrative in-patient treatment is mostly cost-equivalent to conventional treatment. Cost effectiveness studies should be considered to further investigate the potential of integrative in patient treatment.     

Implementation of the Vienna Hydrotherapy Group for Laryngectomees—a pilot study

Goals Laryngectomy involves several problems for the individual, such as the need to cope with a stoma, adjustment to tracheostomal breathing, and the formation of a voice. Contact with water, resulting in aspiration, may prove fatal for laryngectomized patients in the absence of appropriate aids. The aim of this pilot study was to conduct a hydrotherapy group for laryngectomized patients and to evaluate its feasibility and outcome in relation to the goals of therapy.Patients and methods Six male patients who had undergone laryngectomy were included in a pilot study. The patients underwent a structured hydrotherapy rehabilitation program (three times a week for 8 weeks), using a special underwater therapy device. The patients' posture was controlled by posturography and their endurance capacity by standard ergometry and the 6-min walk. The parameters of fatigue, expectoration, mobility, elasticity/flexibility, postural control/coordination, and general well being were registered on a visual analog scale (VAS). Quality of life was assessed by having the patients fill out the German version of the SF-36 Health Survey.Main results Posturograpy findings showed an improvement of two subtests (p<0.028). Exercise testing showed an improved endurance capacity (p<0.028). The patients were able to walk a greater distance in the 6-min walking test (p<0.028). The VAS also showed an improvement of endurance capacity (p<0.028), fatigue (p<0.028), expectoration (p<0.043), mobility of the neck and shoulder (p<0.027), flexibility (p<0.027), postural control and coordination (p<0.028), and general well being (p<0.028). On the SF-36 Health Survey, the patients were improved in the items "Physical functioning" (p<0.027), "Vitality" (p<0.027) "Role-physical" (p<0.026), and "Social functioning" (p<0.043).Conclusions A hydrotherapy group for laryngectomized patients proved to be safe, feasible, and effective in this pilot study.     

Could BNP screening of acute chest pain cases lead to safe earlier discharge of patients with non-cardiac causes? A pilot study

BACKGROUND: The assessment of chest pain relies on clinical assessment and markers of cell necrosis such as Troponin T (TnT). B-type natriuretic peptide (BNP) is also raised in myocardial ischaemia and therefore may be useful in deciding if acute chest pain is of cardiac origin or not. AIM: To investigate the role of BNP in the assessment of unselected patients presenting with acute chest pain. METHODS: A prospective observational study of 100 patients presenting with chest pain to the Acute Medical Admissions Unit was carried out. All patients had BNP and TnT levels measured. The primary outcome was categorization of chest pain as cardiac or non-cardiac. This was determined by the discharge diagnosis. BNP cutoffs were derived from a receiver operated characteristic (ROC) curve. The sensitivity, specificity, positive predictive accuracy (PPA) and negative predictive accuracy (NPA) were all calculated for BNP, TnT and for the composite of BNP and TnT. RESULTS: Mean BNP in patients with cardiac chest pain was significantly greater than mean BNP for patients with non-cardiac chest pain (P 相似文献   

Does teaching scald burn prevention to families of young children make a difference? A pilot study

This article reports a pilot project designed to ascertain what scald burn prevention practices parents of young children used and whether teaching would lead to implementation of burn-related home-safety practices. The sample (n = 49) was followed up longitudinally, and participants completed a survey during two home interviews conducted at 4-week intervals. There was a statistically significant change in the number of scald burn prevention measures (p <.001) implemented by parents after public health nurses provided teaching. Changes in parental behavior were correlated with ethnicity (p <.05). The results have implications for teaching families effective scald burn prevention strategies.     

The effectiveness of a functional training programme for patients with chronic low back pain – a pilot study

Introduction.?To investigate the effect of an individualised functional training programme for patients with low back pain (LBP).

Methods.?A randomised, controlled trial with single-blind design was conducted. Patients with non-specific LBP for at least 3 months were recruited and randomised into training and control groups. Both groups maintained their current treatment, and the training group participated in an additional programme for 100 h. Measures were performed initially and after completing the programme, and included rating determining impairment associated with pain, Oswestry disability index (ODI) and functional capacity evaluation (FCE).

Results.?Thirteen in the training group completed the training and measurements, and 12 in the control group completed their measurements. Twelve items in FCE had significant improvement in training group, but only one in control group. Severity of pain (11.8 ± 3.6–5.6 ± 3.6), activity limitation from pain (3.2 ± 1.5–1.5 ± 1.1) and emotional disturbance by pain (4.3 ± 1.7–2.2 ± 1.4) significantly decreased in the training group, no significant change in the control group. The ODI demonstrated a significant reduction (p = 0.044) in the training group (22 ± 9–16 ± 9), but not in the control group.

Conclusion.?An individualised functional training programme benefits chronic LBP patients.     

Does Modafinil improve the level of consciousness for people with a prolonged disorder of consciousness? a retrospective pilot study

Background and aim: Modafinil is best known as a sleep regulator among healthy individuals, but studies suggest that it reduces excessive daytime sleepiness in patients with brain injury. This retrospective pilot study evaluated the effectiveness of Modafinil for people with a prolonged disorder of consciousness and whether those with a traumatic brain injury did better than those with a non-traumatic brain injury.

Method: Twenty four prolonged disorder of consciousness patients who were prescribed Modafinil, were assessed at least four times both before and during treatment. The Coma Recovery Scale-Revised was used to determine if patients had a disorder of consciousness and the Wessex Head Injury Matrix was used to monitor behavior during baseline and treatment periods. Patients with a traumatic brain injury (N?=?12) were compared with those with non-traumatic brain injury (N?=?12). A chi-square test with significance at 0.05 was used and when frequencies were below 5 a Fisher’s Exact Test was used.

Results: Cognitive improvements were noted in domains of wakefulness, awareness, concentration, tracking and following commands. Significant differences were found for the whole group between baseline and Modafinil (x^2?=^?9.80; p?=?0.002). Eleven of the 12 traumatic brain injury patients had higher Wessex Head Injury Matrix scores when on Modafinil (x^2?=^?8.33, p?p?=?0.29).

Conclusion: Modafinil appears to be beneficial for enhancing cognition in prolonged disorder of consciousness patients. Traumatic brain injury patients benefited more than non-traumatic brain injury patients.

• Implications for Rehabilitation

• People with prolonged disorders of consciousness are those in coma, a vegetative state or a minimally conscious state.

• Sensorimotor and neuromodulations (pharmacological and brain stimulation) are the available treatment strategies to this group.

• Modafinil promotes attention, concentration and maintains wakefulness in a patient with narcolepsy, obstructive sleep apnea and shift work sleep disorders.

• In a relatively small sample, this retrospective pilot study shows the effectiveness of Modafinil in conjunction with good care, suitable medications and multidisciplinary rehabilitation in enhancing arousal in prolonged disorders of consciousness patients.

     

Using a cultural dance program to increase sustainable physical activity for breast cancer survivors—A pilot study

BackgroundStudies have shown that physical activity can reduce the risk of mortality for female breast cancer patients and improve quality of life, reduce weight, and alter circulating biomarker levels. We conducted a pilot trial to determine the feasibility of increasing physical activity through a cultural dance intervention to achieve similar benefits.MethodsConducted a pilot trial implementing a cultural dance intervention to increase and sustain physical activity for breast cancer survivors, which consisted of a six-month group-based intervention of Hula Dance. Anthropometric measures, fasting blood draws, and self-reported questionnaires to assess physical activity, mood, and quality of life, were completed at baseline, at the end of the 6-month intervention (time point month-6), and at two additional post-intervention time points (month-12 and month-24) to assess sustainability.ResultsA total of 11 women with a median age of 63 years were enrolled in the intervention trial. Eight of the 11 (73%) completed the trial to month-12 and demonstrated an overall significant increase in weekly moderate exercise. There were no significant changes in intra-individual body mass index (BMI). However, there was a sustained post-intervention reduction in waist circumference and significant changes in circulating biomarker levels. For the self-reported measures, there was a significant increase in vigor/activity (p < 0.001; Profile of Mood States-Short Form).ConclusionOur intervention pilot trial demonstrated that a cultural dance program could achieve a sustainable increase in physical activity for breast cancer survivors, with potential to improve quality of life, increase vigor, and decrease levels of circulating cytokines associated with obesity and inflammation.