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1.
The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study
Background
Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges. However little is known about the care of these patients in intensive care.Objective
To explore medical and nursing practices and attitudes in intensive care when caring for critically ill morbidly obese patients.Methods
A focused ethnographic approach was adopted. Participant observation of care practices and interviews with intensive care doctors and nurses were undertaken over a four month period. Qualitative analysis was conducted using constant comparison.Setting
An 18 bedded tertiary intensive care unit in New Zealand.Participants
Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40 kg/m2.Findings
Morbidly obese patients present significant physical and language challenges for intensive care practice. The physical shape of morbidly obese patients did not appropriately fit the different equipment used. Staff used specific knowledge of the patient’s body size and shape to adapt care practices and keep patients safe and comfortable. There were also specific language challenges where staff expressed concern about what words were most appropriate to use to describe body mass when in the presence of morbidly obese patients.Conclusions
Bariatric care pathways need to be developed that use more suitable body measurements to inform the use of bariatric equipment. Intensive care staff need to engage in debate about what is acceptable, respectful, and appropriate language in the delivery of bariatric patient care. 相似文献2.
3.
Objective
To compare clinical pain intensity, exercise performance, pain sensitivity and the effect of aerobic and isometric exercise on local and remote pressure pain thresholds (PPTs) in patients with chronic musculoskeletal pain with high and low levels of kinesiophobia.Design
An experimental pre–post within-subject study.Setting
An exercise laboratory in a multidisciplinary pain clinic.Participants
Fifty-four patients with chronic musculoskeletal pain.Interventions
Acute aerobic and isometric leg exercises.Main outcome measures
Clinical pain intensity (numerical rating scale, range 0 to 10), Tampa Scale of Kinesiophobia, aerobic and isometric exercise performances (intensity and maximal voluntary contraction), and PPTs at local and remote body areas before and after exercise conditions.Results
Patients with a high degree of kinesiophobia demonstrated increased pain intensity compared with patients with a low degree of kinesiophobia [high degree of kinesiophobia: 7.3 (1.6) on NRS; low degree of kinesiophobia: 6.3 (1.6) on NRS; mean difference 1.0 (95% confidence interval 0.08 to 1.9) on NRS]. Aerobic and isometric exercises increased PPTs, but no significant group differences were found in PPTs before and after exercise.Conclusions
Clinical pain intensity was significantly higher in patients with a high degree of kinesiophobia compared with patients with a low degree of kinesiophobia. Despite a difference in isometric exercise performance, the hypoalgesic responses after cycling and isometric knee exercise were comparable between patients with high and low degrees of kinesiophobia. If replicated in larger studies, these findings indicate that although kinesiophobic beliefs influence pain intensity, they do not significantly influence PPTs and exercise-induced hypoalgesia in patients with chronic musculoskeletal pain. 相似文献4.
Objectives
Chronic fatigue syndrome/myalgic encephalopathy (CFS/ME) is a chronic illness which can cause significant fatigue, pain and disability. Activity pacing is frequently advocated as a beneficial coping strategy, however, it is unclear whether pacing is significantly associated with symptoms in people with CFS/ME. The first aim of this study was therefore to explore the cross-sectional associations between pacing and levels of pain, disability and fatigue. The second aim was to explore whether changes in activity pacing following participation in a symptom management programme were related to changes in clinical outcomes.Design
Cross-sectional study exploring the relationships between pacing, pain, disability and fatigue (n = 114) and pre–post treatment longitudinal study of a cohort of patients participating in a symptom management programme (n = 35).Setting
Out-patient physiotherapy CFS/ME service.Participants
One-hundred and fourteen adult patients with CFS/ME.Main outcome measures
Pacing was assessed using the chronic pain coping inventory. Pain was measured using a Numeric Pain Rating Scale, fatigue with the Chalder Fatigue Scale and disability with the Fibromyalgia Impact Questionnaire.Results
No significant associations were observed between activity pacing and levels of pain, disability or fatigue. Likewise, changes in pacing were not significantly associated with changes in pain, disability or fatigue following treatment.Conclusions
Activity pacing does not appear to be a significant determinant of pain, fatigue or disability in people with CFS/ME when measured with the chronic pain coping index. Consequently, the utility and measurement of pacing require further investigation. 相似文献5.
6.
Marcelo Camargo Saad Rodrigo Antunes de Vasconcelos Letícia Villani de Oliveira Mancinelli Matheus Soares de Barros Munno Rogério Ferreira Liporaci Débora Bevilaqua Grossi 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(5):408-416
Objective
To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics.Methods
A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention.Results
All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities.Conclusion
Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/). 相似文献7.
Objective
To investigate the prognostic importance of a number of sensorimotor and psychological factors for global perceived effect (GPE) after physiotherapy in patients with neck pain. In addition to baseline values, change scores were used as independent variables to identify treatment-modifiable factors.Design
Clinical cohort study.Setting
Primary and secondary healthcare physiotherapy clinics.Participants
Patients (n = 70) with non-specific neck pain.Intervention
Usual care physiotherapy.Methods
A three-dimensional motion tracking system was used to measure neck motion and sensorimotor variables, in addition to self-reported outcomes covering personal, somatic and psychological factors at baseline (before treatment) and at 2 months. Logistic regression was used to analyse associations between the prognostic variables and the primary outcome (GPE) at 2 months.Results
At baseline, neck motion and motor control, pain duration and functioning were the strongest predictors for GPE, with no effect of psychological factors. Among the change variables, reduced pain intensity [odds ratio (OR) 1.86; 95% confidence interval (CI) 1.31 to 2.62], increased functioning (OR 1.46; 95% CI 1.11 to 1.92), reduced disability (OR 1.12; 95% CI 1.05 to 1.20), reduced kinesiophobia (OR 1.21; 95% CI 1.07 to 1.37), reduced catastrophising (OR 1.09; 95% CI 1.09 to 1.18) and increased self-efficacy (OR 1.12; 95% CI 1.03 to 1.21) were significantly associated with GPE.Conclusions
Both baseline values and change in pain intensity and functioning predicted GPE at 2 months. Psychological factors such as kinesiophobia, catastrophising and self-efficacy were only able to predict outcome by their change scores, indicating that these factors are modifiable by common physiotherapy practice and are important for GPE. 相似文献8.
C. López-López A. Arranz-Esteban M.V. Martinez-Ureta M.C. Sánchez-Rascón C. Morales-Sánchez M. Chico-Fernández 《Enfermería intensiva / Sociedad Espa?ola de Enfermería Intensiva y Unidades Coronarias》2018,29(2):64-71
Objective
To analyse the influence of psychotropic substance use on the level of pain in patients with severe trauma.Design
Longitudinal analytical study.Scope
Intensive Care Unit (ICU) of Trauma and Emergencies.Patients
severe trauma, non-communicative and mechanical ventilation > 48 hours. Two groups of patients were created: users and non-users of psychotropic substances according to medical records.Interventions
Measurement of pain level at baseline and during mobilization, using the Pain Indicator Behaviour Scale.Variables
demographic characteristics, pain score, sedation level and type and dose of analgesia and sedation.Results
Sample of 84 patients, 42 in each group. The pain level in both groups, during mobilisation, showed significant differences p = 0.011, with a mean of 3.11 (2.40) for the user group and 1.83 (2.14) for the non-user group. A relative risk of 2.5 CI (1,014-6,163) was found to have moderate / severe pain in the user group compared to the non-user group. The mean dose of analgesia and continuous sedation was significantly higher in the user group: P=.032 and P=.004 respectively. There was no difference in bolus dose of analgesia and sedation with P=.624 and P=.690 respectively.Conclusions
Patients with a history of consumption of psychoactive substances show higher levels of pain and experience a higher risk of this being moderate/severe compared to non-users despite receiving higher doses of analgesia and sedation infusion. Key words: pain, multiple trauma, drug users. 相似文献9.
Objective
To determine the factors associated with physical activity participation in adults with chronic cervical spine pain.Methods
A systematic review was conducted including searches of PubMed (MEDLINE), EMBASE and CINAHL from inception to June 12th, 2016. Grey literature and reference checking was also undertaken. Quantitative studies including factors related to physical activity participation in adults with chronic cervical spine pain were included. Two independent authors conducted the searches, extracted data and completed methodological quality assessment.Results
A total of seven studies met the selection criteria, however, four papers were finally included in the final review. A modified Downs and Black criteria was used to assess methodological quality, each study included was classed as moderate quality. A total of six factors were assessed against physical activity participation for people with chronic neck pain. These included: pain, fear of movement, smoking habits, socioeconomic status, gender, leisure and work time habits. A significant relationship was demonstrated between pain, leisure and work time habits and physical activity. Subjects were less likely to participate in physical activity if they were in pain. Subjects with neck pain were less likely to participate in physical activity in their leisure and work time.Conclusion
This review, based on a small number of heterogeneous studies demonstrated key factors that are likely to affect physical activity in people with chronic neck pain, most notably, pain levels, leisure and work habits. This review suggests that more in-depth, high quality studies are required to fully understand the impact of chronic pain on physical activity.Systematic review registration number
PROSPERO CRD42015027970. 相似文献10.
11.
Jaume Morera-Balaguer José Martín Botella-Rico Mari Carmen Martínez-González Francesc Medina-Mirapeix Óscar Rodríguez-Nogueira 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(6):484-492
Background
Over recent years there has been a paradigm shift towards a patient-centred biopsychosocial care model in physical therapy. This new paradigm features a growing interest in understanding the contextual factors that influence the patient's experience of disease, pain and recovery. This includes generalized consensus regarding the importance of establishing a therapeutic relationship that is centred on the patient.Objective
To explore physical therapists’ perceptions and experiences regarding barriers and facilitators of therapeutic patient-centred relationships in outpatient rehabilitation settings.Methods
This is a qualitative study with four focus groups including twenty-one physical therapists. Two researchers conducted the focus groups, using a topic guide with predetermined questions. The focus group discussions were audiotaped and videotaped, transcribed verbatim and analysed thematically using a modified grounded theory approach.Results
Physical therapists perceived that the therapeutic patient-centred relationship not only depends on the personal qualities of the professional, but also on the patient's attitudes and the characteristics of the context, including the organization and team coordination.Conclusions
Although being more linked towards the patients’ contextual factors and needs than towards the practice of the profession, a therapeutic relationship is worth considering by physical therapists. Furthermore this study highlights the need for physical therapists and administrators to rethink the situation and propose strategies for improvement. 相似文献12.
Roselien Pas Mira Meeus Anneleen Malfliet Isabel Baert Sophie Van Oosterwijck Laurence Leysen Jo Nijs Kelly Ickmans 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(3):248-253
Background
Current treatment for adults with chronic pain often includes Pain Neuroscience Education (PNE) to make people understand the nature underlying their pain and thus provides a clear rational for a biopsychosocial approach. Despite recommendations to use Pain Neuroscience Education as well in children with chronic pain, a specific program, tailored to children aged 6–12 years is lacking.Objectives
The aim of this study was to develop a Pain Neuroscience Education program for children with chronic pain and test its feasibility.Methods
First the internet and scientific literature was searched for sources (e.g., books, videos, etc.) that might be supportive in teaching children about the neurophysiology of pain. Based on this content, we developed a Pain Neuroscience Education program for children, ‘PNE4Kids’, which was tested for feasibility in three groups of healthy children (n = 18; 9 girls and 9 boys) aged between 6 and 12 years old.Results and conclusions
This paper provides both scientists and clinicians with a specific program to explain the neurophysiology of pain to children with chronic pain, since it is past high time to use a modern neuroscience approach in this vulnerable population. Further research should examine the effectiveness of this developed PNE4Kids program on pain-related outcomes in children with chronic pain.Registration number: NCT02880332 (https://clinicaltrials.gov/ct2/show/NCT02880332). 相似文献13.
Matthew L. Stevens Chung-Wei C. Lin Mark J. Hancock Trish Wisby-Roth Jane Latimer Chris G. Maher 《Physiotherapy》2018,104(2):217-223
Background
Before beginning a large and complex trial it is considered good practice to run a pilot study to assess the feasibility and acceptability so that quality is maintained and resources are not wasted.Objective
To assesses the feasibility and acceptability of procedures for TOPS: Trial Of Prevention Strategies for low back pain.Design
Randomised controlled pilot trial.Methods
This is a trial of an 8 week, physiotherapist-led group exercise and education program for preventing recurrence of low back pain (LBP) in those recently recovered from LBP. We assessed the feasibility of recruitment and data-collection procedures, acceptability of the trial interventions and loss-to-follow up.Results
The feasibility of recruitment, acceptability of the intervention and feasibility of physical activity data-collection procedures were all below anticipated levels. We enrolled 12 participants over 44 weeks, the adherence rate for the intervention group was 63% and valid physical activity data were obtained for 67% of the measurements. Follow-up methods for collection of LBP recurrence were successful with this information able to be collected for 100% of participants.Conclusion
In response to the pilot, modifications were made to the main trial protocol. We will increase recruitment by relaxing inclusion criteria and expanding recruitment sites to include workplaces, community centres and via social media. We will facilitate compliance by expanding treatment sites to provide more options for participants to access the program and we will limit missing data by checking the validity of baseline physical activity measures prior to enrolment.Trial registration: The study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ref: ACTRN12614000706673). 相似文献
14.
Objective
To identify and explore the feelings and experiences of people living with knee pain as a precursor to exploring how this might contribute to improved care in the future.Design
The qualitative meta-synthesis was undertaken in three parts (1) a systematic search of the literature, (2) a critical appraisal of the relevant studies and (3) meta-aggregation of the findings from the selected studies. A qualitative meta-synthesis is a process that enables researchers to answer a specific research question by combining and summarising a variety of qualitative sources. This was undertaken using a contextualist approach which acknowledges different realities exist but tries to determine an underlying ‘truth’.Setting
The participants from the selected studies were from a range of settings and ethnic groups, and cultural backgrounds.Participants
There were nine articles included in the meta-synthesis. Articles focused on the experiences of surgery, return to sport, or other aspects of care were excluded.Results
No articles were excluded following critical appraisal. Eleven categories were identified from 55 findings which resulted in two synthesised findings being identified: knee pain affects every aspect of life and Searching for the best way forward.Limitations
Articles were largely limited to older adults living with osteoarthritis. Many of the findings did not report demographic data. Only English language studies were included.Conclusion
Many people living with knee pain struggle to adapt to living with knee pain and this is often exacerbated by a lack of knowledge and available information to help them plan for the future.PROSPERO No
CRD42017070227. 相似文献15.
Objective
To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity (PA) compared with standard medical care in patients with moderate chronic obstructive pulmonary disease (COPD).Design
Randomised controlled trial.Setting
Primary care physiotherapy.Participants
Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale.Intervention
Ten-week combined exercise training and home-based walking programme compared with standard medical care.Main outcomes
At baseline and after 10 weeks, daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task. In addition, daily activities (Physical Activity Scale for the Elderly), functional exercise capacity (6-minute Walk Test), health-related quality of life (Chronic Respiratory Questionnaire) and exercise self-efficacy (Exercise Self-Regulatory Efficacy Scale) were measured.Results
Fifty-two patients {34 females; mean age 70.2 [standard deviation (SD) 9.5] years; mean forced expiratory volume in 1 second 67% (SD 9.2) of predicted} were randomised. PA, adjusted for baseline differences, increased significantly in the intervention group compared with the control group, by 26.1 minutes/day [95% confidence interval (CI) 7.3 to 44.9]. The increase in functional capacity between groups was clinically relevant (34.0 m, 95% CI 2.3 to 65.6) in favour of the intervention group.Conclusions
A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD.Clinical trial registration number NL24766.018.08. 相似文献16.
17.
Objective
To identify the most effective interventions in overweight and obese adults.Method
A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria.Results
Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss.Conclusions
The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost. 相似文献18.
Question
What is the effectiveness and what are the adverse effects.Design
Systematic review with meta-analysis.Participants
Patients with shoulder or upper extremity pain or dysfunction.Intervention
Trigger point dry needling (TDN) compared to control, another intervention or another needling technique.Outcome measures
Primary outcome measures included shoulder or upper limb pain, shoulder or upper limb dysfunction.Results
Eleven randomized trials involving 496 participants were appraised. There was very low evidence that trigger point dry needling of the shoulder region is effective for reducing pain and improving function in the short term. There is some evidence that needling both active and latent trigger points is more effective than needling an active trigger point alone for pain immediately and 1-week after treatment (SMD = ?0.74, 95%CI = ?1.2 to ?0.3; and SMD = ?1.0, 95%CI = ?1.52 to ?0.59).Conclusion
There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction. Two studies reported adverse effects to TDN interventions. Most common adverse effects included bruising, bleeding, and pain during or after treatment. Future studies are likely to change the estimates of the effectiveness of TDN for patients with upper extremity pain or dysfunction.PROSPERO: CRD42016045639. 相似文献
19.
Maurício Oliveira Magalhães Josielli Comachio Paulo Henrique Ferreira Evangelos Pappas Amélia Pasqual Marques 《Revista brasileira de fisioterapia (S?o Carlos (S?o Paulo, Brazil))》2018,22(1):82-91
Background
Low back pain (LBP) is a major health and economic problem worldwide. Graded activity and physiotherapy are commonly used interventions for nonspecific low back pain. However, there is currently little evidence to support the use of one intervention over the other in the medium-term.Objective
To compare the effectiveness of graded activity exercises to physiotherapy-based exercises at mid-term (three and six months’ post intervention) in patients with chronic nonspecific LBP.Methods
Sixty-six patients were randomly allocated to two groups: graded activity group (n = 33) and physiotherapy group (n = 33). These patients received individual sessions twice a week for six weeks. Follow-up measurements were taken at three and six months. The main outcome measurements were intensity pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire).Results
No significant differences between groups after three and six month-follow ups were observed. Both groups showed similar outcomes for pain intensity at three months [between group differences: ?0.1 (95% confidence interval [CI] = ?1.5 to 1.2)] and six months [0.1 (95% CI = ?1.1 to 1.5)], disability at three months was [-0.6 (95% CI = ?3.4 to 2.2)] and six months [0.0 (95% CI = ?2.9 to 3.0)].Conclusion
The results of this study suggest that graded activity and physiotherapy have similar effects in the medium-term for patients with chronic nonspecific low back pain. 相似文献20.
Swati Jha Stephen J. Walters Oscar Bortolami Simon Dixon Abualbishr Alshreef 《Physiotherapy》2018,104(1):91-97