Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure

Jan Y-K, Brienza DM, Geyer MJ, Karg P. Wavelet-based spectrum analysis of sacral skin blood flow response to alternating pressure.

Objectives

To provide insight into the physiologic mechanisms associated with alternating pressure, using wavelet analysis of skin blood flow (SBF) oscillations, and to determine whether the application of alternating pressure induces myogenic responses, thereby enhancing SBF as compared with constant loading.

Design

Repeated-measures design.

Setting

University research laboratory.

Participants

Healthy, young adults (N=10; 5 men, 5 women; mean age ± standard deviation, 30.0±3.1y).

Intervention

Alternating pressure for 20 minutes (four 5-min cycles with either 60mmHg or 3mmHg) and constant loading for 20 minutes at 30mmHg on the skin over the sacrum.

Main Outcome Measures

A laser Doppler flowmeter was used to measure sacral SBF response to both alternating pressure and constant loading. Wavelet-based spectrum analysis of SBF oscillations was used to assess underlying physiologic mechanisms including endothelium-related metabolic (.008-.02Hz), neurogenic (.02-.05Hz), and myogenic (.05-.15Hz) controls.

Results

Alternating pressure stimulated an increase in sacral SBF of compressed soft tissues as compared with constant loading (P<.01). SBF during the high-pressure phase of 4 alternating pressure cycles showed an increasing trend. An increase in power in metabolic frequency range and a decrease in power in the myogenic frequency range during alternating pressure were observed compared with SBF prior to loading. Power increased in the myogenic frequency range during the low-pressure phase of alternating pressure and decreased during the high-pressure phase.

Conclusions

SBF control mechanisms, as assessed by the characteristic frequencies embedded in SBF oscillations, show different responses to 2 loading pressures with the same average pressure but different patterns. Our study suggests that optimization of operating parameters and configurations of alternating pressure support surfaces to compensate for impaired SBF control mechanisms in pathologic populations may be possible using wavelet analysis of blood flow oscillations.     

Older people and adherence with medication: a review of the literature

Background

Older people represent a sizeable population of the UK. Many older people receive drug treatment for long-term conditions. Adherence with medication is therefore an important clinical, financial and resource intensive concern.

Objectives

This review aimed to examine patient's beliefs, perceptions and views in relation to adherence with medication.

Design

A comprehensive search of the literature was undertaken using numerous approaches. The search of revealed 30 research papers.

Findings

Articles were initially evaluated using Critical Appraisal Skills Programme principles to identify those relevant to the review. Relevant studies were then subjected to a narrative analysis to assist the development of relevant themes. Four themes were identified; experience of adherence; perceptions and attitudes to medication adherence and non-adherence; patients acceptance of their illness and impact on medication taking behaviour and shared decision making.

Conclusions

The findings of this review imply that there is a need for more emphasis on shared decision making between the older patient and the prescriber. Using this approach, adherence with medication may improve. There is also a need to develop a standardized measure of medication adherence.     

Impact of age on long-term recovery from traumatic brain injury

Marquez de la Plata CD, Hart T, Hammond FM, Frol AB, Hudak A, Harper CR, O'Neil-Pirozzi TM, Whyte J, Carlile M, Diaz-Arrastia R. Impact of age on long-term recovery from traumatic brain injury.

Objective

To determine whether older persons are at increased risk for progressive functional decline after traumatic brain injury (TBI).

Design

Longitudinal cohort study.

Setting

Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers.

Participants

Subjects enrolled in the TBIMS national dataset.

Interventions

Not applicable.

Main Outcome Measures

Disability Rating Scale (DRS), FIM instrument cognitive items, and the Glasgow Outcome Scale-Extended.

Results

Participants were separated into 3 age tertiles: youngest (16-26y), intermediate (27-39y), and oldest (≥40y). DRS scores were comparable across age groups at admission to a rehabilitation center. The oldest group was slightly more disabled at discharge from rehabilitation despite having less severe acute injury severity than the younger groups. Although DRS scores for the 2 younger groups improved significantly from year 1 to year 5, the greatest magnitude of improvement in disability was seen among the youngest group. In addition, after dividing patients into groups according to whether their DRS scores improved (13%), declined (10%), or remained stable (77%) over time, the likelihood of decline was found to be greater for the 2 older groups than for the youngest group. A multiple regression model showed that age has a significant negative influence on DRS score 5 years post-TBI after accounting for the effects of covariates.

Conclusions

This study supported our primary hypothesis that older patients show greater decline over the first 5 years after TBI than younger patients. In addition, the greatest amount of improvement in disability was observed among the youngest group of survivors. These results suggest that TBI survivors, especially older patients, may be candidates for neuroprotective therapies after TBI.     

Activities during interruptions in cardiopulmonary resuscitation: a simulator study

Objective

Studies investigating the quality of cardiopulmonary resuscitation (CPR) have revealed frequent unnecessary interruptions of life support. The primary objective of the study is to analyze what happens during interruptions. We investigated (a) whether interruptions are filled with “secondary activities”, i.e., activities only indirectly related to the primary task of providing life support (e.g., preparatory and diagnostic activities), and (b) whether all group members focus on the same secondary activity during interruptions, thus impeding group coordination, and detracting from the primary task of providing life support.

Design

Prospective observational study.

Setting

Twenty teams of general practitioners were videotaped during a simulated cardiac arrest.

Outcome measures

Resuscitation performance was assessed as hands-on time according to resuscitation guidelines. Unnecessary interruptions were defined as periods the patient received no hands-on support.

Results

Teams of general practitioners achieved hands-on time in accordance with the resuscitation guidelines (chest compression/ventilation/defibrillation) during 62% of the time the patient had no pulse. Unnecessary interruptions consumed 32% of the available time. During most of the unnecessary interruption time, team members engaged in secondary medical activities, particularly observing the monitor (47%) and dealing with the defibrillator (47%). During 56% of the unnecessary interruption time, all team members focussed their attention on the same secondary activity, thus neglecting the need for task distribution among team members.

Conclusions

Unnecessary interruptions of CPR occur frequently and consume approximately one-third of the time patients should receive continuous life support. Unnecessary interruptions are mainly characterized by secondary medical activities that may be perceived as meaningful. During the majority of unnecessary interruptions, all team members focus on the same secondary activity, indicating shortcomings in task distribution in the resuscitation team. The findings emphasize the importance of team training with particular emphasis on situational awareness and task distribution.     

Do psychosocial factors moderate the association of fixed-term employment with work interference with family and sleeping problems in registered nurses: A cross-sectional questionnaire survey

Background

The use of fixed-term employment has increased lately, particularly in Europe and in the health care sector. Previous studies have shown that especially among the health care sector employee's organizational justice perceptions and job control are important factors that are directly related to the welfare and attitudes of employees and may also help to buffer the negative impacts of many detrimental factors.

Objective

The present study examined the association of employment type (fixed-term vs. permanent) with work interference with family (WIF) and sleeping problems. In addition, we examined whether organizational justice and job control were able to moderate above-mentioned associations.

Design

Cross-sectional study design.

Setting

A random sample of registered nurses in Finland from the Central Register of Health Care Professionals.

Participants

1767 Finnish registered nurses (1676 women and 91 men) aged 23-60 years (mean = 42.6, SD = 10.0) formed a final study sample.

Methods

The relationships were studied by linear regression analyses and the effects of gender, age, marital status, employment sector, work shift, number of children, and overtime work hours were adjusted for.

Results

Our results showed that organizational justice moderated the association between employment type and WIF. That is, those employees who were employed in fixed-term contracts and experienced low levels of organizational justice had higher levels of WIF than others. Employment type was not directly associated with WIF or sleeping problems. High justice levels were directly associated with less WIF and less sleeping problems, and high job control levels with less sleeping problems.

Conclusion

According to our results it would be important to promote fair organizational procedures and management in the health care sector especially for those who are employed with fixed-term contracts and in organizations with a lot of fixed-term employees.     

Career transitions of inactive nurses: A registration database analysis (1993-2006)

Background

One important strategy to address nursing shortages is to tap into the pool of licensed nurses who are not currently working in nursing and induce them to return to the nursing labour market. However, there is a paucity of research examining their likelihood of return to the active labour market.

Objective

Analyze the career transitions of nurses registered with the College of Nurses Ontario but not working in the province's nursing labour market to determine the proportion of these nurses rejoining the active nursing workforce and examine the variation by inactive sub-category and age group.

Design

Quantitative analysis of a linked longitudinal database for all those registered with the College of Nurses of Ontario for the years 1993-2006.

Methods

Registration records of all 215,687 nurses registered at any time in those years were merged by their unique registration number. Each nurse was placed for each year into an employment category. Two groups of nurses were defined: active (registered, working in nursing in Ontario) and inactive (registered, not working in nursing in Ontario). Inactive nurses were then sub-categorized into five mutually exclusive sub-categories: ‘not working and seeking nursing employment’, ‘working in non-nursing and seeking nursing employment’, ‘not working and not seeking nursing employment’, ‘working in non-nursing and not seeking nursing employment’ and ‘working outside Ontario’. One-year career movements of nurses were tracked by generating 13 year-to-year transition matrixes.

Results

In the short-term, inactive nurses seeking a nursing job had the highest average rate of return to the active workforce (27.3-30.8%), though they might become high risk of leaving the profession if they do not find employment in a timely manner. Inactive nurses not seeking nursing employment are a heterogeneous group, and include nurses on leave who are likely to subsequently rejoin the active workforce should appropriate opportunities arise. The proportion of nurses rejoining the active workforce decreased with age.

Conclusion

Because ‘inactive’ nurses are a heterogeneous group, their optimal reintegration to the nursing workforce requires governments, professional associations and employers to work collaboratively to design targeted and timely recruitment strategies to avoid the permanent loss of skilled nursing resources.     

Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients

Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.

Objective

To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.

Design

Cross-sectional observational study.

Setting

Acute neurologic rehabilitation department.

Participants

Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.

Interventions

Not applicable.

Main Outcome Measures

All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.

Results

Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.

Conclusions

Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area.     

Restoration of Voluntary Muscle Strength After 3 Weeks of Cast Immobilization is Suppressed in Women Compared With Men

Clark BC, Manini TM, Hoffman RL, Russ DW. Restoration of voluntary muscle strength after 3 weeks of cast immobilization is suppressed in women compared with men.

Objective

To investigate sex-related differences in the loss and recovery of voluntary muscle strength after immobilization.

Design

Longitudinal, repeated measures.

Setting

Research laboratory.

Participants

Healthy men (n=5) and healthy women (n=5).

Intervention

Three weeks of forearm immobilization.

Main Outcome Measures

Voluntary wrist flexion muscle strength was assessed at baseline and weekly during the immobilization protocol and 1 week after cast removal. Central activation was assessed before and after immobilization and after 1 week of recovery to determine what percentage of the muscle could be activated voluntarily.

Results

Men and women lost voluntary strength at a similar rate during immobilization. However, after 1 week of recovery voluntary strength had returned to within 1% of baseline in the men, but remained approximately 30% less than baseline in the women (P=0.03). Both sexes displayed reduced central activation after immobilization (P=0.02), but the decrease was similar in both sexes (P=0.82).

Conclusions

These findings suggest sex-dependent adaptations to and recovery from limb immobilization, with voluntary strength recovering slower in women. As such, sex-specific rehabilitation protocols may be warranted, with women requiring additional or more intensive rehabilitation programs after periods of disuse. Future work is needed to determine the extent and mechanisms of these differences.     

Neuromuscular Electrical Stimulation Training: A Safe and Effective Treatment for Facioscapulohumeral Muscular Dystrophy Patients

Colson SS, Benchortane M, Tanant V, Faghan J-P, Fournier-Mehouas M, Benaïm C, Desnuelle C, Sacconi S. Neuromuscular electrical stimulation training: a safe and effective treatment for facioscapulohumeral muscular dystrophy patients.

Objective

To investigate the feasibility, safety, and effectiveness of neuromuscular electrical stimulation (NMES) strength training in facioscapulohumeral muscular dystrophy (FSHD) patients.

Design

Uncontrolled before-after trial.

Setting

Neuromuscular disease center in a university hospital and a private-practice physical therapy office.

Participants

FSHD patients (N=9; 3 women, 6 men; age 55.2±10.4y) clinically characterized by shoulder girdle and quadriceps femoris muscle weakness.

Interventions

Patients underwent 5 months of strength training with NMES bilaterally applied to the deltoideus, trapezius transversalis, vastus lateralis, and vastus medialis muscles for five 20-minute sessions per week.

Main Outcome Measures

Plasma creatine kinase (CK) activity; scores for pain and fatigue on visual analog scales (VAS), manual muscle testing (MMT), maximal voluntary isometric contraction (MVIC), 6-minute walking tests (6MWT), and self-reported changes in daily living activities.

Results

NMES strength training was well tolerated (CK activity and pain and fatigue scores on VAS were not modified). Most of the muscle functions (shoulder flexion and extension and knee extension) assessed by MMT were significantly increased. MVIC of shoulder flexion and abduction and the 6MWT distance were also improved.

Conclusions

In FSHD, NMES strength training appears to be safe with positive effects on muscle function, strength, and capacity for daily activities.     

Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke

Celnik P, Hummel F, Harris-Love M, Wolk R, Cohen LG. Somatosensory stimulation enhances the effects of training functional hand tasks in patients with chronic stroke.

Objective

To test the hypothesis that somatosensory stimulation would enhance the effects of training functional hand tasks immediately after practice and 1 day later in chronic subcortical stroke patients.

Design

Single-blinded and randomized, crossover study.

Setting

Human research laboratory.

Participants

Nine chronic subcortical stroke patients.

Interventions

Three separate sessions of motor training preceded by (1) synchronous peripheral nerve stimulation (PNS), (2) no stimulation, or (3) asynchronous PNS.

Main Outcome Measures

Time to complete the Jebsen-Taylor Hand Function Test (JTHFT time) and corticomotor excitability tested with transcranial magnetic stimulation.

Results

After familiarization practice, during which all patients reached a performance plateau, training under the effects of PNS reduced JTHFT time by 10% beyond the post-familiarization plateau. This behavioral gain was accompanied by a specific reduction in GABAergically mediated intracortical inhibition in the motor cortex. These findings were not observed after similar practice under the influence of no stimulation or asynchronous PNS sessions.

Conclusions

Somatosensory stimulation may enhance the training of functional hand tasks in patients with chronic stroke, possibly through modulation of intracortical GABAergic pathways.     

Validation of the Revised Quick Cognitive Screening Test

Mate-Kole CC, Conway J, Catayong K, Bieu R, Sackey NA, Wood R, Fellows R. Validation of the revised Quick Cognitive Screening Test.

Objective

To validate the revised version of the Quick Cognitive Screening Test (QCST).

Design

Cross-sectional.

Setting

Senior homes; hospital; college campus.

Participants

Participants (N=377; 114 men, 263 women) were recruited comprising healthy controls (n=201; 40 men, 161 women), subjects with dementia (n=93; 34 men, 59 women) including Alzheimer disease (n=73) and vascular dementia (n=20); subjects with psychiatric illness (n=35, 15 men, 20 women), specifically schizophrenia or bipolar disorder; and subjects with other neurologic conditions (n=48, 25 men, 23 women) such as traumatic brain injury (n=12) and cerebrovascular disease (n=31). Diagnoses were confirmed by physicians using appropriate criteria. Recruitment was done in the northeastern region.

Interventions

Not applicable.

Main Outcome Measures

In an effort to examine the reliability and validity of the revised QCST, participants were administered the revised QCST with a number of standardized measures (ie, Alzheimer's Disease Assessment Scale-Cognitive, Mini-Mental State Examination, Tests of Oral Fluency, Trail-Making Test, and Functional Activities Questionnaire).

Results

The results revealed that the revised QCST discriminated between healthy controls and the neuropsychiatric participants. Additionally, the revised QCST significantly correlated with other standardized measures, confirming the revised QCST's reliability and validity as a screening instrument for subjects with cognitive deficits.

Conclusions

The revised QCST provides the clinician with a short yet reliable screening instrument in detecting cognitive deficits in subjects with dementia and other neurologic conditions.     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

Life Habits and Prosthetic Profile of Persons With Lower-Limb Amputation During Rehabilitation and at 3-Month Follow-Up

Zidarov D, Swaine B, Gauthier-Gagnon C. Life habits and prosthetic profile of persons with lower-limb amputation during rehabilitation and at 3-month follow-up.

Objective

To assess performance of life habits among persons with lower-limb amputation at admission, at discharge, and 3 months after rehabilitation discharge and describe their prosthetic profile at discharge and follow-up.

Design

Case series.

Setting

Inpatient rehabilitation.

Participants

Unilateral persons with lower-limb amputation (N=19; 14 men; mean age, 53.4±14.6y).

Intervention

Interdisciplinary rehabilitation.

Main Outcome Measures

Life habits performance and prosthetic profile.

Results

In the daily activities subdomain, the lowest performances were observed for mobility and housing at all evaluation times. Within the social role subdomain, employment, recreation, and community life scores were the lowest for the 3 evaluations. Mean scores for all activities of daily living subdomain categories significantly increased (P<.05) during rehabilitation except for personal care and communication. Only community life (social roles subdomain) significantly increased during rehabilitation; life habits remained unchanged after discharge. Fifty-eight percent of patients at discharge versus 68.4% at follow-up used their prosthesis for more than 9 hours a day, and this increased significantly postdischarge (P=.017). Locomotor capability with prosthesis was similarly high at discharge and follow-up.

Conclusions

Among persons with lower-limb amputation, social role life habits appear to be more disturbed than those associated with activities of daily living. At discharge, prosthetic wear and locomotor capabilities with prosthesis were high and tended to improve on return to the community.     

Asymptomatic median mononeuropathy among men with chronic paraplegia

Liang H-W, Wang Y-H, Pan S-L, Wang TG, Huang T-S. Asymptomatic median mononeuropathy among men with chronic paraplegia.

Objectives

To compare electrophysiologic abnormalities of the median nerve in asymptomatic paraplegic subjects and able-bodied controls and to examine the influence of personal factors on these parameters.

Design

Cross-sectional survey.

Setting

University hospital.

Participants

Forty-seven men with paraplegia and 36 able-bodied controls underwent nerve conduction studies on both upper limbs. All were free of hand numbness in the past month, diabetic mellitus, or neuromusculoskeletal injuries to the upper limbs.

Interventions

Not applicable.

Main Outcome Measure

Nerve conduction studies of the bilateral median and ulnar nerves.

Results

Although the 2 groups were of comparable age and had a similar body mass index (BMI), the subjects with paraplegia had a significantly higher proportion of asymptomatic median mononeuropathy than the controls (25.5% vs 5.6%, P=.02). The spinal cord injury (SCI) group had a prolonged median distal latency and a slowed digit-wrist sensory nerve conduction velocity. Multivariate general linear model analysis showed that prolonged motor and sensory latencies of the median nerve were associated with the SCI group and with greater BMI.

Conclusions

The asymptomatic subjects with paraplegia had a significantly higher frequency of median mononeuropathy than the able-bodied controls. There was also an association between BMI and distal latency of the median nerve.     

Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study

Background

Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care.

Aims

The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care.

Methods

A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed.

Results

There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood.

Conclusion

Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.     

A Chinese version of Iowa Infant Feeding Attitude Scale: reliability and validity assessment

Background

To achieve the goal of increasing the proportion and duration of breastfeeding in Taiwan, it is essential to assess the role of attitudes in determining which method of infant feeding will be chosen. Understanding maternal attitudes toward infant feeding methods may have utility in the development and implementation of public health policy and interventions facilitating increasing breastfeeding rates. However, no validated instrument to assess breastfeeding attitudes is available in Chinese for use in Taiwan.

Objective

To translate the Iowa Infant Feeding Attitude Scale (IIFAS) into Chinese and assess its psychometric properties among Taiwanese breastfeeding women.

Design

Methodological study.

Setting

One public hospital in Taichung city, Taiwan.

Participants

A convenience sample of 140 in-hospital breastfeeding women was recruited.

Methods

The IIFAS was translated into Chinese using forward translation, back-translation, semantic equivalence, and pilot testing. Predict validity and internal consistency was assessed. The final sample consisted of 120 women (14% attrition) that were interviewed by telephone at 6 weeks postpartum to record the breastfeeding duration and infant feeding method.

Results

One item was modified to better reflect the item content. In-hospital IIFAS scores significantly predicted breastfeeding duration as well as exclusive breastfeeding at 6 weeks postpartum. The Cronbach's alpha coefficient for internal consistency was 0.74.

Conclusions

This study provides evidence that the Chinese version of the IIFAS can be considered valid and reliable scale for assessing attitudes toward breastfeeding among breastfeeding women in Taiwan.     

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.     

Updating the Minimal Important Difference for Six-Minute Walk Distance in Patients With Chronic Obstructive Pulmonary Disease

Holland AE, Hill CJ, Rasekaba T, Lee A, Naughton MT, McDonald CF. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease.

Objective

To establish the minimal important difference (MID) for the six-minute walk distance (6MWD) in persons with chronic obstructive pulmonary disease (COPD).

Design

Analysis of data from an observational study using distribution- and anchor-based methods to determine the MID in 6MWD.

Setting

Outpatient pulmonary rehabilitation program at 2 teaching hospitals.

Participants

Seventy-five patients with COPD (44 men) in a stable clinical state with mean age 70 years (SD 9y), forced expiratory volume in one second 52% (SD 21%) predicted and baseline walking distance 359 meters (SD 104m).

Interventions

Not applicable.

Main Outcome Measures

Participants completed the six-minute walk test before and after a 7-week pulmonary rehabilitation program. Participants and clinicians completed a global rating of change score while blinded to the change in 6MWD.

Results

The mean change in 6MWD in participants who reported themselves to be unchanged was 17.7 meters, compared with 60.2 meters in those who reported small change and 78.4 meters in those who reported substantial change (P=.004). Anchor-based methods identified an MID of 25 meters (95% confidence interval 20-61m). There was excellent agreement with distribution-based methods (25.5-26.5m, κ=.95). A change in 6MWD of 14% compared with baseline also represented a clinically important effect; this threshold was less sensitive than for absolute change (sensitivity .70 vs .85).

Conclusions

The MID for 6MWD in COPD is 25 meters. Absolute change in 6MWD is a more sensitive indicator than percentage change from baseline. These data support the use of 6MWD as a patient-important outcome in research and clinical practice.     

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis

Johnson KL, Yorkston KM, Klasner ER, Kuehn CM, Johnson E, Amtmann D. The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis. Arch Phys Med Rehabil 2004;85:201-9.

Objective

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace.

Design

Qualitative research methodology comprising a series of semistructured interviews.

Setting

Community-based setting.

Participants

Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews.

Interventions

Not applicable.

Main outcome measure

Accounts of personal experiences related to employment.

Results

Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working.

Conclusions

Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.