Perceptions About the Efficacy and Acceptability of Telephone and Video-Delivered Allied Health Care for Adults With Disabilities During the COVID-19 Pandemic: A Cross-sectional National Survey

ObjectiveTo investigate and compare perceptions about the efficacy and acceptability of allied health care delivered via telephone and video call for adults with disabilities during the COVID-19 pandemic.DesignCross-sectional national survey.SettingParticipants who accessed occupational therapy, physiotherapy, psychology, or speech pathology care via telephone or via video call from June to September 2020.ParticipantsFive hundred eighty-one adults with permanent or significant disabilities, or their carers, partners, or family members, who were funded by the Australian National Disability Insurance Scheme.InterventionsNot applicable.Main Outcome MeasuresExperiences (eg, safety, efficacy, ease of use) with telephone and video-delivered care. Data were analyzed by calculating response proportions and chi-square tests to evaluate differences in experiences between allied health professions and between telephone and video modalities.ResultsResponses were obtained for 581 adults with disabilities. There was no evidence of differences between experiences with telephone or video-delivered services or across allied health professions. Overall, 47%-56% of respondents found telehealth technology easy to use (vs 17%-26% who found it difficult), 51%-55% felt comfortable communicating (vs 24%-27% who felt uncomfortable), 51%-67% were happy with the privacy and/or security (vs 6%-9% who were unhappy), 74% were happy with the safety (vs 5%-7% who were unhappy), and 56%-64% believed the care they received was effective (vs 17% who believed it was ineffective). Despite this, 48%-51% were unlikely to choose to use telephone or video consultations in the future (vs 32%-36% who were likely).ConclusionsAdults with disabilities in Australia had generally positive experiences receiving allied health care via telehealth during the COVID-19 pandemic, although some experienced difficulties using and communicating via the technology. Findings indicated no differences between satisfaction with telephone or video modalities, or between physiotherapy, speech pathology, occupational therapy, or psychology services.     

Treatment and prognostic factors in patients with hepatocellular carcinoma.

INTRODUCTION: Hepatocellular carcinoma is a leading cause of death from cancer worldwide. Survival of patients depends on tumor extension and liver function, but yet there is no consensual prognostic model. AIMS: To evaluate the influence on survival of pretreatment parameters (clinico-laboratorial, liver function, tumor extension, Okuda and Cancer of the Liver Italian program (CLIP) staging) and treatment modalities. METHODS: We retrospectively analyzed 207 patients, diagnosed between 1993 and 2003. The initial treatment was: surgery--six patients; radiofrequency ablation--21; percutaneous ethanol injection--29; transarterial chemoembolization--49; tamoxifen--49; supportive care alone--53. Factors determining survival were assessed by Kaplan-Meier method and Cox regression models. RESULTS: Median survival was 24 months. In univariate analysis, Child-Pugh classification and Model for end-stage liver disease (MELD) score, portal vein thrombosis (PVT), tumor size, number of lesions, Okuda and CLIP scores were all associated with prognosis (P < 0.001). Alpha-fetoprotein levels were not predictive of survival. Independent predictors of survival were ascites, bilirubin, PVT and therapeutic modalities (P < 0.001). In early stage hepatocellular carcinoma (HCC), survival was similar for both percutaneous ablation modalities, either radiofrequency or ethanol injection (P = NS). In advanced HCC, survival was better in patients receiving tamoxifen than supportive care alone (P < 0.001). CONCLUSION: This study reinforces the importance of baseline liver function (Child-Pugh classification and MELD score) in the survival of patients with HCC, although staging systems allowed the stratification of patients in different prognostic groups. Ascites, bilirubin and PVT were independent pretreatment predictors of survival. All treatments influenced the patient's outcome, whether in early or advanced stages.     

Birth ball use for women in labor: A systematic review and meta-analysis

ObjectiveTo evaluate, with the best level of evidence, the possible benefits of using birth balls during labor in maternal and neonatal outcomes.MethodsThis research was made using MEDLINE/PubMed, LILCAS, CINAHL, CENTRAL, and SCOPUS databases, with no period or language restrictions. The terms "labor" and "birth ball" were used. Clinical trials (randomized and non-randomized) were included when compared a group with parturients using birth ball with control group under usual care. The following primary outcomes were: maternal outcomes: pain intensity; length of first and second stage; perineal trauma and episiotomy. Neonatal outcomes: APGAR score, admission to neonatal intensive care unit and delivery room resuscitation. The quality of evidence was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applies whenever possible.ResultsSeven studies were included. The pain outcome showed differences in the subgroups of 20/30 min on the birth ball (mean difference) −1,46; 95% Confidence Interval: 2,15 to −0,76, p < 0.0001), 60 min (mean difference −1,95; 95% Confidence Interval: 2,68 to −1,22; p < 0.00001) and 90 min (mean difference −1,72; 95% Confidence Interval: 2,44 to −1,00; p < 0.0001), based in a moderated quality of evidence. Other outcomes did not showed differences between groups after the interventions, with a low and very low level of evidence.ConclusionsUse the birth ball reduced pain after 20–90 min of use and there was no difference in the other outcomes. The low quality of the studies included in this meta-analysis suggests that new trials with better methodology quality are necessary.     

Mapping physical therapy research: The geographical affiliations and methodological quality of 2,959 randomized controlled trials

Evidence suggests that research benefits from diversity, yet science is concentrated to a small group of countries. Diversity in physical therapy research has so far not been studied thoroughly, and this is the first study to map physical therapy research geographically. The objective was to study the frequency and methodological quality of physical therapy-related randomized controlled trials (RCTs) across the world. PEDro was searched for RCTs in physical therapy published between January 1 2015 and December 5 2016. For each trial, the first and last authors’ affiliations and the PEDro scale were extracted. Using the first and last authors’ affiliations, each article was geocoded using the Data Science Toolkit API. The search located 2,959 RCTs, which were affiliated primarily with a small cluster of countries. The median PEDro score for all trials was 5 (IQR 4:7). The geographical spread of the RCTs was focused around Europe, the Middle East, Southeast Asia, Oceania, the United States, and parts of South America. The lack of diversity might be problematic for the research field, even though the average clinical trial in physical therapy is of fair quality.     

Nonopioid Analgesics for Osteoarthritis: Availability of Topical NSAIDs

ABSTRACT

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are pain-related anxiety, its symptoms, and possible treatment approaches.     

Continuous positive airway pressure therapy in sleep apnoea

Sleep apnoea is associated with increased mortality and morbidity. The treatment goal is to reduce the neurocognitive and cardiovascular sequelae. CPAP therapy in sleep apnoea is discussed in two parts in the article. The first part will consider CPAP therapy in the more common form of sleep apnoea (i.e. obstructive or mixed sleep apnoea) and the second part will consider CPAP therapy in central sleep apnoea. Alternative positive airway pressure modalities are discussed. CPAP therapy has been extensively studied and it remains the mainstay of treatment in obstructive sleep apnoea, as it is still the most consistently efficacious and safe option. However, its major disadvantage is that it does not confer a cure to this disorder and hence therapy is generally life long with its usual treatment compliance problems. As such, there are continuous improvement strategies. The role of CPAP therapy in central sleep apnoea is more limited. There has been increasing data on the beneficial effect of CPAP on central sleep apnoea/Cheyne-Stokes respiration in congestive heart failure. Evidence for CPAP therapy in sleep apnoea has evolved significantly over the last decade. However, more research and publication of large-scale long-term randomized trials of treatment in sleep apnoea to assess patient-orientated outcomes and preferences are necessary.