Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and ...meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain.
To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval CI) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry.
We included 95 studies, with 60 separate cohorts in the systematic review (
= 17 974) and 47 cohorts (
= 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain.
Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain.
PROSPERO - CRD42020207442.
Abstract
Background
High-stakes assessments are often used as a ‘gate-keeper’ activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession ...are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia.
Methods
A retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management.
Results
Fifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment.
Conclusion
These findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.
Physical frailty is associated with increased risk of falls, hospitalisation and mortality. There is a dearth of information on physical frailty of older adults living in residential aged care. This ...study aimed to describe physical frailty in aged care residents and investigate possible determinants of frailty.
A retrospective audit of resident records was undertaken across 14 residential aged care facilities. Data were extracted on all consenting residents who had completed measures relating to frailty (Short Physical Performance Battery SPPB; grip strength). All data of the first record of measures were extracted, resident characteristics, and the time from admission to assessment. Summary statistics were completed. Differences between sub-groups were explored (Mann-Whitney U, Kruskall-Wallis Ranked tests). Associations between variables were explored with Chi-squared and Pearson correlations. Determinants of physical frailty were determined with linear regression analyses. Alpha (2-sided) was 0.05.
Data were extracted for 1241 residents (67% female), with a mean age of 86.0 (7.6) years. Males had a significantly lower time from admission to assessment of frailty (p ≤ 0.001). The average SPPB score was 4.1 (3.3), 75% of residents were frail and 19% pre-frail. Bivariate analyses indicated no significant relationships between grip strength and SPPB score, but significant differences for grip strength, where males were significantly stronger (males 20.2 ± 8.3 kg; females 12.4 ± 5.4 kg; p ≤ 0.001). There was a significant positive relationship between SPPB total score and grip strength, gender (p ≤ 0.001), and marital status (p = 0.049) and a negative relationship between time from admission to assessment and SPPB total score (p ≤ 0.001). There were significant negative relationships between gender (p ≤ 0.001) and age (p ≤ 0.001), and time from admission to assessment (p ≤ 0.001) with grip strength.
Older adults living in residential aged care have a high level of physical frailty which may lead to increased risk of adverse outcomes. Time in the residential aged care setting and age appear to predict physical frailty. There is a need for a consistent battery of measures to continually monitor frailty and programs to address the high levels of frailty in residential aged care.
The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to ...systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).
This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.
Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.
There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.
Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the ...impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.
Background:
As the elderly population continues to grow, so does the demand for new and innovative solutions to tackle age-related chronic diseases and disabilities. Virtual Reality (VR) has been ...explored as a novel therapeutic tool for numerous health-related applications. Although findings frequently favors VR, methodological shortcomings prevent clinical recommendations. Moreover, the term “VR” is frequently used ambiguously to describe e.g., video games; the distinction remains vague between immersive VR (IVR) systems and non-immersive VR (NVR). With no distinct demarcation, results of outcome measures are often pooled in meta-analyses, without accounting for the immersiveness of the system.
Objective:
This systematic review focused on virtual reality-based rehabilitation of older adults (+60) in motor rehabilitation programs. The review aims to retrospectively classify previous studies according to the level of immersion, in order to get an overview of the ambiguity-phenomenon, and to utilize meta-analyses and subgroup analyses to evaluate the comparative efficacy of system immersion in VR-based rehabilitation.
Methods:
Following PRISMA guidelines, we conducted a systematic search for randomized controlled trials, describing virtual rehabilitation or video games interventions for older adults (+60). Main outcomes were pain, motivation, mobility, balance, and adverse events.
Results:
We identified 15 studies which included 743 patients. Only three studies utilized IVR. The rest used various NVR-equipment ranging from commercial products (e.g., Nintendo Wii), to bespoke systems that combine tracking devices, software, and displays. A random effects meta-analysis of 10 studies analyzed outcome measures of mobility, balance, and pain. Protocols and dosage varied widely, but outcome results were in favor of immersive and non-immersive interventions, however, dropout rates and adverse events were mostly in favor of the control.
Conclusions:
We initialize a call-for-action, to distinguish between types of VR-technology and propose a taxonomy of virtual rehabilitation systems based on our findings. Most interventions use NVR-systems, which have demonstrably lower cybersickness-symptoms than IVR-systems. Therefore, adverse events may be under-reported in RCT-studies. An increased demand for IVR-systems highlight this challenge. Care should be given, when applying the results of existing NVR tools to new IVR-technologies. Future studies should provide more detail about their interventions, and future reviews should differentiate between NVR and IVR.
In the past 2 decades, researchers have demonstrated the potential for virtual reality (VR) technologies to provide engaging and motivating environments for stroke rehabilitation interventions. Much ...of the research has been focused on the exploratory phase, and jumps to intervention efficacy trials and scale-up evaluation have been made with limited understanding of the active ingredients in a VR intervention for stroke. The rapid pace of technology development is an additional challenge for this emerging field, providing a moving target for researchers developing and evaluating potential VR technologies. Recent advances in customized games and cutting-edge technology used for VR are beginning to allow for researchers to understand and control aspects of the intervention related to motivation, engagement, and motor control and learning. This article argues for researchers to take a progressive, step-wise approach through the stages of intervention development using evidence-based principles, take advantage of the data that can be obtained, and utilize measurement tools to design effective VR interventions for stroke rehabilitation that can be assessed through carefully designed efficacy and effectiveness trials. This article is motivated by the recent calls in the field of rehabilitation clinical trials research for carefully structured clinical trials that have progressed through the phases of research.
: Post-stroke survivors with right hemisphere injury have more impairments in postural control and balance. However, the impact of the hemisphere injured on the process of balance reacquisition has ...not been fully explored. We hypothesized that stroke survivors could learn balance tasks (H1), but right hemisphere damaged patients would show poor motor learning if compared to left hemisphere damaged patients (H2)
: To investigate whether the brain-damaged side after stroke affects the learning of a balance task. Methods: Three groups were recruited: twenty stroke survivors (ten left and ten right hemisphere damage) and twenty healthy volunteers. The participants practiced a balance task for thirty minutes, four consecutive days. The task was the Table Tilt game (Nintendo
Company), which induces balance demands with a progression of complexity. Motor performance was assessed at baseline, post-practice and after one week (retention test). Accuracy, errors, and complexity of the task achieved during the trial were assessed
: Participants in all groups improved their performance (
< .001) and maintained it at the retention test. The control group showed better performance if compared to the right and left hemisphere damaged stroke survivors (
< .05). There was no difference between individuals with right and left hemisphere damaged, but the right hemisphere damaged patients demonstrated more errors at higher levels of complexity
: Stroke survivors can learn balance tasks (H1), and the right hemisphere damaged patients demonstrate more errors than those with left hemisphere injury in higher complexity conditions (H2).
Virtual Humans for Learning Swartout, William; Artstein, Ron; Forbell, Eric ...
The AI magazine,
12/2013, Letnik:
34, Številka:
4
Journal Article
Recenzirano
Virtual humans are computer‐generated characters designed to look and behave like real people. Studies have shown that virtual humans can mimic many of the social effects that one finds in ...human‐human interactions such as creating rapport, and people respond to virtual humans in ways that are similar to how they respond to real people. We believe that virtual humans represent a new metaphor for interacting with computers, one in which working with a computer becomes much like interacting with a person and this can bring social elements to the interaction that are not easily supported with conventional interfaces. We present two systems that embody these ideas. The first, the twins are virtual docents in the Museum of Science, Boston, designed to engage visitors and raise their awareness and knowledge of science. The second, Sim‐Coach, uses an empathetic virtual human to provide veterans and their families with information about PTSD and depression.
IntroductionMotivating behavioural change during client consultations is of crucial importance across all health professions to address the growing burden of chronic conditions. Yet health ...professionals often lack the skills and confidence to use evidence-based counselling interventions to support clients’ behavioural change and mobilise clients’ resources and self-efficacy for change to address their long-term needs.AimsThis pre–post pilot study will develop a motivational interviewing (MI) virtual client training tool for health professionals and test the effectiveness of the educational content and usability of the virtual client interaction.Methods and analysisPostgraduate students across a range of health disciplines will be recruited. Data assessing attitudes towards preventive healthcare will be collected using a modified version of the Preventive Medicine Attitudes and Activities Questionnaire. Conversations with the virtual client will be analysed using the Motivational Interviewing Treatment Integrity code to assess changes in MI skills. The System Usability Scale will be used to assess the usability of the virtual client training tool.Ethics and disseminationThis protocol was approved by the Flinders University Social and Behavioural Research Ethics Committee in May 2019. The results of the pilot study will inform the development of an avatar-based mobile application consisting of MI teaching and interactions with a generic virtual client that can be easily adapted to multiple scenarios.
PDF
