Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that ...simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions.
This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance.
Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected.
Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (
= 0.02). Higher anxiety was correlated with poorer skill performance (
= -0.410).
Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.
To investigate the applicability and impact of a physiotherapy tele-rehabilitation program (TRP) on children with Juvenile Idiopathic Arthritis (JIA) and their families.
Thirty JIA patients, applying ...an individualized home-exercise program (HEP), were randomly divided in the tele-rehabilitation (TRG, n=15) and control group (CG, n=15). Each TRG patient participated in a 30-minute tele-session, under a paediatric physiotherapist's supervision, twice a week, for 12 weeks. Before and after the TRP (T1 and T2, respectively), all participants and a parent/guardian completed the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) questionnaire and a questionnaire regarding the HEP implementation and compliance. Residual disease was estimated at T1 and T2. At T2, TRG patients/parents completed a questionnaire evaluating the TRP. One month after T2, a reassessment of compliance with the HEP was performed.
The patients' median age was 12.8 (8-16) years. At T2, the TRG patients performed the HEP significantly more frequently (p=0.023), for a longer time (p=0.034) and with less urging (p=0.004), compared to T1. Moreover, they exhibited significantly increased compliance with HEP (p=0.001), better functionality (p=0.008), better quality of life (p=0.007) and less pain (p=0.017). The CG patients showed no significant changes. Residual disease improved in both groups (TRG:p=0.002, CG:p=0.018), but more in the TRG (p=0.045). TRP's applicability and total benefit were rated as excellent by patients/parents. Finally, one month after T2, compliance with the HEP was still greater than at T1(p=0.001).
An interactive physiotherapy TRP can be implemented effectively for JIA patients, providing an additional tool for their rehabilitation.
Identify the perceptions and experiences of how UK entry-level programs educationally prepared pediatric physiotherapists for their first clinical role. Review the extent programs taught essential, ...recommended, and additional content as per the International Organisation of Physical Therapists in Pediatrics (IOPTP).
Mixed methods design involving qualified UK pediatric physiotherapists. Forty-two physiotherapists completed an online questionnaire and nine (21%) completed a follow-up semi-structured interview.
All 42 respondents felt they were "Not Well" (median 2, IQR 1.75-2.75) prepared for clinical practice. Not enough curricula emphasis was given to pediatric content (100%), with 31% (
= 13, CI 95% 19-46) reporting no pediatric content throughout their program. Only 15 (36%, 23-51) respondents experienced a pediatric placement. Themes from the follow-up interviews were (1) UK programs are adult focused; (2) placements are the only meaningful opportunity to develop competency; (3) programs lacked non-clinical content; and (4) experiencing pediatric patients was overwhelming due poor preparation. The majority of the IOPTP curriculum guidance is not embedded within UK curriculums.
Respondents reported they were not well prepared for pediatric clinical practice. Some entry-level programs did not include any pediatric teaching throughout the entirety of the course.
Aquatic physiotherapy: a vestibular rehabilitation option Pereira, Carolina Maria Maia; Pinheiro do Vale, Jalene de Sarah; de Oliveira, Wellington Pinheiro ...
Brazilian Journal of Otorhinolaryngology,
11/2021, Letnik:
87, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because ...they act simultaneously on musculoskeletal disorders and balance improvement.
To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations.
This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life.
When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors.
In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.
Chronic pelvic pain (CPP) is a common pain condition. However, treatment remains challenging. Musculoskeletal findings are frequent; therefore physiotherapy might be helpful. The purpose of this ...review was to evaluate the current evidence on physiotherapy in patients with CPP (PROSPERO registration number CRD42016037516).
Six databases were searched and additional hand searches were performed. Two reviewers independently conducted the database search and selected studies using a two-step approach. The methodological quality was assessed applying the Critical Review Form - Quantitative Studies.
A total of eight studies were included. Trigger point therapy was examined in four studies; two of which were randomized controlled trials. All studies indicate a significant change in pain measurement. The other four studies evaluated the effect of biofeedback, Thiele massage, Mensendieck somatocognitive therapy and aerobic exercises, whereas the last two were tested in controlled trials. All studies showed significant improvements in pain assessment.
The evidence currently available is sparse with methodological flaws, making it difficult to recommend a specific physiotherapy option. There is an urgent need for high-quality randomized controlled trials to identify the most effective physiotherapy management strategy for patients with CPP.
Implantable cardioverter-defibrillators (ICDs) prevent sudden death from cardiac causes in selected patients but require the use of transvenous lead systems. To eliminate the need for venous access, ...we designed and tested an entirely subcutaneous ICD system.
First, we conducted two short-term clinical trials to identify a suitable device configuration and assess energy requirements. We evaluated four subcutaneous ICD configurations in 78 patients who were candidates for ICD implantation and subsequently tested the best configuration in 49 additional patients to determine the subcutaneous defibrillation threshold in comparison with that of the standard transvenous ICD. Then we evaluated the long-term use of subcutaneous ICDs in a pilot study, involving 6 patients, which was followed by a trial involving 55 patients.
The best device configuration consisted of a parasternal electrode and a left lateral thoracic pulse generator. This configuration was as effective as a transvenous ICD for terminating induced ventricular fibrillation, albeit with a significantly higher mean (+/-SD) energy requirement (36.6+/-19.8 J vs. 11.1+/-8.5 J). Among patients who received a permanent subcutaneous ICD, ventricular fibrillation was successfully detected in 100% of 137 induced episodes. Induced ventricular fibrillation was converted twice in 58 of 59 patients (98%) with the delivery of 65-J shocks in two consecutive tests. Clinically significant adverse events included two pocket infections and four lead revisions. After a mean of 10+/-1 months, the device had successfully detected and treated all 12 episodes of spontaneous, sustained ventricular tachyarrhythmia.
In small, nonrandomized studies, an entirely subcutaneous ICD consistently detected and converted ventricular fibrillation induced during electrophysiological testing. The device also successfully detected and treated all 12 episodes of spontaneous, sustained ventricular tachyarrhythmia. (ClinicalTrials.gov numbers, NCT00399217 and NCT00853645.)
Objective
The purpose of this study was to determine the interrater reliability and measurement error of the standardized Timed Up and Go (TUG) Test manual using the fastest of the three timed TUG ...trials in hospitalized and community‐dwelling older individuals.
Methods
Thirty participants (19 from a hospital and 11 from an outpatient geriatric centre: 20 women, 10 men), 65 years or older, all of whom had been referred to physiotherapy due to a functional decline, were included. All participants performed the TUG Test across two sessions (three trials in each) on the same day, separated by a minimum of 30 min. The two raters were blinded to each other's ratings until the end of the study, and the rater order was randomized.
Results
Participants from the outpatient centre had a higher prereferral functional level when evaluated with the New Mobility Score and performed the TUG Test significantly faster than the hospital group. Accordingly, reliability estimates are reported for each specific group. Interrater reliability was excellent for both groups (intraclass correlation coefficient2.1 ≥ 0.93), and no systematic between‐rater difference for obtained TUG times was found. The measurement error was acceptable both at the group (standard error of measurement SEM = 1.7 s and SEM% = 8 hospital vs. 0.7 s and 6 outpatient) and the individual (minimal detectable change MDC95 = 4.6 s and MDC95% = 23 hospital vs. 1.8 s and 17 outpatient) level.
Conclusion
Findings suggest that using the fastest of the three TUG trials is highly reliable between raters and with acceptable measurement error. We, therefore, suggest that the standardized TUG manual with the fastest of the three timed trials be used for the assessment of functional mobility in hospitalized and community‐dwelling older individuals.
Abstract Question: What are physiotherapists’ perceptions about identifying and managing the cognitive, psychological and social factors that may act as barriers to recovery for people with low back ...pain (LBP)? Design: Systematic review and qualitative metasynthesis of qualitative studies in which physiotherapists were questioned, using focus groups or semi-structured interviews, about identifying and managing cognitive, psychological and social factors in people with LBP. Participants: Qualified physiotherapists with experience in treating patients with LBP. Outcome measures: Studies were synthesised in narrative format and thematic analysis was used to provide a collective insight into the physiotherapists’ perceptions. Results: Three main themes emerged: physiotherapists only partially recognised cognitive, psychological and social factors in LBP, with most discussion around factors such as family, work and unhelpful patient expectations; some physiotherapists stigmatised patients with LBP as demanding, attention-seeking and poorly motivated when they presented with behaviours suggestive of these factors; and physiotherapists questioned the relevance of screening for these factors because they were perceived to extend beyond their scope of practice, with many feeling under-skilled in addressing them. Conclusion: Physiotherapists partially recognised cognitive, psychological and social factors in people with LBP. Physiotherapists expressed a preference for dealing with the more mechanical aspects of LBP, and some stigmatised the behaviours suggestive of cognitive, psychological and social contributions to LBP. Physiotherapists perceived that neither their initial training, nor currently available professional development training, instilled them with the requisite skills and confidence to successfully address and treat the multidimensional pain presentations seen in LBP. Registration: CRD 42014009964. Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O'Sullivan P, O'Sullivan K (2015) Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy 61: 68–76 .
PDF
