Search

Near falls, such as stumbles or slips without falling to the ground, are more common than falls and often lead to a fall. The objective of this study was to investigate which balance tests differentiate near fallers from fallers and non-fallers. This cross-sectional, observational study assessed balance in healthy community dwelling adults aged 40–75 years. Participants reported falls and near falls in the previous 6 months. Balance testing was completed in the local community for static (i.e. feet together and single-leg stance) and dynamic balance (i.e. tandem walk, Functional Movement Screen hurdle step and lunge). Between-group comparative analysis of pass-fail for each balance test was undertaken. Of 627 participants, there were 99 fallers (15.8%), 121 near fallers (19.3%) and 407 non-fallers (64.9%). Near fallers were twice as likely as non-fallers to fail single-leg stance eyes (OR 2.7, 95% CI 1.5–4.9), five tandem steps (OR 2.5, 95% CI 1.5–5.7), hurdle step (OR 2.9, 95% CI 1.4–5.8), and lunge (OR 2.5. 95% CI 1.5–4.1). The predictive capacity differentiates near fallers with a sensitivity of 73.3%. A new battery of tests assessing static and dynamic balance identifies near fallers in seemingly healthy, community dwelling middle- and young-older-aged adults. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines (CPG) are vehicles for translating evidence into practice, but effective CPG‐uptake requires targeted training. This mixed methods research project took a staged evidence‐based approach to develop and test a tailored training programme (TTP) that addressed organisational and individual factors influencing CPG‐uptake by South African physiotherapists treating patients with low back pain in primary healthcare settings. Methods: This multi‐stage mixed methods study reports the development, contextualisation and expert content validation of a TTP to improve CPG‐uptake. Finally, the TTP was evaluated for its feasibility and acceptability in its current format. Results: The TTP (delivered online and face‐to‐face) contained minimal theory, and focussing on practical activities, clinical scenarios and discussions. Pre‐TTP, physiotherapists expressed skepticism about the relevance of CPG in daily practice. However, post‐TTP they demonstrated improved knowledge, confidence, and commitment to CPG‐uptake. Discussion: The phased‐construction of the TTP addressed South African primary healthcare physiotherapists' needs and concerns, using validated evidence‐based educational approaches. The TTP content, delivered by podcasts and face‐to‐face contact, was feasible and acceptable in terms of physiotherapists' time constraints, and it appeared to be effective in improving all outcome domains. This TTP is now ready for intervention to a wider audience. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents regularly engage in screen‐based activities. Complex factors influence adolescents' growth, and habitual sitting posture. The association between over‐time changes in their sitting posture, and upper quadrant musculoskeletal pain (UQMP) is poorly understood. This study tested the association between change over 12 months in seated posture angles (neck flexion [NF]; craniocervical angle [CCA] into flexion and extension; and thoracic flexion [TF]), UQMP, and predictor variables (anxiety and depression; sport activity, music participation; computer use). Methods: A one‐year prospective longitudinal study enrolled 211 asymptomatic 15‐18‐year students. 3D motion analysis captured postural angles while students worked on desktop computers, at baseline and 12 months later. Height, weight, computing time, sport and music participation, and depression and anxiety were measured at both time periods. UQMP in the previous month was captured at 12 months. The association between over‐time change in sitting posture angles and predictor variables was determined using linear regression analysis (r2; p‐values). The association between predictor variables with UQMP, and predictor variables on the association between postural angles and UQMP was assessed using logistic regression models (Odds Ratios [95%CI]). Significant confounding effects were determined when the addition of a predictor variable to the posture‐UQMP model significantly changed the Likelihood Ratio chi square value. Results: N = 153 students (72%) completed the study (48 with UQMP). Significant associations occurred between head flexion (HF) and body mass index (BMI) (r2= 4.20, p =.01); NF and computer use (r2=2.87, p =.036) and CCA and music participation (r2=9.99, p =.047). Music participants and non‐participants in sport or music had increased risk of UQMP with CCA changes into flexion (OR 12.0) and TF changes into extension (OR 7.6) respectively. Conclusion: The association between over‐time‐change in sitting posture angles and UQMP is not influenced by anthropometrics, psychosocial factors or time spent computing. Music students, and students not participating in sport, require further postural analysis. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The use of chemical restraint in emergency situations is to control aggression or violence to protect consumers and staff and is to be used as a last resort when all other behavioural control alternatives have been exhausted.Chemical restraint involves the use of medication. What the paper adds to existing knowledge?: This is the first paper to systematically review the prevalence of the use of chemical restraint.The use of chemical restraint is common across emergency departments and acute psychiatric inpatient units worldwide.Consumers who are restrained are also likely to receive chemical restraint.The studies reviewed demonstrate that there is a need for more standardized data collection so that clearer comparisons can be made between healthcare settings and countries. What are the implications for practice?: Implications of practice include the need to report adverse events post‐chemical restraint as these can deleteriously affect a person's physical health.Identification of and staff education about first‐line management techniques before chemical restraint is administered are significant to reduce its use. Introduction: Chemical restraint is used to manage uncontrolled aggression, agitation or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings. Aim: This systematic review aimed to synthesize the international prevalence of chemical restraint for non‐consenting adults. Method: PsycINFO, CINAHL, MEDLINE/PubMed and Google Scholar databases were searched for peer‐reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice. Results: Forty‐eight papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint. Discussion and implications for practice: This is the first known comprehensive meta‐view of chemical restraint use worldwide, highlighting the need for standardized data collection to enable comparisons between healthcare settings and countries. Relevance statement: There is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesizing the international prevalence of chemical restraint for non‐consenting adults. This meta‐view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines (CPGs) provide conveniently packaged evidence-based recommendations to inform clinical decisions. However, intended end-users often do not know how to source, appraise, interpret or choose among CPGs. Moreover, it can be confusing when recommendations on the same topic differ among CPGs, in wording, intent and underpinning evidence. Objectives: This article reports on the processes of: (1) identifying current CPGs for acute and subacute low back pain (LBP) to fit the needs of South African physiotherapists, (2) collating and summarising CPG recommendations to produce a user-friendly end-user product and (3) testing the utility of the summary CPG document on South African physiotherapy clinicians to efficiently determine acceptability, appropriateness and feasibility to inform clinical decision-making. Method: An adapted approach was followed by systematically searching online CPG repositories and online databases for LBP CPGs; screening and critically appraising identified CPGs; summarising recommendations from relevant CPGs and organising them into clinical practice activities. Feedback on utility was obtained from 11 physiotherapists. Results: Three high-quality, international CPGs provided 25 recommendations on the assessment and management of acute and subacute LBP relevant to South African physiotherapy practice. They were organised into 10 headings. Physiotherapy user feedback suggested that this document would assist in clinical decision-making. Conclusion: Organised recommendations extracted from multiple, relevant CPGs provide an end-user-friendly resource for physiotherapists treating LBP. Clinical implications: Collated and organised CPG recommendations may effectively assist South African physiotherapists' clinical decision-making in assessing and managing patients with acute and subacute LBP. [ABSTRACT FROM AUTHOR]

Background and Purpose The aim of this study is to provide a systematic overview of the past decade of literature on processes of triage for patients with spinal pain, outcomes measured and markers of effectiveness. Methods A systematic search of the literature with narrative synthesis of findings was conducted. Studies in English language of any design concerning spinal triage programmes for adults with acute or chronic spinal complaints were considered for inclusion. Electronic database searches were conducted in OVID, Medline, Embase, CINAHL, Health Source Nursing, Scopus and Web of Science. Additional references were sourced through pearling reference lists, and expert input. Findings were synthesized descriptively. Results Of 216 potentially relevant records, 21 papers (20 studies) were included. There was little commonality in triage activities/programmes and outcomes, although physiotherapists were common members of triage programmes. Positive outcomes were reported most commonly for wait times, with several studies also reporting high levels of patient and physician satisfaction. Outcomes such as surgical conversion rates and selection accuracy were less clear. Discussion Spinal triage programmes have the potential to improve efficiency of care for outpatients with spinal complaints. The evidence gaps in health outcomes, service models and cost effectiveness should be addressed by more robust prospective research designs. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: Although cerebrovascular accident is a leading cause of mortality in the Philippines, there has never been a national survey of stroke client descriptors and rehabilitation practices. This paper reports on data from the audit of stroke care for inpatients in hospitals serviced by physiatrists. Method: Audit was done of the medical records of stroke clients admitted to hospitals with rehabilitation units. Performance indicators for timely referral to rehabilitation were applied. Results: A total of 1683 records were audited. The majority of clients had cerebral infarct followed by cerebral haemorrhage. The median length of stay was 7 days; stay was lengthier for haemorrhagic strokes. Only 54.1% of the clients were referred to rehabilitation, with a median delay of 3 days between admission and referral to rehabilitation. 25.4% of the clients had early referral to rehabilitation. 39.2% of the 1397 clients were referred to rehabilitation earlier than 2 days before discharge. Conclusion: This Filipino study provides valuable information on stroke types and prevalence, demographics and rehabilitation practices. Despite the prevalence of post-stroke rehabilitation, it has been underutilised in the management of stroke. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Declining capacity to function safely and independently in the community is a manifestation of ageing. Multiple measures are used to define and predict functional decline. This paper explores the use of partial least squares ( PLS) analysis to understand the interaction between overtime measures of functional decline. Methods Comprehensive information was captured on individuals aged 65+ who presented at a large metropolitan Australian hospital Emergency Department ( ED) for a complaint, which did not result in a hospital admission. They were followed-up by telephone 1 and 3 months, post- ED discharge. Information was collected each time on home situations (living alone, using community services, using a gait aid and having a formal carer), recent falls, hospitalizations and instrumental activities of daily living ( IADLs). PLS analysis was applied to identify overtime relationships between measures. Results Valid information was provided by 147 individuals at all three time points. The eight individual IADL items clustered clearly around physical, mental or combined mental and physical IADLs. These clusters were strongly related to increased use of community supports, gait aid and carer, and living alone. The relationship was less convincingly for hospitalizations, and falls were not explained well. Conclusion PLS analysis offers a novel and comprehensive way of analysing complex health data, which allows sense to be made of relationships over a 3-month period. This analysis provides a better understanding of declining function over time, than could be provided by current health modelling methods. [ABSTRACT FROM AUTHOR]

Purpose: The Adapted Fresno Test (AFT) is a seven-item instrument for assessing knowledge and skills in the major domains of evidence-based practice (EBP), including formulating clinical questions and searching for and critically appraising research evidence. This study examined the interrater reliability of the AFT using several raters with different levels of professional experience. Method: The AFT was completed by physiotherapists and occupational therapists, and a random sample of 12 tests was scored by four raters with different levels of professional experience. Interrater reliability was calculated using intra-class correlation coefficients (ICC [2, 1]) for the individual AFT items and the total AFT score. Results: Interrater reliability was moderate to excellent for items 1 and 7 (ICC=0.63-0.95). Questionable levels of reliability among raters were found for other items and for the total score. For these items, the raters were clustered into two groups-'experienced' and 'inexperienced'-and then examined for reliability. The reliability estimates for rater 1 and rater 2 ('inexperienced') increased slightly for items 2 and 5 and for the total score, but not for other items. For raters 3 and 4 ('experienced'), ICCs increased considerably, indicating excellent reliability for all items and for the total score (0.80-0.99), except for item 4, which showed a further decrease in ICC. Conclusion: Use of the AFT to assess knowledge and skills in EBP may be problematic unless raters are carefully selected and trained. [ABSTRACT FROM AUTHOR]