Accessing hospital packaged foods and beverages : the importance of a seated posture when eating

Background: Hospitalised and community dwelling older people (65 years and over), have difficulties opening food and beverage items such as cheese portions and tetra packs served in public hospitals. Previously, the role of hand strength on successful pack opening has been explored in a seated position. However, as many people in hospital eat in bed, this laboratory study examined the differences between participants opening a selection of products both in a hospital bed and a chair. Methods: This study used a qualitative method (satisfaction) and quantitative methods (grip and pinch strength, dexterity, time and attempts) in two conditions (bed; chair) with a sample of well older community dwelling adults (n=34). Packs tested included foil sealed thickened pudding, foil sealed thickened water, tetra pack, dessert, custard, jam, cereal, honey sachet and cheese portions. Results: Honey sachets, cheese portions, foil sealed thickened pudding and tetra packs were the most difficult packs to open, with 15% of cheese portions unable to be opened in either the bed or chair posture. While grip strength was consistent for each posture, pinch grips and dexterity were adversely affected by the bed posture. Lying in a hospital bed required greater pinch strength and dexterity to open packs. Conclusions: Eating in a seated position while in hospital has been shown to improve intake. This study demonstrates that eating in a seated posture is also advantageous for opening food and beverage packs used in NSW hospital food service and supports the notion that patients should sit to eat in hospital

A study to compare the reliability of composite finger flexion with goniometry for measurement of range of motion in the hand

OBJECTIVE: To establish the intra- and inter-rater reliability of composite finger flexion (CFF), and to compare this with goniometry. DESIGN: Fifty-one physiotherapists and occupational therapists took part in the study. The hand of a normal subject was splinted in three different positions. Using a goniometer and a ruler alternately, each therapist measured both the proximal interphalangeal joint and CFF of three digits, following a standardized protocol. This process was repeated three times.SETTING: Eighteen NHS hospital sites in the UK.RESULTS: The two measurement methods produced different ranges and standard deviations for each digit. The repeatability coefficient shows that repeated intra-rater goniometric measures fall within 4-5 degrees of each other 95% of the time. Inter-rater goniometric measures fall within 7-9 degrees. Repeated intra-rater CFF measures fall within 5-6 mm of each other, whereas inter-rater fall within 7-9 mm. The influence of occupation, experience in hand therapy, years of practice and routine use were found to have no effect on reliability. Scaling of the two methods of measurement allowed comparison between them to be made. CFF and goniometry are equally reliable when comparing inter-rater reliability, but goniometry displays less variability than composite finger flexion for intra-rater measurements. CONCLUSION: In this study involving a subject with normal joints, goniometry is more reliable than CFF when only one measurer is involved. However, CFF may be a useful alternative where multiple joint measures are required, or when goniometry is impracticable