Leadership and leadership development within the profession of physiotherapy in Ireland

<p><b><i>Background</i></b>: Health service reform, physiotherapy graduate unemployment, and the impending introduction of state regulation mean that physiotherapists in Ireland today are facing many challenges. Leadership is needed to ensure that the profession will be able to adapt to the demands and inevitable changes ahead. <b><i>Objective</i></b>: To investigate the perceptions of physiotherapists in Ireland of leadership and leadership characteristics, and to explore their participation in leadership development training. <b><i>Methods</i></b>: In this cross-sectional nationwide study, an Internet-based survey was administered via e-mail to members of the Irish Society of Chartered Physiotherapists (n = 2,787). <b><i>Results</i></b>: There were 615 responses to the survey. A high proportion of respondents (74.0%) perceived themselves to be a leader. Factors associated with self-declaration as a leader were time since graduation, highest qualification attained, and leadership training. Leadership training was also associated with placing greater importance on achieving a leadership position. Some form of leadership training had been completed by 41.5% of respondents. Communication and professionalism were the most highly rated leadership characteristics in all three settings. <b><i>Conclusion</i></b>: Physiotherapists who have had leadership training were more likely to perceive themselves to be leaders. Leadership training may support physiotherapists to assume leadership roles both clinically and nonclinically.</p

Outcome measures useful to physiotherapists working with patients with rheumatoid arthritis

This paper discusses outcome measures suitable for use by physiotherapists working with patients with rheumatoid arthritis. The measures have been successfully used in clinical practice, audit and research in the area of rheumatology and with other chronic diseases. Together, they provide comprehensive measurement of the disease. Both objective and patient-reported measures are included. The tools are as follows: grip strength, a visual analogue scale to measure pain, a timed walk test, the Arthritis Impact Measurement Scale 2, the Schedule for the Evaluation of Individual Quality of Life and the Quality of Life Index. The tools have been found to be easy to administer and are suitable for clinical use. They provide an effective means of evaluating treatment in both short and long term settings, making them ideal measures for a chronic disease

A randomised controlled trial evaluating the effect of an individual auditory cueing device on freezing and gait speed in people with Parkinson's disease

Background: Parkinson's disease is a progressive neurological disorder resulting from a degeneration of dopamine producing cells in the substantia nigra. Clinical symptoms typically affect gait pattern and motor performance. Evidence suggests that the use of individual auditory cueing devices may be used effectively for the management of gait and freezing in people with Parkinson's disease. The primary aim of the randomised controlled trial is to evaluate the effect of an individual auditory cueing device on freezing and gait speed in people with Parkinson's disease. Methods: A prospective multi-centre randomised cross over design trial will be conducted. Fortyseven subjects will be randomised into either Group A or Group B, each with a control and intervention phase. Baseline measurements will be recorded using the Freezing of Gait Questionnaire as the primary outcome measure and 3 secondary outcome measures, the 10 m Walk Test, Timed "Up & Go" Test and the Modified Falls Efficacy Scale. Assessments are taken 3- times over a 3-week period. A follow-up assessment will be completed after three months. A secondary aim of the study is to evaluate the impact of such a device on the quality of life of people with Parkinson's disease using a qualitative methodology. Conclusion: The Apple iPod-Shuffle™ and similar devices provide a cost effective and an innovative platform for integration of individual auditory cueing devices into clinical, social and home environments and are shown to have immediate effect on gait, with improvements in walking speed, stride length and freezing. It is evident that individual auditory cueing devices are of benefit to people with Parkinson's disease and the aim of this randomised controlled trial is to maximise the benefits by allowing the individual to use devices in both a clinical and social setting, with minimal disruption to their daily routine. Trial registration: The protocol for this study is registered with the US NIH Clinical Trials Registry (NCT00727467)

Inpatient and outpatient rehabilitation for patients with rheumatoid arthritis: a clinical and economic assessment

The aim of this study was to compare inpatient and outpatient rehabilitation for patients with active rheumatoid arthritis from clinical and cost perspectives. A single-centre, randomised trial design was used. Data were completed at baseline, post treatment and at 6 months follow-up. The primary outcome was the Arthritis Impact Measurement Scale 2. Several other disease activity, functional and quality of life measures were also assessed (erythrocyte sedimentation rate, C-reactive protein, visual analogue scale for pain, early morning stiffness, tender and swollen joint count, grip strength, timed ‘Up and Go’ test and Schedule for the Evaluation of the Individual Quality of Life—Direct Weighting). All direct and indirect costs were measured. A total of 47 subjects were randomised to the study. No sustained signifi cant differences were detected between the two groups for the primary or secondary measures at the end of treatment or at follow-up. Total inpatient costs (€81,590) were more than three times higher than total outpatient costs (€25,450)

The effect of a period of rehabilitation in a rheumatic diseases unit on patients with rheumatoid arthritis

The aim of this study was to evaluate the effectiveness of a period of rehabilitation in a rheumatic diseases unit. Thirty-nine patients with rheumatoid arthritis were included in two study periods, which involved assessment of six outcome measures on admission and again on discharge in a rehabilitation unit in Dublin. These measures incorporate each level of disease impact – impairment, disability and handicap (WHO 1980) and the more recent update of the International Classification of Functioning and Disability (ICIDH-2 2000) of body functions and structures, activities and participation. Results suggest an improvement in each area of assessment. Objective measures of grip strength improved in 74% of patients, and timed functional tasks in 77 – 86% of patients. Patient reported measures on the Arthritis Impact Measurement Scale 2 (AIMS2) and Health Assessment Questionnaire (HAQ) and Quality of Life Index (QOL) indicated that 71.4% - 80% and 48% of subjects reported an improvement respectively. These figures suggest the beneficial effect of in-patient rehabilitation for patients with rheumatoid arthritis

Rout_MalesReachAdulthood_Final

Generalized linear mixed model (GLMM) to compare the probability that males reached adulthood in a breeding group (versus a non-breeding group or solitary)

Rout_CoxmePop_Final

Mixed effect Cox model to compare the probabilities for male mountain gorillas and western gorillas to reach adulthood in the same group as their mother and other potential relatives

Rout_HaremSizeAverages_Final

Analysis of variance (ANOVA) to test whether the number of adult females per group is larger for mountain gorillas than western gorillas

Estimated change in elephant dung density (/km²) distribution during 2002–2011 across the Central African forests.

<p>Results are shown as a percentage of the total area of potential elephant habitat overall (A & B) and by country (C & D) for the predictive model with variables: (A & C) survey year, Human Influence Index, corruption and the presence/absence of guards, and (B & D) survey year, proximity to road, human population density, corruption and the presence/absence of guards. The dung density (per km²) intervals are unequal and correspond to the following elephant population categories: extremely low density (0–100), very low (100–250), low (250–500), medium (500–1,000), high (1,000–3,000) and very high (3,000–7,500). With the loss of very high elephant populations in 2011, there is a significant shift into the lower density intervals over the nine years.</p

Elephant dung density and range reduction across the Central African forests.

<p>Predictions are shown for (A) 2002 and (B) 2011 for the model with variables: survey year∧, Human Influence Index***, corruption*** and the presence/absence of guards***, and (C) 2002 and (D) 2011 for the model with variables: survey year∧, proximity to road∧, human population density***, corruption*** and the presence/absence of guards*** (P-values are: ‘***’ <0.001 and ‘∧’ <0.1). Increasingly darker shades of green correspond to higher densities, grey represents extremely low elephant density range (the first interval: 0–100 elephant dung piles/km²) and white is non-habitat (80 survey sites outlined in red). Cutpoints are: 0; 100; 250; 500; 1,000; 1,500; 3,000; 5,000; and 7,500 dung piles/km². Countries 1–5 are: Cameroon; Central African Republic; Republic of Congo; DRC; Gabon.</p