Family-centred practices in the provision of interventions and services in primary health care: A survey of parents of preschool children with cerebral palsy

The aims of this study were to explore how parents of preschoolers with cerebral palsy (CP) experienced the level of family-centred services using the Measure of Processes of Care (MPOC- 20) within primary health care in Norway and to examine the relationships between these experiences and the provided everyday skills interventions and services. A survey was sent to 360 parents of preschool children with CP. The response rate was 34%. Of the MPOC scales respectful and supportive care and coordinated and comprehensive care received the highest ratings, and providing general information received the lowest. Our findings indicate lower levels of family centredness in primary health-care contexts than that reported in specialist health care. Significant positive associations were found between all the five MPOC-20 scales and the parents’ satisfaction with the amount of service coordination (p ¼ .000–.004). The high scores for respectful and supportive care and the low scores for general information indicate that the families experienced relational help giving practices to a larger extent and participatory practices to a lesser extent. To increase the participatory aspects of family-centred practice, further research needs to address facilitators and barriers of information sharing and ways of giving this information both in specialist and primary health care

Effekt av trombolytisk behandling i intervallet 3 til 4,5 timer etter hjerneslag. Rapport fra Folkehelseinstituttet.

Nasjonalt kunnskapssenter for helsetjenesten (nå en del av Folkehelseinstituttet) fikk i oppdrag å oppdatere dokumentasjonsgrunnlaget for effekt av intravenøs trombolytisk behandling gitt i tidsintervallet 3 til 4,5 timer etter hjerneslag. Det fantes allerede en Cochraneoversikt av Wardlaw og medarbeidere fra 2014. Vi søkte etter systematiske oversikter publisert etter Wardlaw sin oversikt, men fant ingen som oppfylte inklusjonskriteriene. Deretter søkte vi etter randomiserte kontrollerte studier publisert senere enn søkedato i Cochrane‐oversikten, men vi fant ingen relevante studier. Derfor har vi formidlet funnene fra Wardlaw og supplert med data fra en metaanalyse med individuelle data. Vi har også vurdert tilliten til effektestimatene med verktøyet GRADE (Grading of Recommendations Assessment, Development and Evaluation). Utfallene er målt 3‐6 måneder etter hjerneslaget og er sammenliknet med placebo. Vi fant at intravenøs trombolyse gitt i tidsrommet 3 til 4,5 timer etter symptomdebut av iskemisk hjerneslag gir: Usikker effekt på utfallet «i live og selvhjulpen i daglige funksjoner» (svært lav tillit til dokumentasjonen) En positiv effekt på utfallet «i live og uten nedsatt funksjon» (middels tillit til dokumentasjonen) Mellom 37 færre og 36 flere per 1000 i risiko for død (lav tillit til dokumentasjonen) Usikker risiko for symptomatisk intrakraniell blødning (svært lav tillit til dokumentasjonen

Digital learning designs i physiotherapy education: a systematic review and meta-analysis

Background: Digital learning designs have the potential to support teaching and learning within higher education. However, the research on digital learning designs within physiotherapy education is limited. This study aims to identify and investigate the effectiveness of digital learning designs in physiotherapy education. Methods: The study was designed as a systematic review and meta-analysis of randomized and non-randomized trials. A search of eight databases on digital learning designs and technology was conducted. Study selection, methodology and quality assessment were performed independently by three reviewers. The included studies were mapped according to the types of digital interventions and studies. For similar interventions, the learning effects were calculated using meta-analyses. Results: Altogether, 22 studies were included in the review (17 randomized controlled trials and five cohort studies). A blended learning design was used in 21 studies, a flipped classroom model in five and a distance learning design in one. Altogether, 10 of the 22 articles were included in meta-analyses, which showed statistically significant effects for flipped classrooms on knowledge acquisition (standardized mean difference [SMD]: 0.41; 95% confidence interval [CI]: 0.20, 0.62), for interactive websites or applications (apps) on practical skills (SMD: 1.07; 95% CI: 0.71,1.43) and for students self-produced videos on a practical skill in a cervical spine scenario (SMD: 0.49; 95% CI: 0.06, 0.93). Overall, the effects indicated that blended learning designs are equally as or more effective than traditional classroom teaching to achieve learning outcomes. Distance learning showed no significant differences compared to traditional classroom teaching. Conclusions: The current findings from physiotherapy education indicate that digital learning designs in the form of blended learning and distance learning were equally or more effective compared to traditional teaching. The meta-analyses revealed significant effects on student learning in favour of the interventions using flipped classrooms, interactive websites/apps and students self-produced videos. However, these results must be confirmed in larger controlled trials. Further, research should investigate how digital learning designs can facilitate students’ learning of practical skills and behaviour, learning retention and approaches to studying as well as references for teaching and learning in digital learning environments

Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis

Background: Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects. Methods: Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses. Results: Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions. Conclusions: Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is neede

Intensive training of motor function and functional skills among young children with cerebral palsy: a systematic review and meta-analysis

Background: Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects. Methods: Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses. Results: Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions. Conclusions: Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is neede

Psykososiale tiltak ved store ulykker og katastrofer

In September 2004, the Directorate for Health and Social Affairs commissioned the Norwegian Knowledge Centre for the Health Services to do a systematic review of the effects of psychosocial interventions after crises, accidents and disasters. We assembled an external expert panel consisting of five persons to assist the systematic review work. It was decided to focus exclusively on interventions after large accidents (transport or industrial accidents) and disasters. We carried out systematic searches in international research databases, study selection according to set criteria, study quality assessments with the use of checklists, and summaries on standardised data collection forms. Results from the included studies were summarised in text only. Fourteen studies were included in the report: six randomised controlled trials, six controlled before-and-after studies, and two cohort studies. Four RCTs investigated the effects of psychological debriefing (PD) after large traumatic events. Two of these reported reductions in psychological distress after PD, but none of the studies were sufficiently methodologically robust to produce reliable effect estimates. The remaining ten studies included various other therapeutic modalities, from specific interventions like “Eye Movement Desensitization and Reprocessing (EMDR) and “Experimental Mastery Technique” to more general group psychotherapy. No or marginal differences in psychological distress between the intervention and control groups were observed. A major trend seemed to be that several types of psychosocial interventions may be beneficial. However, the potential effects of these interventions remain uncertain due to poor study quality, low number of studies, small samples and heterogeneity