Exploration of the experiences of persons in the traumatic spinal cord injury population in relation to chronic pain management

Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain

Mapping two measures to the International Classification Of Functioning, Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context

OBJECTIVE: To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the postacute context. METHODS: Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI. RESULTS: Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of ‘activities and participation’ included as the candidate categories of the brief version. Conclusion: In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific ‘activity’ aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects

Structured feedback on students’ concept maps: the proverbial path to learning?

Good conceptual knowledge is an essential requirement for health professions students, in that they are required to apply concepts learned in the classroom to a variety of different contexts. However, the use of traditional methods of assessment limits the educator’s ability to correct students’ conceptual knowledge prior to altering the educational context. Concept mapping (CM) is an educational tool for evaluating conceptual knowledge, but little is known about its use in facilitating the development of richer knowledge frameworks. In addition, structured feedback has the potential to develop good conceptual knowledge. The purpose of this study was to use Kinchin’s criteria to assess the impact of structured feedback on the graphical complexity of CM’s by observing the development of richer knowledge frameworks. Fifty-eight physiotherapy students created CM’s targeting the integration of two knowledge domains within a case-based teaching paradigm. Each student received one round of structured feedback that addressed correction, reinforcement, forensic diagnosis, benchmarking, and longitudinal development on their CM’s prior to the final submission. The concept maps were categorized according to Kinchin’s criteria as either Spoke, Chain or Net representations, and then evaluated against defined traits of meaningful learning. The inter-rater reliability of categorizing CM’s was good. Pre-feedback CM’s were predominantly Chain structures (57%), with Net structures appearing least often. There was a significant reduction of the basic Spoke- structured CMs (P = 0.002) and a significant increase of Net-structured maps (P < 0.001) at the final evaluation (post-feedback). Changes in structural complexity of CMs appeared to be indicative of broader knowledge frameworks as assessed against the meaningful learning traits. Feedback on CM’s seemed to have contributed towards improving conceptual knowledge and correcting naive conceptions of related knowledge. Educators in medical education could therefore consider using CM’s to target individual student development

Client perspectives on reclaiming participation after a traumatic spinal cord injury in South Africa

BACKGROUND. The development of rehabilitation services promoting participation in people living with a traumatic spinal cord injury (TSCI) is of major concern for physical therapists. What the client sees as effective participation, barriers, and facilitators might be different due to their particular context. This study was conducted to gain insight into the experiences of attaining an important outcome in a developing context. OBJECTIVE. The aim of this study was to explore the experiences of reclaiming participation in community-dwelling people with TSCI in South Africa. DESIGN. This was an explorative, qualitative study with inductive content analysis. METHODS. Individual semistructured interviews were conducted with 17 adults living with a TSCI in order to explore their experience of participation. The verbatim transcripts were analyzed, and the end result was an overall theme that included 4 emerging categories. RESULTS. The theme “participation possibility” denotes the eventual involvement in life situations. Within this theme, there were 4 categories that emerged as a representation of essential aspects along the continuum of reclaiming participation: (1) dealing with the new self, (2) a journey dominated by obstacles, (3) the catalyst of participation, and (4) becoming an agent. Dealing with and recognizing these intervening conditions seem critical for clients to reconstruct the meaning that is necessary for a broader conception of participation. Limitations. The transferability of these findings to dissimilar contexts may be limited. CONCLUSION. Client perspectives on reclaiming participation after injury affirm the notion of eventual participation, with each person finding strategies to succeed. In order to help clients reclaim participation, health professionals should develop contextually sensitive programs that include peer mentoring and reduce the influence of hindering factors

Back pain post partum : Clinical and experimental studies

Background: Half or more of pregnant women experience back pain at some time during pregnancy. Even though back pain exists post partum, it is not well documented and detailed studies concerning different back pain localisations, experiences of pain and activity abilities are scarce. Thus, the prevalence of back pain post partum varies highly, between 2% - 65%, due to different follow-up times, methods and definitions of persisting back pain. Aim: The aim of this thesis was to 1) identify and classify back pain in women post partum and its relation to experience of pain and ability to perform daily activities; 2) quantify differences in kinematics above all with respect to joint co-ordination, temporal parameters and pelvic motion in a lifting task; 3) evaluate how different treatments performed during pregnancy affected pain and activities during pregnancy and in the post partum period. Methods: On average 7 months post partum 119 women were examined and interviewed. The spinal sagittal configuration and mobility were measured in the thoracic and lumbar spine, respectively, with a kyphometer. Eight pain provocation tests were performed for the lumbar spine, sacroiliac joints and symphysis and in addition hip movement and radiating pain were examined. Pain intensity was rated on a visual analogue scale (VAS 0-100 mm) and described with regard to localisation of pain and type of sensation on a pain drawing. Activity ability was scored using the Disability Rating Index (DRI) covering 12 items each rated on a VAS 0-100 mm. Based on clinical examination, 118 women with pelvic girdle pain diagnosed during pregnancy were randomised into three different treatment groups. They were followed throughout pregnancy and until 12 months post partum with respect to perceived pain and self-estimated activity limitations. All three groups received information about the condition and were provided with a non-elastic sacroiliac belt (Rehband®, Sweden). Group 2 received in addition a home training programme consisting of three exercises aiming to activate the muscles around the pelvic girdle and stretching exercises. Group 3 participated in addition in an individual training programme consisting of strengthening exercises. Seven women with low-back pain and nine women without low-back pain participated in a laboratory study on average 6 months post partum. The lifting task consisted of lifting an 8.3 kg box with both hands. A two-camera opto-electronic system (ELITE, BTS, Milan, Italy) recorded the positions of 14 passive light- reflecting markers for calculations of joint and segment angles. Results: In 27% of the women, pain could be provoked in the area of the posterior pelvic/sacroiliac joints, in 18% in the lumbar spine, in 39% in both areas and in 16% no pain could be provoked in the defined areas. The spinal sagittal configuration or mobility and perceived pain intensity did not differ between the groups. In the three groups where pain was provoked in the lower back area, the ability to carry out above all movement related daily activities, was more limited than in the group where no pain could be provoked in that area. There was no significant difference between the three intervention groups during pregnancy or at the three follow-ups regarding pain and activity. In all groups, pain decreased and the activity ability increased between gestation week 38 and at three months follow-up. The performance of the lifting task differed between the women with and without low-back pain concerning the hip-pelvic-lumbar spine motions. The pain group had less hip joint flexion and more lumbar spine flexion at box lift-off. A large percentage in the pain group also showed a non-stop flexion-extension motion of the lumbar spine and an unsteady pelvis motion in space around lift-off. Conclusions: Pain could be provoked from different locations in the back and can thus not be seen as a unitary concept. The measuring of the spinal sagittal configuration and mobility did not further identify or classify post partum back pain. Pain is a symptom, but activity limitations seem to be important, since the findings showed limitations in movement related activities. Performing exercises had no additional value when compared to giving a non-elastic sacroiliac belt and information. During performance of a lifting task, dissimilar kinematics were shown in the motion of the hip-pelvis-lumbar movement. It seems important to pay attention to women with back pain post partum, in order to prevent prolonged pain. Sammanfattning:Syfte: Introduktion: Ca 50% anger ryggbesvär någon gång under graviditeten och mellan 2%-65% har också kvarstående besvär efter förlossningen. Trots att dessa kvinnor anger ryggbesvär efter förlossningen är problemet inte speciellt väl undersökt. Syfte: Det övergripande syftet med avhandlingen var att identifiera olika lokalisering av ryggbesvär hos kvinnor efter förlossningen, samt att beskriva upplevelsen av smärta och hur dessa kvinnor klarar av vanliga vardagliga aktiviteter. Dessutom jämfördes hur tre olika behandlingar påverkade smärta och funktion, dels under graviditeten, men också upp till 12 månader efter förlossningen. Slutligen utfördes en rörelseanalys av ett lyft. Material och Metod: I genomsnitt 7 månader efter förlossningen intervjuades och undersöktes 119 kvinnor med kvarstående ryggbesvär. Åtta vedertagna reliabilitetestestade smärtprovocerande test användes för att undersöka sacroiliacaleden, symfysen och ländryggen. Höftrörligheten testades och den utstrålande smärtan i benet. Den sagittella ryggkonfigurationen och rörligheten i länd- och thorakalryggen mättes med en kyfometer. Skattning av smärtintensitet gjordes på en visuell analog skala (VAS 0-100 mm) och smärtutbredning markerades på en smärtritning. Aktivitetsförmåga skattades med ett aktivitets index, DRI, Disability Rating Index, där tolv dagliga aktiviteter skulle bedömas (0- 100 mm). Totalt 118 gravida kvinnor med smärta från bäckenlederna randomiserades till tre olika sjukgymnastiska behandlingar. Samtliga grupper erhöll information och ett sacroiliacaleds bälte (Rehband®, Sverige). Dessutom fick en grupp ett hemtränings program innehållande övningar för att aktivera de stabiliserande musklerna runt bäckenet samt stretching. Den tredje gruppen deltog i ett styrketränings program på en sjukgymnastmottagning. Utvärdering av smärta och funktion gjordes i graviditetsvecka 38 samt 3, 6 och tolv månader efter förlossningen. Sju kvinnor med resp nio kvinnor utan besvär i nedre delen av ryggen, utförde i två experimentella studier, ett lyft av en 8.3 kg tung låda. Registrering av rörelsen gjordes med ett optoelektroniskt system (ELITE, BTS, Milano). Rörelsen i fot-, knä- och höftled samt i ländrygg, bäcken och bål analyserades. Rörelse- och tidsomfång registrerades samt koordinationen mellan de analyserade ledvinklarna. Resultat: Hos 27% av kvinnorna kunde smärta provoceras i sacroiliacaleden, hos 18% i ländryggen, hos 39% i båda dessa områdena och hos 16% kunde ingen smärta provoceras med de använda testerna. Det förelåg inga skillnader avseende den sagittella ryggkonfigurationen el

Early Intervention with a Compression Sleeve in Mild Breast Cancer-Related Arm Lymphedema : A 12-Month Prospective Observational Study

Background: In our previous randomized controlled trial (RCT), the progression/no progression of mild breast cancer-related arm lymphedema (BCRL) was examined among women randomized to a compression group (CG) with a compression sleeve (compression class (ccl) 1) or not (NCG) for 6 months. In the present prospective study, BCRL in the CG and NCG was followed for 12 months. Methods: At the end of the RCT, 33 women with mild BCRL were eligible in the CG and 37 in the NCG. The proportional differences in no progression/progression of BCRL were defined as a >2% increase from start of RCT or exceeding 10% in the lymphedema relative volume as measured by the water displacement method. In addition, changes in the lymphedema relative volume and tissue dielectric constant ratio, which measures local tissue water, were examined. At the end of the RCT (i.e., after 6 months), a one-month break of the compression treatment was made in the CG. If the lymphedema relative volume progressed by definition, the compression treatment was resumed and continued, with follow-up of all women at 9 and 12 months. Results: A larger proportion of women in the NCG showed progression (57%, 61%, 67%) compared to the CG (16%, 22%, 31%) at 6, 9, and 12 months (p < 0.001, 0.005, 0.012), respectively. Twelve (33%) women in the NCG did not progress at all. No changes of the lymphedema relative volume and local tissue water were found over time at any follow-ups, but were stable on a low level. Conclusions: To avoid the progression of mild BCRL into a chronic issue in the long-term, compression sleeve ccl 1 may be applied immediately after early diagnosis of mild BCRL

Palpation of Increased Skin and Subcutaneous Thickness, Tissue Dielectric Constant, and Water Displacement Method for Diagnosis of Early Mild Arm Lymphedema

Background: Early diagnosis of mild lymphedema and treatment are important to prevent its progress. The tissue dielectric constant (TDC), measuring local tissue water in the skin and upper subcutis, has neither been related to the water displacement method (WDM) nor been used to diagnose mild arm lymphedema in patients at risk. Our aims were to evaluate TDC and WDM in combination with palpation, examine the association between TDC and WDM measurements, and compare lymphedema-related factors. Methods and Results: Seventy-two women treated for breast cancer were diagnosed with mild arm lymphedema using skin palpation in combination with TDC from fixed measurement sites (threshold ratio for upper arm ≥1.45 and forearm ≥1.3) and/or WDM (lymphedema relative volume [LRV]: ≥5% to ≤8%). Results revealed that 32 (45%) women were diagnosed by TDC only, 19 (26%) by WDM only, and 21 (29%) by both TDC and WDM. TDC ratios exceeding the threshold were most frequently identified on the medial site of the arm, proximal and distal to the antecubital fossa. TDC and WDM were negatively associated; LRV (r = -0.545, p < 0.001). The women diagnosed by TDC only were diagnosed earlier after surgery (p = 0.003) and had a lower LRV (1.3%) than those diagnosed by WDM only (6.3%) or both TDC and WDM (6.2%; p < 0.001). Conclusions: TDC and WDM can be used together for early diagnosis of arm lymphedema, but TDC is the most valid method, determining the diagnosis earlier after surgery and at a lower arm volume than WDM

Perceptions of lymphoedema treatment in patients with breast cancer - a patient perspective

Lymphoedema after breast cancer surgery is a chronic condition. Lymphoedema treatment consists of information/advice, compression, physical exercise, skin care, and manual lymph drainage. Little is known about how patients experience, adapt, and respond to lymphoedema treatment. Thus, the purpose of the study was to investigate and describe women's perceptions of lymphoedema treatment after breast cancer surgery. Sixteen women with breast-cancer-related lymphoedema, recruited from four hospitals and two rehabilitation clinics, participated in the study. Semi-structured interviews were conducted and analysed using a phenomenographic method. Five qualitatively different categories of description could be identified: uncertainty, disappointment, guilt and shame, safety, and autonomy. The categories could be described based on a two-dimensional structure: the patients role (internal vs. external locus of control) and an understanding of lymphoedema as a chronic disease or a burden. The study has provided a deeper understanding of different ways in which patients perceive and respond to lymphoedema treatment. The present findings enable the lymphoedema therapist to individualise treatment and counselling based on each patient's approach to the patient role, ability to take responsibility for treatment, and acceptance of lymphoedema as a chronic disease

Tissue Dielectric Constant and Water Displacement Method can detect changes of mild Breast cancer-related arm lymphedema.

Background: Most commonly, volume measurements are used to evaluate the effect of lymphedema treatment, but as the accumulation of lymph fluid can be local, this method may not always be the best. Tissue dielectric constant (TDC) can be applied to identify local lymphedema changes, but has not been used before when evaluating treatment in mild arm lymphedema. Thus, the overall aim of this study was to examine if TDC and water displacement method (WDM) can measure changes in mild breast cancer-related lymphedema during the 6-month standard treatment. More specifically, we examined changes within and between three defined groups based on lymphedema thresholds of TDC and WDM at start of treatment, as well as changes of the highest TDC ratio and site.Methods and Results: Forty-six women with mild arm lymphedema, received treatment with compression sleeves, mostly ccl 1, and instructions about self-care. Local tissue water was measured by TDC at six defined sites and lymphedema relative volume (LRV) by WDM before treatment and at first, second, third, and sixth month. There was a significant decrease in the site with the highest TDC ratio, as well as LRV at all follow-up visits. At 6 months, TDC ratio had decreased mean 0.26 (

Exploration of the Experiences of Persons in the Traumatic Spinal Cord Injury Population in Relation to Chronic Pain Management

Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain. There is a need for chronic pain management beyond pharmacological prescription. Future practices should focus on adopting a holistic, biopsychosocial approach, which includes alternative pain therapy management. In addition, advances in pain management cannot be achieved without adopting a therapeutic alliance between the clinician and patient