Building Future Research Capacity In Student Healthcare Practitioners Through Research-Informed-Teaching

The Research-Informed-Teaching (RIT) agenda aims to broaden the scope of learning and teaching within higher education (Jenkins, Healey and Zetter, 2007). This may encompass raising students’ awareness of the research environment and knowledge base relevant to their discipline, developing advanced skills in critical appraisal of published research, engaging active researchers in the delivery of teaching, plus facilitating students’ direct experience of research processes and conduct. It may be anticipated that that RIT is already intrinsic to the nature of professional education in healthcare, where Evidence-Based Practice (EBP) is a now a fundamental requirement of professional regulation (Health and Care Professions’ Council (2014). However frameworks of RIT are not necessarily sufficiently defined to promote the required depth of critical reflection on clinical practice (Dey, Downe, Milston, Roddam and Hart, 2009)

The Effect of Different Decline Angles on the Biomechanics of Double Limb Squats and the Implications to Clinical and Training Practice

Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint

Delayed effects of a 20-min crushed ice application on knee joint position sense assessed by a functional task during a re-warming period

Delayed effects of a 20-minute crushed ice application on knee joint position sense assessed by a functional task during a re-warming period. Introduction The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play following cryotherapy application at the lower limb. Objectives The aim of this study was to investigate whether a 20 minute application of crushed ice at the knee affects knee joint position sense immediately post and up to 20 mins post ice removal, during a small knee bend. Method 17 healthy male participants took part in the study performing a functional task. Using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden), kinematics of the knee were measured during a weight bearing functional task pre and immediately post, 5, 10, 15 and 20 minutes post cryotherapy intervention. Skin surface temperature (Tsk) cooling was measured via infrared non-contact thermal imaging (Flir Systems, Danderyd, Sweden) over the anterior and medial aspect of the knee. Results Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning. A significant increase (P ≧ 0.05) in rotational movement in the transverse plane occurred, 20 minutes post ice removal. Discussion A 20-minute application of crushed ice to the anterior aspect of the non-dominant knee has an adverse effect on knee joint repositioning and dynamic stability, 20 minutes after ice is removed. In consideration of returning a land-based athlete to dynamic functional activities, post cryotherapeutic intervention at the knee, clinicians should consider these findings due to the potential increase risk of injur

Determining effectiveness of a passive gravity assisted traction (PGAT) device in the management of simple, mechanical low back pain

Objectives Anecdotal evidence supports stretching exercises to minimize symptoms of low back pain (LBP) and improve function. This study aimed to assess whether a passive gravity assisted traction (PGAT) device can reduce LBP through stretching techniques. Methods Sixty-seven participants with simple mechanical LBP were randomly assigned to a control or intervention group for 4 weeks, the intervention group receiving standardized advice and PGAT device and the control group received standardized advice. Outcome measures via questionnaire assessments included; Roland Morris Disability Questionnaire (RMDQ), Patient Reported Outcome Measure (PROMs), Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI). Results Statistically significant score reduction in RMDQ (p=0.01) occurred within the intervention group and PROMs (p=0.01) when comparing intervention to control. There were no significant differences (p=0.06) within the control group. Within the intervention group significant reductions in ‘average’ pain over the previous 24 hours, 7 days and ‘worst’ pain scores over previous 7 days (p<0.05). Significant decreases in ‘average’ and ‘worst’ pain (p=0.01) when comparing intervention to control group when rating an activity that participants found difficult to do, due to LBP. Conclusions Improvements in LBP were demonstrated within the intervention group and comparing intervention to control group. Further research should consider assessing subgroups of posture types to compare response between groups. The use of PGAT devises such as LumbaCurve™ may be useful in the management of back pain

“Spinal alignment” cushion in the management of low back pain – a randomized controlled study

Objectives: To assess the clinical effectiveness of using a spinal alignment cushion compared to standardized care in the management of simple mechanical LBP, whilst laying in the semi-fetal position. Methods: 71 individuals (aged between 18 and 50) with simple mechanical LBP for at least 3 months were recruited to the 4-week intervention after screening using the Red Flags and STarT Back tools. Participants were randomly assigned to either the control (standardized care) or intervention group (standardized care plus spinal alignment cushion). Pre and post assessments were taken using the Roland Morris Disability Questionnaire (RMDQ) (0-24), to assess physical disability associated with low back pain; the Core Outcomes Measure Index (COMI) (0-10), and Patient Reported Outcome Measures that included measures of sleep quality and comfort as well as back and muscle pain and stiffness. Questionnaires were completed online using SNAP survey. Each post assessment was analyzed using ANCOVA with corresponding pre-assessment as a covariate. Results: Clinically and statistically significant differences were seen in the RMDQ (p=0.034) and COMI scores (p=0.008) with the intervention group showing the greater improvement in scores over the four-week intervention. Significant differences were also seen in favor of the intervention group in the frequency (p=0.004) and intensity of back pain (p<0.001), joint/muscle stiffness (p=0.046) and intensity of back stiffness (p=0.022). Conclusions: Overall, results suggest that use of targeted treatments such as a spinal alignment cushion, for symptoms at night can provide clinically important and statistically significant improvements for individuals with LBP with high levels of treatment satisfaction and adherenc

Mapping of skin surface sensitivity and skin surface temperature at the knee over a re-warming period following cryotherapy

Background Current literature proposes proprioceptive changes following cryotherapy applications due to changes in neurodynamic feedback from receptors altering knee joint position sense. However, minimal literature exists on the effect on skin surface sensitivity (SSS) which may be a contributing factor. This study investigated the effects of cryotherapy on knee SSS and temperature (Tsk) using monofilaments and thermal imaging in males and females. Methods SSS in 19 healthy participants mapped using a photographic knee pain map (PKPM), on the non-dominant knee following a 20-minute cryotherapy exposure used an Aesthesio Precision Tactile Sensory Evaluator (DanMic Global, USA) for measurement. Thermal imaging using a non-invasive infrared camera (ThermoVision A40M, Flir Systems, Danderyd, Sweden) measured Tsk. Data were collected pre, immediately post and at five-minute intervals up to 20-minutes. Results Statistical significant decreases in SSS are reported for superior medial section of the PKPM comparing baseline to immediately post intervention (P=0.04), and to 20-minutes post (P=0.04), and between pre to immediately post (P=0.02) and 5-minutes post (P=0.01) in the female participants only. Male only showed significant decrease in SSS between pre and immediately post intervention for the medial patella section (P=0.02). Conclusion Crushed ice application significantly reduces SSS around the medial aspect of the knee immediately post removal and with males and females showing different levels of response. SSS over the medial aspect of the knee had not returned to baseline 20-minutes post cooling. Therapists should be conscious of changes in SSS that may impede return to play following cooling due to feedback mechanisms which may affect joint position sense

Unlicensed “special” medicines: understanding the community pharmacist perspective

Objective: Community pharmacy staff are responsible for obtaining and supplying unlicensed “special” medicines to patients in primary care. Less well-defined parameters for safe and effective use of unlicensed compared to licensed medicines, along with issues around maintaining consistency between care settings or among manufacturers, have been associated with increased risks. This study aimed to explore the views and experiences of community pharmacy staff on accessing and supplying unlicensed “special” medicines to patients in Wales and the perceived impact of challenges faced on patient care.Methods: A qualitative, phenomenological approach was employed, involving semi-structured interviews with pharmacists and pharmacy technicians working at one small chain of community pharmacies in Wales. The interview schedule focused on the personal experiences and perceptions of the participants on the processes involved in accessing and supplying unlicensed “special” medicines from a community pharmacy. Interviews were audio-recorded and transcribed verbatim.Results: A total of six participants completed the interview. Three main themes were constructed from inductive thematic analysis of the transcribed interviews: requirement for additional patient responsibilities; influences on the confidence felt by pharmacy staff when accessing and supplying unlicensed “special” medicines; and continuity of supply.Conclusion: This study gives a preliminary insight into the views and experiences of community pharmacy staff in Wales when accessing and supplying unlicensed “special” medicines. Further research is required to see if these views and experiences are representative of community pharmacy staff across the country