Early CRT monitoring using time-domain optical coherence tomography does not add to visual acuity for predicting visual loss in patients with central retinal vein occlusion treated with intravitreal ranibizumab:A secondary analysis of trial data

Our primary purpose was to assess the clinical (predictive) validity of central retinal thickness (CRT) and best corrected visual acuity (BCVA) at 1 week and 1 month after starting treatment with ranibizumab for central retinal vein occlusion. The authors also assessed detectability of response to treatment

A Survey of Human Gross Anatomy Laboratories in DPT Programs across the United States

Purpose: The purposes of this study were to 1) describe the current teaching methodology used in Doctor of Physical Therapy (DPT) human gross anatomy (HGA) labs, 2) examine the demographics and perceptions of HGA instructors and compare responses based on years of experience, 3) determine the utilization and instructor perceptions related to cadaver dissection and other methods of instruction, and 4) determine which safety/security protocols are used in HGA laboratories. Method: All DPT programs (N=250) in the United States (US) accredited by the Commission on Accreditation of Physical Therapy Education (CAPTE) were eligible to participate. The anonymous, 89-item online survey was completed by either an HGA instructor or DPT program director in March of 2020. Seventy-four individuals responded for a response rate of 29.6%. Results: Respondents represented programs from 65.2% private and 34.8% public institutions. Fifty percent of respondents dedicated 31-60% of their HGA course to face-to-face lab time, with 68% reporting an instructor to student ratio in lab of 1:15 or smaller. Seventy percent of instructors were US licensed PTs, and 78% of those PTs held an academic doctorate. The average years of anatomy teaching experience was 11.3. Ninety-six percent of programs utilized cadavers. Most programs (86%) had students perform hands-on cadaver dissection. Overall, 90% of instructors incorporated learning activities into lab beyond dissection. Ninety-four percent of instructors reported enjoyment teaching HGA, and a majority felt they had adequate teaching support and academic preparation. Sixty percent of respondents felt that cadavers were the only way to teach lab, while 90% felt that cadavers were the best way to teach lab. Regarding safety, 38% of instructors had concerns regarding chemical exposure in lab, and 11% believed their health was at risk. Comparative analyses found significant differences in instructor perceptions based on years of anatomy teaching experience (+/- 10 years). Less experienced faculty were more likely to believe that a non-cadaver approach to teaching HGA can be as effective as using cadavers given the right technology, while more experienced faculty were more likely to believe that teaching HGA with cadavers was the best way to teach lab. Conclusions: DPT program directors and instructors may find this study valuable to compare their HGA course(s) to other programs in the US. Although there is a clear preference for including cadavers in HGA laboratories, it is evident that most instructors are incorporating other learning approaches in their HGA laboratories

A Comparison of Physical Activity Between Home-Based and Centre-Based Pulmonary Rehabilitation:A Randomised Controlled Secondary Analysis

Background: Pulmonary rehabilitation (PR) is a highly effective intervention for individuals with chronic obstructive pulmonary disease (COPD). Physical activity (PA) has been shown to increase after a centre-based programme, yet it is not clear if a home-based programme can offer the same benefit. This study aimed to evaluate the effect of home-based PR compared with the centre-based PR on the PA levels post 7 weeks of PR and 6 months follow-up.Method: In this study, 51 participants with COPD, of them, 36 (71%) men completed physical activity monitoring with a SenseWear Armband, at three time points (baseline, 7 weeks, and 6 months). The participants were randomly assigned to either centre-based supervised PR (n = 25; 69 ± 6 years; FEV1 55 ± 20% predicted) or home-based PR (n = 26; 68 ± 7 years; FEV1 42 ± 19% predicted) programmes lasting 7 weeks. The home-based programme includes one hospital visit, a self-management manual, and two telephone calls. The PA was measured as step count, time in moderate PA (3–6 metabolic equivalent of tasks [METs]) in bouts of more than 10 min and sedentary time (<2 METs).Results: Home-based PR increased step count significantly more than the centre-based PR after 7 weeks (mean difference 1,463 steps: 95% CI 280–2,645, p = 0.02). There was no difference in time spent in moderate PA was observed (mean difference 62 min: 95% CI −56 to 248, p = 0.24). Sedentary behaviour was also significantly different between the centre and home-based groups. The home group spent 52 min less time sedentary compared with the centre-based (CI −106 to 2, p = 0.039). However, after 6 months, the step count and time spent in moderate PA returned to baseline in both the groups.Conclusion: This study provides an important insight into the role of home-based PR which has the potential to be offered as an alternative to the centre-based PR. Understanding who may best respond from the centre or home-based PR warrants further exploration and how to maintain these initial benefits for the long-term.Trial Registry: ISRCTN: No.: ISRCTN81189044; URL: isrctn.com

The development and pilot testing of the Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD)

Purpose: There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Patients: Participants with a confirmed diagnosis of COPD were recruited from primary care. Methods: A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks. Results: The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23–1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47–443.03, P < 0.001). Conclusion: This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care

A comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation:A randomised non-inferiority trial

Background: Standardised home-based pulmonary rehabilitation (PR) programmes offer an alternative model to centre-based supervised PR for which uptake is currently poor. We determined if a structured home-based unsupervised PR programme was non-inferior to supervised centre-based PR for participants with COPD. Methods: A total of 287 participants with COPD who were referred to PR (187 male, mean (SD) age 68 (8.86) years, FEV1% predicted 48.34 (17.92)) were recruited. They were randomised to either centre-based PR or a structured unsupervised home-based PR programme including a hospital visit with a healthcare professional trained in motivational interviewing, a self-management manual and two telephone calls. Fifty-eight (20%) withdrew from the centre-based group and 51 (18%) from the home group. The primary outcome was dyspnoea domain in the chronic respiratory disease questionnaire (Chronic Respiratory Questionnaire Self-Report; CRQ-SR) at 7 weeks. Measures were taken blinded. We undertook a modified intention-to-treat (mITT) complete case analysis, comparing groups according to original random allocation and with complete data at follow-up. The non-inferiority margin was 0.5 units. Results: There was evidence of significant gains in CRQ-dyspnoea at 7 weeks in both home and centre-based groups. There was inconclusive evidence that home-based PR was non-inferior to PR in dyspnoea (mean group difference, mITT: −0.24, 95% CI −0.61 to 0.12, p=0.18), favouring the centre group at 7 weeks. Conclusions: The standardised home-based programme provides benefits in dyspnoea. Further evidence is needed to definitively determine if the health benefits of the standardised home-based programme are non-inferior or equivalent to supervised centre-based rehabilitation