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

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

A systematic review of randomised controlled trials on the effectiveness of exercise programs on lumbo pelvic pain among postnatal women

Background: A substantial number of women tend to be affected by Lumbo Pelvic Pain (LPP) following child birth. Physical exercise is indicated as a beneficial method to relieve LPP, but individual studies appear to suggest mixed findings about its effectiveness. This systematic review aimed to synthesise evidence from randomised controlled trials on the effectiveness of exercise on LPP among postnatal women to inform policy, practice and future research. Methods: A systematic review was conducted of all randomised controlled trials published between January 1990 and July 2014, identified through a comprehensive search of following databases: PubMed, PEDro, Embase, Cinahl, Medline, SPORTDiscus, Cochrane Pregnancy and Childbirth Group’s Trials Register, and electronic libraries of authors’institutions. Randomised controlled trials were eligible for inclusion if the intervention comprised of postnatal exercise for women with LPP onset during pregnancy or within 3 months after delivery and the outcome measures included changes in LPP. Selected articles were assessed using the PEDro Scale for methodological quality and findings were synthesised narratively as meta-analysis was found to be inappropriate due to heterogeneity among included studies. Results: Four randomised controlled trials were included, involving 251 postnatal women. Three trials were rated as of ‘good’ methodological quality. All trials, except one, were at low risk of bias. The trials included physical exercise programs with varying components, differing modes of delivery, follow up times and outcome measures. Intervention in one trial, involving physical therapy with specific stabilising exercises, proved to be effective in reducing LPP intensity. An improvement in gluteal pain on the right side was reported in another trial and a significant difference in pain frequency in another. Conclusion: Our review indicates that only few randomised controlled trials have evaluated the effectiveness of exercise on LPP among postnatal women. There is also a great amount of variability across existing trials in the components of exercise programs, modes of delivery, follow up times and outcome measures. While there is some evidence to indicate the effectiveness of exercise for relieving LPP, further good quality trials are needed to ascertain the most effective elements of postnatal exercise programs suited for LPP treatment

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

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women

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