An Initiative to Build Research Capacity within a Physiotherapy Department: Hits and Misses Over a 20-year Period

Purpose: Building research capacity within a busy clinical allied health department is important but can be limited by time, resources and expertise. In 1995, a role was created in our Physiotherapy Department whereby an individual with an interest and expertise in clinical research was identified and a proportion of their workload (12 hours/week) designated to fulfil a research co-ordination role. The aim of this role was to foster research and build research capacity within the Physiotherapy Department. This paper reports the achievements associated with this initiative to highlight its successes, difficulties and failures. Method: A retrospective descriptive review of research and other research-related activities undertaken over a 20-year period within the Physiotherapy Department of an adult, tertiary, public hospital was carried out, with particular attention to successes, difficulties and failures. Results: Since the introduction of a designated research co-ordinator in 1995, there have been 54 major publications in peer-reviewed journals and 91 presentations at a national/international conferences. Successes have included the high number of publications/presentations, the broad range of clinical areas where research has been undertaken, the clinical relevance of the research, the large number of staff involved, collaboration with other hospital departments/universities and staff involvement in post-graduate degrees. Difficulties have included slow recruitment rates to clinical trials, resource issues and lack of career structure for those interested in pursuing research as a career option within the healthcare sector. Failures have been infrequent but have included the need to abandon three studies due to recruitment or personnel issues, and a single instance of the inadvertent use of incorrect data. Conclusions: Identifying a clinician with an interest and expertise in clinical research and quarantining time to enable them to fulfil a broader research co-ordinating role was successful at fostering research and building research capacity within a clinical allied health department

Staff Perceptions of the Barriers to Mobilizing ICU Patients

Purpose: Whilst early progressive mobilization is known to be safe and beneficial for patients in an intensive care unit (ICU), barriers still exist to its implementation. As part of a broader quality improvement project that had the overall aim of increasing the frequency of mobilization in our ICU, we conducted a survey of ICU staff to investigate their perceptions of the barriers to the early progressive mobilization of ICU patients. Method: A prospective survey of ICU staff in an Australian, tertiary care, public hospital ICU was undertaken. A total of 93 medical, nursing, and physiotherapy staff participated. A purpose-designed survey that investigated staff perceptions of the barriers to the early progressive mobilization of ICU patients was developed. The survey predominantly comprised closed statements requiring responses using a visual analogue scale. Barriers to early progressive mobilization were separated into three sections: patient-related, institutional-related, and other barriers. Results: Patient-related barriers were generally perceived as having the greatest influence on the mobilization of ICU patients, followed closely by institutional-related barriers. The factors that were perceived as most frequently preventing mobilization were hemodynamic instability, reduced level of consciousness, sedation, agitation, impending medical procedure, staff availability, and time constraints. Conclusions: ICU staff perceived that barriers to the early progressive mobilization of ICU patients were multifactorial and most frequently involved patients’ medical condition and resource limitations

The Effectiveness of Kinesiotaping for Patients with Fractured Ribs: A Single-subject Experimental Design

Purpose: Kinesiotape is an elastic, adhesive tape applied to the skin that has been used extensively to reduce pain associated with various musculoskeletal conditions. Its use in the setting of fractured ribs is less clear. The aim of this preliminary study was to investigate the effect of kinesiotaping for patients with rib fracture(s) on pain levels, pulmonary function, and mobility. Method: We prospectively evaluated five patients admitted with fractured ribs using a single-subject experimental ABAB design. Each phase lasted 24 hours with kinesiotape applied during B phases. All participants received usual medical, nursing, and allied health care. Outcome measures included pain levels (participant-rated), pulmonary function, and maximum mobility. The occurrence of skin irritation was tracked. Results: Considerable variability was seen between- and within-participants for pain levels. There was some evidence, albeit inconsistent, that pain levels were lower when the kinesiotape was in situ compared to when it was not. Pulmonary function and mobility levels showed no consistent pattern between intervention phases. Skin irritation occurred in one participant and another required escalation of medical therapy for pneumonia. Conclusions: Kinesiotaping may reduce pain for patients with fractured ribs but further research, preferably randomized controlled trials with homogenous samples and standardized medication regimens, is required to confirm its effectiveness in the acute care setting

A Retrospective Review of the After-Hours Social Work Service in a Tertiary-Care Public Hospital in Australia

Purpose: After-hours social work (SW) services seem to be provided in many major healthcare centres but there appear to be no data describing these services, in terms of the number of patients seen, their characteristics, types of problems, SW interventions provided, their effectiveness or the impact of providing after-hours services on the provider. The aim of this study was to investigate the patient characteristics and types of interventions provided to patients who received an after-hours SW service and the effect of providing these services on the service-provider. Method: A retrospective review of data collected on patients who had received after-hours SW service for urgent/crisis scenarios over a three-year period in a tertiary-care public hospital in Australia was undertaken, with two illustrative case scenarios. Results: A total of 172 occasions of service were delivered, with most services provided to patients/families in the Emergency Department (ED) or Intensive Care Unit (ICU) following trauma or with a medical condition. Counselling for trauma, grief or loss were the types of interventions most often provided. Interventions were most frequently rated by the SW-provider as highly complex and imperative. At times, providing the after-hours service negatively impacted on the service-provider the following day, with tiredness and hypervigilance most frequently reported. Conclusion: An after-hours SW service within a tertiary-care hospital was provided approximately five times/month, predominantly involving counselling to patients/families in the ED or ICU, and rated as highly complex and imperative. These results provide evidence, albeit anecdotal, that an after-hours SW service is of value in this setting

Facilitating Upper Limb Function using Assistive Technology in a Neurological Patient with Bilateral Upper Limb Impairment: A Case Report

Purpose: A combination of a stroke and spinal cord injury adversely affecting both upper limbs is an unusual combination for a patient presenting for outpatient rehabilitation services. Although the management of these conditions in isolation is well documented, there is limited literature regarding rehabilitation for these conditions in combination, particularly the use of assistive technology in this setting. Methods: A case report is presented of a 53-year-old male referred for outpatient rehabilitation following a left-sided stroke, with resultant dense right sided hemiplegia. A pre-existing spinal cord injury had affected his left upper limb such that he had marked proximal weakness. This combination of impairments meant he was unable to perform even basic activities of daily living involving the upper limbs. A therapy program, led by an occupational therapist with support and input from the multi-disciplinary team, included the use of an assistive device (a mobile arm support) to facilitate functional upper limb activities. This greatly improved his ability to do upper limb functional activities. Conclusion: The use of an assistive device enabled the patient to engage in meaningful activities of daily living involving the upper limbs

Incidence and severity of shoulder pain does not increase with the use of circuit class therapy during inpatient stroke rehabilitation: a controlled trial

QuestionsDoes circuit class therapy result in a greater incidence or severity of shoulder pain compared with individual therapy? Is the incidence influenced by the degree of active shoulder control?DesignControlled trial with intention-totreat analysis.ParticipantsSixty-eight people (6 drop-outs) undergoing inpatient rehabilitation after stroke.InterventionParticipants received either individual therapy or group circuit class therapy.Outcome measuresIncidence of shoulder pain over the previous 24 hours was measured as a yes/no response while severity of shoulder pain was measured using a visual analogue scale at admission, Week 4, and discharge.ResultsThere was no greater chance of participants receiving circuit class therapy having shoulder pain at Week 4 (OR 0.95, 95% CI 0.32 to 2.80) or discharge (OR 0.38, 95% CI 0.11 to 1.45) than participants receiving individual therapy. Of those participants who reported pain, there was no difference between groups in the severity of pain at Week 4 (mean difference –0.2 cm, 95% CI –3.2 to 2.7) or discharge (mean difference –2.1 cm, 95% CI –4.8 to 0.6). There was a greater chance of participants who had no active shoulder control having shoulder pain at Week 4 (OR 5.8, 95% CI 1.6 to 20.4) and at discharge (OR 3.8, 95% CI 1.0 to 13.9) than participants who had active shoulder control.ConclusionThe incidence and severity of shoulder pain was influenced by degree of active shoulder control but not by type of physiotherapy service delivery. Concerns regarding shoulder pain should not be a barrier to the implementation of circuit class therapy during inpatient stroke rehabilitation

The prevalence of thumb problems in Australian physiotherapists is high: an observational study

QuestionWhat is the lifetime and current prevalence of thumb problems in Australian physiotherapists and what are the factors associated with thumb problems?DesignSurvey of a random cross-section of physiotherapists.Participants1562 (approximately 10% of the total) registered Australian physiotherapists.Outcome measuresGeneral questions covered demographic information, area of practice, hours worked per week, and years worked as a physiotherapist. Specific questions about thumb problems covered thumb affected, symptoms, onset of symptoms, treatment sought, relevance of work-related factors, and joint hypermobility.Results1102 (71%) questionnaires were returned and 961 (68%) completed. The lifetime prevalence of thumb problems was 65% and the current prevalence was 41%. Factors that were significantly associated with thumb problems included: working in orthopaedic outpatients (OR 3.2, 95% CI 1.8 to 5.8); using manual therapy (OR 2.3 to 3.4, 95% CI 1.7 to 5.1), trigger point therapy (OR 2.3, 95% CI 1.7 to 3.0) and massage (OR 2.1, 95% CI 1.6 to 2.8); having thumb joint hypermobility (OR 2.2 to 2.6, 95% CI 1.4 to 4.5); or an inability to stabilise the joints of the thumb whilst performing physiotherapy techniques (OR 4.2, 95% CI 2.9 to 5.9). Of those respondents who reported thumb problems, 19% had changed their area of practice and 4% had left the profession as a result of their thumb problems.ConclusionThe prevalence of thumb problems in Australian physiotherapists appears to be high and can be of sufficient severity to impact on careers

A Novel Approach to the Safe and Effective Mobilization of a Super-Obese Patient: A Case Report

Purpose: The incidence of obesity is rising worldwide, as is the presentation of these patients to the acute hospital setting. As a result of their complex nature, including medical co-morbidities, psychosocial issues, and healthcare resource limitations, management of these patients requires a coordinated and intensive multi-disciplinary approach. Although there are considerable data reporting the surgical management of obese patients, there is very limited literature regarding non-surgical interventions, including approaches to safe and effective mobilization. Methods: A case report is presented of a 55-year-old super-obese male transferred to a major tertiary referral healthcare centre for management of his overall medical condition and rehabilitation. As a result of the patient’s inability to tolerate the supine position because of central obesity, a novel approach to mobilization was undertaken whereby a bariatric tilt-table was used to facilitate standing and walking from the semi-prone position. This mobilization program was led by a physiotherapist with support and input from the multi-disciplinary team. Conclusion: It was safely and effectively implemented and enabled the patient to be discharged to his desired rural location

Physiotherapy in intensive care: towards and evidence-based practice. Chest

Abbreviations: ABG ϭ arterial blood gas; APACHE ϭ acute physiology and chronic health evaluation; CPP ϭ cerebral perfusion pressure; Fio 2 ϭ fraction of inspired oxygen; ICP ϭ intracranial pressure; MH ϭ manual hyperinflation; V /Q ϭ ventilation/perfusion; Vt ϭ tidal volume I n most hospitals in developed countries, physiotherapy is seen as an integral part of the management of patients in ICUs. The precise role that physiotherapists play in the ICU varies considerably from one unit to the next, depending on factors such as the country in which the ICU is located, local tradition, staffing levels, training, and expertise. The referral process is one example of this variation, whereby in some ICUs, physiotherapists assess all patients, whereas in other ICUs, patients are seen only after referral from medical staff. As the cost associated with the management of ICU patients is very high, the requirement for all those who work in ICUs, including physiotherapists, to provide evidence-based practice is mandatory. The aim of this article is to review the evidence regarding the effectiveness of physiotherapy for patients in the ICU and thus provide a framework for evidence-based practice. Potential areas for future research are also discussed. This review is primarily concerned with the management of intubated, mechanically ventilated, adult patients. The role of physiotherapy for nonintubated patients, including those receiving noninvasive mechanical ventilation, and pediatric patients is beyond the scope of this review. Initially, a description of the individual physiotherapy treatment techniques and their physiologic rationale will be provided. The literature review of the effectiveness of physiotherapy for intubated patients receiving mechanical ventilation in the ICU will then be discussed under the following headings: pulmonary function; hemodynamic and metabolic factors; the incidence of pulmonary complications; the clinical course of pulmonary conditions; overall outcome; and the effectiveness of the individual components of physiotherapy. Evidence concerning the effectiveness of continuous rotational therapy, which can be considered a type of physical therapy, will be reviewed in the treatment technique research section. In view of the large number of studies identified in some of these areas, details of each study will not be provided. Instead, selected studies that are considered to be landmark studies or characteristic of those conducted in the area will be described. Subsequent to the literature review, recommendations for evidence-based practice for physiotherapy in the ICU are considered under the following headings: prevention of pulmonary complications; treatment of pulmonary conditions and complications; short-term benefits; selection of individual treatment techniques; and monitoring required during physiotherapy. To ensure that the major relevant articles were reviewed, literature searches were performed using a CD-ROM version of the databases MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) with appropriate subject headings and keywords, including physical therapy, intensiv

Childhood cancer incidence and survival in Japan and England: A population-based study (1993-2010).

The present study aimed to compare cancer incidence and trends in survival for children diagnosed in Japan and England, using population-based cancer registry data. The analysis was based on 5192 children with cancer (age 0-14 years) from 6 prefectural cancer registries in Japan and 21 295 children diagnosed in England during 1993-2010. Differences in incidence rates between the 2 countries were measured with Poisson regression models. Overall survival was estimated using the Kaplan-Meier method. Incidence rates for Hodgkin lymphoma, renal tumors and Ewing sarcomas in England were more than twice as high as those in Japan. Incidence of germ cell tumors, hepatic tumors, neuroblastoma and acute myeloid leukemia (AML) was higher in Japan than in England. Incidence of all cancers combined decreased in Japan throughout the period 1993 to 2010, which was mainly explained by a decrease in registration of neuroblastoma in infants. For many cancers, 5-year survival improved in both countries. The improvement in survival in chronic myeloid leukemia (CML) was particularly dramatic in both countries. However, 5-year survival remained less than 80% in 2005-2008 in both countries for AML, brain tumors, soft tissue sarcomas, malignant bone tumors and neuroblastoma (age 1-14 years). There were significant differences in incidence of several cancers between countries, suggesting variation in genetic susceptibility and possibly environmental factors. The decrease in incidence for all cancers combined in Japan was related to the cessation of the national screening program for neuroblastoma. The large improvement in survival in CML coincided with the introduction of effective therapy (imatinib)