Leading Communities of Practice in Social Work. Groupwork or management?

Social work in the UK has undergone a period of momentous change in the last decade with the introduction of a ‘modernising agenda’ that has increased managerial approaches to the organisation, development and delivery of services. Whilst posing a threat to some, these approaches are embedded and social workers must find ways of working within them to synthesise appropriate responses that promote the values and cultural heritage of social work within the new context. This paper considers the possibilities offered by communities of practice to develop learning organisations in which a managed and participatory approach to social care can be generated. A super-ordinate model of contending cultures is developed and practice that draws on and is predicated by groupwork principles is presented as a potential way forward

A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study.

Osteoarthritis of the hip is associated with pain, stiffness and limitations to activities of daily living. The aims of this quality improvement project were to introduce a service developed to promote the self-management of hip osteoarthritis through exercise and education, and to assess the impact of the programme on pain, function and quality of life. The service was a six-week cycling and education programme. 119 participants took part. Statistically significant improvements were found for Oxford Hip Score (Mean (SD) change 4.14 (95% CI (3.02, 5.25 ), p<0.001); Sit-to-stand score (mean change 3.06s 95% CI (2.33, 3.79), p<0.001); EQ5D-5L Utility (mean change 0.06 (95% CI 0.03,0.09), p<0.001); EQ5D VAS (mean change 7.05 (95% CI 4.72,9.39) p<0.001); pain on weight-bearing (WB) (mean change 1.56 (95% CI 0.77,2.36), p<0.001), HOOS function (median change (IQR) 7.35 (1.84 to 19.12), p<0.001) and TUG test (median change 1.11s (0.31 to 2.43), p<0.001). Participants reported improvements in pain and function; increased confidence in managing hip pain; and an increase in motivation to exercise. These findings were supported by a Patient and Public Involvement Forum who suggested extending the programme to eight weeks. These results suggest that the service has potential in the management of hip osteoarthritis

A Novel Approach to Overcome Movement Artifact When Using a Laser Speckle Contrast Imaging System for Alternating Speeds of Blood Microcirculation

The laser speckle contrast imager (LSCI) provides a powerful yet simple technique for measuring microcirculatory blood flow. Ideal for blood dynamic responses, the LSCI is used in the same way as a conventional Laser Doppler Imager (LDI). However, with a maximum skin depth of approximately 1 mm, the LSCI is designed to focus on mainly superficial blood flow. It is used to measure skin surface areas of up to 15 cm x 20 cm. The new technique introduced in this paper accounts for alternating speeds of microcirculations; i.e. both slow and fast flow flux measurement using the LSCI. The novel technique also overcomes LSCI's biggest shortcoming, which is high sensitivity to artifact movement. An adhesive opaque patch (AOP) is introduced for satisfactory recording of microcirculatory blood flow, by subtracting the LSCI signal from the AOP from the laser speckle skin signal. The optimal setting is also defined because the LSCI is most powerful when flux changes are measured relative to a reference baseline, with blood microcirculatory flux expressed as a percentage change from the baseline. These changes may be used for analyzing the status of the blood flow syste

Stair negotiation as a rehabilitation intervention for enhancing recovery following total hip and knee replacement surgery.

Background - Total hip replacement (THR) and total knee replacements (TKR) are common orthopaedic procedures. However, an optimal programme for post-operative rehabilitation has yet to be established. Stair negotiation is a challenging, habitual task, regularly used as a post-operative functional outcome measure; yet as a physical rehabilitation intervention it appears to be rarely used. Aim - The review purpose was to investigate the effectiveness of stair climbing as a rehabilitation intervention for THR and TKR patients. Methods - MEDLINE, PsycINFO, Science Citation Index, CINAHL, SPORTDiscus, and the Cochrane Database of Systematic Reviews were searched. The systematic review targeted studies using stair negotiation as a rehabilitation intervention. Randomised and non-randomised controlled trials, pilot studies, and case studies were included; systematic reviews and meta-analyses were excluded. Results - Of 650 articles identified, ten studies were eligible for review. A predefined data table to extract information from selected studies was used. Of the ten identified reports, two prehabilitation and eight rehabilitation studies included stair negotiation exercises as part of multi-modal physical interventions. Outcome measures were classified as: functional self-reported, perceptual, psychological and those relating to quality of life. Conclusion - Studies were methodologically heterogeneous and typically lacked adequate control groups. It was not possible to determine the impact of stair negotiation exercise on the positive outcomes of interventions. Stair negotiation warrants further investigation as a rehabilitation activity

Patient-reported importance of assistive devices in hip and knee replacement Enhanced Recovery after Surgery (ERAS) pathways

Introduction: This study examines patients’ perceptions of the usefulness of occupational therapy and assistive devices provided, in achieving discharge criteria and assisting with activities of daily living once home, following an Enhanced Recovery After Surgery protocol for total hip and total knee replacement patients. Methods: Two weeks following discharge, 197 patients who had undergone total hip replacement or total knee replacement were telephoned to ask how useful they found occupational therapy education and advice and the assistive devices provided. Results: 114 patients (58%) answered the call. Over 96% of patients found occupational therapy education and advice useful. Ninety-seven percent of posterior total hip replacement patients were still using the assistive devices 2 weeks following discharge, compared to 90% of anterior total hip replacement patients and 87% of total knee replacement patients. Over 95% of all patients found that assistive devices enhanced their ability to undertake activities of daily living, and were extremely or partly useful in achieving early discharge. Conclusion: Over 85% of patients who responded perceived the occupational therapist’s advice and education, and assistive devices provided, to be useful in achieving discharge criteria, and in enhancing their ability to undertake activities of daily living once back in a home environment

Validation of joint angle measurements: comparison of a novel low cost marker-less system with an industry standard marker-based system

Human motion tracking is widely used for assessment of movement dysfunction in orthopaedic patients. Currently, most clinical motion analysis centres use marker based three-dimensional (3D) systems as they are deemed to be the most accurate method. However, due to space, costs and logistics they are not available in many clinical settings. This study compared joint angles measured in functional tests using the novel low-cost Microsoft Kinect Perfect Phorm system with the established marker based Nexus VICON system. When measuring right and left knee flexion, the average difference between the VICON and Kinect Perfect Phorm measurement was 13.2%, with a SD of 19.6. Both overestimation and underestimation of the joint angle was recorded in different participants. Although the average percentage difference during hip abduction tests was lower at -3.9%, the range of error was far greater (SD=75). From this, it can be concluded that the level of accuracy presented in the new low cost Kinect Perfect Phorm system is not yet suitable for clinical assessments. However, for general tests of performance, and for tracking cases where absolute accuracy is less critical, future versions of this software may have a place