Training and assessment of physiotherapy assistants

This paper discusses some of the issues relevant to the role and training of physiotherapy assistants. It describes the processes of role definition, assessment and training of one particular assistant, developed in the context of a larger research study. A small survey of senior physiotherapists' views on task delegation, training and working with assistants was conducted, using semi-structured interviews. The method and findings are described; broad agreement between the physiotherapists was found. A training and assessment package was then developed and implemented. The training was specifically related to treatment of the upper limb of acute stroke patients. While delegation to assistants is part of everyday practice for many physiotherapists and the training of these staff a professional obligation, the structure and support to do so are often lacking. In the context of the description of a particular case, this paper provides some insights and points of interest for clinicians involved in training and task delegation to assistants

Ageing and quality of life in family carers of people with dementia being cared for at home: a literature review

Background: Despite the increasing older population providing care for family members with dementia at home, there is no consensus in the literature in terms of how caring impacts on their quality of life (QoL) and the association of the family carer's age with QoL outcomes. Aims: To explore the available literature investigating the QoL of older family carers (family carers aged > 60) and the association of family carers' age and QoL outcomes in a dementia context. Methods: A review of the literature to December 2013 was conducted using Embase-O VID, CINAL, Medline-OVID, Psyc INFO-OVID, Grey literature and the references of the included studies. Cross-sectional or prospective longitudinal studies published in English were eligible. The selection and appraisal processes were performed by two reviewers independently and the methodological quality was assessed by STROBE statement. Results: From the 12 selected studies, 4 were carried out with older family carers' samples and 8 associated the variable 'age' with QoL outcomes. Eight different instruments were used to assess family carers' QoL, however none were designed specifically for older people or older family carers. The mean age of the carers' samples ranged from 55.2 to 76.0 years old. Older family carers showed low levels of QoL and were often below the age-matched standard population. Carers' age was negatively correlated with QoL outcomes in most of the studies. Conclusion: Older people are increasingly involved with dementia care and family carer's advanced age was shown to be associated with low levels of QoL. Future research should investigate the QoL of older family carers separately and use QoL instruments containing older family carers' specific needs and perspectives of QoL. In planning care and support, primary health care practitioners should consider family carer's age group and their specific needs

Quality of life on the views of older family carers of people with dementia

Older family carers of people with dementia represent an increasing but overlooked population of family carers. This research aimed to explore how these individuals make sense of their own quality of life and to identify the factors that enhance or compromise this. Four focus groups were conducted in 2014 with 19 older family carers in community-based support groups in Nottinghamshire, United Kingdom. Data was transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Thirty-three subthemes emerged and were collated into three superordinate themes: 1) aspects of care and caregiving, 2) feelings and concerns, and 3) satisfaction with life and caregiving. This study identified a broad range of aspects that are of particular importance to the QoL of older family carers of people with dementia. These findings are expected to inform future research as well as health and social care providers with the aim of improving life quality for this population

The development and validation of the Dementia Quality of Life Scale for Older Family Carers (DQoL-OC)

Purpose: Little is known about how caregiving affects the quality of life (QoL) of older family carers and no dementia and age-specific QoL scale is available for use with this population. This study aimed to develop and validate a unique dementia caregiving- and age-specific tool – the ‘Dementia Quality of Life Scale for Older Family Carers’ (DQoL-OC). Methods: The scale items were identified in focus groups with older family carers in the UK. Content and face validity were evaluated by a panel of six experts. A set of 100 items assessed on a 5-point Likert scale was tested with 182 older family carers. Test–re-test reliability was conducted with 18 individuals. Exploratory factor analysis was used to identify the QoL model and reduce the number of scale items. Convergent construct validity and internal consistency were also established. Results: A one-factor solution containing 22 items was obtained. Test–re-test reliability (lower bound r = 0.835; p < 0.001), internal consistency (Cronbach's α = 0.936), and convergent construct validity were established. Significantly lower levels of QoL were found in female older carers; those who perceived their relatives with dementia as being at the earlier stages of the disease and with unstable dementia symptoms; those providing care more hours per day and more days per week; and those in younger-old age. Conclusions: The DQoL-OC is a valid and reliable scale that will be useful for research and in clinical practice with older family carers of people with dementia. These study results will inform future health and social care aiming to improve life quality for this overlooked population of carers

Enhanced Characterization of the Smell of Death by Comprehensive Two-Dimensional Gas Chromatography-Time-of-Flight Mass Spectrometry (GCxGC-TOFMS)

Soon after death, the decay process of mammalian soft tissues begins and leads to the release of cadaveric volatile compounds in the surrounding environment. The study of postmortem decomposition products is an emerging field of study in forensic science. However, a better knowledge of the smell of death and its volatile constituents may have many applications in forensic sciences. Domestic pigs are the most widely used human body analogues in forensic experiments, mainly due to ethical restrictions. Indeed, decomposition trials on human corpses are restricted in many countries worldwide. This article reports on the use of comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry (GCxGC-TOFMS) for thanatochemistry applications. A total of 832 VOCs released by a decaying pig carcass in terrestrial ecosystem, i.e. a forest biotope, were identified by GCxGC-TOFMS. These postmortem compounds belong to many kinds of chemical class, mainly oxygen compounds (alcohols, acids, ketones, aldehydes, esters), sulfur and nitrogen compounds, aromatic compounds such as phenolic molecules and hydrocarbons. The use of GCxGC-TOFMS in study of postmortem volatile compounds instead of conventional GC-MS was successful

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Randomized, Controlled Trial to Evaluate Increased Intensity of Physiotherapy Treatment of Arm Function After Stroke

This paper is closed access.Background and Purpose—Many patients have impaired arm function after stroke, for which they receive physiotherapy. The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained, supervised assistant. The physiotherapy followed a typical British approach, which is Bobath derived. Ten hours of additional therapy were given over a 5-week period. Methods—The study design was a single-blind, randomized, controlled trial. Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke. They were randomly allocated to routine physiotherapy, additional treatment by a qualified physiotherapist, or additional treatment by a physiotherapy assistant. Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living. Results—There were 282 patients recruited to the study. The median initial Barthel score was 6.5, and the median age of the patients was 73 years. The median initial Rivermead Motor Assessment Arm score was 1. There were no significant differences between the groups at randomization or on any of the outcome measures. Only half of the patients allocated to the 2 additional-therapy groups completed the program. Conclusions—This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied. A number of other studies of interventions aimed at rehabilitation of arm function have reported positive results. Such findings may have been due to the content of these interventions, to the greater intensity of the interventions, or to the selection of patients to whom the treatments were applied

Ageing and quality of life in family carers of people with dementia being cared for at home: a literature review

Background: Despite the increasing older population providing care for family members with dementia at home, there is no consensus in the literature in terms of how caring impacts on their quality of life (QoL) and the association of the family carer's age with QoL outcomes. Aims: To explore the available literature investigating the QoL of older family carers (family carers aged > 60) and the association of family carers' age and QoL outcomes in a dementia context. Methods: A review of the literature to December 2013 was conducted using Embase-O VID, CINAL, Medline-OVID, Psyc INFO-OVID, Grey literature and the references of the included studies. Cross-sectional or prospective longitudinal studies published in English were eligible. The selection and appraisal processes were performed by two reviewers independently and the methodological quality was assessed by STROBE statement. Results: From the 12 selected studies, 4 were carried out with older family carers' samples and 8 associated the variable 'age' with QoL outcomes. Eight different instruments were used to assess family carers' QoL, however none were designed specifically for older people or older family carers. The mean age of the carers' samples ranged from 55.2 to 76.0 years old. Older family carers showed low levels of QoL and were often below the age-matched standard population. Carers' age was negatively correlated with QoL outcomes in most of the studies. Conclusion: Older people are increasingly involved with dementia care and family carer's advanced age was shown to be associated with low levels of QoL. Future research should investigate the QoL of older family carers separately and use QoL instruments containing older family carers' specific needs and perspectives of QoL. In planning care and support, primary health care practitioners should consider family carer's age group and their specific needs

Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke

Background and Purpose—Many patients have impaired arm function after stroke, for which they receive physiotherapy. The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained, supervised assistant. The physiotherapy followed a typical British approach, which is Bobath derived. Ten hours of additional therapy were given over a 5-week period. Methods—The study design was a single-blind, randomized, controlled trial. Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke. They were randomly allocated to routine physiotherapy, additional treatment by a qualified physiotherapist, or additional treatment by a physiotherapy assistant. Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living. Results—There were 282 patients recruited to the study. The median initial Barthel score was 6.5, and the median age of the patients was 73 years. The median initial Rivermead Motor Assessment Arm score was 1. There were no significant differences between the groups at randomization or on any of the outcome measures. Only half of the patients allocated to the 2 additional-therapy groups completed the program. Conclusions—This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied. A number of other studies of interventions aimed at rehabilitation of arm function have reported positive results. Such findings may have been due to the content of these interventions, to the greater intensity of the interventions, or to the selection of patients to whom the treatments were applied