Patient experiences of hydrodistension as a treatment for frozen shoulder: a longitudinal qualitative study

Background Frozen shoulder is a condition associated with severe shoulder pain and loss of function impacting on a persons' physical and mental health. Hydrodistension treatment that has been widely adopted within the UK National Health Service for the condition. However, evidence of clinical effectiveness and understanding of the patient experiences of this treatment are lacking. This study explored the experiences of people with a frozen shoulder who received hydrodistension treatment. Methods A qualitative design with repeat semi-structured interviews was used to explore participants' experiences of hydrodistension treatment. Participants were interviewed 2-4 weeks and again at 8-10 weeks after treatment. Interviews were audio-recorded and transcribed verbatim. Findings were analysed using an inductive thematic analysis framework. The study is reported in accordance with the consolidated criteria for reporting qualitative (COREQ) research. Results 15 participants were interviewed online or over the phone. Three themes were identified: 'Preparing for and having a hydrodistension', 'Physiotherapy after hydrodistension', and 'Outcome of hydrodistension '. Participants believed hydrodistension would benefit them, was well tolerated by many, and the effects were apparent to most within the first week. Physiotherapy still seemed to be valued to support recovery beyond this timepoint, despite these early effects. Some participant's experienced harms including severe procedural pain and blood sugar dysregulation. Conclusion This is the first study to investigate the experiences of people who undergo hydrodistension for frozen shoulder. Hydrodistension appears an acceptable treatment to participants with a frozen shoulder, acceptability is enhanced through adequate shared decision making. Further high-quality research is required to understand the comparative effectiveness of hydrodistension as a treatment for frozen shoulder, including adverse events, and the benefit of treatment by a physiotherapist after hydrodistension

The Use of Protein Adducts to Investigate the Disposition of Reactive Metabolites of Benzene

Benzene is metabolized to a number of electrophilic species that are capable of binding to both DNA and proteins. We used adducts of hemoglobin (Hb) and bone marrow proteins to study the disposition of three benzene and metabolites (benzene oxide [BO], 1,2-benzoquinone [1,2-BQ], and 1,4-benzoquinone [1,4-BQ]) in F344 rats and B6C3F1 mice following a single oral dosage of [13C6]benzene and/or [14C]benzene. Our assays focused upon cysteine adducts that accounted for 38 to 45% of protein binding to Hb and 63 to 81% of protein binding to bone marrow. Although both mice and rats showed dose-related increases in Hb and bone marrow protein adducts of BO and of the two benzoquinones, large intertissue and interspecies differences were noted, suggesting different preferences in metabolic pathways. The highest levels of adducts in mice were of 1,4-BQ (10-27% of all cysteine adducts), while in rats, BO adducts predominated in Hb (73% of all cysteine adducts) and 1,2-BQ adducts predominated in the bone marrow (14% of all cysteine adducts). High background levels of 1,2-BQ and 1,4-BQ adducts were also detected in both species, indicating that the toxic effects of quinone metabolites may only be important at high levels of benzene exposure

Development of a Method for the Isolation and Quantitation of Albumin for Use in the Analysis of Protein Adducts

In order to improve exposure assessment in epidemiological studies, alternatives to traditional methods such as air sampling are under investigation. The ability to detect individual exposures through the use of biomarkers is thought to be a way to improve the accuracy and specificity of exposure assessment. Protein adducts are biomarkers which show potential for giving more specific information about exposure. Since 1985, investigators have been validating methods that measure adducts of potentially genotoxic species with serum albumin. One of the major difficulties encountered by these researchers is the isolation and quantitation of albumin. This research involved testing two procedures for the isolation of albumin from plasma (affinity chromatography and ammonium sulfate precipitation), two methods for desalting the isolated albumin (gel filtration and dialysis), and two methods for albumin quantitation (Bradford assay and absorbance at 280nm). Based on purity of albumin obtained (as judged by SDS-PAGE), comments in the literature, and applicability of the methods to screening large numbers of plasma samples, a rapid method of albumin isolation and quantitation was developed for use in analyzing protein adducts.Master of Science in Public Healt

Older adults' perceptions of adherence to community physical activity groups

© 2014 Cambridge University Press.Community physical activity (PA) groups have come in to being worldwide to inspire older adults to engage in PA. However, there is limited evidence that older adults adhere to these groups, particularly those of a lower socio-economic status, with health conditions, from black and minority ethnic (BME) groups and men. This study aimed to explore experiences of attending PA groups from the viewpoint of community-living older adults, including those sub-groups of the population highlighted above. The purpose was to gain an understanding of what would influence long-term adherence to community PA groups. Eighteen participants aged 65 and above took part in three focus groups carried out in North West England. Thematic network analysis was used for theme generation and interpretation. Low-cost, universal locations are essential to enable older adults to engage regularly in PA, however, it is the social space that is created within these physical settings that is most influential in fostering their long-term adherence. Facilitating cross-cultural relationships and supporting older adults to have more control in shaping the PA environment will ensure that these settings are more conducive to the long-term adherence of diverse groups of older adults

Future proofing the Physiotherapy Profession

Purpose To explore the role of the physiotherapist as viewed by physiotherapy academics and undergraduate physiotherapy students. The intention is to gain an insight into the future scope of the physiotherapy profession. Methods The study had an exploratory qualitative design, which was undertaken from an interpretive paradigm. A purposive sample was used to recruit participants to two focus groups. One focus group was with academic staff, the second was with 3rd year BSc (Hons) undergraduate physiotherapy students. All participants were recruited from a university in England in 2016. Both focus groups were carried out by the same researcher (SH). Each focus group interview lasted 50-70 minutes and were digitally recorded. An interview schedule was used to guide the interviews. Interview data were transcribed verbatim and analysed using thematic analysis. Results Six participants were recruited to the academic focus group; four were female. Their experience of working in academia ranged from 2 to 23 years. Seven students were recruited to the second focus group; five were female. Three themes were identified and were common to both groups: ‘philosophy of practice’, ‘changing role’, ‘tension between cultures’. Conclusion ‘Philosophy of practice’: The underpinning philosophy of practice was identified which included transferrable skills, wellbeing, and holistic care. ‘Changing role’: A changing role of the physiotherapist was identified. This included a need to incorporate health economics in healthcare provision; and an extended role with a public health focus. Participants perceived the role was being shaped by changes in the Health Service, which was shaped being shaped by the UK government’s ideology. ‘Tension between cultures’ were highlighted by both groups. This included: university and clinical practice; the market-place and practice; and current practice and the vision for the future. Implications The physiotherapy profession is ideally placed to lead the way in revolutionising the management of chronic conditions. By understanding how the profession sees itself can ensure the profession is fit for the future. From this the profession can create a vision for the future that may involve a radical change in practice, including the capacity to take on the role of public health promoters

Recommendations on patient-facing websites regarding diagnostic imaging for low back, knee, and shoulder pain: A scoping review

Objective To describe and synthesise the content of public-facing websites regarding the use of diagnostic imaging for adults with lower back pain, knee, and shoulder pain. Methods Scoping review conducted in accordance with PRISMA guidance. A Google search was performed to identify public-facing websites that were either United Kingdom-based, or National Health Service affiliated. The DISCERN tool was used to appraise website quality before information regarding the use of imaging was synthesised using thematic analysis. Results Eighty-six websites were included, with 48 making reference to the use of imaging. The information within the majority (n = 43) of public-facing websites aligns with best available evidence. Where there is inconsistency, this may be explained by lower website quality. Three themes were apparent regarding the use of imaging – imaging to inform diagnosis and management; imaging in context; patient experience and expectations. Conclusion The recommendations and rationale for use of imaging contained within public-facing websites does not appear to justify the increase in imaging rates for musculoskeletal pain in the UK. Innovation Publicly available information following a novel search strategy, is largely aligned with best evidence, further understanding is required to determine reasons for requesting imaging from a patient and clinician perspective

Sensory processing and anxiety in central sensitisation pain

Background: Patients with non-specific chronic low back pain (NSCLBP) and central sensitisation (CS) have been shown to exhibit sensory processing alterations, somatosensory hypersensitivity and differences in the brain's emotional networks. The concept that the extent of CS pain might be related to the patient's own trait sensory processing and anxiety characteristics has not yet been explored. This presentation will cover the background of CS pain, sensory processing, particularly trait sensory sensitivity and its relationship to trait anxiety. There are overlapping physiological mechanisms in sensory sensitivity and the individual behavioural responses to sensory stimuli in populations with CS, anxiety and abnormal sensory processing profiles. A pilot study designed to explore this topic will also be presented. Pilot Study Objectives: To establish concept plausibility by 1) exploring the range of CS in NSCLBP patients and 2) determining potential relationships between CS pain, trait anxiety and trait sensory processing profiles Study Design: Cross sectional observation study Methods: Questionnaires were administered to N=21 NSCLBP in physiotherapy outpatient clinics in New Zealand. Excluded were those with predominantly neuropathic or nociceptive pain. Outcome measures: Central Sensitisation Inventory (CSI), Adolescent/Adult Sensory Profile, State/Trait Anxiety Inventory (Trait section) and the Marlow Crown Sociable Desirability Questionnaire. Results: 76% (N=16/21) of respondents were classed as having CS pain, scoring ≥40 on the CSI. Of those with CS pain, higher CSI scores were associated with a) abnormal trait sensory processing profiles; b) higher trait anxiety sub-types and c) minimal low trait anxiety. Higher trait anxiety scores were associated with higher Sensory Sensitivity and Low Registration sensory profile scores and lower Sensation Seeking sensory profile scores