Credible biodiversity offsetting needs public national registers to confirm no net loss

Publisher Copyright: © 2022 The AuthorsIn the face of the ongoing biodiversity crisis, questions are arising regarding the success, or lack thereof, of biodiversity offset schemes, where biodiversity losses from human development are compensated by producing equitable gains elsewhere. The overarching goal of offsetting is to deliver no net loss (NNL) of biodiversity. Assessing whether offsetting does indeed deliver NNL is, however, challenging because of a lack of clear and reliable information about offset schemes. Here we consider barriers in tracking NNL outcomes, outline criteria of public offset registers to enable accessible and credible reporting of NNL, and show how existing registers fail to satisfy those criteria. The lack of accessibility and transparency in existing registers represents a fundamental gap between NNL targets and a valid tracking system, which challenges the impetus to enact the transformative changes needed to reverse biodiversity decline.Peer reviewe

Patient age is related to the types of physical therapy interventions provided for chronic low back pain: An observational study

STUDY DESIGN: Retrospective analysis of a longitudinal cohort of patients treated for chronic low back pain (CLBP). OBJECTIVES: To determine whether patient age is associated with types of physical therapy interventions received for CLBP. BACKGROUND: Advancing age is associated with less positive treatment outcomes in patients with CLBP. If patient age influences a therapistifs choice of interventions, it may partially explain the difference in treatment outcomes. METHODS: Data were examined in a sample of 7392 patients (62% women, 38% men; mean ± SD age, 56.7 ± 16.5 years) with CLBP. We used a generalized estimating equation to examine the probability of each subject receiving each of the individual intervention categories in the presence of the other intervention categories. RESULTS: A significant interaction between intervention category and age existed after controlling for gender, duration of symptoms, comorbidities, payer source, and functional status at initial intake (χ = 130.27, df = 8, P\u3c.0001). The changes in probability of receiving an intervention category averaged 10% as patient age increased. The probability of receiving exercise or task-specific training did not change with advancing age. The probability of receiving postural exercises, pain modalities, joint mobility techniques, ice, or McKenzie exercises decreased with advancing age. The probability of receiving augmented soft tissue mobilization and balance/mobility training increased as age increased. CONCLUSION: The impact of age on physical therapist treatment choices varies depending on the type of intervention. Other variables in addition to age may have an impact on treatment choice. Further research is needed to determine how therapists incorporate age into their clinical decision making. Copyright © 2012 Journal of Orthopaedic & Sports Physical Therapy.

The relationships between neuromusculoskeletal impairments and function in frail older adults

In a population of disabled older adults, neuromusculoskeletal impairments are found to be positively correlated with function. Balance have the strongest relationship to function, strength is more strongly related to function than range of motion, and upper extremity impairments are more strongly related to function than lower extremity impairments. The interventions should include balance training, and upper extremity exercises to increase or maintain function in the older population. These interventions are needed to evaluate the functional outcomes of programmes geared toward reducing neuromusculoskeletal impairments in the older population

Implementing a cognitive-behavioral pain self-management program in home health care, part 2: Feasibility and acceptability cohort study

Purpose: The prevalence of pain in older adults receiving home health care is high, yet safety concerns for analgesic therapy point to a need for nonpharmacologic approaches to pain management in this population. The purpose of this study was to determine the feasibility and acceptability to physical therapists (PTs) and patients of a cognitive-behavioral pain self-management (CBPSM) program. Methods: Thirty-one PTs volunteered to participate, completed two 4-hour training sessions, and recruited 21 patients with activity-limited pain who consented to participate in the study. Physical therapists completed pre- and posttest assessments of CBPSM knowledge at the first training session, provided structured survey feedback after the second training session, and responded to a phone survey 3 months after training. Patients provided feedback during weekly phone interviews, while receiving the CBPSM program. Treatment sessions were audiotaped during delivery of the self-management pain protocol. Audiotapes were evaluated by independent raters for program fidelity. Results: Participating PTs were experienced in physical therapy (average 16.5 years) and in home health care (average 11.0 years). Analysis of pre- and posttest data showed that PTs\u27 CBPSM knowledge increased from a pretest mean of 60.9% to a posttest mean of 85.9%. Audiotape analysis indicated 77.7% therapist adherence to the protocol. At 3-month follow-up, 24.0% of therapists continued to use the entire protocol with their patients presenting with activity-limiting pain. Patient data show high rates of patient recall of being taught protocol components, trying components at least once (ranging from 84.4% to 100.0%) and daily use of protocol components (ranging from 47.3% to 68.4%). The percentage of patients finding a technique helpful for pain management ranged from 71.4% to 81.2%. Conclusion: This study offers preliminary data on the use of nonpharmacologic pain self-management strategies by PTs in home health setting. Positive feedback from PTs and patients suggests that the translated protocol is both feasible and acceptable. Copyright © 2013 The Section on Geriatrics of the American Physical Therapy Association

Implementing a cognitive-behavioral pain self-management program in home health care, part 1: Program adaptation

Background and Purpose: Pain is highly prevalent among older adults receiving home care, contributing to disability, increased health care utilization, nursing home placement, and diminished quality of life. Pain is a particular problem in the home care setting, where current approaches are often inadequate, resulting in persistent high levels of pain and disability in this vulnerable population. Cognitive-behavioral approaches to pain management have demonstrated effectiveness in reducing pain intensity and associated disability but have not been systematically implemented in home health care. The purpose of this project was to adapt a communitybased, cognitive-behavioral pain self-management program designed for patients with persistent back pain for implementation by physical therapists (PTs) to use with patients with activity-limiting pain in the home care setting. Methods: In this observational study, 2 groups of PTs practicing in home care were trained in the community-based program and completed surveys and participated in discussions during the training workshops to gather input on the program components perceived to be most helpful for their patients with pain; modifications to the program and the patient education materials for use in home care; and recommendations concerning program training and support required for successful implementation. Data collected during the workshops were summarized and presented to 2 expert panels for additional input and final decisions regarding program adaptations. Results: Seventeen PTs with an average of 16.6 years of practice as a PT received the training and provided input on the community-based program. Program modifications based upon PT and expert panel review included reduction in the number of sessions, deletion of content, modification of the exercise component of the program, revision of patient materials, and modification of therapist training. Discussion/Conclusions: This study successfully adapted a group-based pain management program for implementation by health care providers in a home care setting. The process described here may be useful for other groups planning to implement evidence-based programs in new settings. Part 2 of this study, a companion article in this issue, describes the field-testing of this home-care adapted program. Copyright © 2013 The Section on Geriatrics of the American Physical Therapy Association