Which outcome measure is most appropriate for a falls prevention programme?

The efficacy of physiotherapeutic treatment is best assessed, and thus justified, by the use of an appropriate outcome measure. The Irish Health Service Executive (HSE) in its 2004 Standard recommended that the clinician is obliged to; “Take account of the patient’s problems, and where possible (use) a published, standardised, valid, reliable and responsive outcome measure to evaluate the change in the patient’s health status”.1 Regarding mobility, balance and falls risk in an elderly population, a number of such tools exist

OroPress a new wireless tool for measuring oro-lingual pressures: a pilot study in healthy adults

Background: Commercially available tools for measuring oro-lingual pressures during swallowing or isometric (tongue 'pushing') tasks have either poor, or unknown, psychometric properties (stability, reliability) which means their validity in a clinical setting is unknown. A new wireless tool, OroPress, has been designed to address the shortcomings of existing devices. In this pilot cohort study of normal adults (i.e., people without dysphagia), the face validity of OroPress was examined when it was used to measure oro-lingual pressures during (i) isometric tongue strength (ITS) tasks and (ii) isometric tongue endurance (ITE) tasks.The effects of gender on isometric oro-lingual data, captured using OroPress, were compared to published oro-lingual pressure data recorded using either the Kay Swallowing Workstation or the Iowa Oral Performance Instrument (aka commercial tools).Methods: Thirty five adults (17 males, 18 females), were purposefully recruited at the University of Limerick (UL), Ireland. They attended one session at the university-based clinic where their oro-lingual pressures were recorded while undertaking two isometric tasks by speech and language therapy student clinicians. OroPress was used to capture tongue strength and tongue endurance pressures during two trials of each condition and data were downloaded and analysed post-hoc. An independent-samples t-test and an ANOVA were used to examine the effect of gender on ITS pressures (as data were normally distributed) and an independent-samples t-test was used for the effect of gender on ITE pressures (where data were not normally distributed).Results: OroPress is a portable tool that was reported as being 'easy to use' by student SLT clinicians. The intra-oral sensor was reportedly comfortable and 'felt non-invasive' for participants. Data from 34 participants (16 males, 18 females) are reported.Males did not demonstrate significantly higher mean ITS pressures than females (P = 0.057), although this approached significance, and there was no gender effect for ITE oro-lingual pressure. These results were consistent with published data from studies where other tools have been used to measure ITS pressures.Conclusions: Preliminary face validity of OroPress as a tool for recording isometric oro-lingual pressures was supported. This new wireless tool shows promise for being a criterion standard for recording oro-lingual pressures during isometric tasks

Bed utilisation in an Irish regional paediatric unit – a cross-sectional study using the Paediatric Appropriateness Evaluation Protocol (PAEP)

Background: Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods: We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results: Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion: At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria, improvements could be made regarding emergency access to social services, management of parental anxiety, and optimisation of access to community-based services. Potential ways to provide nasogastric or intravenous fluid therapy on an ambulatory basis, and outpatient antimicrobial therapy (OPAT) should be explored. Elective surgical admissions should adhere to day-of-surgery admissions (DOSA) policy

Community mental health teams: determinants of effectiveness

Community mental health teams have their Irish origins both in the deinstitutionalisation policy of the 1984 “Planning for the Future” framework1 and the challenge of intervention and recovery strategies for acute episodic and enduring mental illness. In 1994, Corrigan et al.2 observed that rehabilitation produces a set of barriers that are best overcome by multi-disciplinary teams (MDTs). The multidisciplinary approach was again emphasised in the Government’s 2006 policy document, ‘A Vision for Change’3 and the Mental Health Commission’s 2005 study on quality in mental health care4. The reality of the performance of such an approach, however, has not met stakeholder expectations, according to the Commission’s discussion document on MDTs5. It states, that despite user access to such teams during the past 20 years, only a small number of well functioning MDTs are operating in the Adult Mental Health Services

Getting the balance right: a randomised controlled trial of physiotherapy and exercise interventions for ambulatory people with multiple sclerosis

Background : People with multiple sclerosis have a life long need for physiotherapy and exercise interventions due to the progressive nature of the disease and their greater risk of the complications of inactivity. The Multiple Sclerosis Society of Ireland run physiotherapy, yoga and exercise classes for their members, however there is little evidence to suggest which form of physical activity optimises outcome for people with the many and varied impairments associated with MS. Methods and design : This is a multi-centre, single blind, block randomised, controlled trial. Participants will be recruited via the ten regional offices of MS Ireland. Telephone screening will establish eligibility and stratification according to the mobility section of the Guys Neurological Disability Scale. Once a block of people of the same strand in the same geographical region have given consent, participants will be randomised. Strand A will concern individuals with MS who walk independently or use one stick to walk outside. Participants will be randomised to yoga, physiotherapy led exercise class, fitness instructor led exercise class or to a control group who don't change their exercise habits. Strand B will concern individuals with MS who walk with bilateral support or a rollator, they may use a wheelchair for longer distance outdoors. Participants will be randomised to 1:1 Physiotherapist led intervention, group intervention led by Physiotherapist, group yoga intervention or a control group who don't change their exercise habits. Participants will be assessed by physiotherapist who is blind to the group allocation at week 1, week 12 (following 10 weeks intervention or control), and at 12 week follow up. The primary outcome measure for both strands is the Multiple Sclerosis Impact Scale. Secondary outcomes are Modified Fatigue Impact Scale, 6 Minute Walk test, and muscle strength measured with hand held dynamometry. Strand B will also use Berg Balance Test and the Modified Ashworth Scale. Confounding variables such as sensation, coordination, proprioception, range of motion and other impairments will be recorded at initial assessment. Discussion : Data analysis will analyse change in each group, and the differences between groups. Sub group analysis may be performed if sufficient numbers are recruited. Trial registration: ISRCTN7761041

Aquatic exercise therapy for people with Parkinson’s disease: a randomized controlled trial

Objective To evaluate the effects of aquatic exercise therapy on gait variability and disability compared with usual care for people with Parkinson disease (PD). Design Single-blind randomized controlled trial. Setting Community-based hydrotherapy pool. Participants Individuals with PD (Hoehn-Yahr stages I–III) (N=21). Interventions Participants were randomly assigned to either an aquatic exercise therapy group (45min, twice a week for 6wk) or a group that received usual care. Main Outcome Measures The primary outcome measure was gait variability as measured using a motion capture system. Secondary outcomes were quality of life measured on the Parkinson's Disease Questionnaire-39 and freezing of gait and motor disability quantified by the Unified Parkinson's Disease Rating Scale. Feasibility was evaluated by measuring safety, adverse events, and participant satisfaction. Results People in the aquatic therapy group and usual care group showed similar small improvements in gait variability. The aquatic therapy group showed greater improvements in disability than the usual care group (P<.01). No differences between groups or over time were identified for freezing of gait or quality of life. Aquatic therapy sessions were safe and enjoyable with no adverse events. Conclusions Aquatic therapy appears feasible and safe for some people in the early stages of PD

GP attitudes towards screening and treating mental and substance use disorders in primary care.

no abstract availabl

What are the differences between a literature search, a literature review, a systematic review and a meta-analysis? And why is a systematic review considered to be so good?

It takes time to recognise the differences between a literature search (LS), a literature review (LR), a systematic review (SR) and a meta-analysis (MA), especially as these terms are often used interchangeably by many authors. For example, a colleague said recently that she planned to do SR as part of her background for her post-graduate research thesis. She planned to have it completed within five days. After talking to her, it was clear that she did not understand the concept (or the workload!) involved in a SR. On the other hand, we all do so-called “quick and dirty” LSs every day! Those are the kind of search where you have a question, you open up your favourite search engine (PubMed, EMBASE, etc.), plug in a few key words and press “search”. Usually, with this type of search, you only put more effort into the search strategy if the “quick and dirty” approach does not yield enough (or any) relevant articles or if you are doing the LR for your thesis, or research project

Research confuses me: what is the difference between case-control and cohort studies in quantitative research?

What is the difference between a cohort and a case-control trial? And why is it important? As a student, it is sometimes difficult to appreciate the difference between these two study methods, and why should it matter to us anyway? After all, we study medicine to treat patients, not statistics. Study methodologies were for the scientists; we are clinicians. Fast forward to clinical practice, and the importance of research design becomes apparent. As medical doctors we treat patients, but we also look at the bigger picture: why is this happening to this patient? Why is this patient more likely to be affected than another? In order to truly care for patients it is necessary to search and query and that means doing, or being able to properly interpret, research

Dance for people with Parkinson disease: what is the evidence telling us?

Objectives: (1) To appraise and synthesize the literature on dance interventions for individuals with Parkinson disease (PD); (2) to provide information regarding the frequency, intensity, duration, and type of dance used in these programs; and (3) to inform the development of future studies evaluating dance interventions in this population. Data Sources: Eight databases (MEDLINE, Cumulative Index to Nursing and Allied Health Literature [CINAHL], the Allied and Complementary Medicine Database [AMED], SPORTDiscus, PubMed, PubMed Central, Sage, and ScienceDirect) were electronically searched in April 2014. The references lists from the included articles were also searched. Study Selection: Studies retrieved during the literature search were reviewed by 2 reviewers independently. Suitable articles were identified by applying inclusion criteria. Data Extraction: Data regarding participants and the frequency, intensity, duration, and type of dance form used were extracted. The effect that each dance program had on defined outcomes and the feasibility of each program were also reviewed. Data Synthesis: Thirteen articles were identified. The quality of studies varied, and methodological limitations were evident in some. The evidence evaluated suggests that two 1-hour dance classes per week over 10 to 13 weeks may have beneficial effects on endurance, motor impairment, and balance. Conclusions: Dance may be helpful for some people with PD. This article provides preliminary information to aid clinicians when implementing dance programs for people with PD. Higher-quality multicenter studies are needed to determine the effect of other dance genres and the optimal therapy volume and intensity