Efficacy of physiotherapy treatments in children and adolescents with somatic symptom disorder and other related disorders: systematic review of the literature

According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders, somatic symptom and related disorders (SSRDs) are defined as psychopathological manifestations characterized by physical signs not attributable to organic pathology. Their incidence has grown dramatically over the past few decades, and treatment is challenging. Besides other interventions on the child and the family, physiotherapy is considered an integral part of the treatment, although there is no evidence for its efficacy.The study aimed to review the available proof on the effectiveness of physiotherapy in children and adolescents with SSRDs. A systematic literature search was conducted on MEDLINE/PubMed, CINAHL, Cochrane Library, PsycINFO, and PEDro, including 1999 to 2021. The methodological quality of the publications was assessed by applying the guidelines proposed by the Equator network, according to the different study designs. The scientific bibliography on the subject was minimal and had poor methodological quality. The choice of outcome indicators and the scales to measure them varied from study to study and were not standardized, making comparison and meta-analysis challenging.Conclusion: According to the available evidence, it is impossible to answer the review question regarding the effectiveness of physiotherapy in children and adolescents with SSRDs. It is necessary to improve the methodological quality of the studies. Definition of standard rehabilitation treatments, identification of appropriate result indicators, and adoption of standardized evaluation scales are needed

Supervision in Practice Education and Transition to Practice: Student and New Graduate Perceptions

Purpose: Transitioning into occupational therapy practice is a complex process in which new graduates develop their skills and professional identity. Evidence suggests this process requires guidance and support through supervision. This study investigated final year students’ and newly graduated occupational therapists’ perceptions and expectations of the role and efficacy of supervision as they transition into practice. Methods: A cross sectional online survey was sent to final year students and newly graduated occupational therapists within Australia and New Zealand, to explore experiences, perceptions, and the content of supervision received in practice. Results: Of 151 participants, 96% received supervision from an experienced occupational therapist and reported it facilitated skill development and enhanced quality of service to clients; however 4% reported they do not receive supervision in practice. The frequency of supervision decreased between students (63% weekly) and new graduates (41% monthly) and perceptions of supervision effectiveness changed over time. Conclusions: The transition to occupational therapy practice is complex and perceptions of the effectiveness of supervision change. Provision of education regarding supervision within undergraduate curriculum, and training for supervisors may alleviate associated stressors. Increasing the frequency of supervision and understanding the supervisory role may support transitioning into practice

Helmet therapy in infants with positional skull deformation: randomised controlled trial

Objective To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months. Design Pragmatic, single blinded, randomised controlled trial (HEADS, HElmet therapy Assessment in Deformed Skulls) nested in a prospective cohort study. Setting 29 paediatric physiotherapy practices; helmet therapy was administered at four specialised centres. Participants 84 infants aged 5 to 6 months with moderate to severe skull deformation, who were born after 36 weeks of gestation and had no muscular torticollis, craniosynostosis, or dysmorphic features. Participants were randomly assigned to helmet therapy (n=42) or to natural course of the condition (n=42) according to a randomisation plan with blocks of eight. Interventions Six months of helmet therapy compared with the natural course of skull deformation. In both trial arms parents were asked to avoid any (additional) treatment for the skull deformation. Main outcome measures The primary outcome was change in skull shape from baseline to 24 months of age assessed using plagiocephalometry (anthropometric measurement instrument). Change scores for plagiocephaly (oblique diameter difference index) and brachycephaly (cranioproportional index) were each included in an analysis of covariance, using baseline values as the covariate. Secondary outcomes were ear deviation, facial asymmetry, occipital lift, and motor development in the infant, quality of life (infant and parent measures), and parental satisfaction and anxiety. Baseline measurements were performed in infants aged between 5 and 6 months, with follow-up measurements at 8, 12, and 24 months. Primary outcome assessment at 24 months was blinded. Results The change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups, with a mean difference of −0.2 (95% confidence interval −1.6 to 1.2, P=0.80) and 0.2 (−1.7 to 2.2, P=0.81), respectively. Full recovery was achieved in 10 of 39 (26%) participants in the helmet therapy group and 9 of 40 (23%) participants in the natural course group (odds ratio 1.2, 95% confidence interval 0.4 to 3.3, P=0.74). All parents reported one or more side effects. Conclusions Based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, we discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformatio

Electromechanical and robotic devices for gait and balance rehabilitation of children with neurological disability: a systematic review

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols\u2019 and devices\u2019 descriptions

A core outcome set for aphasia treatment research: the ROMA consensus statement

Background: A core outcome set (COS; an agreed, minimum set of outcomes) was needed to address the heterogeneous measurement of outcomes in aphasia treatment research and to facilitate the production of transparent, meaningful and efficient outcome data. Objective: The Research Outcome Measurement in Aphasia (ROMA) consensus statement provides evidence-based recommendations for the measurement of outcomes for adults with post-stroke aphasia within phase I-IV aphasia treatment studies. Methods: This statement was informed by a four-year program of research which comprised investigation of stakeholder-important outcomes using consensus processes, a scoping review of aphasia outcome measurement instruments, and an international consensus meeting. This paper provides an overview of this process and presents the results and recommendations arising from the international consensus meeting. Results: Five essential outcome constructs were identified: Language, communication, patient-reported satisfaction with treatment and impact of treatment, emotional wellbeing, and quality of life. Consensus was reached for the following measurement instruments: Language: The Western Aphasia Battery Revised (WAB-R) (74% consensus); emotional well-being: General Health Questionnaire (GHQ)-12 (83% consensus); quality of life: Stroke and Aphasia Quality of Life Scale (SAQOL-39) (96% consensus). Consensus was unable to be reached for measures of communication (where multiple measures exist) or patient-reported satisfaction with treatment or impact of treatment (where no measures exist). Discussion: Harmonisation of the ROMA COS with other core outcome initiatives in stroke rehabilitation is discussed. Ongoing research and consensus processes are outlined. Conclusion: The WAB-R, GHQ, and SAQOL-39 are recommended to be routinely included within phase I-IV aphasia treatment studies. This consensus statement has been endorsed by the Collaboration of Aphasia Trialists, the British Aphasiology Society, the German Society for Aphasia Research and Therapy, and the Royal College of Speech Language Therapists

The role of the occupational therapist in case management in South Africa.

Master’s Degree. University of KwaZulu-Natal, Durban.ABSTRACT Case Management has evolved as an important strategy in managing healthcare to ensure quality and cost effectiveness. Various health professionals utilise case management in numerous practice settings and the researcher has been observed that occupational therapists have adopted this approach in managing disability and incapacity in the workplace when illness or injury impacts on work ability and retention of the employee. The occupational therapist as case manager has been documented in international literature however the role of the occupational therapist in South Africa is not defined and their contributions to the field is not well recognised. The aim of the study was to identify the occupational therapists’ role and scope of practice in case management in South Africa. A quantitative research method for a descriptive study was selected to establish associations between variables and to draw conclusions based on the data collected. This entailed compilation of a questionnaire as a data collection tool that was informed by literature on case management. A pilot study preceded data collection. Purposive sampling was used and the questionnaire was distributed electronically using Surveymonkey to a targeted group of 180 occupational therapists working in private practice, health consulting, for RAF and Workmen’s Compensation given the field of work and their experience in managing individuals with long term medical conditions and incapacity due to ill-health/injury. The data collected was exported to excel for analysis using the mean and a bivariate study to present the non-random associations between two categorical variables. Data from open ended questions were categorised into subthemes and themes using manual coding and was presented thematically. Results of the study revealed that occupational therapists are involved in case manager functions and the extent and intensity of involvement was in relation to the practice area. The findings suggest that occupational therapists in South Africa have adopted case management as an operational component of disability management and as an element of vocational rehabilitation. The results further indicate the standards applied in case management, the models used, the skill base and knowledge relevant to case management and a description of the challenges and effectiveness of case management as experienced by occupational therapists. These findings highlight the need for occupational therapists to expand their knowledge and to promote their skills in the field to enable appropriate and timely uptake of the service. Moreover these results indicate areas for further research on academic preparation relative to the field, evidence to validate the effectiveness and standards of practice to strengthen the occupational therapist as a case manager.Abstract available in the PDF

Barriers and facilitators to delivery of group audiological rehabilitation programs : a survey based on the COM-B model

OBJECTIVE : To canvas the views of Australia-based hearing healthcare clinicians regarding group audiological rehabilitation practices. DESIGN : A national cross-sectional self-report survey. Data were analysed using descriptive statistics and content analysis. STUDY SAMPLE : Sixty-two Australia-based hearing healthcare clinicians, with experience working in an adult rehabilitation setting. RESULTS : Clinicians appeared to positively view the provision of group audiological rehabilitation services, yet were limited in their ability to deliver these services due to organisational barriers. Although some organisational barriers were non-modifiable by the clinician (such as group AR services not prioritised within their workplace, a lack of support from colleagues/managers, lack of resources, and a lack of funding for the delivery of group AR services), others were within the clinicians’ ability to change (such as habit formation for recommending these services during clinical appointments). Participants expressed a desire for resources to assist them in delivering group AR, including downloadable lesson plans and information sheets for clients, clinician training videos and client educational videos. Clinicians called for increased diversity in program offerings, specifically relating to the emotional, relational and social impacts of hearing loss. CONCLUSIONS : These results provide a framework for the development of interventional studies to increase the utilisation of group audiological rehabilitation services.https://www.tandfonline.com/loi/iija202022-06-13hj2022Speech-Language Pathology and Audiolog

Information management within the Nursing Department at Hamad Medical Corporation (HMC), Qatar

Hamad Medical Corporation, the main healthcare provider in the state of Qatar, sponsored this study to investigate the use of electronic records management as the basis for a novel information management system in its Nursing Department. To assess the viability of an electronic records management system a questionnaire survey of a representative sample of the staff and interviews with key post holders were under taken. Results obtained indicated a wide spread dissatisfaction with the existing manual system. However, introduction of any computer-based technology requires great care. To assist with identifying any issues with this technological change, Soft System Methodology (SSM) was employed to discern what changes could be made to improve the current problematic situation found in the Nursing Department. In fact the change archetypes uncovered (procedural, attitudinal, structural and cultural) formed an innovative input into obtaining a roadmap for development of the electronic staff records system. This roadmap was facilitated by the use of Nominal Group Technique (NGT) and Interpretive Structural Modelling (ISM): In fact the roadmap was an ISM intent structure. The roadmap suggested that change could be affected by having written policy documents and the top goal to be achieved reflected an improvement in manpower placing and budgetary forecasts. The use of a multi-methods approach meant that as well as this study's main objectives being reached, the process encompassed some methodological innovations. This study is the first to use the output of SSM to facilitate the NGT and ISM interactions. Equally, it is the first study of its sort to be applied to the Nursing Department at HMC, Qatar, which is an example of a cross-cultural eastern philosophical tradition. The methods used here revealed some significant findings, and have helped in the development of an electronic records management system for use at HMC, Qatar