Ann Taylor

Responsiveness of Common Outcome Measures for Patients With Low Back Pain

STUDY DESIGN A prospective cohort study assessing the responsiveness of two disease-specific questionnaires and a generic health questionnaire for patients with low back pain and sciatica. OBJECTIVES To compare the responsiveness of the eight scales and two summery scales of the SF-36 questionnaire with that of the Oswestry Disability Index and Low Back Outcome Score questionnaires. SUMMARY OF BACKGROUND DATA Evaluation of treatment outcome is being determined more frequently from a patients perspective, particularly the impact treatment has on current health status. METHODS Patients were recruited from two orthopedic back pain clinics in a tertiary hospital. Patients completed the pretreatment questionnaire 1 month before treatment and follow-up questionnaires a minimum of 2-6 months after treatment. Patients undergoing surgery were also observed for a minimum of 2 years. RESULTS Overall, the Oswestry Disability Index was most responsive; however, individual scales from the SF-36 questionnaire showed equal or greater sensitivity to change than the Oswestry Disability Index in each of the patient subgroups. The SF-36 Role Physical scale was prone to floor effects (a high percentage of respondents score zero), and the change scores from the SF-36 Role Emotional scale varied by 100 points in either direction in each of the patient subgroups. CONCLUSION Responsiveness varied according to which method was used in its calculation. The responsiveness of the SF-36 questionnaire shows that it can be a useful adjunct in the assessment of patients with low back pain when combined with disease-specific questionnaires.

Enhancing interprofessional student practice through a case-based model

Healthcare workers are increasingly being called upon to work collaboratively in practice to improve patient care and it seems imperative that interprofessional working should be mirrored in student education, especially during placements. This short report describes a qualitative evaluation of a client-centered, case-based model of interprofessional education (IPE) which aimed to improve interprofessional communication and team working skills for the students and therapists involved in practice placements. The IPE project implemented the meet, assess, goal set, plan, implement, evaluate (MAGPIE) framework for interprofessional case-based teaching (Queensland-Health (2008)) alongside the International Classification of Function, Disability and Health (ICF) (WHO, 2001). Three separate focus groups explored the experiences of the students, therapists and placement facilitators from the disciplines of occupational therapy, physiotherapy and speech and language therapy. Three themes emerged: IPE as a motivating experience, IPE enhancing the depth of learning and clarity of expectations. This report concluded that IPE in the clinical setting, using the client-centered MAGPIE model, provided a strong foundation for enhanced learning in practice education contexts.

Cardiac rehabilitation: do exercise programmes make a difference?

Summary Two studies were performed to investigate the benefits of participating in a supervised, individually prescribed exercise programme. One study involved patients in the early period of recovery after a myocardial infarction and the other investigated patients with chronic heart failure. This paper presents the changes in psychosocial function in both studies following a short period of exercise training. A total of 54 patients, within two weeks after a myocardial infarction were randomized to a control group, group who only attended education/information sessions and a group who additionally participated in an exercise programme. The patients who attended the six-week exercise and education programme showed significantly greater improvements ( P P >0.05). Eight patients with stable chronic heart failure participated in a randomized 16-week crossover study. After an eight-week period of exercise training, patients with chronic heart failure showed significant improvements in depression, quality of life and walking activity ( P

The MAGPIE model: An interprofessional learning opportunity for therapy students

Inter Professional Education (IPE) is not commonplace within Ireland. This paper presents the development and practical application of an IPE placement experience initiated by the University of Limerick. Several factors contributed to its development, including the establishment of posts based within several universities and the health service specifically to facilitate placement education. The MAGPIE model (Meet, Assess, Goal-Set, Plan, Implement and Evaluate) was used as a platform for the case-based IPE sessions involving Occupational Therapy and Physiotherapy students. Each student experienced 10.5 hours of discussion-based inter-professional activity within a placement and presented an inter-professional case study. The IPE experience was evaluated via focus groups involving students, practice educators and placement facilitators. Strengths of the experience included increased motivation, improved team working skills and development of a greater understanding of professional roles. Recommendations to enhance future case-based IPE sessions are identified.

Supervising role emerging placements: a CPD opportunity that supports innovation in practice

ABSTRACT Supervision of occupational therapy students on placements is a challenging, but rewarding experience. There is a growing body of literature related to role emerging placements but the experiences of the occupational therapists who undertake the role of off-site supervisors are underrepresented. These placements are based in settings where there is no defined occupational therapy role and the professional supervisor is not based at the placement site. Drawing from research in two European countries with off-site supervisors the enablers and barriers of this role are presented. Supervising students with innovative occupational therapy interventions positively influenced the off-site supervisors’ professional practice. Practical guidance for those interested in this role is shared to encourage occupational therapists to pursue this rewarding role including the need for peer support while undertaking this valuable role.

A NICE Experience

The National Institute for Clinical Excellence (NICE) for England and Wales has organised the development of a national multi-professional guideline on the management of chronic heart failure in primary and secondary care ( NICE, 2003 ) which was published on July 23. This is one of a rolling programme of clinical guidelines which will form part of the evidence base from which practitioners work. The Government will expect these guidelines to be implemented into clinical practice and the establishment of the Commission for Health Improvement is one mechanism for overseeing this.

Effects of Rehabilitation in Patients with Cardiac Disease

Prospective, randomised controlled trials were performed to investigate the benefits of cardiac rehabilitation in two selected patient groups. One group comprised patients in the early stage of recovery after an uncomplicated myocardial infarction. The other consisted of patients with stable chronic heart failure, who are usually excluded from exercise programmes. The reliability and validity of a new method of measuring ambulatory activity was determined. The rehabilitation programme for the post myocardial infarction patients lasted six weeks and contained education and exercise components. Three groups were recruited; a control group, a group who only undertook the education sessions and a group who also participated in a training programme. Comparison of changes in psycho-social parameters and physiological function were made between the groups after completing the programme and three months later. The education + exercise group showed significantly greater improvements (p<0.05) in anxiety, ambulatory activity and rehabilitation status compared to the other groups. Indications of predominantly peripheral adaptation to training were observed, but no significant differences in physiological function were found between the three groups. The education only group did not show any significant differences to the control group in any areas. A crossover-design was used in the chronic heart failure study. This comprised a control and exercise period, each lasting two months. Assessments of psycho-social parameters and physiological function were made at monthly intervals. Exercise training produced significant improvements in depression, quality of life and ambulatory activity. Both central and peripheral adaptations to training were observed, with significant benefits in peak cardiac index, oxygen uptake and resting heart rate. Improvements in ventilator efficiency were also noted.

The Mixed Economy of Care and its Relationship to Multiprofessional Work and Training: A CCETSW workshop

This was the third conference in conjunction with the Schools Masters course in Inter professional Health and Welfare Studies. Each year die Masters course features a key topic in die form of an annual conference—previous diemes have covered Europe 1992: Health and Welfare, Provision and Professions and Managing Change. The present Course Director, Tony Leiba, introduced the day with an overview of interprofessional issues and their importance for the ediics of care.