Anne Kärki

IMPAIRMENTS, ACTIVITY LIMITATIONS AND PARTICIPATION RESTRICTIONS 6 AND 12 MONTHS AFTER BREAST CANCER OPERATION

OBJECTIVE To describe the impairments of upper body and limbs, activity limitations and participation restrictions 6 and 12 months after operation for breast cancer and to examine the impact of impairments on activity limitations. DESIGN A prospective survey 6 and 12 months after operation. PATIENTS Ninety-six breast cancer patients. METHODS A questionnaire for assessing the impairments, activity limitations and participation restrictions was developed. RESULTS The most common impairments 6 months after operation were breast and axilla scar tightness, axilla oedema and neck-shoulder pain. At 12-month follow-up the breast scar tightness (p=0.008) and axilla oedema (p=0.023) decreased, and limb ache (p=0.005) increased significantly. The most limiting impairments were axilla oedema and limb numbness 6 months after operation, and at 12-month follow-up axilla oedema. Lifting, carrying and reaching out caused worsening of impairments to more than half of the respondents at 6-month follow-up. Regression analysis showed that many impairments together were determinants of activity limitations and sleep impairment. Participation restrictions were constant. Respondents had not given up participation in activities in the home, but some had abandoned leisure activities and felt that their work ability had decreased. CONCLUSION Impairments and their impact on activities were frequent and constant. There is an urgent need for developing rehabilitation protocols for breast cancer patients.

Lymphoedema therapy in breast cancer patients - a systematic review on effectiveness and a survey of current practices and costs in Finland

Background. This study systematically evaluates the effects and harms of physiotherapy methods and explores current treatment practices and costs in relation to lymphoedema in breast cancer patients in Finland. Material and methods. A systematic review of randomized controlled trials (RCTs) on physiotherapy interventions for breast cancer patients with lymphoedema. A postal survey to lymph therapists, a telephone and register survey for therapy costs. Results. We identified 14 RCTs, of which two had moderate and the others high risk of bias. There was moderate evidence that compression bandages decreased lymphoedema, and that pneumatic pumps had no effect on lymphoedema. In Finland lymph therapy practice is a combination of manual lymph drainage (MLD), compression bandages, therapeutic exercises and guidance for self-treatment, with an annual average cost of EUR 799 per patient. Conclusions. Compression bandages are likely to reduce upper limb lymphoedema in breast cancer patients. Evidence on other physiotherapy methods and their combinations is limited due to the poor quality of the trials. No evidence was found on any outcomes other than upper limb volume. We call for well-designed trials with patient-related outcomes on the effectiveness of MLD, guidance and therapeutic exercises.

A narrative literature review of games, animations and simulations to teach research methods and statistics

Basic competence in research methods and statistics is core for many undergraduates but many students experience difficulties in acquiring knowledge and skills in this area. Interest has recently turned to serious games as providing engaging ways of learning. The CHERMUG project was developed against this background to develop games to support students in learning about research methods and statistics. As a first step in designing the CHERMUG games a narrative literature review was carried out to establish whether similar games, animations and simulations already existed. Search terms used in the literature review included varied terms for digital games, simulations and animations, terms relevant to the twin goals of learning and engagement in games and terms for research methods and statistics. Application of the inclusion criteria led to 26 papers which were considered relevant. Synthesis of the papers suggested that there is reason to be optimistic that a game-based approach might be effective in learning in this area.

Anterior knee pain and cold knees: a possible association in women.

Abnormal reactions to environmental cold have been observed in some patients with Anterior Knee Pain (AKP). The aims of this study were to investigate whether palpation of the knee could classify patients into those with and those without cold knees; whether this classification could be objectively validated using thermal imaging; whether the cold and not cold knee groups varied in response to a cold stress test and in patient-reported measures. Fifty eight patients were recruited; palpation classified them into cold and not cold groups. Twenty-one (36%) patients were classified as having a cold knee by palpation: fourteen (36%) females and seven males (37%). Preliminary analysis suggested gender might be an effect modifier and the number of men was small, therefore the analysis focussed on females. Women with cold knees had a significantly smaller patellar skin fold, lower levels of activity and worse scores on the MFIQ, there also appeared to be an association with a traumatic onset. Women with cold knees were more likely to report cold weather affected their knees and they preferred a hot water bottle compared to an ice-pack on their knee; there was also a trend towards having to wear extra tights/long johns in the winter. This study has helped to define a clinical profile for a group of females with AKP and cold knees. This group appears to demonstrate a mild form of Reflex Sympathetic Dystrophy.

Effects of Whole Body Cryotherapy and Cold Water Immersion on Knee Skin Temperature

This study sought to (a) compare and contrast the effect of 2 commonly used cryotherapy treatments, 4 min of -110 °C whole body cryotherapy and 8 °C cold water immersion, on knee skin temperature and (b) establish whether either protocol was capable of achieving a skin temperature (<13 °C) believed to be required for analgesic purposes. After ethics committee approval and written informed consent was obtained, 10 healthy males (26.5±4.9 yr, 183.5±6.0 cm, 90.7±19.9 kg, 26.8±5.0 kg/m2, 23.0±9.3% body fat; mean±SD) participated in this randomised controlled crossover study. Skin temperature around the patellar region was assessed in both knees via non-contact, infrared thermal imaging and recorded pre-, immediately post-treatment and every 10 min thereafter for 60 min. Compared to baseline, average, minimum and maximum skin temperatures were significantly reduced (p<0.001) immediately post-treatment and at 10, 20, 30, 40, 50 and 60 min after both cooling modalities. Average and minimum skin temperatures were lower (p<0.05) immediately after whole body cryotherapy (19.0±0.9 °C) compared to cold water immersion (20.5±0.6 °C). However, from 10 to 60 min post, the average, minimum and maximum skin temperatures were lower (p<0.05) following the cold water treatment. Finally, neither protocol achieved a skin temperature believed to be required to elicit an analgesic effect.

A Review of the Role of Circulatory Deficit in the Genesis of Patellofemoral Pain

Abstract Most physiotherapy for patellofemoral problems has a mechanical basis, consisting of lower limb exercises, stretches, taping/bracing and foot orthotics; however, in many cases physiotherapy is unhelpful. Due to the refractory nature of the condition it may be appropriate to also explore non-mechanical alternative factors, which could improve understanding and treatment of the condition. This paper provides a review of anatomy of the blood supply to the patellofemoral joint and of the roles of circulatory deficits and inflammatory processes in the production of patellofemoral pain. In addition, a simple clinical model is proposed to help practitioners categorize patellofemoral patients as hypoxic, mechanical, or inflammatory. The classification of patients in this way may improve treatment outcomes, increasing both patient and therapist satisfaction.

Technology and active agency of older adults living in service house environment

Abstract Purpose: The purpose of the study was to explore whether or not the assistive and safety technology that is currently used in service house environment supports the active agency of the elderly residents. Method: Twelve purposively chosen elderly residents were interviewed. The data were analyzed by theory-driven content analysis using the modalities of the agency-model as a theoretical frame. Results: The technological devices and systems partially support the active agency of the residents. Deterioration of their functioning seems to limit the use of devices as well as complicate their learning on how to use these systems. The respondents had only few insights of the possibilities that this technology could offer to them in their daily life and they were not expecting their functioning to improve in the future. The homeliness and intimacy of the environment was highly appreciated. Conclusions: Although the attitude towards technology was, in general, reserved, technology was seen as one possibility to support active agency. The current technologies seem to be designed from the needs of the organization and not from the needs of the residents. In the future, more emphasis needs to be put on designing individualized devices in cooperation with the users. Implications for Rehabilitation To support independence, autonomy and active agency of the older adults, the technological solutions must be based on perceived needs of the individual and the design should be adaptable to the functional limitations one has. Nursing staff’s knowledge about assistive devices and technologies need to be updated on regular bases in order to be able to recommend appropriate devices for the elderly. Taking into account the fact that many older adults have mild to moderate memory problems as well as difficulties with vision and hearing, more attention needs to be paid to didactics, i.e. how the introduction and guidance of the use of new technologies, assistive devices or safety systems is best done with them.

A case study on the design and development of minigames for research methods and statistics

Research methodology involves logical reasoning and critical thinking skills which are core competences in developing a more sophisticated understanding of the world. Acquiring expertise in research methods and statistics is not easy and poses a significant challenge for many students. The subject material is challenging because it is highly abstract and complex and requires the coordination of different but inter-related knowledge and skills that are all necessary to develop a coherent and usable skills base in this area. Additionally, while many students embrace research methods enthusiastically, others find the area dry, abstract and boring. In this paper we discuss the design and the first evaluation of a set of mini-games to practice research methods. Games are considered to be engaging and allow students to test out scenarios which provide concrete examples in a way that they typically only do once they are out in the field. The design of a game is a complex task. First, we describe how we used cognitive task analysis to identify the knowledge and competences required to develop a comprehensive and usable understanding of research methods. Next, we describe the games designed and how 4C-ID, an instructional design model, was used to underpin the games with a sound instructional design basis. Finally, the evaluation approach is discussed and how the findings of the first evaluation phase were used to improve the games.

Nurses' perspectives on implementation of safety technology in elderly care - A mixed method study

The demographic change in Finland is fast and is estimated that in 2030 the share of persons aged 65 or more is about 26%. This study aims to develop usability of the technical safety systems in co-operation with the end-users, i.e. staff and the residents as well as to develop an environment that could enhance security and comfort of living of the elderly. A mixed-method approach combining questionnaires and focus group interviews was used to gather the data. Results brought up development ideas and suggestions of safety technology in elderly care, such as need of further technical support and user-centered education. Discussion between the developers and the users of safety technology should be on-going process before and during the implementation of new technology in the housing environment of elderly residents.