Anne Mandy

Changing self-efficacy in individuals following a first time stroke: preliminary study of a novel self-management intervention:

Objective: To examine the effects of a self-management workbook intervention designed for use with individuals disabled after first time stroke. Design: Multiple-participant two-phase (baseline followed by treatment) single subject design. The intervention was introduced at a randomly generated time-point. Setting: Community. Subjects: Seven men and three women, with a mean age of 61.5 years (SD 8.15), on average 24.2 weeks (SD 18.29) following first stroke, all with residual restriction of activity and participation. Intervention: An individualized self-management workbook based on self-efficacy principles, incorporating sections to increase mastery, vicarious experience and feedback. Main measures: Stroke Self-Efficacy Questionnaire, General Self-Efficacy Scale, Recovery Locus of Control Scale, Rivermead Mobility Index, Rivermead Activities of Daily Living Scale, Subjective Index of Physical and Social Outcome and the Hospital Anxiety and Depression Scale. Individual data were analysed with weighted mean trend test and two standard deviation band test. Group data were analysed with a randomization test. Results: Visual inspection of the data over the 14-week period showed steady improvement for all of the 10 participants on the majority of variables. A randomization test indicated a statistically significant change in Stroke Self-Efficacy Questionnaire scores and Recovery Locus of Control Scale scores which followed introduction of the intervention. Measures of activity, participation and mood scores did not show a statistically significant change. Conclusion: There is preliminary evidence that the use of an individualized stroke self-management intervention is acceptable and can lead to a change in self-efficacy in this small sample.

Evidence of a possible role of altered angiotensin function in the treatment, but not etiology, of depression.

BACKGROUND Angiotensin-converting enzyme inhibitors are reportedly effective in the treatment of depression; furthermore, antidepressants decrease angiotensin function. It appears therefore that reduced angiotensin function may be important in the treatment of depression. The aims of this study were to elucidate the actions of antidepressants on angiotensin receptors; to investigate the antidepressant potential of an angiotensin antagonist; and to study angiotensin receptors in depressed puerperal women. METHODS The effects of antidepressant drugs on angiotensin receptors and the relationship between mood and platelet receptors in puerperal women were investigated using radioligand binding. The antidepressant potential of the angiotensin antagonist losartan was assessed using the mouse forced swim test. RESULTS Desipramine, but neither fluoxetine nor tranylcypromine, displaced angiotensin from its receptor; however, there was no significant relationship between receptor number and depressed mood. In the forced swim test losartan was shown to possess antidepressant like activity. CONCLUSIONS These findings indicate that antidepressants differ in the mechanism by which they reduce angiotensin function, but the link between antidepressants and angiotensin is reiterated by the demonstration that losartan possesses antidepressant like activity. There is, however, no evidence of abnormal angiotensin receptors in women with depressed mood postpartum.

Reasons for recovery after stroke: a perspective based on personal experience

Purpose. The purpose of this study was to learn more about individual beliefs and personal strategies used to support the period of recovery after stroke. It sought to identify the factors that were perceived to be enablers as well as challenges to recovery. Personal actions or experiences, which were perceived to be effective in influencing progress, would be identified. Method. Qualitative in-depth interviews were carried out with 10 participants (mean age 61.8 years). Time following stroke onset ranged between 6 weeks and 13 months. All participants had some residual activity limitation and three participants had varying degrees of aphasia. The interviews were ∼60 – 90 minutes and all data was subjected to content analysis. Results. Analyses of interview data identified two main themes which were perceived to have influenced progress after stroke. The first related to internal factors such as personal control over progress, optimism and fears of dependency and the second included more external factors, such as the influence of therapeutic interactions and success with a specified marker of independence such as dressing, washing and walking. Conclusion. An important finding of this study was that individuals all identified a number of specific factors which had supported or hindered their own recovery. There were a diversity of both internal/personal and external factors which may not be surprising, given the complexity of stroke, but all participants stressed the importance of both factors. The findings from this study are preliminary and relate only to this particular group of participants, as such they cannot be generalizable to the stroke population as a whole. However, the interaction between the two themes identified requires further exploration, especially in relation to therapy which could have both a positive and negative influence on personal control. There is a clear need to understand how professionals can, in the first place, take time to identify each individuals preferences and personal goals and secondly, make sure that these are fully addressed in a planned treatment programme. This will ensure that progress in individuals after stroke is supported by professionals with a more eclectic, individualized approach.

Development and reliability of a system to classify the eating and drinking ability of people with cerebral palsy

The aim of this study was to develop a valid classification system to describe eating and drinking ability in people with cerebral palsy (CP), and to test its reliability.

Hip subluxation and dislocation in cerebral palsy – a prospective study on the effectiveness of postural management programmes

BACKGROUND AND PURPOSE Hip subluxation and dislocation are common sequelae in children with bilateral cerebral palsy and are currently managed by surgical interventions. This study aimed to investigate the effectiveness of early postural management programmes on hip subluxation and dislocation at five years, and the need for treatment in children with bilateral cerebral palsy, and to compare these findings with a historical control group. METHODS A prospective cohort study followed 39 children who commenced using postural management equipment under 18 months of age. Levels of ability, type and amount of equipment use and treatments were recorded every three months. At 30 and 60 months, the hips were X-rayed and the hip migration percentage was measured. The results were compared with the historical control group. RESULTS Children who used equipment at recommended and moderate levels had significantly less chance of both hips being subluxed than those using equipment at minimal levels (two-tailed Fishers exact chi(2) p = 0.024). The frequency of children with hip problems was significantly less in the intervention group in comparison to the historical control group at five years (chi(2) = 11.53, df = 2, p = 0.006). The frequency of children receiving bilateral or unilateral treatments, i.e. surgery, use of a hip and spinal orthosis and/or botulinum toxin injections, in the intervention group was significantly less compared to the historical control group (two-tailed Fishers exact p = 0.001). CONCLUSION The early provision of postural management equipment has a role to play in reducing the number of hip problems and therefore the need for treatment of hip subluxation/dislocation in cerebral palsy at five years of age.

Physiotherapy students' sources of stress, perceived course difficulty, and paid employment: Comparison between Western Australia and United Kingdom

Physiotherapy education is changing, and educators are increasingly concerned about the levels of stress observed in students. Considerable research has investigated stressors in medical and nursing students; however, studies of physiotherapy students were conducted more than a decade ago. This study examined the sources of stress, perceived course difficulty, and hours of paid employment in undergraduate physiotherapy students in Western Australia (WA) and the United Kingdom (UK). The Undergraduate Sources of Stress questionnaire was administered to students in all years of Bachelor of Science (Physiotherapy) programs (n = 249 WA; n = 161 UK) and a Master of Physiotherapy (graduate entry) program (n = 24 WA) with an overall response rate of 70%. Academic concerns were rated highest for all students, particularly the amount to learn, time demands of the course, and conflict with other activities. The course was perceived to be more difficult than expected by 71% of students. Although the mean (SD) hours per week worked in paid employment by WA and UK students is 12.52 (13.90) and 7.16 (4.02), respectively, there was no correlation between any stress subscale and number of hours worked. Reducing the amount of content and revision of the outcomes of physiotherapy curricula could potentially reduce academic stress.

Burnout and occupational stress: comparison between United Kingdom and Australian podiatrists.

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups.

Reduction of responses to angiotensin II by antidepressant drugs

The effects of the antidepressant drugs desipramine, fluoxetine and tranylcypromine and the non-antidepressant control cocaine on angiotensin II function were determined in vivo by use of angiotensin-induced drinking in rats and in vitro using contractile responses of the rat uterus. The results of the drinking studies showed that the three antidepressants, but not cocaine, reduced the dipsogenic effects of angiotensin II. In vitro, all of the drugs reduced the effects of not only angiotensin but also acetylcholine and oxytocin on the uterus. The inhibition appeared to be non-competitive in all cases. These results indicate that the antidepressant drugs reduced the activity of angiotensin II, albeit non-selectively, and suggest that the previously reported effects of antidepressants on isoprenaline-induced drinking in rats reflect an action on angiotensin activity rather than a reduction of beta-adrenoceptor activity as previously suggested.

Patients' expectations of private osteopathic care in the UK: a national survey of patients.

BackgroundPatients’ expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet.MethodsThe study involved development and application of a questionnaire about patients’ expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis.The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation “did not happen”.Results1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP.ConclusionsThe findings reflected the complexity of providing osteopathic care and meeting patients’ expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research.

Repeatability and limits of agreement in measurement of hip migration percentage in children with bilateral cerebral palsy

Summary Objective To determine the repeatability and limits of agreement for X-ray measurement of hip migration percentage in children with cerebral palsy. Design An inter-rater and intra-rater study. Data Twenty hip and pelvic X-rays (40 hips) were measured by three health professionals on two separate occasions. Results Repeatability of the measure was expressed as 95% limits of agreement. Measurements of hip migration were within 7.6% of each other when measured by the same rater on two occasions. When two raters were compared, measurements were within 8.1% of each other. Conclusion Measurement of hip and pelvic X-rays can be made using the described method within limits of agreement that are acceptable for clinical decision-making. The information thus obtained on the degree and rate of hip subluxation/dislocation can be used to inform therapy and surgical decision-making.