Jessica Stanhope

Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature

Purpose This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods A comprehensive open-ended search was conducted using electronic library data-bases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.

The risky business of being an entomologist: a systematic review

BACKGROUND Adverse work-related health outcomes are a significant problem worldwide. Entomologists, including arthropod breeders, are a unique occupational group exposed to potentially harmful arthropods, pesticides, and other more generic hazards. These exposures may place them at risk of a range of adverse work-related health outcomes. OBJECTIVES To determine what adverse work-related health outcomes entomologists have experienced, the incidence/prevalence of these outcomes, and what occupational management strategies have been employed by entomologists, and their effectiveness. METHODS A systematic search of eight databases was undertaken to identify studies informing the review objectives. Data pertaining to country, year, design, work-exposure, adverse work-related health outcomes, incidence/prevalence of these outcomes, and occupational management strategies were extracted, and reported descriptively. DISCUSSION Results showed entomologists experienced work-related allergies, venom reactions, infections, infestations and delusional parasitosis. These related to exposure to insects, arachnids, chilopods and entognathans, and non-arthropod exposures, e.g. arthropod feed. Few studies reported the incidence/prevalence of such conditions, or work-related management strategies utilised by entomologists. There were no studies that specifically investigated the effectiveness of potential management strategies for entomologists as a population. Indeed, critical appraisal analysis indicated poor research quality in this area, which is a significant research gap. CONCLUSIONS Entomologists are a diverse, unique occupational group, at risk of a range of adverse work-related health outcomes. This study represents the first systematic review of their work-related health risks. Future studies investigating the prevalence of adverse work-related health outcomes for entomologists, and the effectiveness of management strategies are warranted to decrease the disease burden of this otherwise understudied group.

Role, implementation, and effectiveness of advanced allied health assistants: a systematic review

Background The purpose of this systematic review was to determine the effectiveness and implementation of advanced allied health assistant roles. Methods A systematic search of seven databases and Google Scholar was conducted to identify studies published in English peer-reviewed journals from 2003 to 2013 and reporting on the effectiveness and implementation of advanced allied health assistant (A/AHA) roles. Reference lists were also screened to identify additional studies, and the authors’ personal collections of studies were searched. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, and appraisal of higher-level studies (III-1 and above) conducted using the Centre for Evidence Based Medicine Systematic Review Critical Appraisal Sheet for included systematic reviews or the PEDro scale for level II and III-1 studies. Data regarding country, A/AHA title, disciplines, competencies, tasks, level of autonomy, clients, training, and issues regarding the implementation of these roles were extracted, as were outcomes used and key findings for studies investigating their effectiveness. Results Fifty-three studies were included, and most because they reported background information rather than investigating A/AHA roles, this representing low-level information. A/AHAs work in a range of disciplines, with a variety of client groups, and in a number of different settings. Little was reported regarding the training available for A/AHAs. Four studies investigated the effectiveness of these roles, finding that they were generally well accepted by clients, and provided more therapy time. Issues in integrating these new roles into existing health systems were also reported. Conclusion A/AHA roles are being implemented in a range of settings, and appear to be effective in terms of process measures and stakeholder perceptions. Few studies have investigated these roles, indicating a need for research to be conducted in this area to enable policy-makers to consider the value of these positions and how they can best be utilized.

The role of extended scope physiotherapists in managing patients with inflammatory arthropathies: a systematic review.

Objectives To review the literature to identify whether, and how, physiotherapists working in extended scope of practice (ESP) engage with patients with inflammatory arthropathies. Measures of effectiveness of ESP were particularly sought. Methods A comprehensive library database search was conducted to identify English language studies published in full text in peer-reviewed journals during the years 2002–2012. Studies were allocated into the National Health and Medical Research Council hierarchy of evidence, but were not critically appraised. Data was extracted on conditions treated, ESP roles and responsibilities, and effectiveness. Data was analyzed and reported descriptively. Results We identified 123 studies, and included four. All were low hierarchy (highest being one level III_2 study). Commonly reported conditions were rheumatoid arthritis and ankylosing spondylitis. Information was provided on activities of role extension, such as triaging patients, monitoring and recommending changes to medications, referring to other health and medical professionals, and ordering and interpreting imaging. There was blurring between ESP and non-ESP roles. No study reported measures of effectiveness. Conclusion There are descriptors of ESP physiotherapy activities, but no evidence of effectiveness of ESP physiotherapy in managing patients with inflammatory arthropathies.

University woodwind students’ experiences with playing-related injuries and their management: a pilot study

Background This study aimed to determine the experiences of university classical woodwind students with playing-related injuries (PRIs), the impact of these PRIs, the management selected by students with PRIs, and the perceived effectiveness of this management. Materials and methods All classical woodwind students enrolled in vocational education training or undergraduate courses at a university were sent an email with a link to an online survey. Only those aged 18 years and older were eligible. The survey obtained data regarding demographic information, details of PRI experienced (location, if they lasted for more than 3 months, and if they were current), and the impact of these, as well as the types of management strategies tried and their perceived effectiveness. Data were analyzed using descriptive statistics, and comments were reported descriptively. Results Fourteen students returned the survey; however, one of these only completed the questions regarding demographics, and was therefore excluded. A total of 62% of participants reported having experienced a PRI. Common locations for PRI were the wrist/hand/fingers, lower back, and neck. Reducing practice time by half and missing playing commitments were the most commonly reported consequences of PRIs. Playing-related management strategies were most frequently trialed, with these and passive nonplaying-related strategies perceived to be the most effective. Conclusion PRIs are common in this population, with a range of consequences reported. While it is encouraging that students had tried and found effective playing-related management strategies, active nonplaying-related strategies should be encouraged, particularly in preference to passive nonplaying-related strategies. This was a small-scale study, and the results are only applicable to the institution investigated; therefore, similar larger-scale studies are recommended to determine the generalizability of these findings.

The prevalence and incidence of musculoskeletal symptoms experienced by flautists

BACKGROUND Musculoskeletal symptoms are reportedly common among musicians. Flautists may be at high risk of symptoms, due to their asymmetrical playing posture. AIMS To determine the prevalence and incidence of musculoskeletal symptoms among flautists. METHODS A systematic search of four databases, with reference and citation lists of included studies, screened for additional studies. Included studies were assigned to the Oxford Centre for Evidence-based Medicine levels of evidence and critical appraisal was performed using a previously published tool. Data extracted included the country, sample size, data collection methods, response rates, sample demographics and data pertaining to the prevalence or incidence of musculoskeletal symptoms among flautists. RESULTS Seven studies (evidence levels 1 and 3) were included. These were at moderate to high risk of bias. There was wide variation in the populations and the types of musculoskeletal symptoms investigated. Lifetime prevalence of any musculoskeletal symptoms of any duration varied from 15 to 95% depending on the populations and symptoms investigated. In schoolchildren, this was as high as 79%, and 95% in university students. The upper extremities were most commonly affected, with minimal differences in the prevalence of symptoms between right and left sides. Due to the differences in the types of data collected, different groups of flautists could not be directly compared. CONCLUSIONS The lack of studies with high evidence levels and low risk of bias in this area precludes a clear understanding of the prevalence and location of musculoskeletal symptoms in flautists, although current evidence suggests that the prevalence is high.

Do natural spring waters in Australia and New Zealand affect health? A systematic review

Therapeutic use of spring waters has a recorded history dating back to at least 1550 BC and includes both bathing in and drinking such waters for their healing properties. In Australia and New Zealand the use of therapeutic spring waters is a much more recent phenomenon, becoming a source of health tourism from the late 1800s. We conducted a systematic review aimed at determining the potential health outcomes relating to exposure to Australian or New Zealand natural spring water. We found only low-level evidence of adverse health outcomes relating to this spring water exposure, including fatalities from hydrogen sulphide poisoning, drowning and primary amoebic meningoencephalitis. We found no studies that investigated the therapeutic use of these waters, compared with similar treatment with other types of water. From the broader literature, recommendations have been made, including fencing potentially harmful spring water, and having signage and media messages to highlight the potential harms from spring water exposure and how to mitigate the risks (e.g. not putting your head under water from geothermal springs). Sound research into the potential health benefits of Australian and New Zealand spring waters could provide an evidence base for the growing wellness tourism industry.

Health effects of natural spring waters: A protocol for systematic reviews with a regional case example.

BACKGROUND Spring water therapies have been used since at least 1550 BC. Despite the growing body of evidence supporting these therapies for a range of conditions, including musculoskeletal, dermatological, respiratory and cardiovascular conditions, they do not currently form part of mainstream healthcare in many countries. The protocol established in this paper aims to support systematic reviews that examine the health outcomes associated with human exposure to regional spring waters, using the Australia and New Zealand context as a case study. METHODS/DESIGN The protocol searches for studies in eight health/medical databases, searches three local health/medical journals, and includes forwards and backwards searching. Standard systematic review methods are used including: specifying pre-determined inclusion criteria and data management plans, appraising the studies for bias, and allocation to a hierarchy of evidence. DISCUSSION The protocol supports a review and comprehensive synthesis of the current evidence regarding the health effects of natural spring water, and can be adapted for reviews in other regions. From this evidence, recommendations regarding practice and future research can be made on the therapeutic role of spring water.

Health outcomes of beekeeping: a systematic review

Honey bees and the business of beekeeping have profound economic importance for global agricultural production. Bee populations and the beekeeping industry are experiencing threats to sustainability. The beekeeping industry brings with it health risks for beekeepers and those living in proximity to hives. While there are a wide range of potential adverse health outcomes there has been no systematic review of these. We address this gap, examining the symptomatic adverse health outcomes among beekeepers and those living in proximity to hives. We demonstrate a dearth of published studies (nine unique studies) on the health impacts. Adverse outcomes included bee venom and propolis allergies (including anaphylaxis) and Lyme borreliosis associated with tick bites while beekeeping. Systemic reactions to bee venom allergies were associated with a range of risk factors. However, the probability of allergic reactions decreased as years of beekeeping increased. There is a clear need for greater research into the adverse health outcomes for this population. Nevertheless, our systematic review demonstrates important health consequences, and suggests an appreciation of the range of consequences is relevant. This is appropriate for reducing the disease burden of beekeeping in order to facilitate greater participation and aid in maintaining global pollination services and food security.