Morag Thow

A comparison of home and hospital-based exercise training in heart failure: immediate and long-term effects upon physical activity level:

Background: In heart failure, reduced physical activity level can adversely affect physical and psychosocial functioning. No previous heart failure research has compared effects of home and hospital-based exercise training upon physical activity level, or has objectively assessed their long-term effects upon physical activity. This study used an activPAL™ monitor to examine immediate and long-term effects of home and hospital-based aerobic exercise training upon physical activity level. Design: Randomized controlled trial. Methods: Sixty patients with heart failure (mean age 66 years; NYHA class II/III; 51 male/9 female) were randomized to home training, hospital training or control. Both programmes consisted of aerobic circuit training, undertaken twice a week for one hour, for eight weeks. All participants wore the activPAL™ at baseline, and after eight weeks, for one week. Six months after cessation of training, a subgroup of participants from the home and hospital training groups (n = 10 from each group) wore the activPAL™ for a further week. Results: Hospital-based training significantly increased steps taken per day during ‘extra long’ (P = 0.04) and ‘long’ (P = 0.01) walks. Neither programme had any immediate effect upon physical activity level otherwise. Though daily upright duration for the home group significantly improved six months after cessation of training (P = 0.02), generally physical activity level was maintained in the long term for both training groups. Conclusions: Hospital-based training enabled participants to walk for longer periods. It is clinically important that both training groups maintained physical activity level in the long term, given the potential for heart failure to worsen over this time period.

The Writing Consultation: Developing Academic Writing Practices.

This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic contexts. This article proposes that the process of revealing and developing writing practices in a specific form of regular, structured, collegial discussion has potential to prompt academics to reconceptualise their writing practices and, perhaps crucially, to find different ways to write. In addition, it demonstrates, in a new way, how recognised behaviour change strategies might be embedded in the academic writing process. The writing consultation draws on principles established in other contexts. This article makes the case for adapting them to the context of academic writing, in order to support and improve academic writing output.

Peer-formativity: a framework for academic writing

The system currently deployed to assess research outputs in higher education can influence what, how and for whom academics write; for some it may determine whether or not they write at all. This article offers a framework for negotiating this performative context – the writing meeting. This framework uses the established theoretical underpinning of motivational interviewing, which involves autonomy, self-determination, environmental factors and social support. A study showed that the framework helped academics negotiate performativity and re-connect their writing to their values. In this way, they could both privilege writing that was meaningful to them and meet personal and institutional targets. Writing meetings did this by developing writing-oriented peer relationships, defined in this article as peer-formativity. Using writing meetings, academics can submit for research assessment systems without surrendering to performativity.

Facilitating Student Writing during Project Supervision A practical approach

Summary Many undergraduate and postgraduate students are required to write a project report, dissertation or thesis, which will be the largest piece of academic work they undertake. Because the writing is not produced in sequential order, it presents new difficulties for them. It may also be the first time they interact with academics acting as supervisors. This paper aims to give both students and supervisors a method for approaching what is often a daunting writing task. The process of visualising the structure of the project report has proved helpful in early discussions with students. In addition, group discussions of project reports can both enable students to address their concerns and save supervisors valuable time. The supervisor acts as facilitator, introducing a structured approach to writing and enabling students to adapt it to their projects. Integrating the dimensions of projects, including time, writing and conceptualisation, helps students to develop an understanding of the type of writing that will be involved throughout the project process. It enables them to begin writing at an early stage in the project.

A United Kingdom survey of physiotherapists involvement in cardiac rehabilitation and their perceived skills and attributes

Abstract Purpose The aim was to establish the provision of physiotherapists in the United Kingdom in cardiac rehabilitation and the perceived skills and attributes required in the delivery of cardiac rehabilitation, using a survey tool devised by a local clinical interest group. Background In the United Kingdom, the grades and provision of physiotherapists involved in the delivery of cardiac rehabilitation has not been fully established. Furthermore, unlike other countries the common and specialist tasks, including skills and attributes of each member of cardiac rehabilitation teams, have not been defined. Method A focus group, made up of members of the West of Scotland Cardiac Rehabilitation Clinical Effectiveness Group, was established to design a survey tool. The characteristics and demographic information of the physiotherapist formed the first part of the survey tool. The second part included 54 questions in four sections, addressing general, professional, exercise and measurement questions pertaining to physiotherapists skills and attributes. The survey was piloted and then sent to all registered centres in the British Association for Cardiac Rehabilitation and the Scottish Cardiac Rehabilitation Interest Group data bases. A total of 292 cardiac rehabilitation centres were identified and surveyed. Results There were 198 responses, giving a response rate of 67.8%. A small number of responses came from other health professionals and these were not included in the analysis. A total of 188 responses were therefore included in the final analysis. Those in the static posts numbered 157 (83.5%), while 24 (12.8%) were in rotational posts. There were seven (3.7%) non-responses. The majority, 148 (78.7%) were at Senior I grade and above. Of the hours involved in cardiac rehabilitation delivery, 134 (71.3%) physiotherapists provided less than 18h per week. The mean number of years involved in cardiac rehabilitation was 5 years. The majority of involvement was 83% in the outpatient phase III component of cardiac rehabilitation. Twenty-nine of the 54 listed criteria were rated as either essential or important. Conclusions The findings from this survey provide a picture of the grades and levels of involvement of physiotherapists in cardiac rehabilitation. The majority of physiotherapists were Senior I and above grades and were involved in phase III. The exercise component of risk stratification, prescription, delivery, referral and continuous professional development, were perceived as the main requirements of cardiac rehabilitation physiotherapists.

A Medical Humanities Roadshow: ‘Spreading the Word’

Summary This paper, written jointly by a physiotherapist and a non-physiotherapist, describes a touring Medical Humanities Roadshow (Scotland and Ireland). Medical humanities is an approach using literary texts on medical subjects to stimulate discussion among health professionals. The aim of the roadshow was to spread this approach beyond an established group in Glasgow and to assess the effectiveness of the roadshow as a method of doing this. We provide an outline of a medical humanities discussion, for those who may be interested in trying out this approach. Responses to medical humanities at the different venues are summarised; all were positive and enthusiastic. All participants found their first experience of medical humanities stimulating and enjoyable. Physiotherapists in education considered medical humanities in the undergraduate curriculum, or for personal reading, or for in-service education. Specific applications of medical humanities in physiotherapy are suggested. The question of who should lead the group — physiotherapist or literary expert — is also considered, from the point of view of both authors. In conclusion, this paper argues that there is interest in medical humanities across a variety of locations and institutions; the next challenge will be to assess how it affects practice.

Non-cardiac Conditions and Physiotherapy in Phase III Cardiac Rehabilitation Exercise Programmes

Summary Purpose The West of Scotland Cardiac Rehabilitation Clinical Effectiveness Group set out to establish the type of non-cardiac conditions and physiotherapy interventions by physiotherapists in the exercise component of phase III cardiac rehabilitation. Background In the United Kingdom the functions and roles of members of cardiac rehabilitation teams have not been investigated or defined fully. Guidelines in Australia have more clearly defined the roles and educational needs of team members. In addition to assessing and prescribing the exercise component of cardiac rehabilitation, the Australian guidelines for cardiac rehabilitation ( Goble and Worcester, 1999) identify a physiotherapist key role to assess musculoskeletal, physical needs and problems of patients within cardiac rehabilitation. They do not provide data on the demands this makes on physiotherapists in terms of specific conditions and interventions. Methods A focus group was established identifying the non-cardiac medical conditions with which patients most frequently presented and the physiotherapy interventions for these conditions. A survey tool was designed and distributed to the eight centres taking part in the study. There were ten identified categories of non-cardiac conditions encountered in phase III cardiac rehabilitation and seven interventions for these conditions. Results Of the 657 patients at the eight centres, 701 interventions were given for the ten identified non-cardiac conditions. The three centres with less than one full-time equivalent physiotherapist predominately used only adaptation of exercise or advised patients on how to participate in the cardiac rehabilitation exercise programmes. Conclusions The findings from this small survey indicate that physiotherapists play a considerable role in assessing and managing the non-cardiac conditions of many patients at this stage of their rehabilitation. This includes assessment of non-cardiac symptoms and intervention.

An investigation into the Possible Effect of Music on the Perception of Effort and Mood During Aerobic Type Exercise

The current trend in physiotherapy towards encouraging both symptomatic and apparently normal individuals to participate in regular aerobic exercise continues to increase. Areas of therapy intervention may include rehabilitation of cardiac and respiratory patients, health related benefita in poet-natal and ante-natal care, weight reduction, primary prevention of coronary heart disease and enhancement of aerobic fitness.

Assessment and Rehabilitation of Patients with Chronic Low Back Pain

Barbara Richardson MSC M C s p DipTp physiotherapy activities and guide practice, research and education today. The need to enable consolidation and development of an exclusive physiotherapy theory which The current reforms in health care are encouraging a can both extend and determine the limits of practice is competitive market economy of both services and discussed. Paradigm studies in this country and personnel. Physiotherapists must be able to respond with elsewhere are considered and ways through which the confidence to the changing demands on their skills and diverse activities of the profession may become more the changing contexts in which they must carry them co-ordinated. Out. Above they must be to defend a strong It is suggested that the critical stance of a reflective and coherent professional profile of expertise within the practitioner, adopted by all members of the profession, multidisciplinary team. is called for to help unravel crucial elements of the This paper explores the concept of paradigm as a unique mode of thinking and acting which is common theoretical framework which may help to express and in professional approaches taken to identify and solve evaluate the fundamental beliefs which underpin physiotherapy problems.