S. Deborah Lucy

Reliability of the six-minute walk test in people with fibromyalgia.

OBJECTIVE To determine the test-retest reliability of the 6-minute walk test in people with fibromyalgia. METHODS Twenty-six subjects (27-59 years of age) performed 3 walk tests over consecutive days before and after a 4-week treatment program. Reliability was determined using a one-way repeated measures analysis of variance and the intraclass correlation coefficient (ICC2,1). RESULTS Reliability of the 6-minute walk test was excellent both at program intake (ICC2,1 = 0.91) and program completion (ICC2,1 = 0.98). On program intake, significant differences (P < 0.01) were found between test 1 (478 +/- 61 m) and test 2 (492 +/- 57 m), and between test 1 and test 3 (495 +/- 60 m). On program completion, there were no significant differences across the 3 replicate tests (507 m, 505 m, and 509 m). CONCLUSIONS The 6-minute walk test is a reliable measure in people with fibromyalgia. In this study, two trials were required to achieve a stable walk performance before a treatment program. This learning effect was not present following the intervention.

Pronounced increase in defibrillation threshold associated with pacing-induced cardiomyopathy in the dog

Progressive changes in myopathology after implantation of an automatic defibrillator could compromise device efficacy. The influence of heart failure development on the defibrillation threshold was evaluated by means of a rapid ventricular pacing model of heart failure in dogs. After transvenous pacemaker lead implantation, adult mongrel dogs were randomly assigned to either the control (n = 7) or rapidly paced group (240 beats/min, n = 6). Seventeen days after implantation, triplicate determinations of the defibrillation threshold were made with three epicardial electrodes. The average defibrillation threshold was four times higher in the rapidly paced group, 13.3 +/- 2.0 joules (mean +/- SEM), than in the control group, 3.3 +/- 0.7 joules (p < 0.01), and was significantly correlated with ventricular weight (r = 0.70, p < 0.01). Both defibrillation threshold energy per gram of ventricle and ventricular weight corrected for body weight were significantly higher in rapidly paced dogs compared with control dogs. It was concluded that myocardial hypertrophy and heart failure may profoundly increase defibrillation energy requirements.

Understanding the Professional Socialization of Canadian Physical Therapy Students: A Qualitative Investigation

PURPOSE To understand the professional socialization of physical therapy (PT) students. METHOD Forty-two students enrolled in our newly developed masters degree programme wrote three-page reflective journals on a critical learning incident after each of three selected clinical experiences. The journals were coded and analyzed, and major themes were identified and described. A separate cohort of 44 students participated in focus groups after the same three clinical experiences to check the trustworthiness of the results. RESULTS Following the first placement, the main themes coded were emotions, self-confidence, professionalism in the real world, communication, and learning by doing. After the intermediate placement, major themes were idealism versus realism, depth of communication with clients, and breadth of communication with family members and colleagues. Aspects of clinical learning were variable, and self-confidence remained an issue. After the final placement, most students were deeply engaged with their clients and self-confidence had developed to the point of self-efficacy. Tensions increased between the concept of ideal practice and the pragmatics of actual practice, and the concept of self as protégé (rather than as object of the supervisors evaluation) emerged. The themes were subsequently assembled in a booklet with representative quotations. CONCLUSION These results contribute to foundational knowledge required by PT educators, including clinical instructors, by explicitly describing the professional socialization of PT students.

Physical Therapy Management for Adult Patients Undergoing Cardiac Surgery: A Canadian Practice Survey

PURPOSE To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery. METHODS A telephone survey was conducted of a selected sample (n=18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery. RESULTS An average of 21 cardiac surgeries per week (range: 6-42) were performed, with an average length of stay of 6.4 days (range: 4.0-10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50-120 m per session 2-5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb. CONCLUSIONS Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required.

Body position and cardiac dynamic and chronotropic responses to steady-state isocapnic hypoxaemia in humans.

Neural mediation of the human cardiac response to isocapnic (IC) steady‐state hypoxaemia was investigated using coarse‐graining spectral analysis of heart rate variability (HRV). Six young adults were exposed in random order to a hypoxia or control protocol, in supine and sitting postures, while end‐tidal PCO2 (PET,CO2) was clamped at resting eucapnic levels. An initial 11 min period of euoxia (PET,O2 100 mmHg; 13.3 kPa) was followed by a 22 min exposure to hypoxia (PET,O2 55 mmHg; 7.3 kPa), or continued euoxia (control). Harmonic and fractal powers of HRV were determined for the terminal 400 heart beats in each time period. Ventilation was stimulated (P < 0.05) and cardiac dynamics altered only by exposure to hypoxia. The cardiac interpulse interval was shortened (P < 0.001) similarly during hypoxia in both body positions. Vagally mediated high‐frequency harmonic power (Ph) of HRV was decreased by hypoxia only in the supine position, while the fractal dimension, also linked to cardiac vagal control, was decreased in the sitting position (P < 0.05). However, low‐frequency harmonic power (Pl) and the HRV indicator of sympathetic activity (Pl/Ph) were not altered by hypoxia in either position. These results suggest that, in humans, tachycardia induced by moderate IC hypoxaemia (arterial O2 saturation Sa,O2≈ 85%) was mediated by vagal withdrawal, irrespective of body position and resting autonomic balance, while associated changes in HRV were positionally dependent.

Situating Primary Health Care within the International Classification of Functioning, Disability and Health: Enabling the Canadian Family Health Team Initiative

Primary health care (PHC) mandates the provision of services delivered by a collaborative team of providers, ultimately to improve quality of care and health status. Considering the challenges related to interprofessional collaboration within novel PHC models, we explored how the World Health Organizations (WHO) International Classification of Functioning, Disability and Health (ICF) could facilitate the enactment of PHC teams. The Canadian Family Health Team (FHT) initiative is used as an example. This paper will explore how the ICF could inform the development of a practice model to enable PHC. Three potential barriers to the envisioned enactment of PHC within the espoused Canadian FHT initiative are identified through a critical gaps analysis; lack of (i) philosophical grounding, (ii) developmental and operational directives, and (iii) evaluation methods. An ICF-informed practice model is proposed to overcome these potential barriers. It is argued that the proposed ICF-informed practice model has international implications as a unifying conceptual framework ideally situated to facilitate the provision of comprehensive evidence-based person-centered care by interprofessional collaborative teams within diverse PHC models.

Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners

Abstract The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of “core” PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted “how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management”. The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

Effects of Defibrillation Shocks Delivered Directly Over a Major Coronary Artery

This study investigated the influence of defibrillator shocks delivered directly over a coronary artery, independent of ventricular fibrillation, on cardiac hemodynamics. Thirty‐six open chest, halothane anesthetized pigs were randomized to receive six shocks at one of 5,0, 7.5, or 10.0 joules (J). Shocks were delivered between two mesh electrodes (Medtronic TX‐7) sutured onto the epicardium, one over the left anterior descending coronary artery and the second directly opposite on the posterobasal ventricular surface. Shock delivery was synchronized to the R wave of the cardiac cycle, to reduce the risk of inducing fibrillation, with a 5‐minute stabilization period between successive shocks. Pressure from the left ventricle, the left anterior descending coronary artery, distal to the mesh electrode and the left circumflex (control) artery and contractility in the regions perfused by both arteries were measured. The shocks invariably produced an immediate (2‐second postshock), but transient, depression in systolic pressure of the same magnitude for the left anterior descending coronary artery, circumflex artery and the left ventricle that recovered by 5‐minute postshock. There was no dose dependent relationship to energy. Also there was no clear difference in myocardial wall motion between the area perfused by the left anterior descending coronary artery and that perfused by the circumflex artery. These results suggest that shocks up to 10 J delivered over an epicardial artery do not cause arterial spasm and do not compromise coronary artery blood flow.