Sheila Kitchen

A Review of Low Level Laser Therapy: Part I: Background, Physiological Effects and Hazards

Summary Therapeutic laser is a relatively new method of electrical treatment available to therapists in Great Britain; it has been in use in Eastern Europe, however, for thirty years. Much early work was unsatisfactory, reports often being anecdotal and lacking detail. Recent years have shown a significant increase in the quality and volume of work in this area; the physical behaviour and physiological effects of laser are considered and the possible hazards reviewed in this paper.

Review of Shortwave Diathermy Continuous and Pulsed Patters

Summary Both continuous and pulsed forms of shortwave diathermy (SWD) are used by physiotherapists in the treatment of a range of conditions including soft tissue lesions and the arthritises. The known physiological effects, clinical efficacy and hazards associated with the use of these two forms of SWD are considered and the need for further research both in the field of basic science and clinical application is highlighted.

The effect of dietary supplements on the nPCR in stable hemodialysis patients

OBJECTIVE To investigate whether (1) dietary supplements raise the normalized protein catabolic rate (nPCR) and/or further improve the nutritional status of stable hemodialysis patients who have both a low nPCR and a low dietary protein intake, <1.2 g/kg body weight/day; and if (2) protein intake measured by nPCR reflects protein intake measured by estimated food diaries in stable patients. DESIGN Prospective experimental study with a single intervention group. SETTING Hospital outpatient hemodialysis unit. SUBJECTS Seventeen stable chronic hemodialysis patients (10 men, 7 women) were studied over 8 months. INTERVENTION Subjects with both a low nPCR and dietary protein intake <1.2 g/kg body weight/day received dietary supplements for the first 2 months. Measurements to assess protein intake and nutritional status were taken at baseline and repeated at the end of 2 months, and at 6 months postintervention. MAIN OUTCOME MEASURE nPCR, dietary protein intake using 7-day estimated food diaries, serum urea, serum albumin, serum creatinine, serum bicarbonate, dialysis adequacy (Kt/V), and body mass index (BMI). RESULTS Dietary supplements significantly increased both the nPCR and the total protein intake at 2 months (1.21 +/- 0.26, 1.10 +/- 0.12, respectively) compared with baseline (0.95 +/- 0.18, 0.75 +/- 0.19, respectively) and 8 months (0.99 +/- 0.12, 0.78 +/- 0.21, respectively), P <.0001, respectively. There was no change in the nutritional status of the subjects. There was a significant difference between the nPCR and the dietary protein intake at baseline, P <.004; at 2 months, P <.047; and at 8 months, P <.001. CONCLUSION Dietary supplements can significantly increase the nPCR and dietary protein intake in stable hemodialysis patients with a low nPCR and dietary protein intake. Because a low nPCR is associated with a high morbidity and mortality rate, it may be prudent to supplement such patients. The use of the nPCR to quantify dietary protein intake in stable hemodialysis patients should be used with caution.

Adverse Effects of Electrotherapy Used by Physiotherapists

A system was set up to collect reports of adverse effects on patients receiving electrotherapy from physiotherapists in NHS hospitals in England and Wales. Report cards were circulated to 200 hospital departments and 148 completed forms were returned over an 18-month period. There were reports of local effects such as burns and rashes and increased pain (87); and general effects such as nausea and fainting (98). A number of different agents were implicated but the largest number of reports were related to the use of interferential. These results, though not enough to demonstrate a causal link, are of concern and suggest caution in the use of some agents in vulnerable patients. A small number of patients (5) with neurological conditions reported serious side effects and because of this a survey of 1 in 10 members of the Association of Chartered Physiotherapists with an Interest in Neurology was undertaken. The results showed that members rarely used the physical agents implicated in the reports of adverse effects in this study, and they recommended caution in their use with neurological patients. For patient safety and best practice more information needs to be collected in a systematic way about the occurrence of adverse side effects of electrotherapy used by physiotherapists.

Research, the therapist and the patient

Increasingly, demands are made of and by PAMs (Professions Allied to Medicine) for efficient, effective client-orientated care and for evidence to substantiate practices and claims; evidence which can be obtained through rigorous research and through regular and thorough audit of daily practice. The majority of these professions are now building increasingly solid foundations on which to base their practice. Philosophical issues about research methodology (questions, designs and tools) and the role of the client, policy issues concerning ways in which demands for evidence-based practice can be met and practical issues about dissemination, implementation and finance are discussed. It is concluded that PAMs are increasingly aware of the need for research and that more and better work is being carried out; however, there are still problems (not exclusive to the PAMs) with respect to dissemination and implementation of findings.

Infra-red Therapy

Summary Infra-red therapy has been used in clinical practice for a considerable period of time; there are, however, a limited number of studies which evaluate the efficacy of this modality in the management of clinical conditions. This review considers the physical behaviour, physiological effects, the efficacy and hazards of infra-red therapy.

A Review of Microwave Diathermy

Summary Microwave diathermy has been used in the clinical management of a variety of pathological conditions for about forty years; it has, however, been unpopular for the last twenty years owing to fears concerning its safety. This review looks at the evidence available for the physiological effects of microwave diathermy, its clinical efficacy and the hazards associated with its use.

A life of living death: the experiences of people living with chronic low back pain in rural Nigeria.

Abstract Purpose: This study explored the experiences of people living with non-specific chronic low back pain (CLBP) in a rural Nigerian community. Method: Qualitative in-depth semi-structured face-to-face interviews were conducted with purposively sampled participants until data saturation. Questions explored back pain beliefs, coping/management strategies and daily activities. Thematic analysis of transcripts was performed using the Framework approach. Results: Themes showed that back pain beliefs were related to manual labour/deprivation, infection/degeneration, spiritual/cultural beliefs and rural–urban divide. These beliefs impacted on gender roles resulting in adaptive or maladaptive coping. Adaptive coping was facilitated by positive beliefs, such as not regarding CLBP as an illness, whereas viewing CLBP as illness stimulated maladaptive coping strategies. Spirituality was associated with both adaptive and maladaptive coping. Maladaptive coping strategies led to dissatisfaction with health care in this community. Conclusions: CLBP-related disability in rural Nigeria is strongly influenced by beliefs that facilitate coping strategies that either enhance or inhibit recovery. Interventions should therefore target maladaptive beliefs while emphasizing behavioural modification. Implications for Rehabilitation Non-specific chronic low back pain (CLBP) is highly prevalent and responsible for much pain and disability in rural Nigeria. No qualitative study has investigated the experiences of people living with CLBP in rural Nigeria or any other rural African context. Qualitative study of peoples’ experiences of living with CLBP in rural Nigeria has the potential of exposing complex socio-cultural and psychological factors associated with CLBP which has potential implications for designing effective interventions. The results of this study may inform the development of complex interventions for reducing the disability associated with CLBP in rural Nigeria and other rural African contexts.

A Review of Ultraviolet Radiation Therapy

Summary: Ultraviolet radiation (UVR) has been used for many years in the treatment of both skin diseases and wounds. Much work has been carried out to evaluate its effects in disease. This review considers the physiological effects, hazards and efficacy of UVR for a variety of skin conditions. Biography : Sheila Kitchen qualified as a physiotherapist in 1971. Since then she has practised clinically and then taught for the last 14 years. She is now senior lecturer at Kings College London, and is course co-ordinator for the MSc degree in research methods for remedial therapists being run at the university. She has undertaken the review of literature in the field of electrotherapy as part of the research programme of the Centre for Physiotherapy Research. Cecily Partridge is a reader in physiotherapy and director of the Centre for Physiotherapy Research, Kings College London. She worked in clinical practice for many years but has been in full-time research since 1975. Her research interests include community physiotherapy, recovery from disability and the measurement and evaluation of practice in physiotherapy.

Identification of stair climbing ability levels in community-dwelling older adults based on the geometric mean of stair ascent and descent speed: The GeMSS classifier.

The aim was to develop a quantitative approach to identify three stair-climbing ability levels of older adults: no, somewhat and considerable difficulty. Timed-up-and-go test, six-minute-walk test, and Berg balance scale were used for statistical comparison to a new stair climbing ability classifier based on the geometric mean of stair speeds (GeMSS) in ascent and descent on a flight of eight stairs with a 28° pitch in the housing unit where the participants, 28 (16 women) urban older adults (62-94 years), lived. Ordinal logistic regression revealed the thresholds between the three ability levels for each functional test were more stringent than thresholds found in the literature to classify walking ability levels. Though a small study, the intermediate classifier shows promise of early identification of difficulties with stairs, in order to make timely preventative interventions. Further studies are necessary to obtain scaling factors for stairs with other pitches.