ABSTRACT
Background: Musculoskeletal conditions such as spinal pain and osteoarthritis are among the leading causes of years lived with disability worldwide. With the COVID-19 pandemic forcing many healthcare providers to change the way in which care for chronic conditions is delivered, telehealth is an alternative to face-to-face consultations that can be used for both assessment and provision of therapy and support. Objectives: To identify, appraise and synthesise findings from all randomised controlled trials (RCTs) that compared telehealth to face-to-face consultations for patients with any type of musculoskeletal condition. Methods: Systematic review and meta-analysis. We used the GRADE approach to assess the quality of evidence related to all outcomes. We searched three electronic databases (PubMed, Embase, CENTRAL), clinical trial registries and citing-cited references of included studies. Results: Five RCTs were includable: one in patients with osteoarthritis of the knee, one in patients with osteoarthritis of the knee or hip in preparation for a total joint arthroscopy and three after total knee replacement. Telehealth was conducted by video in four trials and by phone in one. A total of 402 participants were analysed across the five trials. There were no significant differences in pain outcomes (WOMAC) between telehealth and face-to-face therapy immediate post-intervention (mean difference (MD): 0.12 (95% CI −2.3 to 2.6, p =.92) or two months post-intervention (MD): 1.2, (95% CI: −2.7 to 5.1, p =.55). Similarly, outcomes related to function, quality of life and satisfaction were comparable between the two modes of delivery immediate post-intervention, with no significant differences reported. Conclusion: There is limited low quality evidence that there is no significant differences between telehealth-based delivery of rehabilitation to patients with osteoarthritis or following knee surgery and face-to-face therapy for pain, function, quality of life and satisfaction. These findings should be should be interpreted with caution due to the small number of included studies and small sample size. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Background: The COVID-19 pandemic has forced the introduction of many changes into medical student education. The aim of the study was to evaluate medical students’ perceptions of a Pharmacology course delivered at a Polish medical university before and during the pandemic. Materials and methods: A cross-sectional anonymous survey conducted among medical students. Results: 90 out 122 students participated in the study. The vast majority of students found pharmacology to be a difficult subject. The surveyed group of students preferred active methods of learning, including: teacher explanations (86.5%) and discussions (70.8%) during in-person classes, real-time student-teacher meetings via dedicated web-based platforms (73%) during online classes. Students most often described e-learning as interesting (58.9%) and timesaving (52.2%). Less than 30% described it as stressful, difficult, time-consuming and boring. The most commonly reported advantage was the possibility for students to adjust their pharmacology study-time to a more personalised schedule (82.5%). The main disadvantage included the loss of in-person face-to-face contact with the teacher (61.8%). Conclusions: Overall, students held positive attitudes towards the new teaching format and adapted well to the new conditions. Modern innovations enabling medical students to continue their studies efficiently and effectively during the pandemic must be developed and introduced into practice. Copyright ® Medical University of Gdańsk
ABSTRACT
Objective: We conducted a survey to understand the challenges faced by the staff of residential aged care facilities (RACF), during the COVID-19 pandemic. Background: In the current pandemic, the RACF workforce has been required to work under stressful conditions, with immense mental and physical pressures, resulting in anxiety and stress felt towards their jobs. Study design and methods: We electronically surveyed both clinical and non-clinical staff at public and private RACFs in Australia in June and August 2020. The survey asked a mix of openended and closed questions about preparedness for the pandemic, information flow, experience with personal protective equipment (PPE), management of suspected COVID cases, restrictions on visitors, and impact on RACF staff personal and home life. Quantitative data were analysed in SPSS;qualitative data using content analysis. Results: We received 371 responses: 198 from clinical staff and 168 from non-clinical staff. Respondents were between 20-71 years old, and 87% were female most commonly from Victoria (28%) or New South Wales (28%). The majority (80%) felt that Australian RACFs were well-prepared for the pandemic and 87% agreed that relevant healthcare authorities were contactable for information needed. A total of 37% reported challenges in estimating and ordering appropriate quantities of protective equipment. Ninety percent of facilities reported screening residents for possible symptoms and 77% introduced precautions or quarantine measures to protect residents. Most participants (98%) reported their RACF implemented restrictions on visitor access and 43% reported unfair or abusive treatment by family or friends of the residents. Commonly reported personal impacts included: workload increase, stress, emotional toll, family issues and fatigue. Support from colleagues as well as training, de-brief sessions and frequent meetings were identified as helpful facilitators during this time. Conclusion: We identified a wide range of practices and coping strategies among Australian RACFs. Whilst a majority of respondents reported coping well, a large proportion reported struggling both mentally and physically. Factors reported as helpful by the respondents may assist RACFs in planning for future pandemics. Implications for research, policy and practice: Understanding the challenges faced by all levels of staff within RACFs may aid decision-makers on a range of different levels - researchers, aged care providers, local/regional/state health departments and national leaders within government to help inform the development of interventions that may help the sector to recover, as well as prepare for potential future outbreaks. Of particular importance, are interventions or initiatives that focus on supporting the physical and mental health of staff i.e. those that prevent or minimise worker fatigue, emotional burnout and stress. What is already known about the topic? Nursing staff in Australian RACFs did not feel prepared for the COVID outbreak in their workplace. Early in 2020, RACF nurses experienced a greater overall workload and some had their staff hours reduced by their employers due to financial constraints caused by the outbreak. What this paper adds This paper offers a comprehensive insight into how RACF staff coped both individually and as part of the facility overall during the COVID crisis. It identified that a commonly reported source of stress was first-hand verbal abuse from family or friends of residents in response to visitor and lockdown restrictions implemented by the authorities. The paper highlighted that whilst the majority of respondents felt that RACFs were well prepared for managing residents during the pandemic, some facilities experienced significant problems with workloads, PPE and human resourcing. Furthermore, the survey showed that on an individual level, some staff experienced significant mental and physical stress during the outbreak.