The impact of staffing model in a 6-day rehabilitation physiotherapy service.

BACKGROUND AND PURPOSE: The impact of staffing model providing weekend physiotherapy rehabilitation has not been evaluated. This study aims to determine the impact of staffing a weekend rehabilitation service with physiotherapists currently working in rehabilitation compared to acute hospital physiotherapists, on length of stay (LOS), functional independence and gait and balance, and to determine the impact on neurological, orthopaedic, and reconditioning diagnostic groups. METHODS: A prospective cohort study with historical control was completed in a private, metropolitan Australian rehabilitation unit. All participants admitted to the rehabilitation unit over two, 20-week periods in 2011 and 2012 were included. Weekend physiotherapy was provided by physiotherapists working in rehabilitation in 2012 (intervention) and physiotherapists working in the acute wards in 2011 (control). Outcomes included LOS, Functional Independence Measure (FIM), and gait and balance measures. RESULTS: Overall, there were 504 participants; 234 in 2012 and 270 in 2011. No difference was found in LOS between staffing models (mean difference-1.5 days, 95%CI -4.4 to 1.3). Greater FIM change (mean difference 3.5, 95%CI 0.3 to 6.7) and efficiency (FIM change/LOS: mean difference 0.3, 95%CI 0.1 to 0.5) were found with rehabilitation compared to acute staffing. There was no between-group difference in gait or balance performance. When diagnostic groups were compared, no difference in LOS was found between staffing models. Participants with an orthopaedic diagnosis had a significantly greater FIM change (mean difference 3.8, 95%CI 0.4 to 7.1), whereas FIM efficiency was improved in neurological (mean difference 0.4, 95%CI 0.1 to 0.7) and orthopaedic populations (mean difference 0.3, 95%CI 0.03 to 0.5) with rehabilitation staffing. DISCUSSION: Staffing a weekend rehabilitation service with physiotherapists currently working in rehabilitation influences functional independence. Different diagnostic groups appear to respond differently.

Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations.

OBJECTIVE: The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial. METHODOLOGY: Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n=18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy. RESULTS: No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively. CONCLUSIONS: The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.

A systematic review of axillary web syndrome (AWS).

INTRODUCTION: Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes. METHODS: Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken. RESULTS: Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction. CONCLUSIONS: AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.

Walking Activity of Older Patients in Rehabilitation: A Prospective Study.

OBJECTIVES: To quantify, using accelerometry, walking activity of older rehabilitation inpatients and to examine the relationship between walking activity and functional outcomes. DESIGN: Prospective cohort study. SETTING: Inpatient geriatric rehabilitation unit. PARTICIPANTS: Of 74 consecutive eligible patients, aged 60 years or older and able to walk independently or with assistance, 60 participants (32 males, 28 females) with a mean (SD) length of stay of 37 (26) days completed the study. Intervention Measures: An accelerometer was worn in daytime hours from study recruitment until discharge to monitor daily walking minutes. RESULTS: On study entry, patients spent a median (IQR) of 33 (20 to 48) minutes (7%) of the daily monitored eight hour period walking. By discharge, this had increased to 43 (30 to 56) minutes (9%) (p< 0.001). Average daily walking activity over the week prior to discharge correlated with change in gait speed from admission to discharge (p<0.05). Walking activity prior to discharge was significantly different (p<0.05) between the slowest gait speed group (≤0.4 m/s) and the fastest gait speed group (≥0.8 m/s). Those with discharge gait speeds ≥0.8 m/s (associated with ability to be ambulant in the community) had median (IQR) daily walking times at discharge of 51 (33 to 78) minutes. CONCLUSION: Activity monitoring has the potential to assist clinicians and patients set goals around activity levels to achieve better outcomes.