Efeito do treinamento proprioceptivo no equilíbrio de atletas de ginástica rítmica / Effect of proprioceptive training on balance of rhythmic gymnastics athletes / Efecto del entrenamiento propioceptivo en el equilibrio de atletas de gimnasia rítmica

INTRODUÇÃO: A ginástica rítmica (GR) é uma modalidade esportiva que combina arte a gestos biomecânicos de alta complexidade, que requer alto nível de desenvolvimento de qualidades físicas como: agilidade, flexibilidade, força, impulsão e destreza. Nessa modalidade, estudos comprovam que as lesões mais frequentes ocorrem nas articulações do joelho e tornozelo e, em alguns casos, nas extremidades do punho, sendo os entorses as mais registradas, principalmente em atletas de nível de competição. Diante disso, a propriocepção e o controle muscular possuem papel fundamental na estabilidade articular dinâmica, já que após lesões ortopédicas algumas características sensório-motoras são alteradas e devem ser o foco de programas de reabilitação para que se obtenha melhor retorno às atividades como antes da lesão. OBJETIVO: Avaliar o efeito do treinamento proprioceptivo sobre o equilíbrio postural de atletas de ginástica rítmica, a partir da utilização da plataforma de força. MÉTODOS: Foi realizado um treinamento proprioceptivo no período de 2 meses, subdividido em três fases, com progressão da complexidade dos exercícios a cada fase de treinamento. RESULTADOS: Podemos observar que houve uma melhora significativa dos resultados da última fase do treinamento, quando foram utilizados exercícios de maior complexidade e agilidade, de acordo com o protocolo. CONCLUSÃO: Por se tratarem de atletas de GR de alto desempenho e apresentarem predomínio de atividades em apoio unipodal, os protocolos de propriocepção devem ser mais intensos, gerando um maior nível de perturbações e desequilíbrios posturais. .

INTRODUCTION: Rhythmic gymnastics (RG) is a sport that combines art with biomechanical gestures of high complexity, which requires a high level of development of physical qualities such as agility, flexibility, strength, impulsion and dexterity. In this modality, studies show that the most frequent injuries occur in the knee and ankle joints, and in some cases in the ends of the wrist, being the sprains the most frequently recorded in competition level athletes. Therefore, proprioception and muscle control play a fundamental role in dynamic joint stability, since after some orthopedic injuries the sensorimotor characteristics are altered and should be the focus of rehabilitation programs in order to obtain the better return, as before the injury. OBJECTIVE: Evaluate the effect of proprioceptive training on postural balance of rhythmic gymnastics athletes through the use of a force platform. METHODS: Proprioceptive training was conducted during 2 months, in three stages, with progression of the complexity of the exercises in each training phase. RESULTS: We observed that there was a significant improvement in the results over the last phase of training when exercises of greater complexity and agility were used, according to the protocol. CONCLUSION: Because these athletes practice rhythmic gymnastics of high performance and predominance of activities on one-foot stance, the protocols should be more intense, generating a higher level of disturbance and postural imbalances. .

INTRODUCCIÓN: La gimnasia rítmica (RG) es un deporte que combina el arte con gestos biomecánicos de alta complejidad, que requiere un alto nivel de desarrollo de las cualidades físicas como la agilidad, flexibilidad, fuerza, impulsión y destreza. En esta modalidad los estudios muestran que las lesiones más frecuentes se producen en las articulaciones de la rodilla y del tobillo, y en algunos casos en los extremos de la muñeca, siendo los esguinces los registrados con mayor frecuencia en los atletas de nivel de competencia. Por lo tanto, la propiocepción y el control muscular juegan un papel fundamental en la estabilidad dinámica de la articulación, ya que después de algunas lesiones ortopédicas las características sensoriomotoras son alteradas y deben ser el foco de los programas de rehabilitación con el fin de obtener un mejor retorno a las actividades como eran antes de la lesión. OBJETIVO: Evaluar el efecto del entrenamiento propioceptivo sobre el equilibrio postural de los atletas de gimnasia rítmica, utilizando una plataforma de fuerza. MÉTODOS: El entrenamiento propioceptivo se llevó a cabo durante 2 meses, en tres etapas, con la progresión de la complejidad de los ejercicios en cada fase de entrenamiento.. RESULTADOS: Se observó que hubo una mejora significativa en los resultados de la última fase del entrenamiento cuando se utilizaron ejercicios de mayor complejidad y agilidad, de acuerdo con el protocolo. CONCLUSIÓN: Debido a que estos atletas practican gimnasia rítmica de alto rendimiento y predominio de actividades en la postura de un pie, los protocolos deberían ser más intensos, generando un mayor nivel de perturbación y los desequilibrios posturales. .

Ethical conflicts with hospitals: the perspective of nurses and physicians.

Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question 'What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?' We interviewed 34 registered nurses, 10 nurse managers, and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians.

Barriers and facilitators to consulting hospital clinical ethics committees.

Hospitals in many countries have had clinical ethics committees for over 20 years. Despite this, there has been little research to evaluate these committees and growing evidence that they are underutilized. To address this gap, we investigated the question 'What are the barriers and facilitators nurses and physicians perceive in consulting their hospital ethics committee?' Thirty-four nurses, 10 nurse managers and 31 physicians working at four Canadian hospitals were interviewed using a semi-structured interview guide as part of a larger investigation. We used content analysis of the interview data related to barriers and facilitators to use of hospital ethics committees to identify nine categories of barriers and nine categories of facilitators. These categories as well as their subcategories are discussed and those specific to nurses or physicians are identified. The need to increase health professionals' use of clinical ethics committees through reducing barriers and maximizing facilitators is discussed.

The functioning of hospital ethics committees: a multiple-case study of four Canadian committees.

A multiple-case study of four hospital ethics committees in Canada was conducted and data collected included interviews with key informants, observation of committee meetings and ethics-related hospital documents, such as policies and committee minutes. We compared the hospital committees in terms of their structure, functioning and perceptions of key informants and found variation in the dimensions of empowerment, organizational culture of ethics, breadth of ethics mandate, achievements, dynamism, and expertise.

Care of self - care by other - care of other: the meaning of self-care from research, practice, policy and industry perspectives.

BACKGROUND: Currently, no single definition of self-care is broadly accepted in the literature. Definitions vary as to (i) who engages in self-care behaviour; (ii) what motivates self-care behaviours; and (iii) the extent to which healthcare professionals are involved. Perspectives of self-care differ between healthcare professionals and the general public, and between healthcare professionals in different disciplines and different roles. As different professions view self-care within their own domain of practice, we are left with a multitude of explanations and descriptions. This variety of conceptualisations does impact and complicate research on self-care. As part of a larger enquiry focused on the clarification of this complex concept, this study provides a content analysis of documented definitions of self-care, and a summary of the evolution of the definition of self-care over time. OBJECTIVES: To examine the diversity of definitions of self-care from the perspectives of research, practice, policy and industry, and to identify themes or trends in the evolution of the definition of self-care over time. SEARCH STRATEGY: The search strategy was designed in consultation with a library scientist to find both published and unpublished papers. A three-step search strategy was used to locate the literature. The databases searched included CINAHL, Medline, EMBASE, PsycINFO, AMED, Cochrane Library, Scirus and Mednar. DATA COLLECTION AND ANALYSIS: The definition of self-care was extracted from each paper included in the study. Using an inductive process, a content analysis was performed identifying common terms and phrases from the definitions. The definitions were then divided into four decades, 1970s, 1980s, 1990s and 2000s, and the evolution of the definition of self-care was examined. RESULTS AND CONCLUSIONS: In this study we sought to clarify the concept of self-care by examining in detail the definition of self-care. Content analysis of 139 definitions identified seven components of the definition and a range of terms that were applicable to each component. Evolution of the definition over time showed a more expansive definition by the end of the 2000s. Current and evolving definitions of self-care would benefit by being comprehensive and encompassing as many facets of the concept as possible. IMPLICATIONS FOR PRACTICE: Healthcare professionals assess, guide, instruct and support individuals as they initiate or engage in self-care. Using a comprehensive definition of self-care would provide an anchor linking each discipline as they interact not only with the individual but also among themselves. IMPLICATIONS FOR RESEARCH: The concept of self-care is a many-layered one. Identifying the components in the definition of the term delineates the different areas for potential research in this area. When planning a research project, the definition of the key concept guides the research and shapes the approach to the investigation. For researchers in this area, this study illustrates the wealth and diversity of the definitions of self-care.

Clinical ethical conflicts of nurses and physicians.

Much of the literature on clinical ethical conflict has been specific to a specialty area or a particular patient group, as well as to a single profession. This study identifies themes of hospital nurses' and physicians' clinical ethical conflicts that cut across the spectrum of clinical specialty areas, and compares the themes identified by nurses with those identified by physicians. We interviewed 34 clinical nurses, 10 nurse managers and 31 physicians working at four different Canadian hospitals as part of a larger study on clinical ethics committees and nurses' and physicians' use of these committees. We describe nine themes of clinical ethical conflict that were common to both hospital nurses and physicians, and three themes that were specific to physicians. Following this, we suggest reasons for differences in nurses' and physicians' ethical conflicts and discuss implications for practice and research.

Community leg ulcer bandaging study: lessons learned in a pilot, randomized controlled trial .

Compression is the cornerstone of venous leg ulcer (VLU) care but comparative effectiveness evidence is limited, especially regarding home care. In preparation for a large, community-based randomized controlled clinical trial (RCT), the "Canadian Bandaging Trial" (CBT), a pilot study was conducted to assess the practicality of the CBT study protocol. Nurses who provided home care also performed the research intervention and outcome measurements. All trial procedures were implemented to examine the following aspects of the study protocol: 1) eligibility screening, recruitment, enrollment, and randomization procedures; 2) integration of intervention protocol with usual clinical routines; 3) data collection and management and outcome measures; and 4) database creation and testing. Guided by a Pilot Research Process Framework (PReP), this 6-month pilot RCT was conducted at two community-based sites in Ontario, Canada. Participants included 12 persons with VLUs, 40 nurses providing leg ulcer care, and two site investigators. Individuals with a VLU were randomized to a four-layer or short-stretch compression bandage. Eligibility screening and randomization procedures were found to be efficient but the ratio of screened (49) versus enrolled (12) patients was low and suggested the need for nine additional clinical sites, a change in ulcer size eligibility, and research to evaluate how to incorporate persons with diabetes in leg ulcer trials. Screening practices, data collection form concerns, and wound photo assessment outcomes issues were addressed. The results of this study improved and streamlined the large RCT quality and processes and confirm the value of pilot studies. Research to test the usefulness of the PReP framework for other pilot studies is needed.

Evolution of hospital clinical ethics committees in Canada.

To investigate the current status of hospital clinical ethics committees (CEC) and how they have evolved in Canada over the past 20 years, this paper presents an overview of the findings from a 2008 survey and compares these findings with two previous Canadian surveys conducted in 1989 and 1984. All Canadian hospitals over 100 beds, of which at least some were acute care, were surveyed to determine the structure of CEC, how they function, the perceived achievements of these committees and opinions about areas with which CEC should be involved. The percentage of hospitals with CEC in our sample was found to be 85% compared with 58% and 18% in 1989 and 1984, respectively. The wide variation in the size of committees and the composition of their membership has continued. Meetings of CEC have become more regularised and formalised over time. CEC continue to be predominately advisory in their nature, and by 2008 there was a shift in the priority of the activities of CEC to meeting ethics education needs and providing counselling and support with less emphasis on advising about policy and procedures. More research is needed on how best to define what the scope of activities of CEC should be in order to meet the needs of hospitals in Canada and elsewhere. More research also is needed on the actual outcomes to patients, families, health professionals and organisations from the work of these committees in order to support the considerable time committee members devote to this endeavour.

The experience of self-care: a systematic review.

BACKGROUND: Self-care has been defined quite simply as "the set of activities in which one engages throughout life on a daily basis." Examining this 'set of activities' more closely, we see that a number of activities encompass "a person's attempts to promote optimal health, prevent illness, detect symptoms at an early date, and manage chronic illness." Hence, engaging in self-care activities may result in a range of different experiences depending on the set of activities that are performed and the reasons for their undertaking. OBJECTIVES: To integrate and summarize the experience of engaging in self-care activities as reported by individuals and /or their families. INCLUSION CRITERIA: Types of Studies - Qualitative studies included, but were not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.Types of Participants - Individuals and/or their families who engaged in self-care activities, or were assisted with their self-care activities, or provided support for self-care.Types of Interventions - Individual experiences of self-care in response to an intervention or where no intervention was introduced.Types of Outcomes - Individual experiences of self-care through self-report. Reports from family members who assisted or provided support for self-care were included. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies (e.g., theses). A three-step search strategy was used in each component of this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies. The databases searched included: CINAHL; MEDLINE; EMBASE; PsycINFO; AMED; Cochrane Library; Scirus; and Mednar METHODOLOGICAL QUALITY: Methodological quality of the studies was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument Critical Appraisal Checklist for Interpretive & Critical Research. Two appraisers independently reviewed each study. DATA COLLECTION AND ANALYSIS: Qualitative data were extracted from included studies using an adaptation of the standardized JBI Data Extraction Tool for Qualitative Evidence. DATA SYNTHESIS: The data were synthesized using narrative form. RESULTS AND CONCLUSIONS: Engaging in self-care is a process involving being aware of self, acquiring knowledge and taking responsibility for meeting needs at whatever level they are presented. The performance of self-care behaviours can be influenced both positively and negatively by the attitudes of others. Throughout life, the purpose for performing self-care differs and individuals face challenges that interfere with their ability to master these self-care behaviours. Individuals who are able to find symbolic meaning in the disease/disability or reframe the implications positively are more capable of adapting and maintaining their focus on caring for themselves. Studies revealed that individuals may abandon self-care when overwhelmed by symptoms or disability and/or when they feel that they are not supported. IMPLICATIONS FOR PRACTICE: It is valuable for health care professionals to understand the struggle that individuals experience when trying to engage in self-care. Furthermore, health care professionals need to be cognizant of how important their support is, in terms of encouraging individuals to adopt and maintain self-care behaviours. IMPLICATIONS FOR RESEARCH: This review has provided an insight into the process of engaging in self-care through the different developmental stages of life, as well as the adoption of self-care behaviours to meet different requisites. Further research would be valuable to integrate the range of health care interventions provided to individuals across different disability or disease groupings who engage in self-care activities.

Intervention strategies that support self-care activities: an integrative study across disease/impairment groupings.

BACKGROUND: The incidence of chronic disease and people with complex chronic medical needs is increasing worldwide. Self-care is an important element for these individuals and can pose challenges both to the recipients and providers of care. Health care professionals seeking evidence on how best to support self-care face challenges finding this research. As a care concept it is typically dealt with clinically and studied relative to specific conditions. The Cochrane Database of Systematic Reviews reports on research across 52 different disease/impairment groupings, with many systematic reviews presenting inconclusive results. Although individual reviews may not offer as much evidence as hoped, it is possible that by synthesizing evidence from multiple reviews that further knowledge and direction about the supportive care professionals can provide for self-care can be found and made available to inform practice. OBJECTIVE: To explore and evaluate the evidence on self-care interventions through a cross-cutting, integrative study. INCLUSION CRITERIA: Types of studies: All systematic reviews contained within the Cochrane Database of Systematic Reviews. TYPES OF PARTICIPANTS: Participants who were either recently diagnosed with, or currently living with, a disease, disability or impairment. No age stipulation was applied.Types of interventions: Interventions focused on initiating, supporting or enhancing self-care activities.Types of outcomes: The successful engagement of the individual in self-care activities; the sustainment of self-care activities; health outcomes or health care services utilization. SEARCH STRATEGIES: The search strategy was designed to find all systematic reviews contained within the Cochrane Database of Systematic Reviews that addressed interventions to initiate or enhance self-care. The Cochrane Library was searched directly though Wiley and through the OVID interface. Keywords and index terms were harvested from key reviews and a second round of searching was performed. METHODS OF THE REVIEW: Inclusion criteria: Inclusion criteria were guided by Orem's Theory of Self-Care. Reviews were included that addressed health deviation self-care requisites which refer to changes in self-care activities to regulate the effects of deviation from normal structure or function. INTERVENTIONS: Interventions were examined within the context of knowledge translation, using the Knowledge-to-Action framework by Graham and colleagues. Interventions were grouped into one of two sections in the framework: a) the adaptation to a specific population, or b) the sustainment of knowledge use. OUTCOMES: Outcomes were classified according to the Knowledge Use and Impact framework by Graham and colleagues. This framework categorizes outcomes in terms of what is being measured (knowledge; use of knowledge) as well as the impact of the use of that knowledge (patient/ individual; provider or system outcomes).Assessment of methodological quality: Methodological quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. A cut-off point of 7/10 was established. DATA EXTRACTION: Data were extracted from the systematic reviews using an adaptation of the standardized data extraction form, the JBI Data Extraction Form for Systematic Review of experimental/ Observational Studies. DATA SYNTHESIS: Study results were synthesized and discussed in narrative form. RESULTS: Thirty reviews were included in the analysis spanning 16 different disease/impairment groupings and representing a total of 91,170 participants. The most commonly reported intervention strategies were educational sessions (26 reviews) and self-care management plans (11 reviews), and 27 reviews assessed multiple intervention strategies. Twenty-one reviews reported statistically significant results. CONCLUSION: There is an emerging body of evidence for effective self-care. This study identified two strategies (educational sessions and self-care management plans) that could be used generically as supportive care by professionals as they assist individuals with self-care. IMPLICATIONS FOR PRACTICE: The use of multiple strategies, including educational sessions and self-care management plans have been identified as options that may be effective to support adoption and sustainment of self-care activities. IMPLICATIONS FOR RESEARCH: This study highlighted the pervasive problem of heterogeneous data at the primary research level preventing the effective synthesis of current evidence. Further research to standardize the type of outcome measured and the method of measurement would advance our ability to determine 'best practices' with self-care. Cochrane systematic review authors reported their systematic review methodologies in varying degrees of detail. Also of note was the range of different methods to assess risk of bias.

The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review.

Objectives The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.

The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review.

OBJECTIVES: The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. INCLUSION CRITERIA: This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. SEARCH STRATEGY: The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. METHODOLOGICAL QUALITY: Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA COLLECTION: Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. DATA SYNTHESIS: Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. RESULTS: A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. CONCLUSION: The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self.