Caregiver Experiences Using Orthotic Treatment Options for Developmental Dysplasia of the Hip in Children.

BACKGROUND: Developmental dysplasia of the hip (DDH) is a common condition affecting 5 in 1000 newborns. The standard first line of treatment is the use of an orthotic, which has generally high success rates, but can pose substantial difficulties and put undue burden on caregivers. The general experience of caregivers using these orthotics has not been well documented on an orthotic-specific basis. The purpose of this study was to investigate caregiver experience using prescribed DDH orthotics to identify challenges, differences between treatment options, and areas of improvement. METHODS: A survey assessing treatment prescription, respondent demographics, and caregiver experience was distributed online to caregivers whose child/children were treated for DDH with an orthotic. Seven-point positively phrased Likert scale statements and open-ended questions were included to assess caregiver experience. The results were analyzed using summary statistics and orthotics with more than 30 responses were selected for more in-depth analysis. RESULTS: A total of 530 survey responses were collected with 63% (334/530) of respondents using a Pavlik harness, 45% (236/530) a Rhino brace, and 13% (67/530) a Denis Browne Bar. The overall weighted average score across all Likert Scale statements was positive for the Pavlik harness, Rhino brace, and Denis Browne Bar at 4.19 (95% CI, 3.83 to 4.54), 4.63 (95% CI, 4.27 to 4.99) and 4.91 (95% CI, 4.58 to 5.24), respectively. In the open-ended responses, all 3 orthotics were perceived as easy to use and not hindering child-caregiver bonding, but raised concerns of discomfort and skin irritation, as well as preventing the ability to cuddle their child the way they desired. The Pavlik harness respondents consistently brought up concerns regarding cleanability. CONCLUSIONS: The results show that the DDH orthotics analyzed are generally easy to use and perceived positively by caregivers, but have orthotic-specific challenges that should be a focus of future improvement work. CLINICAL RELEVANCE: This study evaluated opinions and attitudes of caregivers for children being treated with DDH orthotics, revealing experiences, concerns, and challenges associated with the use of commonly prescribed options.

Participation in community-based exercise maintenance programs after completion of hospital-based cardiac rehabilitation: a mixed-method study.

OBJECTIVE: To understand the characteristics associated with participation in community-based exercise maintenance programs in patients with coronary heart disease (CHD) after completion of hospital-based cardiac rehabilitation in Scotland. METHODS: A mixed-methods approach was used (survey and focus groups) to explore determinants of participation in community-based exercise maintenance programs. RESULTS: Of 112 patients (67% male), 81 patients responded (73% response rate). Knowledge was high of the importance (19.2%) or high importance (75.6%) of physical activity to cardiac health. However, the focus groups identified that use of community-based exercise maintenance programs was affected by personal confidence, perceived meaningful support for people with CHD, and suitability of exercises to CHD patients. CONCLUSIONS: Decisions regarding the use of community-based exercise maintenance programs after hospital-based cardiac rehabilitation appear to be impacted by a range of factors linked to the views of exercise, confidence, and suitability of the program regimen to the individual with CHD.

A single session of treadmill running has no effect on plasma total ghrelin concentrations.

Ghrelin is a hormone that stimulates hunger. Intense exercise has been shown to temporarily suppress hunger after exercise. In the present study, we investigated whether post-exercise hunger suppression is mediated by reduced plasma total ghrelin concentrations. Nine men and nine women participated in the study. Their mean physical characteristics were as follows: age 24.8 (s(x) = 0.9) years, body mass index 22.9 (s(x) = 0.6) kg x m(-2), maximal oxygen uptake (VO(2max)) 57.7 (s(x) = 2.2) ml x kg(-1) x min(-1). The participants completed two 3-h trials (exercise and control) on separate days in a randomized balanced design after overnight fasts. The exercise trial involved a 1-h treadmill run at 73.5% of VO(2max) followed by 2 h of rest. The control trial consisted of 3 h of rest. Blood samples were collected at 0, 0.5, 1, 1.5, 2, and 3 h. Total ghrelin concentrations were determined from plasma. Hunger was assessed following blood sampling using a 15-point scale. The data were analysed using repeated-measures analysis of variance. Hunger scores were lower in the exercise trial than in the control trial (trial, P = 0.009; time, P < 0.001; trial x time, P < 0.001). Plasma total ghrelin concentrations did not differ between trials. These findings indicate that treadmill running suppresses hunger but this effect is not mediated by changes in plasma total ghrelin concentration.