Remedial Massage Therapy Interventions Including and Excluding Sternocleidomastoid, Scalene, Temporalis, and Masseter Muscles for Chronic Tension Type Headaches: a Case Series.

BACKGROUND: Tension-type headache (TTH) is the most prevalent primary headache type world-wide. Chronic TTH (CTTH) of >15 headache-affected days per month for > 3 months can cause considerable pain and disability. PURPOSE: This case series aimed to investigate whether massage therapy interventions were more effective when muscles of the anterior neck, jaw, and cranium were included. DESIGN: Four female clients suffering CTTH received six pre-determined massage therapy interventions, 45 minutes each, over three weeks. Case A and B (exclusion cases) received interventions addressing shoulder, posterior neck, and occiput muscles; Case C and D (inclusions cases) received interventions addressing the same areas as well as the sternocleidomastoid, scalene, temporalis, and masseter muscles. INTERVENTION: Treatment included myofascial trigger point release, neuromuscular therapy, and consideration of central sensitization mechanisms present in CTTH. OUTCOME MEASURES: Headache frequency (primary), intensity, and duration (secondary) were recorded via headache diaries for baseline measures (one week), interventions (three weeks), and a runout period (two weeks). Secondary measures also included a headache disability inventory (HDI) at baseline, intervention conclusion, and final measures. After final measures, clients received stretching education and four weeks later, a follow-up phone conversation to note subjective headache reports. RESULTS: All cases had headache frequency and HDI score reductions, while intensity and duration measures fluctuated. At final measures, exclusion Case A and both inclusion cases (C and D) had headache frequency reductions to below CTTH diagnostic criteria, clinically meaningful (> 16%) HDI score reductions, and subjectively reported continued improvements after study completion. Inclusion cases overall had greater decreases in headache frequency and HDI measures. CONCLUSION: Comparative results suggest there may be additional benefit in reducing headache frequency and disability with inclusion of anterior neck, jaw, and cranial muscles in treatment strategies of CTTH. However, limited sample size makes it difficult to rule out outliers or individual variables. Further investigation is recommended.

Missed opportunity? Worsening breathlessness as a harbinger of death: a cohort study.

The aim of the study was to explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients.A prospective, consecutive cohort study obtained point-of-care data of patients of Silver Chain Hospice Care Service (Perth, Australia) over the period 2011-2014 (n=6801; 51 494 data-points). Breathlessness intensity (0-10 numerical rating scale) and physical function (Australia-modified Karnofsky Performance Status (AKPS)) were measured at each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression.Mean±sd age was 71.5±15.1 years and 55.2% were male, most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardiorespiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001).Breathlessness is more intense and increases more in people with better function and cardiorespiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have overestimated breathlessness intensity for many patients in the days preceding death.

Symptom burden of haematological malignancies as death approaches in a community palliative care service: a retrospective cohort study of a consecutive case series.

BACKGROUND: Patients with haematological malignancies are less likely to use palliative care services than are patients with solid tumours. This difference might stem from differing symptom burden, care needs, disease trajectories, or a combination of these factors. We described symptom burden and physical decline over time for people with haematological malignancies compared with people with solid tumours in a consecutive case series. METHODS: We included patients admitted to Silver Chain Hospice Care Service who died between Jan 1, 2011, and Dec 31, 2013, and who completed the eight-item Symptom Assessment Scale (0-10, with 0=no distress and 10=worst distress) at each clinical encounter. Physical function was assessed with the Australia-modified Karnofsky performance scale. Symptom and functional assessments were analysed at 7 days, 30 days, 60 days, and 90 days before death, by descriptive statistics. FINDINGS: We included 4638 participants. For people with haematological malignancies (n=224), the most troublesome symptoms were fatigue (mean score 5·2, SD 2·7) and loss of appetite (2·3, SD 2·9), and both worsened significantly near death (p=0·0035 for fatigue, p=0·016 for appetite). Other symptoms were often absent, and changed little over time. Compared with patients with solid tumours (n=4414), there were no significant differences in individual or cumulative symptom scores, changes over time, or the pattern of functional decline. INTERPRETATION: Community patients with haematological malignancies receiving palliative care have similar symptoms and patterns of physical decline at the end of life to people with solid tumours, suggesting similar care needs. This finding questions present limited palliative care service use by patients with haematological malignancies. FUNDING: None.

An investigation of ecological correlates with hand and foot morphology in callitrichid primates.

Studies of primate taxonomy and phylogeny often depend on comparisons of limb dimensions, yet there is little information on how morphology correlates and contributes to foraging strategies and ecology. Callitrichid primates are ideal for comparative studies as they exhibit a range of body size, limb proportions and diet. Many callitrichid species exhibit a high degree of exudativory, and to efficiently exploit these resources, they are assumed to have evolved morphologies that reflect a level of dependence on these resources. We tested assumptions by considering measurements of limb proportion and frictional features of the volar surfaces in preserved specimens of 25 species with relation to published life history and ecological data. The degree of exudativory and utilization of vertical substrates during foraging were found to correlate both with size and with size-corrected foot and hand dimensions. Smaller species, which engage in greater degrees of exudativory, had proportionally longer hands and feet and more curved claw-like tegulae (nails) on their digits to facilitate climbing on vertical substrates. The density of patterned ridges (dermatoglyphs) on the volar surfaces of the hands and feet is higher in more exudativorous genera, suggesting a role in climbing on vertical tree trunks during foraging. Dermatoglyph comparisons suggest that ridges on the soles and palms may facilitate food procurement by enhancing frictional grip during exudate feeding. Volar pad features corroborate taxonomic relationships described from dental morphology.

The prevalence of bowel problems reported in a palliative care population.

CONTEXT: Constipation and other disturbances of bowel function are distressing problems for people with specialist palliative care needs. Recent observations suggest that such problems may worsen as people become more unwell, but the changes in intensity over time are not well documented. OBJECTIVES: The objectives of this work were to understand the prevalence, intensity, and progression of self-reported bowel disturbances across a community palliative care population, which included people with cancer and noncancer diagnoses. METHODS: All people referred to a community-based palliative care service over a period of 6.3 years had their bowel problem scores reported, using a numerical rating score at every clinical encounter until their death, at four discrete time points, namely, 90, 60, 30, and seven days before death. This allowed change over three time periods to be considered. At the same time, other symptom scores were collected including nausea, fatigue, pain, appetite problems, and breathing problems. Patients were categorized according to the underlying disease that accounted for their referral to palliative care, namely, cancer diagnoses (upper gastrointestinal cancers, lower gastrointestinal cancers, cancers of the associated digestive organs, and other cancers) and nonmalignant diagnoses. Group differences over the time periods were assessed using analysis of variance. Bivariate analysis was used to explore the relationship between bowel disturbances and other symptoms using Spearman's Rho correlation. RESULTS: For 7772 patients, data were collected an average of 22.5 times, generating 174,783 data collection points over an average of 98.6 days on the service. At the time of referral to the service, 3248 (42.4%) people had disturbed bowel scores, 548 (7.2%) of whom described these as severe. Only 1020 (13.1%) people never described disturbed bowel function over their time in palliative care. At each time point, approximately one-third were experiencing disturbed bowel function, with proportionally greater numbers of people experiencing more significant problems as death approached (Χ(2) (9)=119.3; P<0.001). Most referrals to the service were because of cancer diagnoses, with no significant differences noted between the bowel disturbance scores of those with cancer diagnoses compared with those with nonmalignant disease. Associations between bowel problem score and appetite problems, nausea, breathing problems, fatigue, and pain were explored. Although weak, there were statistically significant associations between all symptoms and bowel problem scores except for breathing problems. CONCLUSION: In conclusion, disturbed bowel function consistently remains a problem for people under the care of palliative care services, with the proportion of people with severe problems increasing as death approaches. This is despite the time and number of interventions currently used to palliate these problems.

A descriptive study of the practice patterns of massage new zealand massage therapists.

BACKGROUND: Massage therapy has grown in popularity, yet little is known globally or in New Zealand about massage therapists and their practices. PURPOSE AND SETTING: The aims of this study were to describe the practice patterns of trained Massage New Zealand massage therapists in New Zealand private practice, with regard to therapist characteristics; practice modes and settings, and therapy characteristics; referral patterns; and massage therapy as an occupation. RESEARCH DESIGN AND PARTICIPANTS: A survey questionnaire was mailed to 66 trained massage therapist members of Massage New Zealand who were recruiting massage clients for a concurrent study of massage therapy culture. RESULTS: Most massage therapists were women (83%), NZ European (76%), and holders of a massage diploma qualification (89%). Massage therapy was both a full- (58%) and part-time (42%) occupation, with the practice of massage therapy being the only source of employment for 70% of therapists. Nearly all therapists (94%) practiced massage for more than 40 weeks in the year, providing a median of 16 - 20 hours of direct client care per week. Most massage therapists worked in a "solo practice" (58%) and used a wide and active referral network. Almost all therapists treated musculoskeletal symptoms: the most common client issues or conditions treated were back pain/problem (99%), neck/shoulder pain/problem (99%), headache or migraine (99%), relaxation and stress reduction (96%), and regular recovery or maintenance massage (89%). The most frequent client fee per treatment was NZ$60 per hour in a clinic and NZ$1 per minute at a sports event or in the workplace. Therapeutic massage, relaxation massage, sports massage, and trigger-point therapy were the most common styles of massage therapy offered. Nearly all massage therapists (99%) undertook client assessment; 95% typically provided self-care recommendations; and 32% combined other complementary and alternative medicine therapies with their massage consultations. CONCLUSIONS: This study provides new information about the practice of massage therapy by trained massage therapists. It will help to inform the massage industry and other health care providers, potential funders, and policymakers about the provision of massage therapy in the NZ health care system.

Chronic disease profiles in remote Aboriginal settings and implications for health services planning.

OBJECTIVE: To report the short-term experiences and outcomes of a program to support chronic disease management in three remote communities in Top End Northern Territory and in two Aboriginal Medical Services (AMSs) in Western Australia, and to discuss the implications of findings for health service delivery and policy. METHODS: Programs were health-worker centred. They espoused regular screening of all adults for chronic disease, initiation and modification of treatment where indicated and rigorous documentation. Process measures were documented and rates of hypertension, renal disease and diabetes among adults were calculated. RESULTS: Rates of hypertension, proteinuria and diabetes rose throughout adult life and multiple diagnoses were common. Most people with these conditions were young or middle age adults. Rates were uniformly excessive relative to AusDiab data, but varied greatly among settings. Adherence to protocols improved, many new diagnoses were made, treatments were started or modified and blood pressures in treated hypertensive people fell. In the NT, productivity was seriously limited by lack of health workers and their absenteeism. In the WA AMSs, executive and staff support carried the programs forward to a sustainable future, despite various challenges. CONCLUSIONS: Integrated chronic disease testing must be repeated throughout adult life for timely diagnosis. Health workers can perform all tasks well, with appropriate supports. Blood pressure outcomes alone predict lower cardiovascular and renal mortality. The findings support incorporation of chronic disease into lifetime health care plans.

Massage therapy services for healthcare: a telephone focus group study of drivers for clients' continued use of services.

OBJECTIVE: To explore opinions of why clients use, value and continue to seek massage therapy as a healthcare option. DESIGN: Telephone focus group methodology was used. Current and repeat users (n = 19) of either relaxation, remedial or sports massage therapy services participated in three telephone focus groups. Audiotaped semi-structured interviews were conducted. SETTING: Telephone focus group with massage clients from provincial and urban localities in New Zealand. MAIN OUTCOME MEASURES: Summary of reported themes of the massage experience and suggested drivers for return to, or continuing with massage therapy. Data were transcribed, categorised (NVivo7) and thematically analysed using the general inductive approach. RESULTS: Key drivers for return to, or continuing with, massage therapy were: positive outcomes, expectations of goals being met, a regular appointment and the massage therapy culture. CONCLUSIONS: Massage therapy is perceived and valued as a personalised, holistic and hands-on approach to health management, which focuses on enhancing relaxation in conjunction with effective touch, within a positive client-therapist relationship and a pleasant non-rushed environment. Massage therapy as a health service is result and client driven but is reinforced by the culture of the experience.

The culture of massage therapy: valued elements and the role of comfort, contact, connection and caring.

OBJECTIVE: To explore the attributes of the therapy encounter valued by repeat users of health-related massage therapy. DESIGN: A qualitative design with telephone focus group methodology was used. A total of 19 repeat users of massage therapy participated in three telephone focus groups where audiotaped semi-structured interviews were conducted. SETTING: Telephone focus group with massage clients from a range of provincial and urban regions in New Zealand. MAIN OUTCOME MEASURES: Summary of reported themes of the massage experience. Data were thematically analysed using the general inductive approach. RESULTS: Six valued elements of the massage encounter (time for care and personal attention, engaging and competent therapist, trust partnership, holism and empowerment, effective touch and enhancing relaxation), four modulators (comfort, contact, connection and caring) and two themes relating to adding experiential value (enjoyment, escapism) characterize the massage therapy culture. CONCLUSIONS: The culture of massage therapy care incorporates a number of characteristics that are congruent with the complementary and alternative medicine approach to health. In addition, massage specific factors were identified. The humanistic aspects of the therapy encounter valued by clients offer insight into the growing use of massage therapy and the success of massage therapy outcomes.

Telephone focus groups in physiotherapy research: potential uses and recommendations.

The use of telephone focus groups as a research approach within health-related qualitative studies is emerging as a method of choice for some researchers. A variety of research applications of the telephone focus group method have been used within health settings over the last 10 years and have typically investigated specific health conditions, training needs, and resource development, as well as health practices and knowledge; these are all issues and contexts applicable to physiotherapy and rehabilitation research. The aim of this review is to explore the use of the telephone focus group methodology, update knowledge on its use in disciplines relevant to physiotherapy, and provide potential users with key information to conduct a telephone focus group. We advocate incorporating recent advances in telephone technology into focus group methodology for physiotherapy and rehabilitation studies, which may benefit from wider geographical representation, increased participation rates, and discussion of sensitive issues. We suggest that the telephone focus group could become a practical and valuable methodology for physiotherapy and rehabilitation researchers.

Ultrastructure and physical properties of an adhesive surface, the toe pad epithelium of the tree frog, Litoria caerulea White.

Knowledge of both surface structure and physical properties such as stiffness and elasticity are essential to understanding any adhesive system. In this study of an adhesion surface in the tree frog, Litoria caerulea White, a variety of techniques including atomic force microscopy were used to investigate the microstructure and properties of an epithelium that adheres through wet adhesion. Litoria toe pads consist of a hexagonal array of flat-topped epithelial cells, separated by mucus-filled channels. Under an atomic force microscope, this ;flat' surface is highly structured at the nanoscale, consisting of a tightly packed array of columnar nanopillars (described as hemidesmosomes by previous authors), 326+/-84 nm in diameter, each of which possesses a central dimple 8+/-4 nm in depth. In fixed tissue (transmission electron microscopy), the nanopillars are approximately as tall as they are broad. At the gross anatomical level, larger toe pads may be subdivided into medial and lateral parts by two large grooves. Although the whole toe pad is soft and easily deformable, the epithelium itself has an effective elastic modulus equivalent to silicon rubber (mean E(eff)=14.4+/-20.9 MPa; median E(eff)=5.7 MPa), as measured by the atomic force microscope in nanoindentation mode. The functions of these structures are discussed in terms of maximising adhesive and frictional forces by conforming closely to surface irregularities at different length scales and maintaining an extremely thin fluid layer between pad and substrate. The biomimetic implications of these findings are reviewed.

Status of chronic kidney disease prevention programs: International Federation of Kidney Foundation Members 2005/2007.

The International Federation of Kidney Foundations surveyed its members on chronic kidney disease 'prevention' programs in their regions and countries in 2005 and 2007. A profile was developed, representing 28 countries (56% response). Some form of screening activity was reported in 24 of the 28 countries (85.7%). Two countries (7%) had, or anticipated development of, legislated national screening. Programs were conducted by kidney foundations or research groups, and were variously population based, focused on high risk groups or opportunistic. Tests in 63% of responding programs included weight, height, blood pressure, blood glucose, dipstick urinalysis and serum creatinine. Several programs used the USA's Kidney Early Evaluation Program's and International Society of Nephrology's templates. World Kidney Day activities contributed significantly. Stated needs were for more government recognition, firm policies and approaches, and critically, resources. Repeat responders reported progress in 2007, particularly in government interest and education delivery. Despite difficulties, programs are developing in many regions. Most need more resources and some members need substantial and sustained assistance.

Structural correlates of increased adhesive efficiency with adult size in the toe pads of hylid tree frogs.

Tree frogs are able to climb smooth, vertical substrates using specialised toe pads which adhere via an area-based wet adhesive mechanism. Although the link between pads and arboreality in frogs is well-established, few studies have investigated the influence of morphology on adhesion. Trinidadian tree frogs from the genus Hyla are geometrically similar. There is a tendency towards comparatively reduced mass in larger species, but toe pad area increases as expected with isometry. As adhesion is area-dependent, forces are affected directly by the increase in mass relative to pad area, and there is a decrease in the ability of larger species to adhere to smooth rotation platforms. However, there is an increase in force per unit area that suggests larger species have more efficient toe pads. Toe pad structure is very similar though there are variations in the details of a number of features. Crucially, although differences in morphology appeared small they had demonstrable effects on adhesive efficiency of the pads. Epithelial cell area correlates positively with frog length and adhesive efficiency, related features of cell density and intercellular channel length correlate negatively. These findings are discussed in relation to the different forces involved in the tree frogs' wet adhesive system.

Whole animal measurements of shear and adhesive forces in adult tree frogs: insights into underlying mechanisms of adhesion obtained from studying the effects of size and scale.

This allometric study of adhesion in 15 Trinidadian tree frog species investigates how relationships between length, area and mass limit the ability of adult frog species of different sizes to adhere to inclined and overhanging surfaces. Our experiments show that hylid frogs possess an area-based wet adhesive system in which larger species are lighter than expected from isometry and adhere better than expected from their toe pad area. However, in spite of these adaptations, larger species adhere less well than smaller species. In addition to these adhesive forces, tree frogs also generate significant shear forces that scale with mass, suggesting that they are frictional forces. Toe pads detach by peeling and frogs have strategies to prevent peeling from taking place while they are adhering to surfaces, including orienting themselves head-up on slopes. The scaling of tree frog adhesion is also used to distinguish between different models for adhesion, including classic formulae for capillarity and Stefan adhesion. These classic equations grossly overestimate the adhesive forces that tree frogs produce. More promising are peeling models, designed to predict the pull-off forces of adhesive tape. However, more work is required before we can qualitatively and quantitatively describe the adhesive mechanism of tree frogs.