No description available.

Elbow contractures in burn survivors lead to difficulties in their ability to perform meaningful occupations. Interventions focus on improving movement at the elbow while considering social and psychological factors in the individual's environmental context. The purpose of the review was to determine the methodological quality of research evaluating splinting and serial casting to improve elbow contractures and resulting functional limitations. A comprehensive search strategy uncovered 10 research studies. Standardized critical appraisal tools and protocols were used to analyze the research. Although some methodological issues were identified, the findings were positive. Strengths and weaknesses of the research were delineated to support and guide the use of serial casting and splinting. A body of research was found to warrant consideration of social and psychological factors. Conclusion. There is preliminary quality of evidence to support the use of splinting and serial casting and important considerations for future research. / Rehabilitation Science - Occupational Therapy

Introduction: There is proven therapeutic benefit in bariatric surgery for obese patients. Consequently the National Institute of Clinical Excellence UK has provided referral guidelines for bariatric surgery. Successful bariatric surgery will result in massive weight loss and ptotic skin, which can cause significant functional and psychological problems. As the number of cases of bariatric surgery increases, a corresponding number of massive weight loss patients will require plastic surgery. In this novel field of post massive weight loss surgery there is a lack of understanding of the demographics, physical symptoms and psychological health of this new group of patients. The tools to assess them are few and not validated, the patient pathway is disjointed and there is no consensus on standardised provision. Method: A prospective multicentre, observational study of outcomes in 100 patients undergoing bariatric and post massive weight loss plastic surgery at 2 clinical sites was performed. Each patient followed a standard operating protocol. This included undergoing a semi structured interview, completing five patient-report outcome measures, having anthropometric measurements and clinical photographs taken. Conclusion: This observational study identified key psychosocial themes prevalent in massive weight loss patients, during their weight loss journey. It identified there are no validated patient reported outcome measures available specific to this cohort of patients. This work led to the development of a new validated tool for massive weight loss body contouring.

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-26Bitstream added on 2014-06-13T19:59:21Z : No. of bitstreams: 1 sato_jo_me_botfm.pdf: 837870 bytes, checksum: 61feb55418bf3755870bbd16ff20c4c0 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliar as propriedades clinimétricas do Juvenile Arthritis Damage Index (JADI), e de seus componentes articular (JADI – A) e extra-articular (JADI – E), em diferentes subtipos de Artrite Idiopática Juvenil (AIJ), caracterizando-se os danos e estabelecendo-se a probabilidade de dano articular e extra-articular durante o curso da AIJ. Uma avaliação transversal foi realizada em uma série de casos de AIJ, entre 2006 e 2008. Os dados clínicos e demográficos, exame articular, pontuação do JADI-A e JADI-E, compilação do Childhood Health Assessment Questionnaire (CHAQ) e das escalas visuais analógicas para dor e bem-estar global pelos pais e pelo médico, classificação funcional de Steinbrocker e avaliação radiológica foram realizados durante uma visita ambulatorial. A avaliação longitudinal retrospectiva foi realizada da primeira até última visita ao serviço (1997 a 2008), observando-se as medidas de desfecho e tratamento. As propriedades de medida do JADI-A e JADI-E foram correlacionadas ao desfecho e a probabilidade de dano analisada por meio de curva de sobrevida com cálculo do risco de dano anual. Foram incluídos cento e um casos de AIJ, classificados como oligoarticular persistente (68,3%), artrite relacionada à entesite (8,9%), oligoarticular estendido (7,9%), poliarticular fator reumatóide (FR) + (5,0%), sistêmica (5,0%), poliarticular FR - (4,0%) e artrite psoriásica (1%), idade de início 7,1 anos (0,9 – 14,2) e duração da doença 2,7 anos (0,3 – 18,6), 66,3% em atividade, ANA + em 46,5% e HLA-B27 + em 5%. Noventa e oito porcento receberam AINH, 21,8% corticosteróides, 50,5% corticosteróide intra-articular, 39,6% DMARD e 10,9% agentes biológicos. Oitenta e três porcento não apresentavam incapacidade funcional pela classificação de Steinbrocker, e 53% pelo CHAQ. Foram observados dano articular em 45,5% e extra-articular nem 37,6% dos casos... / To assess clinimetric properties of the Juvenile Arthritis Damage Index (JADI) and its two components, articular (JADI-A) and extraarticular (JADI-E), in different subtypes of Juvenile Idiopathic Arthritis (JIA), in order to characterize the damage and to establish the probability of articular and extraarticular damage during the course of JIA. A cross-sectional evaluation in a JIA case series was carried out, between 2006 and 2008. The clinical and demographic data, joint assessment, JADI-A and JADI-E scoring, Childhood Health Assessment Questionnaire (CHAQ) scoring as well as physician’s global assessment, pain and child’s overall well-being by visual analog scale (VAS), Steinbrocker functional and radiographic assessments were assessed during a routine clinic visit. A retrospective longitudinal case-note revision was performed collecting data from the first to the last visit (1997 to 2008) for recording outcome measures and treatment. JADI-A and JADI-E measurement properties were correlated with outcome measures and the damage probability calculated by survival analysis alongside the damage risk calculated year by year. One hundred and one cases of JIA were included, classified as persistent oligoarthritis (68.3%), enthesitis-related arthritis (8.9%), extended oligoarthritis (7.9%), positive rheumatoid factor (RF) polyarthritis (5.0%), systemic arthritis (5.0%), negative RF polyarthritis (4.0%) and psoriatic arthritis (1.0%), age at onset 7.1 years (0.9 – 14.2), and disease duration 2.7 years (0.3 – 18.6), active disease in 66.3%, positive ANA in 46.5%, positive HLA-B27 in 5%. Ninety eight percent received NSAID, 21.8% corticosteroid, 50.5% intraarticular corticosteroid, 39.6% DMARD and 10.9% biologic agent. Eighty three percent did not have functional disability by Steinbrocker classification, and 53% baseline CHAQ. Overall, joint damage was observed in 45.5% and extraarticular... (Complete abstract click electronic access below)

Orientador: Claudia Saad Magalhães / Banca: Adriana Maluf Elias Sallum / Banca: José Eduardo Corrente / Resumo: Avaliar as propriedades clinimétricas do Juvenile Arthritis Damage Index (JADI), e de seus componentes articular (JADI - A) e extra-articular (JADI - E), em diferentes subtipos de Artrite Idiopática Juvenil (AIJ), caracterizando-se os danos e estabelecendo-se a probabilidade de dano articular e extra-articular durante o curso da AIJ. Uma avaliação transversal foi realizada em uma série de casos de AIJ, entre 2006 e 2008. Os dados clínicos e demográficos, exame articular, pontuação do JADI-A e JADI-E, compilação do Childhood Health Assessment Questionnaire (CHAQ) e das escalas visuais analógicas para dor e bem-estar global pelos pais e pelo médico, classificação funcional de Steinbrocker e avaliação radiológica foram realizados durante uma visita ambulatorial. A avaliação longitudinal retrospectiva foi realizada da primeira até última visita ao serviço (1997 a 2008), observando-se as medidas de desfecho e tratamento. As propriedades de medida do JADI-A e JADI-E foram correlacionadas ao desfecho e a probabilidade de dano analisada por meio de curva de sobrevida com cálculo do risco de dano anual. Foram incluídos cento e um casos de AIJ, classificados como oligoarticular persistente (68,3%), artrite relacionada à entesite (8,9%), oligoarticular estendido (7,9%), poliarticular fator reumatóide (FR) + (5,0%), sistêmica (5,0%), poliarticular FR - (4,0%) e artrite psoriásica (1%), idade de início 7,1 anos (0,9 - 14,2) e duração da doença 2,7 anos (0,3 - 18,6), 66,3% em atividade, ANA + em 46,5% e HLA-B27 + em 5%. Noventa e oito porcento receberam AINH, 21,8% corticosteróides, 50,5% corticosteróide intra-articular, 39,6% DMARD e 10,9% agentes biológicos. Oitenta e três porcento não apresentavam incapacidade funcional pela classificação de Steinbrocker, e 53% pelo CHAQ. Foram observados dano articular em 45,5% e extra-articular nem 37,6% dos casos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: To assess clinimetric properties of the Juvenile Arthritis Damage Index (JADI) and its two components, articular (JADI-A) and extraarticular (JADI-E), in different subtypes of Juvenile Idiopathic Arthritis (JIA), in order to characterize the damage and to establish the probability of articular and extraarticular damage during the course of JIA. A cross-sectional evaluation in a JIA case series was carried out, between 2006 and 2008. The clinical and demographic data, joint assessment, JADI-A and JADI-E scoring, Childhood Health Assessment Questionnaire (CHAQ) scoring as well as physician's global assessment, pain and child's overall well-being by visual analog scale (VAS), Steinbrocker functional and radiographic assessments were assessed during a routine clinic visit. A retrospective longitudinal case-note revision was performed collecting data from the first to the last visit (1997 to 2008) for recording outcome measures and treatment. JADI-A and JADI-E measurement properties were correlated with outcome measures and the damage probability calculated by survival analysis alongside the damage risk calculated year by year. One hundred and one cases of JIA were included, classified as persistent oligoarthritis (68.3%), enthesitis-related arthritis (8.9%), extended oligoarthritis (7.9%), positive rheumatoid factor (RF) polyarthritis (5.0%), systemic arthritis (5.0%), negative RF polyarthritis (4.0%) and psoriatic arthritis (1.0%), age at onset 7.1 years (0.9 - 14.2), and disease duration 2.7 years (0.3 - 18.6), active disease in 66.3%, positive ANA in 46.5%, positive HLA-B27 in 5%. Ninety eight percent received NSAID, 21.8% corticosteroid, 50.5% intraarticular corticosteroid, 39.6% DMARD and 10.9% biologic agent. Eighty three percent did not have functional disability by Steinbrocker classification, and 53% baseline CHAQ. Overall, joint damage was observed in 45.5% and extraarticular... (Complete abstract click electronic access below) / Mestre

Multi-purpose clinically relevant measures such as the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) and the Global Appraisal of Individual Needs (GAIN; Dennis et al., 2003) can be useful for improving services at the individual client, program, organization, and system levels. Yet, emerging research suggests that such measures are often not used consistently or effectively (Mellor-Clark, Cross, Macdonald, & Skjulsvik, 2016), and that poor use of these measures can be in part attributed to how they were put into practice (de Jong, 2016). Systematically conducted, empirical research on the effective implementation of such tools is scarce (Boswell, Kraus, Miller, & Lambert, 2015). Thus, the current study examined the factors and processes that contribute to the effective implementation of clinically relevant measures, specifically the CANS and GAIN, in community-based mental health agencies serving children and adolescents. A second objective was to examine the role of staff participation in the implementation process. Three general research questions guided the study, including: (1) How can clinically relevant measures such as the CANS be implemented effectively? (2) What are the perceived consequences of staff participation in adapting and implementing a version of the CANS and how do these consequences come about? and (3) How does the implementation context affect the process and its outcomes? The study employed qualitative, multiple-case study methods. Four child and youth mental health agencies in Ontario participated, including a total of 44 staff with varying roles (e.g., frontline and management). Several cross-case and within case comparisons were made to examine the contribution of staff participation and tool features, such as tool adaptability, to implementation outcomes. Data was analyzed using guidelines developed by Yin (2009), Miles and Huberman (1994), and Thomas (2006). Results suggest that staff participation in the process of putting clinically relevant measures into practice contributes to effective implementation and increased uptake and use of the measures. When staff are engaged in the process, they have reasons and opportunities to interact, talk about the use of the measure, and “co-create fit” between the measure and their work context. This improved fit then facilitates increased staff commitment and ability to use the measure effectively. Agency leaders play a key role in enabling this fit-making process through: encouraging and supporting a participatory approach to implementation, creating implementation structures, following through with planned activities, and being open and responsive to staff feedback. Findings suggest that the implementation context provides incentives or reasons for implementing a measure, affects the initial fit between the measure and staff members’ work, and affects the feasibility of engaging staff in the fit making process. In conclusion, this study is one of the few empirical studies to examine implementation of clinically relevant measures. The findings have important implications for research and practice, which will be discussed.

In the present health care environment, there is an increased demand for audiologists to measure the outcomes of hearing aid intervention. In addition to the more traditional objective outcome measures, many subjective outcome measures have been developed in the last 20 years. Two such subjective outcome measures are the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Hearing Handicap Inventory for the Elderly (HHIE). These instruments consist of a series of pre-selected questions that may or may not be applicable to an individual. An alternative to the pre-selected question format is an open format design that allows the person with a hearing loss to designate areas of concern to them. One subjective outcome measure that uses this format is the Client Oriented Scale of Improvement (COSI) developed by Dillon and his colleagues in Australia. The COSI has been validated and may be useful for oversight with multi-clinician or for multi-clinic systems. The purpose of this study was to address tthe potential of the COSI for such oversight. Specifically, the study examined the inter-observer agreement of the classification of individually identified situations into general categories. The study also re-examined the clinical utility of the COSI as an outcome measure in individual hearing aid fittings. The results demonstrated very good inter-observer agreement for the classification of individually identified situations. In addition, the study supported the usefulness as a clinical outcome measure that had been found by Dillon and his colleagues in Australia. These results indicate that the COSI has potential for oversight of the outcomes of hearing aid intervention in hearing aid delivery organizations.

Bakgrund: Bröstcancer-relaterat lymfödem (BCRL) är en vanlig komplikation efter bröstcancerbehandling. Tidigare forskning visar varierande förekomst av BCRL, tillståndet tros vara underdiagnostiserat. Tidiga tecken kan beskrivas som en vag tyngdkänsla och/eller spänningskänsla. Detta kan leda till stora negativa konsekvenser vilket motiverar vikten att detektera BCRL i ett tidigt stadie då tidig behandling förbättrar prognosen.  Syfte: Undersöka förekomst av tidiga besvär/symtom samt undersöka sambandet mellan patientrapporterade tidiga besvär/symtom och läkarens bedömning av besvär vid samma tillfälle.  Metod: Kvinnor som genomgått kurativ behandling mot bröstcancer deltog i studien. Datainsamlingen skedde vid återbesöket på onkologmottagningen 3 månader efter avslutad behandling. Data samlades in med patientenkät (avseende besvär/symtom från armen) och läkarbedömning, inom ramen för ett kliniskt utvecklingsprojekt.   Resultat: 61 enkäter ingick i studien. 22 deltagare upplevde besvär från armen på den opererade sidan. 70% av de 43 deltagarna som skattade symtom angav förekomst av ≥1 symtom. I 76% av de 55 läkarbedömningarna hade bedömningen inga besvär gjorts. Samband kunde påvisas gällande frekvensen av patientrapporterade besvär och läkarens bedömning av armsvullnad (p=0,005) och handödem (p=0,003) samt mellan patientrapporterade symtom och läkarens bedömning av armsvullnad (p=0,008). I de fall patienten skattat besvär/symtom fanns en signifikant andel där läkaren bedömt att det inte förekom ödem/svullnad. I de fall patienten inte rapporterade besvär hade läkaren också bedömt frånvaro av ödem/svullnad. Konklusion: Det är vanligt att patienten upplever besvär/symtom från armen på den opererade sidan, och att patienter upplever symtom i större utsträckning än att läkaren gjort bedömningen att handödem, subcutant ödem eller armsvullnad förekommer. / Background: Breast cancer-related lymphedema (BCRL) is a complication following breast cancer treatment, it is probably underdiagnosed and the prevalence varies in previous studies. Early signs can be subtle sensations of heaviness and/or tightness in limbs. BCRL can have several negative impact, this motivates the importance of early detection because early intervention improves the prognosis.   Aim: Investigate the prevalence of early signs/symtoms of BCRL and investigate the association between patient reported outcomes and the physician assessment of BCRL.  Method: Women who underwent curative treatment of breast cancer was included. Data was collected at the follow-up 3 months after finished treatment in purpose for a clinical project. A questionnaire was used for the patient (regarding signs/symtoms from the arm) and physician rescpectively. Results: 61 participants were included. 22 participants reported signs from the arm on the affected side. 70% of those who reported symptoms, reported a presence of ≥1 symtoms. The physicians estimated no signs in 76% of 55 participants. There was an association between the frequency of patient reported signs from the arm and the physicians assessment of armswelling (p=0,005), hand edema (p=0,003) and between patient reported symtoms and the physicians assessment of armswelling (p=0,008). When the patient reported signs/symptoms, there was a significant proportion where the physician estimated no edema/swelling. In cases when the patient reported no signs/symptoms, the physician also assessed absence of edema/swelling. Conclusion: Patients often experience signs/symptoms from the arm on the affected side, and patients reports symptoms more frequent than physicians assess presence of early signs of BCRL.

No description available.

Sammanfattning Bakgrund: Barn med cancer riskerar att drabbas av en rad allvarliga komplikationer till följd av sin sjukdom och cancerbehandling. Syftet med denna studie var att undersöka interventioner, utfallsmått och effekt av fysisk aktivitet hos barn med cancer genom att granska vetenskapliga artiklar  Metod: Systematisk litteraturstudie. Sökning gjordes i databasen PubMed. Tio artiklar inkluderades och granskades sedan med PEDro-scale.  Resultat: Interventionsformerna var aerob träning, kombinerad träning bestående av aerob träning, styrketräning, balans och rörlighet. En studie fokuserade främst på motorisk funktion. Utfallsmåtten var strukturella förändringar i hjärnan, kardiorespiratorisk förmåga, fysisk funktion, muskelstyrka, livskvalitet, bentäthet, kognition och rörelseomfång. Aerob kapacitet och muskelstyrka ökade signifikant i interventionsgrupperna jämfört med kontrollgrupperna. Plasticitet i hjärnan ökade signifikant inom grupperna. Ingen effekt på livskvalitet.   Konklusion: Fysisk aktivitet som intervention hos barn med cancer har flera positiva effekter. I litteraturen råder ej konsensus gällande omfattningen av effekterna eller hur träningen ska utformas. Fler högkvalitativa studier krävs inom området. / Abstract Background: Children with cancer diseases experience long term negative effects on physical fitness and functioning after treatment. The aims of the study were to investigate interventions, outcome measures and effects of physical activity on children with cancer. Method: Systematic review. The search was conducted in the database PubMed. Ten studies were included in the study. The evidence quality of the studies was assessed with PEDro-scale.  Results: The interventions used were aerobic exercise, combined training with aerobic exercises, muscle strengthening, balance and mobility. One study focused on motor function. Outcome measures were change in brain structure, cardiorespiratory fitness, physical function, muscle strength, quality of life, cognition, bone mineral density and range of motion. Cardiorespiratory fitness and muscle strength increased significantly in the intervention group compared to the control group after training. Significant increase of positive changes in brain structure within both groups. No effects were found on quality of life.  Conclusion: Children with cancer diseases can benefit from physical activity and exercise training. The full extent of the effects is still unclear and more studies of high quality and with larger populations are needed. Keywords: Childhood cancer, physical activity, interventions, outcome measures, effect