Factors Influencing Referral to Cardiac Rehabilitation and Secondary Prevention Programs: A Systematic Review.

Factors influencing referral to cardiac rehabilitation and secondary prevention programs: a systematic review.

Eur J Prev Cardiol. 2013 Aug; 20(4): 692-700
Clark AM, King-Shier KM, Duncan A, Spaling M, Stone JA, Jaglal S, Angus J

Referral to cardiac rehabilitation and secondary prevention programs remains very low, despite evidence suggesting strong clinical efficacy. To develop evidence-based interventions to promote referral, the complex factors and processes influencing referral need to be better understood.We performed a systematic review using qualitative meta-synthesis.A comprehensive search of 11 databases was conducted. To be included, studies had to contain a qualitative research component wholly or in a mixed method design. Population specific data or themes had to be extractable for referral to programs. Studies had to contain extractable data from adults >18 years and published as full papers or theses during or after 1995.A total of 2620 articles were retrieved: out of 1687 studies examined, 87 studies contained data pertaining to decisions to participate in programs, 34 of which included data on referral. Healthcare professional, system and patient factors influenced referrals. The main professional barriers were low knowledge or scepticism about benefits, an over-reliance on physicians as gatekeepers and judgments that patients were not likely to participate. Systems factors related to territory, remuneration and insufficient time and workload capacity. Patients had limited knowledge of programs and saw physicians as key elements of referral but found the process of attaining a referral confusing and challenging.The greatest increases in patient referral to programs could be achieved by allowing referral from non-physicians or alternatively, automatic referral to a choice of hospital or home-based programs. All referring health professionals should receive educational outreach visits or workshops around the ethical and clinical aspects of programs. HubMed – rehab

Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain? Outcome 10 years after baseline assessment.

Br J Sports Med. 2013 Jul 11;
Hölmich P, Thorborg K, Nyvold P, Klit J, Nielsen MB, Troelsen A

Adductor-related groin pain and bony morphology such as femoroacetabular impingement (FAI) or hip dysplasia can coexist clinically. A previous randomised controlled trial in which athletes with adductor-related groin pain underwent either passive treatment (PT) or active treatment (AT) showed good results in the AT group. The primary purpose of the present study was to evaluate if radiological signs of FAI or hip dysplasia seem to affect the clinical outcome, initially and at 8-12 years of follow-up.47 patients (80%) were available for follow-up. The clinical result was assessed by a standardised clinical outcome combining patient-reported activity, symptoms and physical examination. Anterioposterior pelvic radiographs were obtained and the centre-edge angle of Wiberg, ? angle, presence of a crossover sign and Tönnis grade of osteoarthritis were assessed by a blinded observer using a reliable protocol.No significant between-group differences regarding the distribution of radiological morphologies were found. There was a decrease over time in clinical outcome in the AT group with ? angles >55° compared to those with ? angles <55° (p=0.047). In the AT group, there was no significant difference in the distribution of Tönnis grades between hips that had an unchanged or improved outcome compared with hips that had a worse outcome over time (p=0.145).No evidence was found that bony hip morphology related to FAI or dysplasia prevents successful outcome of the exercise treatment programme with results lasting 8-12 years. The entity of adductor-related groin pain in physically active adults can be treated with AT even in the presence of morphological changes to the hip joint. HubMed – rehab

Pulmonary Rehabilitation Exercise Prescription in Chronic Obstructive Lung Disease: US SURVEY AND REVIEW OF GUIDELINES AND CLINICAL PRACTICES.

J Cardiopulm Rehabil Prev. 2013 Jul 10;
Garvey C, Fullwood MD, Rigler J

Chronic obstructive pulmonary disease is a common, progressive disorder associated with disabling symptoms, skeletal muscle dysfunction, and substantial morbidity and mortality. Current national guidelines recommend pulmonary rehabilitation (PR) to improve dyspnea, functional capacity, and quality of life. Many PR exercise programs are based on guidelines from the American College of Sports Medicine. Recommendations have also been published by the American Association of Cardiovascular and Pulmonary Rehabilitation and the American Thoracic Society. Translating exercise science into effective training and clinical care requires interpretation and the use of diverse national PR guidelines and recommendations. Pulmonary rehabilitation clinicians often vary in their education and background, with most nurses and respiratory care practitioners lacking formal training in exercise physiology. Patients often have comorbidities that may further complicate exercise provision and prescription. This article describes the results of an informal, nonscientific survey of the American Association of Cardiovascular and Pulmonary Rehabilitation members exploring current PR exercise prescription practices as a basis for discussion and reviews current national exercise recommendations for chronic obstructive pulmonary disease. Further, it describes areas of uncertainty regarding exercise prescription in PR and suggests strategies for providing effective exercise training, given the diversity of guidelines, clinician preparedness, and patient complexity. HubMed – rehab

In vivo anteroposterior translation after meniscal-bearing total knee arthroplasty: effects of soft tissue conditions and flexion angle.

Eur J Orthop Surg Traumatol. 2013 Jul 12;
Ishii Y, Noguchi H, Takeda M, Sato J, Sakurai T, Toyabe SI

Anteroposterior (AP) joint translation is an important indicator of good clinical outcome following total knee arthroplasty (TKA). This study evaluated the in vivo relationship between changes in the degree of voluntary soft tissue tension and flexion angle versus simultaneous AP translation after TKA.A posterior cruciate ligament (PCL)-retaining meniscal-bearing design was investigated in 20 knees of 20 patients. AP translation was measured at 30° and 75° flexion with the KT-2000 arthrometer while patients were anesthetized and non-anesthetized.The mean translations at 30° and 75° were 10.5 and 10.4 mm, respectively, in non-anesthetized patients and 13.8 and 12.7 mm, respectively, in patients under anesthesia. AP translation showed a significant positive correlation with soft tissue tension (p < 0.001), but not with flexion angle (p = 0.366). No interaction was observed between soft tissue tension and the flexion angle in terms of AP translation (p = 0.431).Surgeons should recognize that AP translation is greater in anesthetized patients than in non-anesthetized patients, regardless of the flexion angle, with no significant correlation between flexion angle and translation, regardless of the level of consciousness. Because conformity between the tibial insert and femoral component decreases with flexion, whereas the opposing effects of supporting structures, such as muscles, ligaments, and capsules, increases, proper soft tissue tension, particularly retention of a functional PCL, could have an important role in determining AP translation in the current prosthesis design. HubMed – rehab

[News from the Soteria – A Phenomenologically Inspired Approach to the Rehabilitation of Social and Daily Living Skills.]

Psychiatr Prax. 2013 Jul 11;
Nischk D, Merz P, Rusch J

Soteria is an alternative approach to the treatment of schizophrenia that focuses on human interaction (“being-with”) within a residential community and the cautious use of neuroleptic medication. Despite forty years of promising clinical and empirical evidence, the need for facilities based on the Soteria paradigm is still largely grounded on humanitarian and “moral” reasons. In addition to this, we will try to demonstrate that Soteria might also prove to be a promising approach based on scientific reasons immanent to the disorder. From a phenomenological informed conception of schizophrenia we will explicate clinical implications, specifically the need for a holistic treatment in real life settings, and demonstrate how these conclusions can most adequately be implemented within Soteria. HubMed – rehab