Post Session Research Articles

Online group music therapy: proactive management of undergraduate students' stress and anxiety.

In alignment with the World Health Organization's (WHO) goal to provide comprehensive and integrated mental health services in community-based settings, this randomized control trial explored the efficacy of online group music therapy as a proactive intervention for reducing stress and anxiety in university students who do not necessarily have a diagnosis. The study took place during COVID-19 restrictions. Students who volunteered were randomly assigned to 6 weeks of weekly (1) online active group music therapy, (2) online receptive group music therapy, (3) online group verbal therapy (standard of care), or (4) no-intervention (control group). Students rated their stress (Likert scale) and anxiety [State-Trait Anxiety Inventory, State version (STAI-S)], and provided heart rate variability (HRV) using a phone app, pre and post each therapy session. STAI-S and Likert stress scores significantly reduced from pre to post 45-min online music therapy sessions, with moderate evidence that these changes did not differ from the standard of care (verbal therapy). HRV results were not analyzed statistically as HRV collection was likely compromised due to challenges of remote collection. Students completed the Perceived Stress Scale (PSS) and provided a hair sample for cortisol analysis before and after the 6-week intervention. Changes in stress from week 1 to week 6 were not observed in the PSS measure; however, cortisol increased significantly in the control group as the term progressed, while it remained relatively stable in the therapy groups, suggesting therapy may lead to greater control of stress. Of participants' demographic characteristics, music sophistication, personality, and changes in quality of life, only the personality trait of conscientiousness correlated significantly with PSS, suggesting online group therapy may be beneficial for a wide range of university students. The results suggest group music therapy can be as effective as group verbal therapy. Further, the study indicates that online delivery can be achieved effectively, supporting the idea that remote therapy may be a viable option for other populations. While the study should be replicated with a larger multi-site sample, it provides one example toward achieving a health-promoting culture on university campuses, consistent with the mental health goals of the Okanagan Charter.

Modulation of the heartbeat evoked cortical potential by hypnotizability and hypnosis.

Hypnotizability is a psychophysiological trait measured by scales and associated with several differences, including interoceptive accuracy and the morpho-functional characteristics of interoception-related brain regions. The aim of the study was to assess whether the amplitude of the heartbeat evoked cortical potential (HEP), a correlate of interoceptive accuracy, differs in participants with low (lows) and high (highs) hypnotizability scores (assessed by the Stanford Hypnotic Susceptibility Scale, Form A) before and after the induction of hypnosis. ECG and EEG were monitored in 16 highs and 15 lows during an experimental session, including open eyes baseline (B), closed eyes relaxation (R), hypnotic induction (IND), neutral hypnosis (NH), and post session baseline (Post). No significant difference was observed between groups and conditions in autonomic variables. The HEP amplitude was lower in highs than in lows at the right parietal site, likely due to hypnotizability related differences in the functional connection between the right insula and parietal cortex. It increased in highs and decreased in lows across the session, possibly due to the highs' preeminently internally directed attention and to the lows' possible disengagement from the task. Since interoception is involved in several cognitive-emotional functions, its hypnotizability related differences may contribute to the variability of experience and behavior in daily life.

Effect of Tailored Coaching on Physicians’ Electronic Health Record Proficiency and User Experience: A Randomized Crossover Study

ObjectiveTo examine the effect of a tailored EHR coaching intervention, informed by audit log data, on physicians’ EHR proficiency, and user experience among pediatricians. Patients and MethodsA 12-month (August 2020 – August 2021) randomized crossover quality improvement study of a tailored EHR coaching was conducted on 34 pediatric physicians at a major medical center. Participants were randomized into Group AB or Group BA. The intervention was a single 1-hour, one-on-one coaching session. An Epic certified pediatrician tailored each coaching session to meet each physician needs using their EHR audit log data. We analyzed EHR audit log data for 3 months pre- and post-intervention. ResultsOut of the 34 physicians, 15 (44%) were primary care pediatricians, 19 (56%) were female, 24 (70%) practiced at the medical center. During the initial intervention, the average proficiency score for the Group AB increased by 8.9% (pre-post difference: 0.37, 95% CI: −0.35 to 1.09; P-value=.381). For the crossover intervention, the average proficiency score for Group BA significantly increased by 11.2% (pre-post difference: 0.31, 95% CI: −0.11 to 0.74; P-value=.05). The average perceived EHR workload decreased post coaching sessions compared to pre-session (50.89 vs 46.66, P-value=.06). Post-coaching intervention, the average score for perceived EHR usability improved compared to pre-intervention (4.10 vs 4.34; P-value=.1). ConclusionElectronic health record audit log data can be used to inform tailored coaching to improve physicians’ EHR proficiency levels and user experience. Tailored EHR coaching can increase awareness about efficiency tools available in the EHR. These findings are relevant to decisionmakers and learning health systems interested in provider well-being by optimizing EHR use.

Observational feedback literacy: designing post observation feedback for learning

ABSTRACT The aim of teaching observations and post observation feedback in higher education is to support teachers to reflect on and improve their teaching. Yet, our understanding of tutors’ (observers’) and teachers’ (observees’) capacities for capitalising on these feedback opportunities is limited and there is little empirically derived advice for either the observer or the observee on the post observation feedback processes. We argue for the need to conceptualise and operationalise observational feedback literacy as a particular type of feedback literacy which is played out in both the design of the post observation feedback session, and in the moment-by-moment feedback talk. Drawing on the concept of student and teacher feedback literacies, this paper offers a framework of observational feedback literacy which identifies how observers and observees act in feedback literate ways. The framework foregrounds observer feedback literacy and recognises the importance of providing opportunities for observees to enact feedback.

The Efficacy of High-fidelity Simulation-based Education in Enhancing Knowledge among Undergraduate Medical Students

Background: Medical education has experienced important changes in recent times. The concern for patient's safety is one of the key reasons for the change in medical curricula. Innovative instructional methods like simulation-based medical education (SBME) has evolved to address this problem. SBME has become an essential part of education and training for health professionals in many parts of the world. There are evidences that support that high-fidelity simulation (HPS) training has enhanced clinical knowledge among medical students.
 Aims: The objective of this study was to note the differences in the knowledge made by high-fidelity simulation-based medical education among undergraduate medical education.
 Study Design: It was a quasi-experimental time series study with Pre-test and Post-test interventions.
 Place and Duration of Study: Clinical Skills Lab, Faculty of Medicine, Manipal University College Malaysia, Melaka, between October 2015 and September 2017.
 Methodology: The study involved 347 final year undergraduate medical students. The participants were divided into groups during the simulation sessions and their knowledge was assessed individually with Multiple Choice Questions (MCQ) and also self-reported Pre-test and Post-tests. Paired t-test was used to determine the difference of MCQ scores between pre and post simulation sessions. One-way repeated measure ANOVA was performed to determine the significant difference in knowledge assessment of self-reported Pre-test and Post-test scores. P value < .001 was taken to be of statistical significance.
 Results: In the unpaired t-test, Post-test MCQ scores were higher than Pre-test scores but not statistically significant (P = .013). A one-way repeated measured ANOVA with Bonferroni post hoc analysis demonstrated that the total scores of the self-reported knowledge tests were significantly increased over time (P < .001).
 Conclusion: There is enhancement of knowledge as perceived by the students with self-reported knowledge tests but not statistically significant as revealed by the MCQ scores.

Impact of Educational Intervention on the Knowledge, Attitude, and Practice of Pharmacovigilance Among Nurses at a Tertiary Care Public Hospital.

Nursing students and employees remain the first point of contact in case a patient develops an adverse drug reaction in hospital settings. Thus, it is important for nurses to understand the importance of pharmacovigilance activity and implement the same in their practice. They can also contribute to drug safety by reducing medication errors and adverse drug reaction reporting. After ethics approval, an observational questionnaire-based study was conducted in 2017 that involved nursing students and nursing employees (N=390) to assess their baseline knowledge, attitude, and practice toward pharmacovigilance. Participants who consented were enrolled and a pre-training survey was conducted. Pharmacovigilance sensitization/ training sessions were conducted in the same year after getting their baseline data. Three years later in 2021, the same questionnaire was distributed to a subset of nursing students and employees (N=299) to analyze any change in their knowledge, attitude, and practice towards the pharmacovigilance activity as a posttest. Pre and post sensitization session questionnaire-based survey data was analyzed to confirm the long-term impact of conducting such pharmacovigilance awareness training. The nurses' overall performance before and after training in each of the domains of knowledge, attitude and practice were 17.53%, 72.86%, 39.69% in the pretest group, respectively, and post test scores were 30.77%, OR-3.04, p=0.0 (Knowledge), 85.92%, OR-0.14, p=0.0 (Attitude) and 37.21%, OR-0.08, p=0.08 (Practice) in the corresponding domain. Overall, there was a declining trend in the practice domain of the nurses response between the pre-test and post intervention groups however this decline was not statistically significant (p=0.08). Pharmacovigilance awareness training and sensitization programs had an impact on the knowledge and attitude of nurses but there is a need to ensure that it is implemented in clinical practice.

Active cycle of breathing technique versus oscillating PEP therapy versus walking with huffing during an acute exacerbation of bronchiectasis: a randomised, controlled trial protocol

BackgroundAirway clearance techniques (ACTs) for individuals with bronchiectasis are routinely prescribed in clinical practice and recommended by international guidelines, especially during an acute exacerbation. However, there is limited evidence of the efficacy of these techniques during an exacerbation to improve sputum expectoration, health-related quality-of-life (HRQOL) or exercise tolerance. The primary aim of this study is to compare the effects of the active cycle of breathing technique (ACBT), oscillating positive expiratory pressure (O-PEP) therapy, and walking with huffing on sputum expectoration for adults hospitalised with an acute exacerbation of bronchiectasis. Secondary aims are to compare the effects of these interventions on HRQOL, health status, exacerbation rates and hospital admissions in a six-month period following hospital discharge.MethodsThis multi-centre randomised controlled trial will recruit adults with an acute exacerbation of bronchiectasis requiring hospital admission. Participants will be randomised to receive one of three interventions: ACBT, O-PEP therapy, and walking with huffing. Outcome measures including sputum volume during and 1-h post ACT session, and 24-h sputum, as well as health status, HRQOL and exercise capacity will be completed during inpatient stay on day 2 and day 6 of admission, and within 24 h of hospital discharge. Time to first exacerbation, and time to first hospitalisation will be monitored via monthly phone calls for six months post hospital discharge. Health status and HRQOL will be assessed after discharge at two and six months, and exercise capacity will be assessed at six months post hospital discharge.DiscussionDespite recommendations regarding the importance of ACT for individuals with bronchiectasis during an acute exacerbation, there is a gap in the literature regarding effectiveness of ACT when undertaken by individuals in this clinical state. This study will add to the evidence base regarding the effectiveness of commonly implemented ACTs during a hospital admission with an exacerbation of bronchiectasis. Additionally, it will contribute to knowledge of the long term effects on important and patient-centred outcomes, including incidence of future exacerbations, and HRQOL, which has not been previously established.Trial registration Registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12621000428864).

1342 DO NOT ATTEMPT CONVERSATIONS PRE-REHEARSAL: TEACHING MEDICAL STUDENTS TO HAVE DNACPR CONVERSATIONS

Abstract Introduction The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form is widely adopted to document advanced care plans, including Do Not Attempt Resuscitation (DNACPR) decisions. Communication between clinicians and patients, or next of kin is required for completion. It is widely documented UK medical students have little exposure to these experiences, including being asked to leave whilst they are occurring. During the COVID19 pandemic, Foundation Year 1 (FY1) doctors led discussions with increased frequency and autonomy, with no documented concurrent training. We present a novel learning experience designed to aid these discussions. Students were timetabled to a 1.5 hour workshop, facilitated by a clinical teaching fellow. They were invited to complete ReSPECT form for a celebrity to familiarise themselves with the layout. They then considered a patient admission scenario in 3 different groups from the perspective of the patient, family and medical team, and used this to contemplate potential, future, emergency treatments. Subsequently a discussion surrounding CPR effectiveness, ways of communicating this, and legal advanced decision documents occurred. The session concludes with scrutinising example ReSPECT forms provided by the Resuscitation Council UK. Method Students' confidence levels were measured pre and post session using a Likhert scale questionnaire. Results 90 students attended workshops across 6 rotations. 80% students completed post - session questionnaires, of which 100% reported an increase in confidence with having a DNACPR/advanced care planning discussion compared to before the session. Conclusion DNACPR conversations can incite anxiety in any seniority of health care professionals. Medical educators need to adequately prepare medical students during their training in advanced care planning and DNACPR discussions. This can be done with simulated workshop experiences, reinforced with opportunistic or organised observational experience. Adequate preparation will lead to increased confidence in discussions, ultimately leading to better experiences for patients and their families.

Raising awareness for women with pregnancy induced Hypertension regarding the importance of the antenatal care

Pregnancy-induced hypertension was defined as new hypertension (systolicBP≥140 mmhg and/or diastolic BP ≥ 90 mmhg) that appears after 20 weeks or more gestational age of pregnancy with or without proteinuria (includes preeclampsia, eclampsia, and gestational hypertension). Pregnant mothers diagnosed with pregnancy induced hypertension during the data collection period in the selected antenatal care clinic of the hospitals were included as exposed participants and women without PIH during the same period were also enrolled as a non-exposed participant.Aim of study: Raising awareness for women with pregnancy induced Hypertension regarding the importance of the antenatal care.Subjects and Methods: A quasi experimental research design was be used in this study. The study was be conducted at obstetrics and gynecology department in Aswan- university hospital, Egypt. Purposive sample was be for this study (10 0 pregnant). Tools: Three tools were utilized to collect data.Tool I: assessment sheet Knowledge regarding pregnancy induced hypertension. Tool II: Assessment sheet pregnant women regarding antenatal care with pregnancy induced hypertension.Results: Majority of pregnant Showed good total knowledge regarding pregnancy induced Hypertension post session phases 82% Showed poor total knowledge regarding pregnancy induced Hypertension while more than 22% pre sessions phase.Conclusion: The present study shows that less than half 45% of the studied pregnant women take their knowledge from friends, while minority 8% of the studied pregnant women takes their knowledge from internet, the study results illustrates that there is high statistically significant positive correlation between total knowledge regarding pregnancy induced hypertension and total knowledge regarding antenatal care at post sessions phases. Recommendation: Based on our study finding there are some recommendations to get the proper improvement on PIH among the pregnant women as follows: there is need for improving the knowledge of pregnant women about PIH by health education programs and instruction booklets throughout the wards of the hospital Eencourage earlier booking visit in the first 12 weeks of pregnancy.

Test-Retest Reliability of Indian Stroke Scale on Functional Activities in Chronic Stroke Patient

ABSTRACT
 BACKGROUND: Stroke is a neurological deficit which attributes to acute focal injury of CNS caused by loss of blood supply to brain. Indian Stroke Scale, recently invented scale to assess the participation of daily activities in stroke patients. Hence, this study was done to evaluate the reliability of Indian Stroke Scale on functional activities in chronic stroke patients.
 METHOD: 30 chronic stroke patients were selected and screened through study criteria. The procedure was explained and written consent was taken. Scores of Indian Stroke Scale was taken pre and post treatment session.
 RESULT: Statistical analysis reveals the correlation of 0.996. The level of significance of all subscales was 0.000. Since, the correlation value was between the 0.8 - 1, there was a strong positive correlation.
 CONCLUSION: The study concluded that the Indian Stroke Scale is highly reliable.
 KEYWORDS: INDIAN STROKE SCALE, CHRONIC STROKE, STROKE, CORRELATION, DISABILITY, RELIBILITY

Home-based laboratory experiences during COVID-19 pandemic in undergraduate biochemistry students

The coronavirus pandemic (COVID-19) pointed out new challenges to teaching in laboratory-based disciplines, such as chemistry, biology, and biochemistry with on-site practical sessions interrupted or suspended during 2020 and 2021. Observation and experimentation are part of education in science-based disciplines and provide necessary skills for professional and academic careers. In an effort to solve this disruption to experimental observations, we designed a set of home-based experiences related to chemistry and biochemistry. These included visual identification of lipids, sugars, proteins, and DNA in biological samples using materials easily found at home, such as alcohol, soap, and oil, among others. Each activity was documented with smartphones and discussed in a final portfolio. Fifty-two students were part of an introductory cell biochemistry course. The home-based laboratories were organized into 2.5-h sessions that included a lab session, a post lab session, and a period for preparing the experiment at home. Thirty-six (17 men and 19 women) students answered a survey designed to assess three major domains: (1) student’s demographics and home environment, (2) general perceptions of the laboratory activities, and (3) specific perceptions of each laboratory activity. Sixty two percent of the students thought that these activities helped them to understand how to isolate and identify macromolecules. Eleven percent said these home activities did not contribute to their understanding while 27% stated the activities were not significant for the topic. We conclude that, although the addition of in-house experiments provides a complementary tool for understanding the main concepts in biochemistry along with improving skills in scientific thinking, this should be accompanied by a good feedback mechanism from the instructors. In addition, student to student interaction should be part of the at home activities to increase student motivation. A Flipped laboratory methodology plus tools where metacognition is evaluated, appear to be appropriate to promote the understanding of concepts in the context of the laboratory. And although some aspects of the experimental experience can be substitute with online resources and in home experiences, others can only be achieved by the in-person experience.

8895 Fundamentals of Laparoscopic Surgery for Senior Medical Students Entering Surgical Residency

<h3>Study Objective</h3> The Fundamentals of Laparoscopic Surgery (FLS) is mandatory for OBSTETRICS AND GYNECOLOGY residency. We aimed to evaluate the usefulness of FLS for fourth year medical students to gain confidence and to determine quantitative improvement in FLS tasks and exam. <h3>Design</h3> On the first and last day of the course, students completed a Likert scale (1-10) self-assessment rating confidence in knowledge of laparoscopy, confidence in technical laparoscopic skills, and satisfaction with laparoscopic training during medical school. Students also completed the FLS written assessment. For two weeks, students had didactics and practiced the five practical tasks on FLS trainers: peg transfer, circle cutting, endoloop, extracorporeal and intracorporeal knot tying. Pre and post practice times were recorded. Students were evaluated by OBSTETRICS AND GYNECOLOGY faculty mentors with a pre and post validated global assessment tool per FLS task. <h3>Setting</h3> Fourth year medical school elective in an academic setting. <h3>Patients or Participants</h3> Sixteen fourth year medical students enrolled in the two-week FLS elective course over two years (2021-2022). <h3>Interventions</h3> Participants received daily didactic lessons taught by OBSTETRICS AND GYNECOLOGY faculty, as well as guided practice sessions utilizing laparoscopic task trainers. All interventions were measured pre and post didactic sessions. <h3>Measurements and Main Results</h3> Overall, students felt more confident in their combined laparoscopic knowledge, skills, and training assessment following the course (2.3 (1.7) vs. 6.1 (2.0), p<0.001). Students showed improvement on the written exam (.62 (.10) vs. .87 (.06), p<0.001). The mean time to complete all five of the FLS tasks decreased (seconds, 247 (135) vs. 143 (102), p<0.001). Finally, the average combined faculty global rating assessment of the students' performance improved (2.3 (0.4) vs. 3.9 (0.3), p<0.001). Feedback from students was universally positive. <h3>Conclusion</h3> Implementing the FLS curriculum for fourth year medical students increases confidence in laparoscopic knowledge and performance of technical skills prior to entering a surgical residency.

Acute and chronic effects of cross fit training on the kinetics of the IGF-I / IGFBPs system in young adults

The components of the IGF-I/IGFBPs system constitute a group of growth factors that are directly related to somatic and tissue growth in many species, and exercise programs are related to this anabolic function. The aim of this study was to verify the kinetics of the IGF-I/IGFBPs system in young adults during a CrossFit training program. Eight young adults were evaluated before and after the execution of a standardized training session (Acute effect), during the initial, intermediate and final phases of the CrossFit training program (Chronic effect). To analyze the kinetics of the IGF-I/IGFBPs system throughout the training program, two non-parametric statistical methods were used: the Kruskall-Wallis test for one factor and the Wilcoxon test. The significance level adopted was 0.05. No significant changes were found in the concentrations of IGF-I (p=0.73) and IGFBP-3 (p=0.23) between the initial, intermediate and final phases of the training program. There were also no significant differences in the IGF-I and IGFBP-3 concentrations between the pre and post training sessions in the initial, intermediate and final phases. Even though the standard session was classified between

Instituting Racial Equity: The Allegheny County Racial and Ethnic Approaches to Community Health Initiative.

In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization's mission, goals and subsequent actions. As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work.

Acute and chronic cardiometabolic responses induced by resistance training with blood flow restriction in HIV patients

Resistance training with blood flow restriction (RTBFR) allows physically impaired people living with HIV (PWH) to exercise at lower intensities than traditional resistance training (TRT). But the acute and chronic cardiac and metabolic responses of PWH following an RTBFR protocol are unknown. The objective was to compare the safety of acute and chronic effects on hemodynamic and lipid profiles between TRT or RTBFR in PWH. In this randomized control trial, 14 PWH were allocated in RTBFR (GRTBFR; n = 7) or TRT (GTRT; n = 7). Both resistance training protocols had 36 sessions (12 weeks, three times per week). Protocol intensity was 30% (GRTBFR) and 80% (GTRT). Hemodynamic (heart rate, blood pressure) and lipid profile were acutely (rest and post exercise 7th, 22nd, and 35th sessions) and chronically (pre and post-program) recorded. General linear models were applied to determine group * time interaction. In the comparisons between groups, the resistance training program showed acute adaptations: hemodynamic responses were not different (p > 0.05), regardless of the assessment session; and chronicles: changes in lipidic profile favors GRTBFR, which significantly lower level of total cholesterol (p = 0.024), triglycerides (p = 0.002) and LDL (p = 0.030) compared to GTRT. RTBFR and TRT induced a similar hemodynamic adaptation in PWH, with no significant risks of increased cardiovascular stress. Additionally, RTBFR promoted better chronic adequacy of lipid profile than TRT. Therefore, RTBFR presents a safe resistance training alternative for PWH.Trial registration: ClinicalTrials.gov ID: NCT02783417; Date of registration: 26/05/2016.

Moderate physical activity alters the estimation of time, but not space.

Moderate physical activity can influence cognitive functions and visual cortical activity. However, little is known about the effects of exercise on fundamental perceptual domains, such as spatial and temporal representation. Here we tackled this issue by testing the impact of physical activity on a temporal estimation task in a group of adult volunteers in three different conditions: (1) in a resting condition (baseline), (2) during moderate physical activity (cycling in place – PA), and (3) approximately 15 to 20 min following the physical activity phase, in which participants were seated and returned to a regular heart rate (POST). We show that physical activity specifically impacts time perception, inducing a consistent overestimation for durations in the range of milliseconds. Notably, the effect persisted in the POST session, ruling out the main contribution of either heart rate or cycling rhythmicity. In a control experiment, we found that spatial perception (distance estimation) was unaffected by physical activity, ruling out a major contribution of arousal and fatigue to the observed temporal distortion. We speculate that physical exercise might alter temporal estimation either by up-regulating the dopaminergic system or modulating GABAergic inhibition.

EFFECTS OF ELDOA TECHNIQUE VERSUS MCKENZIE EXTENSION EXERCISES ON NON-SPECIFIC LOW BACK PAIN PATIENTS.: A RANDOMIZED CLINICAL TRIAL

Background: Low back pain may lead cause disability in the patients. There are several physical therapy protocols used to manage the low back pain including McKenzie exercises. The Elongation Longitudinaux Avec Decoaption Osteo Articulaire (ELDOVA) is novel techniques could help to reduce the pain and disability related to lower back problems. Objective: to determine the effects and compare the McKenzie extension exercise and ELDOA stretch in non-specific low back pain patients. Methodology: A randomized clinical trial was conducted at Railway General Hospital, Rawalpindi and Irada Rehabilitation Center, Buchal Kalan from October 2021 - December 2021. The female participants with the age range of 40-69 years and had chronic non-specific low back pain for more than 3 months were included in the study. The participants were randomly divided into group A which received McKenzie extension exercises while group B received ELDOA stretch. The patient’s outcome measures were assessed through Numeric Pain Rating Scale (NPRS), inclinometer for, flexi curve ruler for lordships angle, and Oswestry Disability Index (ODI) for disability. MANCOVA test was used for controlling the covariates at baseline. Friedman with post hoc Wilcoxon test (non-parametric-within group analysis) for ODI variables RMANOVA was applied to observe pairwise changes with-in the groups for ODI total score, lordosis angle at baseline, and end of second, and fourth week of the treatment. NPRS and range of motion (extension, flexion) at pre and post treatment session. Results: The mean age of study participant was 44.29±3.08. Within group analysis showed that significant improvement (p&lt;0.05) was observed in both groups regarding ODI total score, NPRS, Lordosis angle and range of motion (flexion, extension) from baseline to the end of 4th week and at each level of assessment. The group A (McKenzie extension exercises) was a significantly improved on the combined dependent variables as compared to group B (ELDOA stretch) after controlling for baseline values of BMI, NPRS, lordosis angle and ROMs, F (7, 34) = 55.12, p&lt;0.001, Wilks' Λ=0.018, ηp2=0.49.Conclusion: McKenzie extension exercise showed better result in improving pain, range of motion, angle of lordosis and disability than ELDOA technique. Keywords: disability, low back pain, physical therapy, stretching exercises. ROM

Self-Awareness and therapeutic alliance in speech-language treatment of traumatic brain injury

Purpose: To investigate the relationships among client self-awareness, client perception of the therapeutic alliance, and speech-language pathologist (SLP) communicative self-awareness in dyads of SLPs and traumatic brain injury (TBI) clients. Method: Nineteen SLP-TBI client dyads (N = 38) engaged in the same collaborative therapy task. At baseline, client self-awareness and client perception of the therapeutic alliance was assessed. SLP communicative self-awareness was measured by 1) a prediction/reflection questionnaire about their own communicative behaviour, administered pre- and post-treatment sessions, and 2) self-evaluation during a novel procedure using video review within three hours after the session. Result: Client self-awareness was not associated with client perceptions of the therapeutic alliance. Client perceptions of the therapeutic alliance were related to specific communicative intentions of the SLP. Regarding SLP communicative self-awareness, SLPs predicted their primary communication modality with 66% accuracy. The video review procedure yielded more detailed SLP communicative self-awareness ratings and was completed within real-world clinical settings. Conclusion: TBI client self-awareness may not impact the establishment of a strong therapeutic alliance between SLP and client. The finding that specific communicative intentions of the SLP were related to client perception of the therapeutic alliance should prompt further efforts to measure SLP communicative intentions and behaviours during TBI treatment sessions.

Enhancing a Rehabilitation Pathway for Pediatric Heart Transplant Recipients: An Improvement Project to Increase Adherence, Satisfaction, and Outcomes

Aims To refine a cardiac rehabilitation pathway for pediatric heart transplant recipients; assess clinician knowledge and adherence to the program; and evaluate patient outcomes. Methods The center has utilized a rehabilitation pathway for pediatric heart transplant recipients. Challenges in practice include access to centers, lack of data tracing, and adherence to the pathway. The quality initiative focused on program refinements: implementation of text templates to improve data collection, collection of the Pediatric Cardiac Quality of Life Inventory (PCQLI), Functional Independence Measure (WeeFIM) and Child Occupational Self-Assessment (COSA), development of an outreach program, and creation of an educational program for therapists to increase content knowledge and improve clinician satisfaction. Results In the evaluation of rehabilitation follow-up post-transplant, there was no statistical significance between the pre- and post-implementation groups. After the implementation of the refined pathway, there was an increase in the completion of the six-minute walk test post-transplant (p = 0.048). Clinicians’ responses post educational session noted familiarity with the pathway (88%), documentation (78.8%), and outcome measures (97%). Results of outcomes noted improvement in six-minute walk distances and a decrease in the rate of perceived exertion post-transplant. To ensure future pathway adherence, clinical support should be implemented, and key players identified to maintain sustainability.

CONSISTENCY OF AFFECTIVE VALENCE ACROSS BOUTS OF MUSCLE-STRENGTHENING AND AEROBIC EXERCISE IN COLLEGE STUDENTS

Exercise-related affective response are assumed to be consistent in response to the same stimulus, but there is little evidence to support this assumption. PURPOSE: To examine the consistency in ratings of in-task affective valence across eight repeated, remotely supervised home-based exercise sessions. METHODS: Participants (N=15, 20.4 ± 1.5 years old, 80% women) who reported engaging in less than 60 minutes per week of structured exercise were randomly assigned to either the muscle-strengthening (MSE) (N=8) or aerobic (AE) (N=7) group. Each participant met virtually with a trainer for two 30-min circuit-training sessions per week for four weeks. The number, type, and order of exercises (as well as duration of rest intervals) performed each session were held constant. The Feeling Scale (FS) was used to assess affective valence at nine time-points: pre-session, every three exercises before rest (i.e., capturing seven measures of in-task valence), and post session. Two-way mixed intra-class correlation coefficients (ICC) were calculated with 95% confidence intervals for the seven in-task FS overall and by group. For everyone at each session, pre-exercise FS was compared to each in-task value to explore directional change in exercise-related FS (e.g., experiencing positive, negative, or no changes). RESULTS: The ICC for FS measured during AE was 0.852 (95%CI =0.793-0.902). During MSE, the ICC for FS was 0.764 (95%CI = 0.688-0.832). Across all sessions eight participants (53%; AE 5, MSE 3) were consistently categorized as increasers and, zero participants were consistently categorized as decreasers or non-changers for all 8 days. CONCLUSION: This exploratory work represents an initial assessment of consistency in affective responses during repeated exposure to AE and MSE in a non-laboratory setting. However, this study represents only a short-term exposure to a novel, circuit-based (i.e., variety supportive) stimulus. Additional research is needed to understand consistency of in-task affective valence in response to repeated exercise of various modes, performed by a larger, more diverse sample over longer periods of time that would be representative of a typical training intervention.