Pre Intervention Research Articles

Onsite training-mentoring intervention improves data quality: an implementation research.

The quality of health data is not satisfactory in Low and Middle Income Countries (LMICs). Haramaya University, in collaboration with Ministry of Health and Regional Health Bureau, conducted an implementation research in selected public health facilities and administrative units. This research was aimed to test the onsite training-mentoring (OTM) intervention and adaptation of the implementation strategy to improve the routine health information system (RHIS) data quality in the context of public health sector. An interrupted time series design with an onsite training-mentoring intervention was used to improve data quality in public health sector of Jigjiga Woreda, eastern Ethiopia from July 2021 to June 2022. Both the pre and post intervention assessments data were collected by experienced and trained public health professionals using interviewer guided self-administered interview, record review and observation data collection techniques. Data were analyzed using descriptive, bivariate, and multivariate logistic models to identify predictors of data quality. The overall data accuracy was increased from 88.12% before to 95.0% after intervention; and it was above 90% in all the facilities. The overall data content completeness was increased from 75.75% to 89.9%, though it varied among the facilities. The timeliness and report completeness were 100% in all the facilities. The odds of those health workers who had poor knowledge were less likely to ensure data quality (AOR = 0.39; 95%CI: 0.19, 0.83) than their counterparts. The intervention was brought substantial changes of data quality in the study setting. Knowledge of the workers towards data quality is a crucial factor to ensure data quality in the sector. Thus, collective efforts is required to continue this tested intervention to ensure the quality of the routine health information system in the lower levels of the sector.

A Study to Compare the Effects of Mulligan Traction Straight Leg Raise Technique, and Propeoceptive Neuromuscular Facilitation (Hold Relax) Technique on Tightness, and Strength of Hamstring Muscle among Young Adults

Flexibility is defined as the ability of a muscle to lengthen, allowing one joint or more to move through a range of motion (ROM), and is an essential component of normal biomechanical functioning. Hamstring tightness can occur due to the sedentary lifestyle which is the main reason for postural abnormalities. Therefore, it is important to have optimal muscle flexibility for optimal performance. In this line of thought, the present study is designed to compare the effects of Mulligan Traction Straight Leg Raise Technique and Proprioceptive Neuromuscular Facilitation hold relax technique on hamstring tightness among young adults. AIM OF THE STUDY- “To compare the effects of mulligan traction straight leg raise technique and proprioceptive neuromuscular facilitation (hold relax) technique on tightness and strength of hamstring muscle among young adults”. METHODOLOGY- The total duration of the study was one and a half year. Subjects meeting the inclusion and exclusion criteria were selected in the study. A minimum of 60 subjects, both male and female with age between 18-25 years, were selected for the study and subsequently divided into three groups with minimum of 20 subjects in each group. Group A (control group) was given warm up and hot pack for 15 minutes. Groups B and C were experimental groups. Group B was given Mulligan Traction Straight Leg Raise technique in addition to warm up and hot pack. Group C was given PNF hold relax technique in addition to warm up and hot pack. The baseline data was recorded on first day (pre intervention) and on last day of second week (post intervention). All the interventions were performed once a day, five days a week for two weeks. DATA ANALYSIS- The collected data will be analysed using ANOVA and other statistical tests as appropriate (SPSS software). RESULT- The result of present study shows that PNF hold relax is more effective in improving flexibility of the hamstring muscle than Mulligan TSLR.

Impact of multifaceted interventions on the knowledge, attitude, and practice of adverse drug reactions reporting among healthcare workers in Vietnam: a comparative intervention study

BackgroundKnowledge, attitude, and practice of Adverse Drug Reactions (ADRs) and ADRs reporting among healthcare workers were related to the quality and ADRs reporting rate. The aim of this study was to evaluate the effectiveness of the multifaceted interventions on knowledge, attitude, and practice (KAP) of healthcare workers and to compare the proportion of spontaneous ADRs reports at the study center, before and after instituting multifaceted interventions.MethodsA comparative intervention study was conducted among healthcare workers at the hospital. The participants were asked to complete a questionnaire before and after instituting the multifaceted interventions to assess the KAP of ADRs and their reporting. The impact of the multifaceted interventions was assessed by comparing their correct responses to the KAP questions and the proportion of spontaneous ADRs reports before and after the interventions. The pre- and post-intervention scores for KAP questions were compared usingMcNemar test by R Language.Results388 healthcare workers completed the study. The proportion of participants qualified for ADRs reporting increased significantly, from 73.5% (pre–intervention) to 99.2% (post–intervention) for knowledge scores, from 70.6% to 91.8% for attitude scores, and from 81.4% to 97.2% for practice scores (p < 0.001). Similarly, the number of spontaneous ADRs reports increased by 31% after 3 months of interventions.ConclusionMultifaceted interventions instituted at the study center improved the knowledge, attitude, and practice of health workers towards ADRs and spontaneous reporting. It would be beneficial to implement such interventions in other hospitals in Vietnam.

A community action network-based intervention for improving knowledge of zoonoses among wildlife hunters and traders in Epe, Lagos, Nigeria.

The West Africa One Health project is a multi-country project designed to utilise the One Health approach and deploy the Community Action Networks (CAN), a concept rooted in the principles of community-based participatory research, to improve knowledge of high-risk communities on zoonoses. The majority of emerging zoonoses occur at the human-wildlife interface, of which wildlife hunters and traders are critical stakeholders. We assessed the effectiveness of a CAN-based intervention involving the use of a video documentary and case studies as model tools in improving the knowledge of zoonoses among wildlife hunters and traders in Epe, an established hunting community in Lagos State, Nigeria. A single-group pre-post design involving a total of 39 consenting registered wildlife stakeholders was adopted. A pre-tested, semi-structured, interviewer-administered questionnaire was used to obtain data on the participant's sociodemographic characteristics, awareness level, and knowledge of zoonoses pre and post CAN-based intervention. Data were analysed using descriptive statistics McNemar and Wilcoxon Signed Ranks tests at a 5% level of significance. The mean age of the participants was 46.7 ± 10.9 years. Most (76.9%) identified as male and had at least secondary education (89.7%). The number of participants who were aware that diseases could be contracted from animals and that it could be through inhalation and close contact increased significantly from 13 (33.3%), 2 (5.1%), and 9 (23.1%) pre-intervention to 37 (94.9%), 11 (28.2%), and 21 (53.8%) post-intervention, respectively. The overall median knowledge score increased significantly from 1 (Interquartile range (IQR): 0-2) pre-intervention to 3 (IQR: 2-4) post-intervention. The CAN-based intervention involving the use of a video documentary and case studies as model tools was effective in improving the knowledge of zoonoses among wildlife hunters and traders in the hunting community and may be beneficial for future practice.

Cost effectiveness and functional outcomes of smartphone cardiac rehabilitation assisted self-management versus centre based cardiac rehabilitation among patients with coronary heart disease in Southern India: a multicentre randomized clinical trial protocol

Background: To attain the world specific indicators of quality on programs which brings rehabilitation for cardiac diseases and surgeries in India are to be brought to meet the international standards. Dearth of published research on cost effectiveness of smart phone application oriented CR assisted self-management (SCRAM) over centre based (CBCR) in Indian Population drives this study to be done. This study aims to analyze cost effectiveness of SCRAM versus CBCR in coronary artery disease (CAD) patients. Methods: In this multicentre randomized clinical trial, 100 subjects with uncomplicated CAD will be recruited through purposive sampling and divided into group A and B through block randomization. Group A will be treated with CBCR whereas group B with SCRAM. Outcome measures of 6 minutes’ walk test distance, talk test values and SF 36 scores, high density lipoprotein level and 3 months’ average blood glucose level were documented pre and post interventions and 3, 6, 12 months follow up for data analysis. This study will follow human study ethical consideration based on Declaration of Helsinki. Conclusions: Cost effectiveness of experimental group where SCRAM given as intervention may be better post intervention than control group where CBCR given. By this way this RCT protocol may bring the execution cost down with coronary heart disease patients which play a major role in participation of these patients in CR programs. Trial registration: The trial was registered with CTRI – Clinical Trial Registry of India (ICMR) - CTRI/2022/11/047143 (registered on: 09 November 2022) - trial registered prospectively.

Effectiveness of Ultrasound with Isometric Quadriceps Exercise and Retro walking in Osteoarthritis

Introduction: Knee osteoarthritis is a non-inflammatory, painful and degenerative joint disease; pathologic changes in osteoarthritis involve progressive hyaline joint cartilage loss with concomitant changes in subchondral bone and development of osteophyte. About symptomatic knee osteoarthritis affect 13% of women and 10% of men aged 60 years and older. Men have a lower prevalence of knee osteoarthritis than women. The tool used to measure pain intensity, physical functions in this study is WOMAC scale and to assess the range of motion by Universal goniometer. Aim : To Evaluate the Effectiveness of Ultrasound with Isometric quadriceps exercise and retro walking in osteoarthritis of knee. Method : A Total 30 both male and female participants between 45 to 65 years of age selected from RJS Group of institute of kopargaon , Kothari hospital kopargaon by using purposive sampling method according to the inclusion criteria. The total duration of the study is 3 weeks .total 30 participants allocated into two groups A and B 15 in each group. In group A were intervention Ultrasound with isometric quadriceps exercise and group B Ultrasound with retro walking were given for 3 weeks. Pre intervention and post intervention by WOMAC score and universal goniometer were taken analyzed compared using paired’ test. RESULT: As per statistical analysis both groups shown significant improvement but group B ( Ultrasound with Retro walking )was having most significant improvement as compare to group A ( Ultrasound with Isometric quadriceps exercises). CONCLUSION : This study concluded that Ultrasound with Retro walking was effective in participants with Osteoarthritis of knee .Hence there is reduction of pain, improving range of motion at knee joint and functional mobility, Activity of daily living in participants with osteoarthritis of knee.

Patient control preferences prior to discharge after cardiac surgery

Abstract Background The impact of patient preferences and participation in the acute recovery period prior to discharge after cardiac surgery is not well understood. Although there is a plethora of literature describing pre and post discharge interventions to support patients’ recovery there is minimal evidence demonstrating the effectiveness of specific interventions that optimise recovery or patient preferences for participation in decision making related to this period of transition from hospital to home. Purpose The aim of this study was to explore patient preferences for participation in discharge planning. Methods This study took place in a major metropolitan hospital in Victoria, Australia with a population base of over 1 million people that provides over 100,000 episodes of care and approximately 850 cardiothoracic procedures annually. We recruited consecutive adult patients, able to understand and speak English who were being discharged home after cardiac surgery. Prior to discharge, a Registered Nurse conducted a semi-structured interview following patient consent where patients were asked to complete the 5 item Control Preferences Scale (CPS) in relation to 3 discharge planning questions. With each question patients were asked to rate their preferred and actual role in the decision-making process. The CPS has 5 cards each portraying a role in treatment decision making; active (1-2), collaborative (3) or passive (4-5) participation to determine what level of control patients’ desire in relation to their care. Results From 196 patients undergoing cardiac surgery 63 (32.1%) were eligible and agreed to participate. When asked about making plans for discharge 9 (14.3%) patients’ preference was to have an active role in this process, 25 (39.7%) preferred a collaborative approach and 29 (46.1%) a passive approach. Patients perceived their actual role was active (n = 10, 15.9%), collaborative (n = 17, 27.0%) or passive (n = 36, 57.1%). When asked about deciding when to go home 9 (14.3%) patients’ preference was to have an active role in this process, 18 (28.6%) preferred a collaborative approach and 36 (57.1%) preferred a passive approach. Patients perceived their actual role was active (n = 8, 12.7%), collaborative (n = 13, 20.6%) or passive (n = 42, 66.6%). When asked about their preferred role in deciding where they go when discharged 21 (33.4%) patients’ preference was to have an active role in this process, 19 (30.2%) preferred a collaborative approach and 23 (36.5%) a passive approach. Patients perceived their actual role was passive (n = 24, 38.1%), collaborative (n = 16, 25.4%) or passive (n = 23, 36.5%). Conclusion Patient preferences for control were congruous with their perceived experience of involvement in decision making which indicates patients’ preference for control is taken into account by clinicians managing the discharge planning process in this setting.

Reducing research participant disparities through use of a co-developed video intervention: A cohort nested pre-post study

Background Evidence on effective approaches for the recruitment of diverse populations remains limited. This study aimed to assess whether a co-developed study information video would improve participant ethnic diversity within a paediatric study cohort. Methods Pre-post study nested within the Uveitis in childhood prospective national inception cohort study, UNICORNS. Intervention of interest: study information and recruitment video with format and content co-developed with a patient expert group. Outcome of interest: the proportion of families from ethnic minority groups, and of families with primary caregivers without a higher educational degree who were recruited to the study, and the proportion of families who engaged in study activities (returned patient reported outcome metrics following recruitment) pre and post intervention implementation. Results During the study period, 191 children were recruited to UNICORNS (110 pre-intervention era, 81 post-intervention era). A larger proportion of families recruited in the post-intervention era were of an ethnic minority background (36% versus 20%, Fisher’s exact test p=0.02). A larger proportion of families returned self-descriptions of their sociodemographic background (100% versus 87%, Fisher’s exact test p=0.0003) and a larger proportion returned study specific patient reported outcome measures (70% versus 55%, Fisher’s exact test p=0.003). Conclusion Co-created digital research information resources can be an effective tool for ensuring better representation in research studies and may also support participant engagement overall. Our reported methods and findings should support other researchers in developing patient-centred and patient co-developed strategies and tools for the purposes of equitable access to medical research.

The effect of attachment systems and denture cleaning methods on microbial biomass and composition in implant-supported overdentures: an experimental study

ObjectiveThis research endeavors to scrutinize the influence of attachment systems and denture cleaning methodologies on microbial biomass and composition within the realm of implant-supported overdentures, a crucial consideration for patients with dentition defects necessitating such prosthetic solutions.Subjects and methodsEmploying five polymethyl methacrylate specimens designed to emulate the fitting surfaces of traditional dentures and implant-supported overdentures. Following the polishing of each specimen and the quantification of its roughness, co-cultivation with three distinct microbial strains ensued, culminating in ultrasonic cleaning in water. The bar-clip group, differentiated by the depth of attachment, underwent cleaning employing four diverse methods. Biomass quantities were meticulously recorded both pre and post cleaning interventions, with subsequent data analysis via t-testing and one-way ANOVA, maintaining a significance level of α = 0.05.ResultsThe bar-clip groups demonstrated an elevated degree of microbial adhesion, with the deeper locator group exhibiting heightened biomass residue post-cleaning, indicative of increased cleaning complexity. Ultrasonic cleaning predominantly targeted biofilm and deceased bacteria, whereas chemical cleaners primarily reduced the quantity of viable bacteria. The synergistic application of ultrasonics and chemical cleaning treatments yielded the minimal biomass residue.ConclusionIn contemplating the utilization of dentures milled by dental computer-aided design/manufacturing systems, meticulous pre-use surface polishing is imperative. The extent of biofilm adhesion correlates with the chosen attachment system. This study advocates for the incorporation of ultrasonic cleaning in conjunction with chemical cleaning solutions to optimize the removal of biofilm and live cellular entities in the context of implant-supported overdentures.

AN ANALYSIS OF THE PATIENT REPORT OUTCOMES OF A JOINT CNS / AHP NEURO-ONCOLOGY CLINIC ON PATIENTS QUALITY OF LIFE

Abstract AIMS Velindre Cancer Centre established a successful model of collaborative working between CNS and AHP services for neuro-oncology patients to holistically support their complex needs throughout treatment. Building on this success, the clinic has introduced a recognised reliable and valid patient reported outcome measure (PROM) to be completed pre and post clinic intervention. This is in addition to the patient reported experience measure that is already established within the pathway. This PROM will enable an analysis of the clinics impact on patients quality of life. METHOD A quantitative methodology will be utilised to enable a objective evaluation of the impact of the clinic on patients quality of life. An EQ-5D-5L PROM is completed with patients prior to their involvement with the clinic enabling an overview of key aspects related to quality of life including mobility, self-care, participation in usual activities, pain and anxiety / depression. Following interventions within the clinic, patient are provided with a post treatment EQ-5D-5L to enable a comparison of these key indicators of quality of life. RESULTS The data will build on the resounding success of collaborative working between CNS and AHP’s in the neurooncology MDT clinic. An analysis of the pre and post data will demonstrate the impact of having access to this unique and integrated way of working, enabling patient access to specialist timely support throughout their treatment. CONCLUSION This innovative model of working is now established in the patient pathway and findings from patient experience measures have recognised that patients experience of the clinic is extremely highly valued. Findings from this additional dataset will further evidence the impact on patients quality of life. It will add to findings from a proposed gap analysis to evidence the benefits of developing an outreach service for this patient cohort.

Childbirth self-efficacy and birth related PTSD symptoms: an online childbirth education randomised controlled trial for mothers

BackgroundThis study evaluated an online childbirth education course on childbirth self-efficacy and, subsequent birth related posttraumatic stress disorder (PTSD) symptoms and mother-infant relationship quality.MethodThree group (intervention, passive control, active control) parallel randomised controlled trial. Groups were assigned using computer generated random allocation. For the passive control group participants were instructed to carry on with whatever they were currently undertaking with their pregnancy, while the active control group were asked to read a booklet comprised of twelve birth stories. The purpose of the active control was to check if the act of having an activity to complete would influence outcomes. For the online course group (intervention) participants were asked to complete the online version of a birthing course designed by She Births®. One hundred and twenty-five women residing in Australia between 12 and 24 weeks pregnant were recruited online. Participants were asked to complete their required activity between 24 and 36 weeks pregnant. Childbirth self-efficacy scores were tested pre and post intervention (time one and time 2), PTSD symptoms and mother-infant relationship quality were tested at six weeks and six months postnatal.ResultsThere was no significant interaction by group for childbirth self-efficacy scores. Mean difference scores at time one (pre-intervention) and time two (post-intervention) for each group indicated a trend in the online group towards higher childbirth self-efficacy compared with the two control groups. The main effect of group on birth related PTSD scores was not statically significant at six weeks postnatal or at six months postnatal. The main effect of group on mother-infant relationship scores was not statically significant at six weeks postnatal or six months postnatal.ConclusionsTrends showed childbirth self-efficacy scores to be higher in the intervention group compared with the two control groups, demonstrating effectiveness for the intervention. Paradoxically, PTSD scores were higher in the intervention group compared with the two control groups and therefore also reported poorer mother-infant relationship quality. External factors may be more important than childbirth self-efficacy highlighting the need for a holistic approach that addresses systemic and socio-political influences to improve communication, autonomy, and respectful maternity care.Trial RegistrationThis trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry number: ACTRN12624000241538 on March 11, 2024.

Photobiomodulation using red and infrared spectrum light emitting-diode (LED) for the healing of diabetic foot ulcers: a controlled randomized clinical trial.

Assessing the responses to the application of photobiomodulation using red and infrared spectrum light-emitting diodes (LED) on diabetic foot ulcers. Diabetic volunteers, of both genders, aged between 30 and 65 years, with grade I or II ulcers, were randomized into the groups: red LED, infrared LED, LED associated, and control. Home-based interventions took place on a daily basis for 12 weeks. Assessments of sample characterization were performed on day 1 and 90, and the variables wound healing index, mean skin temperature, sensitivity and pain in the wound area were measured at the pre-intervention time on days 1, 30, 60 and 90, with subsequent follow-up 30 days after the end of treatment. For statistical analysis, the software SPSS, version 17.0, intention-to-treat analysis, data normality was tested, and the linear mixed effects model, with a significance level of 5%. Magnitudes of clinical effect by Cohen's d. At the pre vs post intervention time of 90 days, we found a large clinical effect of G-LED V (d=1.7) and G -LED IV (d=1.6) in relation to G-C, where these intervention groups showed a tendency for faster wound healing compared to G-C. We also observed small clinical effect of G-LED IV, which showed greater reduction in the area in relation to G-LED V (d=0.4) and G-LED A (d=0.3). Conclusion: The use of individually applied red and infrared LED phototherapy clinically tended to be more effective for the reduction of diabetic foot ulcer areas, and infrared LED was the most effective. Trial registration: NCT03250533 (clinicaltrials.gov).

An exploratory study of functional brain activity associated with gross motor function improvement in children with unilateral cerebral palsy

ABSTRACT Purpose Identify relations of gross motor function and primary motor cortex (M1) functional activity pre and post gross motor interventions for children with unilateral cerebral palsy (UCP). Methods Thirteen children with UCP completed a gross motor intervention. Pre/post-intervention functional MRI outcomes included the laterality index (LI), activation volume, and spatial overlap of M1 activation during active ankle dorsiflexion. Advanced gross motor function (Challenge) was assessed pre/post-intervention, and 2–6 months later. Bivariate correlations and linear regression assessed relations between neuroimaging and motor function. Results Mean pre-intervention M1 activity was contralateral during dominant (LI = +0.85, SD 0.21) but variable during the affected (LI = +0.43, SD 0.57) ankle dorsiflexion. Changes in motor function and neuroimaging outcomes were not significantly associated. However, smaller affected ankle activation and less spatial overlap between ankle activations pre-intervention predicted Challenge improvements post-intervention (adjusted R2 = 0.74, p = .001.) Conclusions This exploratory study identified pre-intervention neuroimaging predictors of post-intervention improvements in advanced gross motor function.

Is it possible to detect women at higher risk of intrapartum stillbirth? An area-based prospective cohort study.

The aim of the study is to perform an overview of intrapartum stillbirth (SB) at term, assessing risk factors, causes of death and quality of pregnancy care. This is an area-based, prospective cohort study on pregnant women at ≥37 weeks from 2014 to 2021. We compared intrapartum SB' information to alive birth and to antepartum deaths of the same period. Results of logistic regression are reported as the Odds Ratio (OR) with 95% confidence interval (95% CI) and the P value. A descriptive analysis about the causes of death and quality of pregnancy care is performed. The overall rate of SB at term in Emilia-Romagna was 1.06 ‰ births. Among the 260 cases, 27 (10.4%) occurred during labor, with an intrapartum SB rate of 0.11‰. This SB rate was stable during years. SGA newborn (P=0.005, 95% CI 1.47-9.04, OR 3.63), low level of education (P<0.0001, 95% CI 2.98-16.11, OR 6.93), pre pregnancy BMI ≥ 25 kg/m2 (P<0.0001, 95% CI 6.61-31.74, OR 14.50) are independent risk factors for intrapartum SB when compared to alive newborns. Compared with antepartum SB, excessive weight gain in pregnancy (RR 2.91, 1.43-3.98, P=0.001) represents a risk factor for intrapartum ones. Preventing intrapartum SB at term in developed country should be based on both the appropriate antenatal management of fetal growth and the avoidance of maternal excessive weight gain. An effort toward pre conceptional intervention of improving maternal shape could be of value.

Slow breathing exercise improves cardiac autonomic tone in hypothyroid patients: a frequency domain analysis of HRV

Background: Hypothyroidism is associated with autonomic dysfunction and oxidative stress. Slow breathing exercise (SBE), a yoga-based relaxation technique, improves cardiac autonomic nerve function by changing sympathetic or parasympathetic activity. Objective: To assess the effect of SBEon cardiac autonomic tone and in hypothyroid patients. Methods: This non randomized controlled trial was conducted on 50 newly diagnosed drug naive female hypothyroid patients (18-45 years of age)recruited from the outpatient department of the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University,(BSMMU), Shahbag, Dhaka. Twenty five apparently healthy female subjects formed control group. . Among the 50 hypothyroid patients, 25 were consecutively assigned with SBE for 90 days (Group SBE) and the remaining 25 patients were without SBE and followed up after 90 days (Group NSBE). Both groups of patients received treatment with thyroid hormone replacement during their follow up period. Control group did not perform SBE or any other exercise. Data were recorded at baseline(Day 0) and after 90 days in all the subjects. Based on data recording period SBE group was designated as SBE0(at day 0 or pre intervention)and SBE90(at day 90 or post intervention). Similarly, NSBE0(day 0) and NSBE90 (day 90) and control group was also designated as control0 (day 0) and control90 (day 90).Resting cardic autonomic tonic activity was assessed by frequency domain analysis of Heart Rate Variability(HRV). HRV data were recorded by a digital data acquisition device Power Lab, AD Instrument Australia. Data were expressed as mean±SD. For statistical analysis, ANOVA followed by post hoc Bonferroni test and paired sample “t” test were done. Results: At baseline i.e. at day 0 before follow up, diastolic blood pressure (DBP) (p&lt;0.05), low frequency in normalized unit (LF norm) (p&lt;0.001), low frequency/high frequency ratio (LF/HF) (p&lt;0.001) were significantly higher and total power (TP) (p&lt;0.001), low frequency power (LF power) (p&lt;0.01), high frequency power (HF power) (p&lt;0.001), high frequency power in normalized unit (HF norm) (p&lt;0.001) were significantly lower in hypothyroid patients (group SBE0and NSBE0 ) compared to healthy control (group control0). After 90 days of intervention with SBE, SBP, DBP, LF norm, LF/HF ratio decreased significantly and TP, HF power, HF norm increased significantly in group SBE90 compared to SBE0. Whereas, in group NSBE90, after 90 days of follow up, LF norm, LF/HF ratio decreased significantly and HF power, HF norm increased significantly compared to NSBE0. Again, after 90 days of follow up/SBEHF norm were significantly higher and LF norm, LF/HF ratio were significantly lower in SBE90 compared to NSBE90. In addition, significant difference was present in all these parameters between NSBE90 and control90. Also, after 90 days of SBELF norm, HF norm and LF/HF ratio was not significantly different from control. Conclusions: Based on these results, it can be concluded that autonomic dysfunction characterized by reduced vagal tone and sympathetic hyperactivity occurred in drug naïve hypothyroid patients. In addition, thyroid hormone replacement therapy improved autonomic dysfunction by increasing parasympathetic and decreasing sympathetic tonic activity. Moreover, SBE caused further improvement of autonomic dysfunction and could restore sympathovagal balance to its normal state in these patients. J Bangladesh Soc Physiol 2023;18(1): 9-18

Balanced: An Evaluation Of A Newly Established Older Adult Exercise Class

Abstract Background Falls are common in older adults and one of the leading causes of morbidity and mortality globally. Evidence based falls exercise programme have been proven to reduce the risk of falling in community dwelling older persons. This study aimed to evaluate the impact of a new falls exercise class for community dwelling older adults. Methods This class was based on the Falls Management Exercise (FaME) programme model, implemented by a trained Physiotherapist and Exercise Instructor. It consisted of a twenty-six-week programme which included a once weekly supervised group exercise class (1hour) supplemented by a twice weekly home exercise programme. Participants were recruited from primary care services based in the local region. Those who met the inclusion criteria were assessed by a physiotherapist who collected basic demographic data. A range of outcome measures were completed pre and post intervention, assessing motor and behavioural domains. Participant feedback was collected. Data was analysed using SPSS. Results Eleven participants completed this programme. The mean age was 78 years old and 73% of participants were female. Participants completed an average of 22 out of 26 classes. The number of falls reported reduced from 0.8 pre intervention to 0.1 post intervention (p 0.03). Timed Up and Go improved from a mean of 11.28 seconds pre intervention to 9.06 seconds post intervention (p 0.02). Mean Health Today Score was 73.2% pre intervention improving to 82.3% post intervention (p 0.05). Participant feedback was positive. Conclusion This study demonstrated the significant positive impact of an evidence-based exercise class on our participants functional ability, quality of life and reducing falls. This is a preliminary evaluation and analysis of further data is essential. These classes may assist in reducing demands on acute healthcare services and should continue to run and be further investigated.

The Lived Experience of Frailty: Are Frailty Intervention Teams Adding to Patient Quality of Life?

Abstract Background Numerous clinical tools are used to identify and quantify frailty, but the lived experience of frailty is not consistently measured or considered in clinical practice. The project aim was to understand the health perceptions of older adults treated by the Frailty Intervention Team (FIT) and establish if the team has an impact on care burden. Methods Participants were recruited from a hospital based, out-patient Frailty Intervention Clinic over a 4-month period. Older adults were classified as frail by the Clinical Frailty Scale (CFS). The lived experience of frailty was assessed via the EQ 5D 5L a self-rated quality of life measure with a visual analogue scale (EQ VAS). The impact of frailty on carers was examined by the Carer Strain Index (CSI). These subjective measures were recorded on initial assessment and 2 months post intervention. Results 31 individuals were assessed (male n=13, female n=18). The average CFS was 4.98 (4.91 male, 5.05 female), indicative of ‘Living with Mild Frailty’. 74.19% of participants (male n=9, female n=14) responded to the follow up questionnaires. Pre-intervention, EQ VAS average responses were 42.5/100 for males and 49.33/100 for females. Two months post intervention improvements were observed in both males and females with scores of 72.77/100 and 62.5/100 respectively. CFS ratings remained unchanged post intervention. 29% of carers reported a CSI of greater than 7/12 pre intervention – indicating high level of carer burden. Post intervention this figure reduced to 9.6% of carers. Conclusion This FIT model adds positively to the lives of older adults in a holistic manner. The average participant rated their health positively post intervention despite being classified as ‘Living with Mild Frailty’. This underscores that the patient is the expert of their own experience and challenges the negative perceptions of frailty. Highlighting the need for a holistic understanding of frailty beyond classification scales.

The Effect of Physiotherapy on Strength, Mobility and Balance in Older Adults Attending an Integrated Care Programme for Older Persons

Abstract Background Physiotherapy has a significant impact on strength, mobility and balance in older adults but does the presence of frailty negate this? This study aimed to determine the benefit of a six-week physiotherapy intervention as part of an Integrated Care Programme for Older Persons (ICPOP) admission in frail older adults. Methods This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP between 2022 and 2024. All patients had a Clinical Frailty Score of 4-6. Each patient referred to physiotherapy had strength assessments including Five Times Sit to Stand (5TSTS) &amp; Grip Strength Test, mobility assessment including Timed Up and Go (TUG) and balance assessment using the Mini BESTest. Patients with pre- and post-admission outcome measures were included in the study. Patients were offered individualised interventions of strength, mobility, and balance rehabilitation once per week for six weeks. Data was collected from a hospital clinical system using Microsoft Excel. Results 82 patients were included in the data for 5TSTS with an average of 22.3 seconds pre physiotherapy intervention and 18.5 seconds post. 163 patients were included in the Grip Strength Test. Initial mean left/right grip strength was 17.0/18.9kg while final left/right grip strength was 18.2/20.2kg. 173 patients were included in TUG testing with an average of 23.1 seconds pre-physiotherapy and 16.9 seconds post. 41 patients were included in the balance data with mean score of 15.7 pre-physiotherapy intervention and 20.0 post. Conclusion Lower limb strength, mobility and balance had on average minimally clinical important differences (MCID) post physiotherapy intervention despite the presence of frailty. The MCID was not achieved for grip strength potentially reinforcing the appropriateness of grip strength as part of the frailty phenotype.

Digital storytelling: An educational approach for enhancing dyslexic children's writing skills, critical and cultural learning

AbstractThis paper reports an exploratory pilot study‐ which is part of a larger study‐ examining the impact of an innovative approach to enhancing the writing skills of primary school students with dyslexia, digital storytelling (DST), linked to critical and cultural learning. The study adopted a single‐subject design with a pre‐experimental approach (A‐B) to explore connections between the use of digital storytelling, and children's writing skills, as well as cultural and critical dimensions of learning. A socio‐cultural framework, drawing on Green's 3D model, and the Not‐So Simple View of Writing, informed the methodology adopted. A dual perspective aligning with the socio‐cultural theory was adopted, delving into both product and process of digital storytelling. The results revealed significant improvements in writing skills, cultural and critical behaviours, pre and post intervention, with large effect sizes, suggesting this may be a promising classroom approach to improve literacy and learning in children with dyslexia.

Developing intercultural sensitivity in prospective teachers: the potential role of Roma culture immersion field experience

ABSTRACT Teacher preparation programmes through cultural immersion field experiences in Schools as Learning Communities have the potential to increase the intercultural sensitivity of future teachers to provide an effective response to the needs of Roma children. This research evaluated the impact of an intercultural training programme for prospective teachers that included instruction on the situation of the Roma community in the educational system and the transformative potential of the Schools as Learning Communities project, as well as a cultural immersion field experience in a school as a learning community in a vulnerable context. An experimental research design was used that involved collecting pre and post intervention data on a total sample of 321 undergraduate students who were assigned to either a control or experimental group. Results showed that the community-based immersion experience increased the intercultural sensitivity of prospective teachers. Specifically, the intervention, which took place in Spain, had an effect on the dimensions of Respect for Cultural Differences and Interaction Confidence between the control and experimental groups, with greater initial intercultural sensitivity shown by women in the dimensions Respect for Cultural Differences, Interaction Enjoyment and Interaction Engagement. The role of schools as learning communities in contextualised training through direct interaction with culturally diverse individuals is discussed.