Standardized Outcome Measures Research Articles

Peritoneal dialysis related peritonitis: insights from a long-term analysis of an Italian center

BackgroundPeritonitis is a common and severe complication of peritoneal dialysis (PD). For comparative analysis standardized definitions as well as measurements and outcomes are crucial. However, most PD-related peritonitis studies have been using heterogenous definitions and variable methods to measure outcomes. The ISPD 2022 guidelines have revised and clarified numerous definitions and proposed new peritonitis categories and outcomes.MethodsBetween 1st January 2009 and 31st May 2023, 267 patients who started PD at our institution were included in the study. All PD-related peritonitis episodes that occurred in our unit during the study period were collected. The new definitions and outcomes of ISPD 2022 recommendations were employed.ResultsThe overall peritonitis rate was 0.25 episode/patient year. Patient cumulative probability of remaining peritonitis-free at one year was 84.2%. The medical cure and refractory peritonitis rates were equal to 70.3 and 22.4%, respectively. Culture-negative peritonitis accounted for 25.6% of all specimens. The rates of peritonitis associated death, hemodialysis transfer, catheter removal and hospitalization were 6.8%, 18.3%, 18.7% and 64.4%, respectively. Relapsing, repeat, recurrent and enteric peritonitis accounted for 7.8%, 6.8%, 4.1% and 2.7% of all episodes, respectively. Catheter insertion, catheter related and pre-PD peritonitis were 4.2, 2.1 and 0.5%.ConclusionsThe implementation of PD-related peritonitis reports using standardized definitions and outcome measurements is of paramount importance to enhance clinical practice and to allow comparative studies.

Outcome Measures in Adult Vulvar Lichen Sclerosus: A Case Series of Women Diagnosed as Juveniles.

Studies on the consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are limited. A number of measuring tools are available for analyzing adult vulvar lichen sclerosus (VLS), but these have not been applied in studies on JVLS. The aim is to study physical findings, quality of life, sexual well-being, and self-image in adult women with a history of juvenile VLS. Adult women with a biopsy proven history of JVLS were recruited to be examined and surveyed using available standardized measurement tools. This took place in an outpatient setting by physicians who were not involved in the treatment of participants. Twenty-seven women (median age 29 years) with a history of JVLS and median time since biopsy of 19.5 years were recruited. Of these women, 59% currently had symptoms, 63% had signs of active disease, and 85% had moderate to severe architectural changes. Despite these residual signs, vulvar specific-quality of life and vulvar self-image scored favorably while generic health-related quality of life was somewhat effected. JVLS has consequences in adulthood involving physical findings and vulvar quality of life. The use of standardized outcome measures for clinical practice and research purposes facilitates a better understanding of the sequelae to JVLS.

Respiratory syncytial virus vaccination during pregnancy for improving infant outcomes.

Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections (LRTIs) in infants. Maternal RSV vaccination is a preventive strategy of great interest, as it could have a substantial impact on infant RSV disease burden. In recent years, the clinical development of maternal RSV vaccines has advanced rapidly. To assess the efficacy and safety of maternal respiratory syncytial virus (RSV) vaccination for preventing RSV disease in infants. We searched Cochrane Pregnancy and Childbirth's Trials Register and two other trials registries on 21 October 2022. We updated the search on 27 July 2023, when we searched MEDLINE, Embase, CENTRAL, CINAHL, and two trials registries. Additionally, we searched the reference lists of retrieved studies and conference proceedings. There were no language restrictions on our searches. We included randomised controlled trials (RCTs) comparing maternal RSV vaccination with placebo or no intervention in pregnant women of any age. The primary outcomes were hospitalisation with clinically confirmed or laboratory-confirmed RSV disease in infants. The secondary outcomes covered adverse pregnancy outcomes (intrauterine growth restriction, stillbirth, and maternal death) and adverse infant outcomes (preterm birth, congenital abnormalities, and infant death). We used standard Cochrane methods and assessed the certainty of evidence using the GRADE approach. We included six RCTs (25 study reports) involving 17,991 pregnant women. The intervention was an RSV pre-F protein vaccine in four studies, and an RSV F protein nanoparticle vaccine in two studies. In all studies, the comparator was a placebo (saline, formulation buffer, or sterile water). We judged four studies at overall low risk of bias and two studies at overall high risk (mainly due to selection bias). All studies were funded by pharmaceutical companies. Maternal RSV vaccination compared with placebo reduces infant hospitalisation with laboratory-confirmed RSV disease (risk ratio (RR) 0.50, 95% confidence interval (CI) 0.31 to 0.82; 4 RCTs, 12,216 infants; high-certainty evidence). Based on an absolute risk with placebo of 22 hospitalisations per 1000 infants, our results represent 11 fewer hospitalisations per 1000 infants from vaccinated pregnant women (15 fewer to 4 fewer). No studies reported infant hospitalisation with clinically confirmed RSV disease. Maternal RSV vaccination compared with placebo has little or no effect on the risk of congenital abnormalities (RR 0.96, 95% CI 0.88 to 1.04; 140 per 1000 with placebo, 5 fewer per 1000 with RSV vaccination (17 fewer to 6 more); 4 RCTs, 12,304 infants; high-certainty evidence). Maternal RSV vaccination likely has little or no effect on the risk of intrauterine growth restriction (RR 1.32, 95% CI 0.75 to 2.33; 3 per 1000 with placebo, 1 more per 1000 with RSV vaccination (1 fewer to 4 more); 4 RCTs, 12,545 pregnant women; moderate-certainty evidence). Maternal RSV vaccination may have little or no effect on the risk of stillbirth (RR 0.81, 95% CI 0.38 to 1.72; 3 per 1000 with placebo, no difference with RSV vaccination (2 fewer to 3 more); 5 RCTs, 12,652 pregnant women). There may be a safety signal warranting further investigation related to preterm birth. This outcome may be more likely with maternal RSV vaccination, although the 95% CI includes no effect, and the evidence is very uncertain (RR 1.16, 95% CI 0.99 to 1.36; 6 RCTs, 17,560 infants; very low-certainty evidence). Based on an absolute risk of 51 preterm births per 1000 infants from pregnant women who received placebo, there may be 8 more per 1000 infants from pregnant women with RSV vaccination (1 fewer to 18 more). There was one maternal death in the RSV vaccination group and none in the placebo group. Our meta-analysis suggests that RSV vaccination compared with placebo may have little or no effect on the risk of maternal death (RR 3.00, 95% CI 0.12 to 73.50; 3 RCTs, 7977 pregnant women; low-certainty evidence). The effect of maternal RSV vaccination on the risk of infant death is very uncertain (RR 0.81, 95% CI 0.36 to 1.81; 6 RCTs, 17,589 infants; very low-certainty evidence). The findings of this review suggest that maternal RSV vaccination reduces laboratory-confirmed RSV hospitalisations in infants. There are no safety concerns about intrauterine growth restriction and congenital abnormalities. We must be careful in drawing conclusions about other safety outcomes owing to the low and very low certainty of the evidence. The evidence available to date suggests RSV vaccination may have little or no effect on stillbirth, maternal death, and infant death (although the evidence for infant death is very uncertain). However, there may be a safety signal warranting further investigation related to preterm birth. This is driven by data from one trial, which is not fully published yet. The evidence base would be much improved by more RCTs with substantial sample sizes and well-designed observational studies with long-term follow-up for assessment of safety outcomes. Future studies should aim to use standard outcome measures, collect data on concomitant vaccines, and stratify data by timing of vaccination, gestational age at birth, race, and geographical setting.

Overcoming implementation challenges through using a train-the-trainer approach to teach numeracy in a special school setting

Purpose There is a sparsity of research that considers how to overcome implementation challenges for interventions in special school settings where specialist teaching methods are involved. Successful implementation has often relied on considerable researcher involvement, making them inaccessible and not sustainable for the majority of special schools. The purpose of this study was to implementa train-the-trainer approach to train teaching staff to use the Teaching Early Numeracy to Children with Developmental Disabilities (TEN-DD) programme in a large special school in the UK, thereby significantly reducing researcher involvement in its implementation. Design/methodology/approach One staff member was trained to become the school lead for TEN-DD and trained other teaching staff in the school on implementation. This study recruited 13 students aged between 12 and 16 years of age with developmental disabilities to receive TEN-DD. Pre- and post-intervention tests on a standardised numeracy measure were conducted. Findings A train-the-trainer model was developed and successfully delivered to train teaching staff in TEN-DD. A standardised outcome measure indicated that ten students made improvements to their numeracy skills after teachers trained using this approach delivered TEN-DD for between 3 and 10 months. Originality/value Very little research has been carried out to better understand methods for overcoming implementation challenges for delivering evidence-based teaching programmes at scale to students with developmental disabilities who attend special schools. To the best of the authors’ knowledge, this study reports the results of the first evaluation of using a train-the-trainer model for the delivery of a numeracy intervention (TEN-DD), whereby there was no involvement of researchers in implementation beyond the initial training of the school lead. This model of training for interventions may be more sustainable for special schools and help improve the uptake of evidence-based interventions.

Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities.

Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.

Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM).

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation. A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed. A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury. Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.

The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients' Mental Health: A Narrative Review of the Literature.

The gold standard treatment for periprosthetic joint infections is the two-stage revision that includes the spacer placement before definitive reimplantation. The management of PJI affects patients' joint function and, subsequently, their mental health. Even though significant advances have been achieved, little to no attention has been paid to the psychological implications. So, based on standardized patient-reported outcome measures (PROMs), this study aimed to clarify the effect of spacer treatment of infected hip and knee arthroplasties on patients' mental health. We performed research on the literature on PJIs in the English language using the MEDLINE database with the search strings "spacer" OR "spacers" AND "hip" OR "knee" AND "SF-12" OR "SF-36" OR "EQ-5" OR "mental" OR "depression" OR "anxiety." The reference lists of selected articles were also hand-searched for any additional articles. A total of 973 published papers were extracted, and 9 papers were finally included. A total of 384 patients who underwent spacer placement for PJI were identified. Of these 384 patients, 54% were female. The mean age ranged from 62 to 78.2 years. Of the11 papers identified for this review, 4 analyzed only hip spacers, including 119 patients; 4 only knee spacers, evaluating 153 patients; while a single study included 112 patients for both joints. Patients with the spacer are living in a state of mental upset, albeit better than the preoperative state. Clinical improvement with the review is not assured. The alteration of mental state turns out not to be transient for all the patients.

Interventions on gender equity in the workplace: a scoping review

BackgroundVarious studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity).MethodsScoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist.All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework.ResultsWe screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes.ConclusionsThere is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex.Trial registrationOpen Science Framework https://osf.io/x8yae.

Revisiting the impact of Health at Every Size® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta-analysis.

To (1) synthesise evidence from Health at Every Size® interventions on physical and psychological health in people with overweight and obesity and (2) report between-group differences within interventions evaluating the impact of Health at Every Size® interventions on health and health-related outcomes. Six databases (Medline, Embase, Cochrane, PsychInfo, CINAHL, and Scopus) were searched from inception until November 2022. Included studies were conducted in adults with overweight or obesity, used Health at Every Size®-based interventions compared with control interventions and reported dietary, physical and/or psychological outcomes, including diet quality, anthropometry, or quality of life. Data on between-group differences were extracted. Risk of bias was assessed using ROB2. Random-effects meta-analyses were undertaken for outcomes with at least three studies reporting the same or comparable data. From 128 studies identified, 19 full-text articles (10 unique studies, 6 published since 2017), were included. Meta-analysis found a significant reduction for susceptibility to hunger in Health at Every Size® intervention groups relative to controls (p = 0.005), with no significant difference (p > 0.05) between Health at Every Size® interventions and control groups for anthropometric, psychological or cardiometabolic outcomes (total cholesterol, HDL cholesterol, triglycerides, systolic or diastolic blood pressure). Health at Every Size® interventions had similar results compared with weight-based interventions on anthropometric outcomes and cardiometabolic outcomes. Health at Every Size® interventions had a significant benefit for reducing susceptibility to hunger. The decision to use a Health at Every Size®-based intervention should be personalised to individual needs. Further research in more diverse populations is required using standardised outcome measures to facilitate future meta-analyses.

Interventions for Postextubation Dysphagia in Critically Ill Patients: A Systematic Review and Meta-analysis.

This review evaluates the efficacy and safety of dysphagia interventions for patients with prolonged endotracheal intubation (⩾48h) in critical care units. We systematically searched PubMed, Cochrane Library, Medline, Embase, OVID, CINAHL, Wanfang (China), CNKI (China), and ProQuest Dissertations for studies published up to December 31, 2023. Inclusion criteria encompassed randomized controlled trials (RCTs), quasi-randomized trials, and cohort studies comparing dysphagia rehabilitation - such as swallowing stimulation, swallowing and respiratory muscle exercise, and neuromuscular electrical stimulation - with standard care or no treatment. The primary outcomes assessed were dysphagia severity, time to resume oral intake, and incidence of aspiration and aspiration pneumonia. Detailed information on study design, setting, participant demographics, interventions, and outcomes was systematically extracted. Our analysis included ten studies with a total of 1031 participants. The findings demonstrate a significant reduction in dysphagia severity, time to oral intake and the risk of aspiration pneumonia, and an improvement in quality of life among patients receiving swallowing therapy. However, no substantial difference was found in nutritional status. Limited data availability necessitated a descriptive presentation of outcomes like the risk of aspiration, ICU/hospital stay duration, pharyngeal/oral residue severity, and intervention-related adverse events. The current evidence for the effectiveness of dysphagia interventions in critically ill patients with prolonged endotracheal intubation is limited. There is a pressing need for future research, particularly high-quality RCTs employing standardized outcome measures, to substantiate these findings.

Processes and Feasibility of Implementing Standardized Outcome Measurements in an Outpatient MS Program

Processes and Feasibility of Implementing Standardized Outcome Measurements in an Outpatient MS Program

Effectiveness of Art Therapy Programs in Enhancing Recovery and Rehabilitation in Sports Medicine

Purpose: The general aim of the study was to examine the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine.
 Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.
 Findings: The findings reveal that there exists a contextual and methodological gap relating to the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. Preliminary empirical review revealed that art therapy interventions offer a holistic approach to healing, addressing athletes' physical, emotional, and social needs during the recovery process. Through a comprehensive review of empirical studies, the findings demonstrated consistent positive outcomes, including improved physical function, pain management, psychological well-being, and overall recovery among athletes. The study highlighted the importance of interdisciplinary collaboration and patient-centered care in sports medicine rehabilitation, as well as the potential cost-effectiveness of incorporating art therapy into standard practice. These findings underscored the value of art therapy as a complementary intervention in optimizing athletes' recovery and facilitating their successful return to sport.
 Unique Contribution to Theory, Practice and Policy: The Social Cognitive theory, Self- Determination theory and Biopsychosocial model may be used to anchor future studies on the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. The study provided recommendations that contributed to theory, practice, and policy. The findings emphasized the importance of grounding art therapy interventions in established theoretical frameworks, integrating them into standard rehabilitation protocols, advocating for policy support and reimbursement, fostering collaboration and partnerships, developing standardized protocols and outcome measures, and advancing research and evaluation efforts. These recommendations aimed to optimize the use of art therapy as a holistic and effective intervention for athletes recovering from sports injuries, ensuring equitable access to these services and fostering a culture of innovation in sports medicine rehabilitation.

Characterization of Fine Motor and Visual Motor Skills in Aicardi-Goutières Syndrome.

Aicardi-Goutières syndrome is a genetic inflammatory disorder resulting in dispersed neurologic dysfunction. Despite a recognition of overall motor impairment, fine and visual motor skills are undercharacterized. We hypothesize that there is a spectrum of fine and visual motor skills in the Aicardi-Goutières syndrome population as captured by a standard outcome measure, the Peabody Developmental Motor Scales (PDMS-2), which will be proportional to overall disease severity.In a cohort of 74 subjects, the Peabody Developmental Motor Scales-2 grasping and visual-motor integration subtests were administered concurrently with the Aicardi-Goutières syndrome Severity Scale (severe [range 0-3], moderate [range 4-8], and attenuated [range 9-11]). The cohort was also compared by genotype and performance as defined by raw scores. The distribution of Peabody Developmental Motor Scales-2 scores within a genotype was assessed by interquartile ranges (IQRs).Peabody Developmental Motor Scales-2 grasping and visual-motor integration performance was the least variable in the TREX1-cohort (IQR: 10.00-12.00) versus the SAMHD1 and IFIH1 cohorts (IQR: 51.00-132.00 and 48.50-134.00, respectively). Neurologic severity highly correlated with both fine and visual motor skills (Spearman correlation: r = 0.87, 0.91, respectively). A floor effect (lowest 10% of possible scores) was observed within the severe cohort (n = 32/35), whereas a ceiling effect (top 10%) was observed in the attenuated cohort (n = 13/17).This study characterized the spectrum of fine and visual motor function in the Aicardi-Goutières syndrome population, which correlated with overall neurologic dysfunction. The Peabody Developmental Motor Scales-2 grasping and visual-motor integration showed promise as potential assessment tools in moderate and attenuated Aicardi-Goutières syndrome cohorts. A better understanding of fine and visual motor function in this population will benefit clinical care and clinical trial design.

Development of a core set of outcome measures to be applied toward breast cancer-related lymphedema core outcome domains.

For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome measures (OMs) are recommended to be used to measure standardized outcome domains to fully assess the burden of the disease and efficacy of interventions? An integral component of a standardized core outcome set (COS) are the OMs used to measure the COS. A supplemental online survey was linked to a Delphi study investigating a COS for BCRL. OMs were limited to a maximum of 10 options for each outcome domain (OD). There were 14 ODs corresponding to the International Classification of Functioning, Disability, and Health (ICF) framework and respondents rated the OMs with a Likert level of recommendation. The feasibility of the listed OMs was also investigated for most outpatient, inpatient, and research settings. This study identified 27 standardized OMs with a few ODs having 2-3 highly recommended OMs for proper measurement. A few of the recommended OMs have limitations with reliability due to being semi-quantitative measures requiring the interpretation of the rater. Narrowing the choices of OMs to 27 highly recommended by BCRL experts may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields which manage or research BCRL. There is a need for valid, reliable, and feasible OMs that measure tissue consistency. Measures of upper extremity activity and motor control need further research in the BCS with BCRL population.

The Quality of Life in Patients with Spinal Cord Injury: Assessment and Rehabilitation.

Background and Objectives: Spinal Cord Injury (SCI) develops when the spinal cord is damaged and leads to partial or complete loss of motor and/or sensory function, usually below the level of injury. Medical advances in the last few decades have enabled SCI patients to survive after their initial injury and extend their life expectancy. As a result, the need for outcome measures to assess health and Quality of Life (QoL) after rehabilitation is increasing. All QoL assessment measures include implicit or explicit reactions and evaluations of a person's life characteristics. This review aims to investigate QoL and its assessment in patients with SCI and how the instruments that are used may influence rehabilitation. Materials and Methods: Studies were identified from an online search of PubMed, Cochrane Library, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF (n) 892NY. Results: We found that different psychological and physical aspects can positively or negatively influence the QoL of SCI patients, and the measurement of this aspect, despite the number of tools, is limited due to the lack of a universal definition of this theme and the greater prevalence of quantitative rather than qualitative tools. Conclusions: This review has demonstrated that clinicians and psychologists involved in SCI rehabilitation should consider tools that use high-quality standardized outcome measures to detect and compare potential differences and outcomes of interventions related to HRQoL and their relationship with the personality and functional status of the patient.

Use of standardized outcome measures for people with lower-limb amputation: A survey of prosthetic practitioners in Canada.

Outcome measures (OMs) are useful tools; however, clinicians may find implementing them into clinical practice challenging. To characterize Canadian prosthetists' use of OMs for people with lower-limb amputation, including motivations for use, comfort selecting OMs, resources available for administration, and barriers to implementation. A cross-sectional study was conducted between March and July 2021. Orthotics Prosthetics Canada sent Canadian prosthetists an invitation to take the online survey. Forty-nine Certified Prosthetists completed the survey. Only 16% of participants reported that they were expected to use OMs. Participants reported being more comfortable administering performance-based OMs than self-report surveys. More than two-thirds of participants agreed that OMs "can be administered with knowledge they have" and are "within their scope of practice." However, less than 25% agreed that OMs are "administered in a standardized way in the profession," and less than 40% indicated they are "easy to make part of my routine." Participants reported they generally have time and space to do OMs, but there was no agreed-on reason to use them. Use of OMs among Canadian prosthetists seems to be low relative to prosthetists in the United States. Education, financial incentives, or changes to professional expectations are likely needed to increase routine OM use. Efforts to improve the standardization of OM administration and ease the incorporation of OMs into routine practice may also increase use. Canadian prosthetists may elevate their standards of clinical practice and better understand the impact of prosthetic treatments on their patients by more routinely using OMs.

Point of View on Outcome Prediction Models in Post-Stroke Motor Recovery

Stroke is a leading cause of disability worldwide which can cause significant and persistent upper limb (UL) impairment. It is difficult to predict UL motor recovery after stroke and to forecast the expected outcomes of rehabilitation interventions during the acute and subacute phases when using clinical data alone. Accurate prediction of response to treatment could allow for more timely and targeted interventions, thereby improving recovery, resource allocation, and reducing the economic impact of post-stroke disability. Initial motor impairment is currently the strongest predictor of post-stroke motor recovery. Despite significant progress, current prediction models could be refined with additional predictors, and an emphasis on the time dependency of patient-specific predictions of UL recovery profiles. In the current paper a panel of experts provide their opinion on additional predictors and aspects of the literature that can help advance stroke outcome prediction models. Potential strategies include close attention to post-stroke data collection timeframes and adoption of individual-computerized modeling methods connected to a patient’s health record. These models should account for the non-linear and the variable recovery pattern of spontaneous neurological recovery. Additionally, input data should be extended to include cognitive, genomic, sensory, neural injury, and function measures as additional predictors of recovery. The accuracy of prediction models may be further improved by including standardized measures of outcome. Finally, we consider the potential impact of refined prediction models on healthcare costs.

Evaluating the efficacy of nasal irrigation in postoperative functional endoscopic sinus surgery patients: a systematic review and meta-analysis.

Functional endoscopic sinus surgery (FESS) is a mainstay surgical intervention for chronic rhinosinusitis with nasal polyposis (CRSwNP). Nasal irrigation, particularly with normal saline, is a widely recommended postoperative care modality. This systematic review and meta-analysis aimed to assess the efficacy of various nasal irrigation solutions in postoperative FESS patients. A comprehensive search was conducted in multiple databases for randomized controlled trials investigating normal saline and various substances for nasal irrigation post-FESS. The systematic review followed PRISMA guidelines, and the meta-analysis used R software for data synthesis. Outcome measures included SNOT-22 and LKES scores. The Cochrane tool was employed to evaluate the potential for bias. Results from 14 studies, focusing on six each for SNOT-22 and LKES, revealed a significant reduction in symptoms and endoscopic scores with various solutions compared to normal saline. The meta-analysis using the random-effects model indicated a negative standardized mean difference (SMD) of - 0.69(95% CI [- 1.64; 0.27], p = 0.157) for symptoms and endoscopic scores (SMD = - 0.48, 95% CI [- 1.32; 0.36], z = - 1.12, p = 0.264). Subgroup analyses highlighted budesonide's efficacy over normal saline, but substantial heterogeneity and potential publication bias were noted. Nasal irrigation with various solutions postoperative FESS patients demonstrated significant improvements in patient-reported symptoms and endoscopic scores compared to normal saline. Budesonide appeared particularly effective. However, high heterogeneity and potential publication bias warrant cautious interpretation. Standardized outcome measures and further research are needed to strengthen the evidence.

Utilisation of standardised outcomes measures by clinical Physiotherapists working in Namibia: a nationwide cross-sectional study

Introduction The utilisation of standardised outcome measures (SOMs) is crucial for evaluating patients’ health status. Physiotherapists are highly recommended to use SOMs routinely. Despite the well-documented benefits of using SOMs, the utilisation of SOMs in clinical practice is still problematic particularly in Africa. In Namibia, there is dearth of information about SOMs utilisation by physiotherapists and the associated factors. This study was aimed at determining the extent of routine utilisation of SOMs and the associated demographic and work-related factors among physiotherapists. Methods A cross-sectional, nationwide, online survey was conducted and all registered qualified physiotherapists and intern physiotherapists working in public or private hospitals/clinics were invited to participate. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 29.0. The Chi-square (χ2) and Fishers exact test investigated the relationship between the associated factors and routine SOMs utilisation. The alpha level was set at 0.05.Results Of 230 participants who received the invitational link, 99 (43.0%) responded timeously to the call to participate. Although 97.9% (n=94) of the participants indicated having used at least one type of SOMs in the last six months, the frequency of utilisation varied. Routine utilisation, defined as 70%-100% of the time, was reported in only 49.0% of the participants. The Chi-square test only showed significant findings for gender (p=0.01) and clinical specialty (p=0.004). The odds of utilising SOMs were 4.13 greater among physiotherapists with a clinical specialty and 3.88 times greater for females than males.ConclusionThe rates for routine utilisation of SOMs by Namibian physiotherapists are unfavourable. Female gender and clinical specialty influenced the utilisation of SOMs in daily clinical practice. Cognisant of the study limitations, these results call for the need to improve the routine utilisation of the SOMs in Namibia.
  

Restrictive Diets in Patients with Fibromyalgia: State of the Art.

Around 20-30% of Fibromyalgia patients modify their dietary habits after diagnosis, including avoiding certain food groups such as cereals. In this systematic review, we used the PRISMA guidelines to select the main studies that have evaluated the effectiveness of restrictive diets, including elimination and vegetarian diets, in patients with Fibromyalgia. Data on vegetarian/vegan diets are more consistent than data on elimination diets due to higher quality and better results of the published studies. Although the results are favorable in most of the studies, their heterogenicity and the scarce and low quality of the evidence (small number of patients included, often non-randomized and uncontrolled studies and multiple confounding factors and biases) does not allow for a positive recommendation about these restrictive diets in Fibromyalgia patients. Several factors other than food restriction could influence the symptomatic and functional improvements observed after restrictive diets, such as the placebo effect, weight loss that often occurs, coexistence with gastrointestinal diseases and positive effects of unrestricted foods. We must advance more and improve in our knowledge of the effectiveness of restrictive diets and variables related to them before recommending them systematically to all patients with Fibromyalgia. Randomized, placebo-controlled trials with large sample sizes, longer follow-up periods and standardized outcome measures that explore predictors of dietary response are needed to better understand the relationship between Fibromyalgia and nutrition.