- Email: [email protected]
Structured inspection and audit program for walking aids
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
reducing practice errors during FMS training is beneficial for children, especially those with ID (Capio et al., 2013a, 2013b). To facilitate further understanding of such approach follow-up research is important. Purpose: This research consists of two studies that further examined the impact of error-reduced training in improving movement patterns of the FMS of overhand throwing in children with and without ID. Methods: Study 1 involved typically developing children (n = 108; age = 9.16 ± .96 years), while study 2 involved children with mild to moderate ID (n = 39; age = 7.38 ± 2.09 years). Participants practiced 120 trials of overhand throwing in either an outcome error-reduced (ER) or an outcome error-strewn (ES) practice condition. Task difficulty was manipulated so that the ER group had significantly more successful practice trials than the ES group. A pretest–posttest design was adopted to examine change in overhand throwing movement pattern, based on the Test of Gross Motor Development-2. Overhand throwing components consisted of: hand/arm windup, hip/shoulder rotation, weight-shift, and follow-through. A performance measure of throwing accuracy was also conducted. Participants in study 2 were observed during free play, subsequently recording frequency of unprompted throwing. Results: In study 1, analysis of variance of the change in movement components showed that practice condition (ER vs. ES) had a significant effect on only the followthrough component (F(106,1) = 4.929, p = .029). The ER group displayed significant improvements in the diagonal follow-through component, whereas the ES group did not. Children in the ER condition displayed greater improvement in throwing accuracy (F(104,3) = 5.87, p = .017). Followup correlations showed that improved throwing accuracy was associated with improved hand/arm windup (r = .226, p = .019) and hip/shoulder rotation (r = .239, p = .013) components. In study 2, practice condition had a significant effect on hip/shoulder rotation (F(37,1) = 6.813, p = .013), and followthrough (F(37,1) = 8.002, p = .008) components. The ER group displayed greater improvements in these two components compared to the ES group. Children in the ER condition displayed greater increase in unprompted throwing frequency during free play (F(37,1) = 22.056, p < .001). Correlational analysis showed that increased throwing frequency was associated with improved hip/shoulder rotation (r = .311, p = .045) and follow-through (r = .326, p = .043). Conclusion(s): The results suggest that ER training of overhand throwing benefits the distal component – followthrough – in typically developing children. In children with ID, follow-through and rotational trunk movements are improved. Associations with throwing accuracy and unprompted throwing during free play suggest that the beneficial effects on movement components are likely to translate to performance outcomes. Implications: Error-reduced training appears to facilitate improvements in trunk rotation and follow-through com-
ponents of overhand throwing in children. Whether these improvements are associated with kinematic constraints can be explored in future research, possibly through more quantitative methodology (e.g. 3-D motion analysis). Nevertheless, these consistent findings imply that error-reduced training could be considered by physiotherapists in facilitating FMS development of children. Keywords: Error-reduced motor learning; Children; Overhand throwing Funding acknowledgements: This research was supported in part by the Sciences of Learning Strategic Research Theme of the University of Hong Kong. Ethics approval: The studies were approved by the Human Research Ethics Committee for Non-Clinical Faculties of the University of Hong Kong. http://dx.doi.org/10.1016/j.physio.2015.03.056 Special Interest Report Poster Presentation Number: SI-PO-19-20-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 STRUCTURED INSPECTION AND AUDIT PROGRAM FOR WALKING AIDS C.W. Woo 1 , D.W.L. Chan 1 , K.K.L. Leung 2 , M.W.M. Chung 1 , A.C.M. Chan 3 , N.T.Y. Fu 1 , I.H.W. Chow 1 , R.M.W. Chow 2 , P.M.Y. Lau 1 1 Queen
Elizabeth Hospital, Physiotherapy Department, Kowloon, Hong Kong; 2 Kowloon Hospital, Physiotherapy Department, Kowloon, Hong Kong; 3 Hong Kong Buddhist Hospital, Physiotherapy Department, Kowloon, Hong Kong Background: With aging population and improved healthcare services, walking aids are frequently used. Walking aids prescribed by physiotherapist is supposed to provide a sturdy support for patients during ambulation. However, its improper use would increase risk of fall, which may lead to serious consequences. Surveillance data of emergency departments in United States found nearly 50,000 older adult fall injuries associated with walking aids annually (Stevens et al., 2009). While causes are multiple, there are more than 35,000 fall injuries requiring hospital admissions annually in Hong Kong. With more than 3,000 walking aids prescribed annually by physiotherapists in hospitals under Kowloon Central Cluster (KCC) of the Hospital Authority in Hong Kong, incidents relating to walking aids is not uncommon. The reasons of the incidents may be multifactorial that may relate to metal fatigue or its improper use. Purpose: To ensure the quality of walking aids and safe use by patients, a structured inspection and audit program for walking aids was implemented in Physiotherapy Departments in the three KCC hospitals from 2 January 2014 to 30 June 2014. All walking aids (frames, rollators, quadripods,
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
elbow crutches and sticks) prescribed or used by physiotherapists in the hospitals were included in the program. Methods: The program included 1) 2) 3) 4)
a safety checklist developed for each walking aid, scheduled safety inspection by supporting staff, regular audit performed by physiotherapists and education session on safe and proper use of prescribed walking aids for patients and caregivers.
The safety checklist and checking schedule were signed by supporting staff and physiotherapist, the document of which were kept inside a small plastic pocket hung onto each walking aid. Walking aids were inspected for defects. Patient and caregivers were provided with direct coaching by physiotherapists regarding safe and proper use of prescribed walking aids. An educational pamphlet was developed. Together, this served to raise the safety awareness and a handy reference for patients and caregivers. Results: A total of 1,258 serving walking aids were inspected. Two walking frames and one stick were found to have defects and replaced. Education sessions and pamphlets were provided to 1,628 patients and their caregivers. No incident concerning use of walking aids in the department was observed during the implementation period. Patients and caregivers welcomed direct, clear and detailed coaching by physiotherapists and together with the handy pamphlet. Supporting staff were able to perform regular maintenance of walking aids in an easy and structured step-by-step manner. The quality of the walking aids was ensured. The program was integrated into the practice of the physiotherapy departments subsequently. Conclusion(s): Implementation of a structured inspection and audit program can successfully reduce potential patient incidents. The program improves patient and caregiver satisfaction, facilitates maintenance procedures by supporting staff, ensures quality of walking aids and extends their usable life-span. Implications: Proactive measures such as this structured inspection and audit program should be rolled out to other physiotherapy departments to ensure quality and enhance patient safety. Keywords: Walking aids; Quality and safety; Audit Funding acknowledgements: This study received no grant from any funding agency in the public, commercial or not-for-profit sectors. Ethics approval: The current program is a Continuous Quality Improvement project in the hospital with no requirement for ethics approval. http://dx.doi.org/10.1016/j.physio.2015.03.057
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Research Report Platform Presentation Number: RR-PL-3033 Saturday 2 May 2015 16:33 Room 303–304 HEALTH CARE CONTACT FOLLOWING NEW INCIDENTS OF NECK OR LOW BACK PAIN, A PROSPECTIVE STUDY FROM HUNT III A. Woodhouse 1,2 , K. Pape 1 , P. Romundstad 1 , O. Vasseljen 1 1 Norwegian
University of Science and Technology (NTNU), Faculty of Medicine, Department of Public Health and General Practice, Trondheim, Norway; 2 St Olavs Hospital, National Centre for Complex Disorders, Trondheim, Norway Background: Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. Purpose: The aims of this study were to describe the health care contact during a 1-year period in a population with recent onset spinal pain and to explore determinants of such contact. Methods: From 9056 participants in a general health survey in Norway there were 219 persons reporting recent onset (<1 month) of low back or neck pain and who also accepted inclusion for the present study. The study participants were given questionnaires at baseline and after 2, 3, 6 and 12 months from pain debut. The main outcome was health care contact for the pain (medical doctor, psychologist, physiotherapist or chiropractor) within the last month at the five time points. Logistic regression analyses were performed to explore whether health care contact was associated with sociodemographic factors, health related factors and work-related factors or factors linked to the actual pain episode. Results: 93 persons (43%) chose to seek traditional health care, most commonly a doctor, at least once throughout the year following the new incident of spinal pain. 18 persons (8%) chose complementary/alternative health care only. 108 persons (49%) did not seek any kind of health care. All factors linked to the actual pain episode and other health related factors were associated to traditional health care contact in the following year. Particular strong associations were found with reports of coexisting low back and neck pain (OR 2.1 (95% CI 1.1–4.1)), poor self-reported health (OR 3.4 (95% CI 1.9–6.2)), obesity (OR 2.3 (95% CI 1.2–4.7)), smoking (OR 2.3 (95% CI 1.3–4.1)), and with symptoms of anxiety (OR 2.1 (95% CI 1.1–4.0)) or depression (OR 2.5 (95% CI 1.1–5.7)) at baseline. Pain intensity and disability at each time point were strongly associated with health care contact at the same time. Higher education was associated with less health care contact and women had a stronger tendency to seek health care than men.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
reducing practice errors during FMS training is beneficial for children, especially those with ID (Capio et al., 2013a, 2013b). To facilitate further understanding of such approach follow-up research is important. Purpose: This research consists of two studies that further examined the impact of error-reduced training in improving movement patterns of the FMS of overhand throwing in children with and without ID. Methods: Study 1 involved typically developing children (n = 108; age = 9.16 ± .96 years), while study 2 involved children with mild to moderate ID (n = 39; age = 7.38 ± 2.09 years). Participants practiced 120 trials of overhand throwing in either an outcome error-reduced (ER) or an outcome error-strewn (ES) practice condition. Task difficulty was manipulated so that the ER group had significantly more successful practice trials than the ES group. A pretest–posttest design was adopted to examine change in overhand throwing movement pattern, based on the Test of Gross Motor Development-2. Overhand throwing components consisted of: hand/arm windup, hip/shoulder rotation, weight-shift, and follow-through. A performance measure of throwing accuracy was also conducted. Participants in study 2 were observed during free play, subsequently recording frequency of unprompted throwing. Results: In study 1, analysis of variance of the change in movement components showed that practice condition (ER vs. ES) had a significant effect on only the followthrough component (F(106,1) = 4.929, p = .029). The ER group displayed significant improvements in the diagonal follow-through component, whereas the ES group did not. Children in the ER condition displayed greater improvement in throwing accuracy (F(104,3) = 5.87, p = .017). Followup correlations showed that improved throwing accuracy was associated with improved hand/arm windup (r = .226, p = .019) and hip/shoulder rotation (r = .239, p = .013) components. In study 2, practice condition had a significant effect on hip/shoulder rotation (F(37,1) = 6.813, p = .013), and followthrough (F(37,1) = 8.002, p = .008) components. The ER group displayed greater improvements in these two components compared to the ES group. Children in the ER condition displayed greater increase in unprompted throwing frequency during free play (F(37,1) = 22.056, p < .001). Correlational analysis showed that increased throwing frequency was associated with improved hip/shoulder rotation (r = .311, p = .045) and follow-through (r = .326, p = .043). Conclusion(s): The results suggest that ER training of overhand throwing benefits the distal component – followthrough – in typically developing children. In children with ID, follow-through and rotational trunk movements are improved. Associations with throwing accuracy and unprompted throwing during free play suggest that the beneficial effects on movement components are likely to translate to performance outcomes. Implications: Error-reduced training appears to facilitate improvements in trunk rotation and follow-through com-
ponents of overhand throwing in children. Whether these improvements are associated with kinematic constraints can be explored in future research, possibly through more quantitative methodology (e.g. 3-D motion analysis). Nevertheless, these consistent findings imply that error-reduced training could be considered by physiotherapists in facilitating FMS development of children. Keywords: Error-reduced motor learning; Children; Overhand throwing Funding acknowledgements: This research was supported in part by the Sciences of Learning Strategic Research Theme of the University of Hong Kong. Ethics approval: The studies were approved by the Human Research Ethics Committee for Non-Clinical Faculties of the University of Hong Kong. http://dx.doi.org/10.1016/j.physio.2015.03.056 Special Interest Report Poster Presentation Number: SI-PO-19-20-Sat Saturday 2 May 2015 13:00 Exhibit halls 401–403 STRUCTURED INSPECTION AND AUDIT PROGRAM FOR WALKING AIDS C.W. Woo 1 , D.W.L. Chan 1 , K.K.L. Leung 2 , M.W.M. Chung 1 , A.C.M. Chan 3 , N.T.Y. Fu 1 , I.H.W. Chow 1 , R.M.W. Chow 2 , P.M.Y. Lau 1 1 Queen
Elizabeth Hospital, Physiotherapy Department, Kowloon, Hong Kong; 2 Kowloon Hospital, Physiotherapy Department, Kowloon, Hong Kong; 3 Hong Kong Buddhist Hospital, Physiotherapy Department, Kowloon, Hong Kong Background: With aging population and improved healthcare services, walking aids are frequently used. Walking aids prescribed by physiotherapist is supposed to provide a sturdy support for patients during ambulation. However, its improper use would increase risk of fall, which may lead to serious consequences. Surveillance data of emergency departments in United States found nearly 50,000 older adult fall injuries associated with walking aids annually (Stevens et al., 2009). While causes are multiple, there are more than 35,000 fall injuries requiring hospital admissions annually in Hong Kong. With more than 3,000 walking aids prescribed annually by physiotherapists in hospitals under Kowloon Central Cluster (KCC) of the Hospital Authority in Hong Kong, incidents relating to walking aids is not uncommon. The reasons of the incidents may be multifactorial that may relate to metal fatigue or its improper use. Purpose: To ensure the quality of walking aids and safe use by patients, a structured inspection and audit program for walking aids was implemented in Physiotherapy Departments in the three KCC hospitals from 2 January 2014 to 30 June 2014. All walking aids (frames, rollators, quadripods,
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
elbow crutches and sticks) prescribed or used by physiotherapists in the hospitals were included in the program. Methods: The program included 1) 2) 3) 4)
a safety checklist developed for each walking aid, scheduled safety inspection by supporting staff, regular audit performed by physiotherapists and education session on safe and proper use of prescribed walking aids for patients and caregivers.
The safety checklist and checking schedule were signed by supporting staff and physiotherapist, the document of which were kept inside a small plastic pocket hung onto each walking aid. Walking aids were inspected for defects. Patient and caregivers were provided with direct coaching by physiotherapists regarding safe and proper use of prescribed walking aids. An educational pamphlet was developed. Together, this served to raise the safety awareness and a handy reference for patients and caregivers. Results: A total of 1,258 serving walking aids were inspected. Two walking frames and one stick were found to have defects and replaced. Education sessions and pamphlets were provided to 1,628 patients and their caregivers. No incident concerning use of walking aids in the department was observed during the implementation period. Patients and caregivers welcomed direct, clear and detailed coaching by physiotherapists and together with the handy pamphlet. Supporting staff were able to perform regular maintenance of walking aids in an easy and structured step-by-step manner. The quality of the walking aids was ensured. The program was integrated into the practice of the physiotherapy departments subsequently. Conclusion(s): Implementation of a structured inspection and audit program can successfully reduce potential patient incidents. The program improves patient and caregiver satisfaction, facilitates maintenance procedures by supporting staff, ensures quality of walking aids and extends their usable life-span. Implications: Proactive measures such as this structured inspection and audit program should be rolled out to other physiotherapy departments to ensure quality and enhance patient safety. Keywords: Walking aids; Quality and safety; Audit Funding acknowledgements: This study received no grant from any funding agency in the public, commercial or not-for-profit sectors. Ethics approval: The current program is a Continuous Quality Improvement project in the hospital with no requirement for ethics approval. http://dx.doi.org/10.1016/j.physio.2015.03.057
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Research Report Platform Presentation Number: RR-PL-3033 Saturday 2 May 2015 16:33 Room 303–304 HEALTH CARE CONTACT FOLLOWING NEW INCIDENTS OF NECK OR LOW BACK PAIN, A PROSPECTIVE STUDY FROM HUNT III A. Woodhouse 1,2 , K. Pape 1 , P. Romundstad 1 , O. Vasseljen 1 1 Norwegian
University of Science and Technology (NTNU), Faculty of Medicine, Department of Public Health and General Practice, Trondheim, Norway; 2 St Olavs Hospital, National Centre for Complex Disorders, Trondheim, Norway Background: Low back and neck pain are commonly reported in the general population and represent frequent causes for health care consultations. Purpose: The aims of this study were to describe the health care contact during a 1-year period in a population with recent onset spinal pain and to explore determinants of such contact. Methods: From 9056 participants in a general health survey in Norway there were 219 persons reporting recent onset (<1 month) of low back or neck pain and who also accepted inclusion for the present study. The study participants were given questionnaires at baseline and after 2, 3, 6 and 12 months from pain debut. The main outcome was health care contact for the pain (medical doctor, psychologist, physiotherapist or chiropractor) within the last month at the five time points. Logistic regression analyses were performed to explore whether health care contact was associated with sociodemographic factors, health related factors and work-related factors or factors linked to the actual pain episode. Results: 93 persons (43%) chose to seek traditional health care, most commonly a doctor, at least once throughout the year following the new incident of spinal pain. 18 persons (8%) chose complementary/alternative health care only. 108 persons (49%) did not seek any kind of health care. All factors linked to the actual pain episode and other health related factors were associated to traditional health care contact in the following year. Particular strong associations were found with reports of coexisting low back and neck pain (OR 2.1 (95% CI 1.1–4.1)), poor self-reported health (OR 3.4 (95% CI 1.9–6.2)), obesity (OR 2.3 (95% CI 1.2–4.7)), smoking (OR 2.3 (95% CI 1.3–4.1)), and with symptoms of anxiety (OR 2.1 (95% CI 1.1–4.0)) or depression (OR 2.5 (95% CI 1.1–5.7)) at baseline. Pain intensity and disability at each time point were strongly associated with health care contact at the same time. Higher education was associated with less health care contact and women had a stronger tendency to seek health care than men.