- Email: [email protected]
Measuring activity pacing in patients with chronic fatigue syndrome
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Results: Children with CP showed lower mobility in fourth and from sixth to tenth ribs for TD, and from seventh to tenth ribs for . There were no differences between CG and CPG for APD and ␣. Conclusion(s): Children with hemiparetic CP showed lower mobility in lower ribs when compared to typical developmental children. For future researches we suggest to analyse the effects of respiratory intervention to improve their thoracic cage mobility. Implications: Because of lower thoracic cage mobility in mild impairment spastic hemiplegic CP, an earlier intervention to improve thoracic cage mobility and respiratory function may prevent pulmonar disturbances or diseases. Keywords: Cerebral palsy; Thoracic cage; Breathing Funding acknowledgements: Coordination for the Improvement of Higher Education Personnel – CAPES. Ethics approval: This study was approved by the Federal University of São Paulo Ethics Research Committee (n◦ 275.276). http://dx.doi.org/10.1016/j.physio.2015.03.365 Research Report Poster Presentation Number: RR-PO-05-01-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 MEASURING ACTIVITY PACING IN PATIENTS WITH CHRONIC FATIGUE SYNDROME S. Casson 1 , C. Sandler 1,2 , S. Horsfield 1 , A. Lloyd 1,2,3 , B. Barry 4,5 1 University
of New South Wales, Lifestyle Clinic, School of Medical Sciences, Sydney, Australia; 2 University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia; 3 University of New South Wales, Inflammation and Infection Research Centre, School of Medical Sciences, Sydney, Australia; 4 University of New South Wales, School of Medical Sciences, Sydney, Australia; 5 University of New South Wales, Neuroscience Research Australia, Sydney, Australia Background: Activity pacing is a common strategy in the management of chronic fatigue syndrome (CFS), as either a standalone intervention or as a precursor to other therapies. The cardinal symptom of CFS is fatigue, which is exacerbated for prolonged periods by physical tasks previously achieved without difficulty. Accordingly, activity pacing involves planning daily and weekly activities, incorporating rest breaks and segmenting tasks into shorter time blocks, to avoid exacerbating symptoms. Clinical guidelines to implement activity pacing are sparse, and the tools to assess and guide pacing are not formalised. Purpose: The aim of this project was to examine the utility of subjective measures, such as activity dairies and self-report
questionnaires, and objective measures, such as pedometers, to optimise activity pacing. The hypothesis was that the combined use of subjective and objective assessments is necessary to capture activity pacing behaviour. Methods: Patients with CFS attending a tertiary specialist clinic completed a 7-day activity diary and concurrently used a pedometer at the commencement of a 16-week multi-disciplinary intervention incorporating cognitive-behavioural therapy, activity pacing, and graded exercise therapy. The activity diary required the patient to report the main activity performed each hour of the day (cognitive or physical), the perceived intensity of the activity, and information, such as sleep routine and energy ratings throughout the day. Pedometer data were recorded as counts of activity for each day. Patients completed specially designed self-report questionnaires regarding activity pacing. Formalised clinician ratings of the patient’s adherence to activity pacing strategies were based on interview and the diary. Objective and subjective data were compared with clinician ratings of each patient’s activity pacing. Results: The sample of 45 patients included 30 women (67%), with mean age of 37 ± 15 years, a mean duration of illness of 5.1 ± 3.6 years and SF-36 physical function of 49.8 ± 24.2. According to clinician ratings, 49% of the patients adhered to activity pacing “a little”, 29% “not at all”, 18% “moderately”, and only 4% “quite a bit” and 0% “extremely”. There was little relation between day-to-day variation in pedometer step counts and clinician ratings of activity pacing (r = −0.216, p = 0.164) or self-report questionnaires (r = −0.064, p = 0.68). Pedometer total step counts did, however, correspond with patient diary records of physical activities as well as the physical function subscale of the SF-36 (r = 0.518, p < 0.05). Self-report questionnaire items exhibited moderate internal validity (Cronbach’s alpha 0.619) and weak correlation with clinician ratings of activity pacing (r = 0.288, p = 0.055). Conclusion(s): Activity pacing remains a poorly defined construct. Clinician ratings utilise a combination of objective measures and patient report, with limited association between these ratings and any single measure. The lack of concordance between across-day variation in pedometer step counts and clinician ratings of activity pacing suggests that a single daily count of physical activity misses key aspects of pacing behaviour. There is scope for a refined questionnaire to monitor and guide activity pacing. Implications: While activity pacing has a logical foundation – encourage patients to adjust activity to avoid exacerbating symptoms – and is often applied clinically, the availability of valid and reliable assessments and of clinical guidelines is limited. Keywords: Fatigue; Activity pacing; Physical activity measurement Funding acknowledgements: Not applicable.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Ethics approval: The study was approved by the Human Research Ethics Committee of the University of New South Wales (HC13092). http://dx.doi.org/10.1016/j.physio.2015.03.366 Research Report Poster Presentation Number: RR-PO-03-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 THERAPEUTIC STRATEGIES PERFORMED BY PHYSIOTHERAPISTS IN THREE INTENSIVE CARE UNITS (ICUS) IN SANTIAGO, CHILE: PILOT STUDY A.C. Castro Avila 1,2 , C. Merino Osorio 1,3 , L. Henriquez Rodriguez 1,4 , J. Leppe Zamora 1 1 Clinica Alemana-Universidad del Desarrollo, Faculty of Medicine, Santiago, Chile; 2 University of York, Health Sciences, York, United Kingdom; 3 Thorax National Institute, Physiotherapy, Santiago, Chile; 4 Padre Hurtado Hospital, Physiotherapy, Santiago, Chile
Background: To date, there are four systematic reviews suggesting positive effects of rehabilitation and chest physiotherapy during ICU stay. However, in Chile there is no information about the therapeutic strategies used by physiotherapists (PTs) working in this environment. A better understanding of the interventions they perform would shed light on possible areas of improvement. Purpose: To describe the duration and therapeutic strategies used by PTs working at three Level 3 ICUs in Santiago, Chile. Methods: A cross sectional study carried out in three level 3 ICUs in Santiago: a private hospital, a public hospital and a national reference centre for cardiothoracic disorders. PTs were observed in each unit for 24 hours over the course of 8 days, using a structured observation template. Data were collected on time spent on different activities (reading of charts and test results, assessment of patient, intervention, reassessment, writing on patients’ charts, change-of-shift report and administrative work) and therapeutic strategies performed with patients. Frequency of use is presented for the most common activities and the median (P25 -P75 ) of their duration. Chi-squared was used to compare frequencies according to ward. P-value <0.05 were considered statistically significant. Results: 32 PTs were observed for 960 hours during 1131 visits. 121 patients received care from PTs during this period with a median (P25 -P75 ) APACHE II of 13 (9–19). 41 patients (33.9%) were on invasive or non-invasive mechanical ventilation. 88% of the PTs’ working time was spent on activities related to patients’ care and 12% in administrative tasks or clinical meetings with members of staff. The median (P25 -P75 ) duration of a visit was 20 (12–28) min
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including 3 (1–4) different therapeutic strategies. The most commonly used were: mucus clearance techniques (49%), ribcage compression-decompression (48%), active-assisted range of motion (ROM) (21%), sitting on edge of bed (SEB) (19%), mechanical ventilator parameters adjustment (16%) and assisted walking (16%). Neuromuscular electric stimulation or training with cycloergometer, steps or treadmill were not used. Passive ROM was more frequent in the ICUs than High Dependency Units (HDUs) (20% vs 12%, p < 0.0001), while SEB (14% vs 23%, p < 0.0006), assisted standing (11% vs 17%, p < 0.044) and assisted walking (10% vs 20%, p < 0.0001) were more common in HDUs than ICUs. Conclusion(s): Chest physiotherapy techniques are the most commonly used techniques despite conflicting evidence on their benefit. It is noteworthy that some forms of early mobilisation are also frequently performed, although they were more common in HDUs than ICUs. Beliefs about safety of exercise, lack of skills, knowledge or human resources, might be preventing the use of more active ways of rehabilitation. This should be explored in the future in order to increase the quality of care provided. Implications: This pilot study will help to develop a selfreport questionnaire. With it, we aim to survey PTs across Chile in order to establish the current therapeutic strategies used and human resources in the ICU. This information would help to develop policies in relation to the minimum number of PTs and standard of care in the ICU. Keywords: Standard of care; Critical care; Physical therapy modalities Funding acknowledgements: This project was funded by the Universidad del Desarrollo internal research fund 2013. Ethics approval: This project was approved by three ethics committees: Southeast Metropolitan Health Service, East Metropolitan Health Service and Clinica Alemana. http://dx.doi.org/10.1016/j.physio.2015.03.367 Research Report Poster Presentation Number: RR-PO-07-13-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 BUILDING COMMUNICATION STRATEGIES FOR PROMOTING PHYSICAL THERAPY IN MENTAL HEALTH: A QUALITATIVE STUDY D. Catalan-Matamoros 1 , L.H. Skjaerven 2 1 University
Carlos III of Madrid, Department of Journalism and Communication and Spanish Association of Physiotherapists in Mental Health, Madrid, Spain; 2 Bergen University College, Department of Occupational Therapy, Physiotherapy and Radiography, Bergen, Norway Background: People suffering from mental health problems often have body oriented symptoms as well and muscle
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Results: Children with CP showed lower mobility in fourth and from sixth to tenth ribs for TD, and from seventh to tenth ribs for . There were no differences between CG and CPG for APD and ␣. Conclusion(s): Children with hemiparetic CP showed lower mobility in lower ribs when compared to typical developmental children. For future researches we suggest to analyse the effects of respiratory intervention to improve their thoracic cage mobility. Implications: Because of lower thoracic cage mobility in mild impairment spastic hemiplegic CP, an earlier intervention to improve thoracic cage mobility and respiratory function may prevent pulmonar disturbances or diseases. Keywords: Cerebral palsy; Thoracic cage; Breathing Funding acknowledgements: Coordination for the Improvement of Higher Education Personnel – CAPES. Ethics approval: This study was approved by the Federal University of São Paulo Ethics Research Committee (n◦ 275.276). http://dx.doi.org/10.1016/j.physio.2015.03.365 Research Report Poster Presentation Number: RR-PO-05-01-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 MEASURING ACTIVITY PACING IN PATIENTS WITH CHRONIC FATIGUE SYNDROME S. Casson 1 , C. Sandler 1,2 , S. Horsfield 1 , A. Lloyd 1,2,3 , B. Barry 4,5 1 University
of New South Wales, Lifestyle Clinic, School of Medical Sciences, Sydney, Australia; 2 University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia; 3 University of New South Wales, Inflammation and Infection Research Centre, School of Medical Sciences, Sydney, Australia; 4 University of New South Wales, School of Medical Sciences, Sydney, Australia; 5 University of New South Wales, Neuroscience Research Australia, Sydney, Australia Background: Activity pacing is a common strategy in the management of chronic fatigue syndrome (CFS), as either a standalone intervention or as a precursor to other therapies. The cardinal symptom of CFS is fatigue, which is exacerbated for prolonged periods by physical tasks previously achieved without difficulty. Accordingly, activity pacing involves planning daily and weekly activities, incorporating rest breaks and segmenting tasks into shorter time blocks, to avoid exacerbating symptoms. Clinical guidelines to implement activity pacing are sparse, and the tools to assess and guide pacing are not formalised. Purpose: The aim of this project was to examine the utility of subjective measures, such as activity dairies and self-report
questionnaires, and objective measures, such as pedometers, to optimise activity pacing. The hypothesis was that the combined use of subjective and objective assessments is necessary to capture activity pacing behaviour. Methods: Patients with CFS attending a tertiary specialist clinic completed a 7-day activity diary and concurrently used a pedometer at the commencement of a 16-week multi-disciplinary intervention incorporating cognitive-behavioural therapy, activity pacing, and graded exercise therapy. The activity diary required the patient to report the main activity performed each hour of the day (cognitive or physical), the perceived intensity of the activity, and information, such as sleep routine and energy ratings throughout the day. Pedometer data were recorded as counts of activity for each day. Patients completed specially designed self-report questionnaires regarding activity pacing. Formalised clinician ratings of the patient’s adherence to activity pacing strategies were based on interview and the diary. Objective and subjective data were compared with clinician ratings of each patient’s activity pacing. Results: The sample of 45 patients included 30 women (67%), with mean age of 37 ± 15 years, a mean duration of illness of 5.1 ± 3.6 years and SF-36 physical function of 49.8 ± 24.2. According to clinician ratings, 49% of the patients adhered to activity pacing “a little”, 29% “not at all”, 18% “moderately”, and only 4% “quite a bit” and 0% “extremely”. There was little relation between day-to-day variation in pedometer step counts and clinician ratings of activity pacing (r = −0.216, p = 0.164) or self-report questionnaires (r = −0.064, p = 0.68). Pedometer total step counts did, however, correspond with patient diary records of physical activities as well as the physical function subscale of the SF-36 (r = 0.518, p < 0.05). Self-report questionnaire items exhibited moderate internal validity (Cronbach’s alpha 0.619) and weak correlation with clinician ratings of activity pacing (r = 0.288, p = 0.055). Conclusion(s): Activity pacing remains a poorly defined construct. Clinician ratings utilise a combination of objective measures and patient report, with limited association between these ratings and any single measure. The lack of concordance between across-day variation in pedometer step counts and clinician ratings of activity pacing suggests that a single daily count of physical activity misses key aspects of pacing behaviour. There is scope for a refined questionnaire to monitor and guide activity pacing. Implications: While activity pacing has a logical foundation – encourage patients to adjust activity to avoid exacerbating symptoms – and is often applied clinically, the availability of valid and reliable assessments and of clinical guidelines is limited. Keywords: Fatigue; Activity pacing; Physical activity measurement Funding acknowledgements: Not applicable.
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Ethics approval: The study was approved by the Human Research Ethics Committee of the University of New South Wales (HC13092). http://dx.doi.org/10.1016/j.physio.2015.03.366 Research Report Poster Presentation Number: RR-PO-03-07-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 THERAPEUTIC STRATEGIES PERFORMED BY PHYSIOTHERAPISTS IN THREE INTENSIVE CARE UNITS (ICUS) IN SANTIAGO, CHILE: PILOT STUDY A.C. Castro Avila 1,2 , C. Merino Osorio 1,3 , L. Henriquez Rodriguez 1,4 , J. Leppe Zamora 1 1 Clinica Alemana-Universidad del Desarrollo, Faculty of Medicine, Santiago, Chile; 2 University of York, Health Sciences, York, United Kingdom; 3 Thorax National Institute, Physiotherapy, Santiago, Chile; 4 Padre Hurtado Hospital, Physiotherapy, Santiago, Chile
Background: To date, there are four systematic reviews suggesting positive effects of rehabilitation and chest physiotherapy during ICU stay. However, in Chile there is no information about the therapeutic strategies used by physiotherapists (PTs) working in this environment. A better understanding of the interventions they perform would shed light on possible areas of improvement. Purpose: To describe the duration and therapeutic strategies used by PTs working at three Level 3 ICUs in Santiago, Chile. Methods: A cross sectional study carried out in three level 3 ICUs in Santiago: a private hospital, a public hospital and a national reference centre for cardiothoracic disorders. PTs were observed in each unit for 24 hours over the course of 8 days, using a structured observation template. Data were collected on time spent on different activities (reading of charts and test results, assessment of patient, intervention, reassessment, writing on patients’ charts, change-of-shift report and administrative work) and therapeutic strategies performed with patients. Frequency of use is presented for the most common activities and the median (P25 -P75 ) of their duration. Chi-squared was used to compare frequencies according to ward. P-value <0.05 were considered statistically significant. Results: 32 PTs were observed for 960 hours during 1131 visits. 121 patients received care from PTs during this period with a median (P25 -P75 ) APACHE II of 13 (9–19). 41 patients (33.9%) were on invasive or non-invasive mechanical ventilation. 88% of the PTs’ working time was spent on activities related to patients’ care and 12% in administrative tasks or clinical meetings with members of staff. The median (P25 -P75 ) duration of a visit was 20 (12–28) min
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including 3 (1–4) different therapeutic strategies. The most commonly used were: mucus clearance techniques (49%), ribcage compression-decompression (48%), active-assisted range of motion (ROM) (21%), sitting on edge of bed (SEB) (19%), mechanical ventilator parameters adjustment (16%) and assisted walking (16%). Neuromuscular electric stimulation or training with cycloergometer, steps or treadmill were not used. Passive ROM was more frequent in the ICUs than High Dependency Units (HDUs) (20% vs 12%, p < 0.0001), while SEB (14% vs 23%, p < 0.0006), assisted standing (11% vs 17%, p < 0.044) and assisted walking (10% vs 20%, p < 0.0001) were more common in HDUs than ICUs. Conclusion(s): Chest physiotherapy techniques are the most commonly used techniques despite conflicting evidence on their benefit. It is noteworthy that some forms of early mobilisation are also frequently performed, although they were more common in HDUs than ICUs. Beliefs about safety of exercise, lack of skills, knowledge or human resources, might be preventing the use of more active ways of rehabilitation. This should be explored in the future in order to increase the quality of care provided. Implications: This pilot study will help to develop a selfreport questionnaire. With it, we aim to survey PTs across Chile in order to establish the current therapeutic strategies used and human resources in the ICU. This information would help to develop policies in relation to the minimum number of PTs and standard of care in the ICU. Keywords: Standard of care; Critical care; Physical therapy modalities Funding acknowledgements: This project was funded by the Universidad del Desarrollo internal research fund 2013. Ethics approval: This project was approved by three ethics committees: Southeast Metropolitan Health Service, East Metropolitan Health Service and Clinica Alemana. http://dx.doi.org/10.1016/j.physio.2015.03.367 Research Report Poster Presentation Number: RR-PO-07-13-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 BUILDING COMMUNICATION STRATEGIES FOR PROMOTING PHYSICAL THERAPY IN MENTAL HEALTH: A QUALITATIVE STUDY D. Catalan-Matamoros 1 , L.H. Skjaerven 2 1 University
Carlos III of Madrid, Department of Journalism and Communication and Spanish Association of Physiotherapists in Mental Health, Madrid, Spain; 2 Bergen University College, Department of Occupational Therapy, Physiotherapy and Radiography, Bergen, Norway Background: People suffering from mental health problems often have body oriented symptoms as well and muscle