Core capabilities for care delivery during COVID-19

 

Maintaining clinical practice or research in physiotherapy during the COVID-19 pandemic is challenging. The October issue of the Journal of Physiotherapy contains some items to help guide you.

Many physiotherapists have been providing patient care via videoconferencing, but often without formal guidance into all the issues that surround that mode of delivery.

To address this, Luke Davies and colleagues from Melbourne and Brisbane present a framework of core capabilities for physiotherapists to deliver quality care via videoconferencing.

These capabilities were decided by a steering group and an international Delphi panel, which, in combination, included 140 experts from 33 countries.

The 140 were drawn from physiotherapy clinical practice, academia, policy and the private health insurance industry.

The core capabilities covered the domains of compliance, patient privacy/confidentiality, patient safety, technology skills, telehealth delivery, assessment/diagnosis and care planning and management.

Researchers across the world have rapidly responded to the urgent need for clinical trials of treatments for COVID-19.

Maximising the health impacts of this research effort will need trial outcomes that can be interpreted, compared and applied across different populations and countries.

Mariana Hoffman and Professor Anne Holland review a core outcome set for trials involving participants with COVID-19.

This will ease the decision regarding which outcomes should be measured in such trials.

Guidelines for Down syndrome interventions

The physiotherapy profession has much to offer people with Down syndrome.

We have a wide breadth of relevant input spanning early infancy through to old age, making a unique contribution as part of a multidisciplinary team.

Despite this, adequate guidelines for physiotherapy management of Down syndrome have been lacking.

In her Invited Topical Review, Professor Nora Shields provides a thorough summary of the evidence about physiotherapy management of this condition.

The evidence that is discussed includes:

  • early intervention (eg, parent-delivered treadmill training, massage)
  • task-specific training interventions
  • exercise (eg, aerobic training, progressive resistance training, inspiratory muscle training, balance training)
  • health education
  • behaviour change interventions.

Each category of interventions comes with a concise summary paragraph to highlight the implications for clinical practice.

Spinal pain advice

International guidelines for the management of spinal pain endorse advice as part of first-line treatment.

Most guidelines recommend providing the patient, with some form of advice, but the advice varies somewhat from guideline to guideline.

Caitlin Jones and colleagues from Sydney systematically reviewed the evidence about advice or education for spinal pain, with some interesting findings based on data from more than 7000 participants.

Advice had beneficial effects on both pain and disability, but the effects are likely to be insufficient as a standalone intervention.

The amount of benefit from advice did not vary substantially between patients, with various durations/locations of pain or when the advice was delivered in a variety of ways.

Mark Elkins is the scientific editor of Journal of Physiotherapy

Cost savings for COPD treatment

From the Netherlands, Glenn Leemans and colleagues provide a systematic review of the cost-effectiveness of respiratory physiotherapy interventions for people with chronic obstructive pulmonary disease (COPD).

Their review includes 11 cost-effectiveness studies with data on more than 3000 participants for a range of respiratory interventions:

  • pulmonary rehabilitation
  • airway clearance techniques
  • an integrated disease-management program
  • an early assisted discharge program.

They show that respiratory physiotherapy interventions focusing on exercise training in combination with enhancing physical activity levels are likely to be cost-effective in terms of costs per unit gain in quality of life and in quality-adjusted life years.

The heart of the matter

Exercise training has become an important component of the management of people with coronary heart disease.

Despite the established benefits, many patients—especially those with arthritis or obesity—do not undertake recommended amounts of physical activity.

Low-impact exercise strategies may be beneficial in this population.

Recently, Anna Scheer and Prof Andrew Maiorana, with colleagues from Perth, compared the benefits of gym-based and water-based exercise in people who experienced a coronary event at least six months ago.

Participants were randomly allocated to 12 weeks of:

  • three one-hour sessions per week of moderate intensity water-based circuit training exercise with alternating aerobic and resistance stations
  • three one-hour sessions per week of moderate intensity gym-based circuit training exercise or
  • continuing usual activities.

Both training groups significantly improved their aerobic fitness, leg strength and total body fat.

Gym exercise was better at improving one measure of upper limb strength, but otherwise the benefits were similar in magnitude in the two training groups.

This supports the expansion of exercise prescription options for people with stable coronary heart disease to include water-based exercise, which may be useful for adding a low-joint-impact exercise option to facilitate exercise engagement.

Other items in this October issue consider: a new model for managing rehabilitation in multi-trauma in adults, measurement of quality of life in people with cancer, mechanised upper limb rehabilitation in stroke, and a self-directed, web-based exercise and physical activity program supported with text messages for people with knee osteoarthritis.

Click here to read these and other papers from the latest and past issues.

>> Clinical Associate Professor Mark Elkins, APAM, is the scientific editor of Journal of Physiotherapy. Follow him on Twitter @JOP_Editor and follow Journal of Physiotherapy @JPhysiother.

 

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