Japanese physical therapist's evidence-to-practice gap in knee osteoarthritis clinical practice guidelines: A cross-sectional study.

OBJECTIVE: As management for osteoarthritis, clinical practice guidelines (CPGs) have been published worldwide with the aim of attaining optimal treatment and rehabilitation. However, we suspect a lack of knowledge of and/or adherence to osteoarthritis CPGs in physiotherapists' clinical practice. There may be an evidence-to-practice gap in knee osteoarthritis rehabilitation among Japanese physiotherapists. Therefore, we aimed to measure the level of knowledge and adherence to osteoarthritis CPGs within a cohort of Japanese physiotherapists. METHODS: An online survey was created based on three appropriate and high-quality CPGs. The first two sections comprised 23 statements, and participants responded via a five-point Likert scale ("completely disagree" to "completely agree"). Consensus was defined as ≥70% agreement with a statement. In the second section, participants read clinical scenarios and selected what they considered to be the most appropriate management and interventions. RESULTS: The survey was completed by 558 Japanese physiotherapists. The mean age of the participants included in the analysis was 34.8 years, 61 participants were female (13.7%). Consensus was attained in just 12 out of 23 items (52%). In the second section, none of the physiotherapists were considered to have good knowledge of CPGs, 85.2% were considered to have only partial knowledge, and 14.8% had no knowledge. Familiarity with the CPGs was therefore poor and there was clearly poor adherence to the recommended rehabilitation guidelines. CONCLUSIONS: The level of knowledge and adherence to osteoarthritis CPGs within our cohort was poor, suggesting an evidence-to-practice gap in rehabilitation for knee osteoarthritis among Japanese physiotherapists.

Impairment of instantaneous autonomic regulation relates to blood pressure fall immediately after standing in the elderly and hypertensives.

The relation between changes in blood pressure and changes in autonomic activity over a very short period of time has not been reported thus far. To examine this relation, we here introduced a new method of power spectrum analysis with wavelet transformation, which has very fine time resolution and is able to assess changes in autonomic activity quantitatively even during movement. Our subjects were 15 hypertensive and 17 normotensive subjects. A head-up tilt test was performed in all subjects, and during the test, electrocardiogram and blood pressure were recorded continuously. The power spectrums for both parameters were calculated simultaneously every 5 s using wavelet transformation. The high frequency of the RR interval of the electrocardiogram (RR-HF) and low frequency of systolic blood pressure (SBP-LF) were defined and calculated as markers of parasympathetic and alpha-1 receptor blocker, bunazosin-sensitive sympathetic activity, respectively. Focusing on the changes for 2 min immediately after head-up tilting, it was found that the changes in SBP-LF and RR-HF were significantly delayed, by at least 40 s, in hypertensives compared with normotensives and also in elderly compared with non-elderly subjects. Multiple regression analysis demonstrated that the instantaneous change in RR-HF was the most important confounding factor for a fall in blood pressure immediately after head-up tilting. In conclusion, real-time changes in autonomic activity calculated by wavelet transformation may provide sensitive and useful information about acute changes in cardiovascular regulation, such as delayed reaction of the autonomic regulation after head-up tilting, that may be major causes of the blood pressure fall in hypertensive and elderly subjects.

Exercise-induced electrocardiographic changes in patients with chronic respiratory diseases: differential diagnosis by 99mTc-tetrofosmin SPECT.

UNLABELLED: Evaluation of possible cardiac complications is essential for safe and effective respiratory rehabilitation of patients with chronic respiratory diseases (CRDs). The aim of this study is to clarify the pathophysiology of electrocardiographic (ECG) changes during exercise and the prevalence of coronary artery disease (CAD) in CRD patients without a history of myocardial ischemia. METHODS: We studied 42 CRD patients with exercise-induced ST depression by cardiopulmonary exercise testing (CPET). They were selected from 249 consecutive CRD patients without any history of CAD who underwent CPET between January 1999 and December 2001. Thirty-three patients without respiratory diseases who had positive ST depression during exercise were selected as disease control subjects. Exercise myocardial SPECT was performed to evaluate myocardial ischemia and right ventricular (RV) overload as measured by increased RV uptake. RESULTS: Among the 249 consecutive CRD patients without any history of CAD, positive ST depression during exercise was found in 42 (16.9%). Only 2 of the 42 patients (4.8%) had an ST depression other than in II, III, or aVF leads. The incidence of myocardial ischemia by perfusion SPECT was significantly lower in CRD patients (26.2%) than in disease control subjects (78.8%). The most common finding in the CRD patients during exercise was RV overload but without ischemia (26 cases; 61.9%). Ischemia was found in 11 patients (26.2%), with 10 of these patients also having RV overload. Neither ischemia nor RV overload was found in 5 patients (11.9%); these patients were eventually diagnosed as normal. CONCLUSION: The incidence of myocardial ischemia as determined by perfusion SPECT was low in CRD patients with positive exercise-induced ECG changes. On the other hand, RV overload was observed in most such cases. Cardiac perfusion SPECT is a useful technique to evaluate cardiac ischemia and RV overload simultaneously. CPET with 12-lead ECG monitoring is necessary in CRD patients before respiratory rehabilitation. Further examination for ischemia should be done if positive ST depression is found.