Physiotherapy Outcomes Are Associated With Shorter Waiting Times, More Treatment Sessions and Younger Age: Analysis of a Clinical Database.

BACKGROUND: Musculoskeletal (MSK) conditions affect over 20.3 million people in the UK, presenting a substantial economic impact on health and social services. Physiotherapy can alleviate MSK conditions, especially if delivered in the acute or sub-acute period. However, patients often present after significant waiting times. OBJECTIVES: Our analysis examined how waiting times and the number of treatments influenced physiotherapy outcomes for MSK conditions. DESIGN: Retrospective analysis of the Data for Impact, Physio First dataset. METHODS: Logistic regression models assessed the effects of symptom duration, treatment frequency, and other variables on pain, Patient-Specific Functional Scores (PSFSs), and Goal Achievement (GA). RESULTS: Analysis of 15,624 patient records showed that patients treated within two weeks of symptom onset were more likely to have favourable outcomes in pain (odds ratio [OR] = 2.01, 95% Confidence Interval [95% CI] = 1.65-2.45), PSFS (OR = 1.80, 95% CI = 1.55-2.08), and GA (OR = 1.74, 95% CI = 1.51-2.01) compared to those treated after longer durations. Receiving four or more treatment sessions significantly improved outcomes compared with only one session (pain: OR = 4.64, PSFS: OR = 5.72, GA: OR = 1.94, all p's < 0.001), with no additional benefits beyond four sessions. Younger age was associated with better outcomes (approximately OR = 0.99 per year age difference). Other findings included better outcomes in males and in those with fewer previous episodes of the condition. CONCLUSIONS: Shorter waiting times, a greater number of treatments, and younger patient age are associated with better physiotherapy outcomes for MSK conditions.

High concentrations of paracetamol in effluent dominated waters of Jakarta Bay, Indonesia.

The occurrence of several aquatic contaminants, including pharmaceuticals, were investigated in seawater samples collected from effluent-dominated sites in Indonesia: 4 sites in Jakarta Bay and one on the north coast of Central Java. The data presented in this preliminary study provide a snapshot of seawater quality in these areas. Results show that nutrient parameters exceeded the Indonesian Standard Quality of Seawater limits, and some metals were also present. Interestingly, high concentrations of paracetamol were detected at Angke (610 ng/L) and Ancol (420 ng/L), both in Jakarta Bay. To date, this is the first study to report the presence of paracetamol (acetaminophen) in the coastal waters around Indonesia. The high concentrations detected, compared to other levels reported in scientific literature, raise concerns about the environmental risks associated with long-term exposure and, especially, the impact on nearby shellfish farms. Given pharmaceuticals' consideration as emerging contaminants, these data suggest further investigations are needed.

Management of low back pain: Treatment provision within private practice in the UK in the context of clinical guidelines.

OBJECTIVE: To summarise the combination of treatments private UK-based physiotherapists use with patients who have low back pain (LBP) and the extent to which the treatments used are consistent with clinical guideline recommendations. DESIGN: Cross-sectional observational survey. METHODS: Data were collected from physiotherapists within private UK-based clinics using an online standardised data collection system to record the treatment they provided for patients who had LBP with/without leg pain. Treatment data were classified into those that are 'recommended', 'not recommended' and had 'no recommendation'. RESULTS/FINDINGS: Treatment provided to 8003 patients were included in the analyses. Most patients (95.0%) were provided with a 'recommended' treatment. Approximately half of the patients who received 'recommended' treatment were also provided with other treatments that were either 'not recommended' (16.7%), had 'no recommendation' (16.6%) or a combination of both (13.0%). Few patients were provided with only treatments that were 'not recommended' and/or treatment with 'no recommendation' (4.6%). CONCLUSION: This study provides insight into the self-reported practice of participating physiotherapists and highlights how they generally adopted a multimodal treatment model for patients with LBP. Consistent with the National Institute for Health and Care Excellence guidelines, most patients received information and advice often in conjunction with exercise and manual therapy. Only a small proportion of patients were provided with treatments that are 'not recommended' and/or treatment that had 'no recommendation'. These findings are useful in documenting the implementation of clinical guidelines given the need for practitioners to balance the best available evidence with patient expectation and preference and to facilitate the therapeutic alliance.

Development and use of standardised data collection tools to support and inform musculoskeletal practice.

Clinicians all over the world are increasingly being faced with the need to demonstrate and account for the way in which clinical services are delivered and the quality of the delivery. It is also imperative to develop a comprehensive profile of who is accessing these services, who benefits from these services; how much these services cost in terms of clinicians time, the use of other healthcare resources and the effectiveness of interventions utilised in relation to quality outcomes. Clinicians are themselves keen to have mechanisms to identify what approaches are being utilised in their own practice setting, how they work best and how they can be improved from a professional development perspective. They are also anxious to improve their skills based on informed reflective practice and identify gaps in their knowledge and skills. This masterclass identifies how standardised data collection (SDC) tools can be utilised in practice to gather the information required in a robust, agreed and accessible way. It summarises a method of SDC tool development and gives some examples of how SDC has been implemented in physiotherapy National Health Services and in physiotherapy private practice in the United Kingdom. The global relevance is that increasingly all physiotherapy services are being held and will be accountable for the quality and equity of care. In addition clinicians can find it useful to have benchmarks with which to compare their own and their departmental performance in terms of clinical activities and outcomes.

Assessment of biological activity of novel peptide analogues of angiotensin IV.

OBJECTIVES: Angiotensin IV (Ang IV) is a metabolite of angiotensin II which acts on specific AT(4) receptors identified as the enzyme insulin regulated aminopeptidase (IRAP). The transduction process of these receptors is unresolved, but Ang IV inhibits the aminopeptidase activity. Ang IV improves cognition in animal models thus there is a desire to develop metabolically stable analogues for further development. METHODS: Peptide analogues of Ang IV were obtained commercially or synthesised. Each peptide was tested in vitro for its ability to inhibit the aminopeptidase activity (IRAP) of mouse brain homogenates and for its effects on isolated rat uterine smooth muscle. KEY FINDINGS: [Des-Val(1) ]-Ang IV, acetylated-Ang IV-amide, Ang IV-amide and [des-His(4) ]-Ang IV all inhibited IRAP. [Sar(1) , Ile(8) ]-Angiotensin II (10 µm) had an effect greater than that of Ang IV or any of the other analogues studied. In isolated uterine smooth muscle, angiotensins II and IV induced contractions, which could be antagonised by an AT(1) -receptor antagonist. None of the novel peptides induced uterine smooth muscle contractions, but [Sar(1) , des Arg(2) -Gly(8) ]-angiotensin II showed significant antagonism of the contractile effects of angiotensin II and carboxyamide-terminated Ang IV-NH(2) showed antagonism of Ang IV-induced contractions. CONCLUSIONS: This study provides five novel inhibitors of IRAP worthy of assessment in behavioural models of learning and memory. The analogues are devoid of AT(1) receptor agonist properties, and the carboxyamide analogue presents an opportunity to elucidate the mechanism of action of Ang IV as, like Ang IV, it inhibits IRAP, but antagonises the effects of Ang IV on isolated smooth muscle.