Assessment of Intravascular Volume Status in Children with Nephrotic Edema Using Serum and Urinary Indices and Its Correlation with Inferior Vena Cava Collapsibility Index.

Identification of volume status in nephrotic syndrome (NS) is important but clinically challenging. Urinary and serum indices can be helpful in assessing the volume status and so can be inferior vena cava collapsibility index (IVCCI). This study was done to assess the serum and urinary indices in children with nephrotic edema and to correlate them with IVCCI for intravascular volume assessment. Fifty children with nephrotic edema and 47 children in remission were analyzed for blood and urine indices. Volume status was defined as overfilling or underfilling based on the biochemical indices and also by IVCCI. Eighty-four percent individuals among cases and 23% among controls had sodium retention (FENa < 0.5%). Among cases, 54% had primary sodium retention compared to 17% among controls (p = 0.0002). Hypovolemia was observed among 36% cases based on biochemical indices and in 20% cases as per IVCCI. Hypovolemia was significantly associated with low urinary sodium and low serum albumin.

Concurrent validity and reliability of telerehabilitation-based physiotherapy assessment of cervical spine in adults with non-specific neck pain.

INTRODUCTION: The aim of this study was to determine the concurrent validity and reliability of telerehabilitation (TR)-based evaluation of the cervical spine among adults with non-specific neck pain (NS-NP). METHODS: A total of 11 participants with NS-NP were recruited. Pain intensity, active range of motion (AROM), posture, deep neck flexor (DNF) endurance, combined neck movements and disability were measured using face-to-face and TR methods, with a one-hour break in between. TelePTsys, an image-based TR system, was used for TR assessment. RESULTS: A high degree of concurrent validity for pain (bias = 0.90), posture (bias = 0.96°), endurance (bias = -2.3 seconds), disability (bias = 0.10), AROM (extension bias = -0.60 cm, flexion bias = 1.2 cm, side flexion bias = -1.00, rotation bias = -0.30 cm) was found. Standard error of measurement and coefficient of variation (CV) values were within the acceptable level for concurrent validity, except the CV for cervical flexion and endurance. There was a high degree of reliability demonstrated for pain, posture, AROM, endurance and disability measurements. The average-measure interclass correlation coefficient (ICC(3,1)) ranged from 0.96 to 0.99 for inter-rater, and 0.93 to 0.99 for intra-rater reliabilities. There was moderate agreement for combination movement for validity (78.5%, p < 0.05), inter- (78.5%, p < 0.05) and intra-rater (76.4%, p < 0.05) reliabilities. DISCUSSION: TR-based physiotherapy assessment of cervical spine is a valid and reliable tool for measuring pain intensity, AROM, DNF muscle endurance, sagittal neck posture and disability among adults with NS-NP via telePTsys.

Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review.

Purpose The purpose of this review is to systematically explore and summarise the validity and reliability of telerehabilitation (TR)-based physiotherapy assessment for musculoskeletal disorders. Method A comprehensive systematic literature review was conducted using a number of electronic databases: PubMed, EMBASE, PsycINFO, Cochrane Library and CINAHL, published between January 2000 and May 2015. The studies examined the validity, inter- and intra-rater reliabilities of TR-based physiotherapy assessment for musculoskeletal conditions were included. Two independent reviewers used the Quality Appraisal Tool for studies of diagnostic Reliability (QAREL) and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool to assess the methodological quality of reliability and validity studies respectively. Results A total of 898 hits were achieved, of which 11 articles based on inclusion criteria were reviewed. Nine studies explored the concurrent validity, inter- and intra-rater reliabilities, while two studies examined only the concurrent validity. Reviewed studies were moderate to good in methodological quality. The physiotherapy assessments such as pain, swelling, range of motion, muscle strength, balance, gait and functional assessment demonstrated good concurrent validity. However, the reported concurrent validity of lumbar spine posture, special orthopaedic tests, neurodynamic tests and scar assessments ranged from low to moderate. Conclusion TR-based physiotherapy assessment was technically feasible with overall good concurrent validity and excellent reliability, except for lumbar spine posture, orthopaedic special tests, neurodynamic testa and scar assessment.

Managing Patient Factors in the Assessment of Swallowing via Telerehabilitation.

Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities.

Training the allied health assistant for the telerehabilitation assessment of dysphagia.

We examined the effect of knowledge and task specific training provided to an allied health assistant (AHA), prior to her involvement in facilitating assessments of dysphagia (swallowing disorders) via telerehabilitation. The AHA received four hours of training, which included basic theoretical information regarding dysphagia as well as hands-on training with simulated patients. A written test examining swallowing function and its evaluation was completed pre- and then immediately post-training, and then again after the 15th and 30th of 31 consecutive patient assessments. In addition, after each set of 5 clinical dysphagia assessments completed with patients following the training, two speech pathologists rated the AHA's competence in relation to performing the tasks and activities required of her during the telerehabilitation swallowing assessment. The AHA also self-rated the perceived level of confidence at these times. Before training, the assistant's knowledge of dysphagia theory was at 40%. Following training, all tests were above the 80% level. The AHA's performance was rated as competent on each evaluation post-training. The AHA also expressed overall satisfaction with the initial training provided and reported feeling confident after the initial sessions with patients. Thus for an AHA with previous clinical experience, competence and perceived comfort in providing assistance in the sessions was achieved with only a few hours of task specific training.

Groundwater quality assessment at Pali, Rajasthan (India).

Chemical analysis of groundwater samples collected from Pali, Rajasthan (India) showed the direct impact of textile effluents on its quality. Textile printing and dyeing units discharge large volume of effluent per day through lined and unlined channels directed towards the Bandi River. It was observed that the groundwater upstream at Pali has dissolved oxygen (4.06-4.26 mg/L), low salinity (2020-3350 microS/cm), sodium (400-600 mg/L), chloride (545-496 mg/L) and sulphate (88-300 mg/L). It was found that groundwater downstream at Pali is oxygen deficient with dissolved oxygen (0 mg/L), extremely saline (7050-28000 microS/cm), alkaline (330-1430 mg CaCO3/L), rich in sodium (1300-7130 mg/L), chloride (61-818 mg/L) and sulphate (466-4006 mg/L) exhibiting high chemical oxygen demand (153-1788 mg/L). Most of the wells had greenish tinge in water and high salinity. Most of the polluted water had sodium adsorption ratio value above 20 which in combination with high salinity is responsible for reduced crop yield, and low soil permeability has been observed in the affected area.