Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis.

PURPOSE: This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy. METHODS: A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed. RESULTS: In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I2 = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I2 = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I2 = 0%, p = 0.50). CONCLUSION: Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.

As stroke is known to cause long term disability, the implementation of strengthening interventions in rehabilitation becomes an indispensable part to optimize recovery.Peripheral electrical stimulation might be a useful intervention since it has the potential to repetitively activate the sensory-motor system via electrical pulses to nerves and muscles of the paretic limb.Results of the meta-analysis indicate a beneficial effect of electrotherapy on muscle strength when compared to conventional and sham therapy, and muscle thickness when compared to conventional therapy.

Midwifery students' satisfaction with perinatal simulation-based training.

BACKGROUND: Simulation-based training has proved to be an effective teaching and learning approach in healthcare. Nevertheless, any assessment of its effectiveness should also take the students' perspective into account. AIM: To validate the Satisfaction with Simulation Experience Scale (SSES) for use with midwifery students and evaluate midwifery students' satisfaction with perinatal simulation-based training. METHODS: Satisfaction with simulation was assessed using the SSES, a measurement tool translated from English to Dutch. Data was collected in four consecutive years (2016-19). A mixed methods design was used to capture both qualitative and quantitative data. Using the quantitative data, factor analysis was performed to assess the construct validity, while Cronbach's alpha was used to assess internal consistency. Qualitative data was assessed using thematic content analysis. FINDINGS: 367 SSES questionnaires were completed by 251 students. The exploratory factor analysis resulted in a three-factor model covering debriefing and reflection, clinical reasoning and clinical learning. Cronbach's alpha showed good internal consistency. Students were very satisfied with perinatal simulation-based training for all three factors: 4.30 (SD=0.47) for debriefing and reflection, 3.97 (SD=0.55) for clinical reasoning and 4.10 (SD=0.46) for clinical learning. Satisfaction scores remained high and stable over the years investigated. Thematic content analysis identified 6 categories: simulation-based training is valuable, the need for more simulation-based training, fidelity, students, negative feelings, and preparation is vital. CONCLUSION: Students were satisfied with the simulation-based training, experiencing it as providing added value to their education. Simulations gave them the opportunity to make and learn from mistakes in a safe learning environment.

Development and validation of the Midwife Profiling Questionnaire assessing women's preferred perinatal care professional and knowledge of midwives' legal competences.

OBJECTIVES: Currently maternity care organisation is developing worldwide. Therefore insight in the position of the midwife is important. The 'Midwife Profiling Questionnaire' (MidProQ) measures women's preferred perinatal care professional and their knowledge of midwives' legal competences. MidProQ is based on the European legal framework and was tested in a pilot study. This study aims to determine its content and face validity. STUDY DESIGN: A two-phase validation study with a Delphi method questioning content experts (n = 10) on items relevance and clarity as well as its scale and face validity. Further semi-structured interviews were performed with lay experts (n = 10) to evaluate the questionnaire's clarity, layout, phrasing and wording. RESULTS: After round one, most questions (42/47) were considered content valid for relevance and clarity (Item Content Validity Index 0.80-1.00). Scale (Scale Content Validity Index 0.92) and face validity (Face Validity Index 0.89) of the entire instrument was obtained. Five questions were revised until item content (0.83-1.00), scale content (0.92) and face validity (1.00) were appropriate. Lay experts' suggestions for improving the readability and usability were taken into account. CONCLUSIONS: We developed a valid instrument to elicit women's preferred health professional for uncomplicated pregnancy, labour and childbirth and to determine their knowledge about midwives' legal competences. Our instrument can be valuable in identifying knowledge gaps and improving the knowledge of the general population about the midwifery profession and maternity care. Finally, the MidProQ may improve research in the domain of maternity care culture, scale up midwifery and facilitate a more women-centred care.

The experiences of last-year student midwives with High-Fidelity Perinatal Simulation training: A qualitative descriptive study.

BACKGROUND: Simulation training is a powerful and evidence-based teaching method in healthcare. It allows students to develop essential competences that are often difficult to achieve during internships. High-Fidelity Perinatal Simulation exposes them to real-life scenarios in a safe environment. Although student midwives' experiences need to be considered to make the simulation training work, these have been overlooked so far. AIM: To explore the experiences of last-year student midwives with High-Fidelity Perinatal Simulation training. METHODS: A qualitative descriptive study, using three focus group conversations with last-year student midwives (n=24). Audio tapes were transcribed and a thematic content analysis was performed. The entire data set was coded according to recurrent or common themes. To achieve investigator triangulation and confirm themes, discussions among the researchers was incorporated in the analysis. FINDINGS: Students found High-Fidelity Perinatal Simulation training to be a positive learning method that increased both their competence and confidence. Their experiences varied over the different phases of the High-Fidelity Perinatal Simulation training. Although uncertainty, tension, confusion and disappointment were experienced throughout the simulation trajectory, they reported that this did not affect their learning and confidence-building. CONCLUSION: As High-Fidelity Perinatal Simulation training constitutes a helpful learning experience in midwifery education, it could have a positive influence on maternal and neonatal outcomes. In the long term, it could therefore enhance the midwifery profession in several ways. The present study is an important first step in opening up the debate about the pedagogical use of High-Fidelity Perinatal Simulation training within midwifery education.

Inter-professional Perinatal Simulation training: A valuable educational model to improve competencies amongst student midwives in Brussels, Belgium.

Simulation training is a powerful and evidence-based teaching method for students and healthcare professionals. The described educational model of Inter-professional Perinatal Simulation training is the result of a collaborative project with the Erasmus University College Brussels, the Medical School of the Vrije Universiteit Brussel (VUB) and the University Hospital Brussels. This model enhances student midwives to acquire competencies in all fields of midwifery according to national and European legislation and to the International Confederation of Midwives Global Standards for Midwifery Education. In our educational program, simulation training enhanced the achievement of decision-making and inter-professional communication competences.

Compliance of patients wearing an orthotic device or orthopedic shoes: A systematic review.

BACKGROUND: Alongside the positive effects of use of orthotic devices for the lower extremities (ODLE) and orthopedic shoes, complaints and criticism by users possibly lead to non-compliance. OBJECTIVE: The purpose is to determine the compliance of patients wearing an ODLE or orthopedic shoes and to describe the main reasons for using and not using. METHODS: Different online databases were searched for articles about patients' compliance with regard to an ODLE or orthopedic shoes. A methodological quality control was conducted. RESULTS: Ten studies (1576 patients) were included. The data revealed between 6 and 80% not users. Several reasons for not using the orthotic device were described (e.g. pain, discomfort and cosmetically unacceptable). CONCLUSIONS: The high percentage of patients who are not wearing the prescribed orthotic devices leads to a high financial loss for society and a waste of therapeutic effort. These results should be taken into account during the design, construction and selection process of orthotic devices.

A systematic review investigating the relationship between efficacy and stimulation parameters when using transcutaneous electrical nerve stimulation after knee arthroplasty.

OBJECTIVE: To evaluate the clinical efficacy of transcutaneous electric nerve stimulation in the treatment of postoperative knee arthroplasty pain and to relate these results to the stimulation parameters used. DATA SOURCES: PubMed, Pedro and Web of Knowledge were systematically screened for studies investigating effects of transcutaneous electric nerve stimulation on postoperative knee arthroplasty pain. REVIEW METHODS: Studies were screened for their methodological and therapeutical quality. We appraised the influence of the stimulation settings used and indicated whether or not a neurophysiological and/or mechanistic rationale was given for these stimulation settings. RESULTS: A total of 5 articles met the inclusion criteria. In total, 347 patients were investigated. The number of patients who received some form of transcutaneous electric nerve stimulation was 117, and 54 patients received sham transcutaneous electric nerve stimulation. Pain was the primary outcome in all studies. The stimulation settings used in the studies (n = 2) that reported significant effects differed from the others as they implemented a submaximal stimulation intensity. Stimulation parameters were heterogeneous, and only one study provided a rationale for them. CONCLUSION: This review reveals that an effect of transcutaneous electric nerve stimulation might have been missed due to low methodological and therapeutical quality. Justifying the choice of transcutaneous electric nerve stimulation parameters may improve therapeutical quality.