Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial.

OBJECTIVE: To compare the effect of specific interventions aimed at (1) the upper thoracic spine (passive mobilization) and (2) the posterior shoulder (massage, passive mobilization, and stretching) to (3) an active control intervention in a homogeneous group with extrinsic subacromial shoulder impingement (SSI). STUDY DESIGN: Single-centre, prospective, double-blinded, randomized controlled trial. METHOD: Eligible individuals with clearly defined extrinsic SSI were randomized to each group. Treatment duration was 12 consecutive weeks consisting of nine treatments over 6 weeks, followed by 6 weeks when one home exercise was performed daily. Outcomes included (1) active thoracic flexion/extension range of motion, (2) passive glenohumeral internal rotation and posterior shoulder range, (3) pain rating, and (4) shoulder pain and function disability index. Data were analysed at baseline, 6 and 12 weeks. Shoulder pain and function disability index scores were investigated via email 6 months after commencement of treatment. RESULTS: Twenty participants completed treatment in each group. No differences were identified between groups at baseline. Upper thoracic and posterior shoulder interventions, with a targeted home exercise, both significantly decreased pain and increased function scores and increased posterior shoulder range compared with active control at 12 weeks, and 6 months following cessation of the trial. CONCLUSION: Manual therapy treatment that addresses these extrinsic factors, of thoracic spine or posterior shoulder tightness, decreases the signs and symptoms of SSI. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; 12615001303538).

Collection of air samples to quantify exposure to airborne allergens.

Under normal conditions, airborne allergens are present at very low concentrations. Allergens may be carried on relatively large identifiable particles such as grains of pollen and mould spores or smaller amorphous particles or both. The methods that have been applied to quantify animal airborne allergens will be described in this chapter. By careful selection of the air sampling equipment and conditions, samples can be collected which quantify, for example, the personal exposure of an individual when performing a specific task or changes in exposure when allergen control methods are implemented. If as with animal allergens, an airborne allergen is not comprised of identifiable microscopic fragments, it is necessary to extract the soluble allergen for quantification in a specific immunoassay. The basic methods used for the elution of animal allergen from polytetrafluoroethylene (PTFE) filters will be described. The optimization of this method to suit different allergens and the influence of the buffer on extraction efficiency and stability of the allergen during storage will also be discussed.

Levels of spirituality and treatment outcome: a preliminary examination.

OBJECTIVE: The primary aim of this study was to examine whether admission differences in levels of spirituality predisposed alcohol-dependent individuals to favorable or unfavorable outcomes following admission to facilities that differed in the degree to which spirituality was emphasized. It was hypothesized that individuals whose admission level of spirituality was congruent with the treatment program's orientation and who as such were considered optimally placed (i.e., "matched") for treatment would evince better in-treatment outcomes. METHOD: Four hundred and five participants completed measures of spirituality and psychosocial well-being at intake and at end of treatment. RESULTS: In examining the entire sample, no matching effects were observed on discharge status, abstinence efficacy, or desire to drink. When analyses were restricted to those cases scoring in the upper or lower quartiles in spirituality, we observed a paradoxical effect, as individuals recording lower levels of spirituality at the less spiritual program evinced significantly poorer outcomes (i.e., less abstinence efficacy, greater desire to drink). CONCLUSIONS: These findings hint at the importance of spirituality in the environment of care, indicating that individuals low in spirituality were at risk for poorer outcomes, but exposure to a program that emphasized spirituality lowered that risk.

Common stressors experienced by the well elderly. Clinical implications.

The purposes of the article are twofold--first, to report on a study that determined the 10 most commonly experienced stressors in individuals 65 years of age and older, and second, to present nursing interventions for each of the top 10 stressors. The research was conducted on a convenience sample of 200 healthy older adults living in the community using the Stokes/Gordon Stress Scale. The two most commonly experienced stressors were slowing down and concern for world conditions. Others among the top 10 were constant or recurring pain or discomfort, time too short with children or grandchildren, and wishing parts of one's life had been different. Interventions discussed included careful planning of each day's activities, joining discussion groups on world events, participating in a political campaign, using e-mail and other technological communication methods, using reminiscence therapy, and implementing the use of various complementary therapies.