Multi-disciplinary palliative care is effective in people with symptomatic heart failure: A systematic review and narrative synthesis.

BACKGROUND: Despite recommendations, people with heart failure have poor access to palliative care. AIM: To identify the evidence in relation to palliative care for people with symptomatic heart failure. DESIGN: Systematic review and narrative synthesis. (PROSPERO CRD42016029911). DATA SOURCES: Databases (Medline, Cochrane database, CINAHL, PsycINFO, HMIC, CareSearch Grey Literature), reference lists and citations were searched and experts contacted. Two independent reviewers screened titles and abstracts and retrieved papers against inclusion criteria. Data were extracted from included papers and studies were critically assessed using a risk of bias tool according to design. RESULTS: Thirteen interventional and 10 observational studies were included. Studies were heterogeneous in terms of population, intervention, comparator, outcomes and design rendering combination inappropriate. The evaluation phase studies, with lower risk of bias, using a multi-disciplinary specialist palliative care intervention showed statistically significant benefit for patient-reported outcomes (symptom burden, depression, functional status, quality of life), resource use and costs of care. Benefit was not seen in studies with a single component/discipline intervention or with higher risk of bias. Possible contamination in some studies may have caused under-estimation of effect and missing data may have introduced bias. There was no apparent effect on survival. CONCLUSION: Overall, the results support the use of multi-disciplinary palliative care in people with advanced heart failure but trials do not identify who would benefit most from specialist palliative referral. There are no sufficiently robust multi-centre evaluation phase trials to provide generalisable findings. Use of common population, intervention and outcomes in future research would allow meta-analysis.

Reliability of the Fox-walk test in patients with rheumatoid arthritis.

PURPOSE: The Fox-walk test is a new method used to estimate aerobic capacity outside a clinical environment, which may be useful in the implementation of daily health-enhancing physical activity. The aim of our study was to investigate the reliability of the test in people with rheumatoid arthritis (RA). METHOD: Fifteen participants performed the Fox-walk test three times with weekly intervals. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to estimate the reliability. General health perception, lower limb pain and fatigue were measured to determine their potential influence on the reliability. RESULTS: There were no systematic differences between the three test occasions (p = 0.190) and the reliability was almost perfect (ICC = 0.982). None of the covariates influenced the reliability. The SEM was 0.999 ml/kg/min or 3.4% and the SDC was 2.769 ml/kg/min or 9.4%. CONCLUSIONS: These findings demonstrate that the Fox-walk test is reliable in people with RA and enables differentiation between people with RA and monitoring progress. The validity of the test among people with RA is still to be determined. IMPLICATIONS FOR REHABILITATION: • The Fox-walk test is a new method to estimate aerobic capacity and could be performed walking or running. • The test is self administered without expensive equipment and is available in 150 public places in Sweden and several other European countries. • The Fox-walk test is a reliable test for use among people with rheumatoid arthritis monitoring the progress of their physical activity.