The ability of physiotherapists to identify psychosocial factors in patients with musculoskeletal pain: A scoping review.

BACKGROUND: It is not known how well physiotherapists identify psychosocial factors in people with musculoskeletal pain, when using clinical judgement. The purpose of this scoping review was to examine the research related to physiotherapist ability in identifying psychosocial factors and to subsequently identify gaps in the literature to help direct future research. DATA SOURCES: Searches using relevant key words, were conducted of Medline, Cinahl, the Cochrane Library, PEDro, PubMed, Scopus and Google Scholar. All primary quantitative and qualitative research from the year 2000 onwards, which met the search criteria, were included. DATA EXTRACTION AND SYNTHESIS: A data extraction tool was used to tabulate data regarding demographics, study design and key findings of the included papers. The Mixed Methods Appraisals Tool (MMAT) was utilised to help examine the quality of included studies. RESULTS: Overall, the quality of the included studies was moderate. The total number of studies which met the inclusion criteria was relatively small (n = 20). The most common method for determining ability was comparison of physiotherapist estimations with validated screening tools or questionnaires. Physiotherapist estimates of psychosocial factors were poor and in the qualitative research, the lack of clinician confidence in psychosocial assessment was evident. CONCLUSION: The available research suggests that physiotherapists lack confidence and ability in identifying psychosocial factors. More rigorous, mixed-methods research is warranted to capture the complexity of the research question.

Improving the quality of rehabilitation following anterior cruciate ligament reconstruction surgery, in an outpatient physiotherapy department.

Anterior cruciate ligament reconstruction (ACLR) is a type of orthopaedic knee surgery and physiotherapy rehabilitation is undertaken for several months postoperatively, often with the aim of returning the patient to sport. Variations in postoperative protocols to guide rehabilitation exist between National Health Service (NHS) Trusts. Although there is no single guideline to guide clinicians, strong evidence does support several clinical measures to be included post-ACLR, to improve outcomes and reduce the need for revision surgery. This project aimed to align our NHS Trust's ACLR physiotherapy care with best-evidence.A literature review was completed to establish key quality standards for ACLR rehabilitation. A retrospective notes audit was then undertaken to quantify the baseline quality of care, measured against these standards. Quality improvement methods were used to improve the quality of care and postoperative rehabilitation processes for ACLR patients. A new evidence-based, postoperative rehabilitation protocol was created, a core group of clinicians was formed to see ACLR patients and a rehabilitation class, solely for ACLR patients was also implemented.The key process measure for the project was patients engaging in 'criteria-driven progressions of rehabilitation'. This 'criteria-driven progressions' rate increased from 0% at baseline to 100% during the project period. Overall, non-attendance rates maintained at a similar level from 5.4% at baseline to a final rate of 4.8%. There was also an increase in mean 'return to sport' times, from 6 to 9.9 months, which is in line with best-evidence recommendations.The previous rehabilitation provided in our trust was not aligned with current evidence. This quality improvement project has led to improvements in patient care and lessons from the project will allow other trusts to learn from the changes made, to improve their own care pathways.

Non-Linear Regression Applied to the Sorption of Bisphenol A on Multi-Walled Carbon Nanotubes in Aqueous Systems.

In the present study, equilibrium parameters of adsorption of bisphenol A (BPA) on multi-walled carbon nanotubes were determined using non-linear Langmuir and Freundlich sorption models and regression methods were applied. In the calculations, some error functions were applied in the non-linear regression analysis, the best fit between the data being obtained, for a minimum error distribution. Non-linear regression analysis and the error distribution suggested Langmuir isotherm model the best one for estimation of equilibrium parameters. The results will be further used in environmental applications for BPA removal from natural waters, taking into account the spontaneous character of the adsorption process, the endocrine disrupting effect of BPA and the reduced toxicological effects of the impregnated sorbents.

Nursing's role in nutrition.

There are not enough dietitians and nutritionists available to serve the entire healthcare industry. That means that nurses often fill the role of nutrition counselors. Nurses do not receive extensive education about nutrition, but there are great opportunities for nurses in nutrition, both as educators and researchers. One way this can happen is through the use of nutrition assessment tools. This article introduces a freeware nutritional assessment tool for use on Windows-based computers (available at http://nursing.jmu.edu). Unlike currently available tools, the Nutrition Analyzer is a stand-alone, Web-independent product, which builds a database of client data that can be manipulated for analysis and research.

The controversy over sodium modeling: should we use it or not?

Studies presented both for sodium modeling and against modeling have similar results but different conclusions. What is the best solution when confronted with conflicting interpretations of similar data and how can this data support our evidence-based practice? The conclusion is that the nephrology nurse who is the vital link between the provider and patient needs to take an active role in helping to determine the best sodium prescription for each patient.