Is what Filipino children eat between meals associated with body mass index?

The study aimed to assess the association between childhood obesity and snacking. A total of 396 students in grades 4 to 6 enrolled in an elementary school in the Philippines were the participants in this study. Demographic profile; anthropometric measures of height, weight, body mass index; and information about snacking were gathered. Obese group had statistically more servings of sweetened drinks and low-quality snacks. Female obese subjects have statistically more servings at nighttime and greater total snack servings. For the whole cohort, the odds ratio of being overweight with high total snack servings was 2.12 (95% confidence interval = 1.25-3.62) whereas the odds ratio of being obese with calories obtained from snacking was 2.08 (95% confidence interval = 1.01-4.26). Nighttime snacks and bad-quality foods should be minimized. Moreover, reducing food portions at any snack time will protect children from being overweight.

Management of LBP at primary care level in South Africa: up to standards?

BACKGROUND: Primary Health Care (PHC) is well suited for management of low back pain (LBP). Prevalence of (chronic) LBP is suspected to be high among visitors of the South African primary care centers, but currently no information exists on prevalence or guideline adherence. OBJECTIVES: To establish if treatment received for LBP in public PHC in the Cape Town area compares with international evidence based guidelines. METHODS: Cluster randomization determined the 8 community health centres where the study took place. A measurement tool was developed and validated for this population. Descriptive analysis and logistic regression analytical techniques were applied. RESULTS: 489 participants (mean age: 44.8) were included in this study. Lifetime prevalence was 73.2% and 26.3% suffered from chronic low back pain (CLBP) . Pain medication was the only form of treatment received by 90% of the sample. Interventions received seemed to be unrelated to type of LBP (acute, sub acute and chronic). Referral to physiotherapy, education and advice to stay active were rarely done. Participants expressed low satisfaction with treatment. CONCLUSIONS: Current management of LBP at PHC level appears to be ineffective and not conform guidelines. Further South African research should focus on barriers as well as measures to be taken for implementation of LBP guidelines.

Effectiveness of the tailored Evidence Based Practice training program for Filipino physical therapists: a randomized controlled trial.

BACKGROUND: This study evaluated the effectiveness of the contextualized EBP training program for Filipino physical therapists in terms of knowledge, skills, attitudes and behavior. METHODS: A randomized controlled trial was designed to assess the effectiveness of the EBP training program. Fifty four physical therapists were randomly allocated to the EBP group (intervention) and waitlist (control) group. The EBP group had a one day face-to-face training with an online support, whilst the control was waitlisted. There were three measurement points which were pre, post, and three months post intervention for knowledge, skills and attitudes. Activity diaries were used to measure behavior. The diaries were collected after three months. Data analysis was by intention to treat in EBP domains of knowledge, skills and attitudes. RESULTS: Fifty-four physical therapists were included in the study. Fifty two (52) completed the post training assessment and 26 completed the 3 months post training assessment for EBP knowledge, skills and attitudes. There were significant improvements in these domains in the EBP group from pre to post training and over a period of three months (p < 0.05) compared with the waitlist control group. Thirty seven (37) physical therapists completed their activity diaries over three months. Behavior significantly improved in the EBP group in terms of EBP behaviors (formulating PICO, searching, appraising and applying the evidence) when faced with both new/unique and usual case scenarios (p < 0.05). More physical therapists in the waitlist control group significantly performed non-EBP behaviors (asking doctors and reading textbooks) when faced with new/unique cases compared with the EBP group (p < 0.05). No differences were noted between groups regarding non-EBP behaviors (asking colleagues and doctors and reading textbooks) particularly when faced with usual cases. CONCLUSION: The contextually designed EBP training program for Filipino physical therapists was effective in improving knowledge, skills and attitudes to EBP from pre to post training. Improvements were also observed at three months post training in knowledge, skills, attitudes and behavior to EBP. This model of training can be modified as needed based on the needs of the local context. Findings need to be interpreted with caution due to study limitations. CURRENT CONTROLLED TRIALS: ISRCTN74485061 (Registration date: February 9, 2011).

The anthropometric match between high school learners of the Cape Metropole area, Western Cape, South Africa and their computer workstation at school.

STUDY DESIGN: Descriptive study. OBJECTIVE: The objective of this study was to present anthropometric data from high school students in Cape Metropole area, Western Cape, South Africa that are relevant for chair design and whether the dimensions of computer laboratory chairs currently used in high schools match linear anthropometrics of high-school students. Summary of Background Data. Learner-chair mismatch is proposed as a cause of poor postural alignment and spinal pain in adolescents. A learner-chair mismatch is defined as the incompatibility between the dimensions of a chair and the anthropometric dimensions of the learner. Currently, there is no published research to ascertain whether the furniture dimensions in school computer laboratories match the anthropometrics of the students. This may contribute to the high prevalence of adolescent spinal pain. METHODS: The sample consisted of 689 learners, 13-18 years old. The following body dimensions were measured: stature, popliteal height, buttock-to-popliteal length and hip width. These measurements were matched with the corresponding chair seat dimensions: height, depth and width. Popliteal and seat height mismatch was defined when the seat height is either >95% or <88% of the popliteal height. Buttock-popliteal length and seat depth mismatch was defined when the seat depth is either >95% or <80% of the buttock-popliteal length. Seat width mismatch is defined where the seat width should be at least 10% and at the most 30% larger than hip width. RESULTS: An 89% of learners did not match the seat. Five percent of learners matched the chair depth, the majority was found to be too big. In contrast, 65% of the learners matched the chair width dimension. CONCLUSIONS: A substantial mismatch was found. The school chairs failed standard ergonomics recommendations for the design of furniture to fit the user. This study supports the conclusion that there is no one-size-fits-all solution. There is an urgent need for chairs that are of different sizes or that are adjustable.

Which chronic obstructive pulmonary disease care recommendations have low implementation and why? A pilot study.

BACKGROUND: Clinical care components for people with COPD are recommended in guidelines if high-level evidence exists. However, there are gaps in their implementation, and factors which act as barriers or facilitators to their uptake are not well described. The aim of this pilot study was to explore implementation of key high-evidence COPD guideline recommendations in patients admitted to hospital with a disease exacerbation, to inform the development of a larger observational study. METHODS: This study recruited consecutive COPD patients admitted to a tertiary hospital. Patient demographic, disease and admission characteristics were recorded. Information about implementation of target guideline recommendations (smoking cessation, pulmonary rehabilitation referral, influenza vaccination, medication use and long-term oxygen use if hypoxaemic) was gained from medical records and patient interviews. Interviews with hospital-based doctors examined their perspectives on recommendation implementation. RESULTS: Fifteen patients (aged 76(9) years, FEV1%pred 58(15), mean(SD)) and nine doctors participated. Referral to pulmonary rehabilitation (5/15 patients) was underutilised by comparison with other high-evidence recommendations. Low awareness of pulmonary rehabilitation was a key barrier for patients and doctors. Other barriers for patients were access difficulties, low perceived health benefits, and co-morbidities. Doctors reported they tended to refer patients with severe disease and frequent hospital attendance, a finding supported by the quantitative data. CONCLUSIONS: This study provides justification for a larger observational study to test the hypothesis that pulmonary rehabilitation referral is low in suitable COPD patients, and closer investigation of the reasons for this evidence-practice gap.

Cross-cultural adaptation and validation of the South African Pain Catastrophizing Scale (SA-PCS) among patients with fibromyalgia.

BACKGROUND: Pain catastrophization has recently been recognized as a barrier to the healthy development of physical functioning among chronic pain patients. Levels of pain catastrophization in chronic pain patients are commonly measured using the Pain Catastrophizing Scale (PCS). OBJECTIVE: To cross-culturally adapt and validate the South African PCS (SA-PCS) among English-, Afrikaans- and Xhosa-speaking patients with fibromyalgia living in the Cape Metropole area, Western Cape, South Africa. METHODS: The original PCS was cross-culturally adapted in accordance with international standards to develop an English, Afrikaans and Xhosa version of the SA-PCS using a repeated measures study design. Psychometric testing included face/content validity, internal consistency (Cronbach's alpha-α), test-retest reliability (intraclass coefficient correlations-ICC), sensitivity-to-change and cross-sectional convergent validity (by comparing the adapted SA-PCS to related constructs). RESULTS: The cross-culturally adapted English, Afrikaans and Xhosa SA-PCS showed good face and content validity, excellent internal consistency (with Chronbach's α = 0.98, 0.98 and 0.97 for the English, Afrikaans and Xhosa SA-PCS, as a whole, respectively), excellent test-retest reliability (with ICC's of 0.90, 0.91 and 0.89 for the English, Afrikaans and Xhosa SA-PCS, respectively); as well as satisfactory sensitivity-to-change (with a minimum detectable change of 8.8, 9.0 and 9.3 for the English, Afrikaans and Xhosa SA-PCS, respectively) and cross-sectional convergent validity (when compared to pain severity as well as South African versions of the Tampa scale for Kinesiophobia and the revised Fibromyalgia Impact Questionnaire). CONCLUSION: The SA-PCS can therefore be recommended as simple, efficient, valid and reliable tool which shows satisfactory sensitivity-to-change and cross-sectional convergent validity, for use among English, Afrikaans and Xhosa-speaking patients with fibromyalgia attending the public health sector in the Western Cape area of South Africa.

Current evidence on evidence-based practice training in allied health: a systematic review of the literature.

INTRODUCTION: It is essential that allied health practice decisions are underpinned by the best available evidence. Therefore, effective training needs to be provided for allied health professionals to do this. However, little is known about how evidence-based practice training programs for allied health professionals are delivered, the elements contained within them, how learning outcomes are measured or the effectiveness of training components in improving learning outcomes. METHODS: We conducted a systematic literature review to identify effectiveness of evidence-based practice training programs and their components for allied health professionals. Key words of evidence-based practice programs OR journal clubs OR critical appraisal AND allied health OR physiotherapists OR occupational therapists OR speech pathologists AND knowledge OR skills OR attitudes OR behaviour were applied to all available databases. Papers were critically appraised using the Joanna Briggs Institute and McMaster tools and the checklist of recommendations for educational interventions. Data were extracted on participants, training program components and underpinning theories, methods of delivery and learning outcomes. Data were synthesised using a combination of narrative and realist synthesis approaches. RESULTS: Six relevant studies (four randomised controlled trials and two before-and-after studies) reported on the effectiveness of evidence-based practice training programs for evidence-based practice for groups of health professionals. Specifically, only three of these studies (one randomised controlled trial and two before-and-after studies) reported on allied health professionals (physiotherapists, occupational therapists and social workers). Among these three studies on allied health, outcomes were variably measured, largely reporting on knowledge, skills, attitudes and/or behaviours. Significant changes in knowledge and skills were reported in all studies. Only the social work study, which reassessed outcomes after 3 months, reported significant changes in attitudes and behaviours. Training took from 3 hours to 2 days. While there was information on training program components, there was no evidence of effectiveness related to learning outcomes. CONCLUSION: Overall, there is limited research regarding training of allied health professionals in evidence-based practice and learning outcomes. From the limited evidence base, there was consistent evidence that any training significantly influenced knowledge, skills and attitudes, irrespective of the allied health discipline. There was little information, however, regarding how to change or measure behaviours. This review cannot recommend components of training for allied health professionals in evidence-based practice, which significantly improve learning outcomes.

Does journal club membership improve research evidence uptake in different allied health disciplines: a pre-post study.

BACKGROUND: Although allied health is considered to be one 'unit' of healthcare providers, it comprises a range of disciplines which have different training and ways of thinking, and different tasks and methods of patient care. Very few empirical studies on evidence-based practice (EBP) have directly compared allied health professionals. The objective of this study was to examine the impact of a structured model of journal club (JC), known as iCAHE (International Centre for Allied Health Evidence) JC, on the EBP knowledge, skills and behaviour of the different allied health disciplines. METHODS: A pilot, pre-post study design using maximum variation sampling was undertaken. Recruitment was conducted in groups and practitioners such as physiotherapists, occupational therapists, speech pathologists, social workers, psychologists, nutritionists/dieticians and podiatrists were invited to participate. All participating groups received the iCAHE JC for six months. Quantitative data using the Adapted Fresno Test (McCluskey & Bishop) and Evidence-based Practice Questionnaire (Upton & Upton) were collected prior to the implementation of the JC, with follow-up measurements six months later. Mean percentage change and confidence intervals were calculated to compare baseline and post JC scores for all outcome measures. RESULTS: The results of this study demonstrate variability in EBP outcomes across disciplines after receiving the iCAHE JC. Only physiotherapists showed statistically significant improvements in all outcomes; speech pathologists and occupational therapists demonstrated a statistically significant increase in knowledge but not for attitude and evidence uptake; social workers and dieticians/nutritionists showed statistically significant positive changes in their knowledge, and evidence uptake but not for attitude. CONCLUSIONS: There is evidence to suggest that a JC such as the iCAHE model is an effective method for improving the EBP knowledge and skills of allied health practitioners. It may be used as a single intervention to facilitate evidence uptake in some allied health disciplines but may need to be integrated with other strategies to influence practice behaviour in other practitioners. An in-depth analysis of other factors (e.g. individual, contextual, organisational), or the relative contribution of these variables is required to better understand the determinants of evidence uptake in allied health.

Number and frequency of physiotherapy services for motor vehicle-induced whiplash: interrogating motor accident insurance data 2006-2009.

OBJECTIVE: Whilst prognostic factors for recovery from whiplash associated disorders have been documented, factors related to high physiotherapy use are not well recognized. This study profiles predictors for high use of physiotherapy services from a large dataset from an Australian state insurer for motor vehicle accidents. METHOD: A dataset of Motor Accident Commission claims in South Australia for whiplash associated disorders (2006-2009) was interrogated. RESULTS: The median number of physiotherapy services per claimant was 15 (range: 1-194). The typical high user of physiotherapy was female, aged 25-59 years, living in a high socio-economic area, with legal representation, who delayed obtaining physiotherapy for at least 28 days after the accident. The largest mean number of days between treatments (5.4 days) in the first 5 treatments related to the lowest subsequent use of physiotherapy services. CONCLUSION: This represents the first review of physio-therapy service use based on an insurance dataset. A range of factors were related to high use of physiotherapy services. It is hoped that identifying the mean number and spread of physiotherapy interventions for whiplash associated disorders, and the profile of high users of physiotherapy will help gauge the success of strategies to maximize the efficacy of physiotherapy management of whiplash associated disorders.

The role of extended scope physiotherapists in managing patients with inflammatory arthropathies: a systematic review.

OBJECTIVES: To review the literature to identify whether, and how, physiotherapists working in extended scope of practice (ESP) engage with patients with inflammatory arthropathies. Measures of effectiveness of ESP were particularly sought. METHODS: A comprehensive library database search was conducted to identify English language studies published in full text in peer-reviewed journals during the years 2002-2012. Studies were allocated into the National Health and Medical Research Council hierarchy of evidence, but were not critically appraised. Data was extracted on conditions treated, ESP roles and responsibilities, and effectiveness. Data was analyzed and reported descriptively. RESULTS: We identified 123 studies, and included four. All were low hierarchy (highest being one level III_2 study). Commonly reported conditions were rheumatoid arthritis and ankylosing spondylitis. Information was provided on activities of role extension, such as triaging patients, monitoring and recommending changes to medications, referring to other health and medical professionals, and ordering and interpreting imaging. There was blurring between ESP and non-ESP roles. No study reported measures of effectiveness. CONCLUSION: There are descriptors of ESP physiotherapy activities, but no evidence of effectiveness of ESP physiotherapy in managing patients with inflammatory arthropathies.