[Needs assessment to improve the applicability and methodological quality of a German S3 guideline]. / Bedarfsanalyse zur Verbesserung der Anwendbarkeit und methodischen Qualität einer S3-Leitlinie.

BACKGROUND: Clinical practice guidelines can change the practice in healthcare only if their recommendations are implemented in a comprehensive way. The German S3 guideline "Local Therapy of Chronic Wounds in Patients with Peripheral Vascular Disease, Chronic Venous Insufficiency, and Diabetes" will be updated in 2017. The emphasis here is on the guideline's validity, user-friendliness and implementation into practice. Therefore, the aim was to identify the improvements required in regard to the guideline's methods and content presentation. METHODS: The methodological approach used was the critical appraisal of the guideline according to established quality criteria and an additional stakeholder survey. Both were conducted between August and November 2016. The guideline and its related documents were reviewed independently by two researchers according to the criteria of the "Appraisal of Guidelines for Research and Evaluation" (AGREE-II). Published reviews and peer reviews by external experts and organisations were also taken into account. For the stakeholder survey, a questionnaire with open questions was distributed by e-mail and via the Internet to health professionals and organisations involved in the care of patients with leg ulcers in Germany. The questions were aimed at amendments and new topics based on the stakeholders' experience in inpatient and outpatient care. In addition, the survey focused on gathering suggestions to improve the applicability of the guideline. Suggested new topics and amendments were summarised thematically. The stakeholders' suggestions to improve the applicability, the results of the critical appraisal and the relevant aspects of the external reviews were then summarised according to the AGREE-II domains and presented in a cause and effect diagram. RESULTS: 17 questionnaires (out of 864 sent out by e-mail) were returned. Due to high practice relevance, the stakeholders suggested an expansion of the inclusion criteria to patients with infected wounds and pressure ulcers. They also proposed that plastic surgical procedures, several specific wound products and complementary measures should be included. The guideline is of high methodical quality with respect to the systematic synthesis and the formal expert recommendations. From both the stakeholders' and reviewers' perspectives, the guideline should be more in line with what guideline users regarded as key issues. The recommendations should be more action-oriented. Implementation concepts should be provided to teach, implement and evaluate the guideline in healthcare facilities. The updating process should also follow current standards for guideline development, for systematic reviews and for managing conflict of interests. CONCLUSION: The guideline is of high methodological quality but currently difficult to implement in clinical practice. The structured evaluation clearly reflects not only the potential for improvement but also provides a transparent theoretical framework for experts and scientific medical societies involved in the guideline updating process. Although some valuable insights were gained from the stakeholders' perspective, the representativeness is limited by the low response rate.

Uso da Técnica de Energia Muscular em mulheres com cervicalgia / Use of the Muscle Energy Technique in women with neck pain

A Técnica de Energia Muscular (TEM) utiliza contrações isométricase a articulação tratada é mobilizada até a barreira motora nostrês planos do espaço sendo definida como uma forma de tratamentomanipulativo osteopático. O objetivo do trabalho foi elaborar umaproposta de intervenção terapêutica para mulheres que sofrem dedor e desconforto com indicativo para cervicalgia. Foram tratadas22 mulheres com 37,18 (± 13,23) anos, que apresentavam dor edesconforto na região cervical. Utilizou-se três avaliações: Questionáriode Dor e Desconforto, Escala Visual Analógica da Dor (EVA) eQuestionário WHOQOL BREF. Todas as mulheres foram avaliadaspré e pós-tratamento e foram realizadas 10 intervenções da referidatécnica 2 a 3 vezes por semana com duração de 15 minutos, 3 repetiçõespara cada músculo com 7 segundos de duração. Os resultadosdemonstraram pelo coeficiente de variação 92,80% de melhora dador, 52,60% no desconforto e 72,73% pela EVA. No questionáriohouve, no domínio físico, ganho de 200%, no psicológico 39,06%,relações sociais 100%, qualidade de vida 1,29% e no meio ambientenão houve ganho. Conclui-se que a técnica proposta apresentoumelhora nos sintomas de dor e desconforto...

The Muscle Energy Technique (MET) uses isometric contractionsand the treated joint is mobilized up to the motor barrier inthe three planes of space, defined as a form of osteopathic manipulativetreatment. The aim of this study was to develop a proposalfor therapeutic intervention for women who suffer from pain anddiscomfort indicating cervicalgia. 22 women 37.18 (± 13.23) yearsold with neck pain and discomfort were treated, using 3 differentevaluations: Pain and Discomfort Questionnaire, Pain Visual AnalogScale (VAS) and WHOQOL BREF Questionnaire. These womenwere evaluated before and after the treatment. 10 interventions of15 minutes using this technique were performed, 2 to 3 times perweek, with 3 repetitions of 7 seconds for each muscle. The resultsshowed the coefficient of variation of 92.80% for reducing of pain,52.60% for discomfort and 72.73% with the VAS. In relation tothe questionnaires was observed a gain of 200% in the physicaldomain, 39.06% in the psychological domain, 100% in the socialrelationships, 1.29% in the quality of life and no gain in environment.It was concluded that this technique improves the symptomsof pain and discomfort...