Does wearing arthritis gloves help with hand pain and function? A qualitative study into patients' views and experiences.

OBJECTIVE: Arthritis gloves are frequently prescribed to people with undifferentiated inflammatory arthritis (UIA) or RA to help reduce hand pain and improve function. Nested within a randomized controlled trial testing the effectiveness of arthritis gloves (Isotoner gloves vs loose-fitting placebo gloves) in people with RA and UIA, this qualitative study aimed to explore participants' views on the impact of wearing arthritis gloves on their hand pain and function. METHODS: Semi-structured one-to-one interviews were conducted with purposively selected participants following 12 weeks of glove wearing. Participants and the interviewer were blinded to the treatment allocation. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Participants (intervention: n = 10; control: n = 9) recruited from 13 National Health Service hospital sites in the UK participated in the interviews. Two main themes, with sub-themes, were elicited from the data: mechanisms determining glove use: 'As soon as your joints get a bit warmer, the pain actually eases' (thermal qualities; glove use in daily activities; glove use during sleep); and ambivalence about benefits of arthritis gloves: 'I suppose a normal pair of gloves would do the same sort of thing?' (are they a help or hindrance?; aesthetic appeal; future use of gloves). CONCLUSION: Participants had ambivalent views on the impact of both the intervention and the loose-fitting placebo gloves on their hand pain and function, identifying warmth as the main benefit. Ordinary mid-finger-length gloves widely accessible from high street suppliers could deliver warmth and provide the perceived benefits to hand pain and function. Trial registration: ISRCTN, ISRCTN25892131; registered 5 September 2016 : retrospectively registered.

Pressure redistributing static chairs for preventing pressure ulcers.

BACKGROUND: Sitting can be viewed as a therapeutic intervention and an important part of a person's recovery process; but the risk of ulceration must be mitigated. Interventions for ulcer prevention in those at risk from prolonged sitting include the use of specialist cushions and surfaces, especially for wheelchair users. Whilst there is interest in the effects of different pressure redistributing cushions for wheelchairs, the benefits of pressure redistributing static chairs, compared with standard chairs, for pressure ulcer development in at-risk people are not clear. OBJECTIVES: To assess the effects of pressure redistributing static chairs on the prevention of pressure ulcers in health, rehabilitation and social care settings, and places of residence in which people may spend their day. SEARCH METHODS: In June 2021 we searched the following electronic databases to identify reports of relevant randomised clinical trials: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase and EBSCO CINAHL Plus (Cumulative Index to Nursing and Allied Health Literature). We also searched clinical trials registers for ongoing and unpublished studies, and reference lists of relevant systematic reviews, meta-analyses and health technology reports. There were no restrictions by language, date of publication or study setting. SELECTION CRITERIA: We sought to include published or unpublished randomised controlled trials that assessed pressure redistributing static chairs in the prevention or management of pressure ulcers. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection. We planned that two review authors would also assess the risk of bias, extract study data and assess the certainty of evidence according to GRADE methodology. MAIN RESULTS: We did not identify any studies that met the review eligibility criteria, nor any registered studies investigating the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. AUTHORS' CONCLUSIONS: Currently, there is no randomised evidence that supports or refutes the role of pressure redistributing static chairs in the prevention or management of pressure ulcers. This is a priority area and there is a need to explore this intervention with rigorous and robust research.

Evaluating the impact of the Tissue Viability Seating guidelines.

INTRODUCTION: Internationally, guidelines are developed to ensure safe, effective, person centred, timely, efficient, and effective practice. However, their use in clinical practice is found to be variable. The Tissue Viability Society (TVS) published updated seating guidelines in 2017, yet, little is known about how these guidelines are being used. METHODS: The aim of this evaluation was to gauge the impact of the Tissue Viability Seating Guidelines on clinical practice and policy. A cross-sectional questionnaire was used to elicit the responses from anyone with an interest or role within seating and pressure ulcer prevention and management. The survey was distributed through a variety of methods including email to members of the Tissue Viability Society and social media platforms from September to December 2019. RESULTS: and Discussion: There were thirty-nine responses, the bulk of which were from healthcare professionals across primary and secondary care. All but one respondent was from the United Kingdom. Eleven had incorporated the latest TVS seating guidance into policy and sixteen into practice. The results of our survey demonstrates congruence with the literature as the main themes that emerged included incorporating the guidance into everyday clinical practice, education, and training, and as a resource or dissemination tool. Barriers to implementation included being unaware of the guidelines and unaware of one's own professional and collective organisational responsibility to guideline dissemination. However, many respondents were planning to incorporate the guidelines using a variety of methods. CONCLUSION: This survey has shown there are some examples of successful implementation of the TVS Seating guidelines. Future TVS guidelines should include implementation strategies, interventions, and goals for local champions to ensure barriers to implementation are both assessed and addressed. Future work could also include a trial of the guidelines within a pilot project.

Use of night-time positioning equipment in care home residents with postural asymmetry: a pilot study.

BACKGROUND: Twenty four-hour postural care that includes the use of night-time positioning equipment (NTPE) is being increasingly recommended. However, because most of the published studies focus on children, there is a lack of evidence on the use of NTPE in adults. AIM: The aim of this pilot study was to assess the effect of NTPE use in UK care home residents with complex health conditions and postural asymmetry. METHODS: Ten care home residents trialled NTPE over a 12-week period. Qualitative and quantitative data were collected before and after each trial using standardised assessment tools. Semi-structured interviews were conducted with participants and relatives after each trial. Staff's views were elicited via two focus groups at the end of the study. RESULTS: There were notable benefits of NTPE use in terms of participants' pain levels, sleep quality, risk of pressure ulcers, risk of choking, and weight. There was also evidence of improvements in participants' function, ability to undertake activities of daily living and quality of life. However, some equipment was abandoned during the trials because participants found it too hot or restrictive. CONCLUSION: This pilot study increases the evidence base for a personalised approach to 24-hour postural care that can support older people's health and well-being. Further empirical studies are required to determine how NTPE can be used to improve older people's quality of life.

Developing the tissue viability seating guidelines.

BACKGROUND: Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on seating and preventing pressure ulcers. At the request of the UK Tissue Viability Society the aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. METHODS AND FINDINGS: The evidence base informing the guidelines was obtained by applying a triangulation of methods: a literature review, listening event and stakeholder group consultation. The purpose was to engage users and carers, academics, clinicians, inspectorate and charities, with an interest in seating, positioning and pressure management to: gather views, feedback, stories, and evidence of the current practices in the field to create a greater awareness of the issue. CONCLUSION: The new guidelines are inclusive of all people with short and long-term mobility issues to include all population groups. The document includes evidence on where pressure ulcers develop when seated, risk factors, best possible seated position and what seat adjustments are required, the ideal seating assessment, interventions, self-help suggestions and key seating outcomes. The updated TVS CPGs have been informed by the best available evidence, the insights and wisdom of experts, stakeholders and people who spend extended periods of time sitting.

Evaluating the impact of WaterCell® Technology on pressure redistribution and comfort/discomfort of adults with limited mobility.

AIM OF THE STUDY: The aim of the study was to evaluate the effect of WaterCell® Technology on pressure redistribution and self-reported comfort and discomfort scores of adults with mobility problems who remain seated for extended periods of time. METHODS: Twelve participants, were recruited and ranged in gender, age, height, weight, and body mass index. Five were male, seven were female, and five were permanent wheelchair users. Each participant was randomly allocated a chair, whose seat comprised of visco-elastic memory foam, high-elastic reflex foam, and watercells, to trial for a week. Data collected at day one and day seven included: interface pressure measurements taken across the gluteal region (peak and average); physiological observations of respiratory rate, pulse rate, and blood pressure; skin inspection and comfort and discomfort scores. RESULTS: Watercell® technology was found to offer lower average pressures than those reported to cause potential skin injury. Peak pressure index findings were comparative to other studies. No correlation was found between discomfort intensity rating and pressure redistribution. Discomfort intensity rating was low for all participants and general discomfort ranged from very low to medium. Physiological observations decreased for 50% of participants over the seven days. CONCLUSION: From our study we have found that WaterCell® technology offers comparable pressure redistribution for people with a disability who need to sit for prolonged periods of time and the chairs were found to be comfortable.

Multidisciplinary approaches to moving and handling for formal and informal carers in community palliative care.

Health professionals such as nurses, physiotherapists and occupational therapists provide a wealth of support in the community to patients and their carers receiving palliative care. Moving and handling is one such support that needs careful consideration and assessment including risk, by appropriately qualified professionals. A combination of skills are required as well as knowledge of up to date equipment to assist the health professional in deciding how to formulate safe moving and handling interventions in a timely way. Patients with palliative care needs and their carers should be given the appropriate care and support necessary using a holistic, flexible and patient-centred approach to service delivery.

Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis.

UNLABELLED: ♦ INTRODUCTION: Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis in which gastrointestinal (GI) symptoms reduce appetite and dietary intake. Adequate nutrition is important, especially if surgery is required. Although the incidence of EPS is low, the present report is able to detail preoperative nutrition status and treatment in a large cohort of patients from a national EPS referral center. ♦ METHODS: Of 51 patients admitted to this EPS specialist center hospital for their first peritonectomy in the study period, 50 had a preoperative dietetic assessment, and 49 underwent upper-arm anthropometry. ♦ RESULTS: Mean body mass index (BMI) was 20.6 kg/m(2). Mean weight loss was 14% of body weight in the preceding 6 months, with 35 of 50 patients losing more than 10%. On anthropometry, 25 of 49 patients were below the 5th percentile for mid-arm circumference (MAC), 17 of 49 were below for triceps skinfold thickness (TSF), and 21 of 49 were below for mid-arm muscle circumference (MAMC). Mean handgrip strength (HGS) was 60% of normal, with 43 of 49 patients being below 85% of normal. Appetite was poor in 21 of 50 patients, and 37 of 50 had upper and 40 of 50 had lower GI symptoms. By subjective global assessment, 27 of 51 patients were graded as severely malnourished, and 5 of 51, as well-nourished. Mean serum albumin was 28 g/L and did not correlate with BMI, MAC, TSF, MAMC, or HGS. In most patients, C-reactive protein was elevated (mean: 111 mg/L). Preoperative parenteral nutrition was given to 46 of 51 patients for a mean of 21 days. ♦ DISCUSSION: Our findings demonstrate the poor nutrition status of patients admitted for EPS surgical intervention. Anthropometrics reveal depleted fat and lean body mass in EPS patients, which might be a result of anorexia and inflammation, and the reason that albumin was not an accurate marker of nutrition. Poor nutrition status is likely to negatively affect outcome in this patient group. ♦ CONCLUSIONS: Early recognition of GI symptoms may herald a diagnosis of EPS. Optimization of preoperative nutrition status with intensive nutrition support is needed.