Interpreting Meaningful Change in the Distance Walked in the 10-Metre ISWT in Cardiac Rehabilitation.

BACKGROUND: The interpretability of change in exercise test scores is an important measurement property. This study aimed to provide a framework for the interpretation of individual change scores of the 10metre incremental shuttle walk test (ISWT) in cardiac rehabilitation. METHODS: In a quantitative pre-post design study, 52 patients who were referred to a hospital outpatient department for cardiac rehabilitation participated in this study. Participants completed two ISWTs prior to cardiac rehabilitation. Post cardiac rehabilitation, participants completed a global rating of change score and two ISWTs. Change scores were analysed for smallest detectable change (SDC) and minimum important change (MIC). RESULTS: The SDC for an individual was 47 metres. The predicted MIC for participants to report an improvement ranged from 70 to 92 metres. The predicted MIC for participants who did not report a deterioration in the global rating of change (i.e., those who reported unchanged or improved) ranged from 16 to 42 metres. CONCLUSIONS: The MIC for patients who report any improvement in physical fitness and functional capacity is 70 metres. These results suggest that over an 8-week program, patients would need to improve by at least seven shuttles to perceive an improvement in their physical fitness and functional capacity. Patients with small increases in the 10-metre ISWT distance may still report deterioration in their physical fitness and functional capacity.

Is the 10 m incremental shuttle walk test a useful test of exercise capacity for patients referred to cardiac rehabilitation?

BACKGROUND: Field exercise tests are a feasible alternative to the symptom-limited exercise test for measuring exercise capacity in patients attending cardiac rehabilitation. AIMS: To evaluate the criterion validity of the 10 m incremental shuttle walk test (ISWT) as a useful tool for measurement of exercise capacity for patients eligible for cardiac rehabilitation. METHODS: Fifteen patients eligible for cardiac rehabilitation completed a treadmill symptom-limited exercise test and two ISWTs with the order of testing randomised. Associations between the symptom-limited exercise test and the ISWT were explored and the ability of the ISWT to predict symptom-limited exercise test duration estimated. RESULTS: There was a moderate to high association ( r2 ⩾0.72) between ISWT duration and distance, and symptom-limited exercise test duration; and a moderate association between ISWT peak heart rate and end of test oxygen saturation and these outcomes on the symptom-limited exercise test (0.47⩽ r2 ⩽0.67). However, prediction of symptom-limited exercise test duration based on the ISWT produced wide 95% confidence intervals, for example, ranging from 9.1 to 16.3 minutes for an individual who completes the ISWT. Order of testing did not affect the results and the association between the ISWT and symptom-limited exercise test was similar for both the first (ISWT 1) and second test (ISWT 2) ISWT. CONCLUSIONS: The results provide support for the ISWT as a convenient field test of exercise capacity in a cardiac rehabilitation population, but not as a surrogate to predict symptom-limited exercise test duration for individuals. A single ISWT may provide as good an estimate of exercise capacity as repeating the test.

Strategic Moments: IDENTIFYING OPPORTUNITIES TO ENGAGE CLIENTS IN ATTENDING CARDIAC REHABILITATION AND MAINTAINING LIFESTYLE CHANGES.

PURPOSE: There has been extensive investigation of attendance rates at cardiac rehabilitation (CR) but little attention to client reasoning around attendance. This study explored decision-making drivers for attendance or nonattendance at CR programs in rural Victoria, Australia. METHODS: All new patients referred to the CR programs at either the local hospital or community health service over a 6-month period were invited to participate and were interviewed before, after, and at 6 months post-CR. Content analysis was used to identify and group common themes that emerged from the semistructured interviews. RESULTS: Eighty-four of the 114 patients referred agreed to participate in the study. Multiple barriers or facilitators affected the decisions of all clients. Three themes were identified that reflected the participant decision-making experience: (1) invitation and information about participation in CR; (2) person-centered approach to CR provision; and (3) ongoing support needs. Significant decision-making points identified were after the cardiac event; before and after hospital-based CR; before and after community-based CR; and at 6 months after the cardiac event. At any time there is a risk that the client can become lost or disengaged in the service system, but providing contact at these points can allow them to reengage. CONCLUSIONS: This study provided the opportunity to hear participant voices, describing their decisions around CR attendance after a cardiac event. They highlighted the complexity of issues confronting them and suggested improvements to optimize their attendance and to maintain lifestyle changes.

The 10m incremental shuttle walk test is a highly reliable field exercise test for patients referred to cardiac rehabilitation: a retest reliability study.

OBJECTIVES: To determine the retest reliability of the 10m incremental shuttle walk test (ISWT) in a mixed cardiac rehabilitation population. DESIGN: Participants completed two 10m ISWTs in a single session in a repeated measures study. Ten participants completed a third 10m ISWT as part of a pilot study. SETTING: Hospital physiotherapy department. PARTICIPANTS: 62 adults aged a mean of 68 years (SD 10) referred to a cardiac rehabilitation program. MAIN OUTCOME MEASURES: Retest reliability of the 10m ISWT expressed as relative reliability and measurement error. Relative reliability was expressed in a ratio in the form of an intraclass correlation coefficient (ICC) and measurement error in the form of the standard error of measurement (SEM) and 95% confidence intervals for the group and individual. RESULTS: There was a high level of relative reliability over the two walks with an ICC of .99. The SEMagreement was 17m, and a change of at least 23m for the group and 54m for the individual would be required to be 95% confident of exceeding measurement error. CONCLUSIONS: The 10m ISWT demonstrated good retest reliability and is sufficiently reliable to be applied in practice in this population without the use of a practice test.

Randomized controlled trial of the effect of additional functional exercise during slow-stream rehabilitation in a regional center.

OBJECTIVE: To evaluate whether adding functional exercise training to standard physiotherapy during residential slow-stream rehabilitation (SSR) improves discharge outcomes and functional ability. DESIGN: Randomized controlled trial. SETTING: A regional hospital. PARTICIPANTS: Older people (N=60) admitted to SSR. INTERVENTION: All participants received standard physiotherapy. An individualized functional incidental training (FIT) program was implemented for intervention participants consisting of 4 extra episodes of functional exercise daily for the period of SSR. Research assistants visited twice weekly to practice and progress FIT programs. MAIN OUTCOME MEASURES: Outcome measures included discharge destination, participant-expected discharge destination, and functional tests of the Berg Balance Scale (BBS), de Morton Mobility Index (DEMMI), and 5 times sit-to-stand test (FTSTS) at admission and discharge. RESULTS: Fifty-two participants completed the study. At baseline, the SSR group achieved higher scores on the BBS, DEMMI, and FTSTS. There was no significant difference in discharge destination between groups (P=.305). The difference in functional change between groups from admission to discharge on the BBS, DEMMI, and FTSTS was not significant. Participant-expected discharge destination was significantly associated with eventual discharge destination (χ1(2)=8.40, P=.004). CONCLUSIONS: Adding FIT to standard physiotherapy did not improve discharge outcomes and did not have a statistically significant effect on function, but may have a small effect on balance. Patient expected and actual discharge destinations were associated.

A common Asn680Ser polymorphism in the follicle-stimulating hormone receptor gene is not associated with ovarian response to gonadotropin stimulation in patients undergoing in vitro fertilization.

OBJECTIVE: To assess the role of the variant p.Asn680Ser in the follicle-stimulating hormone receptor (FSHR) gene in determining ovarian response in patients undergoing in vitro fertilization (IVF) treatment. DESIGN: Prospective observational study. SETTING: Tertiary referral center for reproductive medicine. PATIENT(S): Women (n = 421) undergoing their first cycle of controlled ovarian stimulation for IVF and 83 healthy, ethnically matched controls. INTERVENTION(S): Baseline pelvic ultrasound and blood tests taken on days 2 to 3 of the cycle for assessment of baseline hormones and for DNA extraction. MAIN OUTCOME MEASURE(S): Genotypes for FSHR p.Asn680Ser determined using TaqMan allelic discrimination assay, and ovarian response to gonadotropin treatment classified as normal, poor, or overresponse based on the number of oocytes retrieved. RESULT(S): The FSHR p.Asn680Ser genotype frequencies were similar in IVF patients and controls. The number of oocytes retrieved was comparable between patients with different FSHR receptor genotypes. The total amount of gonadotropin used was also similar in all the genotype groups. A logistic regression analysis showed nonstatistically significant twofold difference in the distribution of genotypes between the groups with poor and normal ovarian response. CONCLUSION(S): The variant FSHR p.Asn680Ser was not shown to be predictive of ovarian response, but clinically relevant differences cannot be ruled out.

Does exercise reduce pain and improve physical function before hip or knee replacement surgery? A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To investigate the preoperative effects of exercise-based interventions on pain and physical function for people awaiting joint replacement surgery of the hip or knee. DATA SOURCES: Four computer databases (CINAHL, MEDLINE, Embase, and Cochrane Library) were searched until July 4, 2012. Search terms included knee, hip, joint replacement, arthroplasty, physiotherapy, physical therapy, exercise, hydrotherapy, rehabilitation, and preoperative. Reference lists of retrieved articles were also screened. STUDY SELECTION: Randomized or quasi-randomized studies comparing an exercise-based intervention with a no-intervention group for people awaiting hip or knee joint replacement surgery were included. Outcomes were pain and physical function including self-reported function, walking speed, and muscle strength. One of 2 reviewers determined that 18 studies met the inclusion criteria. DATA EXTRACTION: The methodologic quality of each study was independently assessed by 2 reviewers using the PEDro scale, and a final PEDro score was determined by discussion and consensus between the reviewers. Participants' characteristics, content and design of the interventions, and data for quantitative synthesis were extracted by 1 reviewer. DATA SYNTHESIS: For participants awaiting knee replacement surgery, quantitative data synthesis found no significant differences between the exercise and no-intervention groups for pain, self-reported function, walking speed, or muscle strength. For participants awaiting hip replacement surgery, quantitative data synthesis found a significant difference between the groups, with standardized mean differences (SMDs) indicating a medium-sized effect in favor of intervention for both pain (SMD=.45; 95% confidence interval .15-.75) and self-reported function (SMD=.46; 95% confidence interval .20-.72). CONCLUSIONS: Exercise-based interventions can reduce pain and improve physical function for people awaiting hip replacement surgery but not knee replacement surgery.

Assessing individual breast cancer risk within the U.K. National Health Service Breast Screening Program: a new paradigm for cancer prevention.

The aim of this study is to determine breast cancer risk at mammographic screening episodes and integrate standard risk factors with mammographic density and genetic data to assess changing the screening interval based on risk and offer women at high risk preventive strategies. We report our experience of assessing breast cancer risk within the U.K. National Health Service Breast Screening Program using results from the first 10,000 women entered into the "Predicting Risk Of breast Cancer At Screening" study. Of the first 28,849 women attending for screening at fifteen sites in Manchester 10,000 (35%) consented to study entry and completed the questionnaire. The median 10-year Tyrer-Cuzick breast cancer risk was 2.65% (interquartile range, 2.10-3.45). A total of 107 women (1.07%) had 10-year risks 8% or higher (high breast cancer risk), with a further 8.20% having moderately increased risk (5%-8%). Mammographic density (percent dense area) was 60% or more in 8.3% of women. We collected saliva samples from 478 women for genetic analysis and will extend this to 18% of participants. At time of consent to the study, 95.0% of women indicated they wished to know their risk. Women with a 10-year risk of 8% or more or 5% to 8% and mammographic density of 60% or higher were invited to attend or be telephoned to receive risk counseling; 81.9% of those wishing to know their risk have received risk counseling and 85.7% of these were found to be eligible for a risk-reducing intervention. These results confirm the feasibility of determining breast cancer risk and acting on the information in the context of population-based mammographic screening.

PCOS and peripheral AMH levels in relation to FSH receptor gene single nucleotide polymorphisms.

OBJECTIVES: To determine if an association exists between the follicle-stimulating hormone receptor (FSHR) gene p.Asn680Ser polymorphism and polycystic ovary syndrome (PCOS) or with high anti-mullerian hormone (AMH) levels without PCOS. PATIENTS: Fifty-eight women with PCOS, 24 women with high AMH (>44.5 pmol/L) without PCOS and 80 healthy ethnically matched female controls. MAIN OUTCOME MEASURES: Prevalence of the FSHR p.Asn680Ser polymorphism, baseline serum AMH levels and response to ovulation induction with clomiphene citrate. RESULTS: The frequency of FSHR p.Asn680Ser genotypes were not significantly different between PCOS patients, patients with high AMH without PCOS and controls (p = 0.88). Of the women with PCOS, 34/58 were on clomiphene citrate treatment and 12/34 were resistant. There was no association between sensitivity or resistance to clomiphene and p.Asn680Ser genotypes (p = 0.38). CONCLUSIONS: There is no evidence that FSHR p.Asn680Ser genotypes are associated with PCOS, high AMH levels or response to clomiphene citrate.

Follicle-stimulating hormone receptor gene polymorphisms are not associated with ovarian reserve markers.

OBJECTIVE: To evaluate the association between variants in the FSHR receptor (FSHR) gene and current markers of ovarian reserve (antimüllerian hormone, antral follicle count, FSH). DESIGN: Prospective observational study. SETTING: Tertiary referral center for reproductive medicine. PATIENT(S): Women (n = 421) undergoing their first cycle of controlled ovarian stimulation for IVF. INTERVENTION(S): Baseline pelvic ultrasound and blood tests were taken on day 2-3 of the cycle for assessment of baseline hormones and for DNA extraction. Genotypes for FSHR p.Asn680Ser and p.Thr307Ala variants were determined using TaqMan allelic discrimination assays. MAIN OUTCOME MEASURE(S): Association of FSHR single nucleotide polymorphisms with markers of ovarian reserve. RESULT(S): There was no evidence of any difference in basal FSH, antimüllerian hormone, or antral follicle count between the patients with different genotypes, with or without an adjustment for age or body mass index. CONCLUSION(S): No associations of FSHR genotypes with markers of ovarian reserve were detected in our cohort.

Community ambulation: perceptions of rehabilitation physiotherapists in rural and regional communities.

Research has highlighted the impact of the external environment on the ability to walk in the community but little research exists about the abilities, skills, or contextual factors that physiotherapists identify as important to enable a client to return to walking in their rural or regional community. This article investigates the abilities, skills, and contextual factors that rehabilitation physiotherapists practicing in rural and regional communities in Australia perceive significant in enabling clients post stroke to return to walking in their rural or regional community. Physiotherapists involved in treating clients with stroke were interviewed about their perceptions of the skills and abilities required by clients post stroke with a mobility problem that are significant in enabling a return to walking in the community. Data were interpreted by using a grounded theory methodology that involved coding and analysing observational notes and interview transcripts to develop an understanding of the emergent themes. Six key themes were identified: 1) ability to walk at speed and physical fitness, 2) the ability to negotiate different terrains, 3) ambient conditions, 4) the ability to reason and monitor the environment, 5) to have support of a person or aid, and 6) to have the drive (internal and external) to walk in the community. Some of these abilities are described in the current literature, but others are not. The findings of this research will add to the existing body of knowledge on physiotherapist's decision making around the emerging topic of community ambulation.

The retest reliability of the six-minute walk test in patients referred to a cardiac rehabilitation programme.

BACKGROUND AND PURPOSE: The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. METHODS: Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC(2,1) ), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. RESULTS: The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. CONCLUSION: Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation.

Fine-mapping CASP8 risk variants in breast cancer.

BACKGROUND: Multiple genome-wide and candidate gene association studies have been conducted in search of common risk variants for breast cancer. Recent large meta analyses, consolidating evidence from these studies, have been consistent in highlighting the caspase-8 (CASP8) gene as important in this regard. To define a risk haplotype and map the CASP8 gene region with respect to underlying susceptibility variant/s, we screened four genes in the CASP8 region on 2q33-q34 for breast cancer risk. METHODS: Two independent data sets from the United Kingdom and the United States, including 3,888 breast cancer cases and controls, were genotyped for 45 tagging single nucleotide polymorphisms (tSNP) in the expanded CASP8 region. SNP and haplotype association tests were carried out using Monte Carlo-based methods. RESULTS: We identified a three-SNP haplotype across rs3834129, rs6723097, and rs3817578 that was significantly associated with breast cancer (P < 5 × 10(-6)), with a dominant risk ratio and 95% CI of 1.28 (1.21-1.35) and frequency of 0.29 in controls. Evidence for this risk haplotype was extremely consistent across the two study sites and also consistent with previous data. CONCLUSION: This three-SNP risk haplotype represents the best characterization so far of the chromosome upon which the susceptibility variant resides. IMPACT: Characterization of the risk haplotype provides a strong foundation for resequencing efforts to identify the underlying risk variant, which may prove useful for individual-level risk prediction, and provide novel insights into breast carcinogenesis.

Natural history of azathioprine-associated lymphopenia in inflammatory bowel disease patients: a prospective observational study.

INTRODUCTION: Azathioprine (AZA) is commonly used in inflammatory bowel disease (IBD) patients. Lymphopenia is a recognized effect of this treatment, but lymphopenia-related complications in IBD patients have not been widely reported. The incidence and progression of AZA-induced lymphopenia in IBD patients is not well described. There is no consensus on its optimal management in this group. AIMS AND METHODS: We assessed the incidence and progression of lymphopenia and its related complications in a cohort of IBD patients over a 14-month period in two large tertiary gastroenterology units. Analysis of prospectively collected data was performed. RESULTS: Fifty-two patients were studied prospectively with a median age of 34 years. Eighteen patients (34.6%) developed lymphopenia (<1.0×10(9)/l) during the course of treatment and 10 of them had severe lymphopenia (<0.6×10(9)/l). Lymphopenia lasted on average 85.4 days and spontaneously resolved in 13 patients. No lymphopenia related-complications were documented. Patients treated with steroids had a significantly higher rate of lymphopenia (83.3 vs. 44.1%, P=0.0083). CONCLUSION: Lymphopenia is common among IBD patients treated with AZA. However, it did not seem to be associated with a higher risk of opportunistic infections and spontaneously resolved in the majority of cases.

Land-based versus pool-based exercise for people awaiting joint replacement surgery of the hip or knee: results of a randomized controlled trial.

OBJECTIVE: To compare the preoperative effects of multidimensional land-based and pool-based exercise programs for people awaiting joint replacement surgery of the hip or knee. DESIGN: Randomized, single-blind, before-after trial. SETTING: Physiotherapy gymnasium and hydrotherapy pool. PARTICIPANTS: Patients awaiting elective hip or knee joint replacement surgery. INTERVENTIONS: Land-based (n=40) or pool-based exercise program (n=42). Each 6-week program included an education session, twice-weekly exercise classes, and an occupational therapy home assessment. MAIN OUTCOME MEASURES: Participants were assessed immediately before and after the 6-week intervention, then 8 weeks later. Primary outcomes were pain and self-reported function (Western Ontario and McMaster Universities Osteoarthritis Index) and patient global assessment. Secondary outcomes were performance-based measures (timed walk and chair stand) and psychosocial status (Medical Outcomes Study 36-Item Short-Form Health Survey mental component score). Pain was also measured before and after each exercise class on a 7-point verbal rating scale. RESULTS: Although both interventions were effective in reducing pain and improving function, there were no postintervention differences between the groups for the primary and secondary outcomes. However, the pool-based group had less pain immediately after the exercise classes. CONCLUSIONS: While our multidimensional exercise-based interventions appeared to be effective in reducing disability in those awaiting joint replacement surgery of the hip or knee, there were no large differences in the postintervention effects of the interventions. However, pool-based exercise appeared to have a more favorable effect on pain immediately after the exercise classes.

Community ambulation: environmental impacts and assessment inadequacies.

BACKGROUND: Community ambulation is an important goal for both clients and health professionals yet it is an outcome only variously achieved by clients discharged from rehabilitation settings back into their community. OBJECTIVE: To review the available literature about the assessment tools that are currently used to determine community ambulation status and to determine from an evaluation of these tools the effectiveness of the evaluation when compared to known environmental dimensions that impact on ambulation in the community. METHOD: A review of published papers from English language literature using CINAHL, ProQuest, Medline and other databases was conducted. RESULTS: Only eight papers were found in the literature to inform health professionals about the impact of the environment on community ambulation. No current mobility assessment tools were identified that assess all the environmental demands that can impact on the activity of community ambulation. From the tools reviewed the most frequently evaluated environmental mobility dimensions were walking distance and time constraints. CONCLUSIONS: Health professionals need assessment tools that evaluate the impact of the environment on an individual's mobility in order to determine community ambulation status. The literature to date provides little guidance about the impact of the environment and current evaluation tools are limited in clinical usefulness with respect to the depth and breadth of information gained.

Reliability of performance-based measures in people awaiting joint replacement surgery of the hip or knee.

BACKGROUND AND PURPOSE: Understanding the reliability of selected measurement tools is a prerequisite to understanding the effects of clinical interventions. The aim of this investigation was to determine the reliability of the 50-Foot Timed Walk (50 FTW) and 30-second Chair Stand Test (30 CST) in subjects awaiting joint replacement surgery of the hip or knee. METHODS: Eighty-two subjects participating in a 6-week exercise programme were assessed at baseline, 7 weeks and 15 weeks. Four trials of the 50 FTW and two trials of the 30 CST were completed at each assessment. Eleven trained assessors completed the assessments. RESULTS: Intra-class correlations were consistently high for the 50 FTW and 30 CST at all assessments. At the baseline assessment, trial 1 was found to be significantly different from subsequent trials for both the 50 FTW and 30 CST. This effect was not evident at the 7-week and 15-week assessments. At the baseline assessment, scores for the 50 FTW became stable after the first trial. Estimates of minimum detectable change indicated that participants needed to change by more than 3.08 seconds and 1.64 stands to be 90% confident that a real change had occurred for the 50 FTW and 30 CST, respectively. CONCLUSION: The 50 FTW and 30 CST can be reliable measures of physical performance. However, because we found a practice effect at the baseline assessment, a practice trial should be allowed before data collection begins. Because only two trials of the 30 CST were completed, further research is required to confirm whether scores at the initial assessment become stable on repeated testing.

Workplace stressors experienced by physiotherapists working in regional public hospitals.

OBJECTIVE: To identify and measure the effects of workplace stressors experienced by Victorian regional physiotherapists. DESIGN: Survey questionnaire. SETTING AND PARTICIPANTS: A questionnaire was distributed to three Victorian regional public physiotherapy departments and data were collected from 80 physiotherapists. MAIN OUTCOME MEASURES: The type and frequency of workplace stressors, the nature and frequency of common signs and symptoms of stress and the amount of leave taken as a result of stress were measured. RESULTS: Caseload quantity, complexity of patients, constant excessive workload, covering staff on leave and staff shortages, were reported as key workplace stressors. Physiotherapists aged between 20 and 29 years were significantly more likely to report a higher number of workplace stressors (F = 4.173, n = 80, P = 0.009). Inpatient rehabilitation physiotherapists were significantly more likely to report stress at a higher frequency than physiotherapists working in other areas (chi(2) = 14.359, n = 73, P = 0.002). Eleven per cent of all respondents reported taking leave from work as a result of stress with no significant difference identified between those who took leave and those who did not. There was, however, a trend identified with senior staff (Z = 1.792, n = 80, P = 0.073) and those who work in inpatient rehabilitation (chi(2) = 6.926, n = 80, P = 0.074) being more likely to take leave as a result of stress. Many of these physiotherapists did not make their employers aware of the reasons for the leave (77%, n = 9). CONCLUSIONS: High caseloads, periods of increased activity and staff shortages are some of the factors that contribute to stress in regional physiotherapists. Younger therapists were more likely to identify stressors with greater frequency. Strategies to monitor, prevent and manage stress should be implemented to minimise burnout in regional physiotherapists.

Telephone based asthma management - financial and individual benefits.

METHODS: The authors calculated the cost of delivering telephone based asthma management compared to usual care. Self efficacy and quality of life were measured at recruitment, 6 months and 12 months. Participants were invited to comment on their experience of the telephone based intervention. RESULTS: The intervention was well accepted. At 12 months there was a clinically important improvement in mean quality of life in the intervention group not seen in the control group. Telephone based management costs were offset by reductions in the number of readmissions in the intervention group. DISCUSSION: Telephone based asthma management offers a well accepted, low cost yet potentially effective means of delivering asthma care.

A pilot study of telephone based asthma management.

BACKGROUND: Self management programs have been advocated for adults who have recently been admitted to hospital or have recently attended an emergency department because of asthma. A new telephone based approach has already been trialled for the management of a number of other chronic conditions. This study sought to determine the effect of a telephone based asthma management program for adults with asthma. METHODS: Adults with one or more previous admissions for asthma to either or both of two tertiary hospitals between 1 May 2001 and 30 November 2003 were invited to participate. All participants received one face-to-face session with an asthma educator. Participants were randomised to intervention (six telephone calls over 6 months) or control (usual care) groups. Measures of health care utilisation and morbidity were collected weekly for 12 months. RESULTS: Seventy-one adults (54 females) with a mean age of 36.2 years were recruited to the study. Twenty hospital re-admissions were recorded for the control group and one for the intervention group at 12 months. Re-admission was significantly associated with allocation to control group (p=0.05). The control group was significantly more likely to report being woken by asthma on more than half the nights of the week (p=0.03). DISCUSSION: Telephone based self management intervention results in clinically important reductions in hospital re-admission in adults previously hospitalised with asthma.