Planning and Implementation of Guided Self-study in an Undergraduate Physiotherapy Curriculum in Switzerland-A Feasibility Study.

BACKGROUND: Self-directed learning (andragogy) or self-determined learning (heutagogy) can be implemented in guided self-study (GSS) with the aim to foster changes in the knowledge and skills of physiotherapy students in a higher education setting. To date, there is a lack of evidence for the use of GSS in higher education for physiotherapy. AIM: This study aimed to evaluate the feasibility of developing and implementing GSS in an undergraduate physiotherapy educational program in Switzerland. In addition, the effectiveness of GSS in bringing changes in knowledge and skills was assessed. METHOD: Full-time undergraduate physiotherapy students (n = 49) from the third semester volunteered in this feasibility study. Students were randomly allocated into a GSS group or a control group (CG) in the period from October to November 2019. The GSS group prepared a total of 3 clinical cases. Each case was processed in an 8-day cycle. On day 1, the clinical case (ie, description of a patient and symptoms) and learning goals were provided to the students electronically. The students prepared the cases in groups from days 2 to 7. They were guided 2 times by the tutor (physical meeting and via Skype) during this preparation phase. The results of group work were presented and reflected on during a moderated plenum session (90 minutes) on day 8. The feasibility of this higher education study was operationalized as follows: exposure ("dose," ie, the number of GSS sessions performed over 90 minutes, as well as the content of the cases and the learning objectives); students' responsiveness, with an a priori set 100% willingness to participate on day 8; program differentiation, to illustrate differences between the content of GSS cases and the curriculum; and degree of acceptability. In addition, an assessment was made of the total scores in the objective structured clinical examination (OSCE) and written examinations, as well as the amount of GSS. Statistical analyses were conducted using an intention-to-treat approach. RESULTS: All 3 GSS sessions on day 8 lasted the scheduled 90 minutes. The content of the presented cases was aligned with the learning objectives. The responsiveness of students willing to participate on day 8 was 42%. In program differentiation, no differences in content were found between the GSS presentation content and the usual curriculum content when compared with the learning aims. Objective structured clinical examination grades and written examination grades were similar for the GSS and CG. The analysis of the focus group interview showed a low degree of acceptability indicating that the students' workload was high during the GSS period. CONCLUSIONS: This study showed that this GSS program for undergraduate physiotherapy students in its current form is "feasible with modification." Modification of the study protocol (eg, better time planning in the academic calendar) is needed to improve the students' responsiveness. Alternatively, classroom hours may be reduced to favor self-study time. Such adjustments to the timetable should allow the physiotherapy students to better prepare the clinical cases. The effectiveness of the GSS and normal curriculum on OSCE and written examination scores was similar, probably due to the observed low students' acceptability.

Health-related costs in a sample of premenopausal non-diabetic overweight or obese females in Antwerp region: a cost-of-illness analysis.

BACKGROUND: People with overweight or obesity are at increased risk for disease later in life which cause important health costs.The aim of this study was to estimate the health status and the corresponding costs in a sample of females with overweight or obesity which were participating in a Randomized Controlled Trial (RCT) exploring the effect of lifestyle habits changes on ectopic adipose tissue. METHODS: Sixty-two non-diabetic premenopausal females without major comorbidities of overweight and obesity were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp.A RCT-embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight or obese females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants. RESULTS: The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the strict inclusion criteria of the RCT (i.e. overweight or obesity without diabetes type 2 or cardiovascular diseases). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population, only 3 participants were diagnozed with the metabolic syndrome. In this subsample productivity was low due to high average absenteeism, yielding important total costs for the society. CONCLUSION: Secondary prevention to avoid health deterioration in overweight or obese females without major comorbidies is needed to contain health care costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02831621, approval of the ethics committee of the University Hospital of Antwerp (number: 14/17/205 -ref: 7543075363).

The effect of sclerotherapy and prolotherapy on chronic painful Achilles tendinopathy-a systematic review including meta-analysis.

Chronic painful Achilles tendinopathy (AT) is a common disorder among athletes. Sclerotherapy (ST) and prolotherapy (PT) are two promising options among the numerous other conservative therapies. As their efficacy and potential adverse effects (AE) are still unclear, we systematically searched, analyzed, and synthesized the available literature on ST and PT for treating AT. Electronic databases, Google Scholar and articles' reference lists were searched according to PRISMA guidelines. Eligibility criteria were set up according to the PICOS-scheme including human and animal studies. Three authors independently reviewed the results and evaluated methodological quality (Coleman Methodology Score and Cochrane Risk of Bias Assessment). The initial search yielded 1104 entries. After screening, 18 articles were available for qualitative synthesis, six of which were subjected to meta-analysis. The mean Coleman Score of the 13 human studies was 50. Four RCTs were ranked as having a low risk of selection bias. Three of those reported a statistically significant drop in the visual analog scale (VAS) score, one a significant increase in the VISA-A Score. 12 of 13 human studies reported positive results in achieving pain relief and patient satisfaction, whereas only one study's finding differed. Meta-analysis revealed an unambiguous result in favor of the intervention (weighted mean difference D=-4.67 cm, 95% CI -5.56 to -3.76 cm [P<.001]). Only one serious AE and two minor AEs were reported in the entire literature. This systematic review suggests that ST and PT may be effective treatment options for AT and that they can be considered safe. Long-term studies and RCTs are still needed to support their recommendation.

The effect of diet or exercise on ectopic adiposity in children and adolescents with obesity: a systematic review and meta-analysis.

OBJECTIVE: Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta-analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population. METHODS: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Clinical trials that assessed ectopic fat deposition and included study arms with diet and/or exercise were searched in PubMed, PEDro and the Cochrane database. RESULTS: Hepatic fat content and intramyocellular lipid content were described in nine studies and three studies, respectively. Most studies included teenagers, and study duration ranged between 3 and 12 months without follow-up. Using random-effects weights, the standardized mean difference of the change in hepatic adiposity (totalling 320 subjects) was -0.54 Hedges' g (95% confidence interval: -0.69 to -0.38 with p < 0.0001). By re-expressing this effect size, it is seen that diet and/or exercise results in an absolute reduction of intrahepatic lipid with 2%, which accords with a relative reduction up to 70%. Although there were significant ameliorations of insulin sensitivity, no significant changes in intramyocellular lipid were observed. CONCLUSIONS: This meta-analysis showed that diet and/or exercise is effective to reduce hepatic adiposity in youth with obesity.

[Feasibility of balance training on mats in healthy, moderately sportive women in old age. A pilot study]. / Machbarkeit eines Gleichgewichtstrainings auf Matten bei gesunden, moderat sportlichen Frauen im Alter. Eine Pilotstudie.

PURPOSE: The aim of this pilot study was to assess the feasibility and the effect size of weekly group exercise sessions on an Airex® pad with an additional home program on the participants' balance. MATERIALS AND METHODS: Two training sessions (once a week in-group and once a week as a home program) were administered for 4 weeks. The intervention group (IG) trained on Airex® pads and the control group (CG) without the pad. This study examined the feasibility in terms of recruitment and randomization process, and compliance. Moreover, the effects were evaluated for static, dynamic, and functional balance. RESULTS: A total of 11 healthy women were recruited, and 10 women completed the 4-week training program (one drop-out was recorded). Of a total of 88 training sessions, 82 were completed. The IG showed a significant difference for one test of dynamic balance. CONCLUSION: This pilot study was feasible. However, changes regarding recruitment and compliance should be made for future studies. Sensitive measuring instruments must be used for the evaluation of balance changes.

[Does muscle activation during whole-body vibration induce bone density improvement in postmenopausal women?--A systematic review]. / Hat die Aktivierung der Muskulatur durch Ganzkörpervibration einen Effekt auf die Knochendichte von postmenopausalen Frauen? Eine systematische Literaturübersicht.

BACKGROUND: Whole body vibration training (WBV) stimulates muscles by mechanical vibrations. The resulting muscle activity and bone deformation may provoke an increase in bone density. The aim of this systematic review was to evaluate whether muscle activation and muscle strengthening caused by vibration training has an effect on bone density in postmenopausal women. METHODS: This systematic review was conducted according to the guidelines of the PRISMA statement for meta-analyses and systematic reviews. The literature search was conducted in several electronic databases (PubMed und CINAHL) and Google Scholar. The literature search was conducted between June 2012 and August 2013. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool by two independent persons. RESULTS: A total of 246 studies was found. In this present analysis three studies with vertical and two studies with side-alternating WBV were included, totalling 368 participants with an age range between 60.7 and 79.6 years. From those 132 participants trained on vertically while 67 participants trained on side-alternating WBV engines. The included study shows a moderate to high risk of bias. The selected frequencies ranged from 12.0 Hz to 40.0 Hz for vertical WBV and 12.5 Hz for side-alternating WBV. The amplitude ranged between 1.7 and 12.0 mm with an acceleration from 0.1 to 10.0 g. CONCLUSION: This systematic review showed significant influences on the isometric maximal voluntary contraction (IMVC) between 15.1 and 16.5 % and on dynamic maximal strength (DMS) between 7.9 to 16.5 % after vertically WBV (frequencies: 30.0 to 40.0 Hz; 3 sessions per week; 15 minutes per session) and on IMV with 26.6 % (frequency: 12.5 Hz; 3 sessions per week; 15 minutes per session). This increased muscle activity resulted in an improved bone density in the lumbar spine between 0.5 % to 0.7 % and the hip between 0.8 % to 0.9 % in postmenopausal women. These clinically significant findings should be confirmed by a large high-quality randomised controlled trial and reported following the CONSORT Statement guidelines.

The effect of non-surgical weight loss interventions on urinary incontinence in overweight women: a systematic review and meta-analysis.

Although the aetiology of urinary incontinence can be multifactorial, in some cases weight loss could be considered as a part of the therapeutic approach for urinary incontinence in people who are overweight. The objective of this study was to review and meta-analyse the effect of non-surgical weight loss interventions on urinary incontinence in overweight women. Web of Science, PubMed, Pedro, SPORTDiscus and Cochrane were systematically searched for clinical trials that met the a priori set criteria. Data of women who participated in non-surgical weight loss interventions (diet, exercise, medication or a combination) were included in the meta-analysis. After removing duplicates, 62 articles remained for screening on title, abstract and full text. Six articles (totalling 2,352 subjects in the intervention groups) were included for meta-analysis. The mean change in urinary incontinence (reported as frequency or quantity, depending on the study) after a non-surgical weight loss intervention, expressed as standardized effect size and corrected for small sample sizes (Hedges' g), was -0.30 (95%CI = -0.47 to -0.12). This systematic review and meta-analysis shows evidence that a non-surgical weight loss intervention has the potential to improve urinary incontinence and should be considered part of standard practice in the management of urinary incontinence in overweight women.

[Effect of continuous passive motion for cartilage regenerative surgery - a systematic literature review]. / Wirkung von passiven Motorbewegungsschienen nach knorpelregenerativen Eingriffen - eine systematische Literaturübersicht.

BACKGROUND: The aim of this systematic review was to evaluate treatment effects of continuous passive motion (CPM) after surgical cartilage repair. PATIENTS/MATERIAL AND METHODS: A literature search was conducted in the Cochrane Central Register of Controlled Trials, EMBASE, International Clinical Trials Registry Platform, MEDLINE, Trip Database and in bibliographies of included studies. Two independent researchers evaluated the quality of original investigations by the Cochrane Risk of Bias tool. Systematic reviews were checked by the CBO/Dutch Cochrane Centre Guideline. RESULTS: A total of 1541 studies was initially retrieved from the databases. After screening for inclusion criteria, one review and ten original papers could be included for further evaluation. Studies showed methodological weaknesses. Heterogeneity of outcome measures and the fact that 6 of 9 studies with an one-group pre-post design measured the combined effect of surgical treatment and CPM prevented a meta-analysis. CONCLUSION: Three studies described significant improvements with regard to subjective outcome such as pain, swelling, Quality Life Survey, Knee Society score, WOMAC score or rating Cincinnati due to the surgical treatment and the CPM intervention of cartilage defects in the knee. Six (case) studies suggested an enhanced cartilage quality of the patients after CPM. More high-quality randomised controlled trials are needed to provide high level evidence.

Determinants of inpatient rehabilitation length of stay and discharge modality after hip and knee replacement surgery in Switzerland - a retrospective observational study.

QUESTIONS UNDER STUDY / PRINCIPLES: The aims of this study were to identify the determinants influencing the inpatient rehabilitation length of stay (LoS) and discharge modality (DisMod) after hip or knee replacement surgery. METHODS: Data were retrieved for 306 patients (185 females, 121 males) who were admitted to a Swiss orthopaedic rehabilitation facility between 2007 and 2008 after hip or knee replacement surgery. LoS and DisMod were extracted from the medical files along with an additional seven binary and six continuous variables (including scores of timed-get-up-and-go [TUG], walking distance [WDT] and stair climbing tests [FIM_St]). Nonparametric procedures were used to detect differences between the gender groups. For the analysis of the LoS determinants, a linear regression model was used. The nonmotor performance test determinants of DisMod were analysed using a logistic regression model, whereas the motor performance test determinants were examined using binary classification. For both regression models, a backward procedure was used. RESULTS: Unlike DisMod, LoS calculations were conducted after stratification for gender. The simplified regression models explained 22% (females) and 31% (males) of the LoS variance and 20% (both genders) of the DisMod variance. TUG, WDT and FIM_St were all important predictors for LoS, whereas DisMod could be best predicted by WDT. CONCLUSIONS: Patients with good motor ability at admission were discharged earlier and more frequently to home. These findings might be of importance for preoperative physiotherapeutic care and might help to improve care planning as well as more accurately predict the access to inpatients beds and the allocation of resources.

The influence of stratum corneum hydration on body fat determination by bioelectrical impedance analysis.

BACKGROUND/AIMS: Bioelectrical impedance analysis (BIA) is used for the estimation of the amount of body fat. We evaluated the influence of the stratum corneum hydration at the contact areas used for BIA on the body fat estimation. METHODS: Stratum corneum hydration was measured at the sole of the right foot and the palm of the right hand before and after contact with the Tanita Body Composition Analyzer TBF 410(®) and the Omron Body Fat Analyzer(®) , (n=128 females and 126 males), respectively. Changes in stratum corneum hydration during the contact time were calculated (ΔHYD). As a gold standard for body fat estimation, the underwater weighing method (UWW) was used and the deviation of this standard was calculated for the Tanita (DT) and the Omron (DO) measurement. RESULTS: During contact with the Tanita, stratum corneum hydration increased significantly at the foot. Neither stratum corneum hydration measured at the respective contact sites before BIA nor ΔHYD at the respective skin sites was related to DT or with DO. CONCLUSION: The BIA measuring procedure using the Tanita instrument leads to an occlusive effect at the contact site. BIA for the determination of body composition is not influenced by stratum corneum hydration.

Tracking of adult adiposity in early, average and late maturing children: a thirty year longitudinal growth study.

AIM: To investigate if predictability of adult adiposity is related to maturation status in youth. METHODS: Data of the longitudinal ''LEGS''-study (N = 550) from 6 to 18 years were used. At 35 years, 59 men and 60 women participated again. Early (EM), average (AM) and late (LM) maturity groups were established, using tertiles of age at peak height velocity (JPA-method). Pearson correlations between the childhood and the adult measurements were calculated. RESULTS: Female sum of 4 skinfolds (Sigma4SF) correlations increase from very low/moderate (6-9 years) to high at 11 years (EM), 15 years (AM) and 17 years (LM). The highest predictability was 65.6% for the Sigma4SF at 14 years in EM. At this age, predictability is 30.3% in AM and 0.8% in LM (P < 0.05). In EM, BMI correlations are moderate/high until 14 yrs (r2 = 0.64 at 13 years), but low until 15 years in LM. Male Sigma4SF correlations are very low/moderate in the three maturity groups. Significant correlation was found in the LM at 16 yrs. Moderate Body Mass index (BMI) correlations are reached at 9 years (LM) and 11 years (EM). At 16 years predictability = 4.9% for BMI in LM males. CONCLUSION: Predictability of adiposity at 35 years is generally better in girls than in boys. A dose-response effect of maturity on adult adiposity is found in girls but not in boys. Interventions to prevent adult obesity might be more effective in females than in males, particularly in EM females.

Muscular activity of different shooting distances, different release techniques, and different performance levels, with and without stabilizers, in target archery.

The quadruple approach in the title refers to four different studies over a period of 3 years. The common factor in these studies is the methodology of the (Brussels) Electromyographic Signal Processing and Analysis System (ESPAS), a hardware and software EMG data acquisition system that has constantly been improved. Therefore, the ESPAS methodology is described extensively (i.e. the electrodes, amplifier, tape-recorder and processing hardware). Experiment 1 investigated muscular behaviour in target shooting, both indoors (18 and 25 m) and outdoors (50, 70 and 90 m). It was found (via iEMG) that a significant increase in activity only exists between 25 and 50 m, and that there is no linear increase of activity with increased distance. No differences in muscular pattern (IDANCO system: Clarys and Cabri, 1988) or activity between the indoor distances and between the outdoor distances were found. Experiment 2 investigated the muscular economy of four string grips: the three-finger grip, two-finger grip, thumb grip and reversed grip. The largest variations in activity were found for the two most unfamiliar grips, i.e. the thumb and reversed grips; however, low iEMG and the rapid precision improvement (over a limited number of shots) suggest that the thumb grip, if practised long enough, might be the most economical technique. Experiment 3 attempted to differentiate muscular activity and a number of performance variables in three different populations of archers--Olympic athletes, National competitors and beginners--in order to obtain feedback regarding improved performance. Apparently, overall muscle pattern, intensities and arrow speed were not discriminatory. The differences found between the groups (or levels of skill) were affected by the ability to reproduce identical patterns and arrow velocities in consecutive shots and by the constancy of neuromuscular control of the M. trapezius, M. biceps brachii and M. extensor digitorum. Finally, Experiment 4 investigated the muscular activity of elite archers shooting at distances of 70 and 90 m with and without stabilizers. Differences in iEMG were not supported by differences in precision. Over time, the low iEMG in shooting without stabilizers increases precision and delays fatigue.

An active probe for electrocardiography.

In order to improve the signal to noise ratio during the recording of electrocardiographic maps from moving patients, the effect of using active electrodes with built-in amplifiers was investigated. Two kinds of electrodes using different technologies were developed: a miniature printed circuit and a thin film circuit. The first method was found to be suitable for the fabrication of small quantities in a normally equipped electronics workshop while the second, requiring highly specialised equipment, is intended for industrial manufacture in large quantities.