The neglected barrier to medication use: a systematic review of difficulties associated with opening medication packaging.

Difficulty opening medication packaging can have serious consequences that can lead to patient harm via medication mismanagement or poor adherence. However, the quality of literature pertaining to these issues has yet to be collated and critiqued. This systematic review examined cross-sectional studies that objectively examined the ability of participants to open different medication packaging. Of the 8,692 studies identified, 12 met the inclusion criteria, all of which were direct observational studies given that prior research has identified a mismatch between self-report and actual ability. Scoring via the Appraisal Tool for Cross Sectional Studies revealed that the methodological quality of included studies was typically low. Study samples mostly consisted of older adults. All studies reported a non-negligible proportion of participants unable to open packaging, with the most difficulty associated with child-resistant containers. Several studies examined associations; however, no factor was consistently found to be significantly associated with the ability to open packaging. Despite these studies spanning >40 years, the packaging types examined remained largely the same. This suggests that, despite decades of research demonstrating that packaging is problematic, there has been a stagnation in medication packaging development. Whether this is attributed to a paucity of high-quality research, and therefore a lack of strong evidence that change is needed, is unclear. Future research should strive for better methodological quality, with generalisable cohorts assessed via observation in their home. If the problems identified in prior research persist, this may provide the impetus for change that is overdue in the medication packaging industry.

Digital bathroom scales with open source software provide valid dynamic ground reaction force data for assessment and biofeedback.

BACKGROUND: Measuring dynamic vertical ground reaction force allows for assessment of important clinical and physical capacity factors such as weight bearing asymmetry, force distribution, and rate of force development. However, current technologies for accurately assessing ground reaction force are typically expensive. RESEARCH QUESTION: The aim of this study was to examine the validity and reliability of obtaining static and dynamic ground reaction force data from low-cost modified digital bathroom scales. METHODS: Four modified bathroom scales, two units each of two different brands, were examined. Repeated mechanical loading trials were performed with known loads ranging from 0.01 to 65 kg, with acquired data compared against the known loading to calculate accuracy, hysteresis, and non-linearity. Dynamic trials consisting of 5 times sit-to-stand and weight-shifting were performed by 32 adults. Absolute and relative agreement intraclass correlation coefficient, and Pearson's and Spearman's correlations were performed to determine validity and reliability for the mechanical tests. Bland-Altmann plots were created for each comparison. Mean absolute error (MAE) and unbiased cross-correlation were performed on the dynamic data, comparing the calibrated data to the known values from a Bertec force platform. RESULTS: Hysteresis and non-linearity were excellent (<0.2 % full-scale), and mechanical test results showed excellent reliability and validity. Cross-correlation results for the dynamic data were excellent, however MAE for the more rapid sit-to-stand task was higher than the slower weight-shifting test. This may have been due to the low default sampling rate for the lowest noise setting of the HX711 amplifier (10 Hz). SIGNIFICANCE: In summary, our results suggest that digital bathroom scales can be easily and inexpensively modified to obtain accurate vertical ground reaction force data, with sensitivity to detect changes of as little as 0.01 kg.

Validity of a low-cost laser with freely available software for improving measurement of walking and running speed.

OBJECTIVES: Accurately measuring speed and acceleration during walking, running and sprinting has important implications for rehabilitation, planning training and talent identification in sporting and clinical populations. Light detection and ranging laser technology provides a continuous stream of distance data. It has the potential to allow rapid and precise measurement and may be advantageous compared with discrete methods of assessment, such as stopwatches and timing gates, which may be inaccurate over short distances. Therefore, the aim of this study was to assess the validity of a novel, low-cost and easy to implement laser-based system during walking and running trials. DESIGN: Cross-sectional study. METHODS: Thirty-two healthy adults performed walking and running trials from flying and static starts while monitored concurrently with reference standard three-dimensional motion analysis and laser systems. Velocity was calculated over short (0.5m) and longer (3m) intervals using both systems. Validity was assessed using absolute agreement intraclass correlation coefficients (ICC2,1), mean absolute errors, Pearson's correlations and regressions and Bland-Altman plots. RESULTS: All intraclass correlation coefficients and correlations were excellent (ICC>0.88, R>0.89). For the longer interval, all mean absolute errors were <0.03m/s (0.24-1.31%). Slightly higher mean absolute error values were reported for the shorter interval (3.16-5.10%), with the highest error of 0.184m/s evident for the flying start running trial. CONCLUSIONS: These results indicate that a low-cost and accessible laser system can be used to accurately assess walking and running speed. To aid implementation and further research, freely available hardware design descriptions and downloadable software can be accessed at www.rehabtools.org/LIDAR.