Organisation and content of supervised group exercise for people with axial spondyloarthritis in The Netherlands.

Supervised group exercise (SGE) is recommended for people with axial spondyloarthritis (axSpA). Recent literature suggests that its contents and dosage must probably be revised. As a first step towards renewal, this study examined the current SGE organisation and content for people with axSpA in The Netherlands. A pen-and-paper survey was sent to the boards of the 82 local patient associations affiliated with the Dutch Arthritis Society in 2016. One member of each board was asked to complete questions on the nature and organisation of SGE and one of the supervising therapists to complete questions on the SGE supervision and contents. The questionnaire was returned by representatives of 67/82 (82%) local patient associations, of which 17 (25%) provided axSpA-specific SGE (16/17 SGE programmes with both land-based exercise and hydrotherapy and 1/17 with only hydrotherapy). These involved in total 56 groups with 684 participants and 59 supervisors, of whom 54 were physical therapists and 21 had had postgraduate education on rheumatic and musculoskeletal diseases (RMDs). Besides mobility and strengthening exercises and sports (17/17), most programmes included aerobic exercise (10/17), but rarely with heart rate monitoring (1/17), patient education (8/17), periodic assessments (2/17), or exercise personalisation (1/17). In the Netherlands, a quarter of local patient associations organised axSpA-specific SGE, mostly containing land-based exercises combined with sports and hydrotherapy. Most supervisors lacked postgraduate education on RMDs and most programmes lacked intensity monitoring, patient education, periodic assessments, and personalisation, which are needed for optimising exercise programmes according to current scientific insights.

The effect of aquatic physical therapy on patients with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: The aquatic environment has unique properties, such a buoyancy, turbulence, hydrostatic pressure, and resistance, which can be used to gain a range of exercise benefits. During the last decade, hydrotherapy has spread in a very heterogeneous rehabilitation field. However, the efficacy of this kind of rehabilitation is not clear in scientific literature. The purpose of this study is to conduct a systematic review with meta-analysis to evaluate the qualitative and quantitative results of physical therapy treatments in an aquatic setting for individuals with Multiple Sclerosis. METHOD: PRISMA guidelines were used to carry out the systematic review and meta-analysis. Three bibliographic databases were searched: MEDLINE, PEDro, and the Cochrane Library. Papers included in the study have the following characteristics: (a) a randomized controlled trial design of research and (b) published in English. The quality of the clinical trials included were evaluated according to a Jadad score and through meta-analysis. RESULTS: After the elimination of duplicates, 116 records were screened. Among these, 11 Randomized Controlled Trials (RCTs) were included in the systematic review. Ten of these were involved in the meta-analysis. From the qualitative analysis, a larger number of studies were found with a high level of quality. Most of the results of the quantitative analysis were statistically significant (p< 0.05). CONCLUSION: Aquatic physical therapy is a valid means of rehabilitation for people with Multiple Sclerosis. The integration of this methodological approach with conventional physical therapy is recommended. Nevertheless, more studies, a larger number of participants, and short-, medium-, and long-term follow-up are required to confirm current results.

First aid is associated with improved outcomes in large body surface area burns.

BACKGROUND: Animal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%). METHODS: Data was prospectively collected for patients with ≥20% TBSA burns from 2004- 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes - mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury. FINDINGS: 390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12-1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI -13.6% to -6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI -19% to -4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI --0.29 to -0.08; P < 0.001). INTERPRETATION: Adequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.

Actualización sobre los efectos de los estiramientos en la lumbalgia: una revisión sistemática / Update on the effects of stretching in low back pain: a systematic review

Objetivo: Analizar la literatura científica actual para conocer los efectos de los estiramientos en pacientes con lumbalgia. Estrategia de búsqueda: La búsqueda se llevó a cabo en enero de 2014 en Medline, CINAHL, Scopus, WOS, LILACS y PubMed. Selección de los estudios: Se obtuvieron un total de 350 artículos publicados entre 2009 y 2014, y aplicando los criterios de inclusión y exclusión, 12 fueron válidos para la revisión. Resultados: En muchos de los artículos seleccionados se realizaron estiramientos de la musculatura de la cadena posterior, en uno de ellos se hizo estiramiento del tejido nervioso, y otro comparó estiramientos musculares con movilización neural. Conclusiones: Los estiramientos, en general, obtienen resultados positivos. La calidad metodológica de los artículos analizados fue baja, por lo que serían necesarios más estudios de mejor calidad y con tamaños de muestra más amplios que verificasen los buenos resultados

Objective: To analyze the current scientific evidence to know the effects of stretching in patients with low back pain. Research strategy. The research was carried out in January 2014 using Medline, CINAHL, Scopus, WOS, LILACS and PubMed. Study selection: A total of 350 papers, published between 2009 and 2014, were review. Of these, 12 were finally selected for review after applying the inclusion and exclusion criteria. Results: Stretching of posterior muscle chain was done in many of the articles. In one article, the nervous tissue was stretched, and in another, muscle stretching was compared with neural mobilization. Conclusions: In general, stretching resulted in positives results. The methodological quality of the papers analyzed was low. Therefore, more studies with better quality and larger samples sizes are needed to verify the good results

Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis.

OBJECTIVE: This paper presents a systematic review and meta-analysis of the effectiveness of aquatic exercise for treatment of knee osteoarthritis (OA). METHODS: PubMed, the Cochrane Library, Embase, CAMbase, and the Web of Science were screened through to June 2014. Only randomized controlled trials (RCTs) comparing aquatic exercise with control conditions were included. Two authors independently selected trials for inclusion, assessed the included trials, and extracted data. Outcome measures included pain, physical function, joint stiffness, quality of life (QOL), and safety. Pooled outcomes were analyzed using standardized mean difference (SMD). RESULTS: There is a lack of high quality studies in this area. Six RCTs (398 participants) were included. There was moderate evidence for a moderate effect on physical function in favor of aquatic exercise immediately after the intervention, but no evidence for pain or QOL when comparing aquatic exercise with nonexercise. Only one trial reported 3 months of follow-up measurements, which demonstrated limited evidence for pain improvement with aquatic exercise and no evidence for QOL or physical function when comparing aquatic exercise with nonexercise. There was limited evidence for pain improvement with land-based exercise and no evidence for QOL or physical function, when comparing aquatic exercise with land-based exercise according to follow-up measurements. No evidence was found for pain, physical function, stiffness, QOL, or mental health with aquatic exercise immediately after the intervention when comparing aquatic exercise with land-based exercise. Two studies reported aquatic exercise was not associated with serious adverse events. CONCLUSION: Aquatic exercise appears to have considerable short-term benefits compared with land-based exercise and nonexercise in patients with knee OA. Based on these results, aquatic exercise is effective and safe and can be considered as an adjuvant treatment for patients with knee OA. Studies in this area are still too scarce and too short-term to provide further recommendations on how to apply this therapy.

Prevalence and antibiotic resistance of Pseudomonas aeruginosa isolated from swimming pools in northern Greece.

Pseudomonas aeruginosa is an important agent of opportunistic infection in aquatic environments. Our aim was to evaluate the occurrence and antimicrobial resistance of P. aeruginosa in the water of swimming pools in northern Greece. Water samples were obtained from hydrotherapy pools, jacuzzis/spas and swimming pools. A total of 16.6% (45/271) of the samples were positive for P. aeruginosa. Of the amenities examined, the most contaminated were hydrotherapy pools (25% of samples positive). A small percentage of isolates (20.0%) showed resistance to antibiotics. Compared with other studies, the prevalence of P. aeruginosa in swimming pools was relatively low, while the antibiotic resistance pattern of these community isolates was not high.

Survey on current hydrotherapy use among North American burn centers.

The authors have reviewed hydrotherapy practices in North American burn centers and described the epidemiology of hydrotherapy-associated nosocomial infections. A web-based survey was distributed to the directors of all burn care facilities listed by the American Burn Association. Questions addressed aspects of practice, including the method, additives, disposable liners, decontamination practices, nosocomial pathogens, and perceptions regarding the "ideal" method of hydrotherapy. The response rate was 44%, 59 of 142 centers, or 827 of 1900 beds. Hydrotherapy is regularly used by 83% of centers. Among these centers, 10% use exclusively immersion hydrotherapy (IH), 54% use exclusively shower cart hydrotherapy (SCH), and 35% use a combination of IH and SCH. Disposable liners are used at 80% of centers. Tap water alone is used by 51% of centers, 27% add detergent, 16% chlorhexidine, and 7% povidone-iodine. The majority of centers (57%) do not routinely culture their hydrotherapy equipment, 20% culture weekly, 7% monthly, and 17% less than once per month. Directors believe that Pseudomonas aeruginosa, methicillin-sensitive Staphylococcus aureus, and methicillin-resistant S. aureus are the most common nosocomial pathogens, followed by Acinetobacter species and Candida albicans. The relative frequency of occurrence of the first three pathogens did not vary with regard to the hydrotherapy method used. Given the opportunity to redesign, 45% of burn unit directors would implement SCH only, 42% a combination of SCH and IH, 2% exclusively IH, and 11% no hydrotherapy or bedside irrigation only. The prevalence of hydrotherapy use at North American burn centers has decreased since 1990 (83% vs 95%), yet continues to be used at the majority of centers. The use of IH has also declined (55% vs 81%). The trend away from the exclusive use of IH will likely continue, because more centers incorporate showering methods.

Effects of mild-stream bathing on recovery from mental fatigue.

BACKGROUND: Bathing in hot water is very common in Japan; people bathe in order to clean their bodies and to recover from physical and mental fatigue. However, there have been few reports examining the effects of bathing on recovery from mental fatigue. The purpose of this study was to examine the effects of mild-stream bathing on recovery from mental fatigue. MATERIAL/METHODS: During mild-stream bathing, a mild stream continuously passes from the sole to the calf, thigh, waist and back, thus providing a massage function. In a double-blinded, placebo-controlled, crossover experiment, 14 male healthy volunteers were randomized into normal bathing and mild-stream bathing experiments. After a fatigue-inducing mental task for 4 hours, subjects took a normal or mild-stream bath. RESULTS: Heart rate was higher, muscle stiffness in the waist was lower and plasma cortisol levels tended to be lower after mild-stream bathing when compared to normal bathing. In addition, after mild-stream bathing, mental task performance, as assessed by reaction times on an advanced trail making test, was better than that after normal bathing. CONCLUSIONS: The present results suggest that improved working memory processing, diminished waist muscle tone, and attenuated mental stress are induced by mild-stream bathing. Therefore, mild-stream bathing appears to be more effective for alleviating mental fatigue than normal bathing.

Agentes físicos superficiales y dolor. Análisis de su eficacia a la luz de la evidencia científica / Superficial physical modalities and pain. Analysis of their efficacy in light of the scientific evidence

Introducción: Los agentes físicos son todos los elementos físicos con que cuenta el fisioterapeuta que se emplean para intervenir en el cuerpo con fines curativos; sin embargo, el aumento de las publicaciones científicas ha llevado a un incremento en el conocimiento de la efectividad de ciertos agentes fisioterapéuticos en relación con el dolor. Materiales y métodos: Se realizó una búsqueda amplia en las bases de datos Pubmed (Medline), Physiotherapy Evidence Database (PEDro) y Centre for Reviews and Dissemination (DARE), donde la búsqueda se realizó entre el 1 de agosto y el 1 de noviembre del año 2008, con los siguientes límites: estudios publicados desde el año 2003 en adelante, escritos en idioma inglés y español, hechos en humanos; se aceptaron sólo estudios metaanálisis, revisiones sistemáticas, estudios controlados y aleatorios y guías de práctica clínica. Resultados: De los 2.477 estudios que potencialmente podrían entrar a este trabajo, al pasar por los criterios de inclusión y exclusión sólo se incluyeron para su análisis 30investigaciones.Conclusiones: Falta investigación en el estudio de los agentes físicos superficiales para el tratamiento del dolor y que son tan utilizadas actualmente; pese a esto se dispone de evidencia de buen nivel que sustenta la aplicación de ciertos agentes fisioterapéuticos en ciertas enfermedades dolorosas (AU)

Introduction: Physical agents are all of the physical elements that physiotherapists use to intervene in the body with curative intent. However, the increase in scientific publications has allowed greater knowledge to be gained on the effectiveness of certain therapeutic agents in relation to pain. Material and methods: We performed a broad, systematic search of Pubmed (Medline),the Physiotherapy Evidence Database (PEDro) and the Centre for Reviews and Dissemination(D.A.R.E) between August 1 and November 1, 2008 with the following criteria: studies published since 2003, written in English or Spanish, and performed in humans. Only metaanalyses, systematic reviews, randomized controlled trials and clinical practice guidelines were accepted. Results: Of the 2477 studies that could potentially have been included, only 30 met the inclusion and exclusion criteria. Conclusions: Further investigation is needed into commonly used physical agents. Nevertheless, there is a good level of evidence to support the use of certain therapeutic agents in some painful conditions (AU)

[Study EMSEI-2006]. / Estudio EMSEI-2006.

To evaluate the properties of the Indafoam hydro-regulating dressing, the authors planned a study on the clinical application these materials have in relation to the evolution of injuries and their etiology at the same time evaluating the behavior of these products in diverse aspects related to the healing processes. This study is an open, multi-centric prospective observational study having repeated measurements in a group of patients who suffered from injuries having diverse etiology

An outbreak of Legionella pneumophila suspected to be associated with spa pools on display at a retail store in New Zealand.

AIM: To investigate and characterise a cluster of six cases of severe pneumonia in the Wellington region notified to Regional Public Health in November 2003. And to describe the public health response to an identified subgroup of Legionella infections. METHODS: The case definition was "a person admitted to Wellington or Hutt Hospital between 29 October 2003 and 9 November 2003 with severe pneumonia". The cluster was initially investigated by interviewing patients to obtain histories of activities and exposures, and by reviewing medical notes. Medical teams sent further clinical specimens for testing (sputum for polymerase chain reaction [PCR], convalescent Legionella serology, and urine for Legionella antigen testing). Further investigation of Legionella pneumophila cases involved obtaining detailed exposure histories, environmental investigations at the suspect source of infection, and taking water and biofilm swabs for Legionella detection and serotyping. RESULTS: Three cases from the cluster were confirmed as, or compatible with, Legionella pneumophila serogroup 2. With the other three cases there was evidence of infection with L. longbeachae (two cases) or respiratory syncytial virus (one case). Exposure histories for the L. pneumophila cases revealed that the three cases had visited a Lower Hutt retail outlet with operating spa pools on display. Legionella pneumophila serogroup 1 was cultured from one of three pools. All pools were positive for Legionella on direct fluorescent antibody testing. CONCLUSIONS: Although unproven, the display spa pools were considered to be the most likely source of Legionella infection in the three cases that had visited the retail outlet. Although Legionella isolated from the pools was a different serogroup from that identified in two cases, the pools were considered to be the most likely source of infection in view of inadequate chlorination of the waters. Public health intervention to address the immediate and longer-term health risks from the pools is described. This is the second outbreak of Legionella pneumophila linked to operating display spa pools in New Zealand and it appears to be the fourth recorded outbreak of Legionnaires' disease associated with operating spa pools on display.

Burn care standards in Israel: lack of consensus.

UNLABELLED: In recent years, the need for a national burn center based on ABA guidelines has emerged in Israel. The formation of such a center is now underway in the Chaim Sheba Medical Center. As a first step in the standardization of burn care in Israel, we have conducted a nation-wide survey among burn care personnel (physicians, nurses and other burn team members), regarding different aspects of the treatment of burn patients. METHODS: A questionnaire comprised of 30 questions regarding the severity of burns admitted, the site of initial management, wound care (both burn/skin-graft sites and donor sites), dressing changes protocols, sterility precautions, hydrotherapy, and pressure dressings was presented to 70 health-care professionals involved in the treatment of burns. RESULTS AND DISCUSSION: Seventy-seven percent of interviewed personnel participated in the survey. Consensus was found regarding most local (topical) wound care, (SSD for clean non-facial burns, Sulfamylon (mafenide-acetate) for contaminated non-facial burns, Threolone (chloramphenicol 3% and prednisolone 0.5%) or Bacitracin for facial burns, Paraffin gauzes with or without Sulfamylon for donor and graft sites). Dressing changes regimes were also agreed upon generally. However, there was no consensus regarding the ideal time for the removal of donor site dressings and this issue will need to be resolved. Other important findings are that both Edinborough University Solution of Lime (EUSOL), which has been deemed unsuitable for burn treatment due to toxic effects, and hydrotherapy, which has been proposed as a source of infection and contamination, are still widely used. We anticipate that these issues will be settled in our unified national burn care protocols (which are currently under development and revision).

Influencia do treinamento fisico no meio aquatico para mulheres na terceira idade / Influence of the aquatic physical exercise on third age womem

Este estudo procurou verificar os efeitos da pratica de exercicios fisicos, em meio aquatico , para pessoas a partir da terceira idade como elemento de promocao da saude.Fizeram parte da amostra 25 sujeitos do sexo feminino na faixa etaria de 57 a 77 anos de idade.Foram realizadas avaliacaoes dos componentes: de antropometria, cardiorespiratorio, flexibilidade coluna/quaril, forca, resistencia muscular localizada, abdominal e forca de preensao manual(AAHPERD,1980;SOARES$SESSA,1983).Foi empregada a estatistica descritiva(media, desvio-padrao e percentual) e a estatistica inferencial atraves do teste "t"de Student, sendo o nivel de significancia estabelecido em p menor 0,05.Ocorreram meloras, estatisticamente significativas, na forca e resistencia muscular abdominal e na capacidade cardiorespiratoria.Como pode ser visto o ganho na esfera psicossomatica foi subjetivamente muito superior que os dados objetivamente coletados e acompanhados pela nossa equipe

North American survey of hydrotherapy in modern burn care.

To investigate the role of hydrotherapy in the treatment of patients with burns, a survey was conducted of the use of hydrotherapy in Canada and the United States as part of an intensive investigation into the causes of Pseudomonas aeruginosa infections in burn injury. Results of the survey conducted indicate that hydrotherapy continues to be an important part of burn wound care in most (94.8%) burn centers in North America. Of the burn centers that use hydrotherapy, 81.4% continue to immerse patients, 82.8% perform hydrotherapy on all patients with burns regardless of total body surface area, and 86.9% continue with hydrotherapy throughout the entire phase of the patient's hospitalization. Routine culturing of the hydrotherapy equipment is standard procedure in 49.7% of the units surveyed, and culturing of the water supply to the equipment on a regular basis is done in only 18.6% of those burn units regularly using hydrotherapy. Pseudomonas aeruginosa was identified as the most common, major cause of sepsis in 52.9% of the burn units surveyed, Staphylococcus aureus in 25.5%, and Candida albicans in 5.2%. This survey demonstrates the extensive use of hydrotherapy in North American burn units and the concern for serious infections in patients with burns from gram-negative organisms such as Pseudomonas species. With the increasing number of reports of Pseudomonas infections related to the use of hydrotherapy equipment, the importance for further investigation into burn wound care with and without hydrotherapy, infection rates, and cost analysis appears to be indicated.