Optimizing Recovery: A Systematic Scoping Review of Upper Extremity Exercise Immediately after Cardiac Implantable Electronic Device Implantation.

INTRODUCTION: Cardiac implantable electronic devices (CIEDs), including pacemakers, defibrillators, and resynchronization devices, significantly enhance patient outcomes, reduce sudden cardiac death, and improve health-related quality of life. CIED implantation is associated to persistent shoulder dysfunction in a considerable number of patients one-year post-implantation. This may result in disability, diminished quality of life, work absenteeism, and negative psychological effects. Restoring upper extremity function after CIED implantation should be a standard of cardiovascular care. Our systematic scoping review aimed to summarize available evidence, addressing vital questions about safety, effectiveness, exercise type, and time of exercise initiation immediately after CIED implantation. METHODS: We conducted a comprehensive literature search in 5 electronic databases for original research in English, and a manual search on the references of included studies. We used Rayyan web application for study selection, and PRISMA-ScR to conduct and report the review. We assessed methodological quality using the Cochrane Risk of Bias Assessment Tool and Joanna Briggs Institute critical appraisal checklists. RESULTS: This review included 6 studies that used upper extremity pendular, range of motion, stretching and strengthening exercises. Initiation time varied from the first postoperative day to the second postoperative week. All studies showed significant association between active upper extremity exercise and reduced dysfunction and disability after CIED implantation. There were no significant differences in complication rates between control and experimental groups. CONCLUSION: A limited number of low-to-average quality studies suggest active upper extremity exercise immediately after CIED implantation is safe, effective at reducing dysfunction, and improves quality of life. Higher-quality studies are needed to validate these findings.

Validation of Internal structure of Self-Directed Learning Readiness Scale among Indian Medical Students using factor analysis and the Structural equation Modelling Approach.

BACKGROUND: The Self-Directed Learning Readiness Scale (SDLRS) is a tool that helps in the assessment of the readiness of the students to pursue Self-Directed Learning (SDL). There are no documented studies on the validation of internal structure of the SDLRS among Indian medical students. Hence, the objective of this study is to validate the internal structure of SDLRS among Indian medical students using factor analysis and the Structural Equation Modelling (SEM) approach. METHODS: We administered Fisher's 40-item SDLRS to 750 students after receiving the ethics clearance and the author's permission and taking written informed consent from all the study participants (response rate: 92%). The exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach's alpha were performed using SPSS version 25 and the Lavaan package of R version 3.1.2. RESULTS: The values of the comparative fit index (CFI), standardised root-mean-square residual (SRMR), and root mean square error of approximation (RMSEA) were ≥ 0.9, ≤ 0.08, and ≤ 0.08, respectively, for a model fit to be acceptable. EFA showed that except for Q2 (loading score: 0.210), Q12 (loading score: 0.384), Q13 (loading score: 0.362), and Q25 (loading score: -0.219), all the items loaded well. After the exclusion of the aforementioned items, the factor loading scores for the items in the self-management, desire for learning, and self-control factors ranged from 0.405 to 0.753 (Cronbach α: 0.775), 0.396 to 0.616 (Cronbach α: 0.730), and 0.427 to 0.556 (Cronbach α: 0.799), respectively. The updated model was used for CFA, which displayed a good model fit. CONCLUSIONS: The resultant model consisting of 36 items is shown to have internal structure validity for Indian version of SDLRS, which can be used to assess medical students.

Beyond COVID-19: Evidence-Based Consensus Statement on the Role of Physiotherapy in Pulmonary Rehabilitation in the Indian Context.

Post COVID-19 sequelae includes breathlessness, weakness, fatigue, decreased exercise tolerance and impaired quality of life. Physiotherapy based rehabilitation program is an essential component for post COVID-19 patients in facilitating maximum functional recovery. Expert consensus statements are available from the developed countries. There is a need for a guidelines to manage post COVID-19 sequelae in Indian context. The objective of this consensus statement is to provide evidence informed guidelines for post COVID-19 physiotherapy management as a component of pulmonary rehabilitation. This consensus statement was developed by expert panel across India. Published literatures were appraised and used to prepare the recommendations. This is the first of its kind of work providing preliminary guidelines for post COVID-19 physiotherapy.

Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup.

BACKGROUND: With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS: Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS: The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION: This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE: Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.

Knowledge, attitudes, and barriers towards evidence-based practice among physiotherapists in Malaysia.

BACKGROUND: Recently, there has been an increased need for all healthcare disciplines to provide interventions that are effective and evidence based. This has led to more implementation of evidence-based practice (EBP) in clinical settings. Following this, research regarding EBP gained attention to determine its uptake into the physiotherapy profession. Although there are numerous studies to determine the attitudes and barriers of physiotherapists towards EBP, most of them were done in developed nations. As for Malaysia, little research has been carried out, much less among physiotherapists. PURPOSE: The purpose of this study was to identify the knowledge, attitude, and barriers towards the implementation of EBP among physiotherapists in Malaysia. METHODS: A survey was conducted among the members of the Malaysian Physiotherapy Association and other practicing therapists in Malaysia. One hundred and two responses were collected throughout a span of 2 months. RESULTS: Respondents agreed that EBP is necessary to practice and that it helps in decision making as well as improving patient care. Eighty-one percent of the respondents either agreed or strongly agreed that they had received formal training in EBP. However, 61% of the respondents reported that strong evidence is lacking to support their interventions. Thirty percent of the respondents reported reading <2 articles per month, with 57% stating that they read two to five articles in a typical month. This study also found time constraints, limited access to search engines, and lack of generalizability of research evidence as the top three barriers to implementing EBP. CONCLUSION: Physiotherapists in Malaysia had a positive attitude towards EBP and are inclined towards implementing evidence into their clinical practice. They are interested in attending courses to improve their knowledge and skills in EBP.

Nurse's perceptions of physiotherapists in critical care team: Report of a qualitative study.

BACKGROUND: Interprofessional relationship plays a major role in effective patient care. Specialized units such as critical care require multidisciplinary care where perception about every members role may affect the delivery of patient care. The objective of this study was to find out nurses' perceptions of the role of physiotherapists in the critical care team. METHODS: Qualitative study by using semi-structured interview was conducted among the qualified nurses working in the Intensive Care Unit of a tertiary care hospital. The interview consisted of 19 questions divided into 3 sections. Interviews were audio recorded and transcribed. In-depth content analysis was carried out to identify major themes in relation to the research question. RESULTS: Analysis identified five major issues which included role and image of a physiotherapist, effectiveness of treatment, communications, teamwork, and interprofessional relations. Physiotherapists were perceived to be an important member of the critical team with the role of mobilizing the patients. The respondents admitted that there existed limitations in interprofessional relationship. CONCLUSION: Nurses perceived the role of physiotherapist in the critical care unit as an integral part and agreed on the need for inclusion of therapist multidisciplinary critical care team.

Passive movements for the treatment and prevention of contractures.

BACKGROUND: Contractures, a common complication following immobility, lead to restricted joint range of motion. Passive movements (PMs) are widely used for the treatment and prevention of contractures; however, it is not clear whether they are effective. OBJECTIVES: The aim of this review was to determine the effects of PMs on persons with contractures or at risk of developing contractures. Specifically, the aim was to determine whether PMs increase joint mobility. SEARCH METHODS: We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid SP), EMBASE (Ovid SP), ISI Web of Science (SCI-EXPANDED; SSCI; CPCI-S; CPCI-SSH), PEDro and PsycINFO (Ovid SP). The search was run on 21 November 2013. SELECTION CRITERIA: Randomised controlled trials of PMs administered for the treatment or prevention of contractures were included. Studies were included if they compared the effectiveness of PMs versus no intervention, sham intervention or placebo in people with or at risk of contracture. Studies that involved other co-interventions were included, provided the co-interventions were administered in the same way to all groups. Interventions administered through mechanical devices and interventions that involved sustained stretch were excluded. DATA COLLECTION AND ANALYSIS: Three independent review authors screened studies for inclusion. Two review authors then extracted data and assessed risk of bias. Primary outcomes were joint mobility and occurrence of adverse events such as joint subluxations or dislocations, heterotopic ossification, autonomic dysreflexia and fractures or muscle tears. Secondary outcomes were quality of life, pain, spasticity, activity limitations and participation restrictions. We used standard methodological procedures as advocated by the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: Two identified studies randomly assigned a total of 122 participants with neurological conditions comparing PMs versus no PMs. Data from 121 participants were available for analysis. Both studies had a low risk of bias. One within-participant study involving 20 participants (40 limbs) measured ankle joint mobility and reported a mean between-group difference of four degrees (95% confidence interval (CI), two to six degrees) favouring the experimental group. Both studies measured spasticity with the Modified Ashworth Scale, but the results were not pooled because of clinical heterogeneity. Neither study reported a clinically or statistically relevant reduction in spasticity with PMs. In one study, the mean difference on a tallied 48-point Modified Ashworth Scale for the upper limbs was one of 48 points (95% CI minus two to four points), and in the other study, the median difference on a six-point Modified Ashworth Scale for the ankle plantar flexor muscles was zero points (95% CI minus one to zero points). In both studies, a negative between-group difference indicated a reduction in spasticity in the experimental group compared with the control group. One study with a total of 102 participants investigated the short-term effects on pain. The mean difference on a zero to 24-point pain scale was -0.4 points in favour of the control group (95% CI -1.4 to 0.6 points). The GRADE level of evidence about the effects of PMs on joint mobility, spasticity and pain is very low. Neither study examined quality of life, activity limitations or participation restrictions or reported any adverse events. AUTHORS' CONCLUSIONS: It is not clear whether PMs are effective for the treatment and prevention of contractures.

A comparison of physiotherapy students' perception about blended learning with online learning during COVID-19 pandemic: A mixed method of study.

BACKGROUND: The COVID-19 pandemic has affected face-to-face teaching across the globe. The sudden shift in learning methods has impacted learning experiences significantly. Students' perception about online compared to blended learning might affect learning. The objective of this study was to evaluate physiotherapy students' perception of blended compared to online learning. MATERIALS AND METHODS: This mixed-method study documents physiotherapy students' perception about the courses delivered through blended learning (BL) mode during the COVID-19 pandemic. Physiotherapy graduates and postgraduate students who completed their evidence-based physiotherapy practice courses at Sri Ramachandra Institute of Higher Education and Research, Chennai (N = 68) participated in this study. The participants' perceived experience about synchronous online mode and BL during the pandemic was assessed using a questionnaire and focus group discussion. RESULTS: All the participants felt that the course outcomes were met and that they gained knowledge and skills in evidence-based practice. Most of the students (93%) recommended a blended mode of learning compared to online learning alone. Thematic analysis of the focus group discussion (FGD) identified enhanced learning experience, collaborative learning as enablers to BL, and availability of gadgets and quality of online contents as barriers. CONCLUSION: Participants showed par preference for blended learning over online learning as it provided flexibility and facilitated active learning compared to online learning alone.

Interventions for prevention and treatment of vulvovaginal candidiasis in women with HIV infection.

BACKGROUND: Vulvovaginal candidiasis (VVC) is one of the most common fungal infections that recur frequently in HIV infected women. Symptoms of VVC are pruritis, discomfort, dyspareunia, and dysuria. Vulval infection presents as a morbiliform rash that may extend to the thighs. Vaginal infection is associated with white discharge, and plaques are seen on erythematous vaginal walls.Even though rarely or never resulting in systemic fungal infection or mortality, left untreated these lesions contribute considerably to the morbidity associated with HIV infection. Prevention and treatment of this condition is an essential part of maintaining the quality of life for these individuals. OBJECTIVES: -To compare the efficacy of various antifungals given vaginally or orally for the treatment and prophylaxis of VVC in HIV-infected women and to evaluate the risks of the same. SEARCH STRATEGY: The search strategy was comprehensive, iterative and based on that of the HIV/AIDS Cochrane Review Group. The aim was to locate all relevant trials, irrespective of publication status or language. Electronic databases :CENTRAL,Medline, EMBASE, LILACS and CINAHL were searched for randomised controlled trials for the years 1980 to 1st October 2010. WHO ICTRP site and other relevant web sites were also searched for conference abstracts. SELECTION CRITERIA: Randomised controlled trials (RCTs) of palliative, preventative or curative therapy were considered. Participants were HIV positive women receiving one or more of the following:treatment / prophylaxis for VVC or HAART(Highly Active Antiretroviral Therapy). DATA COLLECTION AND ANALYSIS: Three authors independently assessed the methodological quality of the trials and extracted data. The quality of the evidence generated was graded using the GRADE PRO approach. MAIN RESULTS: Our search did not yield any trial investigating treatment of VVC in HIV positive women.Two trials dealing with prophylaxis were eligible for inclusion.One trial (n= 323) favoured the use of weekly Fluconazole as compared to placebo (RR 0.68; 95% CI 0.47 to 0.97).The second trial with three arms of comparison;Clotrimazole,Lactobacillus and Placebo gave no definitive results in preventing an episode of VVC. Clotrimazole against placebo (RR 0.49; 95% CI 0.22 to 1.09), Clotrimazole against lactobacillus (RR 1.11; 95% CI 0.45 to 2.76) and lactobacillus against placebo (RR 0.54 ;95% CI 0.26 to 1.13). AUTHORS' CONCLUSIONS: Implications for practiceNo trials were found addressing treatment of VVC in HIV positive women.In comparison to placebo,Fluconazole was found to be an effective preventative intervention. However, the potential for resistant Candida organisms to develop might impact the feasibility of implementation.Direction of findings suggests that Clotrimazole and Lactobacillus improved the prophylactic outcomes when compared to placebo.Implications for research There is a need to evaluate drugs and drug regimens for VVC treatment and prophylaxis in HIV positive women through randomised clinical trials. Development of resistance to azoles remains under-studied and more work must be done in this area, so as to determine whether routine prophylaxis for VVC is at all needed or whether adequate ART would be sufficient to prevent recurrent VVC. The viral load in vaginal secretions with or without treatment or prophylaxis has not been studied, this is very relevant to the spread of HIV.

Evaluating the effectiveness of an online faculty development programme for nurse educators about remote teaching during COVID-19.

OBJECTIVE: Engaging learners during the COVID-19 pandemic is a significant challenge for educators. The pandemic has propelled the popularity of online learning, with Google Classroom being widely used by educational institutions as a remote learning platform. This study aimed to evaluate the impact of an online faculty development programme on nurse educators' perceived competency in creating and delivering e-content using Google Classroom and other freely available digital tools. METHODS: A pre-experimental design was adopted for the research. A six-module online faculty development course was conducted for 24 nurse educators of an affiliated nursing college, over a period of eight days. A debriefing session was held on ninth day after the completion of the course. A 10-item rating scale was used to assess the participants' perceptions of their competency in using Google Classroom and other digital tools for online teaching before and after the online faculty development course. RESULTS: Out of 24 trained participants, 18 completed the post-evaluation rating scale, giving a response rate of 75%. In the post-evaluation phase, a high level of competency was perceived by 83.3% of participants for using Google Classroom and 66.7% for creating video lectures and using an online grade book. A statistically significant difference (p < 0.001) between pre- and post-course evaluations was observed. CONCLUSION: This study shows that the online faculty development programme enhanced the perceived skills of faculty members in effectively delivering online teaching using various digital tools during the pandemic.

Entry level nursing graduate students' perception and readiness toward online component of blended learning: A mixed method study.

BACKGROUND: Blended learning (BL), the integration of online with face to face teaching, is established as a teaching method in higher education. Understanding the learner's readiness toward online component of BL is important in designing and delivering BL. Nursing students require proficiency in interpersonal relationship and social interaction apart from knowledge and skills. BL may provide an opportunity to acquire the professional skills better than the traditional face to face sessions. The objectives of this study were to identify the nursing student's readiness toward BL and perceptions about the online learning component of BL. MATERIALS AND METHODS: First- and second-year entry level graduate nursing students of Sri Ramachandra Institute of Higher Education, Chennai, India, were the participants of the study. This study used a mixed method approach. An online questionnaire, developed based on the literature and expert consensus, was used in the first phase. A focus group discussion (FGD) with ten random participants of the survey was conducted to understand the perceptions and readiness to adopt the online component of BL. The present study was conducted from December 2019 to January 2020. Survey results were analyzed through descriptively. Content analysis was carried to summarize FGD results. RESULTS: A total 158 students of entry level nursing graduate programme participated in the survey. 53.8% of felt BL will have positive effect on their learning and 70% of the respondents were ready to adopt BL. The FGD identified two themes: (I) Readiness to adopt online learning as a component of BL and (II) perceived barriers and challenges in adopting online contents. CONCLUSION: Entry level nursing graduate students had a positive perception about the online components. Majority of them are confident in accessing the online contents. Willingness to learn through online, previous experience with online learning, and perceived advantages of online component might influence the learner's readiness. Availability of internet and absence of teachers were perceived as the barriers to online learning by the participants.

Blended learning and health professional education: Protocol for a mixed-method systematic review.

Blended learning (BL) refers to a systematic teaching method, which combines the aspects of face-to-face and online interactions using appropriate Information and Communication Technologies. This mixed-method systematic review (SR) protocol is developed with the objective to determine the effectiveness and appropriateness of BL in the health-care professional education. Mixed-method SR protocol: For the purpose of this SR, PICO is defined as P-entry level graduate students of health sciences program; I-BL; C-traditional face-to-face training; and O-achievement of learning outcomes, learner's and teacher's perception (primary). The search will be done through possible database using predetermined search strategy. Eligible studies will be appraised independently by authors. Joanna Briggs Institute's mixed-method protocol will be used to assess and synthesis the data. This protocol is registered with the International Register of Systematic Reviews (PROSPERO) with the registration number CRD42018082699.

Acute changes in arterial stiffness following exercise in people with metabolic syndrome.

BACKGROUND: This study aims to examine the changes in arterial stiffness immediately following sub-maximal exercise in people with metabolic syndrome. METHODS: Ninety-four adult participants (19-80 years) with metabolic syndrome gave written consent and were measured for arterial stiffness using a SphygmoCor (SCOR-PVx, Version 8.0, Atcor Medical Private Ltd, USA) immediately before and within 5-10min after an incremental shuttle walk test. The arterial stiffness measures used were pulse wave velocity (PWV), aortic pulse pressure (PP), augmentation pressure, augmentation index (AI), subendocardial viability ratio (SEVR) and ejection duration (ED). RESULTS: There was a significant increase (p<0.05) in most of the arterial stiffness variables following exercise. Exercise capacity had a strong inverse correlation with arterial stiffness and age (p<0.01). CONCLUSION: Age influences arterial stiffness. Exercise capacity is inversely related to arterial stiffness and age in people with metabolic syndrome. Exercise induced changes in arterial stiffness measured using pulse wave analysis is an important tool that provides further evidence in studying cardiovascular risk in metabolic syndrome.

Effect of an IT-supported home-based exercise programme on metabolic syndrome in India.

Summary We studied the effectiveness of a home-based exercise programme with information technology (IT) support in people with metabolic syndrome in India. Ninety-four participants with metabolic syndrome (mean age 50 years) were randomized into two groups. Both groups received a 12-week home exercise programme and Group 2 received additional IT support for health education. Before and after the exercise programme, participants were measured for arterial stiffness using applanation tonometry, exercise capacity using an incremental shuttle walk test and quality of life (QoL) using the SF-36 questionnaire. Sixty-one participants completed the post intervention tests. There was a significant reduction in systolic blood pressure, mean pressure and aortic systolic pressure in both groups. Pulse wave velocity, aortic pulse pressure and aortic diastolic pressure showed significant reductions only in Group 2. There were no significant changes in QoL measures, except vitality in Group 2. There was significant improvement in fasting blood glucose in Group 2, cholesterol in Group 1 and triglycerides in both groups. The participants' exercise capacity did not change significantly, although the mean duration of regular exercise was 7.2 weeks for Group 1 and 10.0 weeks for Group 2 (P = 0.019). Metabolic syndrome was reversed in 16% of the participants in both groups. IT support, through mobile text messages and phone calls, may be helpful in metabolic syndrome. Longer-term studies are now required.

Physical fitness and activity levels among urban school children and their rural counterparts.

OBJECTIVE: To evaluate and compare physical activity and physical fitness among urban school children and their rural counterparts. METHODS: This cross sectional study included children aged between 9 and 13 y in eight middle schools; 4 urban and 4 rural. Data on health related fitness parameters was obtained by using the procedures described in the Euro fit physical fitness test manual. The data regarding physical activity was collected by using the Self Administered Physical Activity Checklist (SAPAC). RESULTS: Six hundred and fifty subjects (341 rural and 309 urban) with the mean age 10.84 in rural and 10.85 in urban were included. This study showed statistically significant differences in the height, weight, BMI and SAPAC score between the rural and urban children. Also, rural children were more flexible (mean SRT = 23.42 cm) with a good cardiovascular endurance when compared to their urban counterparts. CONCLUSIONS: The results reveal that rural children performed better in flexibility and cardio vascular endurance tests when compared to their urban counterparts. Promotion of health related fitness involves physical activity associated with weight management which is the prime need of the hour.