Friday 29 April 2016

P4R2W4: Steady as you go (SAY Go!)

Lights of Nelson from a plane.

Monday was ANZAC day.
I was in Wellington over the long weekend for a mate's wedding in Silverstream. I took the 30 minute flight across and got to enjoy a birds eye view of Nelson. The wedding was great, and I had a much needed catch up with many of my good friends.



Our research is on the topic falls, and the University of Otago School of Physiotherapy and School of Medicine have some nationally and globally recognised programmes / research in this area... 

  • The 'Otago Exercise Programme' (1997) is one intervention that has been adopted by the CDC (Centre for Disease Control & Prevention) an international advisory group and ACC New Zealand. The 'Otago Exercise Programme' is an strength and balance training intervention for older persons, prescribed by a physiotherapist, and has been shown to reduce falls and fall-related injuries. It involves a home visits and telephone follow-ups and ultimately strives to have individuals successfully self-managing by 12 months. 
  • Steady as you go (SAY Go) New Zealand (not to be confused with the Alberta study of the same name) was developed in 2003. Instead of an individual-based intervention like the 'Otago Exercise Programme', 'SAY Go' drew strengthening and balance training strategies and delivered them in a community setting (a trained peer-led group exercise class).
  • Both interventions demonstrate the effectiveness of balance and strength training, and education for reducing falls (and needless to say, reducing the burden of falls on the individual, their support network including informal carers, as well as the burden on New Zealand health care resources).
My research group is investigating the literature as it pertains to fall prevention strategies, self-efficacy, the individual and their informal carers. This week we have pooled together the fall strategies into a table and found some common themes. There are some interesting quotes from some studies too!

"Nowadays I feel that I don't dare fall, and I feel clumsy. Children often fall, but they don't get hurt much. But if I fall... well, then bad things will happen. I just don't dare fall".
 [~Yikes, this makes ageing seem less desirable!! Steady as you go, people! Haha!~]


On Tuesday we had a conference call with Leigh, Dean of the School of Physiotherapy (a key stakeholder in our research group project). Leigh was in Dunedin, my research group was in Christchurch, and you guessed it - I was in Nelson. We all took this meeting seriously, dressing up in formal attire.... or did we... haha!!

Zoom conference call: Most of my research group in CHCH (top left), myself in Nelson (top right), Dean of the School, Leigh (bottom).
Dress to impress!
More info on our research progress next week!
 

Wednesday 20 April 2016

P4R2W3: Unexpected rest on the ground.

Lighthouse on Nelson's Boulderbank.

Round two of research.

By Thursday we had reviewed, critically appraised each of our included articles and begun looking at review article criteria for submitting to our identified journal. We then made a skeleton outline and detailed aspects we wished to discuss within each section / sub-section... mainly our introduction and methods sections.

And that's about it for the week research-wise.




On Wednesday my flatmate and I went out to the beach for some light painting photography!
...having completed the set tasks / goals for the day.



An advantage of research, for me so far, has been the freedom to sit outside & work in the sun. Nelson is still warm and sunny... and our flat lawn is ideal for studying. That was my unexpected rest on the ground! Haha!! The title of this post also pertains to [a definition of] Accidental Falls... a major research theme for our research project.


Thursday 14 April 2016

P4R2W2: Rally the troops

From Monaco, Nelson

I'm back in Nelson for PHTY459, our research project.



You can spend a whole day searching if you don't know how to search. This was our group on Tuesday... we would search like: 

(‘Falls’ OR 'Trip' OR 'Slip' OR ‘Fall efficacy’ OR ‘Falls Strateg*’ OR ‘Falls prevention’ OR ‘Fall Intervention’) AND (‘Self management’ OR ‘support worker’ OR ‘care giver’ OR ‘Family Support’ OR ‘carer’ OR 'Spouse' OR 'Supportive Assistance') AND (‘Home’ OR ‘Residential’ OR ‘Community’ OR ‘Independent living’) AND (‘Stroke’ OR ‘Cerebrovascular Accident’ OR ‘Parkinson*’ OR ‘Multiple sclerosis’ OR ‘Cerebellar Stroke’ OR ‘cerebral palsy’ OR ‘Falls risk’ OR ‘Disability’ OR ‘Neurological condition’)

=1,542,732 results... most of which are not useful at all.

But really, to get the best results you have to understand how the database is put together... there lies the beauty of MeSH terms. Each database has different filing systems / coding, so you will need to find MeSH terms for each database you look at. They look like this:


(MESH.EXACT("Caregivers") OR MESH.EXACT("Health Personnel")) AND (MESH.EXACT("Self Care") OR MESH.EXACT("Rehabilitation") OR MJMESH.EXACT("Self Care")) AND (MJMESH.EXACT("Accidental Falls")) 

= 5 results... most of which are exactly what we're looking for.

But it's important to recognise that each database MeSH terms are different... here's another database search using MeSH:

("health personnel"[MeSH Terms] or care giver[Text Terms]) AND ("fall prevention"MeSH Terms OR fall prevention[Text Word]) AND Self-management

= 11 results... again, most of these are exactly what we're looking for!


 We've got this party started.


On Wednesday I took my flatmate for a hike up to Angelus Hut in the Nelson Lakes National Park.







 
Friday was back to research and group / Skype meetings! We're still trying to fine-tune our database searches and are thinking about what tools we will use to evaluate our articles.

...
And when the university access to the database fails (not sure why...) it's time to be entertained by comics! Haha!!

Sunday 10 April 2016

P4R2W1: PSW Research Edition.

Old farm house in Nelson

Professional studies week number two!

Monday: we got together to discuss our placement experiences had so far. The students who had completed PHTY458 gave their end of placement presentation - there were a range of topics from treating vertigo, headaches, return to play and music in physiotherapy. Music in physiotherapy was particularly interesting, and was a regular feature of the student's paediatric rehabilitation experience. We were given some homework for Thursday too - a group presentation.


Tuesday: we had morning lectures about Physio Fitt and Green Prescription (the green prescription person forgot to write us into their diary... whoops!) My research group had a meeting with our research supervisor too.

Wednesday: whilst other students went to their area preparation sessions, I whipped up the powerpoint / overview for the group presentation due on Thursday ready for the group meeting at 11am. 

Model of Christchurch Hospital
Thursday: CDHB requirements for safe manual handling! I've already done the Nelson DHB manual handling requirements, but I wasn't sure what would be included in the Canterbury version so I attended this too. The manual handling course was located in the Canterbury DHB Design Lab. The Design Lab is a huge open warehouse-like space where business and the DHB can build mock-ups / sets for rooms or buildings they are designing / building. We used a mock-up for the new Burwood Hospital wards i.e. the rooms were built in this warehouse Design Lab. It was a great experience. The ceiling hoist was a tool that I haven't seen / used before. We were taught many different uses in manual handling for the Slippery Sam (low friction fabric) - including using it to help put a hoist sling on the patient... good to know (often slings are left on patients after a transfer because they are deemed hard to put on/take off... this is not best practice).



Above: peers performing manual handling with a slippery Sam (sheet / material with minimal friction). The second image is the mock patient room that will be in Burwood Hospital (you can see the ceiling hoist by the chair). It reminds me of a oversized dolls house... where we are the dolls.

We had a presentation from a key stakeholder in a new website designed to be a health information hub for Canterbury. The website is: http://www.healthinfo.org.nz/

The Spring presentation series! 
This is a series of  five minute presentations we will give each professional studies week, right through to Spring... it's currently Autumn. The article our group was given was 'Pain worlds: Toward the integration of a sociocultural perspective of pain in clinical physical therapy' by Killick and Davenport (2014). This was an interesting read and I got behind their argument. Here's how we interpreted it / presented the article.
  • The article suggested there was a limited sociocultural perspective in rehabilitation literature and clinical practice. It draws upon sociological theories such as feminism, marxism (capitalism), critical theories (amongst other paradigms) to investigate themes and unravelling sociocultural complexities. This is the premise of a sociological ‘world’. Currently these worlds exist in the art and sports contexts, but not in a rehabilitation context. The article affirms the need for the creation of a rehabilitation world, ultimately to guide rehabilitation practices.
  • The current ICF framework has subcategories within ‘environmental and personal factors’ such as ‘society and individual attitudes, norms, practices and ideologies’, however listing these alone are argued to be insufficient in understanding engrained cultural practices. A rehabilitation world would debunk each of these aspects and provide both dialogue and strategies to understand and influence the sociocultural world of pain. Because no such rehabilitation pain world exists in the literature, this article suggests the Sport’s pain world, an established body of literature, provides evidence that a rehabilitation world would offer practical benefits for rehabilitation practitioners 
  • The authors explain that we develop our own ideas of what pain is and how we present our pain in a socially acceptable manner (pain behaviour). Four factors underpinning this are:
  • Pain talk is the qualitative data received. In the Sports Pain World, pain talk can be categorised / described as: 
    • Hidden pain: hiding pain from others e.g. not telling tramping group you've got blisters.
    • Unwelcome pain: pain is demoralising and must be overcome e.g. it only hurts if you think about it / let it.
    • Combative pain: pain is an enemy, you must fight it e.g. I won't be beaten, I'll keep tramping.
    • Disrespected pain: some pain is more important than others e.g. I don't care about my blisters... I'll stop to rest if I brake my leg.
    • Depersonalised pain: talking about pain as if a separate entity e.g. the wound will heal all by itself - I won't make it worse if I keep going.
    • Pleasurable pain: pain is enjoyable e.g. I know I've done a good day tramping if I've got some blisters, or I tackle hard because it causes other players pain and I know I'm stronger than them.
  • Clinical relevance
    • Practitioners need to listen for pain talk, identify pain behaviours and understand social influences in the patient's environment or their personal factors from the perspective of a 'pain world'.
    • We would then target an intervention, and help the patient to overcome sociocultural barriers and pain - each intervention would be individualised.

Friday: Flu vaccinations!! And a lecture on ethics in clinical practice, particularly discussing topics like receiving gifts and professional practice. A key point was to:
  • Stay professionally and personally connected. Don't become isolated... isolation = distortion.