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- Content and Delivery of Physical Therapy in Multiple Sclerosis across Europe: A SurveyPublication . Řasová, Kamila; Freeman, Jenny; Cattaneo, Davide; Jonsdottir, Johanna; Baert, Ilse; Smedal, Tori; Romberg, Anders; Feys, Peter; Alves-Guerreiro, José; Habek, Mario; Henze, Thomas; Santoyo-Medina, Carme; Beiske, Antonie; Asch, Paul Van; Bakalidou, Daphne; Salcı, Yeliz; Dimitrova, Erieta; Pavlíková, Markéta; Štětkářová, Ivana; Vorlíčková, Jana; Martinková, PatriciaBackground: Guidelines and general recommendations are available for multiple sclerosis rehabilitation, but no specific guidance exists for physical therapists. Describing aspects of physical therapy content and delivery in multiple sclerosis and its determinants and analysing whether general recommendations connected with physical therapy are implemented in practice is important for interpreting clinical and research evidence. Methods: An online cross-sectional survey of physical therapists specialized in multiple sclerosis (212 specialists from 26 European countries) was used. Results: There was distinct diversity in service delivery and content across Europe. Perceived accessibility of physical therapy varied from most accessible in the Western region, and least in the Southern region. Sixty-four physical therapists adjusted their approach according to different disability levels, less so in the Eastern region. Duration, frequency and dose of sessions differed between regions, being highest in Southern and Western regions. “Hands on treatment” was the most commonly used therapeutic approach in all apart from the Northern regions, where “word instruction” (providing advice and information) prevailed. Conclusions: The content and delivery of physical therapy differs across Europe. Recommendations concerning access to treatment and adjustment according to disability do not appear to be widely implemented in clinical practice.
- Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled TrialPublication . Sousa, Joana Pereira; Neves, Hugo; Pais-Vieira, MiguelPatients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).
- The Fenix reborn: Occupational therapy in the first humanitarian mission in PortugalPublication . Roldão, ElisabeteIn Portugal, June 2017, there was a large fire, which was considered a national disaster. It led to changes in people's daily routines, affecting their occupational performance and making them vulnerable. At the time, the non-governmental organisation, Doctors of the World, implemented the first humanitarian mission in Portugal–The Hope Mission. This mission, which was made up of a nurse, a community mediator, two occupational therapists, four occupational therapy students and a clinical educator, intervened with the population of the entire affected region. Their main objective was to meet the needs of the people; involving them in significant activities, re-organising their roles and routines, re-structuring their daily lives, increasing their quality of life and their wellbeing and avoiding social isolation. Home visits, group activities and projects were implemented in partnership with community institutions. One of the projects was the (Re)Start Project. An initial assessment was made by the occupational therapists in order to plan the intervention. The project consisted of home visits (where an evaluation of the home context was made), group sessions (cognitive stimulation, motion sessions and group dynamics) and individual sessions (focusing on the performance issue and difficulties experienced by each person undertaking their daily routines). To understand the degree of satisfaction of the participants, specifically in relation to the (Re)Start project, a questionnaire was given to all who participated for more than one month. From analysis of the questionnaires, the conclusion was drawn that participants were satisfied with the activities developed in the project and found them meaningful. The presence of occupational therapy in this scenario was found to be important and made a difference. It would be useful to repeat this type of intervention at a national level, if a further humanitarian crisis occurs, especially in areas with ageing population or which are geographically isolated.
- Is food insecurity related to health-care use, access and absenteeism?Publication . Dias, Sara; Gregório, Maria João; Melo, António; Matias, Maria Ana; Rodrigues , Ana M; Sousa, Rute Dinis de; Canhão,Helena; Perelman, JulianFood insecurity (FI) is defined as uncertain access to healthy food in quantity and quality. We hypothesize that FI may be associated with greater health-care use and absenteeism because it may amplify the effect of diseases; also, FI may be associated with reduced health-care access because it reflects economic vulnerability. The present study estimates the association between FI and health-care use and access, and absenteeism.Design: Cross-sectional data collected in 2015-2016. Health-care use was measured as the number of consultations, taking any drug and having been hospitalized in the past year. Health-care access was measured by the suspension of medication and having fewer consultations due to financial constraints. Absenteeism was measured by the weeks of sickness leave. Binary variables were modelled as a function of FI using logistic regressions; continuous variables were modelled as a function of FI using negative binomial and zero-inflated negative binomial regressions. Covariates were included sequentially.Setting: Portugal.Participants: Non-institutionalized adults from the EpiDoc3 cohort (n 5648).Results: FI was significantly associated with health-care use before controlling for socio-economic conditions and quality of life. Moderate/severe FI was positively related to the suspension of medicines (adjusted OR = 4·68; 95 % CI 3·11, 6·82) and to having fewer consultations (adjusted OR = 3·98; 95 % CI 2·42, 6·37). FI and absenteeism were not significantly associated.Conclusions: Our results support the hypothesis that FI reflects precariousness, which hinders access to health care. The greater use of health care among food-insecure people is explained by their worse quality of life and lower socio-economic condition, so that the specific role of poor nutrition is unclear.