Research Report Abstracts - Gesundheit

WPT2011, Research Report Abstracts eS1127
these axes systems forces and moments from the transducer
were converted into external moments acting on the second
metacarpophalangeal joints. Three trials were captured for
repeatability and were time normalised. Each key turning
trial was split into locking and unlocking phases.
Results: During key turning, the peak external moments for
females were in the range of 0.9–1 Nm and for males it was
around 1.8 Nm. Average external moments of the 80+ male
group seemed to be inconsistent, with values being the highest
compared to all age groups. Average moments compared
between males versus females showed that males tend to exert
50% extra as much load at the MCP joint when compared to
females.
Conclusions: Results indicate that moments at the MCP joint
are complex for key turning activities, and the elderly rely
mostly on safety margins due to their concern for accuracy
and also their concern about finishing the task adequately, so
that they can remain functionally able despite the changes
that affect them when ageing.
Implications: A normative database could be established,
which is valid and reliable for a specific functional task. Normative
data are important as they provide a reference base as
well as real information of person’s capabilities.
Keywords: Joint moments; Functional capability; ADL
Funding acknowledgements: University of Strathclyde
postgraduate scholarship.
Ethics approval: Received from the Research Ethics
Committee of the Department of Bioenginnering, University
of Strathclyde.
Research Report Platform Presentation
Number: RR-PL-704 Wednesday 22 June 09:45
RAI: E104-105
THE SAFETY AND EFFECTIVENESS OF ON-CALL
PAEDIATRIC RESPIRATORY PHYSIOTHERAPY IN
INTENSIVE CARE
Shannon H. 1,2 , Gregson R.K. 1,2 , Dunne C. 2 , Stocks J. 1 ,
Main E. 1
1UCL Institute of Child Health, Portex Unit: Respiratory
Physiology and Physiotherapy, London, United Kingdom,
2Great Ormond Street Hospital for Children NHS Trust,
Physiotherapy Department, London, United Kingdom
Purpose: To evaluate respiratory physiotherapy treatment
effects, when delivered by specialist respiratory therapists
(SRTs) and non-respiratory on-call therapists (NRTs).
Relevance: Emergency on-call respiratory physiotherapy
(at nights or weekends) in intensive care is often provided
by physiotherapists who ordinarily work in non-respiratory
areas. NRTs have reported serious concerns with regard to
the safety and effectiveness of their treatments when on-call.
Participants: NRTs (who normally worked in nonrespiratory
fields of paediatric care) and SRTs were recruited
to the study. Mechanically ventilated children who were pharmacologically
paralysed or well sedated, haemodynamically
stable and likely to require two physiotherapy treatments
during one day were also recruited. Written, informed consent
was gained from both the physiotherapists delivering
treatments and the families of participating children.
Methods: Recruited children received two physiotherapy
treatments during a single day, one provided by an SRT,
the other by an NRT, in a randomised order. The NICO2
respiratory monitor recorded changes in lung compliance,
resistance, peak inspiratory pressure and tidal volume before
and after treatments. Adverse events occurring during or up
to 30 minutes after treatments were also recorded.
Analysis: Percentage changes from baseline in respiratory
variables were calculated for 30 minutes after treatment. A
clinically important change was defined as either a change of
>10% in 2 or more outcomes (compliance, resistance, tidal
volume or peak inspiratory pressure) within the same 15minute
period, or a change of >10% in 1 outcome, sustained
over two consecutive 15-minute periods after treatment. The
direction of change defined whether the treatment was effective
or deleterious. The effects of treatments in the SRT and
NRT physiotherapy groups were compared using a Fisher’s
two-tailed exact test.
Results: Sixty five children were recruited to the study.
During treatments, both SRTs and NRTs used a combination
of manual lung inflations, chest wall vibrations, saline
instillation and endotracheal suction. There were clinically
important improvements in respiratory outcomes following
32 (49%) of SRT treatments and 21 (32%) of NRT treatments,
a difference that approached statistical significance
(p = 0.07). Clinically important deteriorations in respiratory
outcomes occurred following almost twice as many NRT
treatments compared with SRT (9 and 5 treatments respectively),
although the relatively low incidence meant the
sample size was too small to detect a statistically significant
difference (p = 0.40). The remaining treatments resulted
in clinically negligible changes. Adverse events occurred
following 3 SRT and 8 NRT treatments, with more severe
adverse events (including one cardiac arrest requiring resuscitation)
following NRT treatments.
Conclusions: While the majority of treatments were safe and
effective in both groups, SRTs delivered a greater number
of effective treatments than NRTs, with fewer deleterious
events.
Implications: The concerns of therapists providing on callservices
were well founded and deserve attention. In order
to reduce the gap in clinical outcomes between on-call and
standard treatments, and raise the standard of on-call physiotherapy,
differences in selection and application of treatment
techniques should be addressed through specific training.
Keywords: Respiratory therapy; Intensive care; Paediatrics
Funding acknowledgements: This study was funded by the
Physiotherapy Research Foundation and the Great Ormond
Street Hospital for Children Special Trustees using equip-