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To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes. Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention. 88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around). Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF. The 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke. While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.

Background: Joint hypermobility refers to joints that move beyond their normal limits. Individuals with hypermobility of the fingers experience difficulties in activities of daily living. Finger orthoses are available for managing hypermobility of the fingers, but their effectiveness has received little attention in scholarly literature. Objectives: To determine if use of custom fit finger orthoses leads to improvements in time needed to perform standardised hand function tests, and attentional demand required to perform these tests, in individuals with joint hypermobility syndrome, Hypermobile Ehlers-Danlos syndrome or Classical Ehlers-Danlos syndrome. Study design: Repeated-measures study. Methods: Fourteen participants performed three different hand function tests (target box and block test, writing and picking up coins), with and without their finger orthoses. Time to complete each test was recorded as a measure of functional performance. Brain activity was recorded in the pre-frontal cortices as a measure of attentional demand. Results: Functional performance significantly improved for all but one test (picking up coins with non-dominant hand) when participants wore finger orthoses (p 0.05). Conclusions: Results suggested that finger orthoses improved hand function and provided limited evidence to suggest that they may also affect attentional demand. While the limited sample does not provide conclusive evidence supporting the use of finger orthosis in this clinical population, results warrant further investigation in large scale longitudinal studies or randomised controlled trials.

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Walking with a prosthesis requires substantial concentration on behalf of the user and places increased demands on executive functions. Little is known of the effects that prosthetic knee joint prescription may have on executive functioning.Evaluate executive functioning in trans-femoral prosthesis users during single and dual-task walking, before and after they transition to a Microprocessor-controlled prosthetic knee unit.Multiple case-study design.Single and dual task gait was evaluated while recording cortical brain activity. Testing occasion 1 occurred prior to participants receiving their microprocessor-controlled prosthetic knee, while testing occasion 2 was conducted a minimum of 8 months after they had been fitted with an microprocessor-controlled prosthetic knee.During single-task level walking and walking while performing a dual-task key finding test, executive functions, measured as the relative haemodynamic response in the frontal cortex, reduced for most, but not all participants after transitioning to an Microprocessor-controlled prosthetic knee. There did not appear to be any difference when participants performed a trail walk test.Results suggest Microprocessor-controlled prosthetic knee prosthetic knees may have a positive effect on executive functioning for some individuals who have undergone a lower-limb amputation. A larger, longitudinal study with careful control of extraneous variables (e.g. age, training) is needed to confirm results and determine causality.This article provides some evidence to suggest that prosthetic prescription may influence executive functioning and that microprocessor-controlled prosthetic knee mechanisms may reduce cognitive effort when walking.

Background Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses’ perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations. Method Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group. Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct. Result The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach’s alfa 0.90 and ordinal alpha 0.92. Conclusions The PCAS scale has proven to have acceptable validity. The factors,” confidence in provision of care”, “communication” and “patient perspective” are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.

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Police working in active duty have a high prevalence of musculoskeletal pain, with lower back pain being the most frequently reported. As a part of uniform regulations, Swedish police are mandated to wear body armour and duty belts at all times during work. This study aimed to investigate the effect of different load carriage designs on in-vehicle sitting pressure and self-rated discomfort among police. Results showed less discomfort when wearing the alternate load carriage system incorporating a load-bearing vest and thigh holster compared to the standard load carriage system consisting of a duty belt. Pressures in the lower back were reduced when wearing the load-bearing vest whereas pressures in the upper back region increased. Relocating appointments away from the waist has the potential to improve sitting positions and the ergonomic situation for police when driving fleet vehicles. Included in thesis in manuscript form.

BACKGROUND Researchers and clinicians may find it challenging to identify relevant articles about limb prostheses in online databases. Searches may be improved by using standardized strategies, also known as filters or hedges. OBJECTIVES To develop and validate a highly sensitive MEDLINE (EBSCOHost) search strategy for limb prostheses. STUDY DESIGN Search strategy development/validation. METHODS A gold standard (GS) list of peer-reviewed articles on the topic of limb prostheses was created using a relative recall method. This involved identifying and including relevant systematic reviews/meta-analyses and then adding articles that were included in the analysis section of these reviews. Possible terms for the search strategy were identified through brainstorming and exploration of medical subject headings in MEDLINE (MeSH) and standards from the International Organization for Standardization (ISO). Concepts were grouped using relevant Boolean operators (e.g. AND and OR) and database record search fields (i.e. MeSH terms, title, and abstract). Part of the GS was used to refine the search strategy and reduce the number of records retrieved in total. The remaining GS set was used to validate and calculate sensitivity of the search strategy. Performance of the search strategy was compared against searches using only relevant MeSH terms. RESULTS After screening, the final GS totaled 853 records. The developed search strategy was highly sensitive (99.80%) and performed with higher relative recall than searches with relevant MeSH terms. CONCLUSIONS This study provides a highly sensitive search strategy that can be used by clinicians and researchers when searching for relevant literature on limb prostheses in MEDLINE (EBSCOHost).

This document present a protocol for a systematic review aimed at exploring how intercultural competence is evaluated in students studying at higher education institutions.

Aims To explore factors that predict novice nurses’ trust in their ability to provide care in acute situations and identify factors that are related to their perceived ability to make clinical judgements in acute situations. Design Exploratory cross‐sectional study. Methods Novice nurses employed within somatic care in Swedish hospitals completed an online survey. Univariate analysis facilitated exploration of the data and identification of predictor variables with the greatest association with: (1) trust in their own ability (one item) and (2) ability to make clinical judgements (four items). Multivariate binary logistic regression modelling was used to model the likelihood of outcomes based on each predictor variable. Results The two most important predictors related to trust in ability to provide care were duration of work experience and participation in acute situations during nursing education. For clinical judgement, duration of work experience was significant in all four models and experience of acute situations post‐graduation was significant in two models.

Search string utilized in PubMed database search during construction of gold standard for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

SSG search filter checklist proforma for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

Individual search blocks of prosthetics hedges for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

Prosthestics hedges as single strings for copy/paste from Development and validation of a MEDLINE search hedge to identify literature relevant to limb prostheses.

Optimization of original hedge with NOT operator for Development and validation of a MEDLINE search hedge to identify literature relevant to limb prostheses.

Prosthestics hedges as single strings for copy/paste from Development and validation of a MEDLINE search hedge to identify literature relevant to limb prostheses.

Additional file 1. Supplementary table with Item data description.

Individual search blocks of prosthetics hedges for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

Optimization of original hedge with NOT operator for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

Objective: To investigate the potential of an acute bout of transcranial magnetic stimulation to induce anabolic signalling. Design: Experimental intervention on healthy subjects. Subjects: Ten healthy subjects, 5 women and 5 men (mean age 32 years; standard deviation (SD) 4). Methods: Transcranial magnetic stimulation, resulting in contraction of the quadriceps muscles, was applied at a frequency of 10 Hz for 10 s followed by 20 s of rest, repeated 40 times over 20 min. Electromyography and force data were collected for all transcranial magnetic stimulation sequences. Muscle biopsies were obtained from the vastus lateralis muscle before and 1 and 3 h after stimulation for evaluation of the molecular response of the muscle. Results: The described stimulation decreased phosphorylation of AKT at Thr308 (1 h: -29%, 3 h: -38%; pFunding Agencies|Futurum - the Academy for Health and Care, Region Jonkoping County, Sweden; Swedish Society of Medicine

Prosthestics hedges as single strings for copy/paste from Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses.

Articles not indexed in MEDLINE (lacking PMID) for Development and validation of a sensitive MEDLINE search strategy to identify literature relevant to limb prostheses

Today's nurses face complex patient challenges and increased patient acuity. Novice nurses may feel unprepared for some of the tasks facing them. In order to prevent adverse events and improve patient outcomes, the management of acute situations has been identified as an area needing attention. Despite this, it is not yet clear what novice nurses themselves perceive as an acute situation. Therefore, the aim of this study is to describe novice nurses' perceptions of acute situations.The study has a qualitative, descriptive design with a phenomenographic approach. Semi-structured interviews were conducted with twelve novice nurses, with less than a year of working experience, about their perceptions of acute situations.Acute situations are perceived as situations that occur suddenly, that involve shortage of time, or that generate a sense of insufficient personal competence. When acute situations arise, nurses experience a feeling of overwhelming responsibility. Acute situations involve not only deteriorating patient health but can also include challenging interpersonal relations or deficiencies in organisational procedures.An acute situation, as perceived by novice nurses, contains significantly more than medical manifestations related to the patient, a prominent perception being that interpersonal relations are crucial for appropriate management.

There are currently no national competency standards upon which to develop educational objectives for prosthetist/orthotists in Sweden. While standards have been developed in other countries, they cannot be applied without confirming their relevance in a Swedish context.To describe and obtain consensus on core competencies required for newly graduated prosthetist/orthotists in Sweden.Modified Delphi process.A modified Delphi technique was carried out. Focus groups were initially used to identify core competency domains. Two consecutive questionnaires, containing a list of potential competency items, were sent to a group of stakeholders with ties to the prosthetic and orthotic profession. Stakeholders were requested to rate their level of agreement with each competency item and provide written comments. Finally, two focus groups were conducted to obtain feedback on the draft competency standards.Forty-four competency items, listed under five key domains of practice, were identified as essential for newly graduated prosthetist/orthotists in Sweden.Many similarities exist in core competency descriptions for prosthetist/orthotists in Sweden when compared to other countries. Regional differences do however exist, and it is important to confirm the relevance of core competency items at a national level before they are applied. Clinical relevance Competency standards developed in this study can be used to guide development of learning objectives within an undergraduate prosthetic and orthotic program, provide a framework for workforce development, assist professional organizations in understanding the needs of their members, and prepare for international accreditation.

Purpose Musculoskeletal disorders are considered as a major issue affecting the health and well-being of active duty police. Discomfort from wearing mandatory equipment and sitting for long periods of time in fleet vehicles are workload factors linked to musculoskeletal disorders in police. This study aims to determine the prevalence of multi-site musculoskeletal pain among Swedish police and to explore the possible association to discomfort experience when wearing mandatory equipment and sitting for long periods in fleet vehicles. Methods In this cross-sectional study responses from 4185 police were collected through a self-administered online survey including questions about physical work environment, mandatory equipment and musculoskeletal pain. Multi-site pain was determined through summing pain sites from four body regions. Binomial logistic regression was performed to explore the association between multi-site musculoskeletal pain: (1) discomfort from wearing mandatory equipment and (2) sitting for long periods in fleet vehicles. Results The prevalence of multi-site musculoskeletal pain at least 1 day per week within the previous 3 months was 41.3%. A statistically significant association between discomfort from wearing mandatory equipment and multi-site musculoskeletal pain was found; duty belt [OR 5.42 (95% CI 4.56–6.43)] as well as body armour [OR 2.69 (95% CI 2.11–3.42)]. Sitting for long periods in fleet vehicles was not significantly associated to multi-site musculoskeletal pain. Conclusion Multi-site musculoskeletal pain is a considerable problem among Swedish police and modifying mandatory equipment to decrease discomfort is suggested as a potential means of decreasing the musculoskeletal pain experienced by many police officers.

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Background There is an assumption that provision of assistive technologies, such as prostheses and orthoses, will improve the life situation of people with disabilities; however, this issue has been poorly addressed in low- and middle-income country settings. Objective The objective of this qualitative study was to explore the life experience of people who use lower-limb prosthetic or orthotic devices in Cambodia, with a view to identifying areas in which developments can be made to improve the life experiences for prosthesis and orthosis users. Methods Participants were recruited from 1/urban and 2/rural prosthetic and orthotic clinics, run by the same non-governmental organisation. Individual interviews were conducted in 2019 with 15 users of prosthetic or orthotic devices. Interviews were transcribed and analysed using a thematic analysis approach. Results Three themes were identified: 1) A more positive outlook with an assistive device; 2) assistive devices reduce barriers but do not eliminate them and 3) disability creates social exclusion while assistive devices facilitate inclusion. For participants in this study, life without a prosthesis or orthosis was characterised by financial insecurity and a sense of hopelessness. After receiving an assistive device, participants experienced a greater sense of self-worth and empowerment as well as improved functional performance and social interactions. Conclusions Disability was found to affect multiple facets of participants’ lives including physical and psychosocial factors. Prosthetic and orthotic devices were experienced as being enablers of social inclusion and generally improved the life situation for individuals with disabilities in The Kingdom of Cambodia. Attention should be directed towards improving knowledge of, and access to prosthetic and orthotic services, securing a stable income for users and addressing device related problems.

Keeping pace with the ever-growing orthotic and prosthetic profession : New faces and changes at Prosthetics and Orthotics International

Supplemental Material for Effects of knee orthoses on kinesthetic awareness and balance in healthy individuals by Nerrolyn Ramstrand, Terje Gjøvaag, Inger Marie Starholm and David F Rusaw in Journal of Rehabilitation and Assistive Technologies Engineering

Background: Body armour, duty belts and belt mounted holsters are standard equipment used by the Swedish police and have been shown to affect performance of police specific tasks, to decrease mobility and to potentially influence back pain. This study aimed to investigate the effects on gait kinematics and kinetics associated with use of an alternate load carriage system incorporating a thigh holster. Methods: Kinematic, kinetic and temporospatial data were collected using three dimensional gait analysis. Walking tests were conducted with nineteen active duty police officers under three different load carriage conditions: a) body armour and duty belt, b) load bearing vest, body armour and thigh holster and c) no equipment (control). Findings: No significant differences between testing conditions were found for temporospatial parameters. Range of trunk rotation was reduced for both load carriage conditions compared to the control condition (p

Individuals using a lower-limb prosthesis indicate that they need to concentrate on every step they take. Despite self-reports of increased cognitive demand, there is limited understanding of the link between cognitive processes and walking when using a lower-limb prosthesis.The objective was to assess cortical brain activity during level walking in individuals using different prosthetic knee components and compare them to healthy controls. It was hypothesized that the least activity would be observed in the healthy control group, followed by individuals using a microprocessor-controlled prosthetic knee and finally individuals using a non-microprocessor-controlled prosthetic knee.Cross-sectional study.An optical brain imaging system was used to measure relative changes in concentration of oxygenated and de-oxygenated haemoglobin in the frontal and motor cortices during level walking. The number of steps and time to walk 10 m was also recorded. The 6-min walk test was assessed as a measure of functional capacity.Individuals with a transfemoral or knee-disarticulation amputation, using non-microprocessor-controlled prosthetic knee ( n = 14) or microprocessor-controlled prosthetic knee ( n = 15) joints and healthy controls ( n = 16) participated in the study. A significant increase was observed in cortical brain activity of individuals walking with a non-microprocessor-controlled prosthetic knee when compared to healthy controls ( p 0.05) and individuals walking with an microprocessor-controlled prosthetic knee joint ( p 0.05).Individuals walking with a non-microprocessor-controlled prosthetic knee demonstrated an increase in cortical brain activity compared to healthy individuals. Use of a microprocessor-controlled prosthetic knee was associated with less cortical brain activity than use of a non-microprocessor-controlled prosthetic knee.Increased understanding of cognitive processes underlying walking when using different types of prosthetic knees can help to optimize selection of prosthetic components and provide an opportunity to enhance functioning with a prosthesis.

Aims: Police have a high prevalence of musculoskeletal disorders. While physical factors contributing to this have been explored, little is known regarding the contribution of the psychosocial work environment. This study explores the association between elements of the JDC model, social support and multi-site musculoskeletal pain among Swedish police. Methods: In this cross-sectional study, responses from 4185 police were collected using a self-administered online survey. The survey included questions on the psychosocial work environment and musculoskeletal pain, as well as several potential confounding factors. Logistic regression analyses were performed to explore the degree of association between 1) the indices for job demands, job control, social support and multi-site musculoskeletal pain and 2) the four categories of the JDC model, social support and multi-site musculoskeletal pain. Results: The overall psychosocial work environment of Swedish police was characterised by low control and high social support. Police who reported active and high strain jobs were found to have an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.45 (95% CI 1.08–1.94) and 1.84 (1.51–2.24), respectively). High demands, which is a component in the categories for active and high strain jobs, was also found to be associated with an increase in the odds ratio for multi-site musculoskeletal pain (OR 1.66 (1.45–1.91)). High social support was associated with a decrease in the odds ratio for multi-site musculoskeletal pain (OR 0.72 (0.57–0.86)). Conclusions: The psychosocial work environment should be considered when investigating factors related to the health and wellbeing of police.

Background: Prosthetists and orthotists have a responsibility to direct treatment toward enabling their clients to perform desired activities and to facilitate participation of their clients in all areas of life. This may include provision of assistive technologies to help clients meet goals related to participation in sexual activities. To help prosthetic and orthotic students develop competencies in dealing with the sexual health of their future clients, it is necessary to generate knowledge of their own perceived competence and capacity. Objectives: To explore prosthetic and orthotic students’ attitudes and competence toward working with sexual health and to evaluate reliability and validity of the Students’ Attitudes Towards Addressing Sexual Health questionnaire. Study design: Cross-sectional study. Methods: Students enrolled in all three years of an undergraduate prosthetic and orthotic program were requested to complete the Students’ Attitudes Towards Addressing Sexual Health questionnaire (n = 65). Reliability and validity were evaluated using the content validity index and Cronbach’s alpha. Results: Students felt unprepared to talk about sexual health with future clients and thought that they would be embarrassed if they raised the issue. No differences were identified between students enrolled in each of the three years of the program and few differences were observed between male and female students. The content validity index values were low but improved as the students’ level of education increased. Internal consistency of the questionnaire was acceptable (α = 0.86). Conclusion: Prosthetic and orthotic students are unprepared to address sexual health issues with their future clients. There is a need to provide students with training related to sexual health issues. Clinical relevance: This study indicates the need for additional education of prosthetic and orthotic students in issues related to sexual health and how to address sexual health issues with clients. Results can be used to develop training programs for students and will serve to improve the sexual health of individuals who receive prosthetic and orthotic services.

Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses' ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.