Manual and ventilator hyperinflation parameters used by intensive care physiotherapists in Sri Lanka: An online survey

INTRODUCTION

Hyperinflation is a common procedure to clear secretion, increase lung compliance and enhance oxygenation in mechanically ventilated patients. Hyperinflation can be provided as manual hyperinflation (MHI) or ventilator hyperinflation (VHI), where outcomes depend upon the methods of application. Hence it is crucial to assess the application of techniques employed in Sri Lanka due to observed variations from recommended practices.

OBJECTIVE

This study is aimed to evaluate the application and parameters used for MHI and VHI by physiotherapists in intensive care units (ICUs) in Sri Lanka.

METHODOLOGY

An online survey was conducted among physiotherapists who are working in ICUs in Sri Lanka using WhatsApp groups and other social media platforms.

RESULTS

A total of 96 physiotherapists responded. The survey comprised of three sections to obtain information about socio-demographic data, MHI practices and VHI practices. Most of the respondents (47%) worked in general hospitals and 74% of participants had a bachelor's degree in physiotherapy; 31.3% had 3-6 years of experience; 93.8% used hyperinflation, and 78.9% used MHI. MHI was performed routinely and as needed to treat low oxygen levels, abnormal breath sounds, and per physician orders while avoiding contraindications. Self-inflation bags are frequently used for MHI (40.6%). Only a few participants (26%) used a manometer or tracked PIP. In addition to the supine position, some participants (37.5%) used the side-lying position. Most physiotherapists followed the recommended MHI technique: slow squeeze (57.3%), inspiratory pause (45.8%), and quick release (70.8%). VHI was practised by 19.8%, with medical approval and it was frequently performed by medical staff compared to physiotherapists. Treatment time, number of breaths, and patient positioning varied, and parameters were not well-defined.

CONCLUSION

The study found that MHI was not applied with the recommended PIP, and VHI parameters were not identified. The study indicates a need to educate physiotherapists about current VHI and MHI practice guidelines.

Effects of Different Physical Therapy Interventions in Improving Flexibility in University Students with Hamstring Tightness - A Systematic Review and Network Meta-analysis

The aim of the present study was to identify the different interventions for hamstring flexibility among university students with hamstring tightness and to determine the better treatment method.

Design

Systematic review and network meta-analysis. An electronic search of the databases: Medline, Pubmed, Cochrane, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) was conducted. A total of 11 articles were included in the review. Of these articles, 02 were case-control studies, 02 were interventional pre-post studies and 07 were RCTs. The 07 RCTs were included for network meta-analysis. The findings of the initial network meta-analysis (NMA) which compared control i.e., no intervention with other interventions revealed that all the physical therapy interventions: stretching, electrotherapy combined with stretching, massage, dry needling and neurodynamic exercises combined with stretching and neurodynamics alone were superior to control. Since most studies included stretching as an intervention, a second NMA was conducted to compare the different physical therapy interventions with stretching. The results suggested that US-guided neuromodulation (WMD: -5.80, CI: -12.11, 0.51) had large effects on hamstring flexibility compared to stretching and stretching combined with electrotherapy i.e., cryotherapy and ultrasound (WMD: 0.25, CI: -1.14 to 1.64), MET (WMD: 3.10, CI: -3.28 to 9.48) and massage (WMD: 8.05, CI: -11.90 to 27.18) were inferior to stretching. To further investigate the effects of these interventions three meta-analysis were performed. The results revealed that stretching was more effective (SMD 2.27, 95% 0.72 to 3.81, p < 0.01) compared to control (no intervention). Neurodynamic exercises combined with stretching and neurodynamics alone were found to be superior to stretching alone ((SMD -0.69, 95% -1.35 to -0.03, p < 0.01) and stretching combined with electrotherapy was not significantly better than stretching alone ((SMD -0.07, 95% -1.00 to 0.87, p=0.88). Neurodynamic exercises combined with stretching and neurodynamics alone showed to be superior to the other physical therapy interventions in improving hamstring flexibility for hamstring tightness among university students, however, the reliability of the evidence is low.

Sinhala version of the Cornell Musculoskeletal Discomfort Questionnaire: Cross-cultural adaptation and validation

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) are highly prevalent among people who work in sedentary jobs. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) is a valid tool to assess WMSDs, but is not available in the local language of Sri Lanka (Sinhala).

OBJECTIVE

To cross-culturally adapt the original CMDQ from English to Sinhala and evaluate its psychometric properties.

METHODS

The linguistic and cultural adaptation of the CMDQ to the Sinhala (Si-CMDQ) language followed international guidelines. The adapted pre-version was tested for comprehensibility among 32 subjects from different educational and occupational backgrounds. The Content Validity Index (CVI) was computed with ratings from five experts. The questionnaire was validated further by 111 security guards employed at the university. The tool was validated with reference to the Numeric Rating Scale. Test-retest reliability was assessed at two time points one week apart and internal consistency was tested.

RESULTS

The Si-CMDQ showed adequate cross-cultural, content and construct validity, internal consistency, and test-retest reliability. The Kappa coefficient showed excellent agreement between NRS and Si-CMDQ frequency scale. Spearman's correlation coefficients showed a moderate to a strong significant positive correlation between NRS and the severity scale of Si-CMDQ. The Kappa values for test-retest reliability were moderate to excellent for the three scales of CMDQ. The internal consistency was high.

CONCLUSION

The Si-CMDQ fulfilled the psychometric requirement for questionnaires. This tool will be beneficial to assess WMSDs among sedentary workers in different occupations in Sri Lanka.