American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention

American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention.

ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention

Download Printable Version [PDF]

Full details of the ACS guidelines ranging from whole grains, fats, alcohol, and daily goals for exercise—to the lifestyle changes that may help prevent breast, colon and other specific cancers.

• American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
• Summary of the ACS Guidelines on Nutrition and Physical Activity
• ACS Guidelines for Nutrition and Physical Activity
• Food additives, safety, and organic foods
• Diet and activity factors that affect risks for certain cancers
• Common questions about diet and cancer

Postoperative orthopaedic rehabilitation protocols

I just came across a wonderful website with many postoperative orthopaedic rehabilitation protocols. Amazing work and useful especially for Physical Therapists that work in hospitals.

I have also found two books that offer a more detailed presentation of port-op orthopaedic treatment guidelines:

1. Treatment and Rehabilitation of Fractures, authors: Stanley Hoppenfeld, Vasantha L. Murthy, publisher: Lippincott Williams & Wilkins.

Written by leading orthopaedists and rehabilitation specialists, this volume presents sequential treatment and rehabilitation plans for fractures of the upper extremity, lower extremity, and spine. The book shows how to treat each fracture--from both an orthopaedic and a rehabilitation standpoint--at each stage of healing.Introductory chapters review the fundamentals of fracture management--bone healing, treatment modalities, biomechanics, assistive devices and adaptive equipment, gait, splints and braces, therapeutic exercise and range of motion, and determining when a fracture is healed. Subsequent chapters focus on management of individual fractures.Each chapter on an individual fracture is organized by weekly postfracture time zones, from the day of injury through twelve weeks. For each time zone, the text discusses bone healing, physical examination, dangers, x-rays, weight bearing, range of motion, strength, functional activities, and gait/ambulation. Specific treatment strategies and rehabilitation protocols are then presented. More than 500 illustrations complement the text.

2. Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition, authors: Lisa Maxey & Jim Magnusson, publisher: ELSEVIER Health Sciences.

With detailed descriptions of orthopedic surgeries, Rehabilitation for the Postsurgical Orthopedic Patient, 3rd Edition provides current, evidence-based guidelines to designing effective rehabilitation strategies. Coverage of each condition includes an overview of the orthopedic patient's entire course of treatment from pre- to post-surgery. For each phase of rehabilitation, this book describes the postoperative timeline, the goals, potential complications and precautions, and appropriate therapeutic procedures. New to this edition are a full-color design and new chapters on disc replacement, cartilage replacement, hallux valgus, and transitioning the running athlete. Edited by Lisa Maxey and Jim Magnusson, and with chapters written by both surgeons and physical therapists, Rehabilitation for the Postsurgical Orthopedic Patient provides valuable insights into the use of physical therapy in the rehabilitation process.

Scapular dyskinesis guidelines

Abnormal movement of the shoulder blade (scapula) is known as scapular dyskinesis. This occurs in a variety of shoulder problems. It is an important sign of an underlying shoulder disorder and a guide to shoulder rehabilitation.

Based on PhysioPedia, intervention is aimed at reducing posterior capsule and pectoralis minor restriction and restoring periscapular mm balance through exercises promoting early and increased serratus anterior, lower, and middle trapezius activation while minimizing upper trapezius activity.

• Manual gr 4 mobilization to reduce posterior capsule tension, cross-body stretch.
• Manual stretching and soft tissue mobilization to decrease pec minor tension (cadaveric studies imply that a position of 150 degrees elevation with 30 degrees scapular retraction is optimal).
• Exercises of sidelying forward flexion, external rotation, prone extension, and prone horizontal abduction to strengthen middle and lower trapezius over upper trapezius.
• Quadruped and variable push-up positions to activate serratus anterior.

Here is a very nice guideline for treating scapular dyskinesis, offered by the Beth Israel Deaconess Center (a Harvard Medical School teaching hospital).

The European Burns Association

The European Burns Association is a non-profit making organisation for the benefit of the public, to promote burn prevention, to study the prevention of burn injury and all other aspects of burn treatment.

It also serves as a resource to facilitate communication and collaboration between burn care specialists. An exchange of information between the various burn centres in Europe will help us to promote the goal of the EBA.

The purpose of this forum is to bring medical specialists, researchers, paramedics, nurses and other workers in contact to discuss aspects of burn treatment and research.

Please now click on www.prevention.euroburn.org to access the Prevention site.

You can also find here the European Practice Guidelines for Burn Care.

Total Knee Replacement exercise booklet

Regular exercise to restore your knee mobility and strength and a gradual return to everyday activities are important for your full recovery. Your orthopaedic surgeon and physical therapist may recommend that you exercise approximately 20 to 30 minutes two or three times a day and walk 30 minutes, two or three times a day during your early recovery.

A beautiful booklet with simple and important exercises published by Thunder Bay Regional Health Science Center.

Ankle injury rehabilitation protocol

A very nice ankle injury rehabilitation protocol from University of British Columbia.

Clinical guidelines for hip fractures in adults

A summary of selected new evidence relevant to NICE clinical guideline 124 ‘The management of hip fracture in adults’ (2011).

An online version also available here.

Clinical guidelines for delirium

Delirium (sometimes called 'acute confusional state') is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. It usually develops over 1–2 days. It is a serious condition that is associated with poor outcomes. However, it can be prevented and treated if dealt with urgently. A person may already have delirium when they present to hospital or long-term care or it may develop during a hospital admission or residential stay in long-term care. Delirium can be hypoactive or hyperactive but some people show signs of both (mixed). People with hyperactive delirium have heightened arousal and can be restless, agitated and aggressive. People with hypoactive delirium become withdrawn, quiet and sleepy. Hypoactive and mixed delirium can be more difficult to recognise.

Guidelines for diagnosis, prevention and management of delirium here.

eorthopod.com

The website eorthopod.com offer you "clear, accurate understandable information about your orthopaedic condition. Start here if you are interested in learning more about the anatomy and cause of your condition, how your doctor will make the diagnosis and what treatment options are available to you."

(suggested to me by my classmate Bita Loftalief)

International perspectives on spinal cord injury

New guidelines published by WHO:

"Every year between 250 000 and 500 000 people suffer a spinal cord injury, with road traffic crashes, falls and violence as the three leading causes. People with spinal cord injury are two to five times more likely to die prematurely. They also have lower rates of school enrollment and economic participation than people without such injuries. Spinal cord injury has costly consequences for the individual and society, but it is preventable, survivable and need not preclude good health and social inclusion. Ensuring an adequate medical and rehabilitation response, followed by supportive services and accessible environments, can help minimize the disruption to people with spinal cord injury and their families. 

The aims of International perspectives on spinal cord injury are to: 

• assemble and summarize information on spinal cord injury, in particular the epidemiology, services, interventions and policies that are relevant, together with the lived experience of people with spinal cord injury;

• make recommendations for actions based on this evidence that are consistent with the aspirations for people with disabilities as expressed in the Convention on the Rights of Persons with Disabilities."

Full report in English

Clinical guidelines for stroke management

The National Stroke Foundation: We are a not-for-profit organisation that works with stroke survivors, carers, health professionals, government and the public to reduce the impact of stroke on the Australian community.

We are the voice of stroke in Australia. Our mission is to stop stroke, save lives and end suffering.

Here is the clinical guidelines they have developed for stroke management.

I have already posted the KNGF's guidelines for stroke patients, too.

Clinical practice guidelines for the management of rotator cuff syndrome in the workplace

The University of New South Wales Rural Clinical School, Port Macquarie has developed guidelines for the clinical management of rotator cuff syndrome in the workplace. Shoulder pain is a common musculoskeletal presentation in primary care practice – both degenerative and acute. As such, it provides a challenge to all involved in prevention and treatment, from patients to clinicians to employers. The primary objective of these guidelines is to provide recommendations, based on current evidence, which will hopefully improve clinical outcomes for workers, employers and health care providers.

PTNow - access to clinical practice guidelines

PTNow is where you live—striving to do the best for your patients, within the constraints of bigger and bigger caseloads, less and less time, and more and more information to look up and assess.

PTNow is in aggressive, constant development. Get an overview of what's available to you and start exploring PTNow.

PTNow's mission is to assist physical therapists and physical therapist assistants in day-to-day practice.

PTNow is designed to:

• Make it easier for you to use the best available evidence in patient care
• Lead you to external resources that have been vetted for relevance and credibility
• Help you improve your efficiency

PTNow will be your "multi-tool":

• Translation tool-for translating research to knowledge for practice
• Implementation tool-for implementing evidence in the evaluation and treatment of patients
• Collaboration tool-for sharing information and strategizing when evidence is lacking

PTNow has the long-term goals of helping the physical therapy profession:

• Reduce unwarranted variation in practice
• Demonstrate the value of physical therapist services to the health care system

Evidence based management of acute musculoskeletal pain

This document is the outcome of a multi-disciplinary review of the scientific evidence for the diagnosis, prognosis and treatment of acute musculoskeletal pain. The evidence is summarised in the form of a management plan and key messages that may be used to inform practice. The aim in conducting an evidence review is to facilitate the integration of the best available evidence with clinical expertise and the values and beliefs of patients.

The project was proposed and coordinated by Professor Peter Brooks, Executive Dean of the Faculty of Health Sciences, The University of Queensland. The guideline development process was overseen by a national steering committee and undertaken by multi-disciplinary review groups. Funding for the project was received from the Commonwealth Department of Health and Ageing.

The evidence review was conducted according to standards outlined by the National Health and Medical Research Council (NHMRC) (1999a) and in accordance with ideas expressed by the pioneer of evidence-based medicine, Dr Archie Cochrane (1977). Cochrane proposed the rationalisation of interventions (both diagnostic and therapeutic) to promote those with evidence of safety and effectiveness. To that end he suggested: promoting diagnostic tests likely to have a beneficial effect on prognosis, evaluating existing interventions to exclude those shown to be ineffective or dangerous, and determining the place of interventions when there is insufficient evidence of benefit.

The Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)

From "Physical Therapy - the Journal of the American Physical Therapy Association and de Fysiotherapeur, the Royal Dutch Society for Physical Therapy":

Abstract

Jules M Rothstein, John L Echternach and Daniel L Riddle

In this era of health care accountability, a need exists for a new decision-making and documentation guide in physical therapy. The original Hypothesis-Oriented Algorithm for Clinicians (HOAC) provided clinicians and students with a framework for science-based clinical practice and focused on the remediation of functional deficits and how changes in impairments related to these deficits. The HOAC II was designed to address shortcomings in the original HOAC and be more compatible with contemporary practice, including the Guide to Physical Therapist Practice. Disablement terminology is used in the HOAC II to guide clinicians and students when documenting patient care and incorporating evidence into practice. The HOAC II, like the HOAC, can be applied to a patient regardless of age or disorder and allows for identification of problems by physical therapists when patients are not able to communicate their problems. A feature of the HOAC II that was lacking in the original algorithm is the concept of prevention and how to justify and document interventions directed at prevention.

Ream the entire article here. It surely worths it either for students, or teachers or even Physical Therapists.

Cardiac rehabilitation: endurance, strength or interval training?

I have already posted the KNGF's guidelines for cardiac rehabilitation. What is interesting to note here is the type of exercise that is recommended by these guidelines.

Let's remember first how this guideline defines cardiac rehabilitation:

"These KNGF clinical guidelines have been devised for the implementation of physical therapy in patients who have had an (acute) myocardial infarction, or who have undergone a coronary artery bypass operation, percutaneous transluminal coronary angioplasty, a heart valve operation, or operative correction of a congenital heart disorder".

Cardiac rehabilitation involves a wide range of activities, such as practicing basic skills and daily life activities,  and sports training. Therapy can take the form of fitness or aerobics exercises, swimming, or exercises in  water. The therapeutic approach chosen must provide the most appropriate and specific way of increasing the patient’s daily activities. If therapy is focused on physical training, use of an ergometer and sports training are involved. ECG and blood pressure monitoring are carried out if indicated by the rehabilitation team.

Examples of training variables are the intensity, frequency and duration of training, and the length of the rest intervals. However, training structure is also important. General indications of training variable values are:

1. Practicing specific functions, skills and activities while encouraging the patient to enjoy exercise: training frequency should be 2–3 times a week.

2. Aerobic exercise: training intensity should be at 40–85% of maximum oxygen uptake and at 11–16 on the Borg scale; training should consist of a warm-up period, aerobic training, and a cooling down period, and should last 20–60 minutes; training frequency should be 3–7 days a week.

Effects of aerobic training on the cardiorespiratory system. Source: Jongert et al.(52)

• lowers heart rate;

• increases heart pump output volume;

• increases heart minute volume during maximum-intensity exercise;

• increases blood volume and hemoglobin level;

• increases artery-vein oxygen differential;

• lowers blood pressure;

• increases VO2-max;

• increases anaerobic threshold;

• increases maximum respiratory minute volume;

• increases ventilation;

• increases lung diffusion capacity;

• increases lung volume and capacity.

3. Strength and aerobic exercise: training intensity should be at 40–50% of maximum strength; each training session should comprise 1–3 sequences of 10–15 repetitions with pauses lasting 1–2 minutes; resistance should increase with time, both relatively and absolutely; training frequency should be 2–3 times a week. Circuit training should last for 20–30 minutes and should consist of a warm-up period, strength training, and a cooling-down period.

Effects of strength training on skeletal muscle. Source : Jongert et al.(52)

• functional hypertrophy;

• increased mitochondrial numbers (mitochondrial hypertrophy);

• increased capillary circulation;

• increase in muscle enzymes;

• increased energy-rich phosphate level.

4. Reduction of risk factors: exercises that have a longer duration, lower intensity and higher frequency are recommended for patients with obesity, hypertension, diabetes mellitus (type-II), and lipid disorders.

Individual exercise programs are devised using the results of tests of maximum symptom-limited aerobic capacity.

The ICF Framework

The WHO's ICF reflects the modern day thinking about disability and embodies a paradigm shift in the way health and disability are understood and measured. ICF is based on a bio-psychosocial model of functioning and disability, in which functioning and disability are multi-dimensional phenomena experienced at the level of the body, the person, and society. In addition, a classification of environmental factors is included that allows users of the ICF to record the positive or negative impact of the environment on a person's functioning.

Continue reading.

After reading this chapter, the reader should be able to:

Understand ICF's model and structure

Appreciate importance of standards to disability statistics

Describe ICF's structure and coding for population data collection

(this link was suggested to me by my classmate Bita Lotfaliei)

Assessment & treatment guidelines_2

After "Assessment & treatment guidelines_1", I am posting the next file with assessment and treatment guidelines for the following cases:

Cervical radicular syndrome
Lumbar radicular syndrome
Collum femoris fracture
Esophagectomy
Coronary artery bypass
WAD
COPD
Scoliosis
L4 fracture
Subcapital humerus fracture
Acute myocardial infarction

Physiotherapy after dynamic hip screw (DHS)

After a fractured hip a dynamic hip screw (DHS) is used to hold the bones in place while the fracture heals.  It allows you to start walking straight after surgery, preventing the complications that can occur if you stay in  bed for long periods.

Physiotherapy is vital to make the most of your surgery and is essential to ensure the success of the operation.

Ream more and find the guidelines for physiotherapy after dynamic hip screw, posted by the The Royal Free London Orgnanization.

Total hip replacement rehab protocol

Ellis & Badenhausen Orthopedics, PSC is dedicated to providing the Louisville community with the highest quality of orthopaedic service. We will ensure that patient care remains the focus of our medical practice by maintaining an experienced staff and by keeping on the forefront of medical technology and research.

The following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance.