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Biomedical subjects

Annette Swinkels

Publications and source records attributed to Annette Swinkels.

8 recordsLinked to original sources
PubMed2006

Two physiotherapists, one librarian and a systematic literature review: collaboration in action.

AIM: This paper explores the processes of collaboration between a librarian and two academic physiotherapists working on a systematic review jointly funded by the University of the West of England (UWE), Bristol, and the Royal National Hospital for Rheumatic Diseases (RNHRD), Bath, UK. The aim of this paper is to describe and evaluate some of the processes of collaboration between the three authors in their work in progress on a funded systematic literature review on the topic of hydrotherapy and pain. METHODS: The vehicle for describing and analysing these processes is a joint (National Health Service Trust and University) funded systematic literature review currently in progress on the topic of hydrotherapy and pain. RESULTS: Systematic review methodology is becoming increasingly complex and is rapidly developing its own research base. Librarian input is a key element in a successful systematic review. CONCLUSIONS: Systematic reviews play a critical role in informing healthcare delivery and research in the UK. The individual nature and inherent complexity of each review demands close collaboration between librarians, academics and clinicians. In addition to enhancing the reviews themselves, there are many other personal and institutional benefits of collaborative working. Consideration may need to be given to library staff structures and roles if these benefits are to be maximized and sustained.

Cooperative Behavior↗
PubMed2005

Pelvic floor exercises for erectile dysfunction.

OBJECTIVE: To examine the role of pelvic floor exercises as a way of restoring erectile function in men with erectile dysfunction. PATIENTS AND METHODS: In all, 55 men aged > 20 years who had experienced erectile dysfunction for > or = 6 months were recruited for a randomized controlled study with a cross-over arm. The men were treated with either pelvic floor muscle exercises (taught by a physiotherapist) with biofeedback and lifestyle changes (intervention group) or they were advised on lifestyle changes only (control group). Control patients who did not respond after 3 months were treated with the intervention. All men were given home exercises for a further 3 months. Outcomes were measured using the International Index of Erectile Function (IIEF), anal pressure measurements and independent (blinded) assessments. RESULTS: After 3 months, the erectile function of men in the intervention group was significantly better than in the control group (P < 0.001). Control patients who were given the intervention also significantly improved 3 months later (P < 0.001). After 6 months, blind assessment showed that 40% of men had regained normal erectile function, 35.5% improved but 24.5% failed to improve. CONCLUSION: This study suggests that pelvic floor exercises should be considered as a first-line approach for men seeking long-term resolution of their erectile dysfunction.

Adult↗
PubMed2004

Spinal position sense and disease progression in ankylosing spondylitis: a longitudinal study.

STUDY DESIGN: A longitudinal study of spinal position sense in 27 patients with mild ankylosing spondylitis (AS). OBJECTIVES: To test the hypothesis that disease progression in AS is associated with deficits in spinal position sense. SUMMARY OF BACKGROUND DATA: AS is a progressive disease that frequently leads to deterioration in spinal posture. The cause of postural change is unknown. However, pathologic involvement of spinal entheses that contain proprioceptive afferents suggests that impaired pro-prioception may play a role. This study investigates whether longitudinal changes in posture and other measures of disease progression are associated with deficits in spinal position sense in patients with mild AS. METHODS: Position sense was assessed using an electromagnetic movement analysis system, the 3-Space Fastrak, to determine the absolute error in reproducing flexed and upright spinal postures. Measurements were taken from sensors at T1, T7, L1, and S2 and repeated following a mean time interval of 13.7 months. Assessments of posture, disease activity, and function were also made on both occasions. RESULTS: Patients showed a significant increase in disease activity, and losses in spinal mobility, over time. However, no significant changes in spinal posture or position sense were found. Repositioning errors in flexed postures were < or = 3.50 at the first testing session and < or = 3.77 degrees at follow-up. Corresponding values for upright postures were < or = 2.71 degrees and < or = 2.25 degrees, respectively. CONCLUSIONS: Spinal position sense appears unaffected by disease progression in patients with mild AS. Longer follow-ups may help determine any association between disease-related postural change and spinal position sense in AS.

Adult↗
PubMed2004

Spinal position sense in ankylosing spondylitis.

STUDY DESIGN: A cross-sectional comparison of spinal position sense in 50 patients with mild ankylosing spondylitis and 50 healthy controls. OBJECTIVES: To determine if spinal position sense is impaired in patients with mild ankylosing spondylitis. SUMMARY OF BACKGROUND DATA: Pathologic processes in ankylosing spondylitis target sites in the spine where joint capsules, ligaments, and tendons attach into bone. Because these sites contain receptors conveying position sense, proprioception may become impaired, and this may contribute to the spinal deformity that often develops in the more advanced stages of the disease. If deficits in proprioception are apparent then specialized exercise regimes aimed at improving proprioception in ankylosing spondylitis patients could prove beneficial. METHODS: Position sense was assessed in patients and controls by determining the absolute error in reproducing upright and flexed postures in the coronal and sagittal planes using an electromagnetic tracking device, the 3-Space Fastrak (Polhemus, Colchester, VT). Measurements were taken from sensors placed on the skin overlying T1, T7, L1, and S2. In patients, the association between position sense and validated radiographic, disease activity, and functional scores was explored. RESULTS: No deficits in spinal position sense were found in patients with mild ankylosing spondylitis. In these subjects, repositioning errors were < or = 3.88 degrees in flexed postures and < or = 2.76 in upright postures. Corresponding results for controls were < or = 4.86 degrees and < or = 3.42 degrees, respectively. Weak correlations were found between position sense and other ankylosing spondylitis outcome measures, which included indexes of function, disease activity, and posture and mobility, but in all cases, the overall trend was for position sense acuity to improve slightly with more advanced disease. CONCLUSION: Spinal position sense is unaffected in patients with mild ankylosing spondylitis and is therefore unlikely to be a useful outcome measure in this condition.

Adult↗
PubMed2004

Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction.

BACKGROUND: The pelvic floor muscles are active in normal erectile function. Therefore, it was hypothesised that weak pelvic floor muscles could be a cause of erectile dysfunction. AIMS: To compare the efficacy of pelvic floor muscle exercises and manometric biofeedback with lifestyle changes for men with erectile dysfunction. DESIGN OF STUDY: Randomised controlled trial. SETTING: The Somerset Nuffield Hospital, Taunton, United Kingdom. METHOD: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78 years) were enrolled from a local urology clinic. Of these, 28 participants were randomised to an intervention group and engaged in pelvic floor exercises, as well as receiving biofeedback and suggestions for lifestyle changes. Twenty-seven controls were solely advised on lifestyle changes. Baseline, 3- and 6-month assessments were: erectile function domain of International Index of Erectile Function (IIEF), Partner's International Index of Erectile Function (PIIEF), Erectile Dysfunction-Effect on Quality of Life (ED-EQoL), anal manometry, digital anal measurements, and clinical assessment by an assessor blind to treatment allocation. After 3 months, the control group were transferred to the active arm. RESULTS: At 3 months, compared with controls, men in the intervention group showed significant mean increases in the erectile function domain of the IIEF (6.74 points, P = 0.004); anal pressure (44.16 cmH(2)O, P <0.001); and digital anal grades (1.5 grades, P <0.001). All showed further improvement in these outcomes at 6 months. Similar benefits were seen in men of the control arm after transfer to active treatment. A total of 22 (40.0%) participants attained normal function, 19 (34.5%) participants had improved erectile function, and 14 (25.5%) participants failed to improve. CONCLUSION: Pelvic floor muscle exercises and biofeedback are an effective treatment for men with erectile dysfunction.

Adult↗
PubMed2004

Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction: a randomized controlled trial.

PURPOSE: The purpose of this trial was to compare the efficacy of pelvic floor muscle exercises and manometric biofeedback for post-micturition dribble (PMD) in men with erectile dysfunction. METHODS: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78) were enrolled from a local urology clinic. Twenty-eight subjects were randomized to an intervention group and received pelvic floor muscle exercises including a strong post-void "squeeze out" pelvic floor muscle contraction, biofeedback, and suggestions for lifestyle changes. Twenty-seven control subjects were solely advised on lifestyle changes. The PMD status, anal manometry, and digital anal muscle grade were assessed at baseline, 3, and 6 months. After 3 months, the control group received the intervention with pelvic floor muscle exercises and biofeedback. Both groups were followed for an additional 3 months of home exercises. An independent assessor who was blinded to the grouping assessed the PMD status of subjects at 3 and 6 months. RESULTS: Thirty-six (65.5%) of the 55 subjects reported PMD at baseline. At 3 months, there was significant reduction in PMD after intervention (p=0.001) compared to the control subjects (p=0.102). In both groups combined after 3 months of pelvic floor muscle exercises and 3 months of home exercises, 27 (75%) subjects became asymptomatic of PMD, 3 (8.3%) improved, 5 (13.9%) dropped out, and 1 (2.8%) subject still reported PMD. PMD was not correlated to age, erectile function, anal manometric pressure, or digital anal muscle grade. CONCLUSION: Pelvic floor muscle exercises including a post-void "squeeze out" pelvic floor muscle contraction are an effective treatment for post-micturition dribble in men with erectile dysfunction.

Adult↗
PubMed2002

Evidence-based practice in health and social care: where are we now?

This paper explores evidence-based practice (EBP) in health and social care in the UK from the individual perspectives of professionals in physiotherapy, midwifery, nursing and social care. The present interest in EBP emerges as a natural derivative of contemporary economic, social and political trends and concerns. There is optimism and broad acceptance of the overall philosophy of EBP and each profession demonstrates a concerted organisational attempt to bridge the research--practice divide. This includes the interpretation of research outcomes in the form of practice guidelines, protocols and standards. However, adherence to these is poor and resistance to EBP is growing. This is attributed to practical and philosophical tensions common to all of the professions. These include the continued dominance of randomised controlled trials (RCTs) in the hierarchy of evidence. RCTs often fail to capture the multi-faceted individualistic nature of health and social care interactions or the development of qualitative methodologies within the professions. Concern is expressed that professional autonomy and the art of practice will be eroded by the enforcement of guidelines and protocols. EBP is currently located within individual professions rather than the broader context of interprofessional practice. The future of EBP is dependent, at least in part, on educational initiatives, organisational commitment and support, patient/client involvement and the development of a broader interprofessional perspective.

Attitude of Health Personnel↗