Critically Appraised Topics

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Now showing 1 - 5 of 162
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    Evaluating Strategies to Use for Decreasing Operating Room Turnaround Time
    (Creighton University, 2024-05-11) Neal, Leslie
    Operating room turnaround times are continuously scrutinized by surgeons and hospitals, as operating rooms generate the most revenue for a hospital. Texas Childrens Hospital specifically has notably lengthy turnarounds. As costs of healthcare continue to increase, it is important to address the operating room utilization, and the techniques equipped by the team to smoothly transition from one operating room to another. There are many factors that can have a significant impact on the length of an operating room turnaround. These can include: type of surgery and severity of patient illness, so it is important to address the factors that are possible to address, and provide recommendations in order to decrease this time. This is important because the impact of not turning an operating room around quickly has severe implications on patient satisfaction, financial stability and staff satisfaction. A literature review of 11 articles found three similar recommendations including implementing the Lean Six Sigma methodology, a PIT crew approach to turning around a room, and lastly scheduling consistent staff and surgeons in specific rooms. These recommendations implemented with the STAR theoretical framework written by Dr. Stevens, should have a great impact on the operating room turnarounds for the patients and staff at Texas Childrens Hospital
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    Effectiveness of Electrical Stimulation on Improving Upper Extremity Function for Adults with Spinal Cord Injury
    (Creighton University, 2025-05) Hiebert, Isaac; Juffer, Mara; Miles, Kyra; Stegeman, Grace
    Background: Spinal cord injuries (SCIs) affect up to 500,000 individuals worldwide annually, with significant physical, psychological, social, and financial implications. The physical limitations that come with SCIs, such as decreased upper extremity (UE) function, can lead to decreased participation in society and daily activities. Decreased independence in meaningful activities can lead to a lower quality of life for individuals with SCIs. Aim: The aim of this critical analysis topic (CAT) is to highlight the critical role of occupational therapy in SCI recovery and analyze the research on the use and effectiveness of electrical stimulation techniques in facilitating recovery of upper extremity function and promoting independence in desired activities. Method: Articles included in this review were peer-reviewed, published in 2013 or later, categorized as Level IB and Level IIB studies, composed of articles with a study population of individuals that have sustained a spinal cord injury, and included electrical stimulation techniques as a component of the intervention. Students critically analyzed articles using the inclusion criteria to synthesize the information. Students then used the information to develop implications for occupational therapy practice. Results: Protocols for electrical stimulation will vary based on the individuals' strengths, areas of improvement, and goals, but research indicates that use of electrical stimulation in adjunct with task-specific training, massed practice, or other purposeful client-centered interventions can lead to improved upper extremity function in individuals with SCI. Electrical stimulation in conjunction with other therapies can promote increased participation in self-care activities by improving upper extremity strength, dexterity, range of motion, and sensation. Further research on electrical stimulation for patients with SCI should incorporate larger sample sizes in order to generalize results.
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    Effects of Electrical Stimulation on Spinal Cord Injury to Improve Activities of Daily Living
    (Creighton University, 2024-04) Baker, Evonne; Jones, Samantha; McKenzie, Mia; Ross, Sara; Schumacher, Grace
    ABSTRACT BACKGROUND: In the US, around 302,000 people have experienced traumatic SCIs, with motor vehicle accidents being a leading cause (National Spinal Cord Injury Statistical Center, 2023). Depending on the severity of the injury, individuals with SCI may encounter posttraumatic complications, musculoskeletal problems, skin-related complications, bowel/bladder issues, and mental health concerns, which can make it more challenging to carry out basic tasks such as grooming, oral hygiene, eating/feeding, bathing, dressing, toileting, and sexual activities (Atchison & Dirette, 2023). Electrical stimulation has several benefits including strengthening or preventing disuse atrophy during or following immobilization or inactivity, maintaining or “improving range of motion (ROM), facilitating voluntary motor control, decreasing edema through muscle pumping action, decreasing spasticity and muscle spasm, facilitating sensory neural pathways, and acting as a substitute for orthotic devices (Bracciano, 2022). AIM: This critically appraised topic (CAT) is aimed at determining the effectiveness of electrical stimulation for adults with spinal cord injuries (SCIs) on improving activities of daily living (ADL) performance. METHODS: Literature search analysis led to the inclusion of Level 2A and 2B studies regarding the prioritized aim. Studies were further analyzed to include literature within the last ten years which met the following criteria: adults with incomplete or complete spinal cord injury participating in a form of electrical stimulation to increase performance of activities of daily living. Seven studies that met the established standards were included. RESULTS: Level 2A and 2B research completed on the use of electrical stimulation for SCI has revealed moderate evidence for the effectiveness of using electrical stimulation to improve ADL performance in clients with SCIs. Further research should include randomized control trials with larger sample sizes and systematic reviews to increase the strength of evidence for electrical stimulation and to determine [p-0[optimal parameters for increased client performance and outcomes.
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    What is the effectiveness of virtual reality on increasing upper extremity function in adults diagnosed with a CVA?
    (Creighton University, 2024-04-26) Belanger, Emily; Howatt, Hannah; Springer, Bliss; Wolfe, Folasade
    ABSTRACT BACKGROUND: The Centers for Disease Control and Prevention (CDC) estimate that every 40 seconds someone in the U.S. has a stroke, with a death occurring from a stroke every 3 minutes and 14 seconds (2021). According to Mayo Clinic (2024), common side effects of stroke include hemiparesis, dysphagia, aphasia, memory loss, emotional dysregulation, pain, and limitations in performing activities of daily living (ADLs). Not only does upper extremity dysfunction affect a person’s physical performance, but it also impacts their emotions, cognition, and behaviors influencing their health and well-being (Poltawski et al., 2016). It is estimated that 70% of stroke patients will experience upper extremity dysfunction (Uchiyama et al., 2024). Recently, the use of virtual reality (VR) has been explored as an alternative or adjunctive treatment to conventional therapies to treat upper extremity dysfunction following a stroke. Interventions utilizing VR typically include the use of active participation in a simulated environment that is either non-immersive (on a screen), semi-immersive (extended visual display), or fully immersive using a headset (AOTA, 2020). AIM: The aim of this critically acclaimed topic (CAT) is to determine the effectiveness of virtual reality interventions on increasing upper extremity function in adults post-CVA. METHODS: Multiple databases were searched for level 1A and 1B articles that studied the effects of various virtual reality interventions and their impact on upper extremity function. The articles were further condensed to include only those published within the past four years. These seven articles had at least one outcome measure that focused on upper extremity function utilizing virtual reality interventions. RESULTS: Articles appraised included Level 1A and 1B evidence, which were shown to demonstrate a strong level of support for the use of virtual reality interventions with patients following their stroke to increase overall upper extremity function. Further research with high levels of evidence (systematic reviews and meta-analyses of homogenous RCTs) are recommended, however, including those with larger sample sizes, more restrictive inclusion criteria, longer lengths of studies, and efforts to reduce bias to build upon the current literature available.
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    What is the effectiveness of electrotherapy in reducing pain in adults with hemiplegic shoulder?
    (Creighton University, 2024-04) Barnes, Sophia; Christensen, Libby; Kerr, Kaylee; Meekin, Lindsay; Schmal, Makenna
    BACKGROUND: Hemiplegic shoulder is an upper extremity cognition that occurs two to three months following a stroke with a reported incidence between 16-84%. Hemiplegic shoulder can result in reduced limb movement, pain, longer hospital stays, and an overall decrease in quality of life. These implications can impact their ability to engage in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). AIM: The critically appraised topic (CAT) is aimed at determining the effectiveness of electrotherapy in reducing pain in adults with hemiplegic shoulder. METHODS: Literature search analysis led to the inclusion of Level 1A, 1B, and 2B studies regarding the prioritized aim. Studies were further analyzed to include literature within the last ten years that met the following criteria: adults with a hemiplegic shoulder participating in electrotherapy to reduce pain. Seven total studies were included which met the established standards. RESULTS: Level 1A, 1B and 2B research completed on electrotherapy has revealed positive evidence regarding the effectiveness of electrotherapy in reducing pain in adults with hemiplegic shoulders. Further RCTs with larger sample sizes and systematic reviews should be completed to increase the strength of evidence for electrotherapy.