Physiotherapy for Diabetic Peripheral Neuropathy (DPN)

Physi otherwiseapy for Diabetic Peripheral Neuropathy (DPN)1. Introduction of contractorsIn this section the contractors of this project duty assignment leave behind be introduced.1.1 ClientFisioterapia Alcobendas is a private institutionalise specialized in physiotherapy handlings. Its owner is Marc van Zuilen, HvA graduate who has been operating his own clinic since 1999. The clinics principal(prenominal) objective is to propose quality and personalized wellnesscare to the community and its lymph glands. Among the areas of expertise , the following can be listed tendinitis, hernias, low back pain, whiplash, cervicalgia, tennis elbow, rheumatoid arthritis, arthrosis, scoliosis, stick outtar fasciitis, fibromyalgia, cystic fibrosis, asthma, neuropathies, spina bifida, Bells palsy, etc. Besides being the owner of the clinic, Marc van Zuilen is also a lecturer for Universidad de Alcal de Henares, Universidad de Castilla La Mancha, Asociacin Fisioterapia Deporte de lite. As lift off of his professional endeavours, by having this product in his hands, would benefit both the clinic and his actualization for theatrical role in lecturing.The client would like to employ for use in his manage a systemized recommendation for exercise for patients with diabetic circumferential neuropathy (DPN). Providing the client with an evidence based approach toward intercession of DPN would im stand up the outcomes in their patients well being and would provide the clinic with a valuable tool to employ in prescribing the appropriate interposition parameters for this sort out.1.2 Educational InstitutionHogeschool van Amsterdam, located at Amsterdam, Tafelbergweg 51, 1105 BD, pertaining to the Amsterdam School of health Professions (ASHP) the European School of Physiotherapy (ESP), represented by our coach- Cia Kesselaar.1.3 StudentsMihaela Cosarca and Finda Morsay, last year ESP students volition be questioning this topic as their professional assignment project.1.4 reach information contractorsNameTitlePhoneEmailFisioterapia Alcobendas, SpainClient0034916238440emailprotectedCia KesselaarCoachemailprotectedMihaela CosarcaStudentemailprotectedFinda MorsayStudentemailprotected2. AssignmentIn this section the assignment proposed by the client bequeath be introduced. Then, the setting of the assignment will be described. Furthermore, the end products will be defined and the physiotherapeutic clinical relevance will be explained.2.1 Introduction assignmentFisioterapia Alcobenda is a well known, established institution in the surrounding community of Madrid, Spain. It is dedicated to the wellbeing of the community its serving. The clinic would like to give an evidence based approach to treatment of some of the most common pathologies encountered in their patients diabetic neuropathy. In order to do that, they would like to have functional a research on the recommended exercise interventions supported by literature. By making use of this tool, the clinic will ensure the best results in their patients.The purpose of this assignment is to investigate diabetic peripheral neuropathy (DPN) as a complication from diabetes and to present the evidence based in favor of exercising as a treatment modality that could prevent, delay or halt the course of this disease. Further on, we will focus on determining which exercise interventions should be incorporated into treatment designs for this group of patients and conclude which parameters of exercising are proven to be effective (type, intensity, frequency, duration).This project plan is developed by Mihaela Cosarca and Finda Morsay, students at the European School of Physiotherapy (ESP) in order to provide a structural approach to tackle the project assignment proposed by our client.2.2 Background problem and clinical relevanceIn 2011, WHO estimated that 347 millions spate worldwide were suffering from diabetes, with an estimated annual death toll of 3.4 millions. The International Di abetes Federation has an updated number for 2013 382 mil people worldwide living with diabetes with a forecasted 55% profit to reach 592 million by year 2035.Diabetes is an epidemic and people diagnosed with diabetes are at increased risk of developing a series of serious health problems cardiovascular disease, nephropathy, neuropathy, retinopathy or dental disease (CDC 2011). According to American Diabetes Association (2011) of people diagnosed with diabetes, 60-70% will develop peripheral neuropathy and this complication has been deemed responsible for more than 60% of all non-traumatic amputations, in addition to contribution to other consequences lessen sensation and strength, decreased proprioception, decreased reflexes, poor balance and increased risk of falling, decreased confidence, decreased level of activity and participation and overall decreased quality of life.The 2010 joint verbalizement of ACSM and American Diabetes Association (ADA) recommends different exercise i nterventions mostly for prevention and reckon of insulin resistance diabetes and to prevent complications. Similarly, a Cochrane analyze (Thomas et al. 2009) found that exercise was beneficial for people with diabetes as is correlated with glycemic control and significantly contributes to reduction in intuitive and subcutaneous adipose tissue, decreases triglycerides and increases insulin response. However, this review did not research the effect of exercise on DPN. The purpose of our study is to determine if exercise is a valid treatment modality for DPN and it will go further into details and to probe which exercise interventions are benefic for those diabetes patients who developed neuropathy and in which combination.The standard of care for diabetic peripheral neuropathy is based on a number of drugs and emphasis on feet care, but the main problem of the pharmacological approach is the fact that it produces side effects (Wamboldt et. al 2006), has been proven to have moderate to no improvement on this condition (Zochodne et. al 2008) and lacks the ability to lessen the progression of DPN (Zilliox et. al 2011, Callaghan et. al 2012).It is our responsibility as healthcare professionals to improve the odds of this patients and to contribute to a better quality of life for this population. In physiotherapy practice, the physiotherapists make use of different treatment modalities for diverse conditions. Exercise is one of the most accessible and easily prescribed intervention with successful results in many pathologies. Given the existing literature will prove exercise as a worthy intervention, we believe it has the potential to change the course of the disease and the quality of life of the DPN patients and it will be a expedient tool in any clinic that treats these patients.Through this review, the students intend to research the main medical databases and to analyze the selected literature to determine the effectiveness of different exercise interventio ns in the treatment management of DPN. The findings will fill the lack of knowledge on the validity of this intervention as treatment of DPN and will outline the specifics of the treatment as evidenced by literature. This study has the potential to formalize the use of exercise as an evidence based modality for the treatment of peripheral neuropathy in diabetic patients.Description of research question3.1 MethodsAll the delivered end products must meet the requirements of a Bachelors degree. In order to complete this task, the students will use the following resources3.1.1 Search strategyTo gather the studies for both background information and the domineering review part, we used the following methods1) For the evidence based part for the arrogant review the students recruited RCTs, systematic reviews, meta-analysis and existing guidelines. The search was conducted in the following databases PubMed, PEDro, CINAHL, Cochrane, TripDatabase, ScienceDirect and Google Scholar. An indiv idual Cochrane search was conducted to prevent any systematic reviews being omitted during the first step.2) For all the background information considered relevant for this topic, we also gatheredarticles from the reference list contained in the systematic reviews and guidelines andarticles found finished the aforesaid databases that fall under the inclusion/ ejection criteria.3.1.2 KeywordsThe keywords and the MESH equipment casualty (Medical Subject Headings) used were3.1.3 Inclusion criteriaFor the background information on DPN, case series, population-based studies, clinical trials, clinical and pilot studies, randomised-controlled trials (RCTs), systematic reviews and guidelines published amongst January 2000 and September 2014 were taken into consideration. The background information focuses on definition, factors involved in pathogenesis of DPN, incidence and prevalence, clinical show signs and symptoms, risk factors, diagnostic methods, evaluation (EBP scales) and progn osis, available treatment methods. The inclusion of these articles was considered only if they were include in the reference section of an existing guideline or systematic review.For the systematic review- guidelines, systematic reviews, meta-analyses and randomized control studies published between 2000 and September 2014 were included. Available scientific studies in languages other than incline or Spanish were excluded. In addition, some RCTs and case series were also included as long as they were published at a posterior date to the latest systematic reviews or guidelines.CriterionJustification1English LanguageMost specialty journals are published in English22004- 2014Last decade studies capture the most frequently used visible modalities existing in practice today13Studied the effects of dry needling MTrPts on patients with PF4Humans 18 y.oEnsures homogeneity between studies and possibly a bigger population count5Diagnostic criteria based on clinical findingsDiagnostic crite ria must be stated so that it can be easily determined how likely it was the subjects had PF and how similar the population was compared to other studies population6Quantitative study design incl. RCTs, non RCTsIncluded studies have to reflect the state of our knowledge and exact limitation case studies excluded, unless published after latest RCT or systematic review3.1.4 Exclusion criteria3.1.5 Criteria for grading articlesThe articles are graded agree to the Pedro criteria list (see appendix ?). In order to assess thequality of the criteria list, we conducted a pilot study where articles were individually graded and gains were compared by the reviewers. Where there was disagreement, raillery was done to reach a consensus. The list consists of 10 questions, scored between 0 and 1, max score 10. Eacharticle was scored as followsGood- if scored Very good score between 7 and 9Excellent if scored 9 or 10After the screening process with the criteria list articles were considered re levant for the study.4. End ProductsThe end products that will be delivered by the students are1. upchuck Plan- this document is meant as an organizational framework for the project. It outlines the content of the final end product of our PAP a systematic review to help determine if exploitation exercise as a treatment modality in the management of DPN is recommendable as good practice for PTs and other healthcare professionals. This plan describes the manner in which the students can guarantee quality end products. Efficient work is ensured by a clear task function and a thorough schedule. Buffer days/ weeks are set up to allow margins for the unexpected factors. Lastly, the quality of end products feedback and evaluation of the work is assured through collaboration with competent professionals and guidance from the ESP coach.2. Systematic Review the objectives of the proposed review are the followingTo serve as an EBP tool for practitioners and students looking for an updated s olution for using different exercise interventions in the management of DPNTo provide practical guidance based on corroborating any existing EBP guidelines and including latest literature in terms of the exact interventio, the duration, frequency and the length of a standard treatment that could be beneficial for patients with this diagnosis.To provide a list of most common findings encountered through our research and conclude if exercise can be recommended and at what stage of the pathology can give a better prognosis- if evidence allows this conclusionRecommendations for future research3.PowerPoint exhibit on the students will present the project. The specifics of the investigated intervention will be thoroughly explained with the accent on the most relevant findings of the review.5. Project framesFor optimal management, the project will be divided into three frames preparation phase, decision making phase and completion phase.5.1 Preparation phaseThe preparatory phase (week 3 7 to.. ) was dedicated to an taste and selection of relevant literature and an outlining of the project. At the moment, the project is more defined and a more concrete design process is under construction. In this phase the following activities take placeOnline or phone meetings with the client and personal meetings with the PAP coordinatorA contract between client, student and the universityA project plan is being written by the students and approved by the charge coach5.2 regretsision Making and Progression phaseIn the decision making phase (week AA to AAA) the following activities take placeA progress report is made weekly and discussed with the coachA personal report is drawn up each two weeksEvery day the student dedicates 6-8h/ day for synthesizing the selected literature and writing of the thesisRealization of project deliver systematic review, leaflet and reportsThe innovation ennoble plus brief description is submitted5.3 Completion phaseIn the completion phase (week AAA to BBB) the following activities will take placeA intromission of the results given by the studentThe final interview with the coach to discuss the process report and the personal report, the end product (protocol and thesis) and feedback of the client acceptting products to PAP coordinator6. Goals 6.1 separate SMART goalsMIHAELASMARTFINDASMART 6.2 Group SMART goalsSMART 6.3 End Product goalSProduce an answer to our research question, which is clinically relevant in physiotherapy practiceMBy following the standard scientific format Abstract, introduction, methods, results, discussion and conclusionAWith good guidance from coach and using our knowledge on evidence based practiceRA systematic review will be our end productTUntil the end of project, mid Dec 20147. Process 7.1. Pitfalls and safety net planning 7.2. Quality control 7.3 Rules and regulations for work 7.3.1 Task division 7.3.2 Coach contribution8. Planning and timetableThe following are the remote deadlines for the productsProductExternal deadlineContractProject plan deadline20.10.2014Project plan retake deadline27.10.2014Title and brief description presentation20.11.2014Green light presentation coach24.11.2014Deadline all products (1st chance)12.12.2014Deadline all products (2nd chance)07.01.2015Deadlines and Official PAP coordinator coach meetings (proposals)WeekDayDateTimeDescriptionRemarks37TH12.091130- 1300Group members meet to discuss topic after PAP coordinator assigns the team members37FR13.09project description sent to PAP coordinator38MON15.091430- 1515Group had first meeting with PAP coordinator to discuss the topic, client, backup topicSearch for coach continues until Wed38WED17.091800Topic/ Coach to be confirmed by PAP coordinator/ Green Light38TH18.091600Turn in PAP registration form38FRI19.091000Kick off project plan38MON/TUE22.09- 23.09Meeting PAP coordinator to finalize topic detailsCoach assigned on 25th Sept 201439TUE30.091100Meeting with coach39WED, THResearch for new top ic40TUE07.101230Meeting with coachDiscuss new topic and suggestions41MON13.101230Project plan first draft41?Project plan feedback meeting41TH- MONIntegrate feedback42MON20.101800Deadline project plan42MON-TH20- 23.10Searching engines and screening of articles for review42TH-SUN23- 26.10Screening of articles for review43MON27.101800Deadline Retake project plan43TUE- SUN28.10 -02.11Grade articles for review44TH-TH03.11- 09.11Writing Introduction and methods sections for review45MON10.111200Deadline INTRO and METHODS45FRI14.111200Feedback coach intro and methods45-46MON- WED10.11- 19.111800Integrate feedback, writing results and discussion sections46TH20.111800Deadline RESULTS and DISCUSSION46TH20.1118.00Title and brief description presentation deadline47MON24.111700Feedback coach47MON24.111700Greenlight presentation coach48MON01.121800Deadline generalization and CONCLUSION and submit first draft of the review to coach48FRI05.121700Extended feedback on draft49WED10.121800Submit final version of the review for feedback49FRI12.121800DEADLINE process report and individual report50FRI12.121800DEADLINE PAP2 systematic review, leaflet, individual and group reports51.MON- TH15.12- 18.12preparation presentation52winter BREAK1.winter BREAK2WED07.01.2015DEADLINE retake PAP 22MON- FRI05.01- 11.01preparation presentation?PRESENTATIONOfficial client meetingsWeekDayDateTimeDescription38TUE16.091200Kick off meetingEvaluation Project Plan sign contractMidterm evaluation projectDemonstration of end productEnd evaluation1to be determined which period we use