Water is an essential nutrient for all persons; thus, maintaining a chronic state of optimal hydration is recognized to provide health benefits. Fluid balance is maintained via thirst, a feedback-controlled variable, regulated acutely by central and peripheral mechanisms. However, voluntary drinking is also a behavior influenced by numerous social and psychological cues. Therefore, whether "thirst-guided" drinking maintains optimal hydration status is a multifactorial issue. Thirst perception is typically assessed by subjective ratings using either categorical or visual analog scales; however, which instrument yields greater sensitivity to change in hydration status has not been examined. Ratings of thirst perception do not always yield predictable patterns of voluntary drinking following dehydration; therefore, perceived thirst and ad libitum drinking are not equivalent measures of human thirst. The recommendation "drink to thirst" is frequently given to healthy individuals during daily life. However, factors and conditions (e.g., age, disease) that influence thirst should be recognized and probed further.
Background: Chronic wounds in the United States are prevalent and costly, both financially and socially. Wound measurement is a cornerstone of best practice for wound management and reimbursement. For evidence-based best practice, wound measurement should be accurate and reliable to optimize patient care and outcomes. Purpose: The purpose of this narrative review was to articulate available measurement tools and techniques along with their accuracy, reliability, and clinical feasibility. Methods: CINAHL and MEDLINE were searched using combinations of key words related to wound measurement, wound types, measurement tools, reliability, repeatability, accuracy, or feasibility. Results: A total of 71 articles were included. Descriptions of the measurement tools were reported, as well as advantages/disadvantages related to inter- and intrarater reliability, accuracy, and feasibility were extracted. Measurement mechanisms were classified as contact versus noncontact. Measurement mechanisms described include rulers, manual tracing, photography, smartphone technology, laser-assisted technology, and stereophotogrammetry. Conclusion: Accuracy, reliability, and feasibility of wound measurement are critical to optimal evidence-based practice. This review finds that, at a minimum, noncontact measurement methods such as digital planimetry or analysis software should be used along with digital photography. More expensive accurate and reliable options, including laser-assisted technology or stereophotogrammetry, are appropriate if financially feasible.
Abstract-TheStepWatch activity monitor has not been validated on multiple indoor and outdoor surfaces in a population using ambulation aids. The aims of this technical report are to report on strategies to configure the StepWatch activity monitor on subjects using a cane and to report the accuracy of both leg-mounted and cane-mounted StepWatch devices on people ambulating over different surfaces while using a cane. Sixteen subjects aged 67 to 85 yr (mean 75.6) who regularly use a cane for ambulation participated. StepWatch calibration was performed by adjusting sensitivity and cadence. Following calibration optimization, accuracy was tested on both the legmounted and cane-mounted devices on different surfaces, including linoleum, sidewalk, grass, ramp, and stairs. The legmounted device had an accuracy of 93.4% across all surfaces, while the cane-mounted device had an aggregate accuracy of 84.7% across all surfaces. Accuracy of the StepWatch on the stairs was significantly less accurate (p < 0.001) when comparing surfaces using repeated measures analysis of variance. When monitoring community mobility, placement of a StepWatch on a person and his/her ambulation aid can accurately document both activity and device use.
Purpose: To survey physical therapists and physical therapist assistants practicing in wound management environments regarding their personal beliefs, clinical practices, and perceived barriers to incorporating health promotion, wellness, and prevention (HPWP) in practice. Methods: A 30-question validated survey was sent to wound care therapists. Results: The qualified response rate was 29%. Therapists reported a belief in their professional role in HPWP as follows: physical (97%), psychological (82%), emotional (79%), intellectual (73%), occupational (73%), social (71%), and spiritual (55%). Practice behaviors that were frequently included by these individuals included nutrition optimization (88%), diabetes/metabolic syndrome education (81%), physical activity/fitness prescription (81%), and tobacco cessation (78%). Conditions least addressed included violence (91%) and substance-free living (75%). Common barriers included lack of resources, time, patient interest, and economic limitations of patients. Respondent lifestyles were generally healthier than adults in the United States. Conclusions: There is an increasing need in physical therapist practice to actively promote health and wellness at the level of the individual. Modeling health behaviors is important to include as well and may be beneficial to support patient healthy lifestyle. While wound management therapists do well in promoting health in certain areas, work is still needed in others.
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