Background: Acute care physical therapists regularly use therapeutic exercise to target body structures and functions as a supplement to or even replacing activity-based interventions. Interestingly, little is known regarding the mechanism of action explaining how exercise enables future activity and participation. One potential mechanism of action is the repeated bout effect (RBE), which is the phenomenon that a single bout of exercise provides protective adaptations for future exercise/physical activity. Purpose: To perform a systematic review examining the exercise parameters required to induce the RBE and explore how the results apply to acute care physical therapists. Data Sources: Academic Search Complete, CINAHL, MasterFILE Premier, MEDLINE, PsycINFO, and SPORTDiscus. Study Selection: The search included articles appearing before January 1, 2017. The following were the inclusion criteria: human subjects, randomized controlled trial design, published in English, treatment and control group engaged in exercise, lower extremity exercise intervention, and pre- and postintervention creatine kinase blood marker measurement. Data Extraction and Quality Assessment: Three reviewers extracted data and then assessed the methodological quality of the included articles. Results: Of the 1780 potential studies, seven were included. The RBE can be induced with exercise that includes an eccentric component, as well as with maximal voluntary isometric contractions at elongated muscle lengths. Concentric-only exercise does not induce the RBE and could instead blunt it. Stretching does not induce the RBE; however, it does not blunt it. Conclusion: The RBE enhances a person's tolerance for future exercise/physical activity. Consequently, the use of exercise to induce the RBE would be advantageous during initial and subsequent acute care physical therapist interventions. Future research is needed to specifically address the precise dose needed to induce the RBE in middle-aged and older adults, those with acute and chronic diseases, and women of all ages.
Introduction Incontinence-associated dermatitis (IAD), the most common form of moisture-associated skin damage (MASD), puts patients at higher risk for ulceration. Treatment of MASD/IAD includes application of zinc oxide, typically applied using gloved hands directly to the area of concern. A computational model was utilized to examine a cost comparison of a touch-free zinc oxide treatment versus traditional zinc oxide for MASD/IAD. Methods A literature search was performed using PubMed, a nursing journal database (CINAHL), and MEDLINE for publications from January 1, 2010 through November 30, 2017. Data on prevalence of MASD/IAD, average length of stay, and time to heal were extracted and utilized in the computational model. Cost per patient stay and annual total hospital costs were calculated for three and four applications of zinc oxide per patient with an averaged prevalence rate of 25% for a hypothetical hospital. Results The computational model estimated a range of cost savings between $181.88 to $2,000.63 per patient stay, and $4,728.88 to $52,016.25 over a 12-month period compared to traditional zinc oxide application. Conclusions The computational model estimated a cost savings of up to $52,016.25 per year in a hypothetical 250-bed acute care hospital compared to traditional zinc oxide application. Future prospective studies examining clinical effectiveness and health economics of touch-free zinc oxide are necessary.
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