Examining sedentary behaviours of adults with intellectual disabilities: A qualitative analysis

Sedentary behaviours among adults with intellectual disabilities have not been well studied. A sedentary lifestyle puts adults with and without disabilities at high risk of developing health conditions and diseases. Current literature revealed few empirical studies on the benefits of reducing sedentary behaviours with respect to the health of adults with intellectual disabilities. This research explored the factors that helped or hindered sedentary behaviours of adults with intellectual disabilities in the Canadian population. Guided by the socio-ecological model, Critical Incident Technique (CIT) was conducted. Five adults with intellectual disabilities from the Province of Ontario were interviewed and 102 critical incidents were collected. Adults with intellectual disabilities identified personal and environmental related factors that led to increased sedentary behaviours; and revealed helpful factors and wish-lists of actions that decreased sedentary lifestyle. Findings may be useful when developing programs aimed to decrease prolonged periods of sedentary behaviours specific to this vulnerable population.

A qualitative exploration of exercise motivation among colorectal cancer survivors: an application of the theory of planned behavior

PURPOSE

The purpose of this qualitative study was to use semi-structured interviews and thematic analysis to elicit key influencing factors (i.e., behavioral, normative, and control beliefs) related to physical activity and exercise in colorectal cancer survivors.

METHODS

Colorectal cancer survivors (N = 17) were recruited from exercise programs designed for colorectal cancer survivors at the Yonsei Cancer Center, Seoul, South Korea. A purposive sampling method was used. Interview questions were informed by the theory of planned behavior (TPB). Semi-structured face-to-face interviews were conducted, and open-ended questions addressed the research question. Interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Participants were on average 2.2 years post-treatment. The mean age of the sample was 55.9 years. Key behavioral, normative, and control beliefs emerged in the data. For behavioral beliefs, colorectal cancer survivors believed that exercise would result in physical and psychological improvements, and improve their bowel problems. For normative beliefs, most colorectal cancer survivors wanted their oncologists' approval for participation of exercise. Family members, more specifically the spouse, were also influencing factors for colorectal cancer survivors adopting physical activity. The most frequently mentioned control belief was that supervised exercise with an exercise specialist made exercise participation easier.

CONCLUSIONS AND IMPLICATIONS

Beliefs identified in this study can inform TPB-based physical activity interventions tailored for colorectal cancer survivors. While information alone may not lead to behavior change, integrating these beliefs with other influential factors can potentially enhance intervention efficacy and promote physical activity in this population.

Extraordinary claims in the literature on high-intensity interval training (HIIT): III. Critical analysis of four foundational arguments from an interdisciplinary lens

Kinesiology aspires to be an integrated, interdisciplinary field that studies human movement from multiple perspectives. However, the main societal deliverables of the field, namely exercise prescriptions and physical activity recommendations, still reflect fragmentation, placing more emphasis on physiological outcomes than on behavioral and other considerations. Recently, researchers have called for the introduction of High-Intensity Interval Training (HIIT) to the domain of public health, based on the argument that HIIT can maximize fitness and health benefits for a fraction of the time recommended by the prevailing model of physical activity in public-health guidelines. Here, we show that an unintended side-effect of arguments underpinning the implementation of HIIT in the domain of public health might have been the exacerbation of segmentation. To highlight the value of interdisciplinarity, four foundational claims in support of HIIT are critiqued by tapping into cognate literatures: (1) the primary reason people do not exercise is lack of time, (2) HIIT is relevant to public health, (3) HIIT is being proposed as merely another option, so there is no basis for controversy, and (4) HIIT is safe and well tolerated. These claims are contradicted by credible lines of evidence. To improve the accuracy and effectiveness of its public claims, kinesiology should remain committed to the ideals of integration and interdisciplinarity.

Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review

BACKGROUND

Despite advancement in the treatment of inflammatory bowel disease (IBD), induction and maintenance of remission remain challenging to achieve in many patients and a significant proportion of patients with IBD experience mental health conditions, including anxiety, depression, and fatigue, which impair their quality of life (QoL). We aim to describe the available evidence regarding the effects of physical activity (PA) on the onset of IBD, its disease course, and important patient-reported outcome measures (PROMs), such as QoL, fatigue, and mental health.

METHODS

A literature search was performed using electronic databases to identify original articles that assessed the effects of PA in patients with IBD using PROMs.

RESULTS

Prospective cohort and case-control studies demonstrate inverse relationships between PA and new-onset IBD in Crohn's disease but not in ulcerative colitis; however, they have small sample sizes and caution must be taken in considering associations versus causation. Small randomized controlled trials suggest promise for PA and beneficial outcomes, such as maintenance of clinical remission and improvement in QoL, fatigue, depression, and anxiety. However, these studies were small and underpowered, and limited by outcome measurements and durations of follow-up.

CONCLUSIONS

Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered.

Physical Activity in Renal Disease (PAIRED) and the effect on hypertension: a randomized controlled trial

INTRODUCTION

Exercise is an effective strategy for blood pressure (BP) reduction in the general population, but efficacy for the management of hypertension in CKD is not known. We evaluated the difference in 24-hour ambulatory systolic BP with exercise training in people with moderate to severe chronic kidney disease (CKD).

METHODS

Participants with an estimated glomerular filtration rate (eGFR) of 15-44 mL/min per 1.73m2 and SBP >120 mmHg were randomized to receive thrice weekly, moderate intensity aerobic-based exercise over 24 weeks, or usual care. Phase 1 included supervised in-center and home-based sessions for eight weeks. Phase 2 was 16 weeks of home-based sessions. BP, arterial stiffness, cardiorespiratory fitness, and markers of CV risk were analyzed using mixed linear regression.

RESULTS

We randomized 44 people; 36% were female, median age was 69 years, 55% had diabetes and the median eGFR was 28 mL/min per 1.73m2. Compared with usual care, there was no significant change in 24-ambulatory SBP at eight weeks 2.96 mmHg (95% CI -2.56, 8.49) or 24 weeks. Peak oxygen uptake improved by 1.9 mL/kg/min in the exercise group (95% CI 0.03, 3.79) at eight weeks with a trend toward higher BMI 1.84 kg/m2 (95% CI -0.10, 3.78) and fat free mass, but this was not sustained at 24 weeks. Markers of CV risk were unchanged.

CONCLUSIONS

Despite an improvement in VO2peak and body composition, we did not detect a change in 24-hour ambulatory systolic BP in people with moderate to severe chronic kidney disease.

A247 MEDITATION AND YOGA FOR IRRITABLE BOWEL SYNDROME (MY-IBS): A RANDOMIZED CONTROLLED TRIAL

Background

When delivered in person, yoga is effective in managing Irritable Bowel Syndrome (IBS) symptoms. However, research is needed to determine the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually.

Aims

The aim was to explore the feasibility and effectiveness of a yoga program, delivered virtually, for patients with IBS. We hypothesized the program would be feasible and effective in improving outcomes in the intervention group compared to the control group.

Methods

Adults diagnosed with IBS were randomized to receive either a Hatha yoga intervention or to an advice-only control group. The intervention consisted of facilitator-led weekly online classes for eight weeks delivered using Microsoft Office Teams and daily home practice. Yoga sessions included sequential delivery of postures, chanting, breathing exercises, and meditation over four weeks, with integrated practice over the final four weeks. Feasibility was evaluated with recruitment and attrition rates, adherence, and safety. The primary outcome was severity of IBS symptoms (IBS-Symptom Severity Score, IBS-SSS). Secondary outcomes included anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and stress (Perceived Stress Scale) assessed at baseline and eight weeks. Unadjusted and adjusted analysis of variance (and covariance) models compared baseline and post-intervention data between groups using intent to treat analysis.

Results

Sixty-five participants participated (32 treatment, 33 control). The mean age was 44.2±14.1 years and 91% identified as female. Participants had been living with IBS for 11.7±11 years. Fifteen participants were lost to follow-up (20% attrition rate). Participants attended on average 5.9±1.7 out of a possible 8 sessions (74% adherence) and accumulated 1,187±545 minutes in daily practice over eight weeks. No adverse events were reported. The groups did not differ at baseline (P>0.05). From baseline to post intervention, unadjusted ANOVA models indicated the yoga program was not statistically superior to the control group for IBS-symptoms (-17.5 points; 95% CI -62.6 to 27.6; P = 0.440), anxiety (-0.91 points; 95% CI -2.47 to 0.64; P = 0.245) and stress (-0.65 points; 95% CI -1.73 to 0.44; P = 0.239). Significant differences between groups were seen for depression (-1.82 points; 95% CI -3.49 to -0.15; P = 0.033). A second model considered relevant covariates including age, comorbidities, and years since diagnosis (i.e., ANCOVA), and the results were similar to the unadjusted model.

Conclusions

Our virtual Hatha yoga and mediation program was feasible, and participants showed improvement in their depression scores. However, they did not experience a significant improvement in their IBS symptoms, anxiety, or stress, perhaps due to the short timeframe of the intervention.

Funding Agencies

None

A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer: Protocol for a Single-Arm Feasibility Trial

BACKGROUND

About 5% of breast cancer cases are metastatic at diagnosis, and 20%-30% of localized breast cancer cases become secondarily metastatic. Patients frequently report many detrimental symptoms related to metastasis and treatments. The physical, biological, psychological, and clinical benefits of physical activity during treatment in patients with localized breast cancer have been demonstrated; however, limited literature exists regarding physical activity and physical activity behavior change in patients with metastatic breast cancer.

OBJECTIVE

The primary objective of this study is to assess the feasibility of a 6-month physical activity intervention with activity trackers in patients with metastatic breast cancer (the Advanced stage Breast cancer and Lifestyle Exercise, ABLE Trial). Secondary objectives are to examine the effects of physical activity on physical, psychological, anthropometrics, clinical, and biological parameters.

METHODS

We plan to conduct a single-center, single-arm trial with 60 patients who are newly diagnosed with metastatic breast cancer. Patients will receive an unsupervised and personalized 6-month physical activity program that includes an activity tracker Nokia Go and is based on the physical activity recommendation. Patients will be encouraged to accumulate at least 150 minutes per week of moderate-to-vigorous intensity physical activity. Baseline and 6-month assessments will include anthropometric measures, functional tests (eg, 6-minute walk test and upper and lower limb strength), blood draws, patient-reported surveys (eg, quality of life and fatigue), and clinical markers of tumor progression (eg, Response Evaluation Criteria In Solid Tumors criteria).

RESULTS

Data collection occurred between October 2016 and January 2018, and the results are expected in August 2018.

CONCLUSIONS

The ABLE Trial will be the first study to assess the feasibility and effectiveness of an unsupervised and personalized physical activity intervention performed under real-life conditions with activity trackers in patients with metastatic breast cancer.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 (Accessed by WebCite at http://www.webcitation.org/71yabi0la).

REGISTERED REPORT IDENTIFIER

RR1-10.2196/10487.

Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses

PURPOSE/OBJECTIVES

To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. 
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DESIGN

Randomized, controlled trial.
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SETTING

Online.
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SAMPLE

54 oncology nurses.
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METHODS

Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
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MAIN RESEARCH VARIABLES

Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
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FINDINGS

Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. 
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CONCLUSIONS

The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
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IMPLICATIONS FOR NURSING

This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.

High glucose variability is associated with poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy

BACKGROUND

In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population.

OBJECTIVE

To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE.

STUDY DESIGN

In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score <70, Bayley III Language Score <70 and Bayley III Cognitive Standard Score <70.

RESULTS

The neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (-0.28 to -0.03, 95% CI, p = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance.

CONCLUSIONS

Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies.

Breast and Colon Cancer Survivors' Expectations About Physical Activity for Improving Survival

PURPOSE/OBJECTIVES

To compare physical activity outcome expectations related to cancer survival with traditional physical activity outcome expectations in breast and colon cancer survivors
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DESIGN

Cross-sectional survey
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SETTING

Canada and the United States.

SAMPLE

146 participants
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METHODS

Self-reported survey instruments and height and weight measurement. The online survey was completed once by each participant
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MAIN RESEARCH VARIABLES

Godin Leisure-Time Exercise Questionnaire, Multidimensional Outcome Expectations for Exercise Scale (MOEES), and an item assessing physical activity outcome expectations related to cancer survival.

FINDINGS

Paired sample t tests indicated that the mean score for the physical subscale of the MOEES was significantly higher than the mean score on the physical activity outcome expectations related to cancer survival variable (p < 0.001). Multiple regression analyses indicated that physical activity outcome expectations related to cancer survival explained 4.8% of the variance in physical activity (p = 0.011)
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CONCLUSIONS

Findings from the current study suggest that, among breast and colon cancer survivors, outcome expectations related to cancer survival may influence physical activity levels and may not be as realized as traditional outcome expectations
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IMPLICATIONS FOR NURSING

Oncology nurses should familiarize themselves with the guidelines and benefits of physical activity for survivors so they can provide guidance and support to patients.

Sedentary behavior, gestational diabetes mellitus, and type 2 diabetes risk: where do we stand?

A substantial number of pregnancies are complicated by gestational diabetes mellitus (GDM) and up to 70 % of women with GDM go on to develop type 2 diabetes. Given the extensive body of research suggesting physical activity reduces the risk of type 2 diabetes, facilitating physical activity, and reducing sedentary time may be effective approaches to promote the health of women with a previous GDM diagnosis. Here, we discuss physical activity, exercise, and sedentary behavior, in the context of GDM and the potential for type 2 diabetes risk reduction.

Newly diagnosed lung cancer patients' preferences for and beliefs about physical activity prior to chemotherapy

Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients.

Health Literacy, Pedometer, and Self-Reported Walking Among Older Adults

OBJECTIVES

We examined the association of health literacy with physical activity and physical activity guideline adherence in older adults.

METHODS

We used cross-sectional data from a 2012 population-based study in Alberta, Canada, assessing health literacy, and deriving moderate-to-vigorous physical activity (MVPA) and metabolic equivalent of task (MET) minutes per week from the Godin Leisure-Time Exercise Questionnaire, and steps per day via a pedometer.

RESULTS

Mean age of participants (n = 1296) was 66.4 (SD = 8.2) years, 57% were female, and 94% were White. Nine percent had inadequate health literacy, and 46% met guidelines for self-reported physical activity and 18% for steps per day. Participants with inadequate health literacy had nonsignificant adjusted decrements of 58 MVPA minutes and 218 MET minutes per week and were less likely to meet physical activity guidelines (MVPA: odds ratio = 0.63; 95% confidence interval [CI] = 0.41, 0.97; P = .037; MET: odds ratio = 0.65; 95% CI = 0.42, 1.01; P = .057) compared with their health-literate counterparts. Such differences were nonsignificant for steps per day.

CONCLUSIONS

Inadequate health literacy was associated with less likelihood of meeting MVPA guidelines based on self-reported physical activity, but not based on an objective measure of steps per day.

Apneic Oxygenation during Rapid Sequence Intubation in Critically Ill Children

This prospective case series documented hypoxemia and potential complications associated with apneic oxygenation in critically ill pediatric patients during rapid sequence intubation. Forty-four patients received apneic oxygenation via nasal cannula at rates of 5, 10, and 15 L/min for ages <4, 4 to 12, and 12 to 18 years, respectively. Pre- and postintubation attempt mean Spo ₂ were 98.9 ± 2.95 and 90.7 ± 1.95%, respectively. Postintubation Spo ₂ < 80% were significantly less with one intubation attempt, compared with multiple attempts (p < 0.001). No serious complications were noted. Apneic oxygenation was well tolerated in critically ill children.

Associations of Daily Pedometer Steps and Self-Reported Physical Activity With Health-Related Quality of Life: Results From the Alberta Older Adult Health Survey

OBJECTIVE

The aim of this article is to examine associations of self-reported physical activity (PA) and pedometer steps with health-related quality of life (HRQoL) among a population-based sample of older adults.

METHOD

Adults ≥55 years (N = 1,296) were recruited through random-digit dialing and responded to a questionnaire via computer-assisted telephone interviewing methods. Questionnaires assessed demographic variables and validated measures of PA and HRQoL. Participants received a step pedometer and waist circumference tape measure via post.

RESULTS

Compared with participants in the low-step group (0-6,999 steps/day), participants in the high-step group (>10,000 steps/day) had significantly higher scores on mental health (Mdiff = 3.1, p < .001, confidence intervals [CI] = [1.8, 4.3]), physical health (Mdiff = 3.5, p < .001, CI = [2.2, 4.7]), and global health (Mdiff = 3.5, p < .001, CI = [2.3, 4.7]). Waist circumference and body mass index did not moderate any associations of pedometer steps and PA with HRQoL.

CONCLUSION

Older adults exceeding established step thresholds reported significantly higher HRQoL indices compared with those achieving lower thresholds.

Biological control of plant pathogens: advantages and limitations seen through the case study of Pythium oligandrum

The management of certain plant beneficial microorganisms [biological control agents (BCAs)] seems to be a promising and environmental friendly method to control plant pathogens. However, applications are still limited because of the lack of consistency of BCAs when they are applied in the field. In the present paper, the advantages and limitations of BCAs are seen through the example of Pythium oligandrum, an oomycete that has received much attention in the last decade. The biological control exerted by P. oligandrum is the result of a complex process, which includes direct effects through the control of pathogens and/or indirect effects mediated by P. oligandrum, i.e. induction of resistance and growth promotion. P. oligandrum antagonism is a multifaceted and target fungus-dependent process. Interestingly, it does not seem to disrupt microflora biodiversity on the roots. P. oligandrum has an atypical relationship with the plant because it rapidly penetrates into the root tissues but it cannot stay alive in planta. After root colonisation, because of the elicitation by P. oligandrum of the plant-defence system, plants are protected from a range of pathogens. The management of BCAs, here P. oligandrum, is discussed with regard to its interactions with the incredibly complex agrosystems.

Prescription for physical activity a survey of Canadian nurse practitioners

Although nurse practitioners are well placed to counsel patients about getting enough exercise, little abstract is known about their attitudes and practice in this area of health promotion. The authors used a self-administered Internet-based questionnaire to explore how Canadian NPs perceive their competence in prescribing physical activity and the importance they ascribe to doing so. Participants were asked to identify factors that most commonly prompt physical activity prescription. Overall, the respondents felt fairly competent in their ability to prescribe physical activity (mean score 4.49/6.0, SD = .90) and felt that this function was important (mean score 4.82/6.0, SD = .85). Competence in prescribing physical activity and a perception that this intervention is important were both positively correlated with frequency of prescribing. The most commonly reported barrier to prescribing physical activity was a lack of time. On average, respondents prescribed physical activity to 59 per cent of their patients. The patient factors that most commonly prompted physical activity prescription were overweight or obesity, type 2 diabetes, hypertension and cardiovascular health. The lack of specific education in preventive medicine (e.g., obesity prevention, physical activity, nutrition) reported by 63 per cent of respondents points to the need for a physical activity prescription curriculum within nursing education to equip future NPs to respond to the high prevalence of physical inactivity in Canadian society.

Influence of Pythium oligandrum on the bacterial communities that colonize the nutrient solutions and the rhizosphere of tomato plants

The influence exerted by the biocontrol oomycete Pythium oligandrum on the bacterial populations proliferating in the rhizosphere of tomato plants grown in a hydroponic system and in the circulating solutions is studied in the present experiment. Quantitative PCR and single-strand conformation polymorphism were used to investigate the genetic structure and dynamics of the bacterial communities colonizing the root systems and the various circulating solutions. Quantitative PCR assays showed that bacteria heavily colonized the rhizosphere of tomato plants with, however, no significant density changes throughout the cultural season (April–September). Single strand conformation polymorphism fingerprints revealed the occurrence of transient perturbations in the rhizospheric indigenous bacterial communities following P. oligandrum introduction in the root system of plants. This effect was, however, transient and did not persist until the end of the cropping season. Interestingly, the genetic structure of the bacterial microflora colonizing either the roots or the nutrient solutions evolved throughout the cropping season. This temporal evolution occurred whatever the presence and persistence of P. oligandrum in the rhizosphere. Evidence is also provided that bacterial microflora that colonize the root system are different from the ones colonizing the circulating solutions. The relationships between these 2 microflora (at the root and solution levels) are discussed.

Understanding physical activity maintenance in breast cancer survivors

OBJECTIVES

To examine predictors of physical activity (PA) 6 months after a randomized controlled trial.

METHODS

Breast cancer survivors (N=377) completed assessments at baseline, postintervention, and 6 months after the intervention. Data were collected on demographic, medical, psychosocial, motivational, and behavioral variables at baseline, postintervention, and 6 months.

RESULTS

Survivors meeting PA guidelines at baseline (OR = 5.54, 95% CI = 2.99-9.82, P < 0.001) and postintervention (OR = 2.92, 95% CI = 1.63-5.23, P < 0.001) had a greater likelihood of meeting PA guidelines at 6 months follow-up.

CONCLUSIONS

Interventions promoting PA maintenance should focus on optimizing PA behavior, psychosocial functioning, and motivation.

South-East Scotland trabeculectomy survey

AIM

Assessment of trabeculectomy in South-East Scotland (SESTS) with comparison to National Survey of Trabeculectomy (NST) and outcomes of consultant and trainee surgery.

METHOD

A retrospective study of 304 consecutive, primary trabeculectomies, in two Scottish centres (Edinburgh and Dunfermline) with two glaucoma specialists and higher surgical trainees, was performed. The study group had primary open angle glaucoma (65.5%), pseudoexfoliation (6.9%), normal tension glaucoma (7.6%), pigment dispersion syndrome (1.6%), and other complicated glaucoma (18.4%). All patients underwent trabeculectomy by the glaucoma specialist (57.6%) and higher surgical trainee (42.4%) with close scrubbed supervision.

RESULTS

Compared to the NST, the waiting time for surgery (<3 months) was significantly less in the SESTS (P<0.001). There was also significantly more use of intraoperative antimetabolites (P<0.01), bleb intervention (P<0.001), and a higher rate of early complications (P<0.025). There was no significant difference in outcome at intraocular pressure (IOP)<2/3 listing IOP (qualified and unqualified) between the SESTS and the NST. Significantly, more patients achieved an unqualified success of IOP<21 mmHg (P<0.01) and an unqualified success of IOP<16 mmHg in the SESTS than the NST (P<0.05). At 1 year post surgery, visual loss of greater than one Snellen line was more common in the NST (P<0.01) as was the use of anti-glaucoma medication (P<0.001). Trainee cases returned to theatre more frequently (P<0.025) and merited more bleb intervention (P<0.01) than consultant cases, but the long-term outcome was similar.

CONCLUSION

Our study highlights significant changes in the practice and outcome of trabeculectomy compared to the national survey conducted a decade ago.