Saudi Cultural Missions Theses & Dissertations
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Item Restricted Can wobble board training improve balance in the elderly and diabetic population with and without peripheral neuropathy?(Cardiff University, 2024) Aljawaee, Madawi; Jones, Michael; Williams, JJonathanDiabetes mellitus (DM) affects 537 million adults, and this number is expected to increase to 634 million by 2030. Long-term, exposure to diabetes can result in diabetic peripheral neuropathy (DPN), which is characterised by a progressive deterioration of the sensorimotor system. It leads to neurogenic muscle atrophy and loss of muscle strength, ultimately contributing to impaired balance and an increased risk of falling. Thus, there is a need to lower the fall risk of people with diabetes (PWD), particularly those with DPN, since fall-related injuries can significantly affect quality of life and associated treatment costs. Therefore, a wobble board (WB) training programme was suggested, which is proven to improve balance in young adults and athletes. Three studies were conducted to investigate the effectiveness of WB training. The first study used a systematic literature review to determine the effectiveness of WB training for improving balance in healthy elderly individuals. The result of this review was a recommendation to assess WB improvement via a multi-modal assessment. The second study investigated the effect of biological sex, anthropometrics, footwear, physical activity and DT on static balance and WB performance in healthy adults, to provide normal values for use. The findings of this study indicate that females outperform males with respect to balance. The Wilcoxon test was used to test the differences between singles and DT, as well as between with and without footwear. In both sexes, footwear and DT has a minimal influence on static balance and WB performance, except during double leg stance with eyes close (DLSEC), static balance performance was better without footwear than with footwear in both sexes, but with footwear resulted in better static balance performance and WB performance during single leg stance (SLS) in males only, with no large effect size (the large ES ≥0.9 or ≤ -0.9). Being taller, heavier or having a larger upper torso are associated with poorer static balance and WB performance. The third study determined the effects of age, anthropometrics, severity of DPN, neuropathic pain, duration of DM, balance confidence, muscle strength and physical activity on static balance and on WB performance among PWD and individuals with DPN. Spearman’s rho correlation test was used to determine the relationship between previous baseline characteristics and static balance, as well as WB performance. Overall, anthropometrics factors affect static balance and WB performance. By benefitting from previous studies and their findings, a progressive, six-weeks WB training programme for PWD and individuals with DPN was implemented. The programme’s effect on static balance, WB performance, severity of DPN, neuropathic pain, balance confidence, muscle strength and physical activity were investigated. Positive results (P-value ≤ 0.001) were achieved after six weeks in terms of improved most of the previous factors, with large effect size. It is concluded that WB training is successful in improving sensorimotor system, which is responsible for controlling balance.2 0Item Restricted A cross-sectional clinical audit of rapid tranquillisation practices for elderly patients at Surrey and Sussex Healthcare NHS trust(Saudi Digital Library, 2023-11-01) Almutairi, Bader Awadh; Barrett, RavinaIntroduction: Rapid tranquillisation (RT) is a procedure that is often used in hospitals for confused, agitated, aggressive or violent patients. RT is most commonly used with the elderly, often suffering from delirium or dementia. The goal is to sedate the patient, thus minimising the risk of harm to themselves or others. The procedure in East Surrey Hospital (ESH) (locus of this audit) is governed by Surrey and Sussex Hospital Trust (SASH), as the medications used may require careful selection according to various factors. The aim of this audit was to explore the extent to which SASH adheres to its published RT Policy, specifically concerning the RT of elderly patients (aged 75 and above). Method: The study was a cross-sectional retrospective clinical audit. The inclusion criteria were that the patients were to be aged 75 or older, have received RT at ESH between 1st May 2023 and 14th June 2023. The data were analysed using SPSS software, Version 28. Findings: Overall, an 84% adherence rate was achieved for the 14 standards that were applied. The rate of non-adherence ranged from 0% to 100%. Eight of the standards were met with 100% adherence; one standard and three standards achieved adherence rates between 90 and 99% and between 80 and 89%, respectively; one standard had an adherence rate of 30%; and one standard achieved an adherence rate of 0%. For 25%, 44.7% and 14.9% of the patients, 13, 12 and 11 standards were met, respectively, At least 12 of the 14 standards were met in over 85% of cases. In terms of adherence by the medical and surgical wards, for nine standards, the adherence rates were either identical or very similar; for three standards, the medical wards showed higher compliance; and for one standard, the surgical wards showed a higher rate of adherence. Thus, overall, the two kinds of wards showed very similar levels of adherence. Discussion: The audit was a valuable tool, with significant results that need to be further explored. It was suggested that adherence may have been negatively affected by work overload, the need for training or the clinical situation that presented itself. Five recommendations were made: (1) The findings should be presented to and discussed with the care team; (2) staff should be given training regarding the guidelines; (3) the clinical audit should be repeated annually; (4) an RT care plan should be published, and a computerised system installed to provide alerts when non-adherence occurs; (5) audits should be conducted at different times of the year, When hospital busyness varies. Future research may include longitudinal and qualitative studies. The clinical audit should form part of a hospital’s continuous improvement programme.21 0