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==== '''Overview''' ====
==== '''Overview''' ====
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CSP's ''Frontline'' magazine highlighted the need for cardioprespiratory physiotherapy in prisons due to the increased number of prisoners that smoke, which is further reinforced by a statistic reported by Conroy stating that it is estimated 90% of prisoners smoke<ref name="Conroy 2013">Conroy, B.D. The Management of COPD in a Secure Prison Environment. 2013. Available from: http://priory.com/cmol/copdprison.htm (accessed: 20th November, 2013).</ref>. Furthermore, due to the increasing ageing population, the prevalence of chronic obstructive pulmonary disease (COPD) in prisons is also likely to increase putting a greater demand on physiotherapists treating respiratory conditions, predominantly COPD. COPD,
an umbrella term often used to define various conditions of
which chronic bronchitis and emphysema
are the most commonly observed
, is characterised as a difficulty in breathing due to permanent damage to the lungs.
Other diseases that
contribute to
COPD are
obstructive bronchiolitis, pulmonary vascular disease, cor pulmonale (right sided heart failure and pulmonary heart disease), and systemic syndrome of cachexia and muscle weakness. While the damage on the lungs is non-reversible, it is a preventable and treatable condition<ref name="Hansel 2013">Hansel, T.T. &amp;amp;amp;amp;amp; Kon, O.M. (2009). Chapter 1: Global Burden and natural history of COPD, IN Chronic Obstructive Pulmonary Disease (COPD), Oxford University Press, Oxford: UK, http://books.google.co.uk/books?id=7xyiBAtcnTMC&amp;amp;amp;amp;amp;lpg=PT95&amp;amp;amp;amp;amp;ots=Srs1JIvE5r&amp;amp;amp;amp;amp;dq=kon%20and%20hansel%20copd%20online&amp;amp;amp;amp;amp;pg=PT95#v=onepage&amp;amp;amp;amp;amp;q=kon%20and%20hansel%20copd%20online&amp;amp;amp;amp;amp;f=false (accessed 22 Nov 2013).</ref>. It is the most prevalent cause for morbidity and mortality worldwide and, subsequently, places a heavy economic and social burden on governments<ref name="Celli 2013">Celli, B.R., MacNee, W. &amp;amp;amp;amp;amp; committee members. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004; 23: 932-946.</ref>.
+
CSP's ''Frontline'' magazine highlighted the need for cardioprespiratory physiotherapy in prisons due to the increased number of prisoners that smoke, which is further reinforced by a statistic reported by Conroy stating that it is estimated 90% of prisoners smoke<ref name="Conroy 2013">Conroy, B.D. The Management of COPD in a Secure Prison Environment. 2013. Available from: http://priory.com/cmol/copdprison.htm (accessed: 20th November, 2013).</ref>. Furthermore, due to the increasing ageing population, the prevalence of chronic obstructive pulmonary disease (COPD) in prisons is also likely to increase putting a greater demand on physiotherapists treating respiratory conditions, predominantly COPD. COPD, which
is made up of
chronic bronchitis and emphysema, is characterised as a difficulty in breathing due to permanent damage to the lungs.
COPD may also
contribute to
other respiratory problems such as
obstructive bronchiolitis, pulmonary vascular disease, cor pulmonale (right sided heart failure and pulmonary heart disease), and systemic syndrome of cachexia and muscle weakness. While the damage on the lungs is non-reversible, it is a preventable and treatable condition<ref name="Hansel 2013">Hansel, T.T. &
amp;
amp;amp;amp;amp;amp;amp;amp; Kon, O.M. (2009). Chapter 1: Global Burden and natural history of COPD, IN Chronic Obstructive Pulmonary Disease (COPD), Oxford University Press, Oxford: UK, http://books.google.co.uk/books?id=7xyiBAtcnTMC&
amp;
amp;amp;amp;amp;amp;amp;amp;lpg=PT95&
amp;
amp;amp;amp;amp;amp;amp;amp;ots=Srs1JIvE5r&
amp;
amp;amp;amp;amp;amp;amp;amp;dq=kon%20and%20hansel%20copd%20online&
amp;
amp;amp;amp;amp;amp;amp;amp;pg=PT95#v=onepage&
amp;
amp;amp;amp;amp;amp;amp;amp;q=kon%20and%20hansel%20copd%20online&
amp;
amp;amp;amp;amp;amp;amp;amp;f=false (accessed 22 Nov 2013).</ref>. It is the most prevalent cause for morbidity and mortality worldwide and, subsequently, places a heavy economic and social burden on governments<ref name="Celli 2013">Celli, B.R., MacNee, W. &
amp;
amp;amp;amp;amp;amp;amp;amp; committee members. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004; 23: 932-946.</ref>.
[[Image:Smoking trends in prison.jpg|center|400x300px]]<ref name="NHS Smoking 2013">NHS. Smoking and health inequalities. Health development agency, 6 p.;http://www.nice.org.uk/nicemedia/documents/smoking_and_health_inequalities.pdf (accessed 22 Nov 2013.</ref><br>
[[Image:Smoking trends in prison.jpg|center|400x300px]]<ref name="NHS Smoking 2013">NHS. Smoking and health inequalities. Health development agency, 6 p.;http://www.nice.org.uk/nicemedia/documents/smoking_and_health_inequalities.pdf (accessed 22 Nov 2013.</ref><br>
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The prevalence of COPD’s effect on economy is greatly underestimated due to its consequential late diagnosis, because people often present with moderate or severe symptoms. Onset of the disease can occur as early as 35 years old; however, it is more commonly seen in individuals over the age of 65<ref name="British Lung 2013">British Lung Foundation: COPD. http://www.blf.org.uk/Conditions/Detail/COPD (accessed 22 Nov 2013).</ref>. Several factors, including late diagnosis and socioeconomic factors, are responsible for this varying age in diagnosis. Characterised by a progressive reduction in airflow resulting in an atypical inflammatory lung response to carcinogenic particles or gases, COPD is a preventable and treatable disease state. Smoking is the leading cause of COPD, however other factors, such as air pollution, environmental factors, and genetics factors, can also be precursors to the development of COPD<ref name="British Lung 2013" />.
The prevalence of COPD’s effect on economy is greatly underestimated due to its consequential late diagnosis, because people often present with moderate or severe symptoms. Onset of the disease can occur as early as 35 years old; however, it is more commonly seen in individuals over the age of 65<ref name="British Lung 2013">British Lung Foundation: COPD. http://www.blf.org.uk/Conditions/Detail/COPD (accessed 22 Nov 2013).</ref>. Several factors, including late diagnosis and socioeconomic factors, are responsible for this varying age in diagnosis. Characterised by a progressive reduction in airflow resulting in an atypical inflammatory lung response to carcinogenic particles or gases, COPD is a preventable and treatable disease state. Smoking is the leading cause of COPD, however other factors, such as air pollution, environmental factors, and genetics factors, can also be precursors to the development of COPD<ref name="British Lung 2013" />.
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<br> '''Smoking - the leading cause of COPD '''
-
'''Smoking - the leading cause of COPD '''
+
It has been estimated that smoking contains 1017 reactive oxidant species (ROS). ROS instigate a wide range of inflammatory, mucosecretory, proteolytic, and fibrotic responses, which consequently cause the release of chemotactic factors and cytokines due to epithelial cell injury and macrophage activation. Macrophage and neutrophil involvement cause the breakdown of the extracellular matrix, which corresponds with an inflammatory response. Pathologically, an increase in cigarette smoke parallels a greater number of inflammatory and repair (fibrosis as a consequence) cycles on these response systems, which commonly manifests as mucus hypersecretion, fibrosis, proteolysis, and airway and parenchymal remodelling<ref name="Hansel 2013" />. Smoking cessation can gradually reduce your risk of getting COPD, or slow its progression if diagnosed in the earlier stages of COPD. Initiatives are being made in efforts to decrease smoking rates in prisons. Most recently, a smoking ban has been proposed
for
prisons in England and Wales. See 'COPD and Physiotherapy: In the News'.
-
+
-
It has been estimated that smoking contains 1017 reactive oxidant species (ROS). ROS instigate a wide range of inflammatory, mucosecretory, proteolytic, and fibrotic responses, which consequently cause the release of chemotactic factors and cytokines due to epithelial cell injury and macrophage activation. Macrophage and neutrophil involvement cause the breakdown of the extracellular matrix, which corresponds with an inflammatory response. Pathologically, an increase in cigarette smoke parallels a greater number of inflammatory and repair (fibrosis as a consequence) cycles on these response systems, which commonly manifests as mucus hypersecretion, fibrosis, proteolysis, and airway and parenchymal remodelling<ref name="Hansel 2013" />. Smoking cessation can gradually reduce your risk of getting COPD, or slow its progression if diagnosed in the earlier stages of COPD. Initiatives are being made in efforts to decrease smoking rates in prisons. Most recently, a smoking ban has been proposed
from
prisons in England and Wales. See 'COPD and Physiotherapy: In the News'.
+
==== Physiotherapy<br> ====
==== Physiotherapy<br> ====
-
Various physiotherapy techniques have been well-documented in having a positive effect on symptoms experienced by COPD patients
. The goal of pulmonary rehabilitation is to assist the clearance of secretions and improved overall quality of life
. Common techniques include the following: <br><br>''Manual Chest Techniques<ref name="Garrod 2013">Garrod, R., Lasserson, T. Role of physiotherapy in the management of chronic lung disease: An overview of systemic reviews. Respiratory Medicine. 2007; 101: 2429-2436.</ref><ref name="Yohannes 2013">Yohannes, A.M., Connolly, M.J. A national survey: percussion, vibration, shaking and active cycle of breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease. Physiotherapy. 2007; 93: 110-113.</ref>:''
+
Various physiotherapy techniques have been well-documented in having a positive effect on symptoms experienced by COPD patients. Common techniques include the following: <br><br>''Manual Chest Techniques<ref name="Garrod 2013">Garrod, R., Lasserson, T. Role of physiotherapy in the management of chronic lung disease: An overview of systemic reviews. Respiratory Medicine. 2007; 101: 2429-2436.</ref><ref name="Yohannes 2013">Yohannes, A.M., Connolly, M.J. A national survey: percussion, vibration, shaking and active cycle of breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease. Physiotherapy. 2007; 93: 110-113.</ref>:''
*chest percussion
*chest percussion
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*intermittent positive pressure breathing (IPPB)
*intermittent positive pressure breathing (IPPB)
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<br>The benefits of physical activity also cannot be underestimated. Pulmonary rehabilitation classes are commonly offered in the community. Patients suffering from COPD in prisons would greatly benefit from these types of programmes; however, there are many challenges associated with organising these programmes, including funding, security, and manpower. <br>
+
<br>The benefits of physical activity also cannot be underestimated. Pulmonary rehabilitation classes are commonly offered in the community
. The goal of pulmonary rehabilitation is to assist the clearacne of secretions and improve overall quality of llife
. Patients suffering from COPD in prisons would greatly benefit from these types of programmes; however, there are many challenges associated with organising these programmes, including funding, security, and manpower. <br>
<br>
<br>
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==== '''''In the news: COPD and Physiotherapy''''' ====
==== '''''In the news: COPD and Physiotherapy''''' ====
-
Recent publications by CSP's ''Frontline'' magazine presented initiatives being made by UK physiotherapists working in English and Welsh prisons to improve the health of prisoners suffering from COPD. It was estimated that patients needing to be transferred and escorted to hospital was costing £500 per incident <ref name="McMillan 2013" />. The article raised awareness of the high prevalence of COPD in prisons and, particularly, the lack of training and/or equipment that is available to provide rehabilitation to prisoners suffering from COPD. In Maidstone prison in England, a pulmonary rehabilitation physiotherapist and a prison healthcare nurse organised and led a two-hour health promotion and exercise class two times per week over a seven weeks. The classes consisted of an educational component (one hour) from a member of the multi-disciplinary team (e.g. GP, dietician, physio, nurse, pharmacy assistant) discussing smoking cessation, mental health, benefits of exercise, and breathing techniques to name a few.
Patients
reported feeling less out of breath, better recovery times post exercise, decreased heart rate and blood pressure, increase in energy, positive mental state, increased motivation, and a feeling of improved general wellbeing.
+
Recent publications by
the
CSP's ''Frontline'' magazine presented initiatives being made by UK physiotherapists working in English and Welsh prisons to improve the health of prisoners suffering from COPD. It was estimated that patients needing to be transferred and escorted to hospital was costing £500 per incident <ref name="McMillan 2013" />. The article raised awareness of the high prevalence of COPD in prisons and, particularly, the lack of training and/or equipment that is available to provide rehabilitation to prisoners suffering from COPD. In Maidstone prison in England, a pulmonary rehabilitation physiotherapist and a prison healthcare nurse organised and led a two-hour health promotion and exercise class two times per week over a seven weeks. The classes consisted of an educational component (one hour) from a member of the multi-disciplinary team (e.g. GP, dietician, physio, nurse, pharmacy assistant) discussing smoking cessation, mental health, benefits of exercise, and breathing techniques to name a few.
Following these classes, patients
reported feeling less out of breath,
had
better recovery times post exercise, decreased heart rate and blood pressure, increase in energy, positive mental state, increased motivation, and a feeling of improved general wellbeing.
-
Another initiative being proposed by the Prison Service is instilling a
no-
smoking ban in prisons to primarily reduce the amount of second-hand smoke which affect prison staff and non-smoking prisoners. Secondly, it would help reduce the amount of COPD cases suffered by prisoners, and alleviate stress on clinicians and finances. Initially proposed in 2007 by the Prison Officers Association (POA), the smoking ban has been also supported by the Association for Chartered Physiotherapists in Respiratory Care<ref name="Mcmillan2 2013">Mcmillan, I.A. Plan to stub out smoking in prisons given cautious welcome by physios. 2013. http://www.csp.org.uk/frontline/article/plan-stub-out-smoking-prisons-given-cautious-welcome-physios (accessed 18 Nov 2013).</ref>. However, the success of a smoking ban would need to be supported by an established programme such as the seven-week health promotion and exercise class offered in Maidstone Prison. Other countries who have also recently adopted smoking bans in prisons include New Zealand, the United States, and Canada.
+
Another initiative being proposed by the Prison Service is instilling a
smoking ban (similar to the
smoking ban in
public places) inside
prisons to primarily reduce the amount of second-hand smoke which affect prison staff and non-smoking prisoners. Secondly, it would help reduce the amount of COPD cases suffered by prisoners, and alleviate stress on clinicians and finances. Initially proposed in 2007 by the Prison Officers Association (POA), the smoking ban has been also supported by the Association for Chartered Physiotherapists in Respiratory Care<ref name="Mcmillan2 2013">Mcmillan, I.A. Plan to stub out smoking in prisons given cautious welcome by physios. 2013. http://www.csp.org.uk/frontline/article/plan-stub-out-smoking-prisons-given-cautious-welcome-physios (accessed 18 Nov 2013).</ref>. However, the success of a smoking ban would need to be supported by an established programme such as the seven-week health promotion and exercise class offered in Maidstone Prison. Other countries who have also recently adopted smoking bans in prisons include New Zealand, the United States, and Canada.
<br>
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<br>Security is obviously a major concern in prisons and remains a priority when treating prisoners both for the safety of the health professionals and the prisoners. Based on the information obtained from the conducted interviews, there are definite security considerations which must be taken into account when working with prisoners.
<br>Security is obviously a major concern in prisons and remains a priority when treating prisoners both for the safety of the health professionals and the prisoners. Based on the information obtained from the conducted interviews, there are definite security considerations which must be taken into account when working with prisoners.
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<br>When the physiotherapist enters the prison, they must go through the same lengthy security process as each visitor and employee
;
this can take up to 15 minutes. It involves having all of your personal belongings passed through an x-ray machine, as well as walking through a metal detector yourself. One of our interviewees
also mentioned the presence of sniffer dogs on occasions
. '''Physiotherapist A'''
described it as going through security at an airport.
+
''' Physiotherapist A''' 
;also mentioned the presence of sniffer dogs on occasions
and
described it as going through security at an airport.
<br>Once inside the prison, you are free to walk to the health centre and around the prison by yourself, but only if you have completed the intense personal protective training program. For physiotherapists who have not completed such training, they must be accompanied by a security guard at all times. Each health professional wears a small personal alarm at all times, which can be pressed in case of an emergency.
<br>Once inside the prison, you are free to walk to the health centre and around the prison by yourself, but only if you have completed the intense personal protective training program. For physiotherapists who have not completed such training, they must be accompanied by a security guard at all times. Each health professional wears a small personal alarm at all times, which can be pressed in case of an emergency.