However, this level of adherence Staurosporine in vivo may differ in the longer term or among users who are new to the interventions. On the basis of these results, we suggest that clinicians should encourage adults with cystic fibrosis who use hypertonic saline and

airway clearance techniques to inhale the saline before or during the techniques. A bronchodilator should be inhaled before the hypertonic saline. If dornase alpha is also to be used, it could be inhaled after the airway clearance techniques or at another time of the day, because these timing regimens do not reduce the benefit of dornase alpha (Dentice and Elkins 2011). Other medications such as inhaled antibiotics could be inhaled after airway clearance techniques, which theoretically would improve their deposition by reducing airway obstruction by mucus. eAddenda: Table 3 available at jop.physiotherapy.asn.au Ethics: The Sydney Local Health District (RPAH Zone) Ethics Committee approved this study (X09-0283, HREC/09/RPAH/477). All participants gave written informed consent before data collection began. Competing interests: None. Support: This

study was supported by the NHMRC CCRE in Respiratory & Sleep Medicine Postgraduate Research screening assay Scholarship and the US Cystic Fibrosis Foundation grant BYE04A0. The authors are grateful to the participants for their involvement and the Department of Physiotherapy at Royal Prince Alfred Hospital. “
“Contractures, or loss of passive joint range of motion (Dudek and Trudel 2008), are common after stroke (Ada and Canning 1990). Contractures can limit performance of functional activities such as standing, walking, dressing, and grooming (Ada and Canning 1990, Dudek and Trudel 2008, Fergusson et al 2007). They are also associated with pain, pressure Idoxuridine ulcers, falls, and other complications that increase dependence (Wagner and Clevenger 2010). Yet there are few quantitative data on the proportion of patients who develop contractures, the location of contractures, or the characteristics of patients most susceptible to developing contractures after stroke. Two prospective cohort studies have

estimated the incidence of contractures one year after stroke. One reported an incidence of 23% (Pinedo and de la Villa 2001) whereas the other reported an incidence of 60% (Sackley et al 2008). One possible explanation for why these estimates differ may be that one cohort consisted of patients recruited from a rehabilitation hospital (Pinedo and de la Villa 2001) and the other consisted of patients with a severe disabling stroke identified from a register (Sackley et al 2008). To our knowledge, no studies have documented the incidence of contractures in the broader population of patients who present to hospital with stroke. Such data are needed to quantify the magnitude of the problem of contractures after stroke. It would be useful to identify patients who are most susceptible to developing contractures.