ORCID Profile
0000-0002-1484-1113
Current Organisations
La Trobe University
,
University of Tasmania
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Publisher: Elsevier BV
Date: 09-2021
Publisher: SAGE Publications
Date: 2022
DOI: 10.33151/AJP.19.929
Abstract: Paramedics are key to the provision of emergency care in the community. Those living with dementia use paramedic services at a high rate, due to a range of issues related to comorbid conditions and other acute events which mean care cannot continue in the home. There is a paucity of literature related to care provided in such instances. Anecdotally, a perception exists that providing care to this group of people is challenging for paramedics in situations where high level assessment and emergency care are paramount. Paramedics in one Australian state were sought to participate in an exploratory study to enhance understanding of how they currently worked with people who lived in the community and had dementia. Sixteen participants were recruited to the study, and they worked in a number of areas, including urban and rural. Experience was broad, ranging from one to 36 years in the paramedic role. Inductive thematic analysis of interviews revealed key themes that framed the paramedic role and permeated interactions, assessment and decision-making. Paramedics participating in this study recognised people living with dementia who had high level impacts of the condition, suggesting those with less visible symptoms may remain hidden. With the projected increase of people diagnosed with dementia it is imperative that paramedics are aware of, and integrate dementia knowledge, skills and confidence into their practice. Deeper exploration of the area that includes volunteer ambulance personnel and further inquiry of the role of paramedics in relation to those living with dementia is needed. A focus on education and professional development to equip paramedics to work with people living with dementia is recommended. The findings suggest that greater work in this area is required.
Publisher: Wiley
Date: 09-05-2019
DOI: 10.1111/AJAG.12669
Abstract: To assess the effect of Saturday allied health services on a geriatric evaluation and management ward. A controlled before-and-after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre-intervention (N = 331) and intervention (N = 462). Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7-10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6-5.7) and no difference in the proportion discharged home. Cost-effectiveness demonstrated no significant difference in cost ($2639, 95% CI $-386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8-6.5) favouring the experimental ward. These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay.
Publisher: Wiley
Date: 09-12-2021
DOI: 10.1111/AJAG.12886
Abstract: To evaluate the dementia knowledge of allied health professionals and identify their specific learning needs. An online survey was conducted with allied health professionals enrolled in the Understanding Dementia Massive Open Online Course, a free course open to anyone, worldwide. The primary outcome measure was the Dementia Knowledge Assessment Scale, assessed prior to course commencement. The survey was completed by 1591 participants. The mean dementia knowledge score was 35.0 (SD 8.4), with 13% (n = 207) achieving a target score of 45/50 or above, indicating comprehensive dementia knowledge. Key knowledge gaps were in the areas of dementia onset and non‐pharmacological management of behavioural and psychological symptoms of dementia. Allied health professionals surveyed had significant gaps in dementia knowledge. Educators planning dementia curriculum for allied health professionals could consider addressing areas of knowledge related to the identified items, with view to providing a foundation for excellence in dementia care.
Publisher: Informa UK Limited
Date: 18-01-2022
DOI: 10.1080/09593985.2022.2028324
Abstract: To explore the experiences of physiotherapy students on working with people with dementia during their clinical placements. Qualitative study using a Web-based survey of students in a 2-year entry-level Masters of Physical Therapy (MPT) program. A total of 55 students (93%) completed the survey. Two overarching themes were mastery and inequity. Mastery described dementia care physiotherapy as a complex and potentially rewarding area of practice, requiring education and development throughout the professional continuum from student to expert. Inequity captured the barriers people with dementia experience to receiving excellent physiotherapy care. Six categories supported the themes: 1) physiotherapist characteristics for a successful therapeutic relationship 2) communication strategies 3) best practice physiotherapy skills and knowledge 4) education strategies 5) desire to work with people living with dementia and 6) equity. The study found physiotherapy students' experiences were informed by the preceptors' approach to delivery of care for people living with dementia. The students also articulated areas they wish they had known before placement and provided suggestions for teaching development in this area.
Publisher: SERDI
Date: 2023
Publisher: Informa UK Limited
Date: 12-09-2023
Publisher: Wiley
Date: 30-07-2023
DOI: 10.1002/ALZ.13401
Abstract: Finding low‐cost methods to detect early‐stage Alzheimer's disease (AD) is a research priority for neuroprotective drug development. Presymptomatic Alzheimer's is associated with gait impairment but hand motor tests, which are more accessible, have hardly been investigated. This study evaluated how home‐based Tasmanian (TAS) Test keyboard tapping tests predict episodic memory performance. 1169 community participants (65.8 ± 7.4 years old 73% female) without cognitive symptoms completed online single‐key and alternate‐key tapping tests and episodic memory, working memory, and executive function cognitive tests. All single‐key ( R 2 adj = 8.8%, ΔAIC = 5.2) and alternate‐key ( R 2 adj = 9.1%, ΔAIC = 8.8) motor features predicted episodic memory performance relative to demographic and mood confounders only ( R 2 adj = 8.1%). No tapping features improved estimation of working memory. Brief self‐administered online hand movement tests predict asymptomatic episodic memory impairment. This provides a potential low‐cost home‐based method for stratification of enriched cohorts. We devised two brief online keyboard tapping tests to assess hand motor function. 1169 cognitively asymptomatic adults completed motor‐ and cognitive tests online. Impaired hand motor function predicted reduced episodic memory performance. This brief self‐administered test may aid stratification of community cohorts.
Publisher: Hindawi Limited
Date: 04-02-2015
DOI: 10.1111/IJCP.12600
Abstract: To explore the validity and reliability of eye healthcare professionals with different levels of training in diagnosing and/or identifying glaucomatous progression. Substantial pressure is being placed on our current eye healthcare workforce by chronic diseases such as glaucoma. Shared care schemes and role expansion of professionals other than ophthalmologists are being proposed to alleviate this pressure. A sound evidence base is imperative to determine whether other allied health professionals are skilled and clinically competent, when it comes to taking on these new roles in glaucoma management. A systematic review of research articles identified in MEDLINE, CINAHL, Embase, Scopus and Cochrane Library was performed. Studies which investigated rater reliability of various health professionals in diagnosing and/or identifying glaucoma progression against a reference standard were included. Of the 4088 publications identified by the initial database search, 32 met the inclusion criteria. The majority of studies demonstrated positive results, with most finding moderate to substantial agreement for inter- and intra-rater reliability across all testing modalities. The eye health professionals with ophthalmology training consistently attained the greatest agreement. When allied health professionals with different levels of training were compared, those who had completed residency training were significantly better than those who had not. The studies included in this review show promising results, including those raters without ophthalmology training. A lack of power calculations, unequal s le sizes in some studies and the ersity of the testing procedures used make it difficult to make sound inferences.
Publisher: Elsevier BV
Date: 2024
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.APMR.2012.11.022
Abstract: To investigate whether allied health therapy provided by caregivers improves patient outcomes. Electronic databases MEDLINE, CINAHL, Embase, Allied Health Evidence, and Cochrane Central Register of Controlled Trials were searched from the earliest available date until July 2011. The search strategy included synonyms for allied health disciplines, caregivers, and randomized controlled trials. Of 1761 potentially relevant articles evaluated by 2 reviewers independently, 29 trials met inclusion criteria. After data were extracted, 2 reviewers independently assessed the quality of trials using the Physiotherapy Evidence Database Scale. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess quality of evidence across studies. The 29 trials included 1196 participants and investigated speech and language therapy (n=19), physical therapy (n=2), social work (n=1), psychology (n=1), and combinations of 2 or more disciplines (n=6). Meta-analysis provided high-quality evidence that when compared with no intervention, caregiver-administered speech and language therapy improved language outcomes in children. Meta-analysis provided moderate-quality evidence that therapy provided by speech and language therapists was not superior to caregiver-administered therapy for children with speech impairments. The smaller number of physical therapy, psychology, and social work trials could not be combined in meta-analyses but provided ex les of caregiver-administered therapy being more effective than no intervention and as effective as clinician-administered therapy. There is moderate-quality evidence that caregivers can be trained to provide effective speech and language therapy interventions. This approach needs more evaluation, but may be applicable in the disciplines of physical therapy, occupational therapy, social work, psychology, dietetics, and podiatry.
Publisher: Elsevier BV
Date: 08-2022
Publisher: Springer Science and Business Media LLC
Date: 18-07-2022
DOI: 10.1186/S12883-022-02772-5
Abstract: The worldwide prevalence of dementia is rapidly rising. Alzheimer’s disease (AD), accounts for 70% of cases and has a 10–20-year preclinical period, when brain pathology covertly progresses before cognitive symptoms appear. The 2020 Lancet Commission estimates that 40% of dementia cases could be prevented by modifying lifestyle/medical risk factors. To optimise dementia prevention effectiveness, there is urgent need to identify in iduals with preclinical AD for targeted risk reduction. Current preclinical AD tests are too invasive, specialist or costly for population-level assessments. We have developed a new online test, TAS Test, that assesses a range of motor-cognitive functions and has capacity to be delivered at significant scale. TAS Test combines two innovations: using hand movement analysis to detect preclinical AD, and computer-human interface technologies to enable robust ‘self-testing’ data collection. The aims are to validate TAS Test to [1] identify preclinical AD, and [2] predict risk of cognitive decline and AD dementia. Aim 1 will be addressed through a cross-sectional study of 500 cognitively healthy older adults, who will complete TAS Test items comprising measures of motor control, processing speed, attention, visuospatial ability, memory and language. TAS Test measures will be compared to a blood-based AD biomarker, phosphorylated tau 181 (p-tau181). Aim 2 will be addressed through a 5-year prospective cohort study of 10,000 older adults. Participants will complete TAS Test annually and subtests of the Cambridge Neuropsychological Test Battery (CANTAB) biennially. 300 participants will undergo in-person clinical assessments. We will use machine learning of motor-cognitive performance on TAS Test to develop an algorithm that classifies preclinical AD risk (p-tau181-defined) and determine the precision to prospectively estimate 5-year risks of cognitive decline and AD. This study will establish the precision of TAS Test to identify preclinical AD and estimate risk of cognitive decline and AD. If accurate, TAS Test will provide a low-cost, accessible enrichment strategy to pre-screen in iduals for their likelihood of AD pathology prior to more expensive tests such as blood or imaging biomarkers. This would have wide applications in public health initiatives and clinical trials. ClinicalTrials.gov Identifier: NCT05194787 , 18 January 2022. Retrospectively registered.
Publisher: SAGE Publications
Date: 06-06-2019
Abstract: To investigate the safety and effectiveness of augmenting physiotherapy with family-assisted therapy, to inform a future, fully powered trial. Parallel pilot randomized controlled trial. Transition Care Program. Thirty-five older adults with multimorbidity, recently hospitalized, with a mean age of 84.1 years (SD = 6.1 years) and mean Modified Barthel Index of 67.8 units (SD = 19.2 units), and 40 family members. The control group ( n = 18) received usual physiotherapy care. The experimental group ( n = 17) received usual physiotherapy care and family-assisted therapy from a family member trained by a physiotherapist. Primary outcomes were falls-related self-efficacy measured by the Short Falls Efficacy Scale – International and falls during the intervention period. Secondary outcomes included daily steps, EQ-5D-3L (three-level version of the EuroQoL five-dimensional health-related quality of life questionnaire) and ICECAP-O (ICEpop CAPability measure for Older people), Modified Barthel Index and Modified Caregiver Strain Index. There were no between-group differences for falls-related self-efficacy. Relative to the control group, the experimental group was observed to have a reduced risk of falling (relative risk = 0.38, 95% confidence interval (CI) = 0.09–1.60) and a reduced falls rate (incidence rate ratio = 0.22, 95% CI = 0.04–1.20) was of borderline statistical significance. The experimental group walked a mean of 944 daily steps more than the control group (95% CI = 139–1748) and had a significant reduction in activity limitation. There were no between-group differences for quality of life or caregiver strain. Augmenting physiotherapy with family-assisted therapy is feasible for older people transitioning from hospital to the community. A fully powered randomized controlled trial is indicated.
Publisher: Elsevier BV
Date: 2018
Publisher: BMJ
Date: 10-2023
Publisher: Wiley
Date: 22-02-2019
DOI: 10.1111/AJAG.12636
Abstract: To investigate whether physical training (alone or in a multi-component intervention) is effective in preventing delirium or improving outcomes for adult patients with delirium in the hospital setting. A systematic review, qualitative synthesis and meta-analysis of randomised controlled trials identified by searches of electronic databases, combining key concepts of delirium and physical training (the target intervention). Outcomes were incidence of delirium (for prevention trials) and delirium duration, delirium severity and hospital outcomes (for management trials). Seven trials were included, five of which were multi-component. The odds of developing delirium were lower for patients who received physical training compared with a control intervention [odds ratio 0.46 (95% confidence interval 0.32-0.65), P < 0.01] (moderate-quality evidence). There was insufficient evidence to draw conclusions about managing established delirium. Strategies incorporating physical training appear to prevent delirium in the hospital setting. More research is required regarding management of established delirium.
Publisher: Wiley
Date: 08-2023
DOI: 10.1002/GPS.5988
Abstract: Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. ‘One‐stop’ cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one‐stop State‐wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. A novel single‐visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross‐sectional evaluation was undertaken using the RE‐AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. Over the first 52 consecutive weekly clinics: Reach : 130 adults were assessed (mean age [SD] 70.12 years [10.31] 59.2% female) with 40 (36.8%) from rural/remote areas. Effectiveness : 98.5% (128/130) received a same‐day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption : 22.9% (156) of General Practitioners referred patients. Implementation : Nearly all ‘ideal’ diagnostic clinical practices were met and % of surveyed patients reported ‘good/very good’ clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). This ‘one‐stop’ model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.
Publisher: Oxford University Press (OUP)
Date: 04-06-2021
Abstract: To determine whether preexisting dementia is associated with poorer quality of care and outcomes after stroke in the acute hospital phase. This was a retrospective analysis of pooled data from the Australian Stroke Foundation national audit conducted in 2015 and 2017. Dementia status was obtained from the medical records. Processes of care to assess quality included: stroke unit care, time-dependent therapy, nursing/allied health assessments, and preparation for discharge. Outcomes included in-hospital complications, independence on discharge, and destination. Logistic regression was used to examine associations between dementia status and processes of care. Multilevel random effects logistic regression, with level defined as hospital, was used to examine associations between dementia status and outcomes. There were 683/7,070 (9.7%) audited patients with dementia included. Patients with dementia were less likely to be treated in stroke units (58.3% vs 70.6%), receive thrombolysis if an ischemic stroke (5.8% vs 11.1%), have access within 48 hours to physiotherapy (56.4% vs 69.7%) or occupational therapy (46.8% vs 55.6%), see a dietitian if problems with nutrition (64.4% vs 75.9%), or have mood assessed (2.6% vs 12.3%). Patients with dementia were more likely to receive no rehabilitation (adjusted odds ratio 1.88, 95% confidence interval 1.25, 2.83) and be discharged to residential care (adjusted odds ratio 2.36, 95% confidence interval 1.50, 3.72). People with dementia received poorer quality of care and had worse outcomes after stroke. Our findings raise questions regarding equity and the need for better understanding of why the quality of care differs after stroke for people with dementia.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.JPHYS.2019.05.009
Abstract: What is the experience of patients and families participating in a family-assisted therapy intervention to augment physiotherapy in Transition Care? Qualitative study using an interpretive description framework. Thirteen patients and 18 family members of patients in a Transition Care Program, who had participated in a family-assisted therapy intervention. A 4-week family-assisted therapy program to augment usual physiotherapy care. Families were trained and supported by a physiotherapist to assist with safe and simple activities tailored to the patient's goals. Semi-structured interviews were audio-recorded and transcribed verbatim. Researchers independently coded transcripts line by line, and themes and subthemes were derived inductively. Qualitative results were triangulated with quantitative outcomes from a concurrent randomised controlled trial. The unifying theme was that family-assisted therapy empowered families in a healthcare setting. There were four subthemes: families made a complementary contribution to rehabilitation family-assisted therapy brought physical and psychosocial benefits simplicity, boundaries, training and support were important elements of the family-assisted therapy program and implementation of family-assisted therapy requires a supportive policy and environment. Findings largely converged with quantitative outcomes from the randomised controlled trial. Family-assisted therapy to augment usual physiotherapy care was a positive and empowering experience for patients and families in Transition Care. This study indicates that family-assisted therapy may increase opportunities for physical activity and, importantly, engage family in a meaningful activity that gives them a genuine role in the healthcare team. ACTRN12616000565448.
Publisher: Informa UK Limited
Date: 14-01-2015
DOI: 10.3109/09638288.2014.996673
Abstract: To generate an understanding of the opinions of key people associated with a program for older people transitioning from hospital back to the community and explore their thoughts around training family members to help provide physiotherapy. A qualitative study using focus groups and semi-structured interviews was conducted. Participants included patients admitted to a transitional care program, their family members, physiotherapists working in transitional care and members of a consumer group from the health service where the transitional care program was based. Data were transcribed verbatim and a thematic analysis was conducted. Four patients, four family members, four consumer group members and eight physiotherapists participated in this study. Three themes emerged: family members providing physiotherapy may improve outcomes for patients training family members to provide physiotherapy should include key elements and be in idualised and involving family members in physiotherapy may impact positively and negatively on people and relationships. Older people transitioning from hospital to the community are at risk of functional decline and may receive very little physiotherapy. Training family members to assist with physiotherapy was perceived as a way to improve patient outcomes and relationships between patients and their family, although there were concerns raised about caregiver stress. Evaluation of the feasibility and effectiveness of this approach is warranted. Older people transitioning from hospital to the community are at risk of functional decline and often receive very little physiotherapy. Training family members to assist with simple physiotherapy programs may increase the amount of physiotherapy patients transitioning from hospital to the community can receive and improve functional outcomes for patients. Stakeholders perceive that in idualising a program to patient and family member needs is important. Involving family members in physiotherapy may not increase caregiver stress and may improve relationship dynamics between patients and family members.
Publisher: Elsevier BV
Date: 2011
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.JBI.2022.104030
Abstract: With populations aging, the number of people with dementia worldwide is expected to triple to 152 million by 2050. Seventy percent of cases are due to Alzheimer's disease (AD) pathology and there is a 10-20 year 'pre-clinical' period before significant cognitive decline occurs. We urgently need, cost effective, objective biomarkers to detect AD, and other dementias, at an early stage. Risk factor modification could prevent 40% of cases and drug trials would have greater chances of success if participants are recruited at an earlier stage. Currently, detection of dementia is largely by pen and paper cognitive tests but these are time consuming and insensitive to the pre-clinical phase. Specialist brain scans and body fluid biomarkers can detect the earliest stages of dementia but are too invasive or expensive for widespread use. With the advancement of technology, Artificial Intelligence (AI) shows promising results in assisting with detection of early-stage dementia. This scoping review aims to summarise the current capabilities of AI-aided digital biomarkers to aid in early detection of dementia, and also discusses potential future research directions. In this scoping review, we used PubMed and IEEE Xplore to identify relevant papers. The resulting records were further filtered to retrieve articles published within five years and written in English. Duplicates were removed, titles and abstracts were screened and full texts were reviewed. After an initial yield of 1,463 records, 1,444 records were screened after removal of duplication. A further 771 records were excluded after screening titles and abstracts, and 496 were excluded after full text review. The final yield was 177 studies. Records were grouped into different artificial intelligence based tests: (a) computerized cognitive tests (b) movement tests (c) speech, conversion, and language tests and (d) computer-assisted interpretation of brain scans. In general, AI techniques enhance the performance of dementia screening tests because more features can be retrieved from a single test, there are less errors due to subjective judgements and AI shifts the automation of dementia screening to a higher level. Compared with traditional cognitive tests, AI-based computerized cognitive tests improve the discrimination sensitivity by around 4% and specificity by around 3%. In terms of speech, conversation and language tests, combining both acoustic features and linguistic features achieve the best result with accuracy around 94%. Deep learning techniques applied in brain scan analysis achieves around 92% accuracy. Movement tests and setting smart environments to capture daily life behaviours are two potential future directions that may help discriminate dementia from normal aging. AI-based smart environments and multi-modal tests are promising future directions to improve detection of dementia in the earliest stages.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.APMR.2011.08.007
Abstract: To investigate whether short message service (SMS) reminders reduce nonattendance in physical therapy outpatient clinics. Prospective single-blinded randomized controlled trial. Two physical therapy outpatient departments in metropolitan acute public hospitals. Participants with an appointment in a physical therapy outpatient clinic and who provided a contact mobile telephone number were included. Participants were excluded if their appointment was scheduled for the same day on which they made the appointment. Participants allocated to the intervention group received an SMS reminder before their next appointment participants allocated to the control group did not receive a reminder. The primary outcome was rate of nonattendance without cancellation. Secondary outcomes were cancellation and attendance rates and exploration of other factors associated with nonattendance. Patients (N=679) were allocated to receive either an SMS reminder (n=342) or no reminder (n=337). The nonattendance rate for patients who did not receive a reminder (16%) was more than nonattendance for patients receiving the SMS reminder (11% odds ratio, 1.61 95% confidence interval [CI], 1.03-2.51 number needed to treat, 19 95% CI, 9-275). There were no differences in cancellation or attendance rates between groups. Exploration of other factors found that patients who were younger with a neck and trunk musculoskeletal or a neuromuscular disorder and who were scheduled to have an initial appointment or an appointment on a Monday or Friday were significantly predictive of increased nonattendance. SMS reminders can reduce nonattendance in physical therapy outpatient clinics.
Publisher: MDPI AG
Date: 20-10-2021
Abstract: Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint 2. Support for legislation 3. Restraint-free environments are not possible 4. Low-level restraint 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.
Publisher: Wiley
Date: 17-12-2022
DOI: 10.1111/AJAG.13167
Abstract: To understand the barriers and enablers to participation in family‐assisted therapy for older people in Transition Care. A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family‐assisted therapy trial. Semi‐structured interviews were conducted, transcribed verbatim and analysed thematically. Forty‐four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family‐assisted therapy . The unifying theme was illustrated by three subthemes. The first, what is possible for the family now , described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now , recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate. The decision to participate in family‐assisted therapy is complex and is best made by patients and their families. Clinicians offering family‐assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide.
Publisher: BMJ
Date: 21-01-2020
DOI: 10.1136/PRACTNEUROL-2019-002335
Abstract: Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer’s disease and other dementias. Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension. With the rising prevalence and lack of neuroprotective drugs, there is renewed focus on dementia prevention strategies across the lifespan. Neurologists encounter many people with risk factors for dementia and are frequently asked whether lifestyle changes may help. Exercise has emerged as a key intervention for influencing cognition positively, including reducing the risk of age-related cognitive decline and dementia. This article focuses on the current evidence for physical inactivity as a modifiable dementia risk factor and aims to support neurologists when discussing risk reduction.
Publisher: Springer Science and Business Media LLC
Date: 20-06-2023
DOI: 10.1007/S11357-023-00844-Z
Abstract: Upper limb motor function is a potential new biomarker of cognitive impairment and may aid discrimination from healthy ageing. However, it remains unclear which assessments to use. This study aimed to explore what methods have been used and to describe associations between upper limb function and cognitive impairment. A scoping review was conducted using PubMed, CINAHL and Web of Science. A systematic search was undertaken, including synonyms for key concepts ‘upper limb’, ‘motor function’ and ‘cognitive impairment’. Selection criteria included tests of upper limb motor function and impaired cognition in adults. Analysis was by narrative synthesis. Sixty papers published between 1998 and 2022, comprising 41,800 participants, were included. The most common assessment tasks were finger tapping, Purdue Pegboard Test and functional tasks such as writing. Protocols were erse in terms of equipment used and recording duration. Most participants were recruited from clinical settings. Alzheimer’s Disease was the most common cause of cognitive impairment. Results were mixed but, generally, slower speed, more errors, and greater variability in upper limb movement variables was associated with cognitive impairment. This review maps the upper limb motor function assessments used and summarises the available evidence on how these associate with cognitive impairment. It identifies research gaps and may help guide protocols for future research. There is potential for upper limb motor function to be used in assessments of cognitive impairment.
Publisher: AMPCo
Date: 19-01-2021
DOI: 10.5694/MJA2.50911
Publisher: University of Toronto Press Inc. (UTPress)
Date: 08-2020
Abstract: Purpose: We explored physiotherapists’ perceptions of clinical supervision. Method: In idual semi-structured interviews were conducted with a purposive s le of 21 physiotherapists from a public hospital. Qualitative analysis was undertaken using an interpretive description approach. The Manchester Clinical Supervision Scale (MCSS–26) was administered to evaluate the participants’ perceptions of the effectiveness of the clinical supervision they had received and to establish trustworthiness in the qualitative data by means of triangulation. Results: The major theme was that the content of clinical supervision should focus on professional skill development, both clinical and non-clinical. Four subthemes emerged as having an influence on the effectiveness of supervision: the model of clinical supervision, clinical supervision processes, supervisor factors, and supervisee factors. All sub-themes had the potential to act as either a barrier to or a facilitator of the perception that clinical supervision was effective. Conclusions: Physiotherapists reported that clinical supervision was most effective when it focused on their professional skill development. They preferred a direct model of supervision, whereby their supervisor directly observed and guided their professional skill development. They also described the importance of informal supervision in which guidance is provided as issues arise by supervisors who value the process of supervision. Physiotherapists emphasized that supervision should be driven by their learning needs rather than health organization processes.
Publisher: SAGE Publications
Date: 04-10-2017
Abstract: To investigate whether two additional home visits improve outcomes for rehabilitation outpatients with balance impairments compared to usual care. Randomized controlled trial. Outpatient rehabilitation. Fifty with balance impairments. Both groups received usual care including weekly group exercise over eight weeks. The intervention group received two home visits to in idualize home exercises. Primary outcome measure was the Balance Outcome Measure for Elder Rehabilitation (BOOMER) score, and secondary outcomes included force platform measures using the NeuroCom Balance Master There was no between-group difference for BOOMER score. There were significant between-group differences in favour of the intervention group for limits of stability reaction time at week 9 (mean difference (MD) -0.27, 95% confidence interval (CI) -0.44 to -0.09) and week 22 (MD -0.28, 95% CI -0.45 to -0.10) and for limits of stability maximal excursion at week 9 (MD 8.66, 95% CI 1.67 to 15.65) and week 22 (MD 14.58, 95% CI 7.59 to 21.57). Significant between-group differences favoured the control group for Clinical Test of Sensory Interaction of Balance at week 9 (MD 0.40, 95% CI 0.13 to 0.66) and week 22 (MD 0.45, 95% CI 0.18 to 0.72) and step quick turn time at week 9 (MD 0.56, 95% CI 0.02 to 1.10). Two exercise-focussed home visits improved some dynamic balance outcomes in older patients with balance impairments. Some outcomes showed significant improvements with small effect sizes in favour of the control group which may be chance findings or because they completed a standard home exercise programme.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-02-2021
Publisher: MDPI AG
Date: 24-08-2021
DOI: 10.20944/PREPRINTS202108.0466.V1
Abstract: Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected & lsquo Restraint& rsquo as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the & lsquo last resort& rsquo . To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, doctors, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint 2. Support for Legislation 3. Restraint-free environments are not possible 4. Low-level restraint, and 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly & lsquo low-level& rsquo forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but stated that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.
No related grants have been discovered for Katherine Lawler.