ORCID Profile
0000-0003-4200-5363
Current Organisation
University of South Australia
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Publisher: Springer Science and Business Media LLC
Date: 25-11-2014
Publisher: Medical Journals Sweden AB
Date: 2016
Abstract: To undertake a cost-utility analysis of the In idual Nutrition Therapy and Exercise Regime: A Controlled Trial of Injured, Vulnerable Elderly (INTERACTIVE) trial. Cost-utility analysis of a randomized controlled trial. A total of 175 patients following a hip fracture were allocated to receive either alternate weekly visits from a physical therapist and dietitian (intervention group), or social visits for 6 months (control group). Costs for utilization of hospitals, health and community services were compared with quality-adjusted life years gained, calculated from responses to the Assessment of Quality of Life instrument. There were minimal differences in mean costs between the intervention ($AUD 45,331 standard deviation (SD): $AUD 23,012) and the control group ($AUD 44,764 SD: $AUD 20,712, p = 0.868), but a slightly higher mean gain in quality-adjusted life years in the intervention group (0.155, SD: 0.132) compared with the control group (0.139, SD: 0.149, p = 0.470). The incremental cost-effectiveness ratio was $AUD 28,350 per quality-adjusted life year gained, which is below the implied cost-effectiveness threshold utilized by regulatory authorities in Australia. A comprehensive 6-month programme of therapy from dietitians and physical therapists could be provided at a relatively low additional cost in this group of frail older adults, and the incremental cost-effectiveness ratio indicates likely cost-effectiveness, although there was a very high level of uncertainty in the findings.
Publisher: Informa UK Limited
Date: 02-10-2022
DOI: 10.1080/02640414.2022.2148051
Abstract: The purpose of this study was to explore the relationship between postural control and fundamental motor skills in girls. An observational cross-sectional study was conducted in 47 girls, aged 8-10 years. Postural control (postural sway centre of pressure) was evaluated during tandem stance, leading with dominant and non-dominant limbs with eyes open and closed, using an AMTI force platform. Fundamental motor skills were assessed using the Test of Gross Motor Development 2nd Edition, examining total, locomotor and object control scores. Data were analysed using linear regression, adjusted for body mass index percentile and household income. For locomotor skills, significant relationships were found with a number of postural sway outcomes for adjusted and unadjusted analyses (r - 0.287 to r - 0.425, p ≤ 0.042). Total motor skill score was significantly related to postural sway in the tandem dominant eyes closed condition for unadjusted and adjusted analyses (r ≥ -0.294, p ≤ 0.04). In conclusion, our findings indicate that postural control may be important for fundamental motor skill proficiency and movement quality in pre-adolescent girls, particularly for locomotor skills. Our study provides evidence supporting the clinical practice of assessing postural control in girls presenting with motor skill deficits.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 24-11-2018
DOI: 10.1111/SCS.12545
Abstract: Problems experienced by older people with complex needs to live at home have been reported in the literature. This qualitative study builds on previous research and investigates enduring issues older people face when interacting with healthcare services. To gain an in-depth understanding of what is involved in providing good quality health care for older people who need support to live at home. We adopted an interpretive descriptive approach and conducted semi-structured interviews with older people (n = 7), carers (n = 8) and key informants (n = 11). Initial and secondary analysis of qualitative data was completed. Major themes emerged about meanings of partnership in health care, and invisibility of the older person as a partner in health care. Partnership in health care was understood to mean being treated as an equal, being involved in decision-making, and making contributions which impact on health care and health systems. The metaphorical concept of 'invisibility' related to the older person not being seen and heard as a partner in health care, as well as being a recipient of care. We concluded that older people who need support to live at home are not highly visible to health providers, policymakers and researchers as a central partner and consumer to be meaningfully engaged in shaping their health care. Opportunities to address persistent issues with quality of health care may in future be achieved through stronger partnerships between older people and health providers, to find new ways to improve the quality of care for older people.
Publisher: Elsevier BV
Date: 06-2013
Publisher: Oxford University Press (OUP)
Date: 11-2014
DOI: 10.2522/PTJ.20130412
Abstract: Older adults have an increased risk of falls after discharge from the hospital. Guidelines to manage this risk of falls are well documented but are not commonly implemented. The aim of this case report is to describe the novel approach of using the Theoretical Domains Framework (TDF) to develop an intervention to change the clinical behavior of physical therapists. This project had 4 phases: identifying the evidence-practice gap, identifying barriers and enablers that needed to be addressed, identifying behavior change techniques to overcome the barriers, and determining outcome measures for evaluating behavior change. The evidence-practice gap was represented by the outcome that few patients who had undergone surgery for hip fracture were recognized as having a risk of falls or had a documented referral to a community agency for follow-up regarding the prevention of falls. Project aims aligned with best practice guidelines were established 12 of the 14 TDF domains were considered to be relevant to behaviors in the project, and 6 behavior change strategies were implemented. Primary outcome measures included the proportion of patients who had documentation of the risk of falls and were referred for a comprehensive assessment of the risk of falls after discharge from the hospital. A systematic approach involving the TDF was useful for designing a multifaceted intervention to improve physical therapist management of the risk of falls after discharge of patients from an acute care setting in South Australia, Australia. This framework enabled the identification of targeted intervention strategies that were likely to influence health care professional behavior. Early case note audit results indicated that positive changes were being made to reduce the evidence-practice gap.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-04-2022
Publisher: Mark Allen Group
Date: 12-2006
DOI: 10.12968/IJTR.2006.13.12.22472
Abstract: Balance screening within therapy assessments for older clients is an efficient method to assess a client's need for further balance assessment and intervention. The ‘Balance Screening Tool’ (BST), a six-task functional standing balance test, is a simple and quickly administered method of screening balance in older adults. This study aimed to determine the intra- and inter-rater reliability of the BST and to establish its concurrent validity with the Berg Balance Scale (BBS). A group of 14 falls risk assessment community care clients and a group of 16 community dwelling older adults were screened for balance impairment using both the BST and BBS. The Spearman rank correlation coefficient for intra-rater reliability was 0.90, and for inter-rater reliability was 0.89 with no significant difference between the test scores (Wilcoxon sign rank, p = 0.16). For in idual items of the BST, kappa coefficients ranged from 0.64–1.00 for intra-rater reliability and 0.58–0.71 for interrater reliability. Correlation between the total BST and BBS scores were rs = -0.87 and rs = -0.92. The results suggest excellent intra-and inter-rater reliability for the BST, and excellent concurrent validity of the tool with the BBS. The BST is a valid and reliable method to quickly screen older adults for balance problems in a home or clinical setting.
Publisher: Elsevier BV
Date: 2011
Publisher: Springer Science and Business Media LLC
Date: 27-02-2016
Publisher: Springer Science and Business Media LLC
Date: 10-08-2017
Publisher: PeerJ
Date: 27-03-2014
DOI: 10.7717/PEERJ.331
Publisher: Future Medicine Ltd
Date: 04-2016
DOI: 10.2217/PMT.15.66
Abstract: Cognitive–behavioral therapy, an effective management strategy for chronic pain, is frequently conducted in groups. Although clinicians often report ‘knowing when a group will go well or badly’, investigations of the effect that group composition might have on outcomes is lacking. Conceptual models, explanatory theories and experiments have been developed in fields of psychotherapy, organizational, social and educational psychology, but there has been no attempt to take on this issue in our field. The current hypothesis-generating review synthesizes these substantial bodies of literature to identify common themes across fields and integrate them with current concepts of cognitive–behavioral therapy-based pain management. We present a putative conceptual model with testable hypotheses relating to features of each group as a whole, the in iduals in that group and the group’s leader.
Publisher: AOTA Press
Date: 03-12-2021
Abstract: Importance: People with dementia require tailored interventions to support participation and performance in their desired occupations, and informal caregivers need interventions that reduce caregiving burden to enable them to continue with their roles. Objective: This systematic review investigated whether home-based occupational therapy interventions for adults with dementia and their informal caregivers optimized care recipients’ performance of daily occupations and reduced caregiving burden and improved caregivers’ sense of competence. Data Sources: Eight databases were searched from 1946 to November 2019 using MeSH terms, keywords, and subject headings as appropriate for each database. Inclusion criteria were quantitative studies investigating the effects of home-based therapy provided by a qualified occupational therapist for adults with dementia and their informal caregivers. Study Selection and Data Collection: Study selection, data collection, and methodological quality assessments using the Critical Appraisal Skills Programme criteria tool were performed independently by two reviewers. Data analysis involved a two-stage process. Findings: From 1,229 articles identified through searches, 970 titles and abstracts were screened for eligibility after removal of duplicates. Twenty studies reported in 22 articles were included. Moderate evidence supported interventions provided jointly for adults with dementia and their informal caregivers using a combination of intervention strategies. Included studies demonstrated high risk of bias, particularly in blinding of outcome assessments. Conclusions and Relevance: Combining in idualized interventions framed in client-centeredness can enhance occupational performance for adults with dementia, reduce caregiving burden, and improve informal caregivers’ sense of competence. Further research on leisure and home management occupations is warranted. What This Article Adds: The findings provide evidence supporting the effectiveness of home-based occupational therapy for people with dementia and their informal caregivers for consideration by funders of services.
Publisher: MDPI AG
Date: 13-09-2021
DOI: 10.3390/NU13093182
Abstract: It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an in idualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months in idualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the s le size achieved. Participants in the intervention group had greater increment in energy (235 kcal 95% CI, 95 to 375 p = 0.01) and protein intake (9.1 g 95% CI, 1.5 to 16.8 p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.
Publisher: Informa UK Limited
Date: 16-06-2019
Publisher: Informa UK Limited
Date: 21-09-2010
DOI: 10.3109/02699052.2010.511589
Abstract: To investigate the effectiveness of isokinetic strength training of ankle and knee muscles in adults with chronic acquired brain injury (ABI). Series of single case studies. Twelve people with ABI participated in a 2.5-week baseline, 12-week intervention and a 4-week follow-up phase. Concentric isokinetic exercise, twice a week, for plantarflexors (PFs), dorsiflexors (DFs), knee flexors (KFs) and knee extensors (KEs). Peak torque and power at 60 and 90° s⁻¹, PFs and KFs tone at 60° s⁻¹, gait speed and timed chair rises. For single case analyses strength improvements were noted in 11/12 participants' PFs, 5/12 participants' DFs and 7/12 participants' KEs and KFs. Gait speed improved in 8/12 participants and chair rise time improved in 7/12 participants. PFs tone increased in three participants, KFs tone increased in six participants and three participants reported knee pain. For group analyses, peak torque of PFs and KEs, fast gait speed and timed chair rises demonstrated improvement (p < 0.05). Isokinetic strength training may be effective to improve lower limb muscle strength however, care needs to be taken in selecting suitable candidates as some in iduals reported knee pain with this intensive programme.
Publisher: Elsevier BV
Date: 11-1992
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-12-2017
DOI: 10.1097/J.PAIN.0000000000001144
Abstract: This study explored whether group size and group member characteristics (age, sex, and compensation status) were associated with patient outcomes (changes in pain and disability). Retrospective analyses of outcome data obtained from 2 independently run group cognitive behavioural therapy (CBT) programs for chronic pain (Program A: N = 317 and Program B: N = 693) were conducted. Intracluster correlations were significant in both studies, indicating group-level effects on patient outcomes in both group CBT programs for chronic pain. Mixed modelling revealed that group size and group member characteristics (age, sex, and compensation status) were related to patient outcomes, but not consistently across programs. The results of our analyses confirm the contribution of group composition to in idual treatment outcomes in group CBT for chronic pain, and highlight factors that have the potential to contribute to group-level variability in patient outcomes. Further research is needed to identify the mechanisms that account for the impact of group characteristics on the efficacy of CBT for chronic pain.
Publisher: SAGE Publications
Date: 28-09-2011
Abstract: Objective: To determine self-reported physical activity barriers, behaviors, and beliefs about exercise of a representative s le and to identify associated sociodemographic factors. Method: Face-to-face interviews conducted between September and December 2008, using a random stratified s ling technique. Results: Barriers injury and illness were associated with being older, single, and not engaged in full-time work lack of time was associated with being married, younger, female, and working full-time and lack of motivation and cost were associated with being younger than 65 years. Advancing age was significantly associated ( p .001) with reduced physical activity. Factors including age, education, marital status, and area of residence were all associated with preferences for environment to exercise in, while all age groups (74%) felt that walking was the most important type of exercise for older adults. Discussion Barriers to physical activity participation are multifaceted with different sociodemographic factors associated with different barriers. A better understanding of these factors may improve uptake of and adherence to exercise programs across the ages.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 12-2016
Publisher: Wiley
Date: 30-07-2016
DOI: 10.1016/J.PMRJ.2016.07.531
Abstract: To review the evidence connecting risk factors to falls in adults with a lower limb utation (LLA) across the continuum of care settings. Systematic review. Electronic database searches were conducted in MEDLINE, Pubmed, CINAHL, and EMBASE covering January 1988 to January 2016. Noninterventional studies, including cohort and cross-sectional studies, were included. Two reviewers independently completed data extraction and quality evaluation. Twelve studies met the inclusion criteria and quality of reporting was evaluated using the criteria by Tooth et al. The average quality of reporting score was 19.8, scores ranged from 16 to 29. Studies covered the acute hospital stay after the utation, inpatient rehabilitation, and community living. Falls were a common occurrence, with the cohort studies reporting 20.8% for acute hospital stay to 58% in the community years after the utation. Injurious falls also were common, with an occurrence ranging from 40% to 60%. Risk factors that increase falls and are shared with the general population of older adults include lower extremity muscle weakness, increasing age, comorbidities, and number of prescription medications. Risk factors for falls that are unique to adults with LLA are dysvascular etiology of the utation, transtibial level of utation in the postoperative period and transfemoral level postrehabilitation, and reduced sense of vibration. Falls in adults with an LLA are common from the time of the utation to years later living in the community. Risk factors vary across care settings after the utation, which has implications for safety and fall-prevention strategies. III.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.KNEE.2014.08.004
Abstract: Footwear and insoles are used to reduce knee load in people with medial knee osteoarthritis (OA), despite a limited understanding of foot function in this group. The aim of this study was to investigate the differences in foot kinematics between adults with and without medial knee OA during barefoot walking. Foot kinematics were measured during walking in 30 adults 15 with medial knee OA (mean age was 67.0 with a standard deviation (SD) of 8.9 years height was 1.66 with SD of 0.13 m body mass was 84.2 with SD of 15.8 kg BMI was 30.7 with SD of 6.2 kg/m(2) K-L grade 3: 5, grade 4: 10) and 15 aged and gender matched control participants with 12 motion analysis cameras using the IOR multi-segment foot model. Motion of the knee joint, hindfoot, midfoot, forefoot and hallux were compared between groups using clustered linear regression. The knee OA group displayed reduced coronal plane range of motion of the midfoot (mean 3.8° vs. 5.4°, effect size=1.1, p=0.023), indicating reduced midfoot mobility. There was also a reduced sagittal plane range of motion at the hallux in the knee OA group compared to the control group (mean 29.6° vs. 36.3°, effect size=1.2, p=0.008). No statistically significant differences in hindfoot or forefoot motion were observed. People with medial knee OA display altered foot function compared to healthy controls. As foot and knee function are related, it is possible that altered foot function in people with knee OA may influence the effects of footwear and insoles.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11050
Abstract: Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be ided into two distinct phases referral-to-initial appointment (9–24 months), and initial appointment-to-surgery (12–15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an in idual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an in idual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of in iduals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery.
Publisher: Wiley
Date: 06-2004
Publisher: Wiley
Date: 28-06-2022
DOI: 10.1111/JPPI.12435
Abstract: This paper describes the development of a home‐based occupational therapy intervention program for people with Down syndrome who experience early on‐set dementia causing a decline in their performance skills and increasing care dependency on their informal caregivers. A six‐step methodological process adapted from the Medical Research Council framework for developing and evaluating complex interventions was formulated to develop an evidence‐based occupational therapy program for people with both Down syndrome and dementia and their informal caregivers. The first two steps gathered evidence through systematic reviews of the literature and determined the scope of current occupational therapy practice. The gathered evidence was synthesised in step three to develop a client‐centred occupational therapy intervention program for persons with both Down syndrome and dementia and their informal caregivers. In steps four and five, opinions were sought from occupational therapists working in this area of practice on the content of the developed program and its feasibility within the Australian disability services context. The final testing step can be conducted in the future using a single‐case experimental design study. It is important to use rigorous frameworks and gather comprehensive evidence using multiple methods to develop interventions for small heterogeneous populations. The developed occupational therapy program for persons with both Down syndrome and dementia and their informal caregivers appears feasible to be implemented within the Australian disability services however, funding limitations imposes barriers for its implementation in clinical practice.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.ORCP.2019.06.003
Abstract: This study aimed to examine associations between postural control and body composition in 8-10-year-old girls. An observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling. BMI percentile was positively associated with COP sway area (p=0.034) and principal axis (p=0.030) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open (p=0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes (p≤0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)]. Girls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls' postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.APMR.2011.01.021
Abstract: To evaluate whether aerobic exercise improves cognition in adults diagnosed with neurologic disorders. The Cochrane Central Register of Controlled Clinical Trials, MEDLINE, CINAHL, PubMed, EMBASE, PEDro, AMED, SPORTDiscus, PsycINFO, ERIC, and Google Scholar, with the last search performed in December 2010. We included controlled clinical trials and randomized controlled trials with adults diagnosed with a neurologic disorder. Studies were included if they compared a control group with a group involved in an aerobic exercise program to improve cardiorespiratory fitness and if they measured cognition as an outcome. Two reviewers independently extracted data and methodologic quality of the included trials. From the 67 trials reviewed, a total of 7 trials, involving 249 participants, were included. Two trials compared the effectiveness of yoga and aerobic exercise in adults with multiple sclerosis. Two trials evaluated the effect of exercise on patients with dementia, and 2 trials evaluated the effectiveness of exercise to improve cognition after traumatic brain injury. One trial studied the effect of a cycling program in people with chronic stroke. Lack of commonality between measures of cognition limited meta-analyses. Results from in idual studies show that aerobic exercise improved cognition in people with dementia, improved attention and cognitive flexibility in patients with traumatic brain injury, improved choice reaction time in people with multiple sclerosis, and enhanced motor learning in people with chronic stroke. There is limited evidence to support the use of aerobic exercise to improve cognition in adults with neurologic disorders. Of the 67 studies retrieved, less than half included cognition as an outcome, and few studies continued the aerobic exercise program long enough to be considered effective. Further studies investigating the effect of aerobic exercise interventions on cognition in people with neurologic conditions are required.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH12177
Abstract: Objectives. Waiting lists for elective surgery are a persistent problem faced by health systems. The progression through elective surgery waiting lists can be likened to a game of snakes and ladders where barriers (snakes) delay access to surgery and facilitators (ladders) expedite access. The aim of the present study was to describe the barriers and facilitators to delivery of total hip- and total knee-replacement surgery in South Australian public-funded hospitals. Methods. Semistructured interviews with staff, direct observation of administrative processes and documentation analysis were combined under a systems theory framework. Results. System barriers (snakes) were grouped into five categories: resources, workload, hospital engagement, community engagement and system processes. Inadequate resources was the most prominent barrier, patient cancellations resulted in one-third of administrative tasks being repeated and there was a perceived lack of engagement to maximising efficiency. Interestingly, despite a lack of resources being perceived to be the biggest problem, additional resources without system change was not considered an effective long-term strategy. Conclusions. Given the complexity of the elective surgery system, it is not surprising that single-item reforms have not created lasting reductions in waiting times. Multifaceted, whole-system reforms may be more successful. What is known about the topic? Waiting lists and waiting times for surgery are controversial, associated with frequent reforms and negative emotive headlines. We know from existing literature and anecdotal reports that in iduals frequently experience lengthy delays before receiving elective surgery. Anecdotal reports also suggest that there are inefficiencies within elective surgery systems that contribute to these delays and result in cancellations, patient deterioration and poor overall satisfaction with the public health system in Australia. What isn’t clear is whether this perception is accurate and what inefficiencies do exist that could be specifically targeted for reform. What does this paper add? This paper adds weight to the argument that some inefficiencies exist within elective surgery systems, and identifies specific barriers to the delivery of total hip- and total knee-replacement surgery in South Australian public hospitals. It also identifies several strategies that could improve system function, some of which have already been implemented at a local level in response to stress on the system, and some of which require broad region- or state-wide change. In contrast to existing research, the level of detail provided in the present paper should allow for targeted reforms with the potential to improve system function and the efficiency with which joint-replacement surgery can be delivered. What are the implications for practitioners? All clinicians aim to provide the best intervention for their patients. Should the findings of this study be used to inform elective surgery system changes, patients and clinicians should experience a more streamlined approach to referral for and receipt of elective surgery in public hospitals. The consistency with which barriers and facilitators were identified across the four hospitals involved in this research supports the generalisability of the results. This further suggests that although specific to hip and knee replacement, many of the same barriers and facilitators could be in place across numerous surgical and non-surgical disciplines.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.GERINURSE.2016.12.001
Abstract: Perceived experiences of health care for older people who need support to live at home can illuminate areas needing improvement in quality of care, and guide towards better ways to support ageing populations to live at home. This systematic review synthesized findings from the qualitative literature about perceived experiences of health care for older people who need support to live at home, from the perceptions of older people, carers and health providers. Searches of electronic databases and eligibility screening produced 46 included studies for review. Thematic synthesis revealed how health care impacts on the older person's sense of autonomy, both in health care decisions and everyday life. Autonomy is empowered by the older person's own capacity and by respectful conduct of health providers. Engagement between older people, carers and health providers is a negotiated interaction, affected by multiple factors.
Publisher: PeerJ
Date: 10-07-2014
DOI: 10.7717/PEERJ.489
Publisher: SAGE Publications
Date: 12-04-2012
DOI: 10.1111/J.1747-4949.2012.00796.X
Abstract: Falls are common at all stages after stroke, occurring in the acute, rehabilitative, and chronic phases. Consequences of falls include death or serious injury, minor injuries, functional limitations, reduced mobility and activity, and fear of falling. These consequences can have implications for independence and quality of life after stroke. The high frequency of falls may be due to a combination of existing falls risk factors prior to the stroke as well as impairments from the stroke, such as decreased strength and balance, hemineglect, perceptual problems, and visual problems. This paper reviews the magnitude of the problem of falls in people with stroke, highlights risk factors, and summarizes the limited randomized controlled trial evidence on falls prevention in this population. There is a need for further high quality research investigating the effectiveness of interventions to reduce falls and injury in people with stroke from onset through to the chronic stage.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.FOOT.2015.03.005
Abstract: A clinical records audit of the University of South Australia's podiatry clinic clients attending in 2010 was undertaken to determine prevalence of symptomatic flexible pes planus, presenting reasons and treatment options most frequently used. Analysis of rearfoot measures (resting calcaneal stance position, subtalar joint range of motion) between those prescribed a vertical (heel) or inverted (heel) cast pour and a medial heel (Kirby) skive was undertaken. Of 223 clinical records audited, 50% (111/223) of clients were assessed with flexible pes planus, 77% (86/111) of clients with pes planus presented with back or lower limb pain and 58% (64/111) were prescribed customised foot orthoses. Of 42 prescriptions for customised foot orthoses audited 64% (27/42) were prescribed a vertical (heel) cast pour, 36% (15/42) an inverted (heel) cast pour and 19% (8/42) received a medial heel (Kirby) skive. Those prescribed a medial heel (Kirby) skive had a more everted resting calcaneal stance position than those that were not (mean -8.6±2.8° vs. -5.5±3.4°, p=0.02). Those prescribed an inverted (heel) cast pour had a greater range of subtalar joint motion than those prescribed a vertical (heel) cast pour (median 36.0±10.0° vs. 29.0±5.0°, p=0.01).
Publisher: SAGE Publications
Date: 02-06-2022
DOI: 10.1177/20494637221098941
Abstract: Cognitive Behaviour Therapy (CBT)–based programmes for chronic pain are often conducted in groups, most likely for time and cost efficiencies. However, there has been very little investigation of the role that the group itself, and particularly the processes occurring within the group, may play in in idual outcomes. The objective of this study was to explore whether social group processes were relevant to key treatment outcomes of group CBT for chronic pain. Data were collected from 15 groups (N = 118) undertaking a pain management programme in a tertiary setting. Intraclass correlations were computed to determine any clustering of outcomes in groups, and linear mixed modelling analysis explored pre-registered hypotheses of associations between treatment outcomes and the social group processes of Group Identification and Sense of Belonging. A weak association between early identification with the group and changes in pain-related disability was shown. In addition, an enhanced global Sense of Belonging was associated with increased pain self-efficacy. These associations, in a programme that had not been designed to address group processes, suggest that their relevance is worth further investigation, particularly in group programmes that do focus on the social consequences of chronic pain. Future studies should investigate whether manipulation of social group processes within a CBT-based pain programme enhances pain-related outcomes and improves the overall well-being of people with chronic pain.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.APMR.2012.03.031
Abstract: To determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy. A single blind, multicenter, randomized controlled trial with 12-month follow-up. Participants were recruited after discharge from rehabilitation and followed up in the community. Participants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation. Tailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85). Primary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy. There was no significant difference in fall rate (intervention: 1.89 falls erson-year, control: 1.76 falls erson-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60-1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls erson-year, control: .49 injurious falls erson-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome. This multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1016/J.APMR.2006.09.004
Abstract: To investigate predictors of recurrent falls in adults who return to community dwelling after stroke rehabilitation. Prospective observational study. Community. Fifty-five adults with stroke (mean age +/- standard deviation, 68.1+/-12.8y). Not applicable. Baseline measures included balance, gait speed, muscle strength and tone, activity level, hemianopia, visual contrast sensitivity, hemineglect, medication use, fear of falling, and depression. Participants kept a 6-month prospective falls diary after discharge from rehabilitation. Twenty-five (45%) participants reported falling, 12 had recurrent falls (> or =2 falls), and 13 fell once. Participants who fell recurrently had histories of falling during hospitalization or rehabilitation, poorer physical function measures, were taking more medications, and were more likely to have hemineglect than participants who fell once or did not fall (P<.05). A history of falling in the hospital or during rehabilitation, combined with poor balance (either Berg Balance Scale score <49 or step test score <7), predicted recurrent falls with sensitivity and specificity values greater than 80%. Falls are a common occurrence after stroke. The predictive model developed can be used to identify people who are likely to have recurrent falls in the 6 months after stroke rehabilitation.
Publisher: AMPCo
Date: 23-11-2019
DOI: 10.5694/MJA2.12034
Abstract: To identify factors associated with receiving acute goal-directed treatment, being assessed for ongoing rehabilitation, and receiving post-acute rehabilitation after having a stroke. Retrospective analysis of National Stroke Audit data for patients with acute stroke treated at Australian hospitals during 1 September 2014 - 28 February 2015. 112 Australian hospitals that admit adults with acute stroke. Associations between patient-related and organisational factors and the provision of rehabilitation interventions. Data for 3462 patients were eligible for analysis their median age was 74 years, 1962 (57%) were men, and 2470 (71%) had received care in a stroke unit. 2505 patients (72%) received goal-directed treatment during their acute admission it was not provided to 364 patients (10.5%) who were responsive, had not fully recovered, and did not refuse treatment. Factors associated with higher odds of receiving goal-directed treatment included goal-setting with the patient and their family (odds ratio [OR], 6.75 95% CI, 5.07-8.90) and receiving care in a stroke unit (OR, 2.08 95% CI, 1.61-2.70). 1358 patients (39%) underwent further rehabilitation after discharge from acute care factors associated with receiving post-acute rehabilitation included care in a stroke unit (OR, 1.73 95% CI, 1.34-2.22) and having an arm or speech deficit. Dementia was associated with lower odds of receiving acute goal-directed treatment (OR, 0.49 95%, 0.33-0.73) and post-acute rehabilitation (OR, 0.43 95%, 0.30-0.61). Access to stroke units and to early and ongoing rehabilitation for patients after stroke can be improved in Australia, both to optimise outcomes and to reduce the burden of care on underresourced community and primary care providers.
Publisher: Springer Science and Business Media LLC
Date: 10-04-2012
Publisher: University of South Australia Library
Date: 26-07-2020
Abstract: The presence of flexible flat feet is often reported to negatively impact foot health, and endurance during walking. Foot orthoses are commonly prescribed for symptoms associated with flat feet. This study aimed to investigate the impact of in idually prescribed foot orthoses on foot health and endurance measures when used in a flat foot population. Methods This study was a pilot parallel-group single-blinded RCT comparing customised foot orthoses and sham inserts for impact on foot pain, fatigue and function following four weeks of use, and changes in distance travelled measures (m) during the six-minute walk test following four weeks of use and at immediate wear. Results Thirteen participants were recruited (8 female), seven received foot orthoses and six received sham inserts. The study was underpowered to detect change (range 0.05 to 0.20). A statistically significant difference existed between groups at baseline for foot pain. No statistically significant results were observed for the use of foot orthoses or sham inserts after four weeks of use or at immediate wear. The sham insert group were observed to improve their distance travelled (median increase 23.5 m), and foot pain (VAS) in accordance with minimally importance difference when compared to the foot orthoses group (between group difference 15.5 mm) following four weeks of use, however, large variations in response were observed (IQR 34.7 m and 50.5 mm respectively). Discussion No significant differences were found between the foot orthoses and sham insert group for foot health or endurance measures following four weeks of use, however, outcomes should be viewed with caution due to small s le size and variation in in idual response. Further investigations comparing customised foot orthoses and sham inserts in the adult flexible flat foot population are recommended.
Publisher: Elsevier BV
Date: 2010
DOI: 10.1016/S1836-9553(10)70010-2
Abstract: What walking aid prescription occurs at discharge after hip fracture? What changes in walking aid use occur in the following six months? Who initiates changes in walking aids and why? Prospective longitudinal observational study. 95 community-dwelling older adults who had undergone surgical treatment of a hip fracture. Range of walking aids prescribed at discharge and participants' recall of advice about progression were recorded. Progression of walking aids was observed fortnightly over 6 months. With any change in walking aid use, an independent physiotherapist determined if it was appropriate and participants reported the reason for the change. Most participants were discharged from their final inpatient setting with a wheeled frame (92%). Eighty-two (86%) participants were not aware of any goals set by the physiotherapist for the first 6 months and 89 (94%) stated that a review time had not been set. Despite this, 78 (82%) participants changed their walking aid, on average 8 weeks (SD 6) after discharge. However, 32% of those who changed their walking aids were using an inappropriate aid or using it incorrectly. Six months after discharge, 40% of participants had not returned to using their pre-morbid indoor aid and 50% their outdoor aid. A review of walking aid by a physiotherapist is rare within six months after discharge following hip fracture. Most patients make their own decision about what walking aid is most appropriate. This has safety implications in a group at high risk of falls.
Publisher: Oxford University Press (OUP)
Date: 04-09-2010
Abstract: the 'Otago exercise programme' (OEP) is a strength and balance retraining programme designed to prevent falls in older people living in the community. The aim of this review was to evaluate the effect of the OEP on the risk of death and fall rates and to explore levels of compliance with the OEP in older adults. a systematic review with meta-analysis. Clinical trials where the OEP was the primary intervention and participants were community-dwelling older adults (65+) were included. Outcomes of interest included risk of death, number of falls, number of injurious falls and compliance to the exercise programme. seven trials, involving 1503 participants were included. The mean age of participants was 81.6 (±3.9) years. The OEP significantly reduced the risk of death over 12 months [risk ratio = 0.45, 95% confidence interval (CI) = 0.25-0.80], and significantly reduced fall rates (incidence rate ratio = 0.68, 95% CI = 0.56-0.79). There was no significant difference in the risk of a serious or moderate injury occurring as the result of a fall (risk ratio = 1.05, 95% CI = 0.91-1.22). Of the 747 participants who remained in the studies at 12 months, 274 (36.7%) were still exercising three or more times per week. the OEP significantly reduces the risk of death and falling in older community-dwelling adults.
Publisher: Elsevier BV
Date: 2002
Publisher: SAGE Publications
Date: 06-2005
DOI: 10.1191/0269215505CR796OA
Abstract: Objective: To evaluate falls incidence, circumstances and consequences in people who return home after stroke rehabilitation, so that appropriate falls and injury prevention strategies can be developed. Design: Prospective cohort study. Setting: Community. Subjects: Fifty-six subjects with stroke who were participating in a rehabilitation programme and returning to live in a community setting completed the study. Main measures: Subjects completed a prospective falls diary for six months after discharge from rehabilitation, and were interviewed after falls. Physical function was measured by the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM). Results: Forty-six per cent of people (26/56) fell, with most falls (63/103 falls) occurring in the two months after discharge from rehabilitation. One subject had 37 similar falls and these falls were excluded from further analysis. Falls occurred more often indoors (50/66), during the day (46/66) and towards the paretic side (25/66). People required assistance to get up after 25 falls (38%) and 36 falls (55%) resulted in an injury. People sought professional health care after only 16 falls, and activity was restricted after 29 falls (44%). The Berg Balance Scale and Functional Independence Measure scores were lower in people who had longer lies after a fall, and who restricted their activity after a fall (p 0.05). Lower physical function scores were also associated with falling in the morning, wearing multifocal glasses at the time of a fall, and injurious falls (p 0.05). Conclusion: Falls are common when people return home after stroke. Of concern are the small number seeking health professionals’ assistance after a fall, the high proportion restricting their activity as a result of a fall and the number of falls occurring towards the paretic side.
Publisher: Wiley
Date: 27-01-2020
Abstract: Dementia in adults with Down syndrome causes a progressive decline in daily occupations impacting both persons with Down syndrome and their informal caregivers. This study aimed to explore the scope of occupational therapy practice for adults with both Down syndrome and dementia and their informal caregivers living in their homes. A survey was conducted with occupational therapists having clinical experience in providing interventions for adults with Down syndrome. A web-based survey was developed to explore occupational therapy practice for this group of people with Down syndrome and their informal caregivers. Responses to closed-ended questions were analysed descriptively, and inductive content analysis was used for open-ended questions. Forty-three occupational therapists from Australia, Canada, United Kingdom and the United States of America participated in the survey. Two-thirds were from the United Kingdom, most of whom were employed in the public sector and had at least 10 years of clinical experience. Over 90% of respondents received one or more referrals in a typical month for adults with Down syndrome having dementia, 68% of which were for a decline in activities of daily living. Home environment and activities of daily living were frequently assessed areas, and the commonest interventions were compensatory strategies and environmental modifications. Only half the respondents provided interventions for informal caregivers. Risk and safety and manual handling were frequently addressed domains for informal caregivers. Collaboration and developing clinical expertise were the two key perceived enablers for providing effective occupational therapy services. Fragmentation of services and a lack of client-centred care were the common perceived barriers. Occupational therapists often address decline in activities of daily living for in iduals with both Down syndrome and dementia. To support participation in meaningful occupations for these people and support the needs of their informal caregivers, it is essential that services are offered in a collaborative approach.
Publisher: Informa UK Limited
Date: 27-01-2022
DOI: 10.1080/02699052.2022.2033836
Abstract: 1) Understand the experience, and personal significance, of mobility skills for people with severe mobility impairment after brain injury 2) Determine how these evolve over time. Longitudinal qualitative study. Ten adults, unable to walk at 8 weeks post-injury. Participants were interviewed up to three times, at three-month intervals. Semi-structured interviews were transcribed and coded independently by two researchers, then themes developed. Codes were then reviewed longitudinally. Initial analysis derived six themes: I lost everything overnight It feels frustrating Walking is absolutely the most important I need help I'm making progress I can start doing things that I used to be able to do. Participants described overwhelming losses, with loss of mobility affecting many aspects of life. All participants described progress other than walking that was critical for their wellbeing, including assisted standing and transfers without a lifter. Themes from longitudinal analyses: My losses softened by progress Walking means freedom Control helps adjustment happen Challenges keep coming. Over time, participants valued greater control within their lives and progress with mobility was key. Participants saw mobility as crucial to recovering control of life. Mobility achievements other than independent walking matter to in iduals after brain injury.
Publisher: Springer Science and Business Media LLC
Date: 26-02-2008
Abstract: Proximal femoral fractures are amongst the most devastating consequences of osteoporosis and injurious accidental falls with 25–35% of patients dying in the first year post-fracture. Effective rehabilitation strategies are evolving however, despite established associations between nutrition, mobility, strength and strength-related functional outcomes there has been only one small study with older adults immediately following fragility fracture where a combination of both exercise and nutrition have been provided. The aim of the INTERACTIVE trial is to establish whether a six month, in idualised exercise and nutrition program commencing within fourteen days of surgery for proximal femur fracture, results in clinically and statistically significant improvements in physical function, body composition and quality of life at an acceptable level of cost and resource use and without increasing the burden of caregivers. This randomised controlled trial will be performed across two sites, a 500 bed acute hospital in Adelaide, South Australia and a 250 bed acute hospital in Sydney, New South Wales. Four hundred and sixty community-dwelling older adults aged 70 will be recruited after suffering a proximal femoral fracture and followed into the community over a 12-month period. Participants allocated to the intervention group will receive a six month in idualised care plan combining resistance training and nutrition therapy commencing within 14 days post-surgery. Outcomes will be assessed by an in idual masked to treatment allocation at six and 12 months. To determine differences between the groups at the primary end-point (six months), ANCOVA or logistic regression will be used with models adjusted according to potential confounders. The INTERACTIVE trial is among the first to combine nutrition and exercise therapy as an early intervention to address the serious consequence of rapid deconditioning and weight loss and subsequent ability to regain pre-morbid function in older patients post proximal femoral fracture. The results of this trial will guide the development of more effective rehabilitation programs, which may ultimately lead to reduced health care costs, and improvements in mobility, independence and quality of life for proximal femoral fracture sufferers. Australian Clinical Trials Registry: ACTRN12607000017426.
Publisher: Informa UK Limited
Date: 08-10-2022
DOI: 10.1080/09638288.2021.1984592
Abstract: Following a brain injury survivors may have physical, or cognitive changes or behaviours which bring safety risks into play when engaging in activities. Therapists experience tensions in enabling the dignity of participation in the context of managing risk. Ten occupational therapists and seven physiotherapists participated in a grounded theory study utilising semi-structured in-depth interviews to explore the tensions between dignity and management of safety risks. Data were analysed using constant comparative method and a process of moving from open coding to categories to theory development. The process of weighing up was central to the therapists' approach to supporting dignity while managing risk. Respecting dignity itself is placed at risk when preventing harm is weighted higher than living a full life. Therapists who use weighing up as a process that respects dignity place greater value on the principles of respecting autonomy and promotion of justice for people with a brain injury. Rather than taking control and attempting to minimise risk therapists who privilege the perspective of the client, and provide opportunities for learning through failure or success, enable clients to live a full life.IMPLICATIONS FOR REHABILITATIONEnsuring that clients with brain injury are safe often requires therapists to exercise control and remove agency thus removing the rights of the client to the dignity of risk and living a full life.Providing opportunities within rehabilitation for clients to experience failure and success enables learning and thereby support dignity.Privileging the client perspective provides clients the dignity of living a normal life.
Publisher: Elsevier BV
Date: 2009
Publisher: Wiley
Date: 31-10-2022
DOI: 10.1111/HEX.13636
Abstract: Acquired brain injury (ABI) can result in considerable life changes. Having choice and control over daily life is valued by people following ABI. This meta‐synthesis will analyse and integrate international research exploring perspectives of choice and control in daily life following ABI. Databases were searched from 1980 to 13 January 2022 for eligible qualitative studies. After duplicates were removed, 22,768 studies were screened by title and abstract, and 241 studies received full‐text assessment with 56 studies included after pearling. Study characteristics and findings were extracted that related to personal perspectives on choice and control by people with an ABI (including author interpretation and quotes). Data from each study were coded and then segments of coded data across the studies were compared to create multiple broad categories. Findings were then reduced from categories into 3 overarching themes with 12 subthemes. These themes were: (1) feeling like a second‐class citizen (2) reordering life and (3) choosing a path. Participants with an ABI tussled between their feelings of loss following brain injury and their thinking about how they start to regain control and become agents of their own choices. The themes describe their sense of self, their changed self and their empowered self in relation to ‘choice and control’. Re‐engaging with choice and control after ABI is dynamic and can be challenging. Health professionals and supporters need to facilitate a gradual and negotiated return to agency for people following ABI. A sensitive and person‐centred approach is needed that considers the readiness of the person with ABI to reclaim choice and control at each stage of their recovery. Clear service or process indicators that are built on lived experience research are needed to facilitate changes in service delivery that are collaborative and inclusive. This review included the voices of 765 people living with ABI and was conducted by a erse team of allied health professionals with practice knowledge and research experience with people following ABI. Twenty‐nine of the 56 included studies had participants contributing to their design or analysis.
Publisher: Informa UK Limited
Date: 12-10-2011
Publisher: Elsevier BV
Date: 05-1993
Publisher: Wiley
Date: 11-1998
DOI: 10.1111/J.1440-1584.1998.TB00311.X
Abstract: Recent technological advances provide exciting opportunities for the delivery of education to rural and remote allied health professionals. Distance education modes can overcome barriers of distance and cost. However, the use of technologies may allow distance education to be more interactive for rural and remote professionals. Technologies that can be used are audioconferencing, videoconferencing, electronic mail (email), CD-ROM and the Internet. Combinations of any of these technologies and traditional forms of educational delivery are possible. The important objective is to create a learning environment that maximises interactivity and develops information literacy.
Publisher: Informa UK Limited
Date: 02-02-2023
DOI: 10.1080/09593985.2022.2034197
Abstract: Determine how mobility changes over 6 months in people unable to walk at 8-weeks post-Acquired Brain Injury (ABI) if there is an association over time between postural alignment and mobility post-ABI and if alignment after ABI becomes closer to healthy alignment over time. Fourteen adults with ABI, evaluated over 6 months, and a reference s le of 30 healthy adults were studied. The primary measure for changes in mobility was the Clinical Outcome Variables Scale (COVS). Secondary measures were sit-to-stand, timed standing holding rails, independent walking speed and number of testing conditions achieved. The Functional Independence Measure (FIM) was scored at rehabilitation admission and discharge. To analyze postural alignment, participants were recorded in sitting and standing, each repeated holding rails, and walking if able. Three-dimensional kinematic data were used to quantify whole-body postural alignment, equal to mean segment displacements from the base of support in the transverse plane. Associations between three-dimensional kinematic alignment scores and COVS scores were calculated using Linear Mixed-Effects Models. Participants made significant improvements in COVS scores, most secondary mobility scores, and FIM scores over time (p ≤ .001). Relationships between increasing COVS scores and decreasing sitting and standing mal-alignment scores were statistically significant. Visual analysis of graphed segment positions indicated that sitting and standing alignment became more similar to healthy alignment over time this was not clear for walking. Improvement in postural alignment may be a factor for improving mobility in people with severe impairments after ABI.
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1002/JOR.22969
Abstract: Total knee arthroplasty (TKA) in people with knee osteoarthritis increases knee-specific and general physical function, but it has not been established if there is a relationship between changes in these elements of functional ability. This study investigated changes and relationships between knee biomechanics during walking, physical activity, and use of time after TKA. Fifteen people awaiting TKA underwent 3D gait analysis before and six months after surgery. Physical activity and use of time were determined in free-living conditions from a high resolution 24-h activity recall. After surgery, participants displayed significant improvements in sagittal plane knee biomechanics and improved their physical activity profiles, standing for 105 more minutes (p=0.001) and performing 64 min more inside chores on average per day (p=0.008). Changes in sagittal plane knee range of motion (ROM) and peak knee flexion positively correlated with changes in total daily energy expenditure, time spent undertaking moderate to vigorous physical activity, inside chores and passive transport (r=0.52-0.66, p=0.005-0.047). Restoration of knee function occurs in parallel and is associated with improvements in physical activity and use of time after TKA. Increased functional knee ROM is required to support improvements in total and context specific physical activity.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.GAITPOST.2013.09.021
Abstract: Our understanding of age-related changes to foot function during walking has mainly been based on plantar pressure measurements, with little information on differences in foot kinematics between young and older adults. The purpose of this study was to investigate the differences in foot kinematics between young and older adults during walking using a multi-segment foot model. Joint kinematics of the foot and ankle for 20 young (mean age 23.2 years, standard deviation (SD) 3.0) and 20 older adults (mean age 73.2 years, SD 5.1) were quantified during walking with a 12 camera Vicon motion analysis system using a five segment kinematic model. Differences in kinematics were compared between older adults and young adults (preferred and slow walking speeds) using Student's t-tests or if indicated, Mann-Whitney U tests. Effect sizes (Cohen's d) for the differences were also computed. The older adults had a less plantarflexed calcaneus at toe-off (-9.6° vs. -16.1°, d = 1.0, p = <0.001), a smaller sagittal plane range of motion (ROM) of the midfoot (11.9° vs. 14.8°, d = 1.3, p = <0.001) and smaller coronal plane ROM of the metatarsus (3.2° vs. 4.3°, d = 1.1, p = 0.006) compared to the young adults. Walking speed did not influence these differences, as they remained present when groups walked at comparable speeds. The findings of this study indicate that independent of walking speed, older adults exhibit significant differences in foot kinematics compared to younger adults, characterised by less propulsion and reduced mobility of multiple foot segments.
Publisher: Elsevier BV
Date: 06-2009
Publisher: Springer Science and Business Media LLC
Date: 05-04-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
DOI: 10.1161/STROKEAHA.109.570390
Abstract: Background and Purpose— Falls are common after stroke. Despite evidence that single and multifactorial interventions can reduce falls in older people, this issue remains relatively underexplored in stroke survivors. Effective fall prevention in this population has the potential to prevent injury, improve quality of life, and decrease the likelihood of subsequent fear of falling and activity restriction. The aim of this article was to review and integrate the research evidence relating to interventions that reduce falls after stroke. Methods— Published studies evaluating interventions to reduce falls in stroke survivors were retrieved and screened according to predetermined criteria. Included studies were independently assessed. Quality of trials was assessed using the Physiotherapy Evidence Database score. Pooling of results was undertaken for similar interventions with comparable outcomes using the inverse variance method. Results— Thirteen studies met the inclusion criteria, with pooling of results possible for only 2 types of intervention. Methodological quality of the included studies was variable with the main bias because of lack of blinding of participants and those administering the intervention. Variability in falls data reporting was seen across the studies. The only intervention shown to be effective in reducing falls was vitamin D for female stroke survivors in an institutional setting. Other interventions were no more effective than usual care. Conclusions— Fall risk is high in stroke survivors however, the only intervention shown to be effective in reducing falls in this review was vitamin D supplementation. Consistency in outcome measurement would enable comparisons across studies. Additionally, further research evaluating a range of single and multifactorial interventions for fall prevention in the stroke population is required.
Publisher: Oxford University Press (OUP)
Date: 24-09-2012
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.GAITPOST.2012.11.010
Abstract: Confidence in 3D multi-segment foot models has been limited by a lack of repeatability data, particularly in older populations that may display unique functional foot characteristics. This study aimed to determine the intra and inter-observer repeatability of stance phase kinematic data from a multi-segment foot model described by Leardini et al. [2] in people aged 50 years or older. Twenty healthy adults participated (mean age 65.4 years SD 8.4). A repeated measures study design was used with data collected from four testing sessions on two days from two observers. Intra (within-day and between-day) and inter-observer coefficient of multiple correlations revealed moderate to excellent similarity of stance phase joint range of motion (0.621-0.975). Relative to the joint range of motion (ROM), mean differences (MD) between sessions were highest for the within-day comparison for all planar ROM at the metatarsus-midfoot articulation (sagittal plane ROM 5.2° vs. 3.9°, MD 3.1° coronal plane ROM 3.9 vs. 3.1°, MD 2.3° transverse plane ROM 6.8° vs. 5.16°, MD 3.5°). Consequently, data from the metatarsus-midfoot articulation in the Istituto Ortopedico Rizzoli (IOR) foot model in adults aged over 50 years needs to be considered with respect to the findings of this study.
Publisher: Informa UK Limited
Date: 10-03-2021
DOI: 10.1080/09593985.2021.1898066
Abstract: This paper explores the decision-making processes involved in giving physiotherapy students responsibility on clinical placement and the impact on their developing professional autonomy. The qualitative study, using semi-structured interviews, involved physiotherapy students and clinical educators (CEs) from two higher education institutions, one in Australia, and the other in the United Kingdom (UK). Findings led to the development of a heuristic framework of 'graduated supervision,' a process of progressively less direct observation and monitoring of students as clinical proficiency improved. By focusing on the measured exposure of students to increasing complexity and inverse levels of supervision, the framework captures tacit practices, and consistent, yet varied facilitation strategies adopted across specialties, and evident in clinical education settings in both countries. The framework formalizes, for the first time, assumptions and expectations previously unacknowledged. Factors identified as affecting students' progress toward autonomy include the student/CE relationship, the development of mutual trust through ongoing dialogue, and the importance of formal discussions at the commencement of a clinical placement to establish learning goals, preferred supervision styles and learner responsibilities. Insights have significance for the CE community, and students who at times have to second-guess what is required of them and how they might excel on clinical placement.
Publisher: Springer Science and Business Media LLC
Date: 31-03-2009
Publisher: Oxford University Press (OUP)
Date: 10-2011
DOI: 10.2522/PTJ.20100310
Abstract: Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.
Publisher: Elsevier BV
Date: 05-1994
Publisher: Informa UK Limited
Date: 14-06-2010
DOI: 10.3109/02699052.2010.489792
Abstract: To investigate if an isokinetic strength training programme for leg muscles lead to personally meaningful changes in adults with an acquired brain injury (ABI). A qualitative exploratory design. Twelve people with ABI participated in pre- and post-intervention face-to-face interviews with open ended questions. Data were initially analysed using a case study research approach exploring in iduals experiences and then cross case analysis to determine common themes for the group. Twelve-week isokinetic strength training programme for ankle and knee muscles. Participants perceived changes. Thematic analysis determined four main themes arising from the interviews occupation, vitality, sense of self and personal interactions. Participants reported reductions in impairments as a response to the exercise programme and these changes led to increased function and participation in activities they valued. Also marked improvements in vitality were reported as well as increases in self-esteem and general well-being for many participants. An isokinetic strength training programme resulted in improvements in motor skills and functional abilities that were meaningful for the participants.
Publisher: SAGE Publications
Date: 30-12-2019
Abstract: This study explored whether the psychological composition of a group, with respect to mood, catastrophising, fear of movement and pain self-efficacy characteristics at baseline, is associated with in iduals’ treatment outcomes following group cognitive behavioural therapy (CBT)-based programmes for chronic pain. Retrospective analyses of outcomes from two independently run CBT-based pain management programmes (Programme A: N = 317 and Programme B: N = 693) were conducted. Mixed modelling analyses did not consistently support the presence of associations between group median scores of depression, catastrophising or fear avoidance with outcomes for in iduals in either programme. These results suggest that the psychological profiles of groups are not robust predictors of in idual outcomes in CBT groups for chronic pain. By implication, efforts made to consider group composition with respect to psychological attributes may be unnecessary.
Publisher: Oxford University Press (OUP)
Date: 06-2016
DOI: 10.2522/PTJ.20150215
Abstract: Discharge from the hospital is a high risk transition period for older adults at risk of falls. Guidelines relevant to physical therapists for managing this risk are well documented, but commonly not implemented. This project implemented an intervention to improve physical therapists' adherence to key guideline recommendations for managing risk of falls on discharge from one hospital. A pretest-posttest study design was undertaken and was underpinned by the Theoretical Domains Framework (TDF) to aid in the design of interventions to increase physical therapists' adherence to guideline recommendations and to identify barriers to these interventions. A multifaceted intervention was implemented, including the establishment of a governance committee, education sessions, development of a “pathway” to guide practice, modification of an existing standardized assessment proforma, development of standardized processes and indicators for handover, increasing availability of educational handouts, audit and feedback processes, and allocation of dedicated staffing to oversee falls prevention within the physical therapy department. There were significant improvements in physical therapist behavior leading to key guideline recommendations being met, including: the proportion of patients who were identified to be at risk of falls (6.3% preintervention versus 94.8% postintervention) prior to discharge, an increase in documentation of clinical handover at discharge (68.6% preintervention versus 90.9% postintervention), and improvement in the quality of this documented clinical handover (34.9% of case notes met 5 criteria preintervention versus 92.9% postintervention). The approach was resource intensive and consequently may be difficult to replicate at other sites. A multifaceted intervention underpinned by the TDF, designed to modify physical therapists' behavior to improve adherence to guideline recommendations for managing risk of falls on discharge from one hospital, was successful.
Publisher: Springer Science and Business Media LLC
Date: 30-05-2018
Publisher: Hindawi Limited
Date: 04-12-2012
DOI: 10.5402/2012/947828
Abstract: Background. The popular media infer that satisfaction with waiting lists for total hip or knee replacement surgery is poor however, there is little supporting evidence for this. The purpose of this study was to describe patients satisfaction with the service they received for joint replacement surgery in a public hospital. Methods. A cross-sectional design was used to survey 450 patients. Data was analysed descriptively and chi-squared analyses (significance level of P 0.05 ) were used to examine associations between variables. Results. The response rate was 71%. Nearly three-quarters ( n = 312 ) of the s le were “very happy” with the service and 92.0% ( n = 379 ) indicated that they would have their surgery again. Satisfaction was significantly associated with waiting time to the first appointment (chi-square P = 0.002 ), whether the patients enquired about their waiting time (chisquare P = 0.003 ), and the number of preoperative appointments (chisquare P = 0.04 ). Most participants reported a maximum acceptable waiting period for initial appointment of less than 6 months but nearly half waited longer. Conclusions. The perception that patients are unhappy with elective surgery services in Australia may be unfounded despite many waiting longer than they consider appropriate.
Publisher: Informa UK Limited
Date: 25-08-2013
DOI: 10.1080/13557858.2013.828830
Abstract: To explore the process of decision-making of older people with limited English proficiency (LEP) about using a professional interpreter during their health care after stroke. A constructivist grounded theory approach was used. Up to two in-depth interviews were conducted with 13 older people with LEP from seven different language groups, and one older person who preferred to speak English, who had recently received health care after an acute stroke. Professional interpreters assisted with 19 of the 24 study interviews. Data were analysed and theoretical processes developed using a constant comparative method. Professional interpreters were not a strong presence in the health care experience after stroke for participants. The use of professional interpreters was a complex decision for participants, influenced by their perception of the language and health care expertise of themselves and others, their perceived position to make the decision and whom they trusted. Getting by in English allowed participants to follow rules-based talk of health professionals, but did not enable them to understand detailed information or explanation, or to engage in the management of their condition in a meaningful way. Health professionals have an opportunity and a mandate to demonstrate leadership in the interpreter decision by providing knowledge, opportunity and encouragement for people with LEP, to use an interpreter to engage in, and understand, their health care after stroke. Health professionals may need to advise when interpretation is needed for health care situations, when communication difficulties may not be anticipated by the person with LEP.
Publisher: Wiley
Date: 07-06-2012
DOI: 10.1111/J.1365-2648.2011.05719.X
Abstract: This paper is a report of a methodological review of language appropriate practice in qualitative research, when language groups were not determined prior to participant recruitment. When older people from multiple language groups participate in research using in-depth interviews, additional challenges are posed for the trustworthiness of findings. This raises the question of how such challenges are addressed. The Cumulative Index to Nursing and Allied Health Literature, Scopus, Embase, Web of Science, Ageline, PsycINFO, Sociological abstracts, Google Scholar and Allied and Complementary Medicine databases were systematically searched for the period 1840 to September 2009. The combined search terms of 'ethnic', 'cultural', 'aged', 'health' and 'qualitative' were used. In this methodological review, studies were independently appraised by two authors using a quality appraisal tool developed for the review, based on a protocol from the McMaster University Occupational Therapy Evidence-Based Practice Research Group. Nine studies were included. Consideration of language ersity within research process was poor for all studies. The role of language assistants was largely absent from study methods. Only one study reported using participants' preferred languages for informed consent. More ex les are needed of how to conduct rigorous in-depth interviews with older people from multiple language groups, when languages are not determined before recruitment. This will require both researchers and funding bodies to recognize the importance to contemporary healthcare of including linguistically erse people in participant s les.
Publisher: Informa UK Limited
Date: 24-03-2017
DOI: 10.1080/02699052.2017.1283061
Abstract: To examine the relationship between postural alignment and mobility skills for adults after acquired brain injury (ABI). Systematic review of the literature. Seven electronic databases, grey literature and reference lists of the shortlisted publications were searched. Studies were included if participants were adults with ABI, both postural alignment and mobility were measured and analysis included a relationship between alignment and mobility. Those that met the inclusion criteria were assessed with a critical appraisal tool. The review was registered with PROSPERO, registration number CRD42015019867. Seven observational studies were included that had examined a relationship between postural alignment and mobility after ABI. Critical appraisal scores were moderate to strong. While some studies reported that improved postural alignment was related to improved mobility after ABI, results varied and there was insufficient evidence to answer the primary question. Heterogeneous study designs did not allow meta-regression. A small amount of observational evidence exists for a relationship between postural alignment and mobility after ABI. Results vary, with some studies reporting that a more stable, upright trunk correlates with better mobility, and others providing conflicting or ambiguous results. Further research is needed to establish the relationship between postural alignment and mobility skills after ABI.
No related grants have been discovered for Shylie Mackintosh.