ORCID Profile
0000-0002-4436-3108
Current Organisation
University of South Australia
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Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1111/J.1753-6405.2010.00616.X
Abstract: A small percentage of Australians frequently attend hospital emergency departments (ED) with potentially avoidable health crises. These in iduals are termed 'vulnerable' due to their complex health and social needs. When these needs are unmanaged, unnecessary ED and hospital-admission costs are incurred. A holistic community-based program was developed to engage a cohort of vulnerable in iduals in strategies to improve their health and health behaviours, and health service use. A purposive s le of frequent ED attendees was identified in one Australian metropolitan health region. Core program elements included working with clients within their environment, problem solving, empowerment, education, goal setting and mentoring. Evaluation data included services provided for, and time spent with, clients hospital admission and emergency department attendances and related costs client engagement data mental health measures client stories and participant interviews. Data was analysed from 37 clients. On average, staff spent 34 hours with each client, costing approximately $1,700 each. Significant improvements resulted in client health and health behaviours. Crisis emergency department and inpatient admissions decreased, and planned outpatient clinic use increased. Low-cost community-based intervention for frequent ED attendees has the potential for significant tertiary hospital savings.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 02-2018
Publisher: BMJ
Date: 14-02-2017
Publisher: Informa UK Limited
Date: 04-2020
DOI: 10.2147/COPD.S178049
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/14799731221105518
Abstract: Dyspnoea and pain are symptoms of chronic obstructive pulmonary disease (COPD). This review focused upon pain and dyspnoea during hospital admissions for acute exacerbations of COPD (AECOPD), with the aim of examining prevalence, assessment, clinical associations, and researcher-reported implications of these symptoms. Four electronic databases were searched from inception to 31 May 2021. Full text versions of studies were assessed for methodological quality and data were extracted independently by two reviewers. Where data permitted, pooled prevalence of pain and dyspnoea were calculated by meta-analysis. Four studies were included. The pooled prevalence of pain and dyspnoea was 44% (95% confidence interval (CI) 35%–52%) and 91% (95% CI 87%–94%) respectively. An array of instruments with varying focal periods were reported (pain: six tools, dyspnoea: four tools). Associations and clinical implications between the two symptoms at the time of hospital admission were rarely reported. Few studies reported prevalence of pain and dyspnoea during an AECOPD. A greater understanding into the prevalence, intensity and associations of these symptoms during AECOPD could be furthered by use of standardised assessment tools with clearly defined focal periods.
Publisher: Cambridge University Press (CUP)
Date: 21-01-2018
DOI: 10.1017/S1478951517001122
Abstract: Although the needs of the bereaved have been identified widely in the literature, how these needs translate into meaningful, appropriate, and client-centered programs needs further exploration. The application of receptivity to support is a critical factor in participation by the bereaved in palliative care bereavement programs. Receptivity is a complex multifactorial phenomenon influenced by internal and external factors that ultimately influences engagement in psychosocial support in bereavement. This study explored factors that influence receptivity to bereavement support from palliative care services in rural, regional, and remote Western Australia. The study comprised a qualitative descriptive research design using semistructured interviews with 24 bereaved in iduals, nine palliative care health professionals, and four Aboriginal Health Professionals. Participants were recruited via palliative care services in country Western Australia. Interviews were transcribed verbatim and thematically analyzed. Findings revealed that a range of in idual, social, and geographical factors influence receptivity to bereavement support and can impact on utilization of bereavement support services. Receptivity provides a frame of reference to enhance understanding of factors influencing engagement in psychosocial support in bereavement. Receptivity promotes a shift of service provider perspectives of effective supportive care to consumer-centric reasons for engagement.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/6327180
Abstract: Background and Objective . We aimed to assess the validity of using the Global Lung Function Initiative’s (GLI) 2012 equations to interpret lung function data in a healthy workforce of South Australian Metropolitan Fire Service (SAMFS) personnel. Methods . Spirometry data from 212 healthy, nonsmoking SAMFS firefighters were collected and predicted normal values were calculated using both the GLI and local population derived (Gore) equations for forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), and FEV 1 /FVC. Two-tailed paired s le Student’s t -tests, Bland-Altman assessments of agreement, and z -scores were used to compare the two prediction methods. Results . The equations showed good agreement for mean predicted FEV 1 , FVC, and FEV 1 /FVC. Mean z -scores were similar for FEV 1 and FVC, although not FEV 1 /FVC, but greater than 0.5. Differences between the calculated lower limits of normal (LLN) were significant ( p 0.01 ), clinically meaningful, and resulted in an 8% difference in classification of abnormality using the FEV 1 /FVC ratio. Conclusions . The GLI equations predicted similar lung function as population-specific equations and resulted in a lower incidence of obstruction in this s le of healthy SAMFS firefighters. Further, interpretation of spirometry data as abnormal should be based on both an FEV 1 and FEV 1 /FVC ratio LLN.
Publisher: Wiley
Date: 23-09-2013
DOI: 10.1111/RESP.12128
Abstract: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but implementation appears to be low. The aim of this study was to determine the frequency of referral to, and attendance at, PR programmes in a s le of patients with COPD. A cross-sectional study of patients admitted to a tertiary hospital in South Australia, with a primary diagnosis of COPD between March and November 2011 was conducted. Data were collected from medical records and patient interview. From 235 admissions with preliminary coding as COPD, 88 patients had COPD as the primary reason for admission and were potentially eligible for rehabilitation. While 57% had been referred to rehabilitation during their disease course, only 18% had attended and completed at least half the programme. Seven patients had attended in the previous 2 years. Mean percentage predicted forced expiratory volume in 1 s was 42% at the time of referral. During the index admission, discussion of rehabilitation resulting in a referral occurred in 14 cases (16%). No demographic or disease characteristics were associated with referral/no referral being reviewed by a COPD nurse coordinator during admission increased the likelihood of referral (odds ratio = 18.7, 95% confidence interval: 3.8-91.4). PR had been implemented in a small proportion of patients admitted to hospital with an exacerbation of COPD due to gaps in both referral to and subsequent attendance at a programme. Strategies to improve referral to and participation in PR are required.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2012
Publisher: Oxford University Press (OUP)
Date: 12-06-2017
DOI: 10.1093/PTJ/PZX063
Abstract: An increasing variety of short functional exercise tests are reported in people with chronic obstructive pulmonary disease (COPD). Systematic review of the psychometric properties of these exercise tests is indicated. The aim of this study was to determine the reliability, validity, and responsiveness of short (duration & 6 min) lower extremity functional exercise tests in people with COPD. Five databases were searched: MEDLINE, Embase, Scopus, AMED, and CINAHL. Studies reporting psychometric properties of short functional exercise tests in people with COPD were included. Two reviewers independently extracted data and rated the quality of each measurement property using the COnsensus-based Standards for the Selection of Health Measurement INstrument (COSMIN). Twenty-nine studies were identified reporting properties of 11 different tests. Four-meter gait speed [4MGS] and 5 repetition sit-to-stand [5STS] demonstrated high reliability (ICC = .95–.99 .97) with no learning effect (COSMIN study ratings = good–-excellent). Their validity for use as a stratification tool anchored against an established prognostic indicator (area under receiver operator characteristics curve [AUC] = 0.72–0.87 0.82) and responsiveness to change after pulmonary rehabilitation was greatest in more frail people with COPD. Studies of the Timed “Up and Go” [TUG] test support use of a practice test and show discriminative ability to detect falls history and low six-minute walk distance (AUC = 0.77 0.82, COSMIN ratings = fair–excellent). Earlier studies were limited by small s le size. Limited data of lower study quality was identified for step tests and the Two-Minute Walk Test. Selected short functional exercise tests can complement established exercise capacity measures, in stratification and measuring responsiveness to change especially in people with COPD and lower functional ability.
Publisher: PeerJ
Date: 07-07-2021
DOI: 10.7717/PEERJ.11554
Abstract: Blood flow restricted exercise (BFRE) improves physical fitness, with theorized positive effects on vascular function. This systematic review and meta-analysis aimed to report (1) the effects of BFRE on vascular function in adults with or without chronic health conditions, and (2) adverse events and adherence reported for BFRE. Five electronic databases were searched by two researchers independently to identify studies reporting vascular outcomes following BFRE in adults with and without chronic conditions. When sufficient data were provided, meta-analysis and exploratory meta-regression were performed. Twenty-six studies were included in the review (total participants n = 472 n = 41 older adults with chronic conditions). Meta-analysis (k = 9 studies) indicated that compared to exercise without blood flow restriction, resistance training with blood flow restriction resulted in significantly greater effects on endothelial function (SMD 0.76 95% CI [0.36–1.14]). No significant differences were estimated for changes in vascular structure (SMD −0.24 95% CI [−1.08 to 0.59]). In exploratory meta-regression analyses, several experimental protocol factors (design, exercise modality, exercised limbs, intervention length and number of sets per exercise) were significantly associated with the effect size for endothelial function outcomes. Adverse events in BFRE studies were rarely reported. There is limited evidence, predominantly available in healthy young adults, on the effect of BFRE on vascular function. Signals pointing to effect of specific dynamic resistance exercise protocols with blood flow restriction (≥4 weeks with exercises for the upper and lower limbs) on endothelial function warrant further investigation.
Publisher: European Respiratory Society (ERS)
Date: 07-2019
Publisher: Informa UK Limited
Date: 2017
DOI: 10.2147/COPD.S123933
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.JPAINSYMMAN.2019.10.012
Abstract: Explanations provided by health professionals may underpin helpful or harmful symptom beliefs and expectations of people living with chronic breathlessness. This study sought perspectives from health professionals with clinical/research expertise in chronic breathlessness on priority issues in chronic breathlessness explanations and research. Authors (n = 74) of publications specific to chronic breathlessness were invited to a three-round Delphi survey. Responses to open-ended questions (Round 1 "What is important to: include/avoid when explaining chronic breathlessness prioritize in research?") were transformed to Likert scale (1-9) items for rating in subsequent rounds. A priori consensus was defined as ≥70% of respondents rating an item as important (Likert rating 7-9) and interquartile range ≤2. Of the 31 Round 1 respondents (nine countries, five professional disciplines), 24 (77%) completed Rounds 2 and 3. Sixty-three items met consensus (include n = 28 avoid n = 9 research n = 26). Explanations of chronic breathlessness should use patient-centered communication acknowledge the distress, variability, and importance of this sensation emphasize current management principles clarify maladaptive beliefs and expectations and avoid moral culpability and inappropriate reassurance. Research priorities included the need 1) for a comprehensive understanding of breathlessness science 2) to optimize, explore, and develop effective interventions, both pharmacological and nonpharmacological and 3) determine effective models of care including strategies for education and training of health professionals and people caring for, or living with, chronic breathlessness. These consensus-based concepts for chronic breathlessness explanations and research provide a starting point for conversations between patients, carers, clinicians, and researchers within the chronic breathlessness community.
Publisher: SAGE Publications
Date: 15-01-2014
Abstract: A systematic review was conducted to examine the association between co-morbidity and physical performance in people with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials were searched from inception to end-February 2013, using keywords ‘COPD’, ‘exercise’, ‘physical activity’, ‘rehabilitation’, ‘co-morbidity’ and in idual co-morbid conditions. Studies reporting associations of co-morbidities in COPD with at least one objective measure of physical performance were included. Study quality was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Nine studies met inclusion criteria. Mean (standard deviation (SD)) STROBE score was 16 (3) (maximum score = 21). Four studies examined anxiety as a co-morbid condition three examined depression two examined obesity and two examined a range of conditions. Reduced physical performance was associated with higher Charlson score (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.54–0.98), metabolic disease (OR = 0.58, 95% CI = 0.49–0.67), anxiety (OR = 0.37, 95% CI = 0.23–0.59) and osteoporosis (OR = 0.28, 95% CI = 0.11–0.70). Depression had minimal association with physical performance but was associated with higher dropout rates from pulmonary rehabilitation programmes. Obesity was negatively associated with baseline physical performance but not with change from an exercise intervention. The presence of co-morbid conditions in people with COPD may negatively affect physical performance and should be identified and accounted for analysis of interventions.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2016
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/14799731221150435
Abstract: Physiotherapy-led airway clearance interventions are indicated for some people with chronic lung conditions. This study describes Australian clinical models for the provision of adult airway clearance services. This cross-sectional national study recruited public and private health care providers (excluding cystic fibrosis-specific services) identified by a review of websites. Providers were invited to complete an electronic 61-item survey with questions about airway clearance service context, referral demographics, service provision and program metrics. Data were reported descriptively with differences between metropolitan and non-metropolitan services explored with chi-square tests. Between October-December 2019, the survey was disseminated to 131 providers with 91 responses received (69% response rate 87 (96%) public (34 metropolitan 53 non-metropolitan) and 4 (4%) private). Intent (chronic condition self-management) and types of intervention provided (education, breathing techniques, exercise prescription) were common across all services. Geographic location was associated with differences in airway clearance service models (greater use of regular clinics, telephone/telehealth consultations and dedicated cardiorespiratory physiotherapists in metropolitan locations versus clients incurring service and device provision costs in non-metropolitan regions). While similarities in airway clearance interventions exist, differences in service models may disadvantage people living with chronic lung conditions, especially in non-metropolitan regions of Australia.
Publisher: Wiley
Date: 30-09-2023
DOI: 10.1111/RESP.14382
Abstract: Urban firefighters are routinely exposed to both physical and chemical hazards that can negatively impact lung health, but it is unclear if firefighters experience accelerated decline in spirometry parameters due to chronic exposure and acute insults. This study aimed to describe sub‐groups of firefighters with differing spirometry trajectories and examine the relationship between the identified trajectories and demographic, lifestyle and occupational characteristics. Data from six waves of the Respiratory Function Measurement and Surveillance for South Australian Metropolitan Fire Service Study (2007–2019) were used to identify spirometry parameter z‐score trajectories, using group‐based multi‐trajectory modelling (GBMTM). Analysis of variance and chi‐square statistics were used to assess trajectory group differences in baseline self‐reported demographic, lifestyle and occupational characteristics. In the 669 included firefighters, we identified five trajectories for the combination of Forced Expiratory Volume in the first second z‐score (FEV 1 z), Forced Vital Capacity z‐score (FVCz) and the ratio of FEV 1 and FVC z‐score (FEV 1 /FVCz). There were three stable trajectories of low, average and very high lung function and two declining trajectories of average and high lung function. Analysis of subgroup characteristics revealed no significant differences between expected and actual group proportions for the occupational characteristics of years of service and respiratory protection use. Significant differences were seen in respiratory health and body mass index. GBMTM defined distinct, plausible spirometry trajectory sub‐groups. Firefighter longitudinal spirometry trajectory group membership was associated with BMI and respiratory disease or symptoms but not with self‐reported smoking history or occupational factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 10-08-2017
Publisher: Wiley
Date: 12-02-2020
DOI: 10.1111/JORC.12321
Publisher: Elsevier BV
Date: 07-2018
Publisher: Springer Science and Business Media LLC
Date: 30-03-2020
DOI: 10.1186/S12909-020-02006-7
Abstract: Clinicians and people living with chronic breathlessness have expressed a need to better understand and manage this symptom. The aim of this study was to evaluate a 3-day health professional training workshop on the practical management of chronic breathlessness. Workshop design and delivery were based on current understandings and clinical models of chronic breathlessness management, principles of transformative learning, and included sessions co-designed with people living with breathlessness. Registrants were invited to complete pre and post-workshop surveys. Pre and 1-week post-workshop online questionnaires assessed familiarity and confidence about workshop objectives (0[lowest]-10[highest] visual analogue scale), attitudes and practices regarding chronic breathlessness (agreement with statements on 5-point Likert scales). Post-workshop, participants were asked to describe implementation plans and anticipated barriers. Baseline familiarity and confidence were reported as mean (SD) and change examined with paired t-tests. Pre-post attitudes and practices were summarised by frequency ercentages and change examined non-parametrically (5-point Likert scale responses) or using a McNemar test of change (binary responses). Forty-seven of 55 registrants joined the study 39 completed both pre and post-workshop questionnaires (35 female 87% clinicians median 8 years working with people with chronic breathlessness). Post-workshop, greatest gains in confidence were demonstrated for describing biopsychosocial concepts unpinning chronic breathlessness (mean change confidence = 3.2 points 95% CI 2.7 to 4.0, p 0.001). Respondents significantly changed their belief toward agreement that people are able to rate their breathlessness intensity on a scale (60 to 81% agreement) although only a minority strongly agreed with this statement at both time points (pre 11%, post 22%). The largest shift in attitude was toward agreement (z statistic 3.74, p 0.001, effect size r = 0.6) that a person’s experience of breathlessness should be used to guide treatment decisions (from 43 to 73% strong agreement). Participants’ belief that cognitive behavioural strategies are effective for relief of breathlessness changed further toward agreement after the workshop (81 to 100%, McNemar test chi- square = 5.14, p = 0.02). The focus of this training on biopsychosocial understandings of chronic breathlessness and involvement of people living with this symptom were valued. These features were identified as facilitators of change in fundamental attitudes and preparedness for practice.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2018
Publisher: Wiley
Date: 24-03-2017
DOI: 10.1111/RESP.13025
Abstract: The aim of the Pulmonary Rehabilitation Guidelines (Guidelines) is to provide evidence-based recommendations for the practice of pulmonary rehabilitation (PR) specific to Australian and New Zealand healthcare contexts. The Guideline methodology adhered to the Appraisal of Guidelines for Research and Evaluation (AGREE) II criteria. Nine key questions were constructed in accordance with the PICO (Population, Intervention, Comparator, Outcome) format and reviewed by a COPD consumer group for appropriateness. Systematic reviews were undertaken for each question and recommendations made with the strength of each recommendation based on the GRADE (Gradings of Recommendations, Assessment, Development and Evaluation) criteria. The Guidelines were externally reviewed by a panel of experts. The Guideline panel recommended that patients with mild-to-severe COPD should undergo PR to improve quality of life and exercise capacity and to reduce hospital admissions that PR could be offered in hospital gyms, community centres or at home and could be provided irrespective of the availability of a structured education programme that PR should be offered to patients with bronchiectasis, interstitial lung disease and pulmonary hypertension, with the latter in specialized centres. The Guideline panel was unable to make recommendations relating to PR programme length beyond 8 weeks, the optimal model for maintenance after PR, or the use of supplemental oxygen during exercise training. The strength of each recommendation and the quality of the evidence are presented in the summary. The Australian and New Zealand Pulmonary Rehabilitation Guidelines present an evaluation of the evidence for nine PICO questions, with recommendations to provide guidance for clinicians and policymakers.
Publisher: Informa UK Limited
Date: 10-2017
DOI: 10.2147/COPD.S143179
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.JPAINSYMMAN.2021.06.023
Abstract: The Dyspnoea-12 (D-12) and Multidimensional Dyspnea Profile (MDP) were specifically developed for assessment of multiple sensations of breathlessness. This systematic review aimed to identify the use and measurement properties of the D-12 and MDP across populations, settings and languages. Electronic databases were searched for primary studies (2008-2020) reporting use of the D-12 or MDP in adults. Two independent reviewers completed screening and data extraction. Study and participant characteristics, instrument use, reported scores and minimal clinical important differences (MCID) were evaluated. Data on internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient, ICC) were pooled using random effects models between settings and languages. A total 75 publications reported use of D-12 (n = 35), MDP (n = 37) or both (n = 3), reflecting 16 chronic conditions. Synthesis confirmed two factor structure, internal consistency (Cronbach's α mean, 95% CI: D-12 Total = 0.93, 0.91-0.94 MDP Immediate Perception [IP] = 0.88, 0.85-0.90 MDP Emotional Response [ER] = 0.86, 0.82-0.89) and 14 day test-rest reliability (ICC: D-12 Total = 0.91, 0.88-0.94 MDP IP = 0.85, 0.70-0.93 MDP ER = 0.84, 0.73-0.90) across settings and languages. MCID estimates for clinical interventions ranged between -3 and -6 points (D-12 Total) with small variability in scores over 2 weeks (D-12 Total 2.8 (95% CI: 2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1) and six months (D-12 Total 2.9 (2.0 to 3.7), MDP-A1 0.8 (0.6 to 1.1)). D-12 and MDP are widely used, reliable, valid and responsive across various chronic conditions, settings and languages, and could be considered standard instruments for measuring dimensions of breathlessness in international trials.
Publisher: Springer Science and Business Media LLC
Date: 31-07-2013
DOI: 10.1038/IJO.2013.137
Abstract: To investigate whether ventilatory factors limit exercise in overweight and obese children during a 6-min step test and to compare ventilatory responses during this test with those of healthy weight children. Cross-sectional, prospective comparative study. Twenty-six overweight/obese subjects and 25 healthy weight subjects with no known respiratory illness. Various fatness and fat distribution parameters (using air displacement plethysmography and anthropometry), pulmonary function tests, breath-by-breath gas analysis during exercise, perceived exertion. Young people who are overweight or obese are more likely to experience expiratory flow limitation (expFL) during submaximal exercise compared with their healthy weight peers [OR 7.2 (1.4, 37.3), P=0.019]. Subjects who had lower lung volumes at rest were even more likely to experience exercise-induced expFLs [OR 8.35 (1.4-49.3)]. Both groups displayed similar breathing strategies during submaximal exercise. Young people who are overweight/obese are more likely to display expFL during submaximal exercise compared with children of healthy weight . Use of compensatory breathing strategies appeared to enable overweight children to avoid the experience of breathlessness at this intensity of exercise.
Publisher: Wiley
Date: 24-08-2010
DOI: 10.1111/J.1365-2753.2009.01339.X
Abstract: Pre-discharge occupational therapy home assessments are common practice, and considered important for falls prevention in older people. This prospective, observational cohort study describes the association between pre-discharge home assessment and falls in the first month post-discharge from a rehabilitation hospital. 342 inpatients were recruited and followed up 1 month post-discharge. Patients were classified into diagnostic groups (cardiac, orthopaedic trauma, spinal, peripheral joint surgery, neurological and deconditioned). Age, gender, falls risk [Falls Risk Assessment Scoring System (FRASS)], functional independence scores (FIM™) and receipt (or not) of a home assessment were recorded. Patients completed a diary to document post-discharge falls. Logistic regression analysis tested the effect on falling of receiving a home assessment, age, gender, diagnostic group, FRASS and FIM™. Considering all subjects, not receiving a home assessment increased the risk of falling 1 month post-discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7, P=0.003]. Neurological and orthopaedic trauma patients had significantly elevated risks of falling [OR (95% CI), respectively, 12.5 (4.7-33.2), 3.4 (1.4-8.4)] relative to the orthopaedic joint group. For all diagnostic groups except neurological, falls risk was mitigated by a home assessment. In non-neurological patients, adjusting for the effect of diagnostic group, FRASS and FIM™ scores indicated a significant association between not receiving a home assessment and falling (OR 4.2, 95% CI 2.1-8.2, P<0.001). Pre-discharge occupational therapy home assessments are sound post-discharge falls-prevention strategies in non-neurological patients. The decision to conduct a home assessment should consider diagnosis, falls risk and functional independence.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 24-06-2013
Publisher: MDPI AG
Date: 08-06-2023
DOI: 10.3390/HEALTHCARE11121686
Abstract: Chronic breathlessness is a multidimensional, unpleasant symptom common to many health conditions. The Common-Sense Model of Self-Regulation (CSM) was developed to help understand how in iduals make sense of their illness. This model has been underused in the study of breathlessness, especially in considering how information sources are integrated within an in idual’s cognitive and emotional representations of breathlessness. This descriptive qualitative study explored breathlessness beliefs, expectations, and language preferences of people experiencing chronic breathlessness using the CSM. Twenty-one community-dwelling in iduals living with varying levels of breathlessness-related impairment were purposively recruited. Semi-structured interviews were conducted with questions reflecting components of the CSM. Interview transcripts were synthesized using deductive and inductive content analysis. Nineteen analytical categories emerged describing a range of cognitive and emotional breathlessness representations. Representations were developed through participants’ personal experience and information from external sources including health professionals and the internet. Specific words and phrases about breathlessness with helpful or nonhelpful connotations were identified as contributors to breathlessness representations. The CSM aligns with current multidimensional models of breathlessness and provides health professionals with a robust theoretical framework for exploring breathlessness beliefs and expectations.
Publisher: SAGE Publications
Date: 31-07-2023
DOI: 10.1177/17470161231189602
Abstract: Many countries, including Australia, have established a national scheme that supports the recognition of a single ethical review for multi-centre research conducted in publicly funded health services. However, local site-specific governance review processes remain decentralised and highly variable. This short report describes the ethics and governance processes required for a negligible risk national survey of physiotherapy-led airway clearance services in Australia. We detail inconsistencies in research governance document preparation and submission (platforms, processes, forms and signatories) and report the time cost and likely impact of these inconsistencies on health services research outcomes. Processes and strategies that facilitated success in this project are identified and summarised as helpful hints to other researchers looking to embark on negligible risk research in public health facilities.
Publisher: Informa UK Limited
Date: 07-2017
DOI: 10.2147/COPD.S111135
Publisher: Oxford University Press (OUP)
Date: 27-07-2023
Abstract: Workplace health and safety (WHS) is an important responsibility falling on both employers and employees and is most effective when the perspectives of all stakeholders are considered. This study aimed to explore the facilitators and barriers to a voluntary workplace lung function surveillance program from the perspective of urban firefighters and describe their perceptions of its value. Using a qualitative, descriptive methodology, firefighters who had participated in a longitudinal lung function surveillance study were invited to participate in semi-structured interviews. Purposeful, maximum variation s ling was used to achieve ersity in those firefighters invited to participate. We used inductive content analysis to identify themes. Interviews with 15 firefighters identified 3 main themes: (i) practical experience of surveillance (administration, communication, workplace culture change, convenience, acceptability, and appeal) (ii) value of surveillance (lung health efficacy and control, social support, workplace management support/motivations, contribution to global firefighter health) and (iii) contribution of surveillance to health (occupational risk, relevance in the context of total health, workability, and fitness and future value). Practical and psychosocial facilitators and barriers to providing lung function surveillance in the fire service were identified. In addition to the personal benefits of detecting adverse lung health and allowing for medical intervention, factors known to positively influence firefighter workplace wellbeing, such as providing peace of mind, feedback on good work practices, motivation to utilize control measures, management commitment to health, and providing data to assist with global knowledge were valued aspects of longitudinal lung function surveillance.
Publisher: University of Toronto Press Inc. (UTPress)
Date: 10-2010
Abstract: Purpose: This report highlights the current international gap between the availability of high-quality evidence for pulmonary rehabilitation (PR) and its low level of implementation. Key barriers are outlined, and potentially effective strategies to improve implementation are presented. Summary of key points: Although pulmonary rehabilitation (PR) is recommended by international guidelines as part of the management of patients with chronic obstructive pulmonary disease (COPD), participation in PR remains low. Physician referral to PR ranges from 3% to 16% of suitable patients. Barriers to participation include limited availability of suitable programmes and interrelated issues of referral and access. In idual patient barriers, including factors relating to comorbidities and exacerbations, perceptions of benefit, and ease of access, contribute less overall to low participation rates. Chronic care programmes that incorporate self-management support have some benefit in patients with COPD. However, the demonstrated cost-effectiveness of PR is substantial, and efforts to improve its implementation are urgently indicated. Conclusion: To improve implementation, a holistic examination of the key issues influencing a patient's participation in PR is needed. Such an examination should consider the relative influences of environmental (e.g., health-service-related) factors, organizational factors (e.g., referral and intake procedures), and in idual factors (e.g., patient barriers) for all participants. On the basis of these findings, policy, funding, service delivery, and other interventions to improve participation in PR can be developed and evaluated.
Publisher: SAGE Publications
Date: 2021
DOI: 10.1177/14799731211056092
Abstract: This descriptive qualitative study explored perspectives of people with chronic obstructive pulmonary disease (COPD) and health professionals concerning blood flow restricted exercise (BFRE) training. People living with COPD and health professionals (exercise physiologists, physiotherapists, and hospital-based respiratory nurses and doctors) participated in interviews or focus groups, which included information about BFRE training and a facilitated discussion of positive aspects, barriers and concerns about BFRE training as a possible exercise-based intervention. Sessions were audio-recorded, and transcript data analysed using inductive content analysis. Thirty-one people participated (people with COPD n = 6 health professionals n = 25). All participant groups expressed positive perceptions of BFRE as a potential alternative low-intensity exercise mode where health benefits might be achieved. Areas of overlap in perceived barriers and concerns included the need to address the risk of potential adverse events, suitability of training sites and identifying processes to appropriately screen potential candidates. While potential benefits were identified, concerns about determining who is safe and suitable to participate, delivery processes, health professional training and effects on a variety of health-related outcomes need to be addressed before implementation of BFRE training for people with COPD.
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.AUCC.2019.10.006
Abstract: Physical function is often poor in intensive care unit (ICU) survivors, yet objective descriptions of sedentary behaviour and physical activity during acute hospitalisation are lacking. The objective of this study was to examine sedentary and activity patterns during patients' hospital-based recovery from a critical illness and associations with physical function, muscle strength, and length of stay (LOS). This was a prospective cohort study in a tertiary ICU and acute hospital wards, which recruited 40 adults who required ≥5 days of mechanical ventilation. Data were collected at awakening (T1), ICU discharge (T2), and hospital discharge (T3), which included monitoring of body posture (sedentary behaviour) using the activPAL and activity intensity using the GENEActiv. Data were reported as time spent lying/sitting and upright, with the number of sit-to-stand transitions and upright bouts. Statistical analysis was conducted using repeated-measures analysis of variance and Spearman's rho. From awakening to hospital discharge (T1-T3, n = 23), there was a mean [95% confidence interval] decrease in % time spent lying/sitting (-3.0% [-4.6% to1.4%], p ≤ 0.001) corresponding to increased time spent upright (43.0 min [19.9, 66.1], p ≤ 0.001). Sit-to-stand transitions increased (18 [11, 28], p ≤ 0.001). The number of upright bouts ≥2 and ≥ 5 min increased (both p ≤ 0.001), but only from ICU to hospital discharge (T2-T3, 5.3 [3.1, 7.6] and 2.3 [0.9, 3.8] respectively). At ICU discharge (T2), less % of time spent lying/sitting, more minutes spent upright, and more transitions were associated with better physical function (Physical Function in Intensive Care Test-scored and de Morton Mobility Index all rho ≥+/-0.730, p ≤ 0.001) and muscle strength (hand grip, Medical Research Council sum-score all rho≥+/-0.505, p ≤ 0.001). There were no associations between accelerometry and hospital LOS. ICU survivors' transition from highly sedentary behaviour to low intensity activity over their acute hospitalisation. Sedentary breaks may be not spread over the day such that modifying sedentary behaviour to break up prolonged lying/sitting may be a focus for future research. NCT02881801.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2019
DOI: 10.1186/S12913-019-4681-1
Abstract: Consumers frequently access the internet looking for health information. With the growing burden of chronic disease internationally, strategies are focussing on self-management interventions in community and ambulatory settings. The objective of this scoping review was to describe publicly available information on Australian airway clearance services. Publicly funded health services network webpages and Google were systematically searched between July and November 2018 using relevant keywords. We identified the number, location and currency of contact information of services and described the services that were in operation and/or identifiable on the internet. Where specific airway clearance services were not identifiable via searching methods, webpages were navigated for associated physiotherapy services. All identified services were contacted via the listed phone or email to confirm web-based findings. Searching 131 publicly funded health service pages and 191 keyword hits identified four publicly funded airway clearance services (two of which were in operation when confirmed by direct contact) and six private services, all in metropolitan areas of capital cities. Webpages described who their services were for (9/10 services), how to gain referral (4/10) and types of airway clearance techniques available (5/10). A further 286 public physiotherapy services were identified, of which 24 (8%) included descriptors of service provision for respiratory patients on their webpage. In contrast, on direct telephone enquiry airway clearance intervention of some kind was confirmed as being available at 174/286 (61%) sites and unavailable at 69/286 (24%) sites. This scoping review demonstrated inconsistencies between airway clearance service information available on the internet and the reported provision of services confirmed by direct phone contact. Services that are available need to make information visible to consumers on the internet and include details such as referral pathways, interventions and current contact details, to support people with airway clearance problems to access appropriate care in the community.
Publisher: Informa UK Limited
Date: 12-2011
DOI: 10.2147/COPD.S26581
Publisher: European Respiratory Society (ERS)
Date: 2020
DOI: 10.1183/23120541.00343-2019
Abstract: Few studies have examined the contribution of life-course factors in explaining familial aggregation of chronic lung conditions. Using data from the 1958 British Birth Cohort, a life-course approach was used to examine whether, and how, exposure to risk factors through one's life explained the association between parental respiratory disease history and symptomatic airflow obstruction (AO). Cohort participants (n=6212) were characterised in terms of parental respiratory disease history and symptomatic AO at 45 years. Life-course factors ( e.g. smoking, asthma and early-life factors) were operationalised as life period-specific and cumulative measures. Logistic regression and path analytic models predicting symptomatic AO adjusted for parental respiratory disease history were used to test different life-course models (critical period, accumulation- and chain-of-risks models). While some life-course factors ( e.g. childhood passive smoking and occupational exposure) were in idually associated with parental respiratory disease history and symptomatic AO, asthma (OR 6.44, 95% CI 5.01–8.27) and persistent smoking in adulthood (OR 5.42, 95% CI 4.19–7.01) had greater impact on the association between parental respiratory disease history and symptomatic AO. A critical period model provided a better model fit compared with an accumulation-of-risk model and explained 57% of the effect of parental respiratory disease history on symptomatic AO. Adulthood asthma and smoking status explained around half of the effect of parental respiratory disease history on chronic obstructive pulmonary disease. Beyond smoking history, the combination of parental respiratory disease history and adulthood asthma may provide an opportunity for early diagnosis and intervention.
Publisher: Informa UK Limited
Date: 06-2011
DOI: 10.2147/JMDH.S20265
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2005
DOI: 10.1097/01.PEP.0000154340.43505.91
Abstract: This study was designed to determine test-retest repeatability of variables during a maximal cardiopulmonary exercise test (CPET) in children, and to report repeatability coefficients using limits of agreement analysis. This method of analysis is recommended for valid interpretation of outcome measures used in clinical or research interventions, and has not been reported in previous studies of peak oxygen uptake (VO2peak) in children. Two exercise tests were performed three to seven days apart in nine healthy children aged eight to 11 years, using a treadmill protocol. Limits of agreement analyses were performed, with bias (mean difference test 2 - test 1) and coefficients of repeatability (2 standard deviations [SD] of difference) calculated for VO2peak, peak heart rate (HRpeak) and peak minute ventilation (VEpeak). No significant differences were found between test and retest scores for any variable. VO2peak data demonstrated a bias of 1.4 ml kg/min with repeatability coefficient of 4.4 ml kg/min. The range described by 95% limits of agreement for VO2peak was -3 to + 5 ml kg/min. Bias and 95% limits of agreement for VEpeak and HRpeak were similarly described. The 95% limits of agreement for VO2peak imply that on repeated testing, a reduction of 3 or increase of 5.8 ml kg/min is likely to be clinically significant. This study provides reference values for repeatability of key variables during CPET in healthy children that should be considered when interpreting results from repeated testing.
No related grants have been discovered for Kylie Johnston.