ORCID Profile
0000-0002-5217-0242
Current Organisations
University of South Australia
,
Florey Institute of Neuroscience and Mental Health
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Publisher: Informa UK Limited
Date: 07-01-2020
Publisher: Springer Science and Business Media LLC
Date: 08-08-2019
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: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Oxford University Press (OUP)
Date: 11-08-2016
DOI: 10.2522/PTJ.20160141
Abstract: It is of critical importance that findings from the wealth of clinical physical therapist research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physical therapist research findings and evidence-based practice (EBP) into everyday clinical practice in different national settings and contexts. The purpose of this article is to contribute to knowledge about effective strategies for implementing EBP that have been studied in different national physical therapy settings. The specific aims of this article are to share experiences and provide a current multinational perspective on different approaches and strategies for implementing EBP and to highlight important considerations and implications for both research and practice. Six research studies from various settings in 3 countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators a multifaceted EBP training package journal clubs a multifaceted strategy comprising contextualized procedures, protocols, and standardized resources barrier identification, education, audit, feedback, and reminders and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures, and clinical guidelines. Key outcomes across the studies were improved attitudes and increased awareness, knowledge, skills, and confidence in EBP better access to clinical practice guidelines and other EBP resources identification of barriers that could be targeted in future implementation activities earlier referrals and use of recommended outcome measures. The article can serve as a template for other physical therapist researchers in designing implementation studies, as well as to inform policies and practice for health care managers and decision makers who are looking for ways to implement research findings in their organizations.
Publisher: SAGE Publications
Date: 03-11-2010
DOI: 10.1111/J.1747-4949.2010.00488.X
Abstract: Adherence to recommended clinical practices improves stroke outcomes. As a result, stroke clinicians are increasingly expected to evaluate the quality of the care they provide so that areas for improvement can be targeted. Finding the best method to evaluate the quality of dysphagia management can be challenging. To systematically review process indicators used to assess the quality of care provided to patients with dysphagia following acute stroke and examine the level of evidence underpinning these indicators. Databases were systematically searched to identify publications (January 2006–April 2009) that describe process indicators relating to the clinical management of acute stroke-related dysphagia. Relevant process indicators were extracted from the reviewed publications for detailed post hoc analysis including supporting evidence and alignment to the current Australian and English stroke guidelines. Title and abstract review found 150 potential studies. Full-text review resulted in 25 publications that met the study's inclusion criteria. Thirteen process indicators were identified in the literature that related to the initial assessment, clinical management, rehabilitation and discharge planning for patients with acute stroke-related dysphagia. These processes were supported by levels of evidence ranging from high ‘level 1’ (8%) down to ‘expert opinion’ evidence (46%). Two process indicators did not align to recommendations in the clinical guidelines. This systematic review underpins informed selection of process indicators for evaluating the quality of dysphagia management following stroke. The selection of quality indicators is complicated by equivocal supporting evidence however, indicators should reflect expected local practices, align with national stroke guidelines and be feasible for clinical auditing.
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BMJOPEN-2018-023525
Abstract: To examine the personal and social experiences of younger adults after stroke. Qualitative study design involving in-depth semi-structured interviews and rigorous qualitative descriptive analysis informed by social constructionism. Nineteen younger stroke survivors aged 18 to 55 years at the time of their first-ever stroke. Participants were recruited from urban and rural settings across Australia. Interviews took place in a clinic room of the Florey Institute of Neuroscience and Mental Health (Melbourne, Australia), over an online conference platform or by telephone. Four main themes emerged from the discourses: (1) psycho-emotional experiences after young stroke (2) losing pre-stroke life construct and relationships (3) recovering and adapting after young stroke and (4) invalidated by the old-age, physical concept of stroke. While these themes ran through the narratives of all participants, data analysis also drew out interesting variation between in idual experiences. For many younger adults, stroke is an unexpected and devastating life event that profoundly erts their biography and presents complex and continued challenges to fulfilling age-normative roles. While adaptation, resilience and post-traumatic growth are common, this study suggests that more bespoke support is needed for younger adults after stroke. Increasing public awareness of young stroke is also important, as is increased research attention to this problem.
Publisher: Informa UK Limited
Date: 23-08-2017
DOI: 10.1080/10749357.2017.1366010
Abstract: Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.APMR.2017.02.024
Abstract: To report and synthesize the experiences, needs, and preferences of carers of stroke survivors undergoing inpatient rehabilitation. MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science were searched to March 2016. Reference lists of relevant publications were searched. No language restrictions were applied. Eligible qualitative studies reported the experiences of carers of stroke survivors who underwent inpatient rehabilitation. The search yielded 3532 records 93 full-text publications were assessed for eligibility, and 34 documents (33 studies) were included. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research framework. Data on the characteristics of included studies were independently extracted by 2 authors. Differences in data extraction between authors were resolved through discussion or by a third author. All text in studies' results and discussion sections were extracted for analysis. Extracted texts were analyzed inductively using thematic synthesis. Seven analytical themes were developed that related to the carers' experiences, needs, and preferences: (1) overwhelmed with emotions (2) recognition as a stakeholder in recovery (3) desire to be heard and informed (4) persisting for action and outcomes (5) being legitimate clients (6) navigating an alien culture and environment and (7) managing the transition home. This systematic review provides new insights into the experiences, needs, and preferences of carers of stroke survivors undergoing inpatient rehabilitation. Carers experienced distress as they navigated a foreign culture and environment without adequate communication and processes in place for their inclusion. We recommend deliberate efforts to provide a more inclusive environment that better supports and prepares carers for their new role.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2016
Publisher: Oxford University Press (OUP)
Date: 16-05-2008
Publisher: Springer Science and Business Media LLC
Date: 06-07-2011
Publisher: Wiley
Date: 22-01-2017
Publisher: Wiley
Date: 19-03-2009
DOI: 10.1111/J.1365-2753.2008.01023.X
Abstract: Rationale, aim and objective The use of stroke clinical guidelines is widely encouraged yet variably operationalized. The factors which support, or hinder guideline compliance are poorly understood, and there is little research which pertains to the unique roles of Allied Health (AH) staff when operationalizing stroke clinical guidelines. This study identifies factors influencing AH staff compliance with guideline recommendations in an acute stoke unit. Method A retrospective audit was conducted of hospital records of stroke patients admitted to an Australian tertiary metropolitan hospital in 2005. The recorded clinical care provided by an AH team was audited against the 38 recommendations in the Australian acute stroke guidelines relevant to allied health. Results Compliance with guideline recommendations was variable, with better care compliance found for younger patients, patients admitted on weekdays, and patients with poorer functional ability on admission, longer lengths of stay and better functional improvements during admission. Compliance also reflected the congruence of guideline recommendations with 'usual practice'. Conclusions A number of factors influenced AH staff compliance with acute stroke guidelines. These findings are a platform upon which further implementation research can be launched for AH professionals.
Publisher: Oxford University Press (OUP)
Date: 11-08-2016
DOI: 10.2522/PTJ.20160141
Abstract: It is of critical importance that findings from the wealth of clinical physical therapist research are transferred into clinical practice without unnecessary delays. There is a lack of knowledge about strategies that can be used to effectively implement physical therapist research findings and evidence-based practice (EBP) into everyday clinical practice in different national settings and contexts. The purpose of this article is to contribute to knowledge about effective strategies for implementing EBP that have been studied in different national physical therapy settings. The specific aims of this article are to share experiences and provide a current multinational perspective on different approaches and strategies for implementing EBP and to highlight important considerations and implications for both research and practice. Six research studies from various settings in 3 countries are described and synthesized. Key characteristics of the studies and intervention components are tabulated and mapped to the Cochrane Effective Practice and Organisation of Care taxonomy. Commonalities and differences are presented. The implementation strategies described were: a theory-based guideline implementation tailored to identified barriers and facilitators a multifaceted EBP training package journal clubs a multifaceted strategy comprising contextualized procedures, protocols, and standardized resources barrier identification, education, audit, feedback, and reminders and contextualized guidelines. Commonalities were the use of a multifaceted approach, educational measures, and clinical guidelines. Key outcomes across the studies were improved attitudes and increased awareness, knowledge, skills, and confidence in EBP better access to clinical practice guidelines and other EBP resources identification of barriers that could be targeted in future implementation activities earlier referrals and use of recommended outcome measures. The article can serve as a template for other physical therapist researchers in designing implementation studies, as well as to inform policies and practice for health care managers and decision makers who are looking for ways to implement research findings in their organizations.
Publisher: Informa UK Limited
Date: 08-2018
DOI: 10.1080/09638288.2017.1354232
Abstract: Boredom may impede engagement in inpatient rehabilitation following an acquired brain injury. This review aimed to: (1) describe the experience and (2) quantify the incidence of boredom (3) identify measurement tools used to quantify boredom (4) summarize factors contributing to boredom, and (5) outline evidence-based interventions shown to reduce boredom during inpatient rehabilitation. Two researchers independently screened publications retrieved from electronic database searches. Publications presenting patient, carer or staff data relating to boredom in inpatients with acquired brain injuries were included. Two thousand four hundred and ninety-nine references were retrieved, 88 full texts were reviewed, with 24 studies included. The majority of studies reported qualitative data indicating boredom to be a common experience of patients with acquired brain injuries (n = 14 studies +1 review). The incidence of boredom post acquired brain injury is unknown. Personal and organizational factors and the physical environment may contribute to boredom (n = 11 studies +2 reviews). Qualitative work (n = 9 studies) indicates that use of the creative-arts or exposure to environmental enrichment may help alleviate boredom in patients with acquired brain injuries during inpatient rehabilitation. Further mixed-methods research is required to establish the incidence of and contributing factors to boredom in patients with acquired brain injuries undergoing rehabilitation. Understanding this will help inform future research aimed at improving patient engagement in inpatient rehabilitation. Implications for rehabilitation Boredom is commonly reported by hospitalised patients with ABI to negatively affect their rehabilitation yet the scope of the problem has not been measured. Boredom is a complex phenomenon, likely influenced by a number of personal and environmental factors that are not fully understood in this population. Through a better understanding of boredom, interventions may be developed to improve patient engagement in inpatient rehabilitation programs.
Publisher: SAGE Publications
Date: 15-07-2017
Abstract: To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke. Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework. Eight acute stroke units in two states of Australia. Health professionals working in acute stroke units. Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway. Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain ‘social and professional role’) beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation (‘belief about consequences’) the influence of the unit’s relationships with other groups including rehabilitation teams (‘social influences’ domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices (‘knowledge’ domain). This study has identified that health professionals’ perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.
Publisher: Wiley
Date: 2015
DOI: 10.1002/14651858
Publisher: Informa UK Limited
Date: 03-02-2022
DOI: 10.1080/09638288.2021.2019840
Abstract: This study aimed to investigate rehabilitation staff perceptions of factors influencing stroke survivor activity outside of dedicated therapy time for the purpose of supporting successful translation of activity promoting interventions in a rehabilitation unit. Purposive s ling of multi-disciplinary teams from four rehabilitation units was performed, and semi-structured interviews were conducted by telephone, digitally audio-recorded and then transcribed verbatim. A stepped iterative process of thematic analysis was employed until data saturation was reached. All but one of the 22 participants were female, the majority were either physiotherapists or occupational therapists, with a median of 4 years (interquartile range, 2-10) working at their respective rehabilitation units. Analysis of the data revealed three themes: (i) stroke survivor characteristics influence their activity outside therapy, (ii) the rehabilitation environment influences physical, cognitive, and social activity, and (iii) institutional priorities, staff culture, and attitude can be barriers to activity. Rehabilitation units were perceived to be unstimulating, and visitors considered enablers of activity when resources were perceived to be scarce. Our results suggest careful consideration of the involvement of visitors, an in idual's needs and preferences, and the institution's priorities and staff attitude may result in greater stroke survivor activity during rehabilitation.Implications for rehabilitationStaff should consider stroke survivor impairments and a rehabilitation unit's institutional priorities and staff attitudes when aiming to enhance stroke survivor engagement in activity.The physical and social environment of a rehabilitation unit can be optimised by rehabilitation staff to promote activity.Utilisation of visitors of stroke survivors on a rehabilitation unit may be one way to enhance engagement in activity.Discussion within the rehabilitation team concerning "ownership" of the role of supporting stroke survivor activity outside of structured therapy time may support better engagement in same.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2016
Location: Australia
No related grants have been discovered for Julie Luker.