Evaluation Of Exercise Rehabilitation For Survivors Of Intensive Care
Funder
National Health and Medical Research Council
Funding Amount
$359,282.00
Summary
Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical fun ....Intensive care medicine has improved survival in critically ill patients. However, international literature reports poor quality of life and physical outcomes in ICU survivors compared to people of the same age. In addition, patients who require a prolonged ICU stay consume a large amount of resources. This project is testing whether an early ICU physiotherapist-directed exercise rehabilitation program continuing until after hospital discharge will improve patient's quality of life, physical function and decrease the use of health resources compared with patients' receiving standard care. Patients in the rehabilitation group will take part in a physiotherapy exercise rehabilitation program including returning to out patient classes after discharge. The physiotherapist will treat patients daily during hospital stay then twice weekly for 8 weeks after discharge. All patients will complete 2 quality of life questionnaires and physical function will be assessed using a new test developed for the acute ICU stay the 6 minute walk test, which measures how far patients can walk quickly in 6 minutes. The timed up and go test will also be used and it measures how quickly patients can get up from a chair and walk. An activity monitor, worn on the wrist, for some of the time after discharge will measure how much exercise and moving about patients are doing at home. Measurements will performed by a physiotherapist, blinded to the group to which patients were randomly allocated, on admission to the ICU (quality of life only by proxy), on discharge from the ICU, discharge from hospital and at 3, 6, 12 months after discharge. Economic evaluation will be performed to examine overall use of resources using information from the questionnaires.Read moreRead less
My primary research interest is in the effectiveness of physiotherapy interventions. A second research interest is in the mechanical and architectural properties of human muscles and tendons.
Can unloading footwear improve clinical care of people with knee osteoarthritis? Osteoarthritis is a public health problem imposing major economic and personal burden. It is the fourth highest cause of morbidity in Australia and national health expenditure in 2007 was $2.03 billion. Footwear can reduce knee load which is linked to disease pathogenesis. Specially-designed unloading shoes will be evaluated in a clinical trial and biomechanical studies to determine their efficacy at reducing sympto ....Can unloading footwear improve clinical care of people with knee osteoarthritis? Osteoarthritis is a public health problem imposing major economic and personal burden. It is the fourth highest cause of morbidity in Australia and national health expenditure in 2007 was $2.03 billion. Footwear can reduce knee load which is linked to disease pathogenesis. Specially-designed unloading shoes will be evaluated in a clinical trial and biomechanical studies to determine their efficacy at reducing symptoms, mechanical mechanism of pain relief, patient sub-groups that best respond to treatment and whether combined treatment with medial arch supports changes knee biomechanics. Outcomes will impact clinical practice and relieve suffering of people with knee osteoarthritis. Findings will also guide future shoe developments for arthritis. Read moreRead less
The Efficacy Of Manipulation For Recent Onset Neck Pain
Funder
National Health and Medical Research Council
Funding Amount
$393,974.00
Summary
Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence ....Neck pain is extremely common, with a point prevalence of 46% in the general community. Neck pain can cause significant disability, and is the second most common injury causing people to take time off work. Neck pain and its associated disability clearly poses a substantial social and economic burden. Neck manipulation (high velocity thrust of the joints, often associated with a click) is widely used by physiotherapists for the management of recent onset neck pain, but there is no clear evidence for its efficacy. In addition, the use of manipulation is associated with serious, although rare, adverse events such as stroke or even death. The risk-benefit analysis, therefore, does not clearly favour manipulation because efficacy has not been established, while the risks are serious, but infrequent. The findings of the proposed study will clearly and precisely determine the efficacy of manipulation compared with the safer treatment technique of mobilisation (gentle oscillatory pressure applied to the joints), information that is currently unavailable. This information is of vital importance to many different disciplines, including health professionals, insurance companies, and to administrators for development of health policy. Our findings will thus provide evidence-based guidelines for the use of manipulation, and will ultimately lead to safer practice of physiotherapy for neck pain.Read moreRead less
Reducing Knee Load And Slowing Disease Progression With Conservative Interventions In Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$271,503.00
Summary
Knee arthritis is a painful, disabling, costly condition particularly affecting the elderly. As there is presently no cure for arthritis, interventions that slow progression of the disease will reduce the personal and societal burden of arthritis. Recently it has been postulated that specific exercise that targets how the muscles are controlled by the nervous system may have greater disease-modifying effects than exercise aimed at strengthening the muscles. Data are beginning to highlight the co ....Knee arthritis is a painful, disabling, costly condition particularly affecting the elderly. As there is presently no cure for arthritis, interventions that slow progression of the disease will reduce the personal and societal burden of arthritis. Recently it has been postulated that specific exercise that targets how the muscles are controlled by the nervous system may have greater disease-modifying effects than exercise aimed at strengthening the muscles. Data are beginning to highlight the complexity of muscle strategies adopted by the nervous system to compensate for joint derangement in knee arthritis. It is our contention that there may be specific strategies that provide more optimal knee joint loading in relation to slowing disease progression. The first part of this project is to investigate knee control in people with knee arthritis and to evaluate whether this influences disease progression. This will provide the basis for refinement and optimisation of rehabilitation interventions for this patient group. The second part of this project will investigate whether strengthening the hip muscles in patients with knee arthritis influences knee load and hence disease progression. Hip muscle strengthening is currently not routinely included as part of the management of knee arthritis. If the results of this project find it to be effective, then hip muscle strengthening can be recommended for treating knee arthritis.Read moreRead less
The Contribution Of Dopamine To Regulation Of Orofacial, Limb And Trunk Control: System Or Function Specific Effects?
Funder
National Health and Medical Research Council
Funding Amount
$493,124.00
Summary
Treatment for Parkinson's disease, including dopamine replacement therapy and deep brain stimulation, fail to produce the same beneficial effects on all movement systems. Whereas limb function is the primary beneficiary of these treatments, other functions such as speech and postural control are less responsive. Critical to the research is the postulate that such differences may have arisen due to the fact that previous studies of dopamine and movement control have investigated distinct motor sy ....Treatment for Parkinson's disease, including dopamine replacement therapy and deep brain stimulation, fail to produce the same beneficial effects on all movement systems. Whereas limb function is the primary beneficiary of these treatments, other functions such as speech and postural control are less responsive. Critical to the research is the postulate that such differences may have arisen due to the fact that previous studies of dopamine and movement control have investigated distinct motor systems via the assessment of distinct movement constructs, making cross system comparisons an impossible task. The proposed research will assess the effect of Parkinson's disease, deep brain stimulation and dopamine on identical muscle functions within the orofacial, trunk and limb muscle systems. To this end, the results generated from this resarch have the potential to reconceptualise working models of brain-muscle relationships. Further the research will provide guidance for future studies that aim to eradicate trade-off effects (e.g. limb function improved but not speech) relating to symptom relief for people with Parkinson's disease.Read moreRead less
Effects Of Laterally Wedged Insoles On Symptoms And Disease Progression In Knee Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$480,850.00
Summary
Knee arthritis is a painful, disabling, costly condition particularly affecting the elderly. As there is presently no cure for knee arthritis, strategies that slow progression of the disease will reduce the personal and societal burden of arthritis. Most research has focussed on drug therapies, which are effective in reducing pain and disability but have side effects and are expensive. Insoles worn inside the shoes are a simple, cheap, self-administered intervention with the potential to slow di ....Knee arthritis is a painful, disabling, costly condition particularly affecting the elderly. As there is presently no cure for knee arthritis, strategies that slow progression of the disease will reduce the personal and societal burden of arthritis. Most research has focussed on drug therapies, which are effective in reducing pain and disability but have side effects and are expensive. Insoles worn inside the shoes are a simple, cheap, self-administered intervention with the potential to slow disease progression in certain patients, in addition to managing symptoms. However, to date there has been little quality research investigating the effectiveness of insoles in knee arthritis. This study aims to see whether 12 months of wearing insoles can lead to improvements in knee pain and function and slow disease progression in 200 people with knee arthritis. It will use state-of-the-art technology, magnetic resonance imaging, to measure changes in the amount of knee cartilage. This research is timely and the findings will be of major significance as there is increasing world-wide attention on slowing progression of knee arthritis. Insoles are one of the few non-drug therapies with the potential to influence both symptoms and disease progression. If the results show that insoles are beneficial, then this research will: 1. Better inform clinical guidelines to firmly recommend insoles to manage knee arthritis 2. Provide the basis for developing education strategies for health care practitioners and patients about the benefits of insoles 3. Provide the impetus to make insoles more readily available directly to patients 4. Ultimately lead to better patient outcomesRead moreRead less