ORCID Profile
0000-0003-4366-124X
Current Organisations
The University of Newcastle
,
Hunter New England Local Health District
,
Honeysuckle Health
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Publisher: Research Square Platform LLC
Date: 05-07-2022
DOI: 10.21203/RS.3.RS-1744701/V1
Abstract: Background: The disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at co-producing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe i) clinician’s motivations behind, and enablers to, participating in a network ii) the process of network establishment and iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research co-production. Methods We describe the methods and outcomes of three steps we used to establish the network. Step one involved consultation with local opinion leaders and a formative evaluation to understand clinician’s motivations behind, and enablers to, participating in a network. Step two involved establishment activities to generate a founding membership group and co-design a governance model. Step three involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritising research areas. Results Through formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group (n=29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 (70%) are private practice clinicians). Our problem mapping and prioritisation process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes. Conclusions Clinicians are motivated to collaborate with researchers to not only improve research relevance, but to solve a wide array of issues with the delivery of care. Research that follows from this collaboration should, therefore, be maximally useful to clinical practice by addressing issues that may not be possible to address when working in silos. More work is needed to explore the proposed benefits of practice-based research networks.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.APMR.2018.03.018
Abstract: To identify in patients with idiopathic normal pressure hydrocephalus (iNPH) undergoing a cerebrospinal fluid (CSF) tap test (TT) for consideration of a ventricular peritoneal (VP) shunt: (1) gait and balance measures, which identify symptom change (2) differences present between pre- and post-CSF TT scores between patients classified as responders and nonresponder (3) ability of patients with iNPH to accurately quantify change in their gait and balance symptoms from a CSF TT. Prospective observational study. Post-CSF TT assessment was completed 2-4 hours post. Tertiary referral neurological and neurosurgical hospital. Patients (N=74) with iNPH receiving a 30 mL CSF TT for consideration of a VP shunt. Patients underwent a battery of gait and balance measures pre- and post-CSF TT and indicated their perceived change on a global rating of change (GRC). Patients deemed to improve and offered VP shunt insertion by a neurologist or neurosurgeon were labeled responders. Performance oriented mobility assessment (Tinetti), Berg Balance Scale (BBS), timed Up and Go (TUG), 10-meter walk test (10MWT), GRC. Forty patients were classified responders, 34 nonresponders. Significant differences were identified for responders: Tinetti (3.88 points), TUG (3.98 seconds), 10MWT (0.08 m/sec), and BBS (5.29 points). Significant differences were found for nonresponders for the Tinetti (0.91 points) and BBS (2.06 points). Change scores for responders and nonresponders were significantly different for all tests between responders and nonresponders. GRC scores for gait (+2 for responders, 0 for nonresponders) and balance (+2.5 for responders, 0 for nonresponders) were both significantly different. The Tinetti, BBS, and TUG can identify change in patients undergoing a CSF TT for iNPH. Patients appear to be able to accurately identify if change has occurred.
Publisher: Wiley
Date: 23-03-2018
DOI: 10.1111/AJR.12407
Abstract: To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital length of stay and related cost efficiencies clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.CLINEURO.2018.09.015
Abstract: To determine which cognitive and upper limb assessments can identify change in patients undergoing a Cerebrospinal fluid (CSF) tap test (TT) diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH). Prospective observational study of 74 iNPH patients undergoing a CSF TT for consideration of a ventricular peritoneal shunt. Patients who were offered surgical intervention were classified as responders. Patients were assessed with a battery of cognitive and upper limb assessments prior to and following a CSF TT. The Timed up and go cognition (TUG-C), Montreal Cognitive assessment (MoCA) and 9-hole peg test were utilised. 40 patients were classified responders. Significant differences were identified for responders for the MoCA (0.62 points) and TUG-C (-6.02 s). Only the executive function and orientation sub scores of the MoCA showed significant changes for responders. The 9 hole peg test mean change of 4.33 s for responders was not significant. Non-responder change scores for the MoCA (0.22 points), TUG-C (0.3 s) and 9 hole peg test (2.58 s) were not significant. The TUG-C has the potential to identify change in patients resulting from a CSF TT. While statistically significant change was found for the MoCA, a mean change of less than 1 point on this scale is unlikely to be clinically relevant. Similarly, the 9 hole peg test cannot be endorsed as an assessment tool for identifying changed performance in iNPH.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18259
Abstract: ObjectiveThe aims of this study were to identify: (1) whether an after-hours emergency department (ED) collaborative care service using primary contact physiotherapists (PCPs) improves treatment times for musculoskeletal and simple orthopaedic presentations and (2) differences in orthopaedic referral rates and analgesia prescription for patients managed by PCPs compared with secondary contact physiotherapists. MethodsA prospective observational study was conducted of diagnosed, matched patients seen in a 4-day week after-hours ED primary contact physiotherapy service in a tertiary referral ED. Patients presenting with a musculoskeletal or simple orthopaedic diagnosis reviewed by a physiotherapist as either the primary or secondary physiotherapy contact between 1630 and 2030 hours from Saturday to Tuesday were included in the analysis. Outcome measures collected included ED length of stay, orthopaedic referrals in the ED, follow-up plan on discharge from the ED and analgesia prescriptions. ResultsThere were no adverse events, missed diagnoses or re-presentations for any patients managed by an ED PCP. Mean (±s.d.) treatment time for patients seen by an ED PCP was 130±76min, compared with 240±115min for those seen by a secondary contact physiotherapist (P& .001). There were significant differences between patients managed by PCP versus secondary contact physiotherapists, with decreases of 20.4% for referrals to orthopaedics in the ED, 21.2% for orthopaedic clinic referrals on discharge and 8.5% in analgesia prescriptions for patients managed by an ED PCP (P& .001). In addition to these reductions, there was a 17.5% increase in general practitioner referrals on discharge for patients managed by an ED PCP (P& .001). ConclusionAn after-hours ED physiotherapy service is a safe service that reduces ED treatment times, as well as analgesia prescriptions and orthopaedic referrals for patients managed by a PCP. What is known about the topic?PCPs are capable of providing safe and effective care to patients in the ED who present with musculoskeletal complaints. Patients managed by physiotherapists as the primary contact require fewer X-rays and have reduced treatment times. What does this paper add?Compared with previously published articles, this study demonstrates similar reductions in ED treatment times in an after-hours setting for patients managed by an ED PCP. However, this was achieved by physiotherapists who have less reported experience. Furthermore, this study found that management of patients by PCPs resulted in a reduction in the amount of analgesia prescribed and orthopaedic input required for these patients. What are the implications for practitioners?PCPs can be trained to operate in the ED with minor or no prior ED experience while facilitating reductions in the amount of analgesia prescribed, orthopaedic referrals required (in ED and on discharge) and reducing treatment times for patients.
Publisher: Informa UK Limited
Date: 19-12-2014
Publisher: Health Education and Training Institute - HETI
Date: 12-09-2022
Abstract: AbstractPurposeRural workforce shortages are a national issue. One strategy is the use of secondments from larger healthcare sites to staff rural sites on a rotational basis. The purpose of this evaluation is to explore the impact of the development, implementation of an educational, training and supervision package for junior Physiotherapists undertaking rural secondments in Northern NSW.Design/methodology/approachPre post evaluation of a training, education and supervision package to support junior Physiotherapists undertaking rural secondments across Northern NSW. A baseline survey of Physiotherapists who had undertaken a secondment in the previous 12 months defined current practice and limitations. From this a targeted education, training and supervision package was developed. Post implementation surveying for a period of 12 months was undertaken to evaluate the packages implementation.FindingsStatistically significant improvements in staff reporting they felt supported and were aware of escalation processes for patients under their care were reported. Additionally improvements were seen in staff reported access to and completing competencies relevant to their secondment.Research implicationsThese findings provide guidance in regards to junior Physiotherapists working on rural secondments and the importance of structured education, training and support mechanisms.Practical implicationsThe findings from this work support the development and implementation of structured education, training and supervision plans prior to undertaking rural secondments.Originality/valueThese findings provide evidence and support the need for structured and target training, education and supervision for staff undertaking rural secondments to ensure staff are confident to work in a rural setting.LimitationsLarger response rates for post implementation survey results may result in different outcomes being reported in comparison to pre implementation results.
Publisher: Springer Science and Business Media LLC
Date: 26-03-2019
DOI: 10.1007/S00234-019-02192-2
Abstract: To identify if specific findings on magnetic resonance imaging (MRI) cerebrospinal fluid (CSF) flow studies can be utilised to identify which patients with idiopathic normal pressure hydrocephalus (iNPH) will have improved gait following a CSF tap test (TT). Prospective study of patients undergoing a CSF TT for iNPH. Functional gait was assessed using the timed up and go (TUG) test before and after the CSF TT. MRI CSF flow studies accompanied the CSF TT. The minimum clinically important difference for the TUG (3.63 s) was used as a cutoff value to categorise patients as responders to the CSF TT. Fifty-three patients underwent CSF TT and MRI CSF flow studies. Significant differences were identified between groups for (non-responder vs responder) superior sagittal sinus flow (47.10% vs 40.41%), sagittal sinus stroke volume (274 vs 176.5 μl), sagittal sinus to arterial stroke volume ratio (0.203 vs 0.164), sagittal sinus area (42.2 mm A link between gait improvement resulting from CSF drainage and sagittal sinus measurements indicates that the sagittal sinus may play a role in the manifestation of symptoms in iNPH. This may have implications for the diagnosis of iNPH and potentially inform clinical decision making regarding surgical intervention.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-07-2018
Abstract: Idiopathic normal pressure hydrocephalus (iNPH) is treated by insertion of a ventricular peritoneal (VP) shunt. To help identify who would benefit from a VP shunt, patients undergo a tap test (TT). Several measures can identify change from a TT, but the magnitude of change and the combination of measures that indicate the improvement from a TT is unclear. To develop minimal clinically important differences (MCIDs) for a battery of gait, balance, and cognitive measures in relation to improvement from the TT, and to identify which combination of measures best identifies when improvement has occurred. Observational study of iNPH patients undergoing a TT for consideration of a VP shunt. Patients completed the: The Timed Up and Go (TUG), Timed Up and Go cognition (TUG-C), Performance Oriented Mobility Assessment (Tinetti), and Berg Balance Scale (BBS) pre- and post-TT. A Global Rating of Change scale assessed patients' perceived improvements in gait and balance post-TT. MCIDs for the TT were (calculated as percentage changes): TUG: 13%, TUG-C: 11% Tinetti: 36%, and BBS: 20%. A combination of the TUG-C and Tinetti resulted in sensitivity of 90.28% to identify improvement, while the Tinetti and BBS resulted in specificity of 98.58% to exclude improvement from a TT. These MCIDs provide the first evidence to quantify the significance of post-TT symptom changes and provides objective data to guide recommendations for clinical management. Utilizing a combination of measures, and these MCIDs as cut off values, results in high sensitivity and specificity for identifying improvement from a TT.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2023
DOI: 10.1186/S12961-023-00983-X
Abstract: The disconnect between research and clinical practice leads to research evidence that is often not useful for clinical practice. Practice-based research networks are collaborations between researchers and clinicians aimed at coproducing more useful research. Such networks are rare in the physiotherapy field. We aimed to describe (i) clinicians’ motivations behind, and enablers to, participating in a network, (ii) the process of network establishment and (iii) research priorities for a practice-based network of physiotherapists in the Hunter Region of New South Wales (NSW), Australia that supports research coproduction. We describe the methods and outcomes of the three steps we used to establish the network. Step 1 involved consultation with local opinion leaders and a formative evaluation to understand clinicians’ motivations behind, and enablers to, participating in a network. Step 2 involved establishment activities to generate a founding membership group and codesign a governance model. Step 3 involved mapping clinical problems through a workshop guided by systems thinking theory with local stakeholders and prioritizing research areas. Through formative evaluation focus groups, we generated five key motivating themes and three key enablers for physiotherapists’ involvement in the network. Establishment activities led to a founding membership group ( n = 29, 67% from private practice clinics), a network vision and mission statement, and a joint governance group (9/13 [70%] are private practice clinicians). Our problem-mapping and prioritization process led to three clinically relevant priority research areas with the potential for significant change in practice and patient outcomes. Clinicians are motivated to break down traditional siloed research generation and collaborate with researchers to solve a wide array of issues with the delivery of care. Practice-based research networks have promise for both researchers and clinicians in the common goal of improving patient outcomes.
No related grants have been discovered for Ryan Gallagher.