ORCID Profile
0000-0002-4149-6669
Current Organisations
Lincoln Institute of Health Science
,
Curtin University
,
Swinburne University of Technology
,
Monash University
,
La Trobe University
,
Monash University - Peninsula Campus
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Publisher: Wiley
Date: 26-04-2016
Publisher: Springer Science and Business Media LLC
Date: 02-04-2015
Publisher: SAGE Publications
Date: 24-07-2016
Abstract: Lateral elbow tendinosis is a condition that is well known to cause difficult challenges for hand therapists due to its long-term recovery and morbidity. Elastic therapeutic tape is commonly used as a treatment modality, despite limited evidence. A randomized controlled trial was conducted to evaluate the effectiveness of elastic therapeutic tape, in conjunction with eccentric exercises, in the treatment of lateral elbow tendinosis. Forty participants with this condition (12 men, 28 women) were randomly allocated to three groups: (i) elastic therapeutic tape and eccentric exercises, (ii) sham tape and eccentric exercises, and (iii) eccentric exercises alone. All groups received education on activity modification techniques. Interventions were undertaken over a 12-week period (four weekly sessions and four fortnightly sessions) and outcome measures were recorded at baseline, three months and six months post randomisation. At three and six months, improvements were made in all three groups as assessed with the Patient-Rated Tennis Elbow Evaluation, the Short Form 36, pain-free grip strength, and the Occupational Self Assessment. However, there were no statistically significant differences between groups in any of these measures. There were no significant side effects or symptom exacerbation with using the elastic therapeutic tape. Whilst all groups improved on key outcomes, it is possible that exercise alone and/or natural recovery were responsible for improvements. It is positive to note that the use of elastic therapeutic tape was well tolerated by participants and not associated with any significant side effects or symptom exacerbation.
Publisher: Public Library of Science (PLoS)
Date: 31-10-2017
Publisher: Wiley
Date: 09-2013
Abstract: Multidisciplinary pre-admission patient education is commonly recommended for elective surgery patients, and may involve the provision of written information and presentations from the health team. However, the occupational therapy role with elective sternotomy patients in our setting is confined to the post-operative period. We aimed to evaluate cardiac surgery patients' perception of the effectiveness and timing of pre-admission multidisciplinary written information and post-operative verbal education provided by occupational therapy. This cross-sectional study involved a written survey, which was posted to 375 people who had undergone cardiac surgery in 2009-2010. Questions were designed to elicit patient perceptions of both pre-operative written information and post-operative education relating to post-operative precautions and return to activity received from occupational therapy. There were 118 surveys returned equalling a 31.4% response rate. Eighty-nine per cent of respondents recalled receiving and reading the pre-surgery information booklet, and this was significantly correlated with feeling prepared for the post-operative experience and adherence with precautions (P < 0.0001). Exactly 30.4% of respondents stated that they experienced stress and anxiety in relation to post-operative expectations, and 47.3% felt the information provided in the occupational therapy education sessions would have been more beneficial for their understanding and coping if provided prior to surgery. Multidisciplinary written pre-surgery education appears to be providing patients with a good understanding of what to expect following surgery. The results suggest that pre-operative verbal education from occupational therapy would assist in reducing anxiety in a subgroup of patients.
Publisher: SAGE Publications
Date: 02-09-2020
Abstract: Given the high incidence of hand and wrist injuries, they are exceptionally costly to the economy. This prospective, longitudinal study aimed to establish methods for capturing the burden of acute hand and wrist injury from an in idual and societal perspective. A prospective longitudinal design with baseline measures of injury type and severity, and repeated measures of disability, cost, and activity limitations and participation restrictions at six weeks, three months, and six months was selected. Participants were recruited from two large urban Australian public health care services. We sought to establish methods for capturing the burden of acute hand and wrist injury from an in idual and societal perspective and compare survey completion by the method of administration. A total of 206 patients consented to participate in this study, representing 54% of those invited to participate. The survey completion rates were 18% at six weeks, 2.4% at twelve weeks, and 0.004% at six months following injury. From the limited data collected at six weeks, it was noted that nearly half of the patients reported a decrease in usual financial income, 14% reported absenteeism, and 62% reported presenteeism. Participants who elected to have data collected via phone call had the highest survey completion rate ( n = 6/10 30%) at six-week’s follow-up. The study findings highlight the difficulties of completing longitudinal survey research investigating in idual and societal burden with this population. Future research should be carefully designed to encourage participation and retention by considering patient and public involvement in study design, the time burden placed on the participants within and across selected survey time points, providing participants with incentives to participate, and highlighting the relevance and real-world applications of the findings.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.JHT.2022.03.006
Abstract: Electronic Web-based survey INTRODUCTION: Evidence supports the use of health-focused interventions combined with service coordination and work modification components to reduce the in idual, community, and societal burden associated with acute and chronic musculoskeletal conditions. The levels of engagement, skill, and confidence of Australian hand therapists in assisting their patients to return to work (RTW) are currently unknown. To identify current practices, skill, and the need for additional training in management of the RTW process from a s le of Australian hand therapists. An electronic survey was sent to current members of the Australian Hand Therapy Association. Data collected included training and/or professional experience, caseload and/or workplace, scope of and barriers to vocational practice, and satisfaction with own contribution to the RTW process for patients. A total of 99 in idual responses (12.4% of total membership) were included, with most indicating a limited role in the RTW process. Only 52.7% said they regularly monitored and adjusted their patients' RTW program. Most plans were informed by formal tests of underlying body structure and function components rather than the patient's ability to perform of a specific work role or task. Median satisfaction with the quality of RTW service they provided was 6 of 10, with 42% scoring ≤ 5 of 10, indicating considerable scope for improvement. Practice patterns are described for planning and monitoring RTW, and these did not always align with the evidence-base. Further exploration of clinician barriers to implementing RTW interventions is warranted, as is upskilling for those indicating a lack of confidence in this field.
Publisher: Frontiers Media SA
Date: 19-08-2022
DOI: 10.3389/FRESC.2022.935473
Abstract: This umbrella systematic review examined the effectiveness, facilitators, and barriers of interventions for social, community and civic participation for adults on the autism spectrum, or with intellectual or psychosocial disability. Eight databases were searched to identify eligible reviews defined by the: S le (≥50% adults on the autism spectrum or with intellectual or psychosocial disability), Phenomena of Interest (interventions in community settings that aimed to improve social, community or civic participation, or capacity to participate), Design (any), Evaluation (any method that evaluated impacts on participation or capacity to participate), and Research type (reviews as journal articles, dissertations or in grey literature, in English, published 2010-2020). Rapid review methods were used. One researcher screened 27,890 records and 788 potentially eligible full texts. A second reviewer independently screened 20% of records, and ambiguous full text publications. Study quality was extracted, and review quality was assessed with the Assessing Methodological Quality of Systematic Reviews (AMSTAR) checklist. Data from 522 studies in 57 eligible systematic reviews were extracted for narrative synthesis. The Corrected Covered Area (CCA) was calculated to indicate overlap between reviews. There was a pooled s le of 28,154 study participants, predominantly from studies in North America, the UK and Europe. There was very low overlap between reviews (CCA = 0.3%). Reviews were predominantly low quality: 77.2% of reviews met & % of AMSTAR criteria. Most studies were low (45.4%) or moderate (38.3%) quality. Three broad intervention categories improved participation, inclusion and belonging outcomes: (1) interventions to help people identify and connect with participation opportunities (e.g., person centred planning) (2) participation opportunities or activities (e.g., joining a community group, sports or outdoor activities, or arts-based activities) and (3) supports to build skills and capacity to participate socially and in the community. The evidence highlighted that improved social and community participation requires purposeful strategies that identify meaningful participation preferences (e.g., where, when, how, and with whom) and provide support to build capacity or enable ongoing participation. Community capacity building, peer support and advocacy may also be needed to make the community more accessible, and to enable people to exercise genuine choice.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.JHT.2017.08.006
Abstract: Descriptive Epidemiological Study. Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson's) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. II.
Publisher: AOTA Press
Date: 07-2012
Abstract: OBJECTIVE. Hospitalized older people are at risk of functional decline, and risk increases with length of stay (LOS). We measured the impact on LOS and discharge destination of targeted occupational therapy and a functional conditioning program (FCP) for older adults admitted to a metropolitan trauma unit. METHOD. The intervention group consisted of 50 participants & yr old living independently in the community before admission. Outcomes were compared with historical control group data (N = 105). RESULTS. The intervention group’s mean LOS was 2 days less than that of the control group (p = .04). A higher proportion in the intervention group was also discharged to home, but the difference was not statistically significant. Referrals to occupational therapy increased significantly (p = .05), and participants were seen 1.5 days sooner (p = .003) than the control group. Referral to FCP was 7 times higher in the intervention group (p = .001). CONCLUSION. Targeted occupational therapy and FCP can improve LOS in older trauma patients.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.INJURY.2016.09.041
Abstract: Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity. This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature. A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries. Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the in idual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden.
Publisher: Springer Science and Business Media LLC
Date: 07-2014
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.JHT.2013.09.006
Abstract: Bangladesh is a developing country whose health system is highly dependent on project funding from foreign countries. Interplast Australia & New Zealand have supported volunteer hand therapists to provide training to local staff in the management of hand injuries and burns since 2006. We aimed to explore and describe the volunteers' own experience and provide recommendations for future therapy capacity building projects in developing countries. This qualitative study involved nine volunteer therapists, who attended a focus group to discuss their experiences, including the key milestones, challenges, and progress achieved. The two authors analyzed transcripts independently and emergent themes were discussed and identified by consensus. Overall the experience was extremely positive and rewarding for volunteers. Key learnings and challenges encountered in this project were cultural differences in learning styles, the need to adapt our approach to 2 facilitate sustainable local solutions, attrition of skilled local staff, and concerns regarding volunteer health and safety. Recommendations for similar projects include allowing adequate time for in-country scoping and planning, coordination and pooling of resources, and the use of strategies that encourage the shift to confident local ownership of ongoing learning and skill development. Volunteering in a health capacity building program in developing countries can be a challenging but immensely rewarding experience. Programs designed to meet the health demands in developing countries should emphasize adequate training of professionals in the use of transferable, sustainable and cost effective techniques. Time spent in the scoping and planning phase is crucial, as is coordination of efforts and pooling of resources. 2C.
Publisher: SAGE Publications
Date: 08-04-2015
Abstract: ‘Lateral elbow tendinosis’ or ‘lateral elbow tendinopathy’ have been suggested to be more appropriate diagnostic terms instead of ‘lateral epicondylitis’ as the condition is degenerative rather than inflammatory. For this reason, it is important that interventions target this degeneration at the common extensor tendon. A descriptive, retrospective review of a series of four patients with lateral elbow tendinosis was conducted to examine functional outcomes with the use of elastic therapeutic tape, eccentric exercises and activity modification techniques. All patients recorded improved changes in pain and grip strength within three months of treatment using elastic therapeutic tape, eccentric exercises and activity modification techniques. There may be clinical benefit in the use of elastic therapeutic tape, in conjunction with eccentric exercises and activity modification techniques, for the treatment of lateral elbow tendinosis. More rigorous and comprehensive studies are recommended to further investigate this intervention.
Publisher: SAGE Publications
Date: 09-2016
DOI: 10.1177/1558944716660555JC
Abstract: Objective/Hypothesis: We aimed to determine whether an 8-week online training program for developing skills in short course development and delivery was effective in establishing locally driven, sustainable, evidence-based training for Bangladeshi hand therapists. Materials and Methods: Five Bangladeshi therapists from a rehabilitation center participated in the course, which was facilitated online by an Australian university. They completed 8 prerecorded modules over a 3-month period and were assessed in situ on their ability to deliver a hand therapy tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from precourse, postcourse, and 1-year follow-up surveys, observations (including interactions during the course and final participant presentations), and a postcourse focus group. Results: The course achieved 6 of its 9 objectives, with all participants satisfactorily planning and delivering an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence, and developing and executing a teaching plan. This was sustained at 1-year review. The key theme was a shift in participants’ concept of learning from being an expert-driven to a self-driven exercise. Enablers were multimodal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable Internet services, and late delivery of course materials. Conclusions: Online distance education can be effective in producing sustainable change in practitioner skills in developing countries. Future programs would benefit from a blended learning approach incorporating “face-to-face” instructor contact.
Publisher: Georg Thieme Verlag KG
Date: 2015
DOI: 10.4338/ACI-2014-10-RA-0097
Abstract: Background: Hospital length of stay and discharge destination are important outcome measures in evaluating effectiveness and efficiency of health services. Although hospital administrative data are readily used as a data collection source in health services research, no research has assessed this data collection method against other commonly used methods. Objective: Determine if administrative data from electronic patient management programs are an effective data collection method for key hospital outcome measures when compared with alternative hospital data collection methods. Method: Prospective observational study comparing the completeness of data capture and level of agreement between three data collection methods manual data collection from ward-based sources, administrative data from an electronic patient management program (i.PM), and inpatient medical record review (gold standard) for hospital length of stay and discharge destination. Results: Manual data collection from ward-based sources captured only 376 (69%) of the 542 in-patient episodes captured from the hospital administrative electronic patient management program. Administrative data from the electronic patient management program had the highest levels of agreement with inpatient medical record review for both length of stay (93.4%) and discharge destination (91%) data. Conclusion: This is the first paper to demonstrate differences between data collection methods for hospital length of stay and discharge destination. Administrative data from an electronic patient management program showed the highest level of completeness of capture and level of agreement with the gold standard of inpatient medical record review for both length of stay and discharge destination, and therefore may be an acceptable data collection method for these measures. Citation: Sarkies MN, Bowles K-A, Skinner EH, Mitchell D, Haas R, Ho M, Salter K, May K, Markham D, O’Brien L, Plumb S, Haines T.P. Data collection methods in health services research – hospital length of stay and discharge destination. Appl Clin Inf 2015 6: 96–109 0.4338/ACI-2014-10-RA-0097
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.JCLINEPI.2013.08.014
Abstract: Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.APMR.2016.07.008
Abstract: To determine the level of agreement between patient self-report and therapist-assessed performance of mobility using the de Morton Mobility Index (DEMMI). Interrater agreement study. Outpatient hospital clinic. Consecutive s le of patients (N=128) undergoing preoperative assessment for elective lower limb (LL) arthroplasty. Participants completed a therapist-directed assessment of the DEMMI followed by self-report of performance. A random subs le (n=62, 48%) also completed a self-report of anticipated performance before the therapist-directed assessment. Both raters (participant and therapist) were blinded to the scores obtained from the other rater. Interrater agreement between patient self-report and therapist-directed assessment of the total DEMMI scores was assessed using the intraclass correlation coefficient model 2,1 (ICC The intraclass correlation coefficient (ICC) between patient self-report after performance and therapist-directed assessment of the total DEMMI score was .967 (95% confidence interval, .952-.977). The ICC between patient self-report of anticipated performance and therapist-directed assessment of the total DEMMI score was .830 (95% confidence interval, .730-.894). The Bland-Altman plots depicted higher levels of agreement among participants with impaired levels of mobility (≤74 out of 100) than did those with near-maximum DEMMI scores. Patient self-report of anticipated performance is an acceptable proxy for DEMMI scores derived from the therapist rating of performance. Caution should be exercised when interpreting self-report scores of patients with near-maximum levels of mobility. Further research is required to establish whether these results can be generalized across a range of patient populations and to clinicians with differing backgrounds and expertise.
Publisher: Public Library of Science (PLoS)
Date: 22-10-2021
DOI: 10.1371/JOURNAL.PMED.1003833
Abstract: Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control (2) dissemination of written evidence-based practice recommendations and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters ( n = 833 wards) were randomised to either control ( n = 15), recommendation ( n = 16), or knowledge broker ( n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI −8,721.81 to 8,758.02] p = 0.997 knowledge broker versus control β 1.24 [95% CI −6,992.60 to 6,995.07] p = 1.000 recommendation versus knowledge broker β −9.12 [95% CI −3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983 knowledge broker versus control β −0.12 [95% CI −0.54 to 0.30] p = 0.581 recommendation versus knowledge broker β −0.19 [−1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI −1.36 to 5.74] p = 0.219 knowledge broker versus control β −0.55 [95% CI −1.16 to 0.06] p = 0.075 recommendation versus knowledge broker β −3.75 [95% CI −8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level s le due to the grouping of multiple geographically distinct hospitals to avoid contamination. Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. Australian New Zealand Clinical Trials Registry ACTRN12618000029291 .
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.JHT.2017.04.006
Abstract: Case report. Injuries to adjacent fingers with differing extensor tendon (ET) zones and/or sagittal band pose a challenge to therapists as no treatment guidelines exist. This report highlights how the relative motion flexion/extension (RMF/RME) concepts were combined into one orthosis to manage a zone IV ET repair (RME) and a zone III central slip repair (RMF) in adjacent fingers (Case 1) and how a single RME orthosis was adapted to limit proximal interphalangeal joint motion to manage multi-level ET zone III-IV injuries and a sagittal band repair in adjacent fingers (case 2). Adapted relative motion orthoses allowed early active motion and graded exercises based on clinical reasoning and evidence. Outcomes were standard TAM% and Miller's criteria. 'Excellent' and 'good' outcomes were achieved by twelve weeks post surgery. Both cases returned to unrestricted work at 6 and 7 weeks. Neither reported functional deficits at discharge. Outcomes in 2 cases involving multiple digit injuries exceeded those previously reported for ET zone III-IV repairs. Relative motion orthoses can be adapted and applied to multi-finger injuries, eliminating the need for multiple, bulky or functionally-limiting orthoses. 4.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.JPHYS.2018.05.004
Abstract: Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35days (95% CI 0.45 to 4.24, I The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142-158].
Publisher: Wiley
Date: 19-07-2016
Abstract: Limited information about return to productive activities after lung transplantation has been published. The purpose of our study was to identify issues relating to occupational engagement in employment after surgery. We conducted a cross-sectional study of surviving lung transplant recipients from one transplant service in Australia. We used descriptive statistics, chi-square tests and Cox regression to analyse the data. A total of 100 lung transplant recipients completed the assessment (83.3% of 120 eligible surviving recipients). The mean age of respondents was 50 ± 13 years 45% of the s le were men. Cystic fibrosis and chronic obstructive pulmonary disease were the most frequent pre-transplant diagnoses. Fifty-five percent of participants identified employment or alternate occupational engagement prior to transplant. Of those respondents who had not retired from work prior to transplant, 44.2% identified engagement in paid employment after transplantation. Participants who obtained paid employment post-transplantation were more likely to have completed high school (P = 0.05) or worked as managers (P < 0.0001). Occupational therapists should be actively involved in pre- and post-transplantation goal setting and intervention to support return to work. Pre-transplant, participation in any amount of voluntary or paid employment or study will maintain networks, skills, and confidence. Post-transplant, while physician encouragement is known as a key predictor of return to work, occupational therapist support can address function and activity components of work participation.
Publisher: SAGE Publications
Date: 09-2016
DOI: 10.1177/1558944716660555JB
Abstract: Objective/Hypothesis: The objective of this study was to compare swing traction versus no-traction management of complex fractures of proximal interphalangeal (PIP) finger joints. We hypothesized that there is no long-term (ie, month) difference between swing traction and no traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost. Materials and Methods: This cohort study recruited adults with a history of complex PIP fractures affecting ≥ 30% of articular surface injury identified from database searches at 3 public hospitals and a private clinic. The x-rays taken at the time of injury were graded by 2 blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction. Participant data were then grouped by treatment provided. One group (n = 17) was treated with swing traction and the other group (n = 14) had no traction. The primary outcome was combined motion of the PIP and distal interphalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group. Results: Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain, or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times and the no-traction group attended 11.7 times. Average costs for swing traction were less than that for surgical fixation with no traction. Conclusions: Patients treated with the swing traction protocol had greater ROM in the finger however, this did not translate to improved patient ratings of function, pain, or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/02699050701315134
Abstract: This paper describes the approach used by the Victorian Acquired Brain Injury (ABI) specialist team of CRS Australia (formerly Commonwealth Rehabilitation Service) to facilitate participation in the workforce for its clients. The approach and results achieved are compared and contrasted with other models nationally and internationally. This two part study involves a survey of the specialist team members regarding use and efficacy of assessment and intervention strategies and data mining of closed case files to identify predictors of sustainable employment outcomes for people with ABI. CRS Australia's results compare favourably with other published results (50% achieved a minimum of 13 weeks open employment compared to population estimates of 38-46.5%). Results were achieved with people with mild, moderate and severe injury. Assessments and interventions that correlate with successful employment outcome are described. A client-centred approach, combining specialist ABI expertise, skilled assessment and practical workplace-based interventions results in favourable employment outcome rates.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JHT.2016.07.001
Abstract: Scoping review. The relative motion (RM) concept and immediate controlled active motion (ICAM) program, originally applied after zones IV-VII extensor tendon repairs, have been modified and extended to a variety of hand conditions, such as sagittal band injury, boutonniere deformity, and extensor lag. To scope the published and unpublished literature to review ICAM modifications, hand conditions for which the RM concept is used, and describe the preferred degree of relative metacarpophalangeal joint extension/flexion reported and spectrum of orthosis design. Electronic and manual searches of scientific and gray literature and expert consultation were conducted. Documents with quantitative data were assessed with Oxford Levels of Evidence and the Structured Effectiveness Quality Evaluation Scale. Fifteen references met the inclusion criteria 1 was level III evidence, and others were level IV evidence. RM-ICAM modifications, preferred degree of relative extension/flexion, orthotic design, management of other hand conditions and knowledge gaps were identified. RM orthoses may improve outcomes in a variety of hand conditions however, high-quality studies that contribute to the evidence base for its use are needed. Not applicable.
Publisher: Elsevier BV
Date: 10-2014
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.JHT.2014.07.003
Abstract: Traction orthoses are thought to optimize recovery from intra-articular finger fractures by restoring joint space and allowing early motion. Evidence to date has, however, consisted only of case series. To compare swing traction versus no-traction management of complex fractures of proximal inter-phalangeal (PIP) finger joints. We hypothesized that there is no long-term (i.e. >12 month) difference between swing traction and no-traction (with or without surgical fixation) in terms of motion, pain, function, patient satisfaction, or treatment cost. Adults with a history of complex PIP fractures affecting ≥30% of articular surface injury were identified from database searches at three public hospitals and a private clinic and invited to participate. X-rays taken at the time of injury were graded by two blinded assessors, and participants attended a clinic for measurement of range of motion (ROM) and self-reported function, pain, and satisfaction at least one year post injury. Participant data were then were grouped by treatment provided. One group (N = 17) was treated with swing traction and the other group (N = 14) had no-traction. The primary outcome was combined motion of the PIP and distal inter-phalangeal (DIP) joints, expressed as both total active motion and Strickland score. Secondary outcomes were physical function and symptoms as measured by the Disabilities of Arm, Shoulder and Hand (DASH), patient satisfaction, pain, complication rates, and cost of treatment, based on mean resource consumption per group. Patients treated with swing traction had greater finger motion than those in the no-traction group, which was statistically and clinically significant. There were no differences in patient ratings of function, pain or satisfaction. Complications, such as swan-neck deformity, cold sensitivity, malunion, infection, or adhesions occurred in over half of both groups of participants. During the treatment phase, the swing traction group attended hand therapy an average of 13.3 times, and the no-traction group attended 11.7 times. Average costs for swing traction were less than for surgical fixation with no-traction. The significantly different range of motion found in our study did not translate to better DASH scores. The DASH is designed to measure global upper limb physical functioning and symptoms, but lacks sensitivity in populations with finger injuries. Patients treated with the swing traction protocol had greater range of motion in the finger, however this did not translate to improved patient ratings of function, pain or satisfaction. A basic cost comparison indicated that swing traction may be less expensive than other forms of surgical repair. 3.
Publisher: SAGE Publications
Date: 05-2011
DOI: 10.4276/030802211X13046730116498
Abstract: It has been difficult for occupational therapists in Asia to use occupational therapy assessments, such as the Occupational Self Assessment (OSA) version 2.2, that are not validated in the local language. This study aimed to produce and assess the psychometric properties of a Malaysian version of the 21-item OSA. The translation process involved the forward and back translation from the original English version into the Malaysian version, followed by field tests conducted with a small group of occupational therapists and workers to confirm the translation's equivalence and appropriateness. A total of 35 Malaysian injured workers with musculoskeletal disorders who were not involved in a return to work programme were assessed using the Malaysian version of the OSA. Twenty-three were reassessed 7–14 days later to determine test-retest reliability. The Malaysian version of the OSA showed acceptable reliability (internal consistency, corrected item correlation and test-retest reliability) and validity (convergent and discriminant validity). The results suggest that the OSA is reliable and valid in assessing occupational functioning for injured Asian workers with musculoskeletal disorders.
Publisher: MDPI AG
Date: 08-02-2022
DOI: 10.3390/PROSTHESIS4010006
Abstract: (1) Background: This study investigated the feasibility of conducting a two-week “real-world” trial of the Self Grasping Hand (SGH), a novel 3D printed passive adjustable prosthesis for hand absence (2) Methods: Single-group pilot study of nine adults with trans-radial limb absence five used body-powered split-hooks, and four had passive cosmetic hands as their usual prosthesis. Data from activity monitors were used to measure wear time and bilateral activity. At the end of the two-week trial, function and satisfaction were measured using the Orthotics and Prosthetics Users’ Survey Function Scale (OPUS) and the prosthesis satisfaction sub-scales of the Trinity Amputations and Prosthesis Experience Scale (TAPES). Semi-structured interviews captured consumer feedback and suggestions for improvement (3) Results: Average SGH wear time over 2 weeks was 17.5 h (10% of total prosthesis wear time) for split-hook users and 83.5 h (63% of total prosthesis wear time) for cosmetic hand users. Mean satisfaction was 5.2/10, and mean function score was 47.9/100 (4) Two-week real-world consumer testing of the SGH is feasible using the methods described. Future SGH designs need to be more robust with easier grasp lock/unlock.
Publisher: Elsevier BV
Date: 07-2012
Publisher: SAGE Publications
Date: 20-05-2015
Publisher: Springer Science and Business Media LLC
Date: 13-09-2013
DOI: 10.1007/S00520-013-1964-7
Abstract: Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy. Research on the cancer-related fatigue intervention trial (CAN-FIT) programme found that pre-radiotherapy fatigue information and support (pre-RFES) did not improve levels of fatigue, but was associated with improvements in activity-based outcomes. We aimed to measure whether pre-RFES resulted in greater participant self-ratings of their performance of daily living activities, fatigue, quality of life and distress. Thirty people undergoing radiotherapy and/or chemotherapy were randomly allocated to either a 1-h RFES session from the CAN-FIT programme (delivered in idually to participants and modified where necessary for patients undergoing chemotherapy) or standard care. Measures were taken pre- and post-treatment and 6 weeks after completing treatment. There was no significant difference between groups on performance of daily living activities or ratings of distress. Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale (-9.05 [-18.09 -0.018] p < 0.05) and physical fatigue (2.86 [0.58 5.14] p < 0.02) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls. Pre-RFES delivered in idually did not significantly improve participants' ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue. Future trials, ideally comparing in idual and group education to exercise programmes or cognitive-behavioural approaches, are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse.
Publisher: Elsevier BV
Date: 2012
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.ARCHGER.2018.02.010
Abstract: At present there is no clear evidence to support any one particular intervention for engaging adults with chronic health issues in ongoing exercise. An understanding of consumer perceptions and preferences is important, because low rates of exercise adherence are likely to limit any benefits obtained. To identify and compare participants' perceptions about their own motivation, capacity and opportunity to adhere to an allocated exercise program during either a gym-based or a home-based exercise program with telephone follow-up. This qualitative study used convenience s ling to recruit participants (adults with chronic health issues) immediately after a randomised controlled trial comparing gym-and home-based exercise programs conducted for 12 months. Ten people, five from each intervention group, attended face-to- face semi-structured interviews at a local Community Health Service. Thematic analysis methods were used to analyse the dataset. Improved social interaction in the gym-based program was seen to contribute to adherence, however home-based programs were perceived as more convenient and easily integrated into daily routines. In idualized exercise prescription by a health professional with regular follow up (in person or by telephone) promoted an active practitioner-participant relationship. Health coaching combined with exercise was perceived to improve self-efficacy and assisted with the removal of intrinsic and extrinsic exercise barriers. This research presented many common and different themes in participant's motivation, capacity and opportunity in sustained adherence to a gym or home-based exercise program. However, this study found no superior intervention or in idual preference to improve ongoing exercise adherence.
Publisher: Elsevier BV
Date: 2014
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JPHYS.2017.05.018
Abstract: What is the effectiveness of gym-based exercise versus home-based exercise with telephone follow-up amongst adults with chronic conditions who have completed a short-term exercise program supervised by a health professional? A randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome assessment at baseline and 3, 6, 9 and 12 months. The participants were recruited following a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program for 12 months (gym group). The other group received a home-based exercise program for 12 months with telephone follow-up for the first 10 weeks (home group). Outcome measures included European Quality of Life Instrument (EQ-5D), the Friendship Scale, the Hospital and Anxiety and Depression Scale, Phone-FITT, 6-minute walk test, body mass index and 15-second sit-to-stand test. There was no significant difference between study groups in the primary outcome (EQ-5D visual analogue scale, 0 to 100) across the 12-month intervention period, with an estimate (adjusted regression coefficient) of the difference in effects of 0 (95% CI -5 to 4). The gym group demonstrated slightly fewer symptoms of depression over the 12-month period compared to the home group (mean difference 0.8 points on a 21-point scale, 95% CI 0.1 to 1.6). Similar long-term clinical outcomes and long-term exercise adherence are achieved with the two approaches examined in this study. Participation in gym-based group exercise may improve mental health outcomes slightly more, although the mechanisms for this are unclear because there was no change in the selected measure of social isolation or other measures of health and wellbeing. This finding may also be a Type 1 error. Further research to reproduce these results and that investigates the economic efficiency of these models of care is indicated. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2017) Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154-160].
Publisher: Oxford University Press (OUP)
Date: 15-06-2019
Abstract: To explore cost-efficiency, safety and acceptability of trans-disciplinary advanced allied health (AH) practitioners for acute adult general medicine inpatients. Quasi-experimental feasibility study. Three acute general medical units in an Australian urban hospital. Two hundred and fifty-six acute hospital inpatients. Cost-efficiency measures included AH service utilization and length of stay (LOS). Patient outcomes were functional independence, discharge destination, adverse events, unplanned admissions within 28 days, patient satisfaction and quality of life data on admission, and 30 days post-discharge. Ward staff were surveyed regarding satisfaction with the service model, and advanced health practitioners (AHPs) rated their confidence in their own ability to meet the performance standards of the role. Patients allocated to AHPs (n = 172) received 0.91 less hours of AH intervention (adjusted for LOS) (95% confidence intervals (CI): -1.68 to -0.14 P = 0.02) and had 1.76 days shorter LOS relative to expected (95%CI: 0.18-3.34 P = 0.03) compared with patients receiving standard AH (n = 84). There were no differences in patient outcomes or satisfaction. AHPs demonstrated growth in job satisfaction and skill confidence. Trans-disciplinary advanced AH roles may be feasible and cost-efficient compared with traditional roles for acute general medical inpatients. Further development of competency frameworks is recommended.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.BURNS.2016.07.025
Abstract: Hands are the most commonly burnt body part given humans' innate response to guard their face from injury, and are known to have detrimental functional and psychological consequences. Conflicting evidence exists regarding the impact of hand burns on long-term health status and global functioning. The objective of this study was to identify patient and clinical characteristics that predict health status and hand function of people at 12-24 months after hand burn. The Burns Specific Health Scale-Brief (BSHS-B) and the Brief Michigan Hand Outcome Questionnaire (Brief MHQ) were administered to community-dwelling adults who were between one and two years after admission to a statewide burns service for burns including one or both hands. Demographic, injury, and treatment data were collected to identify which factors predict health status and hand function in the second year after admission. Linear regression analyses adjusted for total burn surface area and burn depth were conducted to identify important predictors or outcomes. The s le (n=41) was 80.5% male, with a mean age of 44.5 years and total body surface area (TBSA) of 8.4%. Psychiatric illness (regression coefficient -56.6, confidence interval (95% CI) -76.70, -36.49) and female gender (-20.3 95% CI -0.77, -40.29) were key predictors of poorer global health status on the BSHS-B. Females also scored worse on body image (-5.35 95% CI -1.83, -8.87) and work (-4.13 95% CI -0.64, -7.62) domains of BSHS-B. The need for reconstructive or secondary surgery (-38.84 95% CI -58.04, -19.65) and female gender (-16.30 95% CI -4.03, -28.57) were important predictors of poorer hand function. Women and those with a history of psychiatric illness are particularly vulnerable to poorer outcomes in health status and/or hand function after burns, and may benefit from more intensive rehabilitation support and long-term follow-up.
Publisher: SAGE Publications
Date: 03-2010
Abstract: Non-adherence with therapeutic splinting in acute hand injury can reduce treatment benefits, increase risk of disability and bias assessment of treatment efficacy. This systematic review aims to critically analyse the literature on splinting of acute upper limb injuries to identify key factors that could influence patient adherence with splint wear. Trials were identified from searches of EMBASE, MEDLINE, CINAHL (to June 2009) and reference lists of articles and relevant reviews. Search terms used were patient compliance/adherence behaviour, splint/s, othosis/es and brace. Where possible, randomized controlled trials or prospective cohort studies were sought, and then cross-sectional and retrospective studies if the former were not available. Studies specifically addressing chronic conditions were excluded. All relevant trials were assessed for methodological quality by the author using explicit criteria. Data were extracted using a standardized form designed by the author. Six studies (one randomized controlled trial, two cross-sectional analytic surveys and three retrospective file reviews) involving 490 people were included. Owing to the heterogeneity of studies synthesis is narrative rather than quantitative. There was no consistent correlation between adherence and age or gender. One study found a correlation with patient perception of positive effect, and one found negative correlations with agitation and brain injury severity. Studies found were generally of varied quality and may be susceptible to bias. This is a field with little published scientific evidence, and future research should measure adherence relationships with socioeconomic, health-care system, therapy- and patient-related characteristics.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.JPHYS.2017.11.010
Abstract: What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program? A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon. People with chronic health conditions who had completed a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks. Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L). Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach. The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54].
Publisher: Wiley
Date: 13-06-2016
DOI: 10.1111/JEP.12543
Abstract: The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety indicators.
Publisher: Elsevier BV
Date: 02-2011
DOI: 10.1016/J.APMR.2010.10.035
Abstract: To compare Stack, dorsal, and custom splinting techniques in people with acute type 1a or b mallet finger. Multi-center randomized controlled trial. Outpatient hand therapy clinics (2 public hospitals and 1 private clinic). Patients (N=64) with acute type 1a or b mallet finger. Prefabricated Stack splint (control), dorsal padded aluminum splint, or custom-made thermoplastic thimble splint. All were worn for 8 weeks continuously, with a 4 week graduated withdrawal and exercise program. The primary outcome was extensor lag at 12 and 20 weeks. Secondary outcomes were incidence of treatment failure, complications, range of motion of the distal interphalangeal joint, pain (visual analog scale) patient compliance, and patient satisfaction. There was no difference in the primary outcome between groups at 12 or 20 weeks however, the Stack and dorsal splints had significant rates of treatment failure (23.8% in both groups, compared to none in the thermoplastic group P=.04). There was a medium negative correlation between patient compliance and degree of extensor lag. No significant differences between groups were observed for patient satisfaction or pain. As splints for mallet finger must be worn continuously for 6 to 8 weeks, and compliance correlates with favorable outcomes, treating practitioners must ensure the splint provided is robust enough for daily living requirements and does not cause complications, which are intolerable to the patient. In this study, no extensor lag difference was found between the 3 splint types, but custom-made thermoplastic splints were significantly less likely to result in treatment failure.
Publisher: SAGE Publications
Date: 27-07-2021
DOI: 10.1177/17589983211031259
Abstract: A survey of International Federation of Societies for Hand Therapy (IFSHT) member countries identified relative motion extension as the preferred approach to management of zones V-VI extensor tendon repairs. The aims of this survey were to identify and compare hand therapy practice patterns in Malaysia (a non-IFSHT member country) with findings of the IFSHT survey including an IFSHT subset of Asia-Pacific therapists and to investigate if membership status of the Malaysian Society for Hand Therapists (MSHT) influenced therapy practice patterns. An online English-language survey was distributed to 90 occupational therapists and physiotherapists including MSHT members and non-members. Participation required management of at least one extensor tendon repair in the preceding year. Five approaches were surveyed: immobilisation, early passive motion (EPM) with dynamic splinting, and early active motion (EAM) delivered by resting hand (RH), palmar resting interphalangeal joints free (PR), and relative motion extension (RME) splints. Thirty-seven of the 53 therapists (68%) who commenced the survey completed it. The most used approach was dynamic/EPM (28%), followed by RH/immobilisation (22%) and RH/EAM (22%). A preference for RME/EAM was identified with implementation barriers being surgeon preference and hand therapist confidence. Approach selection for Malaysian therapists differed from the combined IFSHT and Asia-Pacific respondents, with the former using dynamic/EPM and RH/immobilisation compared to IFSHT respondents who predominately used RME/EAM and PR/EAM. This survey provides valuable insights into Malaysian hand therapists’ practices. If implementation barriers and therapist confidence are addressed, Malaysian practice patterns may change to better align with current evidence.
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/02699050802008067
Abstract: Poor compliance with hand splinting treatment in the acute injury stage increases the risk of ongoing disability by affecting recovery and functioning. The aims of this study were to identify key predictors of splinting non-compliance in acute traumatic brain injury (TBI) patients and to determine the suitability of the Westmead PTA scale for predicting splinting compliance in TBI. Retrospective medical record review of all patients who were (1) admitted to a major adult trauma hospital in 2005-2006 and (2) flagged as having concurrent brain and upper limb injuries. Data extracted included demographic information, co-morbidity, injury mechanism, TBI severity, incidence and duration of agitation. Compliance data included loss, removal or agitation with the splint or brace. Of the 71 subjects, 39.5% (n = 28) were non-compliant with their splint or brace 60.5% (n = 43) were compliant. The presence and duration of agitation were the strongest predictors of non-compliance with splinting (p = 0.001 and p = 0.003, respectively). PTA status at splint application does not accurately predict compliance with splinting. This highlights a specific clinical gap in the management of hand injuries against a background of agitation and cognitive impairment.
Publisher: Springer Science and Business Media LLC
Date: 12-05-2017
Publisher: Wiley
Date: 27-02-2019
Abstract: Injuries to the hand and wrist are estimated to account for between 10% and 30% of all ED presentations. The economic burden placed on the healthcare system can be extensive and rise sharply with increase in injury severity. This cost-analysis was performed with the aim of estimating the economic implications of ED attendances for hand and wrist injuries from the perspective of one Australian public health network. Data from two EDs were retrieved from the electronic billing records of one large health network across two financial year periods (2014-2015 and 2015-2016) using ICD-10 codes. All costs that resulted from the treatment of any acute hand or wrist injury across the 2 year period were calculated and are presented by age, sex, injury type and mechanism of injury. A total of 10 024 in iduals presented to the two EDs in the 2 year period, accounting for approximately 5.4% of all presentations. The most common presentations were males (62.2%), people aged 25-34 years (26.9%) and lacerations (31.2%). The total cost in the 2 year study period was $3 959 535.38 ($1 923 852.38 in 2014-2015 $2 035 683.00 in 2015-2016). The mean cost per presentation was $383 (95% CI [$373, $393]) in 2014-2015 and $407 (95% CI [$394, $421]) in 2015-2016. Acute hand and wrist injuries contribute to a significant volume of ED presentations each year in one Australian public health network leading to significant expenditure and health resources. Further research into how to best utilise resources and reduce avoidable injuries should be priority areas to reduce the cost of these injuries to the healthcare system and society.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JHT.2010.01.002
Abstract: The study design is qualitative phenomenological and grounded theory. Intraarticular fractures of the finger joints can severely limit function due to stiffness and pain. Distraction with early movement is thought to deliver the best results and this has been used to treat these types of injuries at The Alfred Hospital for eight years. Qualitative data from patient interviews were used to describe patients' own experiences of treatment with distraction splinting and identify key issues in patient adherence. The key finding was a disconnect between perceived complexity of injury and treatment. Those who adhered with the treatment regime felt that they were well informed of the reasoning behind it. The hand surgery and therapy team must be aware of the patient experience of complex finger injuries and should ensure patients are well supported with education about their injury and treatment. Early preemptive pain control may help optimize adherence to the splint and exercise regime. Findings can be applied to other acute conditions requiring cumbersome splinting and potentially uncomfortable early exercise routines.
Publisher: Springer Science and Business Media LLC
Date: 06-02-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2015
DOI: 10.1002/CHP.21262
Abstract: This study aimed to determine whether an 8-week online training program for developing skills in short-course development and delivery was effective in establishing locally driven, sustainable, evidence-based training for local occupational or physical therapists. Five Bangladeshi therapists from a rehabilitation center participated in the course, which was facilitated online by an Australian university. They completed 8 prerecorded modules over a 3-month period, and were assessed in situ on their ability to deliver a tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from precourse and 1-year follow-up surveys, observations (including interactions during the course and final participant presentations), and a postcourse focus group. The course achieved 6 of its 9 objectives, with all participants satisfactorily planning and delivering an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence and developing and executing a teaching plan. This was sustained at 1-year review. The key theme was a shift in participants' capacity for teaching and learning. Enablers were multimodal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable Internet services and late delivery of course materials. Online distance education can be effective in producing sustainable change in practitioner skills in developing countries. Future programs would benefit from a blended learning approach incorporating "face-to-face" instructor contact.
Publisher: Mark Allen Group
Date: 02-05-2015
DOI: 10.12968/IJTR.2015.22.5.238
Abstract: Upper limb overuse injuries, such as tennis elbow, may be challenging in terms of both diagnosis and management, and there is no consensus on a gold standard intervention. Despite limited evidence in the literature to support the efficacy of kinesiotaping, this new treatment modality has gained popularity among athletes and the general public and is commonly used to treat these conditions. Clinicians are therefore relying on lower levels of evidence and/or expert opinion when deciding whether to use this treatment and it is likely that there are varying perspectives on its potential clinical benefits. The purpose of this study was to compare the opinions of hand therapists, general practitioners (GPs) and hand surgeons on the use of kinesiotape for upper limb overuse injuries. This cross-sectional study used a self-report survey to gather data from respondents (n=157). Survey questions aimed to identify practice patterns and gain an understanding of clinicians' reasons for either recommending or not recommending this modality. Hand therapists rated their understanding of the use of kinesiotape (Mean±SD = 6.51±1.89) significantly higher than levels reported by GPs (Mean±SD = 3.04± 2.50) and surgeons (Mean±SD = 4.16± 2.52). Hand therapists reported a moderate level of success with the use of kinesiotape (Mean±SD = 6.30±1.59), which was significantly higher than that reported by surgeons (Mean±SD = 4.84±1.21) however, there was no notable difference between hand therapists and GPs (Mean±SD = 5.27± 2.10). Of the three groups, GPs were most likely (69.5%) to indicate that they would not use or recommend kinesiotape, compared with 31% of hand therapists and 38.7% of hand surgeons. Hand therapists are more likely to rate kinesiotaping as successful and recommend its clinical use, indicating that they place greater emphasis on their own clinical experience than research evidence. It is inferred that GPs and surgeons have a higher level of scepticism for interventions without supporting evidence, such as kinesiotaping. More evidence from randomised controlled trials is required to inform practitioners on the potential benefits of this intervention.
Publisher: SAGE Publications
Date: 27-10-2022
DOI: 10.1177/10442073221130529
Abstract: A systematic review was conducted to describe, and evaluate the effectiveness and cost-effectiveness of, intermediary services to support people with a disability to implement in idualized funding plans. We included six records, including one subanalysis of randomized trial data, three qualitative studies, and two systematic reviews (reporting on 73 and 18 studies, respectively). No studies directly compared “consumer-directed plan plus intermediary services” to “consumer-directed plan with no/alternative intermediary,” so effectiveness of these interventions is uncertain. There is qualitative evidence from the perspective of disability planners and workers that intermediary interventions are important enablers of successful plan implementation. There is also qualitative evidence from consumer and family perspectives that external support is required to successfully navigate self-directed systems and that strong, trusting, and collaborative relationships with both paid and unpaid in iduals in the person’s support network were facilitators of successful plan implementation. There was evidence of disabling practices and attitudes among some support agencies, resulting in coordinators being very risk averse in order to safeguard their clients. Suggestions for future research include carefully planned and ethically robust comparative trial designs, clear description and consistent delivery of interventions, and long-term evaluation of impact. The protocol was published on PROSPERO (CRD42020177607).
Publisher: Springer Science and Business Media LLC
Date: 24-04-2018
Publisher: John Wiley & Sons, Ltd
Date: 25-01-2006
Publisher: Wiley
Date: 10-2018
Abstract: Hands are commonly involved in burn trauma. Occupational therapy in the acute phase aims to reduce the risk of deformities and facilitate return to usual occupations. This study aimed to describe usual occupational therapy care at a major adult burns service, and measure recovery from hand burns in the first six months post-acute hospital discharge. To describe usual occupational therapy care, an audit of patient contact statistics over six months was undertaken, and occupational therapy staff were interviewed. To measure recovery, a prospective cohort study recruited adults hospitalised with hand/upper limb burns at the Victorian Adult Burns Service. Recruitment occurred over a four month period. Functional recovery was measured at three time points: discharge, three and six months post-discharge. Instruments included the Quick Disabilities of the Arm, Shoulder and Hand and the Functional Assessment for Burns. Usual care was calculated to be one 30 minute session of daily occupational therapy. Interventions were described using the Template for Intervention Description and Replication. Participants (N = 10) were aged 22-65 years and were treated for burns ranging from 2% to 40% total body surface area. Scores on the Functional Assessment for Burns suggested high functional independence at discharge. Quick Disabilities of the Arm, Shoulder and Hand scores improved significantly at each time point, with most substantial improvement occurring between discharge and three months. Involvement of the first web-space was associated with poorer recovery in the first three months post-discharge (P = 0.04). Six participants (60%) had returned to work at the three month follow-up, and seven (70%) at six months. The Quick Disabilities of the Arm, Shoulder and Hand was responsive to recovery in the post-discharge period. Further research into upper limb recovery following burns is needed, including exploration of the relationship between recovery and first web space hand burns.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.JHT.2013.06.003
Abstract: Retrospective cohort study. To measure the impact of initial treatment by a hand therapist of people referred to a hand surgeon for common hand conditions. This retrospective cohort study included 224 patients with Carpal Tunnel Syndrome, Trigger Finger/Thumb, de Quervain's tenosynovitis, and trapeziometacarpal osteoarthrosis. All were invited to attend for assessment and non-operative treatment and were followed up for at least one year. Between groups comparisons for who attended (N = 164) and those who did not (N = 60) were conducted. 40.8% of the non-operative treatment group and 65% of the no treatment group underwent surgery, which was statistically significant (p = 0.02). Univariate analysis found that the variable "attending non-operative treatment" was able to predict those who did not have surgery (p = 0.02). Multivariate analysis using logistic regression also showed that this was the only significant predictor of not progressing to surgery (p = 0.001). Assessment and treatment by a non-operative provider were associated with a decrease in the rate of operative treatment. Prospective, randomized studies could help determine if this observed difference is related to the treatment approach.
Publisher: Wiley
Date: 12-09-2013
Publisher: Informa UK Limited
Date: 13-05-2019
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.JHT.2014.03.004
Abstract: Scoping review. Elastic therapeutic tape is a relatively new intervention for treating a variety of injuries however, there is little evidence to support its effectiveness for neck or upper extremity conditions. This scoping review examines current evidence on the recommended application, purpose and effectiveness of elastic therapeutic tape for treating neck or upper extremity conditions. A scoping review was conducted to examine the evidence in 14 peer-reviewed published articles that reported on the use of elastic therapeutic tape for neck or upper extremity conditions. Six studies reported statistically significant changes to pain with the use of elastic therapeutic tape. Only three studies found statistically significant changes to range of motion. Elastic therapeutic tape may play a role in reducing short-term neck and upper extremity pain, however future high quality studies that contribute to the evidence base for its use are needed. N/A.
Publisher: Informa UK Limited
Date: 12-09-2012
DOI: 10.3109/11038128.2012.720276
Abstract: Workers with musculoskeletal disorders undertaking Malaysia's return to work (RTW) programmes may experience challenges in occupational competence (OC) and negative emotional states (NES). This study aimed to measure and examines the OC and NES of the workers by comparing specific comparison groups and groups of different phases. A total of 76 participants were recruited from a national RTW programme and categorized into three groups based on different RTW phases: off-work (n = 22), re-entry (n = 31), and maintenance (n = 23). Self-report questionnaires consisted of the Occupational Self Assessment version 2.2 and the Depression, Anxiety and Stress Scale-21. Results showed that injured workers exhibited significantly lower OC in comparison with an international group with various disabilities. In contrast, there was significantly higher NES when compared with Malaysia's general population. Significant differences in OC and NES were also found between workers in the three RTW phases. In particular, OC and NES in the off-work and re-entry phases were significantly lower (OC) and higher (NES) than in the maintenance phase. Furthermore, there was a moderate, negative correlation between OC and NES in the off-work and re-entry phase groups. This indicated that low levels of perceived OC were associated with higher levels of NES.
No related grants have been discovered for Lisa O'Brien.