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Akowuah E, Mathias A, Bardgett M, Harrison S, Kasim AS, Loughran K, Ogundimu E, Trevis J, Wagnild J, Witharana P, Hancock HC, Maier RH. Prehabilitation in elective patients undergoing cardiac surgery: a randomised control trial (THE PrEPS TRIAL) - a study protocol. BMJ Open 2023; 13:e065992. [PMID: 36604134 PMCID: PMC9827267 DOI: 10.1136/bmjopen-2022-065992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Prehabilitation prior to surgery has been shown to reduce postoperative complications, reduce length of hospital stay and improve quality of life after cancer and limb reconstruction surgery. However, there are minimal data on the impact of prehabilitation in patients undergoing cardiac surgery, despite the fact these patients are generally older and have more comorbidities and frailty. This trial will assess the feasibility and impact of a prehabilitation intervention consisting of exercise and inspiratory muscle training on preoperative functional exercise capacity in adult patients awaiting elective cardiac surgery, and determine any impact on clinical outcomes after surgery. METHODS AND ANALYSIS PrEPS is a randomised controlled single-centre trial recruiting 180 participants undergoing elective cardiac surgery. Participants will be randomised in a 1:1 ratio to standard presurgical care or standard care plus a prehabilitation intervention. The primary outcome will be change in functional exercise capacity measured as change in the 6 min walk test distance from baseline. Secondary outcomes will evaluate the impact of prehabilitation on preoperative and postoperative outcomes including; respiratory function, health-related quality of life, anxiety and depression, frailty, and postoperative complications and resource use. This trial will evaluate if a prehabilitation intervention can improve preoperative physical function, inspiratory muscle function, frailty and quality of life prior to surgery in elective patients awaiting cardiac surgery, and impact postoperative outcomes. ETHICS AND DISSEMINATION A favourable opinion was given by the Sheffield Research Ethics Committee in 2019. Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer-reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13860094.
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Affiliation(s)
- Enoch Akowuah
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ayesha Mathias
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Harrison
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Kirsti Loughran
- School of Health and Life Sciences, Teeside University, Middlesbrough, UK
| | | | - Jason Trevis
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | | | - Pasan Witharana
- Department of Cardiothoracic Surgery, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, MIddlesbrough, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca H Maier
- South Tees Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
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Piao JJ, Wan B, Zhao H, Shang Z, Yan L, Hao Z, Wang Y, Zhang Y, Gu Y. Effects of different brisk walking intensities on adherence and cardiorespiratory endurance of cardiac rehabilitation among patients with CHD after PCI: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055437. [PMID: 35418429 PMCID: PMC9013999 DOI: 10.1136/bmjopen-2021-055437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is a critical treatment for patients with coronary heart disease after percutaneous coronary intervention. Unfortunately, participation and adherence of CR are unexpectedly poor. This study aims to test whether low-intensity or medium-intensity brisk walking is more helpful in improving early attendance, adherence and physical results. METHODS AND ANALYSIS This randomised controlled study will compare the effects of low-intensity and medium-intensity brisk walking to improve adherence and cardiopulmonary endurance. Participants will be randomly allocated to low-intensity or medium-intensity groups and will be followed-up for 8 weeks. Primary and secondary outcome data will be collected at baseline and at 2, 4 and 8 weeks. Primary outcomes measure changes in oxygen consumption (VO2) peak value (mL/kg/min), as well as adherence. Secondary outcomes include changes in body mass index, oxygen pulse, maximal metabolic equivalent, breathing reserve, vital capacity, ratio of forced expiratory volume in 1 s to forced vital capacity, Δoxygen consumption/Δwork rate (ΔVO2/ΔWR), minute ventilation/carbon dioxide production and self-efficacy. ETHICS AND DISSEMINATION Ethical approval and informed consent form have been obtained from the Ethics Committee of Hebei General Hospital (approval number: NA-2021-03). The study background and main objective, as well as potential benefits and risks, will be fully explained to the participants and their families. Findings from this study will be published on academic journals in Chinese or in English for widespread dissemination of the results TRIAL REGISTRATION NUMBER: ChiCTR2100047568.
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Affiliation(s)
- Jing Jing Piao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Boya Wan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Hebei General Hospital, Shijiazhuang, China
| | - Haomei Zhao
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Zhiyang Shang
- Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Lingjun Yan
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- The Third Hospital Of Shijiazhuang, Shijiazhuang, China
| | - Zhina Hao
- Hospital of Stomatology Hebei Medical University, Shijiazhuang, China
| | - Yonghong Wang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanqing Zhang
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Yanmei Gu
- School of Nursing, Hebei University of Chinese Medicine, Shijiazhuang, China
- Key Laboratory for HealthCare with Chinese Medicine of Hebei Province, Shijiazhuang, China
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Murphy BM, Zaman S, Tucker K, Alvarenga M, Morrison-Jack J, Higgins R, Le Grande M, Nasis A, Jackson AC. Enhancing the appeal of cardiac rehabilitation for women: development and pilot testing of a women-only yoga cardiac rehabilitation programme. Eur J Cardiovasc Nurs 2021; 20:633-640. [PMID: 33748850 DOI: 10.1093/eurjcn/zvab008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022]
Abstract
AIMS Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme; WYCRP); (ii) to investigate programme acceptability; and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. METHODS AND RESULTS Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive; qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76%; P = 0.40), CR completion, and continuation were (95% vs. 56%; P = 0.02, and 72% vs. 12%; P < 0.001, respectively). CONCLUSION This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.
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Affiliation(s)
- Barbara M Murphy
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Department of Psychology, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Zaman
- MonashHeart, Monash Health, Clayton, VIC, Australia.,Monash Cardiovascular Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kim Tucker
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Marlies Alvarenga
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Jenni Morrison-Jack
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Ihana Yoga Centre, St Kilda, VIC, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health, Clayton, VIC, Australia
| | - Alun C Jackson
- Australian Centre for Heart Health, 75-79 Chetwynd Street, North Melbourne, 3051, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Melbourne, VIC, Australia.,Centre on Behavioural Health, University of Hong Kong, Pok Fu Lam, Hong Kong
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Chindhy S, Taub PR, Lavie CJ, Shen J. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Expert Rev Cardiovasc Ther 2020; 18:777-789. [PMID: 32885702 DOI: 10.1080/14779072.2020.1816464] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) significantly reduces secondary cardiovascular events and mortality and is a class 1A recommendation by the American Heart Association (AHA) and American College of Cardiology (ACC). However, it remains an underutilized intervention and many eligible patients fail to enroll or complete CR programs. The aim of this review is to identify barriers to CR attendance and discuss strategies to overcome them. AREAS COVERED Specific barriers to CR attendance and participation will be reviewed. This will be followed by a discussion of solutions/strategies to help overcome these barriers with a particular focus on home-based CR (HBCR). EXPERT OPINION HBCR alone or in combination with center-based CR (CBCR) can help overcome many barriers to traditional CBCR participation, such as schedule flexibility, time commitment, travel distance, cost, and patient preference. Using remote coaching with indirect exercise supervision, HBCR has been shown to have comparable benefits to CBCR. At this time, however, funding remains the main barrier to universal incorporation of HBCR into health systems, necessitating the need for additional cost benefit analysis and outcome studies. Ultimately, the choice for HBCR should be based on patient preference and availability of resources.
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Affiliation(s)
- Shahzad Chindhy
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
| | - Pam R Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, -the University of Queensland School of Medicine , New Orleans, LA, USA
| | - Jia Shen
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
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Astley CM, Chew DP, Keech W, Nicholls S, Beltrame J, Horsfall M, Tavella R, Tirimacco R, Clark RA. The Impact of Cardiac Rehabilitation and Secondary Prevention Programs on 12-Month Clinical Outcomes: A Linked Data Analysis. Heart Lung Circ 2020; 29:475-482. [DOI: 10.1016/j.hlc.2019.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/21/2019] [Accepted: 03/20/2019] [Indexed: 12/12/2022]
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O’Toole K, Chamberlain D, Giles T. Exploration of a nurse practitioner‐led phase two cardiac rehabilitation programme on attendance and compliance. J Clin Nurs 2019; 29:785-793. [DOI: 10.1111/jocn.15133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/13/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Diane Chamberlain
- College of Nursing & Health Science Flinders University Adelaide SA Australia
| | - Tracey Giles
- College of Nursing & Health Science Flinders University Adelaide SA Australia
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Cartledge S, Thomas E, Hollier K, Maddison R. Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process. BMJ Open 2019; 9:e032279. [PMID: 31796485 PMCID: PMC7003389 DOI: 10.1136/bmjopen-2019-032279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme. DESIGN Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes. PARTICIPANTS An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential). MAIN OUTCOME MEASURE Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted. RESULTS 49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted. CONCLUSIONS For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.
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Affiliation(s)
- Susie Cartledge
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Emma Thomas
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Kerry Hollier
- National Heart Foundation of Australia, Melbourne, Victoria, Australia
| | - R Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
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Barker K, Holland AE, Lee AL, Haines T, Ritchie K, Boote C, Saliba J, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases: a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:181. [PMID: 30519483 PMCID: PMC6267787 DOI: 10.1186/s40814-018-0369-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 11/13/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials. METHODS A pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization. RESULTS Sixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval - 16 to 60) compared to 22 (57) meters (95% confidence interval - 69 to 114) (control). CONCLUSIONS It was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.
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Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Anne E. Holland
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - Annemarie L. Lee
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
| | - Terry Haines
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
| | - Kathryn Ritchie
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Claire Boote
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
| | - Joanne Saliba
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050 Australia
| | - Stephanie Lowe
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Fiona Pazsa
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Lee Thomas
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Monica Turczyniak
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Australian Institute of Musculoskeletal Science, Western Centre for Health Research and Education, Western Health, St Albans, Victoria 3021 Australia
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
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