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Whittaker S, Brusco NK, Hill KD, Taylor NF. Self-management programs within rehabilitation yield positive health outcomes at a small increased cost compared to usual care: A systematic review and meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00995-X. [PMID: 38729404 DOI: 10.1016/j.apmr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To determine if self-management programs, supported by a health professional, in rehabilitation are cost-effective. DATA SOURCES Six databases were searched to December 2023. STUDY SELECTION Randomised controlled trials with adults completing a supported self-management program while participating in rehabilitation, or receiving health professional input, in the hospital or community settings, were included. Self-management programs were completed outside of structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost effectiveness ratios (ICERS) were calculated based on the mean difference from the meta-analyses of contributing healthcare costs and quality of life. DATA EXTRACTION Following application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract prior to full text review. Using a customised form, data was extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS Forty-three trials were included and 27 had data included in meta-analyses. Where self-management was a primary intervention there was moderate certainty of a meaningful positive difference in quality of life utility index, of 0.03 units (95% CI 0.01 to 0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention (including education only), or no intervention), potentially favoured the comparison group (MD $AUD90, 95% CI -$AUD130 to $AUD310). The cost per quality adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was $AUD3,000, below the acceptable willingness-to-pay threshold in Australia per QALY gained ($50,000/QALY gained). CONCLUSIONS Self-management as an intervention is low cost and could improve health-related quality of life. PROSPERO REGISTRATION CRD42021275472.
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Affiliation(s)
- Sara Whittaker
- Monash University, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, McMahons Road, Frankston 3199, Australia.
| | - Natasha K Brusco
- Monash University, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, McMahons Road, Frankston 3199, Australia
| | - Keith D Hill
- Monash University, Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, McMahons Road, Frankston 3199, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora 3086, Australia; Eastern Health, 5 Arnold St, Box Hill 3128, Australia
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Jolliffe L, Williams CM, Bozyk N, Collyer TA, Caspers K, Snowdon DA. Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review. AUST HEALTH REV 2024; 48:191-200. [PMID: 38373740 DOI: 10.1071/ah23225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
Objective Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate-high concordance overall (range, 77-96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence.
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Affiliation(s)
- Laura Jolliffe
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and School of Primary and Allied Health Care, Department of Occupational Therapy, Monash University, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | - Cylie M Williams
- School of Primary and Allied Health Care, Department of Podiatry, Monash University, Melbourne, Vic., Australia
| | - Natalie Bozyk
- Allied Health, Peninsula Health, Melbourne, Vic., Australia
| | - Taya A Collyer
- National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | | | - David A Snowdon
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
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Horvey K, Nairn Pederson L, Bath B, St Pierre D. "The right thing for our patients": perspectives of physical therapists transitioning to a 7 day a week service in an urban acute care center in Canada. Physiother Theory Pract 2023; 39:2377-2390. [PMID: 35587372 DOI: 10.1080/09593985.2022.2078254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND True seven day a week acute care physical therapy (PT) coverage is rare. Our facility is one of a few in Canada that has increased weekend PT coverage on medicine units to seven days of full PT staffing levels. OBJECTIVE This article investigates the perspectives of physical therapists involved in the change with the focus on the emotional experiences of those therapists. METHODS Thematic analysis of interview and focus group transcripts with 18 physical therapist and 2 manager participants were aligned with four themes of: 1) optimism, hope and excitement; 2) frustration, guilt, and resentment; 3) fear, anxiety, uncertainty, and vulnerability; and 4) ambivalence, neutrality, and impartiality. RESULTS Although there were several perceived benefits to quality of care and work/life balance, participants' comments also reflected: frustration, guilt, and resentment related to the rapid implementation of the change and the impact of altered work schedules. CONCLUSIONS Participants emphasized the need to discuss large changes with staff prior to implementation in order to prevent frustration and resentment. Participants also felt that increased acute care PT coverage over seven days is valuable, but other allied health professions also need a proportional increase in staffing to improve hospital flow.
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Affiliation(s)
- Karla Horvey
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Lacey Nairn Pederson
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Sciece, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denise St Pierre
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
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Aronson JH, Allen OS, Berkalieva A, Mazumdar M, Gorbenko K, Gunning M, Liu M, Kisswany C, Bhardwaj A, Smith CB. Benefits of an Early Mobility Program for Hospitalized Patients With Cancer. JCO Oncol Pract 2023:OP2200761. [PMID: 37084332 DOI: 10.1200/op.22.00761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
PURPOSE Patients with cancer are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning, including loss of mobility, which likely contributes to increased length of stay (LOS) and increased readmissions. We aimed to determine whether a mobility program would improve quality of care and decrease health care utilization. METHODS We implemented a mobility aide program on an oncology unit in a large academic medical center for all patients without bedrest orders between October 1, 2018, and February 28, 2021. The program consisted of nursing evaluation using the Activity Measure for Post-Acute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥ 250 feet, to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing, and a mobility aide, who is a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day 7 days a week. Using descriptive statistics and mixed effects logistic regression, we evaluated the programs impact on LOS, readmissions, and changes in mobility during this time period compared with the 6-month interval before implementation. RESULTS A total of 1,496 hospitalized patients were identified. The odds of hospital readmission within 30 days of discharge was significantly less for those who received the intervention (OR, 0.53; 95% CI, 0.37 to 0.78; P = .001). The odds ratio (OR) of having a final AMPAC score at or above the median was significantly higher for those who received the intervention (OR, 1.60; 95% CI, 1.04 to 2.45; P < .05). There was no significant difference in LOS. CONCLUSION Use of this mobility program resulted in a significant decrease in readmissions and maintained or improved patients' mobility. This demonstrates that non-PT professionals can effectively mobilize hospitalized patients with cancer, thereby decreasing the burden on PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with health care costs.
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Affiliation(s)
- Julia H Aronson
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Asem Berkalieva
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Madhu Mazumdar
- TCI Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ksenia Gorbenko
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa Gunning
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark Liu
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Carol Kisswany
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
| | - Aarti Bhardwaj
- Department of Rehabilitation and Human Performance, Mount Sinai Health System, New York, NY
| | - Cardinale B Smith
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY
- Department of Rehabilitation and Human Performance, Mount Sinai Health System, New York, NY
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Davies L, Lanyon L, O'Halloran R. The role of speech-language pathology weekend service in inpatient subacute care: A national survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:437-445. [PMID: 34547973 DOI: 10.1080/17549507.2021.1970226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Limited evidence is available on speech-language pathology (SLP) weekend services within the subacute inpatient setting. This study aimed to describe Australian SLP weekend services for stroke adult inpatients in subacute units and to explore clinicians' perspectives on factors that influence the delivery of the service. METHOD Speech-language pathologists who worked in Australian subacute hospital-based units participated in an online cross-sectional survey. Descriptive statistics and content analysis were undertaken to analyse quantitative and qualitative data. RESULT From the total of 83 participating clinicians, 20 (24%) worked in rehabilitation units that provided an SLP weekend service. Assessments and reviews were the main clinical activities provided to stroke inpatients by this service. Workforce and evidence were commonly cited as facilitators and barriers to both the implementation of a new service and the continuation of an existing service. The "ideal" SLP weekend subacute service to stroke inpatients was typically described as a combination of assessment, therapy, education and training. CONCLUSION Findings from this study's sample indicate that an SLP weekend inpatient rehabilitation service to stroke inpatients was not standard practice. Different perspectives regarding the purpose and need of an SLP weekend service were reported.
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Affiliation(s)
- Lidia Davies
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Speech Pathology Department, Barwon Health, Geelong, Australia
| | - Lucette Lanyon
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Centre of Research Excellence for Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Centre of Research Excellence for Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
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Caruana EL, Rowell D, Kuys SS, Brauer SG. Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study. BMC Health Serv Res 2022; 22:617. [PMID: 35534853 PMCID: PMC9082956 DOI: 10.1186/s12913-022-07727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background The first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility. Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs. Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group. After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively. Conclusions Implementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07727-7.
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Affiliation(s)
- Erin L Caruana
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,St Andrew's War Memorial Hospital, Brisbane, Australia
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Suzanne S Kuys
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Hospital Access Block: A Scoping Review. J Emerg Nurs 2022; 48:430-454. [DOI: 10.1016/j.jen.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
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Farlie MK, French F, Haines TP, Taylor NF, Williams C. The impact of additional allied health staffing on rehabilitation outcomes at discharge from a sub-acute geriatric evaluation and management unit: A quasi-experimental, pre-post intervention study. Clin Rehabil 2022; 36:1110-1119. [PMID: 35466720 DOI: 10.1177/02692155221095645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the impact of increasing allied health staffing levels on patient and health service outcomes across 1) all Geriatric Evaluation and Management patients, and 2) Geriatric Evaluation and Management patients discharged to home in the community. DESIGN Quasi-experimental, pre-post intervention study. SETTING Two sub-acute hospital units in an Australian, tertiary health service. SUBJECTS Data related to patients admitted to the study units, who were classified as Geriatric Evaluation and Management patients. INTERVENTIONS Comparison of therapy time across two units with a differential in staffing allocation over a six-month trial period. MAIN MEASURES Primary outcomes: length of stay, readmission rate, and improvement on the Functional Independence Measure. Secondary outcomes: total cost of admission per patient and number of allied health sessions. RESULTS Data were analysed for 214 patients (mean age = 79.9, standard deviation (SD) = 9.4 years, mean Functional Independence Measure (FIM = 64.9, SD = 21.2) admitted to the intervention unit, and 199 patients (mean age = 81.3, SD = 8.5, mean FIM = 64.2, SD = 24.0) admitted to the control unit. The overall difference in staffing allocation between the control and intervention units for the trial period was 21%. There was no statistically significant difference between units in subacute length of stay (Adj Coef = -0.10 days, 95%CI = -0.39 to 0.19), rate of readmission (OR = 1.0, 95%CI = 0.5 to 2.0) or change in function (Coef = 1.42 FIM change score, 95%CI = -2.4 to 5.3). CONCLUSIONS Increasing allied health staffing allocation to a unit over six-months did not impact change in function or length of stay for patients admitted for Geriatric Evaluation and Management.
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Affiliation(s)
- Melanie K Farlie
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Vic, Australia.,2538Monash Health, Cheltenham, Vic, Australia
| | - Freya French
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Vic, Australia.,5644Peninsula Health, Frankston, Vic, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Vic, Australia
| | - Nicholas F Taylor
- 1890Eastern Health, Box Hill, Vic, Australia.,College of Science Health and Engineering, La Trobe University Bundoora, Vic, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Vic, Australia.,5644Peninsula Health, Frankston, Vic, Australia
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Abstract
Elvin Hsing Geng and colleagues discuss mechanism mapping and its utility in conceptualizing and understanding how implementation strategies produce desired effects.
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Affiliation(s)
- Elvin H. Geng
- Center for Dissemination and Implementation, Institute for Public Health and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ana A. Baumann
- Division of Prevention Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Byron J. Powell
- Center for Dissemination and Implementation, Institute for Public Health and Brown School, Washington University, St. Louis, Missouri, United States of America
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Rappaport LG, VanderVennen MC, Monroe KK, McCaffery H, Stewart DA. Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay. Hosp Pediatr 2022; 12:79-85. [PMID: 34889353 DOI: 10.1542/hpeds.2021-006039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs). METHODS Data from 2012-2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions. We defined a weekend as 3 pm Friday to 3 pm Sunday. The Wilcoxon rank test was used for unadjusted analysis. Multiple logistic regression was used to estimate the odds of having LOS >1 day, >2 days, >3 days, and >4 days in weekend versus weekday groups. RESULTS Weekend admission significantly correlated with increased LOS (P < .001). Compared with weekdays, a weekend admission was associated with increased odds of having LOS >1, >2, and >3 days. This remained statistically significant while adjusting for the number of chronic conditions, procedures, and individuals with Black or Hispanic ethnicity compared with White ethnicity. LOS was not associated with sex or age of the patients. CONCLUSIONS Patients with SSRDs admitted on the weekend have an increased LOS compared with those admitted on a weekday. This may be due to a decrease in multidisciplinary care available during weekends. In future studies, researchers should aim to better understand the specific factors that contribute to this disparity and test interventions that may close the gap in care, including expanding to 7-day services, increasing mental health resources, and working to decrease the need for inpatient admissions.
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Affiliation(s)
- Leah G Rappaport
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Kimberly K Monroe
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - David A Stewart
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Sarkies MN, Robins LM, Jepson M, Williams CM, Taylor NF, O’Brien L, Martin J, Bardoel A, Morris ME, Carey LM, Holland AE, Long KM, Haines TP. Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial. PLoS Med 2021; 18:e1003833. [PMID: 34679090 PMCID: PMC8570499 DOI: 10.1371/journal.pmed.1003833] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 11/05/2021] [Accepted: 10/04/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND 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. METHODS AND FINDINGS 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 sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. CONCLUSIONS 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. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000029291.
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Affiliation(s)
- Mitchell N. Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, New South Wales, Australia
- Health Economics and Data Analytics Discipline, School of Public Health, Faculty of Health Sciences, Curtin University, Western Australia, Australia
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Lauren M. Robins
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Megan Jepson
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Cylie M. Williams
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Nicholas F. Taylor
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| | - Lisa O’Brien
- Department Occupational Therapy, School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Jenny Martin
- Department of Social Work and Human Services, School of Arts, Federation University Australia, Victoria, Australia
| | - Anne Bardoel
- Department of Management and Marketing, Swinburne University of Technology, Victoria, Australia
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Victoria, Australia
- Healthscope Academic and Research Collaborative in Health, Victorian Rehabilitation Centre, Glen Waverly, Victoria, Australia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
- Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Victoria, Australia
| | - Anne E. Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Victoria, Australia
| | - Katrina M. Long
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
| | - Terry P. Haines
- School of Primary and Allied Health Care, Monash University, Victoria, Australia
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Jepson M, Sarkies M, Haines T. Variation in inpatient allied health service provision in Australian and New Zealand hospitals. Australas J Ageing 2021; 41:70-80. [PMID: 34346159 DOI: 10.1111/ajag.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the variability of allied health services on weekends, relative to weekdays, throughout Australian and New Zealand hospitals. METHODS A prospective, cross-sectional observational study embedded within a cluster randomised control trial. Allied health managers provided administrative data relating to allied health service events. RESULTS In one month, there were a total of 243 549 allied health service events recorded from 91 sampled hospitals. The mean difference between weekday and weekend allied health service events (daily, per ward) for physiotherapy was 6.52 (95% CI 5.65 to 7.40), acute wards 12.03 (95% CI 10.25 to 13.82) and for metropolitan hospitals 14.47 (95% CI 12.22 to 16.73), revealing more allied health service events of longer duration on weekdays compared to weekends. CONCLUSIONS This research is the first of its kind to describe variation in allied health service provision and potential research to practice gaps across weekday and weekend days in various inpatient settings.
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Affiliation(s)
- Megan Jepson
- Department of Paramedicine, Monash University Peninsula Campus, Melbourne, Vic., Australia.,School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia
| | - Mitchell Sarkies
- School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia.,Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Melbourne, NSW, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia
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Bradley G, Baker K, Bailey C. The meaning of rehabilitation: a qualitative study exploring perspectives of occupational therapists and physiotherapists working with older people in acute care. Disabil Rehabil 2021; 43:2295-2303. [PMID: 31800328 DOI: 10.1080/09638288.2019.1697762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore how occupational therapists and physiotherapists constructed and interpreted the meaning of rehabilitation in relation to older people in acute care. DESIGN A focussed ethnographic study was undertaken, primarily using observation, interviewing and review of clinical records within one acute medical ward in a general hospital in the UK. Five patient participants gave consent for their episode of care to be studied, with observations and interviews primarily involving the identified patients and five occupational therapy and physiotherapy professionals. RESULTS Four themes were identified: rehabilitation as a process to facilitate physical improvement; rehabilitation as physiotherapy-led; rehabilitation as a place…but not here; and rehabilitation as a process which prioritises safety over function. Such conceptualisations of rehabilitation were recognised as rooted in social and historical perceptions and challenged the ideals of rehabilitation professionals. CONCLUSIONS The meaning of rehabilitation in acute care is shaped by a range of cultural, contextual and systemic influences. Recognising these influences, and subsequent challenges to rehabilitation ideals, can encourage professionals to work towards meaningful change.Implications for RehabilitationA reductionist version of rehabilitation was evident within this context which placed value on physical improvement, achieving optimum safety and led by physiotherapy.This version of rehabilitation was unsatisfactory to occupational therapists and physiotherapists in this setting and different to their ideals.Where rehabilitation may be associated with another place, practitioners should reflect on whether this is influencing patients becoming a lower priority for interventions whilst waiting and address this, if required, within their own reasoning, prioritisation and delegation.Those who recognise similarities with their own practice context could individually, and within teams, revisit definitions of rehabilitation to notice, document and have conversations about the ideals of their professions versus the reality of practice.Occupational therapists and physiotherapists can be champions for organisational and cultural change to promote rehabilitation as a multi-disciplinary phase of care working towards optimising improvements in wellbeing, function and safety, irrespective of location.
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Affiliation(s)
- Gemma Bradley
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Katherine Baker
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
| | - Catherine Bailey
- Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK
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14
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Huynh J, Horne D, Bryce R, Leswick DA. Is Call Karma Real? Resident After-Hours On-Call Imaging at the University of Saskatchewan: An Assessment of Call Volumes Including Inter-Resident Variability. Can Assoc Radiol J 2021; 73:38-48. [PMID: 34227429 DOI: 10.1177/08465371211026310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Quantify resident caseload during call and determine if there are consistent differences in call volumes for individuals or resident subgroups. METHODS Accession codes for after-hours computed tomography (CT) cases dictated by residents between July 1, 2012 and January 9, 2017 were reviewed. Case volumes by patient visits and body regions scanned were determined and categorized according to time period, year, and individual resident. Mean shift Relative Value Units (RVUs) were calculated by year. Descriptive statistics, linear mixed modeling, and linear regression determined mean values, differences between residents, associations between independent variables and outcomes, and changes over time. Consistent differences between residents were assessed as a measure of good or bad luck / karma on call. RESULTS During this time there were 23,032 patients and 30,766 anatomic regions scanned during 1,652 call shifts among 32 residents. Over the whole period, there were on average 10.6 patients and 14.3 body regions scanned on weekday shifts and 22.3 patients and 29.4 body regions scanned during weekend shifts. Annually, the mean number of patients, body regions, and RVUs scanned per shift increased by an average of 0.2 (1%), 0.4 (2%), and 1.2 (5%) (all p < 0.05) respectively in regression models. There was variability in call experiences, but only 1 resident had a disproportionate number of higher volume calls and fewer lower volume shifts than expected. CONCLUSIONS Annual increases in scan volumes were modest. Although residents' experiences varied, little of this was attributable to consistent personal differences, including luck or call karma.
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Affiliation(s)
- James Huynh
- Department of Medical Imaging, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - David Horne
- Department of Medical Imaging, University of Saskatchewan and Saskatchewan Health Authority, Saskatoon City Hospital, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- Clinical Research Support Unit, College of Medicine, Health Sciences Building, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David A Leswick
- Department of Medical Imaging, University of Saskatchewan and Saskatchewan Health Authority, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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15
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Sarkies MN, Robinson S, Briffa T, Duffy SJ, Nelson M, Beltrame J, Cullen L, Chew D, Smith J, Brieger D, Macdonald P, Liew D, Reid C. Applying a framework to assess the impact of cardiovascular outcomes improvement research. Health Res Policy Syst 2021; 19:67. [PMID: 33882947 PMCID: PMC8059028 DOI: 10.1186/s12961-021-00710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/21/2021] [Indexed: 01/06/2023] Open
Abstract
Background Health and medical research funding agencies are increasingly interested in measuring the impact of funded research. We present a research impact case study for the first four years of an Australian National Health and Medical Research Council funded Centre of Research Excellence in Cardiovascular Outcomes Improvement (2016–2020). The primary aim of this paper was to explore the application of a research impact matrix to assess the impact of cardiovascular outcomes improvement research. Methods We applied a research impact matrix developed from a systematic review of existing methodological frameworks used to measure research impact. This impact matrix was used as a bespoke tool to identify and understand various research impacts over different time frames. Data sources included a review of existing internal documentation from the research centre and publicly available information sources, informal iterative discussions with 10 centre investigators, and confirmation of information from centre grant and scholarship recipients. Results By July 2019, the impact on the short-term research domain category included over 41 direct publications, which were cited over 87 times (median journal impact factor of 2.84). There were over 61 conference presentations, seven PhD candidacies, five new academic collaborations, and six new database linkages conducted. The impact on the mid-term research domain category involved contributions towards the development of a national cardiac registry, cardiovascular guidelines, application for a Medicare Benefits Schedule reimbursement item number, introduction of patient-reported outcome measures into several databases, and the establishment of nine new industry collaborations. Evidence of long-term impacts were described as the development and use of contemporary management for aortic stenosis, a cardiovascular risk prediction model and prevention targets in several data registries, and the establishment of cost-effectiveness for stenting compared to surgery. Conclusions We considered the research impact matrix a feasible tool to identify evidence of academic and policy impact in the short- to midterm; however, we experienced challenges in capturing long-term impacts. Cost containment and broader economic impacts represented another difficult area of impact to measure. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00710-4.
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Affiliation(s)
- Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talavera Road, Sydney, NSW, 2109, Australia. .,Health Systems and Health Economics Group, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
| | - Suzanne Robinson
- Health Systems and Health Economics Group, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Tom Briffa
- Faculty of Health and Medical Sciences, Population and Public Health, The University of Western Australia, Perth, Australia
| | - Stephen J Duffy
- Department of General Cardiology, Alfred Health, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - John Beltrame
- Discipline of Medicine, University of Adelaide, Adelaide, Australia.,Cardiology Department, Central Adelaide Local Health Network, Adelaide, Australia.,Cardiology Department, Lyell McEwin Hospital, Adelaide, Australia
| | - Louise Cullen
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Derek Chew
- Department of Cardiovascular Medicine, Flinders University, Adelaide, Adelaide, Australia
| | - Julian Smith
- Department of Surgery (School of Clinical Sciences At Monash Health), Monash University, Melbourne, Australia.,Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - David Brieger
- Division of Cardiology, Concord Hospital and University of Sydney, Sydney, Australia
| | - Peter Macdonald
- St Vincent's Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Danny Liew
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Chris Reid
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Health Research and Data Analytics Hub, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia
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16
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Translating evidence into practice: a longitudinal qualitative exploration of allied health decision-making. Health Res Policy Syst 2021; 19:38. [PMID: 33736670 PMCID: PMC7977245 DOI: 10.1186/s12961-020-00662-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. Methods A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved. Results Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints? Conclusions This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.
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17
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Senserrick C, Lawler K, Scroggie GD, Williams K, Taylor NF. Three short sessions of physiotherapy during rehabilitation after hip fracture were no more effective in improving mobility than a single longer session: a randomised controlled trial. Physiotherapy 2020; 112:87-95. [PMID: 34052569 DOI: 10.1016/j.physio.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine if three short daily sessions of physiotherapy for rehabilitation inpatients after hip fracture is more effective than providing one long daily session in improving mobility. DESIGN A single-blinded randomised controlled trial. SETTING Two inpatient rehabilitation wards at a hospital in Melbourne, Australia. PARTICIPANTS Seventy-six rehabilitation inpatients after hip fracture. The key exclusion criterion was not being allowed to weight bear. INTERVENTIONS All participants received multidisciplinary rehabilitation. Experimental participants received three 15-minute sessions of physiotherapy 5 days per week until discharge. Control participants received one 45-minute session of physiotherapy 5 days per week until discharge. MAIN OUTCOME MEASURES The primary outcome, mobility, was assessed with the de Morton Mobility Index 2 weeks after admission and at discharge. Secondary outcomes were Functional Independence Measure mobility (transfers, ambulation, steps), physical activity measured with an accelerometer, length of stay, discharge destination, readmissions within 30 days of discharge, and patient and physiotherapist satisfaction. RESULTS Sixty-seven (88%) participants completed mobility assessment at discharge and 34 (45%) at 2 weeks. There were a greater proportion of missed sessions in the experimental group (84% adherence vs 95%). There was no between-group difference in mobility at discharge (MD -1.9 points, 95%CI-6.9 to 3.2) or at 2 weeks (MD -3.5 points, 95%CI-15.4 to 8.4). There were no between-group differences in any secondary outcomes. CONCLUSIONS Providing inpatient physiotherapy rehabilitation in three shorter sessions resulted in more missed sessions and likely did not improve mobility outcomes compared with providing one longer session for patients recovering from hip fracture. CLINICAL TRIAL REGISTRATION NUMBER ACTRN 12617000863336.
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Affiliation(s)
- Catherine Senserrick
- Physiotherapy Department, Peter James Centre, Eastern Health, Burwood East, Victoria, 3151, Australia.
| | - Katherine Lawler
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria 3128, Australia; Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, 7005, Australia.
| | - Grant D Scroggie
- Physiotherapy Department, Peter James Centre, Eastern Health, Burwood East, Victoria, 3151, Australia.
| | - Kim Williams
- Physiotherapy Department, Peter James Centre, Eastern Health, Burwood East, Victoria, 3151, Australia.
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria 3128, Australia; College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, 3086, Australia.
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18
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Sarkies M, Long JC, Pomare C, Wu W, Clay-Williams R, Nguyen HM, Francis-Auton E, Westbrook J, Levesque JF, Watson DE, Braithwaite J. Avoiding unnecessary hospitalisation for patients with chronic conditions: a systematic review of implementation determinants for hospital avoidance programmes. Implement Sci 2020; 15:91. [PMID: 33087147 PMCID: PMC7579904 DOI: 10.1186/s13012-020-01049-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/01/2020] [Indexed: 12/31/2022] Open
Abstract
Background Studies of clinical effectiveness have demonstrated the many benefits of programmes that avoid unnecessary hospitalisations. Therefore, it is imperative to examine the factors influencing implementation of these programmes to ensure these benefits are realised across different healthcare contexts and settings. Numerous factors may act as determinants of implementation success or failure (facilitators and barriers), by either obstructing or enabling changes in healthcare delivery. Understanding the relationships between these determinants is needed to design and tailor strategies that integrate effective programmes into routine practice. Our aims were to describe the implementation determinants for hospital avoidance programmes for people with chronic conditions and the relationships between these determinants. Methods An electronic search of four databases was conducted from inception to October 2019, supplemented by snowballing for additional articles. Data were extracted using a structured data extraction tool and risk of bias assessed using the Hawker Tool. Thematic synthesis was undertaken to identify determinants of implementation success or failure for hospital avoidance programmes for people with chronic conditions, which were categorised according to the Consolidated Framework for Implementation Research (CFIR). The relationships between these determinants were also mapped. Results The initial search returned 3537 articles after duplicates were removed. After title and abstract screening, 123 articles underwent full-text review. Thirteen articles (14 studies) met the inclusion criteria. Thematic synthesis yielded 23 determinants of implementation across the five CFIR domains. ‘Availability of resources’, ‘compatibility and fit’, and ‘engagement of interprofessional team’ emerged as the most prominent determinants across the included studies. The most interconnected implementation determinants were the ‘compatibility and fit’ of interventions and ‘leadership influence’ factors. Conclusions Evidence is emerging for how chronic condition hospital avoidance programmes can be successfully implemented and scaled across different settings and contexts. This review provides a summary of key implementation determinants and their relationships. We propose a hypothesised causal loop diagram to represent the relationship between determinants within a complex adaptive system. Trial registration PROSPERO 162812
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Affiliation(s)
- Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia.
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Wendy Wu
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Hoa Mi Nguyen
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Emilie Francis-Auton
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Agency for Clinical Innovation, New South Wales, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, New South Wales, Australia
| | - Diane E Watson
- Bureau of Health Information, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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19
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Chiu CY, Oria D, Yangga P, Kang D. Quality assessment of weekend discharge: a systematic review and meta-analysis. Int J Qual Health Care 2020; 32:347-355. [PMID: 32453404 DOI: 10.1093/intqhc/mzaa060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. DATA SOURCES PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. STUDY SELECTION Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. DATA EXTRACTION Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. RESULTS OF DATA SYNTHESIS There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. CONCLUSION In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
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Affiliation(s)
- Chia-Yu Chiu
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - David Oria
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Peter Yangga
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
| | - Dasol Kang
- Department of Internal Medicine, Lincoln Medical Center, Room 8-20, 234 E 149th St, New York, NY 10451, USA
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20
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Haas R, Bowles KA, O'Brien L, Haines T. The effect of transferring weekend physical therapy services from the acute to sub-acute setting in patients following hip and knee arthroplasty: a quasi-experimental study. Physiother Theory Pract 2020; 38:648-660. [PMID: 32568601 DOI: 10.1080/09593985.2020.1777604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Weekend physical therapy services in the acute and/or sub-acute setting may optimize postoperative recovery following hip and knee arthroplasty, though evidence supporting these services is limited. PURPOSE To explore the change in patient and service outcomes of transferring a weekend physical therapy service from the acute to the sub-acute setting following hip and knee arthroplasty. METHODS This was a quasi-experimental research design nested within two stepped-wedge cluster randomized controlled trials. Acute weekend physical therapy services were sequentially discontinued and reallocated to the sub-acute setting in a random order from one ward at a time within the broader trial. Patient and service outcomes for participants 6 weeks following hip and knee arthroplasty (N = 247) were compared during 6 months of acute weekend physical therapy services (Phase 1, n = 117) followed by 6 months of sub-acute services (Phase 2, n = 130). Intention-to-treat statistical analyses were conducted. RESULTS The intervention had a negligible effect on medium-term outcomes. The only statistically significant difference observed was slightly higher ratings of "worst pain experienced over the past week" [coefficient 0.865 (0.123 to 1.606), p = .022] during Phase 2. No interaction effects were observed despite a 2.4-day reduction in length of stay amongst complex patients during Phase 2 (18.28 and 15.86 days in Phase 1 and 2, respectively). CONCLUSIONS No comparative advantage or disadvantage was observed by reallocating a weekend physical therapy budget from the acute to sub-acute setting following hip and knee arthroplasty. Further research investigating the cost-effectiveness of these services in the sub-acute setting may be warranted for complex patients.
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Affiliation(s)
- Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedics, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University and Monash Health Allied Health Research Unit, Frankston, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University and Monash Health Allied, Health Research Unit, Frankston, Australia
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21
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Snowdon DA, Storr B, Davis A, Taylor NF, Williams CM. The effect of delegation of therapy to allied health assistants on patient and organisational outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2020; 20:491. [PMID: 32493386 PMCID: PMC7268306 DOI: 10.1186/s12913-020-05312-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 05/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background Allied health assistants (AHAs) are support staff who complete clinical and non-clinical tasks under the supervision and delegation of an allied health professional. The effect of allied health professional delegation of clinical tasks to AHAs on patient and healthcare organisational outcomes is unknown. The purpose of this systematic review was to investigate the effect of allied health professional delegation of therapy to AHAs on patient and organisational outcomes. Methods A systematic review and meta-analysis was conducted. Databases MEDLINE (Ovid), Embase (Ovid), Informit (all databases), Emcare (Ovid), PsycINFO (Ovid), Cumulative Index to Nursing and Allied Health Literature [CINAHL] (EbscoHost) and the Cochrane Database of Systematic Reviews were searched from earliest date available. Additional studies were identified by searching reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of the study was rated using internal validity items from the Downs and Black checklist. Risk ratios (RR) and mean differences (MD) were calculated for patient and organisational outcomes. Meta-analyses were conducted using the inverse variance method and random-effects model. Results Twenty-two studies met the inclusion criteria. Results of meta-analysis provided low quality evidence that AHA supervised exercise in addition to usual care improved the likelihood of patients discharging home (RR 1.28, 95%CI 1.03 to 1.59, I2 = 60%) and reduced length of stay (MD 0.28 days, 95%CI 0.03 to 0.54, I2 = 0%) in an acute hospital setting. There was preliminary evidence from one high quality randomised controlled trial that AHA provision of nutritional supplements and assistance with feeding reduced the risk of patient mortality after hip fracture (RR 0.41, 95%CI 0.16 to 1.00). In a small number of studies (n = 6) there was no significant difference in patient and organisational outcomes when AHA therapy was substituted for therapy delivered by an allied health professional. Conclusion We found preliminary evidence to suggest that the use of AHAs to provide additional therapy may be effective for improving some patient and organisational outcomes. Review registration CRD42019127449.
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Affiliation(s)
- David A Snowdon
- Professional Academic Unit, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia.
| | - Beth Storr
- Department of Physiotherapy, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education Research (WISER) unit, Monash Health, Clayton, VIC, 3168, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, 3128, Australia.,College of Science, Health and Engineering, La Trobe University, Bundoora, 3083, Australia
| | - Cylie M Williams
- Department of Physiotherapy, Peninsula Health, Monash University, Frankston, VIC, 3199, Australia
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22
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Capo-Lugo CE, Askew RL, Naidech A, Prabhakaran S. Patients With Greater Stroke Severity and Premorbid Disability Are Less Likely to Receive Therapist Consultations and Intervention During Acute Care Hospitalization. Phys Ther 2019; 99:1431-1442. [PMID: 31390013 PMCID: PMC7325450 DOI: 10.1093/ptj/pzz116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/20/2018] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients' functioning. OBJECTIVE The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. DESIGN This was a single-center longitudinal observational study. METHODS Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both. RESULTS Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19-0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28-0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23-0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6-15: OR = 1.43 [95% CI = 1.01-2.33]) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91-13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non-intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations. LIMITATIONS Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions. CONCLUSIONS Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
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Affiliation(s)
- Carmen E Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, SHPB 360X, Birmingham, AL 35294 (USA)
| | - Robert L Askew
- Department of Psychology, Stetson University, DeLand, Florida
| | - Andrew Naidech
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago, Chicago, Illinois
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23
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Brusco NK, Tilley L, Walpole B, Kugler H, Li R, Kennedy E, Morris ME. Feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent tasks and exercises: 'My Therapy'. Aust Occup Ther J 2019; 66:739-752. [PMID: 31602693 DOI: 10.1111/1440-1630.12614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The dosage of occupational therapy and physiotherapy positively correlates with rehabilitation patient and health service outcomes. Nevertheless, increasing the dosage during inpatient rehabilitation without additional resources can be challenging. This study aimed to determine feasibility of increasing the dosage of inpatient occupational therapy and physiotherapy rehabilitation with independent tasks and exercises outside of supervised sessions, the 'My Therapy' programme. METHODS A two-group, quasi-experimental, pre-post-design examined feasibility of delivering My Therapy in addition to usual care, compared to usual care alone, for hospitalised musculoskeletal and frail older rehabilitation patients. My Therapy was prescribed by the occupational therapist and physiotherapist. A booklet was provided with an individually tailored set of tasks and exercises that were a sub-set of routine therapy, to be practised safely, effectively and independently outside of supervised sessions. The primary outcome was feasibility of My Therapy implementation to achieve at least 70% adherence. Secondary outcomes were self-reported daily My Therapy participation (minutes), total daily rehabilitation participation (minutes), adverse events, length of stay, 10-metre walk speed, FIM scores and discharge destination. RESULTS Participation in My Therapy was achieved by 72% (83/116) of the My Therapy group, who averaged 14 min (SD 14) of daily practice outside of supervised sessions. Total daily rehabilitation participation was 177 min (SD 47) for My Therapy participants (n = 116) and 148 min (SD 88) for usual care participants (n = 89); mean difference 30 min (p = .00). A minimal clinically important difference in FIM was achieved for a significantly higher portion of the My Therapy group (22%, n = 26) compared to usual care (10%, n = 9; p = .02). There were no adverse events, safety concerns or group differences for other secondary outcomes. CONCLUSION My Therapy was a feasible and safe way to increase the dosage of inpatient occupational therapy and physiotherapy rehabilitation via independent practice. Clinical Trial Registry: ACTRN12616000691448.
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Affiliation(s)
- Natasha K Brusco
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia.,Alpha Crucis Group, Senior Associate and Health Economist, Melbourne, Victoria, Australia.,Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Louise Tilley
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Brianna Walpole
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Helen Kugler
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Ran Li
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Emma Kennedy
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia
| | - Meg E Morris
- Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Victoria, Australia.,La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Victoria, Australia
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24
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Taylor NF, Lawler K, Brusco NK, Peiris CL, Harding KE, Scroggie GD, Boyd JN, Wilton AM, Coker F, Ferraro JG, Shields N. Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial. Australas J Ageing 2019; 39:64-72. [DOI: 10.1111/ajag.12669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 03/26/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Nicholas F. Taylor
- Eastern Health Allied Health Clinical Research Office Box HillVictoria Australia
- School of Allied Health Human Services and SportLa Trobe University Bundoora Victoria Australia
| | - Katherine Lawler
- Eastern Health Allied Health Clinical Research Office Box HillVictoria Australia
- Eastern Health Allied Health Box HillVictoria Australia
| | | | - Casey L. Peiris
- School of Allied Health Human Services and SportLa Trobe University Bundoora Victoria Australia
| | - Katherine E. Harding
- Eastern Health Allied Health Clinical Research Office Box HillVictoria Australia
- School of Allied Health Human Services and SportLa Trobe University Bundoora Victoria Australia
| | | | - Jude N. Boyd
- Eastern Health Allied Health Box HillVictoria Australia
| | | | - Freya Coker
- Monash UniversitySchool of Primary and Allied Health Care Frankston Victoria Australia
| | | | - Nora Shields
- School of Allied Health Human Services and SportLa Trobe University Bundoora Victoria Australia
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