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Beecroft A, Bolton KA, Mundell NL, Kremer P, Sahlqvist S. "So many people don't understand what exercise physiology is." Understanding the integration of Accredited Exercise Physiologists within Australian healthcare: A qualitative study. J Sci Med Sport 2025; 28:512-518. [PMID: 39757029 DOI: 10.1016/j.jsams.2024.12.011] [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: 09/05/2024] [Revised: 11/10/2024] [Accepted: 12/16/2024] [Indexed: 01/07/2025]
Abstract
OBJECTIVES To explore the perspectives and experiences of Accredited Exercise Physiologists (AEPs) regarding their integration within the Australian healthcare setting. DESIGN A qualitative descriptive approach utilising semi-structured interviews. METHODS Practicing AEPs (n = 15) completed interviews via videoconferencing between May and July 2023. Interviews were digitally transcribed, and data analysed using reflexive thematic analysis. RESULTS Five primary themes were identified: understanding (with three subthemes related to the general population, health professionals, and the role of an AEP in promoting greater understanding), communication (with three subthemes related to the value of communication between AEPs and the referrer, the referrer and the client, and AEPs and other health professionals), the need for greater mentorship, further education and professional development in early-career AEPs, and systemic factors (cost, access, and procedural difficulties). CONCLUSIONS The findings highlight the value of having AEPs co-located with other health professionals (including general practitioners) and suggest that greater education on the role and benefits of an AEP may be required. Future studies should explore the views of the general population, current clients and other health professionals to design solutions for optimising integration of AEP services within the Australian healthcare system.
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Affiliation(s)
- Aaron Beecroft
- School of Exercise and Nutrition Sciences, Deakin University, Australia.
| | - Kristy A Bolton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Niamh L Mundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Peter Kremer
- School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Shannon Sahlqvist
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Australia
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Senior GGC, Stapleton JN. Diversity, physical activity, and referral by university campus healthcare services to physical activity counseling. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2025:1-4. [PMID: 39879523 DOI: 10.1080/07448481.2024.2449427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 11/05/2024] [Accepted: 12/29/2024] [Indexed: 01/31/2025]
Abstract
Objective: To identify student diversity, physical activity (PA), and PA referrals to PA counseling by campus healthcare providers (HCPs). Participants: University students (n = 1030, Mage = 21.14) utilizing on-campus healthcare. Methods: Data were collected from university healthcare visits. PA was measured using Physical Activity Vital Sign. Results: The final sample was predominantly women (74.6%), non-Hispanic or Latino (83.2%), and white (60.9%). Fifty-seven percent were insufficiently active. Men and white students reported significantly more weekly minutes of PA than women and students of color, respectively (ps < .01). There were no significant differences in PA between ethnic groups (p = .39). PA referrals by HCPs were completed in only 1.5% of the sample. Conclusion: Given that most university students were insufficiently active, whilst low rates of PA referrals by HCPs occurred, interventions to increase PA among diverse samples of university students and PA referrals among HCPs are imperative.
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Affiliation(s)
- Gabriella G C Senior
- Department of Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
| | - Jessie N Stapleton
- Department of Clinical and Applied Movement Sciences, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA
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Pascoe MC, Patten RK, Tacey A, Woessner MN, Bourke M, Bennell K, Tran P, McKenna MJ, Apostolopoulos V, Lane R, Koska J, Asilioglu A, Sheeny J, Levinger I, Parker A. Physical activity and depression symptoms in people with osteoarthritis-related pain: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003129. [PMID: 39024243 PMCID: PMC11257243 DOI: 10.1371/journal.pgph.0003129] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/27/2024] [Indexed: 07/20/2024]
Abstract
Osteoarthritis is a leading cause of chronic pain and is associated with high rates of depression. Physical activity reduces depression symptoms and pain levels. It remains unknown if physical activity is associated with lower symptoms of depression irrespective of pain levels in individuals with osteoarthritis. We explored whether pain mediated or moderated the relationship between levels of physical activity engagement and depression symptoms. Individuals with osteoarthritis who were waiting for an orthopaedic consultation at a public hospital in Melbourne, Australia, were recruited. Data collected on pain levels, physical activity engagement and depression symptoms. Descriptive statistics were used to summarise participant characteristics. Moderation and mediation analyses were used to establish the impact of pain on the relationship between physical activity and depression, after adjusting for demographic and joint specific characteristics. The results indicated that the inverse association between physical activity and depression depended on the level of pain, such that the association was stronger in people with greater pain. The mediation results confirm that participating in physical activity is indirectly, inversely associated with symptoms of depression through lower levels of pain. The highest levels of pain were associated with the most potential benefit in terms of reduction in symptoms of depression from engaging in physical activity. Physical activity may be particularly important to manage depression symptoms in people with greater osteoarthritis-related pain as patients with the highest pain may have the greatest benefits.
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Affiliation(s)
- Michaela C. Pascoe
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Rhiannon K. Patten
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Alexander Tacey
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
| | - Mary N. Woessner
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Matthew Bourke
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Canada
| | - Kim Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Phong Tran
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Michael J. McKenna
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Rebecca Lane
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Jakub Koska
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia
| | - Alev Asilioglu
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Jodie Sheeny
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, University of Melbourne and Western Health, Melbourne, Australia
| | - Alexandra Parker
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Gilson ND, Papinczak ZE, Haslam C, Mielke GI, Fooken J, Brown WJ. A stepped down physical activity support program for military service veterans: The Active Choices pilot study. Health Promot J Austr 2024; 35:844-848. [PMID: 37724696 DOI: 10.1002/hpja.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
ISSUE ADDRESSED Referral to supervised physical activity (PA) programs is an effective treatment for military service veterans (MSVs) suffering from a range of chronic diseases. However, many MSVs fail to maintain PA regimes once discharged from supervision. This pilot study assessed Active Choices, a stepped-down program to support MSVs in the transition from allied health treatment to self-managed PA. METHODS Participants were 34 Australian MSVs (mean [SD] age = 61 [15.8] years) who were completing supervised referral to an exercise physiologist or physiotherapist. MSVs stepped-down to Active Choices and received a 12-week, evidence-based PA support program (2020-2021). Analyses compared within-group changes in accelerometer-assessed PA at three time points (Weeks 0, 12, and 24; linear mixed model). Program retention, PA choices, and allied healthcare service costs were also evaluated. RESULTS Relative to baseline (64 [26] min/day), mean (SD) moderate-to-vigorous PA increased (74 [28] min/day; p < .05) and was maintained (62 [28] min/day) at weeks 12 and 24, respectively. Retention in the program was high (86% [29/34 participants] completion rate at 12 weeks), with water-based group activities the most popular PAs of choice (14/24 activities). Average allied healthcare service costs during the study were lower than typical costs for MSVs (60.51 vs. 97.06 AUD/week). CONCLUSION The findings highlight the potential of Active Choices to support MSVs in the transition from supervised to self-managed MVPA. SO WHAT?: The program could promote the health of veterans and reduce costs for ongoing referral if impact is replicated at scale.
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Affiliation(s)
- Nicholas D Gilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Zoe E Papinczak
- Queensland Centre for Mental Health Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Gregore I Mielke
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Maricar N, Khan B, David T, Hyrich KL, Barton A. Factors facilitating and hindering South Asian immigrant adults from engaging in exercise and physical activity - a qualitative systematic review. BMC Public Health 2024; 24:1342. [PMID: 38762730 PMCID: PMC11102233 DOI: 10.1186/s12889-024-18288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/05/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Exercise and physical activity are key components of management in patients with rheumatic musculoskeletal diseases (RMD), but people of the South Asian communities have a lower level of engagement with these activities compared to their Caucasian counterparts. The aim of this qualitative systematic review was to determine the barriers and facilitators of exercise and physical activity in South Asian communities who have migrated and live in western countries, particularly in those who have RMD. METHODS Qualitative studies, published in English between 1999 and 2021 and including evaluation of barriers and/or facilitators to exercise or physical activity behaviour in people of South Asian adult communities who have migrated and/or lived in western countries were identified from Embase, MEDLINE, CINAHL, PsycINFO, Google Scholar and manual searches. The studies were appraised using the CASP checklist. Inductive thematic synthesis was used to identify common and global themes. RESULTS A total of 32 studies that discussed barriers and facilitators of physical activity in South Asian communities who have migrated and lived in western countries were used for this review but there were no studies identified that focussed specifically on those with RMD. Following appraisal of the reporting of the studies, 30 studies were included in the pooling of the results. The facilitators and barriers to physical activities were broadly categorized into 'extrinsic' and 'intrinsic' factors. Extrinsic factors such as 'opportunity' included environmental factors such as weather and safety; socioeconomic factors such as education, language and literacy, and support in the form of social, psychological and resources. Intrinsic factors included cultural factors, such as life stages and family influence, beliefs and knowledge, which impacted attitudes and skills. CONCLUSIONS This review has synthesised evidence of barriers or facilitators and identified potentially modifiable factors influencing physical activity and exercise engagement, which could form the basis of evidence-based interventions to promote participation in healthy behaviour change. Provision of a safe, comfortable and culturally acceptable environment together with culturally-aligned cognitive strategies to facilitate acquisition of exercise-efficacy skills could help engagement. REGISTRATION The systematic review was registered on PROSPERO, registration no. 289,235.
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Affiliation(s)
- Nasimah Maricar
- Northern Care Alliance NHS Foundation Trust, Salford Royal NHS Foundation Trust, Manchester, UK.
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK.
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
| | - Behram Khan
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Trixy David
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
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Chapman N, Marques FZ, Picone DS, Adji A, Broughton BRS, Dinh QN, Gabb G, Lambert GW, Mihailidou AS, Nelson MR, Stowasser M, Schlaich M, Schultz MG, Mynard JP, Climie RE. Content and delivery preferences for information to support the management of high blood pressure. J Hum Hypertens 2024; 38:70-74. [PMID: 35948655 PMCID: PMC10803250 DOI: 10.1038/s41371-022-00723-8] [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] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
Blood pressure(BP) management interventions have been shown to be more effective when accompanied by appropriate patient education. As high BP remains poorly controlled, there may be gaps in patient knowledge and education. Therefore, this study aimed to identify specific content and delivery preferences for information to support BP management among Australian adults from the general public. Given that BP management is predominantly undertaken by general practitioners(GPs), information preferences to support BP management were also ascertained from a small sample of Australian GPs. An online survey of adults was conducted to identify areas of concern for BP management to inform content preferences and preferred format for information delivery. A separate online survey was also delivered to GPs to determine preferred information sources to support BP management. Participants were recruited via social media. General public participants (n = 465) were mostly female (68%), >60 years (57%) and 49% were taking BP-lowering medications. The management of BP without medications, and role of lifestyle in BP management were of concern among 30% and 26% of adults respectively. Most adults (73%) preferred to access BP management information from their GP. 57% of GPs (total n = 23) preferred information for supporting BP management to be delivered via one-page summaries. This study identified that Australian adults would prefer more information about the management of BP without medications and via lifestyle delivered by their GP. This could be achieved by providing GPs with one-page summaries on relevant topics to support patient education and ultimately improve BP management.
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Affiliation(s)
- N Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - F Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University, Melbourne, VIC, Australia
- Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - D S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - A Adji
- Victor Chang Cardiac Research Institute/ St Vincent's Hospital, Sydney, NSW, Australia
| | - B R S Broughton
- Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Q N Dinh
- Centre for Cardiovascular Biology and Disease Research, Department of Physiology, Anatomy and Microbiology, La Trobe University, VIC, Melbourne, Australia
| | - G Gabb
- Cardiology Department, Southern Adelaide Local Health Network, Adelaide, SA, Australia
- Acute and Urgent Care, Central Adelaide Local Health Network, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Medicine, Faculty of Health Science, University of Adelaide, Adelaide, SA, Australia
| | - G W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - A S Mihailidou
- Department of Cardiology & Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
- Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - M R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - M Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - M Schlaich
- Dobney Hypertension Centre, Medical School-University of Western Australia, Perth, TAS, Australia
- Royal Perth Hospital Unit, Perth, WA, Australia
| | - M G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - J P Mynard
- Heart Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, TAS, Australia
| | - R E Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Vaughan B, Fleischmann M, Grace S, Engel R, Fitzgerald K, Steel A, Peng W, Adams J. Osteopathy Referrals to and from General Practitioners: Secondary Analysis of Practitioner Characteristics from an Australian Practice-Based Research Network. Healthcare (Basel) 2023; 12:48. [PMID: 38200954 PMCID: PMC10778730 DOI: 10.3390/healthcare12010048] [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: 11/03/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals (n = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals (n = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.
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Affiliation(s)
- Brett Vaughan
- Department of Medical Education, The University of Melbourne, Melbourne, VIC 3010, Australia;
- School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.F.); (A.S.); (W.P.); (J.A.)
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia; (S.G.); (R.E.)
| | - Michael Fleischmann
- School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.F.); (A.S.); (W.P.); (J.A.)
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC 3001, Australia
| | - Sandra Grace
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia; (S.G.); (R.E.)
| | - Roger Engel
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia; (S.G.); (R.E.)
- Department of Chiropractic, Macquarie University, Sydney, NSW 2000, Australia
| | - Kylie Fitzgerald
- Department of Medical Education, The University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Amie Steel
- School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.F.); (A.S.); (W.P.); (J.A.)
| | - Wenbo Peng
- School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.F.); (A.S.); (W.P.); (J.A.)
| | - Jon Adams
- School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia; (M.F.); (A.S.); (W.P.); (J.A.)
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Ooi JJY, Hutchinson R, Harris GA. Confusion among doctors regarding sports and exercise medicine as a specialty: an Australian multidisciplinary, cross-sectional survey. BMJ Open 2023; 13:e072979. [PMID: 37748847 PMCID: PMC10533687 DOI: 10.1136/bmjopen-2023-072979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This cross-sectional study aims to characterise the understanding and attitudes medical practitioners have towards sports and exercise medicine (SEM). By identifying knowledge gaps, misunderstandings and barriers to SEM referral, interventions may be suggested to improve the integration of SEM within a multidisciplinary approach to healthcare. DESIGN A survey was constructed with a multidisciplinary expert panel. Refinement and consensus were achieved through a modified Delphi method. Both quantitative and qualitative data were analysed and intergroup comparisons made using χ2 test of independence and post-hoc paired comparisons. SETTING The questionnaire was distributed across Australian public and private health sectors, in community and hospital-based settings. PARTICIPANTS Australian medical doctors practising in specialties likely to intersect with SEM were invited; including general practice, orthopaedics, emergency, rheumatology and anaesthetics/pain. Invitation was uncapped with no reportable response rate. A total of 120 complete responses were collected RESULTS: The minority (42.5%) of respondents understood the role and scope of sports and exercise physicians. SEM was poorly recognised and comprehended, with the most common misconception being that SEM is solely for elite athletes and performance. Few (20%) doctors were familiar with referral pathways to SEM services. Lack of awareness, clear scope and public presence were seen as major barriers. There was near unanimous (92.5%) agreement that 'exercise is medicine'. A strong majority felt SEM would be valuable to collaborate with more in their current practice (63.3%) and as a part of the Australian public health system (82.5%). There were some significant differences among subgroups, including that junior doctors were more likely to express confusion about SEM. CONCLUSIONS Among non-SEM doctors, there is significant lack of clarity regarding the role of SEM and its optimal integration. Interdisciplinary education and addressing misconceptions may improve the contribution of SEM to community healthcare.
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Affiliation(s)
| | - Robin Hutchinson
- Novar Musculoskeletal Research Institute, Ballarat, Victoria, Australia
| | - Gregory A Harris
- Ballarat Orthopaedics & Sports Medicine, Ballarat, Victoria, Australia
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Sahlqvist S, Rees B, Hoffmann S, McCoombe S, Santoro G, Kremer P. Physical activity knowledge, attitudes and behaviours of pre-clinical medical students attending an Australian university. BMC MEDICAL EDUCATION 2022; 22:642. [PMID: 35999626 PMCID: PMC9400261 DOI: 10.1186/s12909-022-03695-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Through the provision of advice and counselling, general practitioners (GPs) play an important part in promoting physical activity (PA). Lack of knowledge is a key barrier to engaging in such practice. Little is known about the knowledge and attitudes of current medical students and their preparedness to engage in PA promoting practice in the future. This study aimed to investigate the PA knowledge, attitudes and behaviours of medical students attending an Australian university. METHODS A sample of 107 pre-clinical medical students from an Australian university completed an online survey. Questions asked about age, sex and past-week PA behaviour (using the International Physical Activity Questionnaire-Short form) as well as understanding of key PA messages and perceptions of the role of a GP, confidence to engage in PA promoting practices and satisfaction with current medical school training (responses were on 5-point Likert scale). Descriptive statistics (proportions, means) were used to summarise demographic and attitudinal measures. RESULTS Almost all students (92%) were categorised as being moderately or highly active in the past-week. Knowledge of key PA messages was moderate (3.6 ± 0.9), however understanding of key messages about the dose of PA varied (ranging from 0% to 80.4% agreement). GPs were regarded as having a role to play in promoting PA; with high agreement that discussing the benefits of PA is a part of the role of a GP (4.7 ± 0.5). There was only moderate agreement that participants had received training in the health benefits of PA (3.1 ± 1.0) and in PA counselling (3.2 ± 1.0). Students indicated lower levels of satisfaction with this training (2.5 ± 0.9). CONCLUSIONS Students in this study were typically physically active, had positive attitudes toward PA and felt that it was the role of the GP to engage in PA promoting practices. Students understood key PA messages, and while they reportedly received some training in providing PA counselling, they were somewhat dissatisfied with this training.
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Affiliation(s)
- Shannon Sahlqvist
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3216, Australia.
| | - Brenton Rees
- Centre for Sport Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3216, Australia
| | - Samantha Hoffmann
- Centre for Sport Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3216, Australia
| | - Scott McCoombe
- Medical Education Unit, Medical School, The University of Western Australia, Perth, 6009, Australia
| | - Giuseppe Santoro
- Centre for Sport Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3216, Australia
| | - Peter Kremer
- Centre for Sport Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3216, Australia
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10
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Carrard J, Gut M, Croci I, McMahon S, Gojanovic B, Hinrichs T, Schmidt-Trucksäss A. Exercise Science Graduates in the Healthcare System: A Comparison Between Australia and Switzerland. Front Sports Act Living 2022; 4:766641. [PMID: 35419518 PMCID: PMC8998636 DOI: 10.3389/fspor.2022.766641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/31/2022] [Indexed: 12/17/2022] Open
Abstract
Physical inactivity (PI) is a leading risk factor for global mortality worldwide, a major preventable cause of non-communicable diseases (NCDs) and a socioeconomic burden for healthcare systems. Fortunately, evidence shows that exercise interventions delivered by qualified exercise science graduates is an effective way to reduce PI, prevent and treat NCDs. This study compares the integration of exercise science graduates, defined as university graduates with degrees in sport and exercise science, in the healthcare systems of Australia, a commonly cited model in this regard, and Switzerland, a country considered to have an effective but costly healthcare system. For both countries, three domains were reviewed: healthcare system, exercise science graduates' education, and roles played by exercise science graduates in healthcare system. Australia formally recognizes specifically trained exercise science graduates (referred to as Accredited Exercise Physiologists) as healthcare professionals. The exercise interventions they deliver, which were shown to be cost-effective and lead to positive health outcomes, are covered by Medicare, the Australian universal health insurance. However, Medicare covers only a maximum of 5 yearly sessions of all allied-health services taken together. Conversely, Switzerland, despite offering university master's degrees that focus on physical activity delivery to clinical populations, does not recognize the respective graduates as healthcare providers. As a result, their services are not covered by the Swiss health insurances. The latter do, however, cover a generous number of services (not formally limited) delivered by other allied-health professionals. In conclusion, Australia makes a better use of exercise science graduates than Switzerland does. Switzerland would benefit from establishing a clinical profession for exercise science graduates, defining competencies that they should acquire and setting their scope of practice. The very restricted number of therapy sessions covered by Medicare might limit the positive impact exercise science graduates have on the Australian healthcare system. Overall, mutual learning between countries can promote development and global recognition of clinical positions for exercise science graduates.
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Affiliation(s)
- Justin Carrard
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- *Correspondence: Justin Carrard
| | - Maurin Gut
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Ilaria Croci
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stephen McMahon
- Emergency Department and Orthopaedics Unit, Ballarat Health Services, Ballarat, VIC, Australia
| | - Boris Gojanovic
- Sports Medicine, Swiss Olympic Medical Center, Hôpital de la Tour, Meyrin, Switzerland
- Centre SportAdo, Woman-Mother-Child Department (DFME), Lausanne University and Hospital (CHUV), Lausanne, Switzerland
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Morgan K, Lewis J, Hawkins J, Moore G. From a research trial to routine practice: stakeholders' perceptions and experiences of referrals to the National Exercise Referral Scheme (NERS) in Wales. BMC Health Serv Res 2021; 21:1232. [PMID: 34774040 PMCID: PMC8590360 DOI: 10.1186/s12913-021-07266-7] [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: 06/24/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Over ten years on from a randomised controlled trial and subsequent national roll-out, the National Exercise Referral Scheme (NERS) continues to be routinely delivered in primary care across Wales, UK. Few studies have revisited effective interventions years into their delivery in routine practice to understand how implementation, and perceived effects, have been maintained over time. This study explores perceptions and experiences of referral to NERS among referrers, scheme deliverers and patients. Methods Individual, semi-structured interviews were conducted with 50 stakeholders: scheme referrers (n = 9); scheme deliverers (n = 22); and referred patients (n = 19). Convenience sampling techniques were used to recruit scheme referrers and purposive sampling to recruit scheme deliverers and patients. Thematic analysis was employed. Results Analyses resulted in five key themes; referrer characteristics, geographical disparities in referral and scheme access, reinforcements for awareness of the scheme, patient characteristics and processes and context underpinning a referral. Overall there was a high concordance of views between all three stakeholder groups and barriers and facilitators were found to be entwined within and across themes. Referral barriers persisting since the earlier trial included a lack of consultation time and a lack of referral feedback. Newly identified barriers included a lack of scheme awareness and a referral system perceived to be time intensive and disjointed. Key referral facilitators included patient self-referrals, a growing scheme reputation and promotional activities of scheme deliverers. Conclusions Findings provide evidence that could inform the further development of NERS and wider exercise referral schemes to ensure the referral process is timely, efficient and equitable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07266-7.
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Affiliation(s)
- Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK.
| | - Jennifer Lewis
- School of Medicine, Cardiff University, Neuadd Meirionnydd, CF14 4YS, Cardiff, UK
| | - Jemma Hawkins
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, CF10 3BD, Cardiff, UK
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12
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Dent E, Woo J, Scott D, Hoogendijk EO. Toward the recognition and management of sarcopenia in routine clinical care. NATURE AGING 2021; 1:982-990. [PMID: 37118343 DOI: 10.1038/s43587-021-00136-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/06/2021] [Indexed: 04/30/2023]
Abstract
Sarcopenia, the age-associated decline in skeletal muscle mass and function, is a major cause of functional decline and mortality in older adults. Despite its importance, sarcopenia often remains unrecognized and inadequately managed in routine clinical care. A major hinderance to its clinical integration is the variation in diagnostic tools for sarcopenia. Diagnostic tools include those of the European Working Group on Sarcopenia in Older People (versions 1 and 2), those of the Asian Working Group for Sarcopenia (versions 1 and 2), and that of the Sarcopenia Definition and Outcomes Consortium. The management decision process of sarcopenia warrants an evaluation of risk factors such as a sedentary lifestyle, inadequate exercise, poor nutritional intake, smoking, depression and living circumstances. Herein, we provide an evidence-based update of the prevention and management of sarcopenia and propose practical information to facilitate the disease's adoption into routine care.
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Affiliation(s)
- Elsa Dent
- Torrens University Australia, Adelaide, South Australia, Australia.
| | - Jean Woo
- Chinese University of Hong Kong, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - David Scott
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, the Netherlands
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13
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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14
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Albert FA, Malau-Aduli AEO, Crowe MJ, Malau-Aduli BS. The 'PRICE' of Physical Activity Referral Schemes (PARS): Stakeholders' Recommendations for Delivering Quality Care to Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8627. [PMID: 34444376 PMCID: PMC8394463 DOI: 10.3390/ijerph18168627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022]
Abstract
Evidence-based strategies are needed to curb the growing cases of physical inactivity related morbidities. Delivering holistic care through collaborative shared decision making could boost the effectiveness of physical activity referral schemes (PARS) and foster the quality of care for patients with multimorbidity. A qualitative study involving semi-structured telephone interviews was utilised to gain insights from Australian PARS stakeholders (general practitioners, exercise physiologists, and patients). A pluralistic evaluation approach was employed to explore and integrate participants' opinions and experiences of PARS and their recommendations were used to develop a model for quality care delivery in PARS initiatives. Five overarching themes: promote, relate, incentivise, communicate, and educate were identified as the 'PRICE' for developing effective and functional PARS programmes that foster quality patient care. It was evident that PARS programmes or policies aimed at optimising publicity, encouraging incentives, improving interdisciplinary information sharing and professional relationships between patients and healthcare professionals can transform healthcare delivery and provide top quality PARS care services to patients. Therefore, governments, healthcare systems, and PARS administrators can translate and leverage the insights from this study to optimise the delivery of high quality care to PARS patients.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
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15
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Menz HB, Harrison C, Bayram C. Characteristics of general practitioner referrals to podiatrists in Australia, 2000-2016. Public Health 2021; 193:10-16. [PMID: 33677392 DOI: 10.1016/j.puhe.2021.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to describe patterns of referral to podiatrists by general practitioners (GPs) in Australia. STUDY DESIGN This is a continuous cross-sectional study of Australian general practice activity. METHODS We analysed data from the Bettering the Evaluation and Care of Health program, collected from April 2000 to March 2016 inclusive. Data were summarised using descriptive statistics with 95% confidence intervals around point estimates. Multivariate logistic regression was used to identify GP and patient characteristics independently associated with referral. RESULTS The data set included 1,568,100 encounters, including 5,912 podiatry referrals. Referrals increased from 7.0 to 39.5 per 1000 population over the evaluation period. In multivariate analyses, female GPs were more likely than male GPs to refer, and GPs aged ≥55 years were less likely to refer. Patients referred to podiatrists were more likely to be aged ≥85 years, be Indigenous, be from an English-speaking background and have previously been seen at the practice. The problem generating the highest number of referrals was diabetes. After the introduction of Medicare funding, referred patients were more likely to be women, be aged >45 years, have a healthcare card, be socio-economically disadvantaged and have previously been seen at the practice. CONCLUSIONS GP referral to podiatrists in Australia increased markedly after the introduction of Medicare funding and appears to be targeted to those with the greatest need. Further research is required to determine whether this policy has improved outcomes and is cost-effective.
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Affiliation(s)
- H B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - C Harrison
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
| | - C Bayram
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia
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16
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Gilson ND, Papinczak ZE, Mielke GI, Haslam C, Fooken J, McKenna J, Brown WJ. Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial. JMIR Res Protoc 2021; 10:e21911. [PMID: 33625365 PMCID: PMC7946582 DOI: 10.2196/21911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. Objective This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans’ Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. Methods The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans’ Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. Results Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. Conclusions Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. Trial Registration Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/21911
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Affiliation(s)
- Nicholas D Gilson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Zoe E Papinczak
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Gregore Iven Mielke
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Catherine Haslam
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Jim McKenna
- Active Lifestyles Research Centre, Leeds Beckett University, Leeds, United Kingdom
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
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17
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Hanson CL, Neubeck L, Kyle RG, Brown N, Gallagher R, Clark RA, McHale S, Dawkes S. Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041700. [PMID: 33578836 PMCID: PMC7916623 DOI: 10.3390/ijerph18041700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/20/2022]
Abstract
Physical activity referral schemes (PARS) are implemented internationally to increase physical activity (PA), but evidence of effectiveness for population subgroups is equivocal. We examined gender differences for a Scottish PARS. This mixed-methods, concurrent longitudinal study had equal status quantitative and qualitative components. We conducted 348 telephone interviews across three time points (pre-scheme, 12 and 52 weeks). These included validated self-reported PA and exercise self-efficacy measures and open-ended questions about experiences. We recruited 136 participants, of whom 120 completed 12-week and 92 completed 52-week interviews. PARS uptake was 83.8% (114/136), and 12-week adherence for those who started was 43.0% (49/114). Living in less deprived areas was associated with better uptake (p = 0.021) and 12-week adherence (p = 0.020), and with male uptake (p = 0.024) in gender-stratified analysis. Female adherers significantly increased self-reported PA at 12 weeks (p = 0.005) but not 52 weeks. Males significantly increased exercise self-efficacy between baseline and 52 weeks (p = 0.009). Three qualitative themes and eight subthemes developed; gender perspectives, personal factors (health, social circumstances, transport and attendance benefits) and scheme factors (communication, social/staff support, individualisation and age appropriateness). Both genders valued the PARS. To increase uptake, adherence and PA, PARS should ensure timely, personalised communication, individualised, affordable PA and include mechanisms to re-engage those who disengage temporarily.
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Affiliation(s)
- Coral L. Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- Correspondence: ; Tel.: +44-131-455-3457
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- Sydney Nursing School, Charles Perkins Centre, Johns Hopkins Road, University of Sydney, Sydney, NSW 2006, Australia;
| | - Richard G. Kyle
- Research & Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff CF10 4BZ, UK;
| | - Norrie Brown
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
| | - Robyn Gallagher
- Sydney Nursing School, Charles Perkins Centre, Johns Hopkins Road, University of Sydney, Sydney, NSW 2006, Australia;
| | - Robyn A. Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5001, Australia;
| | - Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4DN, UK; (L.N.); (N.B.); (S.M.); (S.D.)
- School of Nursing, Midwifery and Paramedic Practice, Garthdee Campus, Robert Gordon University, Aberdeen AB10 7QE, UK
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18
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Hanson CL, Oliver EJ, Dodd-Reynolds CJ, Pearsons A, Kelly P. A modified Delphi study to gain consensus for a taxonomy to report and classify physical activity referral schemes (PARS). Int J Behav Nutr Phys Act 2020; 17:158. [PMID: 33267840 PMCID: PMC7709269 DOI: 10.1186/s12966-020-01050-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Physical Activity Referral Schemes (PARS), including exercise referral schemes, are a popular approach to health improvement, but understanding of effectiveness is limited by considerable heterogeneity in reporting and evaluation. We aimed to gain consensus for a PARS taxonomy as a comprehensive method for reporting and recording of such schemes. Methods We invited 62 experts from PARS policy, research and practice to complete a modified Delphi study. In round one, participants rated the need for a PARS taxonomy, the suitability of three proposed classification levels and commented on proposed elements. In round two, participants rated proposed taxonomy elements on an 11-point Likert scale. Elements scoring a median of ≥7, indicating high agreement, were included in the final taxonomy. Results Of those invited, 47 (75.8%) participated in round one, with high retention in round two (n = 43; 91.5%). 42 were UK-based, meaning the resultant taxonomy has been scrutinised for fit to the UK context only. The study gained consensus for a three-level taxonomy: Level 1: PARS classification (primary classification, provider, setting, conditions accepted [have or at risk of], activity type and funding). Level 2: scheme characteristics (staff structure, staff qualifications, behaviour change theories, behaviour change techniques, referral source, referrers, referral process, scheme duration, session frequency, session length, session times, session type, exit routes, action in case of non-attendance, baseline assessment, exit assessment, feedback to referrer and exclusion criteria) and Level 3: participant measures (demographics, monitoring and evaluation, and measures of change). Conclusion Using a modified Delphi method, this study developed UK-based consensus on a PARS classification taxonomy. We encourage PARS practitioners and public health colleagues, especially those working with similar service models internationally, to test, refine and use this taxonomy to inform policy and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-020-01050-2.
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Affiliation(s)
- Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK.
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, DH1 3HN, UK
| | | | - Alice Pearsons
- School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4DN, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, EH8 8AQ, UK
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19
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Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical Activity Promotion: A Systematic Review of The Perceptions of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4358. [PMID: 32570715 PMCID: PMC7345303 DOI: 10.3390/ijerph17124358] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Physical activity (PA) is a cost-effective and non-pharmacological foundation for the prevention and management of chronic and complex diseases. Healthcare professionals could be viable conduits for PA promotion. However, the evidence regarding the effectiveness and benefits of the current forms of PA promotion are inconclusive. Healthcare professionals' perceptions on key determinants impact on the optimum promotion of PA were explored in this review. Thirty-four (34) studies were identified after systematically searching seven databases for peer-reviewed articles published within the last decade. PA advice or counselling was the most recorded form of PA promotion, limited counselling time was the most reported obstacle while providing incentives was viewed as a key facilitator. There is widespread consensus among healthcare professionals (HCPs) on some aspects of PA promotion. Utilisation of all PA promotional pathways to their full potential could be an essential turning point towards the optimal success of PA promotional goals. Hence, strategies are required to broaden chronic disease treatment methods to include preventive and integrative PA promotion approaches particularly, between frontline HCPs (e.g., GPs) and PA specialists (e.g., EPs). Future studies could explore the functionality of GP to EP referral pathways to determining what currently works and areas requiring further development.
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Affiliation(s)
- Francis A. Albert
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
| | - Melissa J. Crowe
- Division of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia;
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia;
| | - Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia;
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Stanton R, Rosenbaum S. Temporal trends in exercise physiology services in Australia-Implications for rural and remote service provision. Aust J Rural Health 2019; 27:514-519. [PMID: 31713303 DOI: 10.1111/ajr.12563] [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: 04/02/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess temporal trends in service provision by Accredited Exercise Physiologists based on remoteness classification using Australian Bureau of Statistics remoteness classifications of Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. DESIGN AND PARTICIPANTS Cross-sectional analysis of publicly available Medicare Benefits Schedule datasets, for Medicare item number 10953 from 2012-2013 to 2016-2017. MAIN OUTCOME MEASURE(S) Number of claims, benefits paid, fees charges and number of providers for Medicare item number 10953. RESULTS Accredited Exercise Physiologist service delivery demonstrates growth across all areas of remoteness classification. Rebates and fees mirror service delivery trends. The rate of service growth was significantly greater in Major Cities compared with all other remoteness classifications. Provider numbers show a steady increase from 2012-2013 to 2016-2017 but number remains higher in Major Cities compared with all other remoteness locations. CONCLUSION Given the high proportion of chronic and complex illness in rural and remote areas, and the limited access to allied health care services, we propose more needs to be done to position Accredited Exercise Physiologists in these regions of increasing need. These findings have implications for future development of the Accredited Exercise Physiologist profession.
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Affiliation(s)
- Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Qld, Australia.,Appleton Institute, Central Queensland University, Adelaide, SA, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Sydney, NSW, Australia
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