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Noeske KE, Snowdon DA, Ekegren CL, Harding KE, Prendergast LA, Peiris CL, Shields N, O'Halloran PD, Porter J, Watts JJ, Taylor NF. Walking self-confidence and lower levels of anxiety are associated with meeting recommended levels of physical activity after hip fracture: a cross-sectional study. Disabil Rehabil 2024:1-7. [PMID: 38635302 DOI: 10.1080/09638288.2024.2338195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. MATERIALS AND METHODS Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender. RESULTS Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds. CONCLUSION Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.
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Affiliation(s)
- Kate E Noeske
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David A Snowdon
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Academic Unit, Peninsula Health, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke A Prendergast
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- The Royal Melbourne Hospital, Allied Health, Parkville, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia
| | - Paul D O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Dorward E, Devlin A, Brusco NK, Dulfer F, Whittaker SL, Reeder S, Ekegren CL. Patients' perceptions of participating in self-directed activities outside supervised occupational and physiotherapy within inpatient and home-based rehabilitation settings: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38625404 DOI: 10.1080/09638288.2024.2341872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To investigate patients' perceptions of participating in self-directed activities, outside supervised occupational and physiotherapy, within rehabilitation settings. METHODS Semi-structured interviews were undertaken with 16 patients and in three instances, their carers, from three health services in Victoria, Australia, two offering inpatient and one offering home-based rehabilitation care. A thematic analysis was performed using a framework approach. RESULTS Themes identified included the role of the clinicians in encouraging patients and instilling confidence, giving feedback and "just being there"; considerations in program delivery, including different formats, support from peers and relatives, and program familiarity and flexibility; patients' different intrinsic driving and limiting forces, including following orders, seeing results, desiring autonomy and having an "inner athlete"; and the environment, including functional activities, space, equipment, time and availability. CONCLUSIONS Patients and their carers reported positive experiences of participating in self-directed therapy programs within rehabilitation settings, with programs perceived as beneficial in optimising recovery. Patients reported a range of driving and limiting factors in relation to completing self-directed activities. Understanding these factors, relating to the patient, their environment and other people, is critical for clinicians so that they can modify their delivery accordingly, ensuring uptake and sustained implementation of self-directed activities in rehabilitation care.
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Affiliation(s)
- Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Peter James Centre, Eastern Health, Burwood East, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Fiona Dulfer
- Physiotherapy Department, Cabrini Health, Malvern, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Sandra Reeder
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
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Kirk AG, Kimmel LA, Pereira J, Ekegren CL. The influence of hospital and home environments on physical activity and sedentary behaviour: Perceptions of people recovering from fractures. Injury 2024; 55:111488. [PMID: 38452700 DOI: 10.1016/j.injury.2024.111488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND A lack of evidence exists contrasting the factors that influence physical activity and sedentary behaviour in both hospital and home settings before and after discharge from acute hospitalisation for fractures. OBJECTIVE To describe and compare perceptions of environmental influences on physical activity in hospital and home settings in people recovering from fractures. METHOD Semi-structured interviews were conducted with patients hospitalised following fractures (hip fracture or multi-trauma), exploring the barriers and enablers to physical activity within hospital and home settings. Interviews were conducted within two weeks of hospital discharge, audio recorded and transcribed prior to thematic analysis via a framework approach. RESULTS Between December 2022 and May 2023, 12 semi-structured interviews were undertaken with an equal number of participants who sustained an isolated hip fracture or multi-trauma. The median (IQR) age of participants was 60 (52-68) years, with half being male, and the majority sustaining their injuries via transport crashes. Three main themes that influenced physical activity behaviours in hospital and home settings were: having the opportunity, having a reason, and having support and assistance to be active. CONCLUSION During the period of reduced physical capability following fracture, patients need to be provided with opportunities and motivation to be active, particularly within the hospital setting. Findings from this study will assist clinicians to better support people recovering from fractures via greater engagement in physical activity within hospital and home settings.
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Affiliation(s)
- Asher G Kirk
- Alfred Health, PO Box 315, Prahran, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
| | - Lara A Kimmel
- Alfred Health, PO Box 315, Prahran, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Jason Pereira
- Alfred Health, PO Box 315, Prahran, VIC 3181, Australia
| | - Christina L Ekegren
- Alfred Health, PO Box 315, Prahran, VIC 3181, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Peninsula Campus, Frankston, VIC 3199, Australia
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Kimmel LA, Raper E, Harris IA, Ackerman IN, Page R, Naylor JM, Burge AT, Hepworth G, Harris A, Woode ME, Gabbe BJ, Ekegren CL, Holland AE. HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER): a protocol for a randomised controlled trial. BMJ Open 2024; 14:e079846. [PMID: 38238172 PMCID: PMC10806657 DOI: 10.1136/bmjopen-2023-079846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Hip fractures result in substantial health impacts for patients and costs to health systems. Many patients require prolonged hospital stays and up to 60% do not regain their prefracture level of mobility within 1 year. Physical rehabilitation plays a key role in regaining physical function and independence; however, there are no recommendations regarding the optimal intensity. This study aims to compare the clinical efficacy and cost-effectiveness of early intensive in-hospital physiotherapy compared with usual care in patients who have had surgery following a hip fracture. METHODS AND ANALYSIS This two-arm randomised, controlled, assessor-blinded trial will recruit 620 participants who have had surgery following a hip fracture from eight hospitals. Participants will be randomised 1:1 to receive usual care (physiotherapy according to usual practice at the site) or intensive physiotherapy in the hospital over the first 7 days following surgery (two additional sessions per day, one delivered by a physiotherapist and the other by an allied health assistant). The primary outcome is the total hospital length of stay, measured from the date of hospital admission to the date of hospital discharge, including both acute and subacute hospital days. Secondary outcomes are functional mobility, health-related quality of life, concerns about falling, discharge destination, proportion of patients remaining in hospital at 30 days, return to preadmission mobility and residence at 120 days and adverse events. Twelve months of follow-up will capture data on healthcare utilisation. A cost-effectiveness evaluation will be undertaken, and a process evaluation will document barriers and facilitators to implementation. ETHICS AND DISSEMINATION The Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients and carers. TRIAL REGISTRATION NUMBER ACTRN12622001442796.
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Affiliation(s)
- Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eleanor Raper
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Richard Page
- School of Medicine, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Orthopaedics, Barwon Health, Geelong, Victoria, Australia
- St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Angela T Burge
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Ekegren CL, Ayton D, Skouteris H, Soh SE. The Exercise Right for Active Ageing Study: Participation in Community-Based Exercise Classes by Older Australians During the COVID-19 Pandemic. J Aging Phys Act 2024:1-11. [PMID: 38194960 DOI: 10.1123/japa.2023-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/21/2023] [Accepted: 09/30/2023] [Indexed: 01/11/2024]
Abstract
The aim of this study was to determine factors associated with participation of community-dwelling older Australians (≥65 years) in the Exercise Right for Active Ageing program, consisting of 12 low- to moderate-intensity group exercise classes, delivered weekly, in person or online, by accredited exercise scientists and physiologists across Australia. Out of 6,949 participants recruited, 6,626 (95%) attended one or more classes and were included in the primary analysis, and 49% of participants attended all 12 classes. Factors associated with higher class attendance included participation in yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% confidence interval]: 1.05 [1.03, 1.08]), and attending online classes (1.19 [1.11, 1.26]). Factors associated with lower class attendance included state of residence, living in inner regional areas (0.95 [0.93, 0.98]), and having two or more comorbidities (0.97 [0.95, 0.99]). High class attendance suggests that the Exercise Right for Active Ageing program was well received by older Australians, particularly in states less impacted by COVID-19 lockdowns.
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Affiliation(s)
- Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
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Kirk AG, Kimmel LA, Behm KJ, Peiris CL, Ekegren CL. Validity of the activPAL and ActiGraph for measuring sitting time and steps in hospitalised orthopaedic patients with altered weight bearing. Disabil Rehabil 2024; 46:378-386. [PMID: 36541196 DOI: 10.1080/09638288.2022.2157896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the criterion validity of the activPAL and ActiGraph for measuring steps and sitting/sedentary time, compared to observation, in people hospitalised following orthopaedic lower limb injury who were weight bearing (WB) (i.e., walking) or non-weight bearing (NWB) (i.e., hopping). MATERIALS AND METHODS Participants wore an activPAL and ActiGraph on the hip/thigh/unaffected (UA)/affected ankle (AA) while completing bouts of walking and sitting. Lin's concordance correlation coefficient, Bland-Altman methods, and ratio of agreement were used to compare device-measured to observed (videoed) step count, sitting/sedentary time. RESULTS In 42 participants, the ActiGraph demonstrated excellent concordance with the observed step count when worn on the ankle (LCC 0.91-0.92) compared to the hip (LCC 0.56) in participants that were WB. The ActiGraph AA achieved the highest concordance (LCC 0.71) with observed steps in participants NWB. The activPAL had poor concordance with observed steps, particularly at slow gait speeds, in participants that were WB (LCC 0.38-0.46), however was less influenced by gait speed and had good concordance in NWB participants (LCC 0.52-0.69). The activPAL (LCC 0.79-0.88) and ActiGraph UA (LCC 0.94) showed excellent concordance with observed sitting and sedentary time, respectively. CONCLUSIONS The ActiGraph worn at the ankle provided the most valid measure of steps in people who are WB and NWB following orthopaedic injury, while the activPAL was best for measuring sitting time.Implications for rehabilitationTo accurately measure both steps and sitting time in people with lower limb orthopaedic injuries, a combination of activity monitors should be used (i.e., ActiGraph for steps, activPAL for sitting time).The ActiGraph device when worn on the ankle demonstrated the strongest agreement with observed step count in people who were weight bearing and non-weight bearing.Caution is needed when using thigh- or hip-worn devices in people who walk slowly.
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Affiliation(s)
- Asher G Kirk
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lara A Kimmel
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kate J Behm
- Department of Physiotherapy, Alfred Health, Prahran, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Christina L Ekegren
- Department of Physiotherapy, Alfred Health, Prahran, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Frankston, Australia
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Ekegren CL, Clark-Ash M, Callaway L, Hill KD, Gabbe BJ, Kunstler B, Keeves J, Kimmel L, Reeder SC. Perspectives of telehealth access and implementation in people recovering from serious transport injury, health care providers and compensation system staff during the COVID-19 pandemic in Australia. Injury 2023; 54:110987. [PMID: 37574380 DOI: 10.1016/j.injury.2023.110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Before the COVID-19 pandemic, few injury compensation schemes supported access to service-delivery via telehealth. The aim of this qualitative study was to explore the perspectives of people recovering from serious transport injury, health care providers, and senior staff of a transport injury compensation scheme, in relation to the uptake and implementation of telehealth during the COVID-19 pandemic, and its ongoing use. METHODS Semi-structured interviews were undertaken with 35 participants, including 15 seriously injured patients, 16 health care providers and 4 compensation scheme staff. A thematic analysis was performed using a framework approach. RESULTS Themes identified included the need to provide continuity of care via telehealth during the pandemic for patients recovering from injury, and the associated organisational and technical support needs. It was noted that some types of services worked well via telehealth, including psychology, while others did not, including physical assessments. The convenience of telehealth was highlighted, in relation to reduced travel. However, there were often safety fears relating to falls, and communication issues with injured people. CONCLUSIONS This research found that the majority of injured patients and health care providers had benefitted from the introduction of service delivery via telehealth during the pandemic for some types of services. Participants saw opportunities for continued benefit post-pandemic, particularly for improving equity of access to health care for people with barriers to mobility and travel.
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Affiliation(s)
- Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia.
| | - Megan Clark-Ash
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Breanne Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, VIC, 3800 Australia
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Lara Kimmel
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia; The Alfred, Commercial Rd, Melbourne, VIC, 3004 Australia
| | - Sandra C Reeder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia; Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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Brusco NK, Walpole B, Kugler H, Tilley L, Thwaites C, Devlin A, Dorward E, Dulfer F, Lee AL, Morris ME, Taylor NF, Dawes H, Whittaker SL, Ekegren CL. Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings. Aust Occup Ther J 2023; 70:617-626. [PMID: 37291993 DOI: 10.1111/1440-1630.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. METHODS My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). RESULTS Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. CONCLUSION Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Brianna Walpole
- Safer Care Victoria, Victorian Government, Melbourne, Australia
| | - Helen Kugler
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Louise Tilley
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Dawes
- Clinical Rehabilitation, University of Exeter, Exeter, UK
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Mather AM, Edwards E, Hau R, Ekegren CL. Primary and Periprosthetic Distal Femur Fractures in Older Adults: No Difference in 12-Month Mortality and Patient-Reported Outcomes. J Orthop Trauma 2023; 37:492-499. [PMID: 37296087 DOI: 10.1097/bot.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare fracture incidence, mortality, and patient-reported health outcomes at 6 and 12 months postinjury between primary and periprosthetic distal femur fractures in older adults. METHODS A registry-based cohort study was conducted including all adults 70 years of age or older registered by the Victorian Orthopaedic Trauma Outcomes Registry who experienced a primary or periprosthetic distal femur fracture between 2007 and 2017. Outcomes included mortality and health status (Three-Level European Quality of Life-Five Dimensions Scale [EQ-5D-3L]) collected at 6 and 12 months postinjury. All distal femur fractures were confirmed by radiological review. Multivariable logistic regression was conducted to report associations between fracture type and mortality and health status. RESULTS A final cohort of 292 participants was identified. Overall mortality for the cohort was 29.8%, and no significant differences were found in mortality rate or EQ-5D-3L outcomes between fracture types (ie, primary vs. periprosthetic). A large proportion of participants reported problems across all EQ-5D-3L domains at 6 and 12 months postinjury, with slightly worse outcomes in the primary fracture group. CONCLUSIONS This study reports high mortality and poor 12-month outcomes in an older adult cohort with both periprosthetic and primary distal femur fractures. Given these poor outcomes, fracture prevention and a greater focus on long-term rehabilitation is needed in this cohort. In addition, the involvement of an ortho-geriatrician should be considered as a routine component of care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anne M Mather
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elton Edwards
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Raphael Hau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia; and
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
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10
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Gabbe BJ, Reeder S, Ekegren CL, Mather A, Kimmel L, Cameron PA, Higgins AM. Cost-effectiveness of a purpose-built ward environment and new allied health model of care for major trauma. J Trauma Acute Care Surg 2023; 94:831-838. [PMID: 36879385 DOI: 10.1097/ta.0000000000003950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
BACKGROUND Targeted rehabilitation within the acute inpatient setting could have a substantial impact on improving outcomes for major trauma patients. The aim of this study was to investigate the cost-effectiveness of the introduction of a purpose-built ward environment, and a new allied health model of care (AHMOC) delivered in the acute inpatient setting, in a major trauma population. METHODS The statewide trauma registry, the trauma center's data warehouse, and electronic medical record data were used for this observational study. There were three phases: baseline, new ward, and new AHMOC. Cost-effectiveness was measured as cost per quality-adjusted life year using preinjury, hospital discharge, 1-month and 6-month 5-level, EQ-5D utility scores. Total costs included initial acute and inpatient rehabilitation care, as well as outpatient, readmission and ED presentations to 6-months. RESULTS Four hundred eleven patients were included. Case-mix was stable between phases. The median (IQR) number of allied health services received by patients was 8 (5-17) at baseline, 10 (5-19) in the new ward phase, and 17 (9-23) in the AHMOC phase. The proportion discharged to rehabilitation was 37% at baseline, 45% with the new ward and 28% with the new AHMOC. Mean (SD) total Australian dollar costs were $69,335 ($141,175) at baseline, $55,943 ($82,706) with the new ward and $37,833 ($49,004) with the AHMOC. The probability of the AHMOC being cost-effective at a willingness-to-pay threshold of $50,000 per quality-adjusted life year was 99.4% compared with baseline and 98% compared with the new ward. CONCLUSION The new allied health model of care was found to be a cost-effective intervention. Uptake of this model of allied health care at other trauma centers has the potential to reduce the cost and burden of major trauma. LEVEL OF EVIDENCE Economic and Value-based Evaluations; Level III.
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Affiliation(s)
- Belinda J Gabbe
- From the School of Public Health and Preventive Medicine (B.J.G., S.R., C.L.E., A.M., L.K., P.A.C., A.M.H.), Monash University, Australia; Health Data Research UK, Swansea University Medical School (B.J.G.), Swansea University, United Kingdom; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre (C.L.E.), Monash University, Australia; Alfred Health, Department of Allied Health (L.K.), Melbourne, Australia; and Emergency and Trauma Centre, Alfred Health (P.A.C.), Melbourne, Australia
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11
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Mackey DC, Ekegren CL, Baldwin C, Young PJ, Gray SM, Ciok A, Wong A. Outcome domains measured in randomized controlled trials of physical activity for older adults: a rapid review. Int J Behav Nutr Phys Act 2023; 20:34. [PMID: 36964571 PMCID: PMC10039503 DOI: 10.1186/s12966-023-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/04/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Toward development of a core outcome set for randomized controlled trials (RCTs) of physical activity (PA) interventions for older adults, the purpose of this study was to identify outcome domains and subdomains ('what' was measured) in previously published RCTs of PA for older adults. METHODS We conducted a rapid review and searched Ovid MEDLINE for recently- published (2015-2021), English-language, RCTs of PA interventions for older adults (mean age 60+ yrs). We limited to articles published in Web of Science top-10 journals in general and internal medicine, geriatrics and gerontology, rehabilitation, and sports science. Two reviewers independently completed eligibility screening; two other reviewers abstracted trial descriptors and study outcomes. We classified study outcomes according to the standard outcome classification taxonomy endorsed by the Core Outcome Measures in Effectiveness Trials Initiative. RESULTS Our search yielded 548 articles; 67 articles were eligible to be included. Of these, 82% were efficacy/effectiveness trials, 85% included both male and female participants, and 84% recruited community-dwelling older adults. Forty percent of articles reported on interventions that involved a combination of group and individual PAs, and 60% involved a combination of PA modes (e.g., aerobic, resistance). Trial sample size ranged from 14 to 2157 participants, with median (IQR) of 94 (57-517); 28,649 participants were included across all trials. We identified 21 unique outcome domains, spanning 4/5 possible core areas (physiological/clinical; life impact; resource use; adverse events). The five most commonly reported outcome domains were physical functioning (included in n=51 articles), musculoskeletal and connective tissue (n=30), general (n=26), cognitive functioning (n=16), and emotional functioning/wellbeing (n=14). Under these five outcome domains, we further identified 10 unique outcome subdomains (e.g., fall-related; body composition; quality of life). No outcome domains or subdomains were reported consistently in all RCTs. CONCLUSIONS We found extensive variability in outcome domains and subdomains used in RCTs of PA for older adults, reflecting the broad range of potential health benefits derived from PA and also investigator interest to monitor a range of safety parameters related to adverse events. This study will inform development of a core outcome set to improve outcome reporting consistency and evidence quality.
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Affiliation(s)
- Dawn C Mackey
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Peninsula Campus, Building G, Moorooduc Hwy, Frankston, Victoria, 3199, Australia
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Level 1, Room N103, Sturt North Sturt Rd, Bedford Park, South Australia, 5042, Australia
| | - Peter J Young
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Samantha M Gray
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Alex Ciok
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Angela Wong
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
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Reeder SC, Ekegren CL, Mather AM, Kimmel LA, Webb MJ, Pellegrini M, Cameron PA, Gabbe BJ. Perceptions of an Interactive Trauma Recovery Information Booklet. J Trauma Nurs 2023; 30:92-102. [PMID: 36881701 DOI: 10.1097/jtn.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Previous research has shown that people with traumatic injuries have unmet information needs with respect to their injuries, management, and recovery. An interactive trauma recovery information booklet was developed and implemented to address these information needs at a major trauma center in Victoria, Australia. OBJECTIVE The aim of this quality improvement project was to explore patient and clinician perceptions of a recovery information booklet introduced into a trauma ward. METHODS Semistructured interviews with trauma patients, family members, and health professionals were undertaken and thematically analyzed using a framework approach. In total, 34 patients, 10 family members, and 26 health professionals were interviewed. RESULTS Overall, the booklet was well accepted by most participants and was perceived to contain useful information. The design, content, pictures, and readability were all positively appraised. Many participants used the booklet to record personalized information and to ask health professionals questions about their injuries and management. CONCLUSION Our findings highlight the usefulness and acceptability of a low-cost interactive booklet intervention to facilitate the provision of quality of information and patient-health professional interactions on a trauma ward.
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Affiliation(s)
- Sandra C Reeder
- School of Public Health and Preventive Medicine (Drs Reeder, Kimmel, Cameron, and Gabbe and Ms Mather) and Central Clinical School (Drs Reeder and Pellegrini), Monash University, Melbourne, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia (Dr Ekegren); Alfred Health, Melbourne, Victoria, Australia (Drs Ekegren, Kimmel, and Cameron and Ms Webb); and Health Data Research UK, Swansea University Medical School, Swansea University Swansea, Wales, United Kingdom (Dr Gabbe)
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13
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Jederström M, Agnafors S, Ekegren CL, Fagher K, Gauffin H, Korhonen L, Park J, Spreco A, Timpka T. A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden. BMJ Open Sport Exerc Med 2023; 9:e001491. [PMID: 36919120 PMCID: PMC10008236 DOI: 10.1136/bmjsem-2022-001491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/10/2023] Open
Abstract
Objectives Little is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness. Methods A cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors. Results In total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001). Conclusion Anxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.
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Affiliation(s)
- Moa Jederström
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Sara Agnafors
- Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health, Linköping University, Linköping, Sweden.,Department of Research, Södra Älvsborgs Hospital, Borås, Sweden
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Kristina Fagher
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
| | - Håkan Gauffin
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden.,Department of Orthopaedics and Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Laura Korhonen
- Department of Child and Adolescent Psychiatry and Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience, Linköping University, Linkoping, Sweden
| | - Jennifer Park
- Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Armin Spreco
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden.,Center for Health Services Development, Region Östergötland, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
| | - Toomas Timpka
- Athletics Research Center, Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden.,Center for Health Services Development, Region Östergötland, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, Linköping, Sweden
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Schwarzman J, Lalor A, Reeder S, Callaway L, Aburumman M, Gabbe BJ, Ekegren CL. Factors influencing care and support for older adults with traumatic injury in Australia: a qualitative study. Disabil Rehabil 2022; 44:6692-6698. [PMID: 34493139 DOI: 10.1080/09638288.2021.1970258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate factors influencing provision of care and support to older adults with traumatic injury in Australia, from a health service and policy perspective. METHODS Semi-structured interviews were undertaken with 16 clinicians, support providers, researchers, policy makers, and representatives from peak bodies in Australia, who had experience across injury, ageing, and disability sectors. A thematic analysis was performed using a framework approach. RESULTS Themes identified included prolonged injury recovery in older adults, limited accommodation options, restricted access to preventive care, escalating care needs over time, issues with siloed funding schemes and funding availability, and the need for advocacy to coordinate care across different schemes. Certain themes were specific to people who were older when injured. Others related to people who had acquired an injury at a younger age and were ageing with injury. However, most themes had relevance for both groups. CONCLUSIONS For older adults, this research has highlighted a range of cross-sector problems which impact upon the potential to recover from injury and to age well with injury. To improve the lives of older adults with injuries, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors, and improved advocacy and case management.Implications for rehabilitationTo address the lack of long-term, multi-disciplinary preventive care for age-related conditions and secondary complications in people with injuries, older adults may need more prolonged, or individualised, care following injury, episodic health checks, and a greater focus on long-term health care.Accessible and well-coordinated specialist housing and support responses, that offer timely access to health care professionals and carers trained in both ageing and disability, and enable greater support for "ageing in place", are required to manage changing care needs of people ageing with injury.There needs to be greater involvement of geriatricians, nurses, and allied health care professionals within the aged care sector in order to care for people with complex needs, including older adults with injury-related disability.To reduce gaps in care and support for injured older adults, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors.
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Affiliation(s)
- Joanna Schwarzman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Sandy Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Mohammed Aburumman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Monash University Accident Research Centre (MUARC), Monash University, Clayton, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ekegren CL, Mather AM, Reeder S, Kimmel L, Ashe MC, Gabbe BJ. Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients' activities and interactions. Clin Rehabil 2022; 36:1314-1323. [PMID: 35712976 DOI: 10.1177/02692155221107739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. DESIGN Explorative case study using behavioural mapping. SETTING Level 1 trauma centre in Melbourne, Australia. PARTICIPANTS Hospitalised trauma patients. MAIN MEASURES Behavioural mapping of patients' activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. RESULTS In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). CONCLUSIONS Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.
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Affiliation(s)
- Christina L Ekegren
- School of Primary and Allied Health Care, 2541Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Anne M Mather
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
| | - Lara Kimmel
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Maureen C Ashe
- Department of Family Practice, 12358The University of British Columbia, Vancouver, Canada
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, 2541Monash University, Melbourne, Australia
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Keeves J, Gabbe BJ, Ekegren CL, Fry R, Beck B. Regional variation in travel to health services following transport-related major trauma. Injury 2022; 53:1707-1715. [PMID: 34974907 DOI: 10.1016/j.injury.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post-discharge healthcare needs are complex and persistent for people following major trauma. A number of geographic barriers to accessing healthcare exist, particularly for people in regional areas. The aim of this study was to explore regional variation in the distances travelled to access health services and identify patterns of health service use in the first three years following transport-related major trauma. METHODS This registry-based cohort study used linked data from the Victorian State Trauma Registry (VSTR) and the Transport Accident Commission (TAC). Victorians who sustained major trauma from a transport-related event between January 1 2006 and December 31 2016, with at least three years of follow-up TAC claims data were included in the study. Geospatial mapping of the median distance travelled to medical and allied health services was conducted for each Victorian Local Government Area. RESULTS In the first three years post-discharge, 4,964 people (75.6%) visited a general practitioner, 5058 (77.0%) saw other medical professionals, 2269 (34.6%) accessed mental health services, 2154 (32.8%) saw an occupational therapist and 4404 (67.0%) attended a physical therapy service. Geospatial mapping revealed that people in regional Local Government Area travelled further distances to access health services. Specific clustering of increased travel distances was observed in regional areas of the far west and north-east of Victoria. The number of people using services declined with each subsequent year beyond hospital discharge. However, the number of trips were consistent over time for those still engaged in services. CONCLUSIONS Distances travelled to access health services vary across geographic regions and may result in an increased travel burden for those in some regional Local Government Area. Understanding gaps in health services by geographic region can assist to improve service availability. Alternate service delivery methods, such as telehealth, may assist to reduce the associated burden of travel for those in regional areas.
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Affiliation(s)
- Jemma Keeves
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia; Department of Physiotherapy, Epworth Hospital, Melbourne, 50 Burwood Rd, Hawthorn VIC 3122, Australia.
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia
| | - Richard Fry
- Swansea University Medical School, Institute of Life Science 2, Sketty, Swansea SA2 8QA, United Kingdom
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne VIC 3004, Australia
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Gelaw AY, Gabbe BJ, Ekegren CL. Chronic physical health conditions up to five years after serious orthopaedic injury. Injury 2022; 53:1459-1468. [PMID: 35177264 DOI: 10.1016/j.injury.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Information about the prevalence of chronic physical health conditions following serious orthopaedic injury is currently lacking in the general population and is essential for quantifying the burden of injury and improving outcomes. OBJECTIVES To determine the prevalence of chronic physical health conditions recorded within hospitalisations and emergency department presentations and associated factors five years following serious orthopaedic injury. METHODS We conducted a registry-based cohort study using data from the Victorian State Trauma Registry (2007-2016) linked with hospital admissions and ED presentations for 16,249 adults with serious orthopaedic injuries. We considered that people who were admitted to hospital or presented to an emergency department with a chronic physical health condition one to five years post-injury had "new-onset" conditions. We applied Kaplan-Meier failure curves and Cox proportional hazard regression models to determine factors associated with new-onset conditions. RESULTS There were 1420 people (11.0%) with at least one new-onset condition. Cancer (6.1%), cardiovascular disease (5.1%) and hypertension (6.2%) were the three most common "new-onset" chronic physical health conditions. Older adults, women, smokers, and people with mental health and alcohol and drug-related conditions had a higher risk of hospitalisation or emergency department presentation with new-onset conditions post-injury. CONCLUSION People with serious orthopaedic injuries experienced a significant additional burden of chronic physical health conditions up to five years after serious orthopaedic injury, posing a new challenge to post-trauma care. Early preventive interventions may be required in people with serious orthopaedic injuries to minimise modifiable risk factors such as smoking, excessive consumption of alcohol or drug use.
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Affiliation(s)
- Asmare Yitayeh Gelaw
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Alfred Emergency and Trauma Centre, Melbourne, Australia.
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Brusco NK, Kugler H, Dufler F, Lee AL, Walpole B, Morris ME, Hill KD, Ekegren CL, Whittaker SL, Taylor NF. Including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment. JRM-CC 2022; 5:1000076. [PMID: 35154583 PMCID: PMC8771766 DOI: 10.2340/20030711-1000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/16/2022]
Abstract
Objective To test the feasibility, safety and effectiveness of the My Therapy programme for inpatients with mild-moderate cognitive impairment. Design Observational pilot study. Patients Rehabilitation inpatients with mild-moderate cognitive impairment. Methods During their inpatient admission, participants received My Therapy, a programme that can increase the dose of rehabilitation through independent self-practice of exercises, outside of supervised therapy. Outcomes included My Therapy participation, falls, Functional Independence Measure (FIM) and 10-m walk test. Outcomes were compared with those of participants without cognitive impairment from the original My Therapy study (n = 116) using χ2 and independent t-tests. Results Eight participants with mild-moderate cognitive impairment (mean (standard deviation (SD)) age 89.6 years (4.8); 3 women) were included. All participants completed the My Therapy programme on at least one day of their admission, with no associated falls. Participants had an 8.4 s (SD 5.1) reduction in their 10-m walk test and a 21.5 point (SD 11.1) improvement on FIM scores from admission to discharge. There were no significant between-group differences in feasibility, safety or effectiveness for participants with and without cognitive impairment. Conclusion This pilot study has shown that including exercise self-management as part of inpatient rehabilitation is feasible, safe and effective for patients with cognitive impairment.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Cabrini Health, Malvern, Frankston, Australia
| | | | | | - Annemarie L Lee
- Cabrini Health, Malvern, Frankston, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | | | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Healthscope, La Trobe University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Cabrini Health, Malvern, Frankston, Australia
- Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Eastern Health, Melbourne, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Bundoora, Australia
- Eastern Health, Melbourne, Australia
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Daly SL, Gabbe BJ, Climie RE, Ekegren CL. Association between type 2 diabetes and long-term outcomes in middle-aged and older trauma patients. J Trauma Acute Care Surg 2022; 92:185-192. [PMID: 34137744 DOI: 10.1097/ta.0000000000003317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients. METHODS In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥45 years) with major trauma were followed up at 24 months postinjury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using χ2 tests. RESULTS Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24 months postinjury and were followed up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared with people without T2D (16%; p < 0.001). After adjusting for confounders, people with T2D had poorer outcomes 24 months postinjury than people without T2D, with respect to functional recovery (Glasgow Outcome Scale Extended) (adjusted odds ratio [AOR], 0.58; 95% confidence interval [CI], 0.48-0.69) and return to work/study (AOR, 0.51; 95% CI, 0.37-0.71]). People with T2D experienced higher odds of problems with mobility (AOR, 1.92; 95% CI, 1.60-2.30), self-care (AOR, 1.94; 95% CI, 1.64, 2.29), usual activities (AOR, 1.50; 95% CI, 1.26-1.79), pain and discomfort (AOR, 1.75; 95% CI, 1.49-2.07), anxiety and depression (AOR, 1.45; 95% CI, 1.24, 1.70), and self-reported disability (AOR, 1.51; 95% CI, 1.28-1.79) than people without T2D. CONCLUSION Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24 months postinjury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- Stuart L Daly
- From the School of Public Health and Preventive Medicine (S.L.D., B.J.G., C.L.E.), Monash University; Emergency Medicine (S.L.D., C.L.E.), Alfred Health, Melbourne, VIC, Australia; Health Data Research UK (B.J.G.), Swansea University, Swansea, UK; Farr Institute (B.J.G.), Swansea University Medical School, Swansea University, Swansea, UK; Baker Heart and Diabetes Institute (R.E.C., C.L.E.), Melbourne; Menzies Institute for Medical Research (R.E.C.), University of Tasmania, Hobart, Tasmania, Australia; and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre (C.L.E.), Monash University, Melbourne, VIC, Australia
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Brusco NK, Ekegren CL, Taylor NF, Hill KD, Lee AL, Somerville L, Lannin NA, Wade D, Abdelmotaleb R, Callaway L, Whittaker SL, Morris ME. Correction to: Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:977. [PMID: 34535151 PMCID: PMC8447696 DOI: 10.1186/s12913-021-07002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia. .,La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Eastern Health, 5 Arnold St, Box Hill, 3128, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Annemarie L Lee
- Cabrini Health, 154 Wattletree Rd, Malvern, 3144, Australia.,School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Lisa Somerville
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia
| | - Natasha A Lannin
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Alfred Health, 55 Commercial Rd, Melbourne, 3004, Australia.,Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, Melbourne, 3004, Australia
| | - Derick Wade
- Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.,School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, Bundoora, 3086, Australia.,Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, Glen Waverley, 3150, Australia
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21
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Brusco NK, Ekegren CL, Taylor NF, Hill KD, Lee AL, Somerville L, Lannin NA, Wade D, Abdelmotaleb R, Callaway L, Whittaker SL, Morris ME. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:811. [PMID: 34384427 PMCID: PMC8361638 DOI: 10.1186/s12913-021-06462-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. METHODS This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios. DISCUSSION The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs. TRIAL REGISTRATION This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia.
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Eastern Health, 5 Arnold St, 3128, Box Hill, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Annemarie L Lee
- Cabrini Health, 154 Wattletree Rd, 3144, Malvern, Australia
- School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Lisa Somerville
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Natasha A Lannin
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
- Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, 3004, Melbourne, Australia
| | - Derick Wade
- Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, OX3 0BP, Oxford, United Kingdom
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, 3150, Glen Waverley, Australia
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Whittaker SL, Taylor NF, Hill KD, Ekegren CL, Brusco NK. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a mixed-methods process evaluation. BMC Health Serv Res 2021; 21:810. [PMID: 34384420 PMCID: PMC8361854 DOI: 10.1186/s12913-021-06463-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Process evaluations have been recommended alongside clinical and economic evaluations to enable an in-depth understanding of factors impacting results. My Therapy is a self-management program designed to augment usual care inpatient rehabilitation through the provision of additional occupational therapy and physiotherapy exercises and activities, for the patient to complete outside of supervised therapy. The aims of the process evaluation are to assess the implementation process by investigating fidelity, quality of implementation, acceptability, adoption, appropriateness, feasibility and adaptation of the My Therapy intervention; and identify contextual factors associated with variations in outcomes, including the perspectives and experiences of patients and therapists. METHODS The process evaluation will be conducted alongside the clinical and economic evaluation of My Therapy, within eight rehabilitation wards across two public and two private Australian health networks. All participants of the stepped wedge cluster randomised trial (2,160 rehabilitation patients) will be included in the process evaluation (e.g., ward audit); with a subset of 120 participants undergoing more intensive evaluation (e.g., surveys and activity logs). In addition, 24 staff (occupational therapists and physiotherapists) from participating wards will participate in the process evaluation. The mixed-methods study design will adopt a range of quantitative and qualitative research approaches. Data will be collected via a service profile survey and audits of clinical practice across the participating wards (considering areas such as staffing profiles and prescription of self-management programs). The intensive patient participant data collection will involve structured therapy participation and self-management program audits, Exercise Self Efficacy Scale, patient activity logs, patient surveys, and patient-worn activity monitors. Staff data collection will include surveys and focus groups. DISCUSSION The process evaluation will provide context to the clinical and economic outcomes associated with the My Therapy clinical trial. It considers how clinical and economic outcomes were achieved, and how to sustain the outcomes within the participating health networks. It will also provide context to inform future scaling of My Therapy to other health networks, and influence future models of rehabilitation and related policy. TRIAL REGISTRATION This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).
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Affiliation(s)
- Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia.
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Eastern Health, 5 Arnold St, 3128, Box Hill, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
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23
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Lee DCA, Dissanayaka T, Burton E, Meyer C, Hunter SW, Suttanon P, Ekegren CL, Stout JC, Dawes H, Hill KD. Effectiveness of gait aid prescription for improving spatiotemporal gait parameters and associated outcomes in community-dwelling older people: a systematic review. Disabil Rehabil 2021; 44:6139-6154. [PMID: 34375545 DOI: 10.1080/09638288.2021.1958930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To integrate the evidence of gait aid prescription for improving spatiotemporal gait parameters, balance, safety, adherence to gait aid use, and reducing falls in community-dwelling older people. METHODS Seven health databases were searched to June 2021. Experimental studies investigating gait aid prescription (provision and instruction for use) for older people, reporting gait parameters, balance, falls, and safety of or adherence to gait aid use was included. Mean differences with 95% confidence intervals of gait and balance outcomes in participants at the program's last follow-up were analyzed. The safety of and adherence to gait aid use were described. RESULTS Eight studies were included (N = 555 older people). No meta-analyses could be performed. Five studies used a single gait aid instruction session. Gait aid prescription had inconsistent effects on gait velocity, and no reported benefits in reducing gait variability in older people with mobility problems or fall risks, including Parkinson's or Alzheimer's disease. No study investigated gait aid prescription on falls and balance performance. Effects on safety and adherence to gait aid use were unclear. CONCLUSION Research is needed to investigate the benefits of extensive gait aid training in older people with mobility problems, including those with dementia or high falls risk.IMPLICATIONS FOR REHABILITATIONThere is little evidence currently addressing the benefits of gait aid prescription on gait and associated outcomes in older people with mobility problems or fall risks.Gait aid prescription yielded inconsistent effects on increasing gait velocity and did not appear to reduce gait variability in older people with mobility problems or fall risks, nor in those with Parkinson's disease or Alzheimer's disease.Clinicians may consider using a more extensive gait aid training approach to optimize learning of safe gait patterns and gait aid use, which may produce better outcomes.
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Affiliation(s)
- Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston, Australia.,Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Thusharika Dissanayaka
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston, Australia.,Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Elissa Burton
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Bolton Clarke Research Institute, Brisbane, Australia.,Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Bangkok, Thailand
| | - Christina L Ekegren
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston, Australia.,Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Julie C Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Frankston, Australia
| | - Helen Dawes
- Department of Sport, Health Sciences and Social Work, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.,Oxford Health Biomedical Research Centre (Oxford Health NHS Foundation Trust and the University of Oxford), Oxford, UK
| | - Keith D Hill
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston, Australia.,Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
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Taylor NF, O'Halloran PD, Watts JJ, Morris R, Peiris CL, Porter J, Prendergast LA, Harding KE, Snowdon DA, Ekegren CL, Hau R, Mudiyanselage SB, Rimayanti MU, Noeske KE, Snowdon M, Kim D, Shields N. Motivational interviewing with community-dwelling older adults after hip fracture (MIHip): protocol for a randomised controlled trial. BMJ Open 2021; 11:e047970. [PMID: 34108169 PMCID: PMC8191622 DOI: 10.1136/bmjopen-2020-047970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation. METHODS AND ANALYSIS An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews. ETHICS AND DISSEMINATION Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars. TRIAL REGISTRATION NUMBER ACTRN12619000936123.
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Affiliation(s)
- Nicholas F Taylor
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Paul D O'Halloran
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rebecca Morris
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- College of Science Health and Engineering, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
| | - Casey L Peiris
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Luke A Prendergast
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Katherine E Harding
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedics and Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Shalika B Mudiyanselage
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Made U Rimayanti
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Kate E Noeske
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Megan Snowdon
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Daniel Kim
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Nora Shields
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
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Ekegren CL, Edwards ER, Kimmel L, Gabbe BJ. Do levels of sedentary behaviour and physical activity differ according to weight-bearing status after lower limb fracture? A prospective cohort study. Journal of Orthopaedics, Trauma and Rehabilitation 2021. [DOI: 10.1177/22104917211020436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background/purpose: To determine whether sedentary behaviour and physical activity differ according to initial weight-bearing status 2 weeks and 6 months after lower limb (LL) fracture. Methods: Two weeks and 6 months following LL fracture, 47 adults aged 18–69 wore ActiGraph and activPAL accelerometers for 10 days. Sitting time, steps, and moderate-intensity physical activity (MPA) were compared between weight-bearing (WB) and non-weight-bearing (NWB) groups. Results: Two weeks post-discharge, the NWB group sat significantly more than the WB group (median: 14.1 h/day vs. 13.3 h/day; p = 0.04). These differences were apparent for female and middle-aged participants. At 6 months, there were no significant differences between weight-bearing groups for sitting time, steps or MPA. Conclusion: Weight-bearing restriction had an early impact on sitting time, but this impact lessened over time. While considering the need for rest, advice about reducing sitting time may be particularly important for people who are NWB post-fracture.
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Affiliation(s)
- Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
- The Alfred, Melbourne, Australia
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- The Alfred, Melbourne, Australia
| | - Lara Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- The Alfred, Melbourne, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Crabtree A, Lane TJ, Mahon L, Petch T, Ekegren CL. The impact of an End-PJ-Paralysis quality improvement intervention in post-acute care: an interrupted time series analysis. AIMS Medical Science 2021. [DOI: 10.3934/medsci.2021003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gelaw AY, Gabbe BJ, Braaf SC, McPhail S, Ekegren CL. Chronic physical health conditions and associated factors among people with serious orthopaedic injuries: A systematic review. Trauma 2020. [DOI: 10.1177/1460408620968341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction A clear understanding of the development of chronic physical health conditions following orthopaedic injury is essential to fully recognise the magnitude and burden of injury, improve treatment and predict certain outcomes. This review aimed at systematically identifying and evaluating current evidence of the incidence and prevalence of chronic physical health conditions and factors associated with chronic physical health conditions following serious orthopaedic injury. Materials and method Systematic literature search was performed using Ovid MEDLINE, Scopus, and Embase via Ovid, Cochrane Library and Ovid Emcare up to 30 December 2018. Observational studies relating to the incidence or prevalence of chronic physical health conditions and associated factors in people with serious orthopaedic injuries were included. Data extraction and methodological quality assessment were carried out independently by 2 reviewers. Result Of the 4835 references identified in the initial search, only five studies with sample sizes ranging from 83 to 3846 met the criteria for inclusion. The most prevalent conditions reported in people with serious orthopaedic injury included coronary artery disease, arrhythmias, myocardial infarction, hypertension, diabetes mellitus and chronic heart failure. Bronchial, rectal, prostate and breast cancers were also causes of late death in orthopaedic injury survivors. Most of the studies included in this review were unable to determine whether these conditions were related to injuries. Conclusions Chronic physical health conditions are prevalent among people with serious orthopaedic injury. Little is known about factors associated with chronic physical health conditions following serious orthopaedic injury or whether physical health conditions are associated with injury. Further work needs to be done to identify causal pathways and the longer-term effects of orthopaedic injury on the risk of developing chronic physical health conditions.
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Affiliation(s)
- Asmare Yitayeh Gelaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Sandra C Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Steven McPhail
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Alfred Emergency and Trauma Centre, Melbourne, Australia
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Veitch WG, Climie RE, Gabbe BJ, Dunstan DW, Owen N, Ekegren CL. Agreement between the International Physical Activity Questionnaire and Accelerometry in Adults with Orthopaedic Injury. Int J Environ Res Public Health 2020; 17:ijerph17176139. [PMID: 32846977 PMCID: PMC7504024 DOI: 10.3390/ijerph17176139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/21/2022]
Abstract
Orthopaedic injury can lead to decreased physical activity. Valid measures for assessing physical activity are therefore needed in this population. The aim of this study was to determine the agreement and concordance between the International Physical Activity Questionnaire-Short Form (IPAQ) and device-measured physical activity and sitting time in orthopaedic injury patients. Adults with isolated upper or lower limb fracture (n = 46; mean age of 40.5 years) wore two activity monitors (ActiGraph wGT3X-BT and activPAL) for 10 days, from 2 weeks post-discharge. The IPAQ was also completed for a concurrent 7-day period. Lin's concordance correlation coefficients and Bland-Altman plots were calculated to compare walking/stepping time, total METmins, and sitting time. The IPAQ overestimated device-derived walking time (mean difference = 2.34 ± 7.33 h/week) and total METmins (mean difference = 767 ± 1659 METmins/week) and underestimated sitting time (mean difference = -2.26 ± 3.87 h/day). There was fair concordance between IPAQ-reported and device-measured walking (ρ = 0.34) and sitting time (ρ = 0.38) and moderate concordance between IPAQ-reported and device-measured METmins (ρ = 0.43). In patients with orthopaedic injury, the IPAQ overestimates physical activity and underestimates sitting time. Higher agreement was observed in the forms of activity (walking, total PA and sitting) commonly performed by this patient group.
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Affiliation(s)
- William G. Veitch
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
| | - Rachel E. Climie
- Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
- Health Data Research UK, Swansea University Medical School, Swansea SA2 8QA, UK
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
| | - Neville Owen
- Behavioural Epidemiology, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
- Swinburne Centre for Urban Transitions, Swinburne University of Technology, Melbourne 3122, Australia
| | - Christina L. Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia; (W.G.V.); (B.J.G.)
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne 3004, Australia;
- Emergency and Trauma Centre, The Alfred, Melbourne 3004, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston 3199, Australia
- Correspondence: ; Tel.: +61-3-9903-0939
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Ekegren CL, Braaf S, Ameratunga S, Ponsford J, Nunn A, Cameron P, Lyons RA, Gabbe BJ. Adaptation, self-motivation and support services are key to physical activity participation three to five years after major trauma: a qualitative study. J Physiother 2020; 66:188-195. [PMID: 32680743 DOI: 10.1016/j.jphys.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/16/2019] [Accepted: 06/22/2020] [Indexed: 01/24/2023] Open
Abstract
QUESTIONS What are the perceived long-term impacts of major trauma on physical activity participation over time? What factors influence physical activity participation in people recovering from major trauma? DESIGN Longitudinal qualitative study. PARTICIPANTS Sixty-six people aged ≥ 16 years with non-neurological major trauma. METHODS Participants were interviewed 3 years (n = 66), 4 years (n = 63) and 5 years (n = 57) after their injury. A thematic analysis was performed. RESULTS Despite wanting to be physically active, many participants experienced significant, long-term physical activity restriction after their injury, which persisted over time. Restrictions were often related to a fear of re-injury or of exacerbating pain and fatigue levels. These restrictions were a source of distress and frustration for many participants, given the perceived impacts on their social life, family roles and enjoyment of life. Participants were also concerned about weight gain, health decline and reduced physical fitness. Participants valued the support of insurers and specialised services in facilitating access to modified activities, such as clinical Pilates and hydrotherapy. Many participants also recognised the importance of adaptation, goal-setting, self-motivation and determination to be physically active despite limitations. CONCLUSION People recovering from major trauma experienced significant and persistent physical activity restriction after their injury. Given the high prevalence of activity restrictions, distress and health concerns that were reported, there is an urgent need to develop and evaluate support strategies to improve physical activity participation in this group.
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Affiliation(s)
- Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia; Emergency and Trauma Centre, Alfred Health, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - Sandra Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia; Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Ronan A Lyons
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University, Swansea, UK
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University, Swansea, UK
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Ekegren CL, Ashe MC, Gabbe BJ. Association between Patient-Reported Health Status and Physical Activity Six Months after Upper and Lower Limb Fractures in Working-Aged Adults. PM R 2020; 13:353-363. [PMID: 32462821 DOI: 10.1002/pmrj.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Physical activity limitations are common following upper and lower limb fractures in adults of working age. There is a lack of research investigating the factors associated with these limitations, such as pain, mental health problems, and mobility impairments. OBJECTIVES To report health status (EQ-5D) 6 months after upper and lower limb fracture in adults of working age (ages 18-69 years), and to determine the association between sedentary behavior (sitting time) and physical activity (steps, moderate-intensity physical activity [MPA]) 2 weeks and 6 months post-fracture with health status 6 months post-fracture. DESIGN Prospective cohort study. SETTING Major (level I) trauma center. PARTICIPANTS Sixty-three adults 18-69 years of age with upper or lower limb fractures who were recruited consecutively. MAIN OUTCOME MEASURES Participants wore ActiGraph and activPAL accelerometers for 10 days, 2 weeks and 6 months post-fracture. At 6 months, participants completed the EQ-5D. We used linear mixed-effects multivariable regression analyses to explore associations between EQ-5D domains and sitting time, steps, or physical activity. RESULTS Participants with mobility problems (compared to participants without) were highly sedentary at 2 weeks (β = 0.86, P = .04), took fewer steps/d (Ratio of Geometric Means [RGM] = 0.62, P = .02) and engaged in less MPA (RGM = 0.32, P = .01). In addition, they engaged in less MPA at 6 months (RGM = 0.52, P = .02). Participants with self-care problems (compared with participants without) took fewer steps per day at 6 months (RGM = 0.78, P = .04), and engaged in less MPA at 2 weeks (RGM = 0.31, P = .01) and 6 months (RGM = 0.48, P = .02). CONCLUSIONS Adults with mobility and self-care problems 6 months post-fracture engaged in high levels of sedentary behavior and low levels of physical activity. These findings can guide clinicians on health problems to target in order to maximize recovery of physical activity following fracture.
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Affiliation(s)
- Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Maureen C Ashe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Keeves J, Braaf SC, Ekegren CL, Beck B, Gabbe BJ. Caring for people with serious injuries in urban and regional communities: a qualitative investigation of healthcare providers' perceptions. Disabil Rehabil 2020; 43:3052-3060. [PMID: 32109168 DOI: 10.1080/09638288.2020.1728787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose: To understand the factors that affect the management of people after serious injury in urban and regional settings, beyond hospital discharge from the perspectives of allied health professionals (AHPs).Materials and methods: An exploratory qualitative study of AHPs caring for people with serious injuries post-hospital discharge in urban and regional areas of Victoria, Australia was completed. Twenty-five semi-structured interviews were undertaken with AHPs and thematically analysed.Results: Allied health professionals in urban and regional settings reported the benefits of a multi-disciplinary team to deliver high-quality care. However, a number of barriers to service delivery were identified that impacted on their ability to meet the needs of patients. These included insufficient psychological services, a shortage of available carers and an unmet need for external clinical support in regional areas. Communication between AHPs and other services, and care co-ordination of post-discharge services, was also highlighted as key areas to improve for optimal patient care.Conclusions: Factors that influenced optimal patient management included the availability of psychological and carer services, communication between health professionals and coordination of post-discharge care. The experiences of AHPs can offer practical suggestions to optimise service delivery and post-discharge care for people with serious injuries.Implications for RehabilitationAllied health professionals (AHPs) face a number of challenges in the provision of optimal care to people with serious injuries.Improving the availability of psychological support and attendant carers is needed in regional areas.A designated care coordinator role may assist people with serious injuries transitioning between hospital and home to engage with necessary services and reduce administrative burden for AHPs.Telehealth may provide facilitate improved communication between health professionals and support regional clinicians caring for people with complex injuries.
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Affiliation(s)
- Jemma Keeves
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Physiotherapy, Epworth Hospital, Melbourne, Australia
| | - Sandra C Braaf
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Ekegren CL, Climie RE, Simpson PM, Owen N, Dunstan DW, Veitch W, Gabbe BJ. Physical Activity and Sedentary Behavior 6 Months After Musculoskeletal Trauma: What Factors Predict Recovery? Phys Ther 2020; 100:332-345. [PMID: 31588514 DOI: 10.1093/ptj/pzz151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/25/2019] [Accepted: 06/27/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physical activity is increasingly recognized as an important marker of functional recovery following fracture. OBJECTIVE The objectives of this study were to measure sedentary behavior and physical activity 2 weeks and 6 months following fracture and to determine associated demographic and injury factors. DESIGN This was an observational study. METHODS Two weeks and 6 months following fracture, 83 adults who were 18 to 69 years old and had upper limb (UL) or lower limb (LL) fractures wore an accelerometer and an inclinometer for 10 days. We calculated sitting time, steps, moderate-intensity physical activity (MPA), and vigorous-intensity physical activity and conducted linear mixed-effects multivariable regression analyses to determine factors associated with temporal changes in activity. RESULTS At 6 months versus 2 weeks after fracture, participants sat less, took more steps, and engaged in more MPA. Participants with LL fractures sat 2 hours more, took 66% fewer steps, and engaged in 77% less MPA than participants with UL fractures. Greater reductions in sitting time were observed for participants in the youngest age group and with LL fractures, participants with high preinjury activity, and participants who were overweight or obese. For steps, greater improvement was observed for participants in the youngest and middle-aged groups and those with LL fractures. For MPA, greater improvement was observed for middle-aged participants and those with LL fractures. LIMITATIONS Although this study was sufficiently powered for the analysis of major categories, a convenience sample that may not be representative of all people with musculoskeletal trauma was used. CONCLUSIONS Working-age adults with LL fractures had lower levels of physical activity 6 months after fracture than those with UL fractures. Older adults showed less improvement over time, suggesting that they are an important target group for interventions aimed at regaining preinjury activity levels.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and The Alfred, Melbourne, Victoria, Australia
| | - Rachel E Climie
- Baker Heart and Diabetes Institute; and Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Pamela M Simpson
- BSc (Hons), Grad Dip Biostats, Department of Epidemiology and Preventive Medicine, Monash University
| | - Neville Owen
- Baker Heart and Diabetes Institute; and Swinburne University of Technology, Melbourne, Victoria, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute; and Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - William Veitch
- BBiomedSci (Hons), Department of Epidemiology and Preventive Medicine, Monash University
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University; and Health Data Research UK, Swansea University, Swansea, United Kingdom
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Abstract
BACKGROUND Pre-injury health status is an important determining factor of long-term outcomes after orthopaedic major trauma. Determining pre-injury health status of major trauma patients with orthopaedic injuries is also important for evaluating the change from pre to post-injury health status. OBJECTIVES Describe pre-injury health statuses reported at three different time points (6, 12 and 24 months) after injury and compare these with Australian normative values; determine the agreement between pre-injury health status collected at multiple time points post-injury; and identify factors associated with reporting better pre-injury health status. MATERIALS AND METHODS A registry-based cohort study was conducted. Major trauma patients with orthopaedic injuries captured by the Victorian State Trauma Registry with a date of injury from January 2009 to December 2016 were included. Pre-injury health status (measured using the EuroQol-Visual Analogue Scale (EQ-VAS)), reported 6, 12 and 24 months post-injury, was compared against Australian population normative values. The Bland-Altman method of comparison was used to determine the agreement between pre-injury EQ-VAS scores reported 6 to 12 and 6 to 24 months post-injury. Mixed effects ordinal logistic regression was used to determine factors associated with reporting better pre-injury health status. RESULTS A total of 3,371 patients were eligible for the study. The median (IQR) pre-injury EQ-VAS score reported 6, 12 and 24 months post-injury was 90 (85-100) out of 100. Participants' pre-injury EQ-VAS scores reported 6, 12 and 24 months post-injury were significantly higher than Australian population normative values. Pre-injury EQ-VAS scores reported 6 months post-injury agreed with pre-injury EQ-VAS scores reported 12 and 24 months post-injury. A significant association exists between pre-injury health status and age, comorbidities, injury characteristics, socioeconomic status and pre-injury work status. CONCLUSIONS People with orthopaedic major trauma have better pre-injury health compared to the general Australian population. Therefore, population-specific values should be used as baseline measures to evaluate orthopaedic trauma outcomes. Pre-injury health status values reported at three different post-injury time points were comparable. If conducting a retrospective pre-injury health evaluation, researchers need be aware of factors that influence self-reporting of pre-injury health status and the response shift that may happen due to encountering injury.
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Affiliation(s)
- Asmare Yitayeh Gelaw
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, United Kingdom
| | - Pamela M Simpson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Alfred Emergency and Trauma Centre, Melbourne, Australia.
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Keeves J, Ekegren CL, Beck B, Gabbe BJ. The relationship between geographic location and outcomes following injury: A scoping review. Injury 2019; 50:1826-1838. [PMID: 31353092 DOI: 10.1016/j.injury.2019.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Globally, injury incidence and injury-fatality rates are higher in regional and remote areas. Recovery following serious injury is complex and requires a multi-disciplinary approach to management and community re-integration to optimise outcomes. A significant knowledge gap exists in understanding the regional variations in hospital and post-discharge outcomes following serious injury. The aim of this study was to review the evidence exploring the association between the geographic location, including both location of the event and place of residence, and outcomes following injury. MATERIALS AND METHODS A scoping review was used to investigate this topic and provide insight into geographic variation in outcomes following traumatic injury. Seven electronic databases and reference lists of relevant articles were searched from inception to October 2018. Studies were included if they measured injury-related mortality, outcomes associated with hospital admission, post-injury physical or psychological function and analysed these outcomes in relation to geographic location. RESULTS Of the 2,213 studies identified, 47 studies were included revealing three key groups of outcomes: mortality (n = 35), other in-hospital outcomes (n = 8); and recovery-focused outcomes (n = 12). A variety of measures were used to classify rurality across studies with inconsistent definitions of rurality/remoteness. Of the studies reporting injury-related mortality, findings suggest that there is a greater risk of fatality in rural areas overall and in the pre-hospital phase. For those patients that survived to hospital, the majority of studies included identified no difference in mortality between rural and urban patient groups. In the small number of studies that reported other in-hospital and recovery outcomes no consistent trends were identified. CONCLUSION Rural patients had a higher overall and pre-hospital mortality following injury. However, once admitted to hospital, there was no significant difference in mortality. Inconsistencies were noted across measures of rurality measures highlighting the need for more specific and consistent international classification methods. Given the paucity of data on the impact of geography on non-mortality outcomes, there is a clear need to develop a larger evidence base on regional variation in recovery following injury to inform the optimisation of post-discharge care services.
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Affiliation(s)
- Jemma Keeves
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Physiotherapy Department, Epworth Hospital, Melbourne, Australia.
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Devlin A, Beck B, Simpson PM, Ekegren CL, Giummarra MJ, Edwards ER, Cameron PA, Liew S, Oppy A, Richardson M, Page R, Gabbe BJ. The road to recovery for vulnerable road users hospitalised for orthopaedic injury following an on-road crash. Accid Anal Prev 2019; 132:105279. [PMID: 31491683 DOI: 10.1016/j.aap.2019.105279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Pedestrians, cyclists and motorcyclists are vulnerable to serious injury due to limited external protective devices. Understanding the level of recovery, and differences between these road user groups, is an important step towards improved understanding of the burden of road trauma, and prioritisation of prevention efforts. This study aimed to characterise and describe patient-reported outcomes of vulnerable road users at 6 and 12 months following orthopaedic trauma. METHODS A registry-based cohort study was conducted using data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and included pedestrians, cyclists and motorcyclists who were hospitalised for an orthopaedic injury following an on-road collision that occurred between January 2009 and December 2016. Outcomes were measured using the 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3 L), Glasgow Outcome Scale - Extended (GOS-E) and return to work questions. Outcomes were collected at 6 and 12 months post-injury. Multivariable generalized estimating equations (GEE), adjusted for confounders, were used to compare outcomes between the road user groups over time. RESULTS 6186 orthopaedic trauma patients met the inclusion criteria during the 8-year period. Most patients were motorcyclists (42.8%) followed by cyclists (32.6%) and pedestrians (24.6%). Problems were most prevalent on the usual activities item of the EQ-5D-3 L at 6-months post-injury, and the pain/discomfort item of the EQ-5D-3 L at 12 months. The adjusted odds of reporting problems on all EQ-5D-3 L items were lower for cyclists when compared to pedestrians. Moreover, an average cyclist had a greater odds of a good recovery on the GOS-E, (AOR 2.75, 95% CI 2.33, 3.25) and a greater odds of returning to work (AOR = 3.13, 95% CI 2.46, 3.99) compared to an average pedestrian. CONCLUSION Pedestrians and motorcyclists involved in on-road collisions experienced poorer patient-reported outcomes at 6 and 12 months post-injury when compared to cyclists. A focus on both primary injury prevention strategies, and investment in ongoing support and treatment to maximise recovery, is necessary to reduce the burden of road trauma for vulnerable road users.
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Affiliation(s)
- Anna Devlin
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Pam M Simpson
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Melita J Giummarra
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, 260 Kooyong Road, Caulfield, VIC, 3162, Australia.
| | - Elton R Edwards
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.
| | - Susan Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
| | - Andrew Oppy
- Department of Trauma and Orthopaedic Surgery, The Royal Melbourne Hospital, Melbourne, Australia.
| | - Martin Richardson
- Department Surgery, Epworth Clinical school, University of Melbourne, Melbourne, Australia.
| | - Richard Page
- Barwon Centre for Orthopaedic Research and Education, Barwon Health and St John of God Hospital Geelong, 80 Myers St, Geelong 3220, Australia; School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds 3216, Australia.
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Faculty of Medicine, Nursing and Health Sciences, 553 St Kilda Road, Melbourne, VIC, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park Swansea, United Kingdom.
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Daly S, Nguyen TQ, Gabbe BJ, Braaf S, Simpson P, Ekegren CL. Agreement between medical record and administrative coding of common comorbidities in orthopaedic trauma patients. Injury 2019; 50:1277-1283. [PMID: 31109684 DOI: 10.1016/j.injury.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To i) quantify the agreement between comorbidities documented within medical records and an orthopaedic trauma dataset; and ii) compare agreement between these sources before and after the introduction of new comorbidity coding rules in Australian hospitals. STUDY DESIGN AND SETTING A random sample of adult (≥ 16 years) orthopaedic trauma patients (n = 400) were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Diagnoses of obesity, arthritis, diabetes and cardiac conditions documented within patients' medical records were compared to ICD-10-AM comorbidity codes (provided by hospitals) for the same admission. Agreement was calculated (Cohen's kappa) before and after the introduction of new coding rules. RESULTS All comorbidities had the same or higher prevalence in medical record data compared to coded data. Kappa values ranged from <0.001 (poor agreement) for coronary artery disease to 0.94 (excellent agreement) for type 2 diabetes. There was improvement in agreement between sources for most conditions following the introduction of new coding rules. CONCLUSION There has been improvement in the coding of certain comorbidities since the introduction of new coding rules, suggesting that, since 2015, administrative data has improved capacity to capture patients' comorbidity profiles. Consideration must be taken when using the ICD-10-AM data due to its limitations.
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Affiliation(s)
- Stuart Daly
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Tu Q Nguyen
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Health Data Research, UK
| | - Sandra Braaf
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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L. Ekegren C, E. Climie R, G. Veitch W, Owen N, W. Dunstan D, A. Kimmel L, J. Gabbe B. Sedentary behaviour and physical activity patterns in adults with traumatic limb fracture. AIMS Medical Science 2019. [DOI: 10.3934/medsci.2019.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ekegren CL, Edwards ER, de Steiger R, Gabbe BJ. Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture. Int J Environ Res Public Health 2018; 15:ijerph15122845. [PMID: 30551632 PMCID: PMC6313538 DOI: 10.3390/ijerph15122845] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years (n = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia.
- Department of Orthopaedic Surgery, Alfred Hospital, Melbourne VIC 3004, Australia.
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, Richmond VIC 3121, Australia.
- Department of Surgery, University of Melbourne, Parkville VIC 3052, Australia.
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia.
- Health Data Research UK, Swansea University, Swansea SA2 8PP, UK.
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Ekegren CL, Beck B, Simpson P, Gabbe BJ. Ten-year Trends In Major Trauma Or Death Resulting From Sport And Recreation In Victoria, Australia. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536979.21447.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Veitch WG, Climie RE, Gabbe BJ, Dunstan DW, Owen N, Ekegren CL. Validation Of Two Physical Activity And Sedentary Behavior Questionnaires In Orthopedic Trauma Patients. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538342.34469.8a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Background: Sports injuries that result in major trauma or death are associated with significant health care burden and societal costs. An understanding of changes in injury trends, and their drivers, is needed to implement policy aimed at risk reduction and injury prevention. To date, population-level reporting has not been available regarding trends in serious sport and recreation injuries anywhere in Australia over such an extended period, nor have any studies of this length captured comprehensive, long-term data on all sports-related major trauma internationally. Purpose: To describe the incidence of sport and active recreation injuries resulting in major trauma or death over a 10-year period (July 2005 to June 2015) in the state of Victoria, Australia. Study Design: Descriptive epidemiological study. Methods: All sport and active recreation–related major trauma cases and deaths in Victoria, Australia, over a 10-year period were extracted from the population-level Victorian State Trauma Registry and the National Coroners Information System. Poisson regression analysis was used to examine trends in the incidence of sport and active recreation–related major trauma and death. Results: The 10-year study period entailed 2847 nonfatal major trauma cases and 614 deaths (including 96 in-hospital deaths). The highest frequencies of major trauma cases and deaths were in cycling, motor sports, and equestrian activities. The participation-adjusted major trauma and death rate was 12.2 per 100,000 participants per year over the study period. An 8% increase was noted in the rate of nonfatal major trauma (incident rate ratio [IRR], 1.08; 95% CI, 1.06-1.10; P < .001) and a 7% decrease in the death rate (IRR, 0.93; 95% CI, 0.90-0.97; P < .001). Significant increases were found in the rates of major trauma (including deaths) in equestrian activities, motor sports, and cycling. Conclusion: The death rate from sport and active recreation decreased by more than half over the course of 10 years in Victoria, while the rate of nonfatal major trauma almost doubled. This increase is largely attributable to equestrian activities, motor sports, and cycling. Study findings highlight the need to prioritize investments in the prevention of trauma in these activities.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pamela M Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Farr Institute, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales
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Swain CT, Bradshaw EJ, Whyte DG, Ekegren CL. The prevalence and impact of low back pain in pre-professional and professional dancers: A prospective study. Phys Ther Sport 2018; 30:8-13. [DOI: 10.1016/j.ptsp.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/02/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
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C. Ashe M, L. Ekegren C, M. Chudyk A, Fleig L, K. Gill T, Langford D, Martin-Martin L, Ariza-Vega P. Telerehabilitation for community-dwelling middle-aged and older adults after musculoskeletal trauma: A systematic review. AIMS Medical Science 2018. [DOI: 10.3934/medsci.2018.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Ekegren CL, Hart MJ, Cameron PA, Edwards ER, Oppy A, de Steiger R, Page R, Liew S, Hau R, Bucknill A, Gabbe BJ. Do non-steroidal anti-inflammatory drugs impair fracture healing? A survey of Australian orthopaedic surgeons. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christina L. Ekegren
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - Melissa J. Hart
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Orthopaedics; Royal Melbourne Hospital; Melbourne Australia
| | - Peter A. Cameron
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Australia
| | - Elton R. Edwards
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery; Royal Melbourne Hospital; Melbourne; Australia
| | - Richard de Steiger
- Epworth Health; Melbourne Australia
- Department of Surgery; University of Melbourne; Melbourne Australia
| | - Richard Page
- Department of Orthopaedics; University Hospital Geelong; Geelong Australia
- School of Medicine; Deakin University; Geelong Australia
| | - Susan Liew
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Australia
- Department of Surgery; Monash University; Melbourne Australia
| | - Raphael Hau
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Department of Orthopaedic Surgery; Northern Hospital; Epping Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery; Royal Melbourne Hospital; Melbourne; Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
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Beck B, Ekegren CL, Cameron P, Edwards ER, Bucknill A, Judson R, Page R, Hau R, Stevenson M, Gabbe BJ. Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash. Accid Anal Prev 2017; 106:341-347. [PMID: 28710974 DOI: 10.1016/j.aap.2017.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/26/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND As cycling-related injury rates are on the rise, there is a need to understand the long term outcomes of these patients in order to quantify the burden of injury and to inform injury prevention strategies. This study aimed to investigate predictors of return to work and functional recovery in a cohort of cyclists hospitalised for orthopaedic trauma from crashes occurring on-road. METHODS A retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised for orthopaedic trauma following a cycling crash that occurred on-road between July 2007 and June 2015. RESULTS There were 1787 injured cyclists admitted at the participating hospitals. Most cyclists were male (79%), resided in major cities (89%) and were in the highest socioeconomic quintile (52%). The majority of crashes were either non-collisions (41%) or collisions with a motor vehicle (35%). A smaller proportion of cyclists who collided with motor vehicles had returned to work and had returned to pre-injury functional levels at 12 months post-injury, when compared to collisions with other impact counterparts and non-collisions. Mixed effects logistic regression models revealed that compensable patients demonstrated lower odds of complete functional recovery and return to work when compared with non-compensable patients. CONCLUSION Cyclists who collided with motor vehicles had worse outcomes compared to crashes with other impact counterparts and non-collision events. These findings provide support for reducing the potential for interaction between cyclists and motor vehicles.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Orthopaedic Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Rodney Judson
- Department of Surgery, The University of Melbourne, Victoria, Australia; General Surgery, The Royal Melbourne Hospital, Victoria, Australia
| | - Richard Page
- Barwon Centre of Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Raphael Hau
- Melbourne Medical School, Northern Hospital, Victoria, Australia
| | - Mark Stevenson
- Melbourne School of Design/Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Farr Institute, Swansea University Medical School, Swansea University, UK
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Swain CTV, Bradshaw EJ, Whyte DG, Ekegren CL. The Experience Of Low Back Pain In Pre-professional And Professional Dancers. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518041.65209.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ekegren CL, Edwards ER, Oppy A, Liew S, Page R, de Steiger R, Cameron PA, Bucknill A, Hau R, Gabbe BJ. Twelve-month work-related outcomes following hip fracture in patients under 65 years of age. Injury 2017; 48:701-707. [PMID: 28118983 DOI: 10.1016/j.injury.2017.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/14/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recent research has highlighted the need for improved outcome reporting in younger hip fracture patients. For this population, return to work (RTW) is a particularly important measure against which to evaluate treatment outcomes. However, to date, only two small studies have reported RTW outcomes in young hip fracture patients and neither investigated factors predictive of RTW. The aims of this study were to report return to work (RTW) status and predictors of RTW 12 months after hip fracture in patients <65 years. METHODS Two hundred and ninety-one adults aged <65 years, admitted with hip fractures between July 2009 and June 2013 and registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in this prospective cohort study. Twelve-month return to work status was collected through structured telephone interviews conducted by trained interviewers. Multivariate logistic regression was used to identify demographic and injury variables that were important predictors of 12-month work status. RESULTS Sixty-five per-cent of patients had returned to work 12 months after hip fracture (62% of whom had an isolated hip fracture and 38% of whom had additional injuries). Relative to patients aged 16-24 years, odds of RTW was reduced by 78%-89% for each 10-year increase in age (p=0.02). Relative to patients employed as managers/administrators/professionals, odds of RTW were 68% to 95% lower for all other workers (p<0.001). For those reporting a pre-injury disability, odds of RTW were 79% lower compared to those without disability (p=0.004) and 69% lower for patients with multiple injuries compared to isolated hip fracture patients (p=0.002). Finally, patients compensated by a work or transport insurer had a 67% lower odds of RTW relative to patients who were not compensated (p=0.02). CONCLUSIONS Approximately one third of patients <65years had not returned to work 12 months after hip fracture. Patients who are older, have multiple injuries or pre-existing disabilities or who work in more physical occupations may need more assistance to RTW following hip fracture. The compensation system should be examined to determine why compensated patients may be at risk of poor RTW outcomes.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital,Parkville, Australia
| | - Susan Liew
- Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Richard Page
- Department of Orthopaedics, University Hospital Geelong, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - Richard de Steiger
- Epworth Hospital, Richmond, Australia; University of Melbourne,Parkville, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital,Parkville, Australia
| | - Raphael Hau
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Northern Hospital, Epping, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Beck B, Ekegren CL, Cameron P, Stevenson M, Judson R, Bucknill A, Edwards E, Gabbe B. Comparing ICD-10 external cause codes for pedal cyclists with self-reported crash details. Inj Prev 2017; 24:157-160. [DOI: 10.1136/injuryprev-2016-042206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/05/2016] [Accepted: 01/18/2017] [Indexed: 11/04/2022]
Abstract
Accurate coding of injury event information is critical in developing targeted injury prevention strategies. However, little is known about the validity of the most universally used coding system, the International Classification of Diseases (ICD-10), in characterising crash counterparts in pedal cycling events. This study aimed to determine the agreement between hospital-coded ICD-10-AM (Australian modification) external cause codes with self-reported crash characteristics in a sample of pedal cyclists admitted to hospital following bicycle crashes. Interview responses from 141 injured cyclists were mapped to a single ICD-10-AM external cause code for comparison with ICD-10-AM external cause codes from hospital administrative data. The percentage of agreement was 77.3% with a κ value of 0.68 (95% CI 0.61 to 0.77), indicating substantial agreement. Nevertheless, studies reliant on ICD-10 codes from administrative data should consider the 23% level of disagreement when characterising crash counterparts in cycling crashes.
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Fox G, Gabbe BJ, Richardson M, Oppy A, Page R, Edwards ER, Hau R, Ekegren CL. Twelve-month outcomes following surgical repair of the Achilles tendon. Injury 2016; 47:2370-2374. [PMID: 27424531 DOI: 10.1016/j.injury.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/27/2016] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Incidence of Achilles tendon rupture (ATR) has increased over recent years, and debate regarding optimal management has been widely documented. Most papers have focused on surgical success, complications and short term region-specific outcomes. Inconsistent use of standardised outcome measures following surgical ATR repair has made it difficult to evaluate the impact of ATR on a patient's health status post-surgery, and to compare this to other injury types. This study aimed to report the frequency of surgical repairs of the Achilles tendon over a five-year period within an orthopaedic trauma registry, and to investigate return to work (RTW) status, health status and functional outcomes at 12 months post-surgical repair of the Achilles tendon. METHODS Two hundred and four adults registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who underwent surgical repair of the Achilles tendon between July 2009 and June 2014 were included in this prospective cohort study. The Extended Glasgow Outcome Scale (GOS-E), 3-level European Quality of Life 5 Dimension measure (EQ-5D-3L), and RTW status 12 months following surgical ATR repair were collected through structured telephone interviews conducted by trained interviewers. RESULTS At 12 months, 92% of patients were successfully followed up. Of those working prior to injury, 95% had returned to work. 42% of patients reported a full recovery on the GOS-E scale. The prevalence of problems on the EQ-5D-3L at 12 months was 0.5% for self-care, 11% for anxiety, 13% for mobility, 16% for activity, and 22% for pain. 16% of patients reported problems with more than one domain. The number of surgical repairs of the Achilles tendon within the VOTOR registry decreased by 68% over the five-year study period. CONCLUSIONS Overall, patients recover well following surgical repair of the Achilles tendon. However, in this study, deficits in function persisted for over half of patients at 12 months post-injury. The decreased incidence of surgical Achilles tendon repair may reflect a change in practice at VOTOR hospitals whereby surgery may be becoming less favoured for initial ATR management.
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Affiliation(s)
- G Fox
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - B J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - A Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - R Page
- Department of Orthopaedics, University Hospital Geelong, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - E R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia
| | - R Hau
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Northern Hospital, Epping, Australia
| | - C L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Abstract
BACKGROUND AND AIMS Data from sports injury surveillance systems are a prerequisite to the development and evaluation of injury prevention strategies. This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness. METHODS A systematic search was carried out to identify (1) publications presenting methodological details of sports injury surveillance systems within clubs and organisations; and (2) publications describing quality evaluations and the quality of data from these systems. Data extracted included methodological details of the surveillance systems, methods used to evaluate data quality, and results of these evaluations. RESULTS Following literature search and review, a total of 15 sports injury surveillance systems were identified. Data relevant to each aim were summarised descriptively. Most systems were found to exist within professional and elite sports. Publications concerning data quality were identified for seven (47%) systems. Validation of system data through comparison with alternate sources has been undertaken for only four systems (27%). CONCLUSIONS This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings. More surveillance systems are needed across a range of sport settings, as are standards for data quality reporting. These efforts will enable better monitoring of sports injury trends and the development of sports safety strategies.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, VIC, 3353, Australia
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