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Raios C, Keating JL, Skinner EH, Opdam HI, Haines KJ. Exploring current physiotherapy practices in the care of people who are potential lung donors: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00001-8. [PMID: 38365522 DOI: 10.1016/j.aucc.2023.12.003] [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: 09/05/2023] [Revised: 11/19/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to determine physiotherapists' current practices and perspectives regarding their role in caring for people who are potential lung donors in the intensive care unit (ICU). METHODS A qualitative descriptive design was used. Qualitative data were collected through audio-recorded, semistructured focus groups with a purposive sample of physiotherapists with experience working with people who are potential lung donors in ICUs. Two investigators completed independent thematic analysis to identify themes. RESULTS Seven focus groups were completed with 27 physiotherapists at six metropolitan health services in Victoria, Australia. Six key themes were identified: (i) physiotherapists' involvement in care was highly variable; (ii) physiotherapists were not aware of existing evidence or guidelines for the care of people who are potential donors and followed usual practices; (iii) a consistent vision of the physiotherapy role was lacking; (iv) physiotherapists' engagement with the team routinely involved in care of people who are potential donors varied considerably; (v) physiotherapists faced practice challenges associated with delivering care to potential donors; and (vi) several enablers could support a role for physiotherapy in this patient population. CONCLUSIONS Variability in physiotherapy practice is associated with local ICU culture, physiotherapy leadership capabilities, knowledge, and experience. The spectrum of practice ranged from physiotherapists being highly engaged to being completely uninvolved. Physiotherapists held mixed perspectives regarding whether physiotherapists should have a role in managing people who are potential lung donors. It would benefit the profession to develop consensus and standardisation of the role of physiotherapists in caring for these patients. TWEETABLE ABSTRACT Variability in views and practices amongst physiotherapists who provide care to patients who are potential lung donors in the ICU.
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Affiliation(s)
- Cassandra Raios
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of General Medicine, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Helen I Opdam
- Organ and Tissue Authority, Canberra, ACT, Australia; Department of Intensive Care, Austin Health, Heidelberg 3084, Victoria, Australia
| | - Kimberley J Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, Victoria, Australia; Department of Physiotherapy, Western Health, Footscray 3011, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville 3001, Victoria, Australia
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Haines KJ, Hibbert E, Skinner EH, Leggett N, Holdsworth C, Ali Abdelhamid Y, Bates S, Bicknell E, Booth S, Carmody J, Deane AM, Emery K, Farley KJ, French C, Krol L, MacLeod-Smith B, Maher L, Paykel M, Iwashyna TJ. In-person peer support for critical care survivors: The ICU REcovery Solutions cO-Led through surVivor Engagement (ICURESOLVE) pilot randomised controlled trial. Aust Crit Care 2024:S1036-7314(24)00022-5. [PMID: 38360469 DOI: 10.1016/j.aucc.2024.01.006] [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: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies. OBJECTIVES The objective of this study was to establish feasibility of an in-person, co-designed, peer-support model. METHODS Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia. Intensive care unit survivors (and their nominated caregiver, where survivor and caregiver are referred to as a dyad), >18 years of age, able to speak and understand English and participate in phone surveys, were eligible. Participants were randomised to the peer-support model (six sessions, fortnightly) or usual care (no follow-up or targeted information). Two sequential models were piloted: 1. Early (2-3 weeks post hospital discharge) 2. Later (4-6 weeks post hospital discharge). Primary outcome was feasibility of implementation measured by recruitment, intervention attendance, and outcome completion. Secondary outcomes included post-traumatic stress and social support. RESULTS Of the 231 eligible patients, 80 participants were recruited. In the early model we recruited 38 participants (28 patients, 10 carers; 18 singles, 10 dyads), with an average (standard deviation) age of 60 (18) years; 55 % were female. Twenty-two participants (58 %) were randomised to intervention. Participants in the early intervention model attended a median (interquartile range) of 0 (0-1) sessions (total 24 sessions), with 53% (n = 20) completing the main secondary outcome of interest (Impact of Event Scale) at the baseline and 37 % (n = 14) at the follow-up. For the later model we recruited 42 participants (32 patients, 10 carers; 22 singles, 10 dyads), with an average (standard deviation) age of 60.4 (15.4) years; 50 % were female. Twenty-one participants (50 %) were randomised to intervention. The later intervention model attended a median (interquartile range) of 1 (0-5) sessions (total: 44 sessions), with the main secondary outcome impact of events scale (IES-R) completed by 41 (98 %) participants at baseline and 29 (69 %) at follow-up. CONCLUSIONS In this pilot trial, a peer-support model that required in-person attendance delivered in a later posthospital phase of recovery appeared more feasible than an early model. Further research should investigate alternative modes of intervention delivery to improve feasibility (ACTRN12621000737831).
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Erin Bicknell
- Department of Physiotherapy, Melbourne Health, Melbourne, Australia
| | - Sarah Booth
- Department of Social Work, Western Health, Melbourne, Australia
| | - Jacki Carmody
- Department of Psychology, Western Health, Melbourne, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - K J Farley
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Lauren Krol
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
| | - Melanie Paykel
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Theodore J Iwashyna
- Pulmonary and Critical Care Medicine, School of Medicine, John Hopkins University, Baltimore, MD, United States
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3
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Wang YT, Harrison CA, Skinner EH, Haines KJ, Holdsworth C, Lang JK, Hibbert E, Scott D, Eynon N, Tiruvoipati R, French CJ, Stepto NK, Bates S, Walton KL, Crozier TM, Haines TP. Activin A level is associated with physical function in critically ill patients. Aust Crit Care 2023; 36:702-707. [PMID: 36517331 DOI: 10.1016/j.aucc.2022.10.019] [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] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Activin A is a potent negative regulator of muscle mass elevated in critical illness. It is unclear whether muscle strength and physical function in critically ill humans are associated with elevated activin A levels. OBJECTIVES The objective of this study was to investigate the relationship between serum activin A levels, muscle strength, and physical function at discharge from the intensive care unit (ICU) and hospital. METHODS Thirty-six participants were recruited from two tertiary ICUs in Melbourne, Australia. Participants were included if they were mechanically ventilated for >48 h and expected to have a total ICU stay of >5 days. The primary outcome measure was the Six-Minute Walk Test distance at hospital discharge. Secondary outcome measures included handgrip strength, Medical Research Council Sum Score, Physical Function ICU Test Scored, Six-Minute Walk Test, and Timed Up and Go Test assessed throughout the hospital admission. Total serum activin A levels were measured daily in the ICU. RESULTS High peak activin A was associated with worse Six-Minute Walk Test distance at hospital discharge (linear regression coefficient, 95% confidence interval, p-value: -91.3, -154.2 to -28.4, p = 0.007, respectively). Peak activin A concentration was not associated with the secondary outcome measures. CONCLUSIONS Higher peak activin A may be associated with the functional decline of critically ill patients. Further research is indicated to examine its potential as a therapeutic target and a prospective predictor for muscle wasting in critical illness. STUDY REGISTRATION ACTRN12615000047594.
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Affiliation(s)
- Yi Tian Wang
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Physiotherapy, Peninsula Health, Melbourne, Australia.
| | - Craig A Harrison
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Australia.
| | - Elizabeth H Skinner
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia; Department of Physiotherapy, Western Health, Melbourne, Australia; Australian Institute of Musculoskeletal Science, The University of Melbourne, Melbourne, Australia.
| | - Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Australia.
| | - Jenna K Lang
- Department of Physiotherapy, Western Health, Melbourne, Australia.
| | | | - David Scott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
| | - Nir Eynon
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Ravindranath Tiruvoipati
- Department of Intensive Care, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Peninsula Clinical School, Monash University, Frankston, VIC, Australia.
| | - Craig J French
- Department of Intensive Care, Western Health, Melbourne, Australia.
| | - Nigel K Stepto
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia.
| | - Kelly L Walton
- Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Department of Physiology, Monash University, Australia.
| | - Tim M Crozier
- Department of Intensive Care, Monash Health, Melbourne, Australia; Southern Clinical School, Monash University, Melbourne, Australia.
| | - Terry P Haines
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Melbourne, Australia.
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Barker K, Holland AE, Skinner EH, Lee AL. Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review. J Rehabil Med 2023; 55:jrm00377. [PMID: 36876460 PMCID: PMC10015470 DOI: 10.2340/jrm.v55.2551] [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: 04/23/2022] [Accepted: 01/13/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events. DATA SOURCES A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION AND EXTRACTION Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity. DATA SYNTHESIS Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1-7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45-82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI -3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes. CONCLUSION In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes.
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Affiliation(s)
- Kathryn Barker
- Department of Chronic and Complex Care, Western Health, St Albans; Discipline of Physiotherapy, La Trobe University, Bundoora
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora; Central Clinical School, Monash University, Melbourne; Alfred Health, Melbourne; Institute for Breathing and Sleep, Austin Health, Heidelberg
| | - Elizabeth H Skinner
- Alfred Health, Melbourne; Department of Physiotherapy, Monash University, Frankston; Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Austin Health, Heidelberg; Department of Physiotherapy, Monash University, Frankston.
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Alsubheen SA, Beauchamp MK, Ellerton C, Goldstein R, Alison JA, Dechman G, Haines KJ, Harrison SL, Holland AE, Lee AL, Marques A, Spencer L, Stickland M, Skinner EH, Brooks D. Validity of the Activities-specific Balance Confidence Scale in individuals with chronic obstructive pulmonary disease. Expert Rev Respir Med 2022; 16:689-696. [DOI: 10.1080/17476348.2022.2099378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sanaa A. Alsubheen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
| | - Marla K. Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University,Hamilton, ON, Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto ON, Canada
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
| | - Jennifer A. Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Allied Health, Sydney Local Health District, Sydney, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax NS, Canada
- Department of Medicine, Respirology, Dalhousie University and Nova Scotia Health Authority, Halifax NS, Canada
| | | | - Samantha L. Harrison
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Anne E. Holland
- Department of Physiotherapy, Alfred Health, Melbourne VIC, Australia
- Respiratory Research, Monash University, Melbourne VIC, Australia
- Institute for Breathing and Sleep, Melbourne VIC, Australia
| | - Annemarie L. Lee
- Institute for Breathing and Sleep, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
- Department of Allied Health Research, Cabrini Health, Malvern VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, ESSUA) and Institute of Biomedicine, iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW, Australia
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown NSW, Australia
| | - Michael Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton AB, Canada
- G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H. Skinner
- Physiotherapy Department, Western Health, Melbourne VIC, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne VIC, Australia
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto ON, Canada
- Respiratory Research, Monash University, Melbourne VIC, Australia
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6
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Alsubheen SA, Beauchamp M, Ellerton C, Goldstein R, Alison J, Dechman G, Haines KJ, Harrison S, Holland A, Lee A, Marques A, Spencer L, Stickland M, Skinner EH, Brooks D. Age and Sex Differences in Balance Outcomes among Individuals with Chronic Obstructive Pulmonary Disease (COPD) at Risk of Falls. COPD 2022; 19:166-173. [PMID: 35392741 DOI: 10.1080/15412555.2022.2038120] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
No previous research has examined age and sex differences in balance outcomes in individuals with chronic obstructive pulmonary disease (COPD) at risk of falls. A secondary analysis of baseline data from an ongoing trial of fall prevention in COPD was conducted. Age and sex differences were analyzed for the Berg Balance scale (BBS), Balance Evaluation System Test (BEST test) and Activities-specific Balance Confidence Scale (ABC). Overall, 223 individuals with COPD were included. Females had higher balance impairments than males [BBS: mean (SD) = 47 (8) vs. 49 (6) points; BEST test: 73 (16) vs. 80 (16) points], and a lower confidence to perform functional activities [ABC = 66 (21) vs. 77 (19)]. Compared to a younger age (50-65 years) group, age >65 years was moderately associated with poor balance control [BBS (r = - 0.37), BEST test (r = - 0.33)] and weakly with the ABC scale (r = - 0.13). After controlling for the effect of balance risk factors, age, baseline dyspnea index (BDI), and the 6-min walk test (6-MWT) explained 38% of the variability in the BBS; age, sex, BDI, and 6-MWT explained 40% of the variability in the BEST test; And BDI and the 6-MWT explained 44% of the variability in the ABC scale. This study highlights age and sex differences in balance outcomes among individuals with COPD at risk of falls. Recognition of these differences has implications for pulmonary rehabilitation and fall prevention in COPD, particularly among females and older adults.
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Affiliation(s)
- Sanaa A Alsubheen
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada.,Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Alison
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Medicine, Respirology, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Samantha Harrison
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Anne Holland
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia.,Respiratory Research, Monash University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Annemarie Lee
- Institute for Breathing and Sleep, Melbourne, VIC, Australia.,Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.,Centre for Allied Health Research and Education, Cabrini Health, Malvern, VIC, Australia
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Lissa Spencer
- Department of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | - Elizabeth H Skinner
- Physiotherapy Department, Western Health, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Dina Brooks
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, VIC, Australia
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Boden I, Reeve J, Robertson IK, Browning L, Skinner EH, Anderson L, Hill C, Story D, Denehy L. Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial. Perioper Med (Lond) 2021; 10:36. [PMID: 34689825 PMCID: PMC8543902 DOI: 10.1186/s13741-021-00206-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. Results Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. Conclusions Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. Trial registration ANZCTR 12613000664741; 19/06/2013. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00206-3.
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Affiliation(s)
- I Boden
- Department of Physiotherapy, Launceston General Hospital, Launceston, Australia. .,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - J Reeve
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - I K Robertson
- School of Health Sciences, University of Tasmania, Launceston, Australia.,Clifford Craig Foundation, Launceston General Hospital, Launceston, Australia
| | - L Browning
- Directorate of Community Integration, Allied Health and Service Planning, Western Health, Melbourne, Australia
| | - E H Skinner
- Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Australia.,Department of Medicine, The Alfred Hospital, Melbourne, Australia
| | - L Anderson
- Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - C Hill
- Physiotherapy Department, North West Regional Hospital, Burnie, Australia
| | - D Story
- Anaesthesia Perioperative and Pain Medicine Unit, The University of Melbourne, Melbourne, Australia.,Melbourne Clinical and Translational Science Research Platform, Melbourne, Australia
| | - L Denehy
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Allied Health Research, Peter McCallum Cancer Centre, Melbourne, Australia
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8
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Reynolds H, Steinfort S, Tillyard J, Ellis S, Hayes A, Hanson ED, Wijeratne T, Skinner EH. Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial. BMC Neurol 2021; 21:132. [PMID: 33745454 PMCID: PMC7983371 DOI: 10.1186/s12883-021-02052-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training. METHODS A pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9). RESULTS Feasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change. CONCLUSIONS Moderate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored. TRIAL REGISTRATION The trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN 12613000822785 ) on 25/07/2013.
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Affiliation(s)
- Hanna Reynolds
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Steinfort
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Jane Tillyard
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Sarah Ellis
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia
| | - Alan Hayes
- Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia.,The Institute for Health and Sport, Victoria University, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Erik D Hanson
- The Institute for Health and Sport, Victoria University, Melbourne, Australia.,University of North Carolina, Chapel Hill, NC, USA
| | - Tissa Wijeratne
- The University of Melbourne, Melbourne, Australia.,Department of Neurology, Western Health, Melbourne, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, 176 Furlong Rd, St Albans, 3021, Australia. .,Australian Institute of Musculoskeletal Science, Melbourne, Victoria, Australia. .,The University of Melbourne, Melbourne, Australia. .,Monash University, Melbourne, Victoria, Australia.
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9
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Lloyd MA, Tang CY, Callander EJ, Janus ED, Karahalios A, Skinner EH, Lowe S, Karunajeewa HA. Patient-reported outcome measurement in community-acquired pneumonia: feasibility of routine application in an elderly hospitalized population. Pilot Feasibility Stud 2019; 5:97. [PMID: 31372236 PMCID: PMC6661077 DOI: 10.1186/s40814-019-0481-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/19/2019] [Indexed: 01/25/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, but few studies have evaluated the feasibility of routine patient-reported outcome measures (PROMs) in this illness. This study investigates the feasibility and limitations of three credible PROM instruments in a representative hospitalized cohort to identify potential barriers to routine application. Methods A sample of multimorbid hospitalized subjects meeting a standardized CAP definition was recruited. Demographic and clinical data of those able and unable to participate in PROM assessment were compared. The EQ-5D-5L, CAP-Sym 18 Questionnaire, and Late-Life Function and Disability Instrument (LLFDI) were administered (via face-to-face interview) at admission and discharge and (via phone interview or mail) at 30 and 90 days post-discharge. Feasibility measures included the proportion of individuals able to participate in assessment, attrition rates, data completeness, and instrument completion times. Scores at admission and 30 days post-discharge were examined for association with age. Results Of 82 subjects screened, 44 (54%) participated. Cognitive impairment (n = 12, 15%) commonly precluded participation. Seventeen (39%) participants were lost to follow-up by 90 days. Missing data at item level was negligible for all instruments, regardless of the mode of completion. Completion of the three instruments collectively in a face-to-face interview took a median of 17 min (IQ range 13-21) per participant. The burden of reported symptoms at admission was higher for younger participants aged 18-74 years (mean (standard deviation)) CAP-Sym 18 score at admission 34.2 (18.6) vs. 19.0 (11.3) for those aged ≥ 75 years. Conclusions Routine application of PROMs can provide valuable information relating to multiple aspects of clinical recovery for individuals hospitalized with CAP. However, heterogeneous demographic characteristics and complex underlying health status introduce challenges to feasibility and interpretability of these instruments in this population. Trial registration ClinicalTrials.gov, NCT02835040.
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Affiliation(s)
- Melanie A Lloyd
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia
| | - Clarice Y Tang
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,3Department of Physiotherapy, La Trobe University, Bundoora, Victoria 3000 Australia.,4Department of Physiotherapy, Western Sydney University, Penrith, New South Wales 2751 Australia
| | - Emily J Callander
- 5School of Medicine, Griffith University, Southport, Queensland 4215 Australia
| | - Edward D Janus
- 2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia.,6General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria 3021 Australia
| | - Amalia Karahalios
- 7Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010 Australia
| | - Elizabeth H Skinner
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia.,8Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria 3010 Australia.,9Department of Physiotherapy, School of Primary Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199 Australia
| | - Stephanie Lowe
- 1Department of Physiotherapy, Western Health, St Albans, Victoria 3021 Australia
| | - Harin A Karunajeewa
- 2Melbourne Medical School - Western Precinct, The University of Melbourne, St Albans, Victoria 3021 Australia.,6General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria 3021 Australia.,10The Walter and Eliza Hall Institute of Medical Research, Parkville, 3052 Victoria Australia
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10
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Lloyd M, Karahalios A, Janus E, Skinner EH, Haines T, De Silva A, Lowe S, Shackell M, Ko S, Desmond L, Karunajeewa H. Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia: A Stepped-Wedge Randomized Clinical Trial. JAMA Intern Med 2019; 179:1052-1060. [PMID: 31282921 PMCID: PMC6618815 DOI: 10.1001/jamainternmed.2019.1438] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Community-acquired pneumonia remains a leading cause of hospitalization, mortality, and health care costs worldwide. Randomized clinical trials support the use of adjunctive corticosteroids, early progressive mobilization, antibiotic switching rules, and dietary interventions in improving outcomes. However, it is uncertain whether implementing these interventions will translate into effectiveness under routine health care conditions. OBJECTIVE To evaluate the effectiveness of a bundle of evidence-supported treatments under conditions of routine care in a representative population hospitalized for community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTS A double-blind, stepped-wedge, cluster-randomized clinical trial with 90-day follow-up was conducted between August 1, 2016, and October 29, 2017, in the general internal medicine service at 2 tertiary hospitals in Melbourne, Australia, among a consecutive sample of patients with community-acquired pneumonia. The primary analysis and preparation of results took place between May 14 and November 25, 2018. INTERVENTIONS Treating clinical teams were advised to prescribe prednisolone acetate, 50 mg/d, for 7 days (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were also implemented. MAIN OUTCOMES AND MEASURES Hospital length of stay, mortality, readmission, and intervention-associated adverse events (eg, gastrointestinal bleeding and hyperglycemia). RESULTS A total of 917 patients were screened, and 816 (351 women and 465 men; mean [SD] age, 76 [13] years) were included in the intention-to-treat analysis, with 401 patients receiving the intervention and 415 patients in the control group. An unadjusted geometric mean ratio of 0.95 (95% CI, 0.78-1.16) was observed for the difference in length of stay (days) between the intervention and control groups. Similarly, no significant differences were observed for the secondary outcomes of mortality and readmission, and the results remained unchanged after further adjustment for sex and age. The study reported higher proportions of gastrointestinal bleeding in the intervention group (9 [2.2%]) compared with the controls (3 [0.7%]), with an unadjusted estimated difference in mean proportions of 0.008 (95% CI, 0.005-0.010). CONCLUSIONS AND RELEVANCE This bundled intervention including adjunctive corticosteroids demonstrated no evidence of effectiveness and resulted in a higher incidence of gastrointestinal bleeding. Efficacy of individual interventions demonstrated in clinical trials may not necessarily translate into effectiveness when implemented in combination and may even result in net harm. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02835040.
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Affiliation(s)
- Melanie Lloyd
- Department of Physiotherapy, Western Health, The University of Melbourne, Melbourne, Australia.,Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Edward Janus
- Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia.,General Internal Medicine Unit, Western Health, The University of Melbourne, Melbourne, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, The University of Melbourne, Melbourne, Australia.,School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Anurika De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Stephanie Lowe
- Department of Physiotherapy, Western Health, The University of Melbourne, Melbourne, Australia
| | - Melina Shackell
- Department of Physiotherapy, Western Health, The University of Melbourne, Melbourne, Australia
| | - Soe Ko
- General Internal Medicine Unit, Western Health, The University of Melbourne, Melbourne, Australia
| | - Lucy Desmond
- General Internal Medicine Unit, Western Health, The University of Melbourne, Melbourne, Australia
| | - Harin Karunajeewa
- Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia.,General Internal Medicine Unit, Western Health, The University of Melbourne, Melbourne, Australia.,Division of Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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11
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Sarkies MN, Skinner EH, Bowles KA, Morris ME, Williams C, O'Brien L, Bardoel A, Martin J, Holland AE, Carey L, White J, Haines TP. A novel counterbalanced implementation study design: methodological description and application to implementation research. Implement Sci 2019; 14:45. [PMID: 31046788 PMCID: PMC6498461 DOI: 10.1186/s13012-019-0896-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 04/15/2019] [Indexed: 12/27/2022] Open
Abstract
Background Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementation phase of knowledge transfer, as differences between individual and organisational readiness for change combined with small sample sizes can lead to imbalances in factors that impede or facilitate change between intervention and control groups. Within-cluster repeated measure designs could control for variance between intervention and control groups by allowing the same clusters to receive a sequence of conditions. Although in implementation settings, they can contaminate the intervention and control groups after the initial exposure to interventions. We propose the novel application of counterbalanced design to implementation research where repeated measures are employed through crossover, but contamination is averted by counterbalancing different health contexts in which to test the implementation strategy. Methods In a counterbalanced implementation study, the implementation strategy (independent variable) has two or more levels evaluated across an equivalent number of health contexts (e.g. community-acquired pneumonia and nutrition for critically ill patients) using the same outcome (dependent variable). This design limits each cluster to one distinct strategy related to one specific context, and therefore does not overburden any cluster to more than one focussed implementation strategy for a particular outcome, and provides a ready-made control comparison, holding fixed. The different levels of the independent variable can be delivered concurrently because each level uses a different health context within each cluster to avoid the effect of treatment contamination from exposure to the intervention or control condition. Results An example application of the counterbalanced implementation design is presented in a hypothetical study to demonstrate the comparison of ‘video-based’ and ‘written-based’ evidence summary research implementation strategies for changing clinical practice in community-acquired pneumonia and nutrition in critically ill patient health contexts. Conclusion A counterbalanced implementation study design provides a promising model for concurrently investigating the success of research implementation strategies across multiple health context areas such as community-acquired pneumonia and nutrition for critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13012-019-0896-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mitchell N Sarkies
- School of Primary and Allied Health Care, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia. .,Allied Health Research Unit, Monash Health, 400 Warrigal Road, Cheltenham, Victoria, 3092, Australia. .,Department of Physiotherapy, Monash Health, 400 Warrigal Road, Cheltenham, Victoria, 3092, Australia.
| | - Elizabeth H Skinner
- Allied Health Research Unit, Monash Health, 400 Warrigal Road, Cheltenham, Victoria, 3092, Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Building H Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
| | - Meg E Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, 3086, Australia.,North Eastern Rehabilitation Centre, Healthscope, Ivanhoe, Victoria, 3079, Australia
| | - Cylie Williams
- Peninsula Health, 4 Hastings Road, Frankston, Victoria, 3199, Australia
| | - Lisa O'Brien
- Department of Occupational Therapy, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
| | - Anne Bardoel
- Department of Management and Marketing, Swinburne University, BA Buidling John Street, Hawthorn Campus, Hawthorn, Victoria, 3122, Australia
| | - Jenny Martin
- Swinburne University, John Street, Hawthorn, Victoria, 3122, Australia
| | - Anne E Holland
- Alfred Health and La Trobe University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia.,Neurorehabilitation and Recovery, Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health, 245 Burgundy Street, Heidelberg, Victoria, 3084, Australia
| | - Jennifer White
- School of Primary and Allied Health Care, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
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12
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Barker K, Holland AE, Lee AL, Haines T, Ritchie K, Boote C, Saliba J, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. Multimorbidity rehabilitation versus disease-specific rehabilitation in people with chronic diseases: a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:181. [PMID: 30519483 PMCID: PMC6267787 DOI: 10.1186/s40814-018-0369-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 11/13/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Multimorbidity (the co-existence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials. METHODS A pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization. RESULTS Sixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval - 16 to 60) compared to 22 (57) meters (95% confidence interval - 69 to 114) (control). CONCLUSIONS It was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.
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Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Anne E. Holland
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - Annemarie L. Lee
- La Trobe University, Plenty Rd and Kingsbury Drive, Bundoora, Victoria 3086 Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
| | - Terry Haines
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
| | - Kathryn Ritchie
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Claire Boote
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Alfred Health, 55 Commercial Rd, Melbourne, Victoria 3004 Australia
| | - Joanne Saliba
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050 Australia
| | - Stephanie Lowe
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Fiona Pazsa
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Lee Thomas
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Monica Turczyniak
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy/Community Services, Western Health, 176 Furlong Road, St Albans, Victoria 3021 Australia
- Australian Institute of Musculoskeletal Science, Western Centre for Health Research and Education, Western Health, St Albans, Victoria 3021 Australia
- Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria 3199 Australia
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne, Victoria 3000 Australia
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13
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Berney SC, Rose JW, Denehy L, Granger CL, Ntoumenopoulos G, Crothers E, Steel B, Clarke S, Skinner EH. Commencing Out-of-Bed Rehabilitation in Critical Care-What Influences Clinical Decision-Making? Arch Phys Med Rehabil 2018; 100:261-269.e2. [PMID: 30172644 DOI: 10.1016/j.apmr.2018.07.438] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/19/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop a decision tree that objectively identifies the most discriminative variables in the decision to provide out-of-bed rehabilitation, measure the effect of this decision and to identify the factors that intensive care unit (ICU) practitioners think most influential in that clinical decision. DESIGN A prospective 3-part study: (1) consensus identification of influential factors in mobilization via survey; (2) development of an early rehabilitation decision tree; (3) measurement of practitioner mobilization decision-making. Treating practitioners of patients expected to stay >96 hours were asked if they would provide out-of-bed rehabilitation and rank factors that influenced this decision from an a priori defined list developed from a literature review and expert consultation. SETTING Four tertiary metropolitan ICUs. PARTICIPANTS Practitioners (ICU medical, nursing, and physiotherapy staff) (N=507). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A decision tree was constructed using binary recursive partitioning to determine the factor that best classified patients suitable for out-of-bed rehabilitation. Descriptive statistics were used to describe practitioner and patient samples as well as patient adverse events associated with out-of-bed rehabilitation and the factors prioritized by ICU practitioners. RESULTS There were 1520 practitioner decisions representing 472 individual patient decisions. Practitioners classified patients suitable for out-of-bed rehabilitation on 149 occasions and not suitable on 323 occasions. Decision tree analysis showed the presence of an endotracheal tube (ETT) and sedation state were the only discriminative variables that predicted patient suitability for rehabilitation. In contrast, medical staff and nurses reported that ventilator status was the most influential factor in their decision not to provide rehabilitation while physiotherapists ranked sedation most highly. The presence of muscle weakness did not inform the decision to provide rehabilitation. CONCLUSION These results confirm previous observational reports that the presence of an ETT remains a major obstacle to the provision of rehabilitation for critically ill patients. Despite rehabilitation being effective for improving muscle strength, the presence of muscle weakness did not influence the decision to provide rehabilitation.
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Affiliation(s)
- Sue C Berney
- Physiotherapy Department, Austin Health, Melbourne, Australia; Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Joleen W Rose
- Physiotherapy Department, Austin Health, Melbourne, Australia
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia
| | - Catherine L Granger
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Allied Health Department, Melbourne Health, Melbourne, Australia
| | | | - Elise Crothers
- Physiotherapy Department, St Vincent's Hospital, Darlinghurst, Australia
| | | | - Sandy Clarke
- Statistical Consulting Centre, School of Mathematics and Statistics, The University of Melbourne, Melbourne, Australia
| | - Elizabeth H Skinner
- Institute for Breathing and Sleep, Melbourne, Australia; Western Health, Melbourne, Australia; Monash University, Melbourne, Australia
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14
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Barker K, Holland AE, Lee AL, Ritchie K, Boote C, Lowe S, Pazsa F, Thomas L, Turczyniak M, Skinner EH. A rehabilitation programme for people with multimorbidity versus usual care: A pilot randomized controlled trial. J Comorb 2018; 8:2235042X18783918. [PMID: 30057892 PMCID: PMC6060614 DOI: 10.1177/2235042x18783918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multimorbidity, the coexistence of two or more chronic conditions, is common in clinical practice. Rehabilitation for people with multimorbidity may provide access to a rehabilitation programme that can address common symptoms and risk factors for multiple chronic diseases. OBJECTIVE The aims of this study were to (1) evaluate the feasibility of a rehabilitation programme compared to usual medical care (UMC) in people with multimorbidity and (2) gather preliminary data regarding clinical effects and impact on functional exercise capacity, activities of daily living, health-related quality of life and resource utilization. DESIGN A pilot feasibility parallel randomized controlled trial was undertaken. Adults with multimorbidity were randomized to the rehabilitation programme (intervention) or UMC (control). The duration of the rehabilitation programme was 8 weeks and comprised exercise (1 h, twice weekly) and education (1 h, once weekly). The UMC group did not participate in a structured exercise programme. RESULTS One hundred people were screened to recruit 16 participants, with a 71% completion rate for the intervention group. The rehabilitation group achieved a mean (standard deviation) improvement in 6-minute walk distance of 44 (41) m and the UMC group of 23 (29) m. CONCLUSIONS This study suggests that it would be feasible to conduct a larger randomized control trial investigating a rehabilitation programme for people with multimorbidity. Low uptake of the study suggests that refinement of the inclusion criteria, recruitment sources and programme model will be needed to achieve the number of participants required.
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Affiliation(s)
- Kathryn Barker
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
| | - Annemarie L Lee
- Discipline of Physiotherapy, La Trobe University, Bundoora,
Victoria, Australia
- Institute for Breathing and Sleep, Bowen Centre, Austin Health,
Heidelberg, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Science, School of Primary and Allied Health Care, Monash University, Frankston,
Victoria, Australia
| | - Kathryn Ritchie
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Claire Boote
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Department of Physiotherapy, Alfred Health, Melbourne, Victoria,
Australia
| | - Stephanie Lowe
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Fiona Pazsa
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Lee Thomas
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Monica Turczyniak
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy and Community Services, Western Health,
176 Furlong Road, St Albans, Victoria, Australia
- Australian Institute of Musculoskeletal Science, Western Centre for
Health Research and Education, Western Health, Victoria, Australia
- Allied Health Research Unit, Faculty of Medicine, Nursing and Health
Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health
Sciences, Melbourne School of Health Sciences, The University of Melbourne,
Victoria, Australia
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15
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Raios C, Skinner EH, Keating JL. Lung management protocols increase the incidence of lung procurement and organ transplantation: A meta-analysis. Physiother Theory Pract 2018; 36:459-468. [DOI: 10.1080/09593985.2018.1488907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cassandra Raios
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
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16
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Bastick EK, O'Keeffe DD, Farlie MK, Ryan DT, Haines TP, Katz N, Knight JL, Keely LK, Saber KJ, Sturgess TR, Skinner EH. Postgraduate clinical physiotherapy education in acute hospitals: a cohort study. Physiother Theory Pract 2018; 36:157-169. [PMID: 29913072 DOI: 10.1080/09593985.2018.1479906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/14/2022]
Abstract
Background: Junior physiotherapists require satisfactory clinical skills to work effectively within the acute hospital setting for service quality and consistency. Objective: To investigate the effects of stream-specific clinical training on junior physiotherapist self-efficacy, self-rated confidence, and self-rated ability to work independently during weekend shifts. Design: Prospective cohort study. Participants: Eighteen junior physiotherapists. Methods: Physiotherapists undertook 8 h of stream-specific education in: pediatrics, women's health, neuro-medical, musculoskeletal, cardiorespiratory, and critical care over 8 weeks. Learning objectives were evaluated using a self-efficacy (0-100) scale and self-rated confidence was measured with a 4-point Likert scale (not confident to independent). Self-rated ability to independently work weekend shifts was measured dichotomously (yes/no). Results: Participants completed an average of three stream-specific programs in the study period. Post-training, mean improvement in self-efficacy across objectives ranged from 2.9 (95% CI -8.7 to 14.5) to 43.3 (95% CI 4.8-81.8) points, p < 0.05 for 80% of objectives. Self-rated confidence scores improved for 45.6% of stream-specific learning objectives; 52.8% were unchanged and 1.7% reported a decrease in confidence. Self-rated ability to work stream-specific weekend shifts increased from 56-70%, but no stream achieved a significant increase in staff able to independently work weekend shifts (p range 0.10 to 1.0). Conclusions: A stream-specific education program increased junior physiotherapists' self-efficacy and self-rated confidence but not perceived ability to work independently on weekends. Results were non-randomized and actual practice change was not assessed. Future studies could investigate different educational structures in a blinded, randomized manner on clinical practice change.
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Affiliation(s)
- Emma K Bastick
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - David D O'Keeffe
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Melanie K Farlie
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Danielle T Ryan
- Department of Physiotherapy, Monash Health, Melbourne, Australia.,Department of Physiotherapy, Monash University, Melbourne, Australia
| | | | - Nikki Katz
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Jessica L Knight
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Laura K Keely
- Department of Physiotherapy, Monash Health, Melbourne, Australia
| | - Kelly J Saber
- Department of Physiotherapy, Monash Health, Melbourne, Australia
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Sarkies MN, White J, Morris ME, Taylor NF, Williams C, O’Brien L, Martin J, Bardoel A, Holland AE, Carey L, Skinner EH, Bowles KA, Grant K, Philip K, Haines TP. Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol. Implement Sci 2018; 13:60. [PMID: 29690882 PMCID: PMC5916715 DOI: 10.1186/s13012-018-0752-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. METHODS This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. DISCUSSION Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621.
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Affiliation(s)
- Mitchell N. Sarkies
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Jennifer White
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3202 Australia
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, 3086 Australia
- North Eastern Rehabilitation Centre, Healthscope Australia, Melbourne, Australia
| | - Nicholas F. Taylor
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, 3086 Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, 3128 Australia
| | - Cylie Williams
- Peninsula Health, 4 Hastings Rd, Frankston, Victoria 3199 Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Monash University, Building G, McMahons Road, Frankston, Victoria 3199 Australia
| | - Jenny Martin
- School of Arts, Social Sciences and Humanities, Swinburne University, Hawthorn Campus, John St, Hawthorn, Victoria 3122 Australia
| | - Anne Bardoel
- Department of Management and Marketing, Swinburne University, BA 1224 Hawthorn Campus, John St, Hawthorn, Victoria 3122 Australia
| | - Anne E. Holland
- Alfred Health and La Trobe University, 99 Commercial Rd, Melbourne, 3004 Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria 3086 Australia
- Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084 Australia
| | - Elizabeth H. Skinner
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3202 Australia
| | - Kelly-Ann Bowles
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Kellie Grant
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Kathleen Philip
- Department of Health and Human Services, Melbourne, Victoria Australia
| | - Terry P. Haines
- Monash University, Level 3, Building G, Peninsula Campus, McMahons Rd, Frankston, Victoria 3199 Australia
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18
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Skinner EH, Lloyd M, Janus E, Ong ML, Karahalios A, Haines TP, Kelly AM, Shackell M, Karunajeewa H. The IMPROVE-GAP Trial aiming to improve evidence-based management of community-acquired pneumonia: study protocol for a stepped-wedge randomised controlled trial. Trials 2018; 19:88. [PMID: 29402313 PMCID: PMC5800278 DOI: 10.1186/s13063-017-2407-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 12/13/2017] [Indexed: 12/20/2022] Open
Abstract
Background Community-acquired pneumonia is a leading worldwide cause of hospital admissions and healthcare resource consumption. The largest proportion of hospitalisations now occurs in older patients, with high rates of multimorbidity and complex care needs. In Australia, this population is usually managed by hospital inpatient general internal medicine units. Adherence to consensus best-practice guidelines is poor. Ensuring evidence-based care and reducing length of stay may improve patient outcomes and reduce organisational costs. This study aims to evaluate an alternative model of care designed to improve adherence to four Level 1 or 2 evidence-supported interventions (routine corticosteroids, early switch to oral antibiotics, early mobilisation and routine malnutrition screening). Methods/Design The IMPROVing Evidence-based treatment Gaps and outcomes in community-Acquired Pneumonia (IMPROVE-GAP) trial is a pragmatic, investigator-initiated, stepped-wedge randomised trial. Patients hospitalised under a general internal medicine unit who meet a standard case definition for community-acquired pneumonia will be included. Eight general internal medicine units at two Australian hospitals in a single health service will be randomised using concealed allocation to: (i) usual medical, nursing and allied health care delivered according to existing organisational practice or (ii) care supported by a dedicated “community-acquired pneumonia service”: a multidisciplinary team deploying algorithm-based implementation of a bundle of the four evidence-based interventions. The primary outcome measure will be length of hospital stay. Secondary outcome measures include inpatient mortality, 30 and 90 day readmission rates and mortality and health-service utilisation costs. Protocol adherence will be measured and reported, and serious adverse events (rates of hyperglycaemia requiring new insulin; falls during mobilisation) will be collected and reported. Discussion IMPROVE-GAP represents an important and unique precedent for testing a new service-delivery model for improving compliance with a number of evidence-based interventions. Its stepped-wedge randomised controlled trial design provides a means to address some significant ethical, organisational and other methodological challenges to evaluating the effectiveness of health-service interventions in complex hospital populations. The new service-delivery model will effectively be fully implemented by trial completion, facilitating rapid, seamless translation into practice should care outcomes be superior. This trial is currently recruiting. Trial registration ClinicalTrials.gov, NCT02835040. Prospectively registered on 22 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2407-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy, Western Health, 160 Gordon St, Footscray, Victoria, 3011, Australia. .,Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia. .,Department of Physiotherapy, School of Primary Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, 3199, Australia.
| | - Melanie Lloyd
- Department of Physiotherapy, Western Health, 160 Gordon St, Footscray, Victoria, 3011, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, 3021, Australia.,Department of Medicine Melbourne Medical School - Western Precinct, University of Melbourne, Sunshine Hospital, St Albans, Victoria, 3021, Australia
| | - May Lea Ong
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, 3021, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Terry P Haines
- Department of Physiotherapy, School of Primary Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, 3199, Australia
| | - Anne-Maree Kelly
- Department of Medicine Melbourne Medical School - Western Precinct, University of Melbourne, Sunshine Hospital, St Albans, Victoria, 3021, Australia.,Joseph Epstein Centre for Emergency Medicine Research, Western Health, Sunshine Hospital, St Albans, Victoria, 3021, Australia
| | - Melina Shackell
- Department of Physiotherapy, Western Health, 160 Gordon St, Footscray, Victoria, 3011, Australia.,Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Harin Karunajeewa
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, 3021, Australia.,Department of Medicine Melbourne Medical School - Western Precinct, University of Melbourne, Sunshine Hospital, St Albans, Victoria, 3021, Australia.,The Walter and Eliza Hall Institute of Medical Research, G Royal Parade, Parkville, Victoria, 3052, Australia
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19
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Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C, Robertson IK, Story D, Denehy L. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018; 360:j5916. [PMID: 29367198 PMCID: PMC5782401 DOI: 10.1136/bmj.j5916] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. DESIGN Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. SETTING Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. PARTICIPANTS 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial. INTERVENTIONS Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided. MAIN OUTCOME MEASURES The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months. RESULTS The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute risk reduction of 15% (95% confidence interval 7% to 22%) and a number needed to treat of 7 (95% confidence interval 5 to 14). No significant differences in other secondary outcomes were detected. CONCLUSION In a general population of patients listed for elective upper abdominal surgery, a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia. Further research is required to investigate benefits to mortality and length of stay. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ANZCTR 12613000664741.
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Affiliation(s)
- Ianthe Boden
- Department of Physiotherapy, Launceston General Hospital, Launceston, TAS, 7250, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Directorate of Community Integration, Allied Health and Service Planning, Western Health, Melbourne, VIC, Australia
| | - Laura Browning
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Directorate of Community Integration, Allied Health and Service Planning, Western Health, Melbourne, VIC, Australia
| | - Julie Reeve
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Lesley Anderson
- Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Cat Hill
- Physiotherapy Department, North West Regional Hospital, Burnie, TAS, Australia
| | - Iain K Robertson
- Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - David Story
- Anaesthesia Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Linda Denehy
- Melbourne School of Health Sciences, The University of Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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20
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Beauchamp MK, Brooks D, Ellerton C, Lee A, Alison J, Camp PG, Dechman G, Haines K, Harrison SL, Holland AE, Marques A, Moineddin R, Skinner EH, Spencer L, Stickland MK, Xie F, Goldstein RS. Pulmonary Rehabilitation With Balance Training for Fall Reduction in Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e228. [PMID: 29158206 PMCID: PMC5715200 DOI: 10.2196/resprot.8178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/29/2017] [Accepted: 09/30/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. A growing body of evidence shows that individuals with COPD have important deficits in balance control that may be associated with an increased risk of falls. Pulmonary rehabilitation (PR) is a key therapeutic intervention for individuals with COPD; however, current international guidelines do not include balance training and fall prevention strategies. OBJECTIVE The primary aim of this trial is to determine the effects of PR with balance training compared to PR with no balance training on the 12-month rate of falls in individuals with COPD. Secondary aims are to determine the effects of the intervention on balance, balance confidence, and functional lower body strength, and to estimate the cost-effectiveness of the program. METHODS A total of 400 individuals from nine PR centers across Canada, Europe, and Australia will be recruited to participate in a randomized controlled trial. Individuals with COPD who have a self-reported decline in balance, a fall in the last 2 years, or recent near fall will be randomly assigned to an intervention or control group. The intervention group will undergo tailored balance training in addition to PR and will receive a personalized home-based balance program. The control group will receive usual PR and a home program that does not include balance training. All participants will receive monthly phone calls to provide support and collect health care utilization and loss of productivity data. Both groups will receive home visits at 3, 6, and 9 months to ensure proper technique and progression of home exercise programs. The primary outcome will be incidence of falls at 12-month follow-up. Falls will be measured using a standardized definition and recorded using monthly self-report fall diary calendars. Participants will be asked to record falls and time spent performing their home exercise program on the fall diary calendars. Completed calendars will be returned to the research centers in prepaid envelopes each month. Secondary measures collected by a blinded assessor at baseline (pre-PR), post-PR, and 12-month follow-up will include clinical measures of balance, balance confidence, functional lower body strength, and health status. The cost-effectiveness of the intervention group compared with the control group will be evaluated using the incremental cost per number of falls averted and the incremental cost per quality-adjusted life years gained. RESULTS Recruitment for the study began in January 2017 and is anticipated to be complete by December 2019. Results are expected to be available in 2020. CONCLUSIONS Findings from this study will improve our understanding of the effectiveness and resource uses of tailored balance training for reducing falls in individuals with COPD. If effective, the intervention represents an opportunity to inform international guidelines and health policy for PR in individuals with COPD who are at risk of falling. TRIAL REGISTRATION ClinicalTrials.gov NCT02995681; https://clinicaltrials.gov/ct2/show/NCT02995681 (Archived by WebCite at http://www.webcitation.org/6ukhxgAsg).
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Affiliation(s)
- Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
| | - Dina Brooks
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Cindy Ellerton
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Annemarie Lee
- Department of Rehabilitation, Nutrition and Sport, LaTrobe University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jennifer Alison
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
- Sydney Local Health District, Camperdown, Australia
| | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Gail Dechman
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Samantha L Harrison
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Anne E Holland
- Department of Rehabilitation, Nutrition and Sport, LaTrobe University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
- Institute for Biomedicine Research, University of Aveiro, Aveiro, Portugal
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | | | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- GF MacDonald Centre for Lung Health, Edmonton, AB, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's, Hamilton, ON, Canada
- Program for Health Economics and Outcome Measures, Hamilton, ON, Canada
| | - Roger S Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Sarkies MN, Bowles KA, Skinner EH, Haas R, Lane H, Haines TP. The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review. Implement Sci 2017; 12:132. [PMID: 29137659 PMCID: PMC5686806 DOI: 10.1186/s13012-017-0662-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. METHODS An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. RESULTS After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change. CONCLUSIONS Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies. TRIAL REGISTRATION This systematic review was registered with Prospero (record number: 42016032947).
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Affiliation(s)
- Mitchell N. Sarkies
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Kelly-Ann Bowles
- Monash University Department of Community Emergency Health and Paramedic Practice, Building H McMahons Road, Frankston, VIC 3199 Australia
| | - Elizabeth H. Skinner
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Romi Haas
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Haylee Lane
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
| | - Terry P. Haines
- Kingston Centre, Monash University and Monash Health Allied Health Research Unit, 400 Warrigal Road, Heatherton, VIC 3202 Australia
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Haines TP, Bowles KA, Mitchell D, O’Brien L, Markham D, Plumb S, May K, Philip K, Haas R, Sarkies MN, Ghaly M, Shackell M, Chiu T, McPhail S, McDermott F, Skinner EH. Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials. PLoS Med 2017; 14:e1002412. [PMID: 29088237 PMCID: PMC5663333 DOI: 10.1371/journal.pmed.1002412] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/21/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. METHODS AND FINDINGS We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. CONCLUSIONS In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796.
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Affiliation(s)
- Terry P. Haines
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
- * E-mail:
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Victoria, Australia
| | - Deb Mitchell
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Donna Markham
- Monash Medical Centre, Allied Health, Monash Health, Clayton, Victoria, Australia
| | - Samantha Plumb
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kerry May
- Monash Medical Centre, Allied Health, Monash Health, Clayton, Victoria, Australia
| | - Kathleen Philip
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Romi Haas
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Mitchell N. Sarkies
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Allied Health Research Unit, Monash Health, Cheltenham, Victoria, Australia
| | - Marcelle Ghaly
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Melina Shackell
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Timothy Chiu
- Footscray Hospital, Western Health, Footscray, Victoria, Australia
| | - Steven McPhail
- Institute of Biomedical Innovation, Queensland University of Technology and Centre for Functioning and Health Research, Buranda, Queensland, Australia
| | - Fiona McDermott
- Department of Social Work, Monash Medical Centre, Monash Health and Monash University, Clayton, Victoria, Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Footscray Hospital, Western Health, Footscray, Victoria, Australia
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Boden I, El-Ansary D, Zalucki N, Robertson IK, Browning L, Skinner EH, Denehy L. Physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity: a nested mixed-methods randomised-controlled study. Physiotherapy 2017; 104:194-202. [PMID: 28935227 DOI: 10.1016/j.physio.2017.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/15/2016] [Accepted: 08/17/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To (1) assess memorability and treatment fidelity of pre-operative physiotherapy education prior to elective upper abdominal surgery and, (2) to explore patient opinions on pre-operative education. DESIGN Mixed-methods analysis of a convenience sample within a larger parallel-group, double-blinded, randomised controlled trial with concealed allocation and intention-to-treat analysis. SETTING Tertiary Australian hospital. PARTICIPANTS Twenty-nine patients having upper abdominal surgery attending pre-admission clinic within six-weeks of surgery. INTERVENTION The control group received an information booklet about preventing pulmonary complications with early ambulation and breathing exercises. The experimental group received an additional face-to-face 30-minute physiotherapy education and training session on pulmonary complications, early ambulation, and breathing exercises. OUTCOME MEASURES Primary outcome was proportion of participants who remembered the taught breathing exercises following surgery. Secondary outcomes were recall of information sub-items and attainment of early ambulation goals. These were measured using standardised scoring of a semi-scripted digitally-recorded interview on the 5th postoperative day, and the attainment of early ambulation goals over the first two postoperative days. RESULTS Experimental group participants were six-times more likely to remember the breathing exercises (95%CI 1.7 to 22) and 11-times more likely (95%CI 1.6 to 70) to report physiotherapy as the most memorable part of pre-admission clinic. Participants reported physiotherapy education content to be detailed, interesting, and of high value. Some participants reported not reading the booklet and professed a preference for face-to-face information delivery. CONCLUSION Face-to-face pre-operative physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity. TRIAL REGISTRATION ACTRN-12613000664741.
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Affiliation(s)
- Ianthe Boden
- Physiotherapy Department, Launceston General Hospital, P.O. Box 1963, Launceston, 7250, TAS, Australia; Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, VIC, Australia; Clifford Craig Foundation, Launceston General Hospital, P.O. Box 1963, Launceston, 7250, TAS, Australia.
| | - Doa El-Ansary
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, VIC, Australia.
| | - Nadia Zalucki
- Physiotherapy Department, Launceston General Hospital, P.O. Box 1963, Launceston, 7250, TAS, Australia.
| | - Iain K Robertson
- Clifford Craig Foundation, Launceston General Hospital, P.O. Box 1963, Launceston, 7250, TAS, Australia; School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston, 7250, TAS, Australia.
| | - Laura Browning
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, VIC, Australia; Division of Allied Health, Western Health, Furlong Road, St Albans, 3021, VIC, Australia.
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, VIC, Australia.
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry Street, Carlton, 3053, VIC, Australia.
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Skinner EH. Intensive preoperative rehabilitation improves functional capacity and postoperative hospital length of stay in elderly patients with lung cancer [synopsis]. J Physiother 2017; 63:184. [PMID: 28666714 DOI: 10.1016/j.jphys.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 11/16/2022] Open
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O'Brien L, Mitchell D, Skinner EH, Haas R, Ghaly M, McDermott F, May K, Haines T. What makes weekend allied health services effective and cost-effective (or not) in acute medical and surgical wards? Perceptions of medical, nursing, and allied health workers. BMC Health Serv Res 2017; 17:345. [PMID: 28494806 PMCID: PMC5427575 DOI: 10.1186/s12913-017-2279-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background There is strong public support for acute hospital services to move to genuine 7-day models, including access to multidisciplinary team assessment. This study aimed to identify factors that might enable an effective and cost-effective weekend allied health services on acute hospital wards. Methods This qualitative study included 22 focus groups within acute wards with a weekend allied health service and 11 telephone interviews with weekend service providers. Data were collected from 210 hospital team members, including 17 medical, 97 nursing, and 96 allied health professionals from two Australian tertiary public hospitals. All were recorded and imported into nVivo 10 for analysis. Thematic analysis methods were used to develop a coding framework from the data and to identify emerging themes. Results Key themes identified were separated into issues perceived as being enablers or barriers to the effective or cost-effective delivery of weekend allied health services. Perceived enablers of effectiveness and cost-effectiveness included prioritizing interventions that prevent decline, the right person delivering the right service, improved access to the patient’s family, and ability to impact patient flow. Perceived barriers were employment of inexperienced weekend staff, insufficient investment to see tangible benefit, inefficiencies related to double-handling, unnecessary interventions and/or inappropriate referrals, and difficulty recruiting and retaining skilled staff. Conclusions Suggestions for ensuring effective and cost effective weekend allied health care models include minimization of task duplication and targeting interventions so that the right patients receive the right interventions at the right time. Further research into the effectiveness and cost effectiveness of these services should factor in hidden costs, including those associated with managing the service.
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Affiliation(s)
- Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, PO Box 527, Frankston, VIC, 3199, Australia.
| | - Deb Mitchell
- Allied Health Workforce, Innovation, Strategy, Education and Research Unit, Monash Health, Moorabbin, Australia
| | | | - Romi Haas
- Allied Health Research Unit Kingston Centre, Monash Health, Melbourne, Australia
| | - Marcelle Ghaly
- Western Centre for Health Research and Education, Melbourne, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Melbourne, Australia
| | | | - Terry Haines
- Allied Health Research Unit Kingston Centre, Melbourne, Australia
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Skinner EH. Daily rehabilitation improves physical function at 6 months, but not hospital length of stay, in patients with acute respiratory failure [synopsis]. J Physiother 2017; 63:49. [PMID: 27964956 DOI: 10.1016/j.jphys.2016.10.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022] Open
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Raios C, Keating JL, Stitt N, Opdam HI, Skinner EH. Challenges in Providing Timely Physiotherapy and Opportunities to Influence Outcomes for Potential Lung Donors. Prog Transplant 2016; 27:112-124. [PMID: 28617166 DOI: 10.1177/1526924816680098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/31/2023]
Abstract
CONTEXT There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor. OBJECTIVE To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effects on donor lung suitability for procurement. DESIGN Retrospective audit. SETTING Australian tertiary hospital. PATIENTS Potential organ donors (defined as patients who may have been eligible to donate organs for transplantation via either brain death or circulatory death) 75 years or younger presenting to the emergency department or the intensive care unit (ICU) between September 2011 and December 2012. MAIN OUTCOME MEASURES Donation rates, timing of organ procurement from initial hospital presentation, number of persons designated to make health-care decisions approached for and consenting to donation and clinical research, and number of patients assessed and/or treated by physiotherapists. RESULTS Records of 65 potentially eligible donors were analyzed. Eighteen (28%) of the 65 became donors. Organ procurement occurred at a median of 48 hours (interquartile range: 34-72 hours) after ICU admission. All decision-makers approached regarding participation in clinical research (4 [6%] of the 65) consented. Physiotherapists assessed 48 (74%) of the 65 patients at least once and provided 28 respiratory treatments to 18 (28%) of the 65 patients, including lung hyperinflation and positioning. Limitations were the retrospective, single-center design and the "potential organ donor" definition. CONCLUSION Organ procurement occurs early. There is potential for early intervention to improve lung donor rates. Randomized controlled trials investigating protocolized respiratory packages of care may increase the potential donor pool and transplantation rates.
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Affiliation(s)
- Cassandra Raios
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Jenny L Keating
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia
| | - Nicola Stitt
- 3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia
| | - Helen I Opdam
- 4 Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Elizabeth H Skinner
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.,3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia.,5 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Skinner EH, Dinh T, Hewitt M, Piper R, Thwaites C. An Ai Chi-based aquatic group improves balance and reduces falls in community-dwelling adults: A pilot observational cohort study. Physiother Theory Pract 2016; 32:581-590. [PMID: 27710164 DOI: 10.1080/09593985.2016.1227411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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
BACKGROUND Falls are associated with morbidity, loss of independence, and mortality. While land-based group exercise and Tai Chi programs reduce the risk of falls, aquatic therapy may allow patients to complete balance exercises with less pain and fear of falling; however, limited data exist. OBJECTIVE The objective of the study was to pilot the implementation of an aquatic group based on Ai Chi principles (Aquabalance) and to evaluate the safety, intervention acceptability, and intervention effect sizes. DESIGN Pilot observational cohort study. METHODS Forty-two outpatients underwent a single 45-minute weekly group aquatic Ai Chi-based session for eight weeks (Aquabalance). Safety was monitored using organizational reporting systems. Patient attendance, satisfaction, and self-reported falls were also recorded. Balance measures included the Timed Up and Go (TUG) test, the Four Square Step Test (FSST), and the unilateral Step Tests. RESULTS Forty-two patients completed the program. It was feasible to deliver Aquabalance, as evidenced by the median (IQR) attendance rate of 8.0 (7.8, 8.0) out of 8. No adverse events occurred and participants reported high satisfaction levels. Improvements were noted on the TUG, 10-meter walk test, the Functional Reach Test, the FSST, and the unilateral step tests (p < 0.05). The proportion of patients defined as high falls risk reduced from 38% to 21%. The study was limited by its small sample size, single-center nature, and the absence of a control group. CONCLUSIONS Aquabalance was safe, well-attended, and acceptable to participants. A randomized controlled assessor-blinded trial is required.
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Affiliation(s)
- Elizabeth H Skinner
- a Department of Community-based Rehabilitation/Physiotherapy , Western Health , St Albans , Victoria , Australia.,b Australian Institute of Musculoskeletal Science , Western Centre for Health Research and Education, Western Health , St Albans , Victoria , Australia.,c Allied Health Research Unit , Faculty of Medicine, Nursing and Health Sciences, Monash University , Frankston , Victoria , Australia.,d School of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences , University of Melbourne , Melbourne , Victoria , Australia
| | - Tammy Dinh
- a Department of Community-based Rehabilitation/Physiotherapy , Western Health , St Albans , Victoria , Australia
| | - Melissa Hewitt
- a Department of Community-based Rehabilitation/Physiotherapy , Western Health , St Albans , Victoria , Australia.,e Department of Physiotherapy , Mackay Base Hospital, Queensland Health , Mackay , Queensland , Australia
| | - Ross Piper
- f Department of Physiotherapy , Barwon Health , Geelong , Victoria , Australia
| | - Claire Thwaites
- a Department of Community-based Rehabilitation/Physiotherapy , Western Health , St Albans , Victoria , Australia
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29
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Sarkies MN, Bowles KA, Skinner EH, Haas R, Mitchell D, O'Brien L, May K, Ghaly M, Ho M, Haines TP. Do daily ward interviews improve measurement of hospital quality and safety indicators? A prospective observational study. J Eval Clin Pract 2016; 22:792-8. [PMID: 27291891 DOI: 10.1111/jep.12543] [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: 12/30/2015] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aim of this study was to determine if the addition of daily ward interview data improves the capture of hospital quality and safety indicators compared with incident reporting systems alone. An additional aim was to determine the potential characteristics influencing under-reporting of hospital quality and safety indicators in incident reporting systems. METHODS A prospective, observational study was performed at two tertiary metropolitan public hospitals. Research assistants from allied health backgrounds met daily with the nurse in charge of the ward and discussed the occurrence of any falls, pressure injuries and rapid response medical team calls. Data were collected from four general medical wards, four surgical wards, an orthopaedic, neurosciences, plastics, respiratory, renal, sub-acute and acute medical assessment unit. RESULTS An estimated total of 303 falls, 221 pressure injuries and 884 rapid response medical team calls occurred between 15 wards across two hospitals, over a period of 6 months. Hospital incident reporting systems underestimated falls by 30.0%, pressure injuries by 59.3% and rapid response medical team calls by 17.0%. The use of ward interview data collection in addition to hospital incident reporting systems improved data capture of falls by 23.8% (n = 72), pressure injuries by 21.7% (n = 48) and rapid response medical team calls by 12.7% (n = 112). Falls events were significantly less likely to be reported if they occurred on a Monday (P = 0.04) and pressure injuries significantly more likely to be reported if they occurred on a Wednesday (P = 0.01). CONCLUSIONS Hospital quality and safety indicators (falls, pressure injuries and rapid response medical team calls) were under-reported in incident reporting systems, with variability in under-reporting between wards and the day of event occurrence. The use of ward interview data collection in addition to hospital incident reporting systems improved reporting of hospital quality and safety indicators.
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Affiliation(s)
| | - Kelly-Ann Bowles
- Monash University/Monash Health, Cheltenham, Victoria, Australia
| | | | - Romi Haas
- Monash University/Monash Health, Cheltenham, Victoria, Australia
| | - Deb Mitchell
- Monash University/Monash Health, Cheltenham, Victoria, Australia
| | - Lisa O'Brien
- Monash University/Monash Health, Cheltenham, Victoria, Australia
| | - Kerry May
- Monash Health, Dandenong, Victoria, Australia
| | | | - Melissa Ho
- Monash University/Monash Health, Cheltenham, Victoria, Australia
| | - Terry P Haines
- Monash University/Monash Health, Cheltenham, Victoria, Australia
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Williams CM, Skinner EH, James AM, Cook JL, McPhail SM, Haines TP. Comparative effectiveness research for the clinician researcher: a framework for making a methodological design choice. Trials 2016; 17:406. [PMID: 27530915 PMCID: PMC4988047 DOI: 10.1186/s13063-016-1535-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 08/04/2016] [Indexed: 11/15/2022] Open
Abstract
Comparative effectiveness research compares two active forms of treatment or usual care in comparison with usual care with an additional intervention element. These types of study are commonly conducted following a placebo or no active treatment trial. Research designs with a placebo or non-active treatment arm can be challenging for the clinician researcher when conducted within the healthcare environment with patients attending for treatment. A framework for conducting comparative effectiveness research is needed, particularly for interventions for which there are no strong regulatory requirements that must be met prior to their introduction into usual care. We argue for a broader use of comparative effectiveness research to achieve translatable real-world clinical research. These types of research design also affect the rapid uptake of evidence-based clinical practice within the healthcare setting. This framework includes questions to guide the clinician researcher into the most appropriate trial design to measure treatment effect. These questions include consideration given to current treatment provision during usual care, known treatment effectiveness, side effects of treatments, economic impact, and the setting in which the research is being undertaken.
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Affiliation(s)
- Cylie M Williams
- Peninsula Health, Community Health, PO Box 52, Frankston, Melbourne, Victoria, 3199, Australia. .,Monash University, School of Physiotherapy, Melbourne, Australia. .,Monash Health, Allied Health Research Unit, Melbourne, Australia.
| | - Elizabeth H Skinner
- Monash University, School of Physiotherapy, Melbourne, Australia.,Western Health, Allied Health, Melbourne, Australia
| | - Alicia M James
- Peninsula Health, Community Health, PO Box 52, Frankston, Melbourne, Victoria, 3199, Australia
| | - Jill L Cook
- Monash University, School of Physiotherapy, Melbourne, Australia
| | - Steven M McPhail
- Queensland University of Technology, School of Public Health and Social Work, Brisbane, Australia
| | - Terry P Haines
- Monash University, School of Physiotherapy, Melbourne, Australia.,Monash Health, Allied Health Research Unit, Melbourne, Australia
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Skinner EH. A randomised trial of an intensive physiotherapy program for patients in intensive care [synopsis]. J Physiother 2016; 62:166. [PMID: 26960742 DOI: 10.1016/j.jphys.2016.02.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022] Open
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Skinner EH, Thomas P, Reeve JC, Patman S. Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: A modified Delphi technique. Physiother Theory Pract 2016; 32:468-482. [PMID: 27259819 DOI: 10.3109/09593985.2016.1145311] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/13/2022]
Abstract
OBJECTIVE Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clinical practice standards for physiotherapists working in critical care settings in Australia and New Zealand. DESIGN A modified Delphi technique, which consisted of three rounds of questionnaires, was used to obtain consensus on items. SETTING Australian and New Zealand critical care settings. PARTICIPANTS A panel (n = 61) was invited from a pool of eligible physiotherapists throughout Australia and New Zealand (n = 93). Eligibility criteria were defined a-priori on the basis of possession of expertise and experience in the practice and teaching of critical care physiotherapy clinical skills. MAIN OUTCOME MEASURE Questionnaires were disseminated electronically (either via email, or SurveyMonkey®). Items were designated by participants as being 'Essential/Unsure/Not Essential'. Consensus for inclusion was achieved when items were ranked 'Essential' by more than 70% of participants. RESULTS Fifty physiotherapists consented and participated in the initial Delphi round, of whom 45 (90%) completed all rounds. Consensus was reached on 199 (89%) items. The panel agreed that 132 (58%) items were 'Essential' items for inclusion in the final framework. CONCLUSIONS This is the first study to develop a consensus framework of minimum standards of practice for physiotherapists working in critical care. The clinical utility of this framework now requires assessment.
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Affiliation(s)
- Elizabeth H Skinner
- a Department of Physiotherapy , Western Health , Melbourne , Victoria , Australia
| | - Peter Thomas
- b Royal Brisbane and Women's Hospital , Physiotherapy , Brisbane , Queensland , Australia
| | - Julie C Reeve
- c AUT University , School of Rehabilitation and Occupation Studies , Auckland , New Zealand
| | - Shane Patman
- d University of Notre Dame Australia , Physiotherapy , Fremantle , Western Australia , Australia
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Affiliation(s)
- Clare Holdsworth
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Elizabeth H. Skinner
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Victoria, Australia
| | - Clare M. Delany
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Cavill S, McKenzie K, Munro A, McKeever J, Whelan L, Biggs L, Skinner EH, Haines TP. The effect of prehabilitation on the range of motion and functional outcomes in patients following the total knee or hip arthroplasty: A pilot randomized trial. Physiother Theory Pract 2016; 32:262-70. [DOI: 10.3109/09593985.2016.1138174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Stuart Cavill
- Department of Physiotherapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Kylie McKenzie
- Department of Physiotherapy, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
| | - Adrienne Munro
- Department of Occupational Therapy, Alfred Hospital, Prahran, Victoria, Australia
| | - Janice McKeever
- Department of Occupational Therapy, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
| | - Lucy Whelan
- Department of Physiotherapy, Community Rehabilitation, Monash Health, Cranbourne, Victoria, Australia
| | - Luke Biggs
- Department of Physiotherapy, Community Rehabilitation, Monash Health, Cranbourne, Victoria, Australia
| | - Elizabeth H. Skinner
- Allied Health Research Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Physiotherapy, Sunshine Hospital, Western Health, Sunshine, Victoria, Australia
| | - Terry P. Haines
- Allied Health Research Unit, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
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Skinner EH, Williams CM, Haines TP. Embedding research culture and productivity in hospital physiotherapy departments: challenges and opportunities. AUST HEALTH REV 2016; 39:312-314. [PMID: 25774754 DOI: 10.1071/ah14212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022]
Abstract
Few studies have investigated research culture in the Australian hospital system. Although physiotherapists working in tertiary hospital departments conduct and publish research, a conflict between service delivery and research productivity remains. Few departments record research achievements, which limits the accuracy of investigating factors associated with research productivity within allied health. The conduct and translation of research within acute physiotherapy and allied health departments is imperative to improve patient health outcomes, optimise health service efficiency and cost-effectiveness and to improve staff and patient satisfaction and staff retention. Allied health departments should institute a research register and consider implementing other strategies to improve research culture and productivity, such as dedicating equivalent full-time staff to research, supporting staff with joint clinical and academic appointments, ensuring a research register is available and used and having events available for the dissemination of research. Future research should focus on improving research productivity within acute allied health departments to provide Level 1 and 2 evidence of service effectiveness and cost-effectiveness to optimise health care delivery and to maximise the benefit of allied health staff to Australia's healthcare system.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy, Western Health, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Cylie M Williams
- Department of Community Health, Peninsula Health, Hastings Road, Frankston, Vic. 3199, Australia. Email
| | - Terry P Haines
- Allied Health Research Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, Cheltenham, Vic. 3192, Australia. Email
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Boden I, Browning L, Skinner EH, Reeve J, El-Ansary D, Robertson IK, Denehy L. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial. Trials 2015; 16:573. [PMID: 26666321 PMCID: PMC4678689 DOI: 10.1186/s13063-015-1090-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/27/2015] [Indexed: 02/04/2023] Open
Abstract
Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised controlled trial has investigated the effect of pre-operative education and training on post-operative respiratory complications, hospital length of stay, and health-related quality of life following upper abdominal surgery. Methods/design The Lung Infection Prevention Post Surgery - Major Abdominal- with Pre-Operative Physiotherapy (LIPPSMAck POP) trial is a pragmatic, investigator-initiated, bi-national, multi-centre, patient- and assessor-blinded, parallel group, randomised controlled trial, powered for superiority. Four hundred and forty-one patients scheduled for elective open upper abdominal surgery at two Australian and one New Zealand hospital will be randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet, plus one additional pre-operative physiotherapy education and training session. The primary outcome is respiratory complication incidence using standardised diagnostic criteria. Secondary outcomes include hospital length of stay and costs, pneumonia diagnosis, intensive care unit readmission and length of stay, days/h to mobilise >1 min and >10 min, and, at 6 weeks post-surgery, patient reported complications, health-related quality of life, and physical capacity. Discussion The LIPPSMAck POP trial is a multi-centre randomised controlled trial powered and designed to investigate whether a single pre-operative physiotherapy session prevents post-operative respiratory complications. This trial standardises post-operative assisted ambulation and physiotherapy, measures many known confounders, and includes a post-discharge follow-up of complication rates, functional capacity, and health-related quality of life. This trial is currently recruiting. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12613000664741, 19 June 2013.
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Affiliation(s)
- Ianthe Boden
- Physiotherapy Department, Launceston General Hospital, Charles St, Launceston, Tasmania, 7250, Australia. .,Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Laura Browning
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia. .,Division of Allied Health, Western Health, Furlong Road, St Albans, Victoria, 3021, Australia.
| | - Elizabeth H Skinner
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia. .,Department of Physiotherapy, Western Health, 160 Gordon St, Footscray, Victoria, 3011, Australia.
| | - Julie Reeve
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, North Shore City, Auckland, 0622, New Zealand.
| | - Doa El-Ansary
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Iain K Robertson
- School of Health Sciences, University of Tasmania, Locked Bag 1320, Launceston, Tasmania, 7250, Australia. .,Clifford Craig Medical Research Trust, Launceston General Hospital, Charles Street, Launceston, Tasmania, 7250, Australia.
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Haines KJ, Skinner EH, Pastva A, Berney S, Denehy L. How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies. Curr Phys Med Rehabil Rep 2015. [DOI: 10.1007/s40141-015-0100-7] [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: 11/24/2022]
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Skinner EH, Haines KJ, Berney S, Warrillow S, Harrold M, Denehy L. Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study. Respir Care 2015; 60:1476-85. [PMID: 26374909 PMCID: PMC9993754 DOI: 10.4187/respcare.04064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Physiotherapists play an important role in the provision of multidisciplinary team-based care in the ICU. No studies have reported usual care respiratory management or usual care on the wards following ICU discharge by these providers. This study aimed to investigate usual care physiotherapy for ICU subjects during acute hospitalization. METHODS One hundred subjects were recruited for an observational study from a tertiary Australian ICU. The frequency and type of documented physiotherapist assessment and treatment were extracted retrospectively from medical records. RESULTS The sample had median (interquartile range) APACHE II score of 17 (13-21) and was mostly male with a median (interquartile range) age of 61 (49-73) y. Physiotherapists reviewed 94% of subjects in the ICU (median of 5 [3-9] occasions, median stay of 4.3 [3-7] d) and 89% of subjects in acute wards (median of 6 [2-12] occasions, median stay of 13.3 [6-28] d). Positioning, ventilator lung hyperinflation, and suctioning were the most frequently performed respiratory care activities in the ICU. The time from ICU admission until ambulation from the bed with a physiotherapist had a median of 5 (3-8) d. The average ambulation distance per treatment had a median of 0 (0-60) m in the ICU and 44 (8-78) m in the acute wards. Adverse event rates were 3.5% in the ICU and 1.8% on the wards. CONCLUSIONS Subjects received a higher frequency of physiotherapy in the ICU than on acute wards. Consensus is required to ensure consistency in data collection internationally to facilitate comparison of outcomes.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy, Western Health, Footscray, and the Allied Health Research Unit, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Melbourne, Victoria, Australia. School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia.
| | - Kimberley J Haines
- Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Sue Berney
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Stephen Warrillow
- Department of Physiotherapy, Austin Health, Heidelberg, Melbourne, Victoria, Australia
| | - Meg Harrold
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Linda Denehy
- School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Skinner EH. Early physical rehabilitation may improve physical quality of life domains in patients admitted to ICU with sepsis syndromes. J Physiother 2015; 61:158. [PMID: 26031611 DOI: 10.1016/j.jphys.2015.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 11/29/2022] Open
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Haines TP, O'Brien L, Mitchell D, Bowles KA, Haas R, Markham D, Plumb S, Chiu T, May K, Philip K, Lescai D, McDermott F, Sarkies M, Ghaly M, Shaw L, Juj G, Skinner EH. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services. Trials 2015; 16:133. [PMID: 25873250 PMCID: PMC4403707 DOI: 10.1186/s13063-015-0619-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/24/2015] [Indexed: 12/22/2022] Open
Abstract
Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Methods/Design Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism, and patient discharge destination, satisfaction, and functional independence at discharge. Discussion This is the world’s first application of the recently described non-inferiority (roll-in) stepped wedge trial design, and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date. Trial registration Australian New Zealand Clinical Trials Registry. Registration number: ACTRN12613001231730 (first study) and ACTRN12613001361796 (second study). Was this trial prospectively registered?: Yes. Date registered: 8 November 2013 (first study), 12 December 2013 (second study). Anticipated completion: June 2015. Protocol version: 1. Role of trial sponsor: KP and DL are directly employed by one of the trial sponsors, their roles were: KP assisted with overall development of research design and assisted with overall project management; DL contributed to project management, administration and communications strategy. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0619-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terry P Haines
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Lisa O'Brien
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Department of Occupational Therapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Melbourne, Victoria, Australia.
| | - Deb Mitchell
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Romi Haas
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia.
| | - Donna Markham
- Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Samantha Plumb
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Timothy Chiu
- Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
| | - Kerry May
- Allied Health, Monash Health, Melbourne, Victoria, Australia.
| | - Kathleen Philip
- Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia.
| | - David Lescai
- Health Workforce Branch, Department of Health, Melbourne, Victoria, Australia.
| | - Fiona McDermott
- Department of Social Work, Monash Health and Monash University, Melbourne, Victoria, Australia.
| | | | - Marcelle Ghaly
- Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
| | - Leonie Shaw
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Genevieve Juj
- Allied Health, Melbourne Health (Royal Melbourne Hospital), Parkville, Melbourne, Victoria, Australia.
| | - Elizabeth H Skinner
- Allied Health Research Unit, Monash Health and Physiotherapy Department, Monash University, Melbourne, Victoria, Australia. .,Physiotherapy Department, Western Health, Footscray, Melbourne, Victoria, Australia.
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FitzGerald TL, Southby AK, Haines TP, Hough JP, Skinner EH. Is physiotherapy effective in the management of child and adolescent conversion disorder? A systematic review. J Paediatr Child Health 2015; 51:159-67. [PMID: 24923418 DOI: 10.1111/jpc.12630] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
Abstract
Child and adolescent conversion disorder has the potential to impart significant burden on health-care services and affect quality of life. Clinically, physiotherapists are involved in conversion disorder management; however, no systematic reviews have examined physiotherapy effectiveness in its management. The aim of this review is to identify the efficacy of physiotherapy management of child and adolescent conversion disorder. A search of multiple databases (Medline, CINAHL, Embase, PsychINFO, PEDro and the Cochrane Library) was completed along with manual searching of relevant reference lists to identify articles including children 0-18 years with a diagnosis of conversion disorder who received physical management. Two independent reviewers screened titles and abstracts using criteria. Data were extracted regarding study characteristics, functional outcome measures, length of stay, physiotherapy service duration and resolution of conversion symptoms. Methodological quality was assessed using a tool designed for observational studies. Twelve observational studies were included. No functional outcome measures were used to assess the effectiveness of the treatment protocols in the case studies. Resolution of symptoms occurred in all but two cases, with conversion symptoms still present at 11 months and at 2 years. Length of stay varied from 3 days to 16 weeks, with similar variation evident in length of physiotherapy service provision (2.5 weeks to 16 weeks). There was limited and poor quality evidence to establish the efficacy of physiotherapy management of child and adolescent conversion disorders. More rigorous study designs with consistent use of reliable, valid and sensitive functional outcome measures are needed in this area.
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Skinner EH, Haines KJ, Hayes K, Seller D, Toohey JC, Reeve JC, Holdsworth C, Haines TP. Future of specialised roles in allied health practice: who is responsible? AUST HEALTH REV 2015; 39:255-259. [DOI: 10.1071/ah14213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/13/2015] [Indexed: 11/23/2022]
Abstract
Allied health professions have developed specialised advanced and extended scope roles over the past decade, for the benefit of patient outcomes, allied health professionals’ satisfaction and to meet labour and workforce demands. There is an essential need for formalised, widely recognised training to support these roles, and significant challenges to the delivery of such training exist. Many of these roles function in the absence of specifically defined standards of clinical practice and it is unclear where the responsibility for training provision lies. In a case example of physiotherapy practice in the intensive care unit, clinical placements and independence of practice are not core components of undergraduate physiotherapy degrees. Universities face barriers to the delivery of postgraduate specialised training and, although hospital physiotherapy departments are ideally placed, resources for training are lacking and education is not traditionally considered part of healthcare service providers’ core business. Substantial variability in training, and its evaluation, leads to variability in practice and may affect patient outcomes. Allied health professionals working in specialised roles should develop specific clinical standards of practice, restructure models of health care delivery to facilitate training, continue to develop the evidence base for their roles and target and evaluate training efficacy to achieve independent practice in a cost-effective manner. Healthcare providers must work with universities, the vocational training sector and government to optimise the ability of allied health to influence decision making and care outcomes for patients.
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Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, Bradley S, Berney S, Caruana LR, Elliott D, Green M, Haines K, Higgins AM, Kaukonen KM, Leditschke IA, Nickels MR, Paratz J, Patman S, Skinner EH, Young PJ, Zanni JM, Denehy L, Webb SA. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014; 18:658. [PMID: 25475522 PMCID: PMC4301888 DOI: 10.1186/s13054-014-0658-y] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/11/2014] [Indexed: 12/24/2022]
Abstract
Introduction The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. Methods A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. Results Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations. Conclusion Consensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Kathy Stiller
- Department of Physiotherapy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Dale M Needham
- Outcomes After Critical Illness & Surgery (OACIS) Group, Division of Pulmonary & Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA.
| | - Claire J Tipping
- Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Megan Harrold
- School of Physiotherapy & Exercise Science, Curtin University of Technology, Kent Street, Bentley, Western Australia, 6102, Australia.
| | - Claire E Baldwin
- School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, 5001, Australia. .,Physiotherapy Department, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Scott Bradley
- Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Sue Berney
- Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
| | - Lawrence R Caruana
- The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology, Sydney (UTS), 235 Jones Street, Broadway, New South Wales, 2007, Australia.
| | - Margot Green
- Physiotherapy Department, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia.
| | - Kimberley Haines
- Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. .,Department of Physiotherapy, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Kirsi-Maija Kaukonen
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Anaesthesiology and Intensive Care, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, Finland.
| | - Isabel Anne Leditschke
- Intensive Care Unit, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia. .,Australian National University Medical School, The Canberra Hospital, Hospital Road, Garran, Australian Capital Territory, 2606, Australia.
| | - Marc R Nickels
- Physiotherapy Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102, Australia.
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4215, Australia.
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle Campus, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia.
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, Western Hospital, Gordon Street, Footscray, Victoria, 3011, Australia. .,Department of Physiotherapy, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria, 3199, Australia.
| | - Paul J Young
- Capital and Coast District Health Board, Intensive Care Unit, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand. .,Medical Research Institute of New Zealand, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand.
| | - Jennifer M Zanni
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA.
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6006, Australia.
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Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, Bradley S, Berney S, Caruana LR, Elliott D, Green M, Haines K, Higgins AM, Kaukonen KM, Leditschke IA, Nickels MR, Paratz J, Patman S, Skinner EH, Young PJ, Zanni JM, Denehy L, Webb SA. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014. [PMID: 25475522 DOI: 10.1186/s13054=-014-0658-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this study was to develop consensus recommendations on safety parameters for mobilizing adult, mechanically ventilated, intensive care unit (ICU) patients. METHODS A systematic literature review was followed by a meeting of 23 multidisciplinary ICU experts to seek consensus regarding the safe mobilization of mechanically ventilated patients. RESULTS Safety considerations were summarized in four categories: respiratory, cardiovascular, neurological and other. Consensus was achieved on all criteria for safe mobilization, with the exception being levels of vasoactive agents. Intubation via an endotracheal tube was not a contraindication to early mobilization and a fraction of inspired oxygen less than 0.6 with a percutaneous oxygen saturation more than 90% and a respiratory rate less than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other contraindications. At an international meeting, 94 multidisciplinary ICU clinicians concurred with the proposed recommendations. CONCLUSION Consensus recommendations regarding safety criteria for mobilization of adult, mechanically ventilated patients in the ICU have the potential to guide ICU rehabilitation whilst minimizing the risk of adverse events.
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Affiliation(s)
- Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Kathy Stiller
- Department of Physiotherapy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Dale M Needham
- Outcomes After Critical Illness & Surgery (OACIS) Group, Division of Pulmonary & Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA.
| | - Claire J Tipping
- Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Megan Harrold
- School of Physiotherapy & Exercise Science, Curtin University of Technology, Kent Street, Bentley, Western Australia, 6102, Australia.
| | - Claire E Baldwin
- School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, South Australia, 5001, Australia. .,Physiotherapy Department, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Scott Bradley
- Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Sue Berney
- Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
| | - Lawrence R Caruana
- The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland, 4032, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology, Sydney (UTS), 235 Jones Street, Broadway, New South Wales, 2007, Australia.
| | - Margot Green
- Physiotherapy Department, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia.
| | - Kimberley Haines
- Physiotherapy Department, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia. .,Department of Physiotherapy, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Kirsi-Maija Kaukonen
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Anaesthesiology and Intensive Care, Töölö Hospital, Helsinki University Central Hospital, Topeliuksenkatu 5, Helsinki, Finland.
| | - Isabel Anne Leditschke
- Intensive Care Unit, Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, 2605, Australia. .,Australian National University Medical School, The Canberra Hospital, Hospital Road, Garran, Australian Capital Territory, 2606, Australia.
| | - Marc R Nickels
- Physiotherapy Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102, Australia.
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Queensland, 4029, Australia. .,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4215, Australia.
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle Campus, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia.
| | - Elizabeth H Skinner
- Department of Physiotherapy, Western Health, Western Hospital, Gordon Street, Footscray, Victoria, 3011, Australia. .,Department of Physiotherapy, School of Primary Health Care, Monash University, McMahons Road, Frankston, Victoria, 3199, Australia.
| | - Paul J Young
- Capital and Coast District Health Board, Intensive Care Unit, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand. .,Medical Research Institute of New Zealand, Wellington Hospital, Riddiford Street, Wellington, 6021, New Zealand.
| | - Jennifer M Zanni
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, 600 N. Wolfe Street, Meyer 1-130, Baltimore, Maryland, 21287, USA.
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia, 6006, Australia.
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Sevenhuysen S, Skinner EH, Farlie MK, Raitman L, Nickson W, Keating JL, Maloney S, Molloy E, Haines TP. Educators and students prefer traditional clinical education to a peer-assisted learning model, despite similar student performance outcomes: a randomised trial. J Physiother 2014; 60:209-16. [PMID: 25450483 DOI: 10.1016/j.jphys.2014.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 05/13/2014] [Revised: 08/05/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
QUESTION What is the efficacy and acceptability of a peer-assisted learning model compared with a traditional model for paired students in physiotherapy clinical education? DESIGN Prospective, assessor-blinded, randomised crossover trial. PARTICIPANTS Twenty-four physiotherapy students in the third year of a 4-year undergraduate degree. INTERVENTION Participants each completed 5 weeks of clinical placement, utilising a peer-assisted learning model (a standardised series of learning activities undertaken by student pairs and educators to facilitate peer interaction using guided strategies) and a traditional model (usual clinical supervision and learning activities led by clinical educators supervising pairs of students). OUTCOME MEASURES The primary outcome measure was student performance, rated on the Assessment of Physiotherapy Practice by a blinded assessor, the supervising clinical educator and by the student in self-assessment. Secondary outcome measures were satisfaction with the teaching and learning experience measured via survey, and statistics on services delivered. RESULTS There were no significant between-group differences in Assessment of Physiotherapy Practice scores as rated by the blinded assessor (p=0.43), the supervising clinical educator (p=0.94) or the students (p=0.99). In peer-assisted learning, clinical educators had an extra 6 minutes/day available for non-student-related quality activities (95% CI 1 to 10) and students received an additional 0.33 entries/day of written feedback from their educator (95% CI 0.06 to 0.61). Clinical educator satisfaction and student satisfaction were higher with the traditional model. CONCLUSION The peer-assisted learning model trialled in the present study produced similar student performance outcomes when compared with a traditional approach. Peer-assisted learning provided some benefits to educator workload and student feedback, but both educators and students were more satisfied with the traditional model. TRIAL REGISTRATION ACTRN12610000859088. [Sevenhuysen S, Skinner EH, Farlie MK, Raitman L, Nickson W, Keating JL, Maloney S, Molloy E, Haines TP (2014) Educators and students prefer traditional clinical education to a peer-assisted learning model, despite similar student performance outcomes: a randomised trial.Journal of Physiotherapy60: 209-216].
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Skinner EH, Hough J, Wang YT, Hough CR, Southby A, Snowdon DA, Sturgess T, Haines TP. Physiotherapy departments in Australian tertiary hospitals regularly participate in and disseminate research results despite a lack of allocated staff: a prospective cross-sectional survey. Physiother Theory Pract 2014; 31:200-6. [PMID: 25412563 DOI: 10.3109/09593985.2014.982775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/13/2022]
Abstract
OBJECTIVES To establish the level of research activity in physiotherapy departments of Australian tertiary hospitals. DESIGN Prospective cross-sectional survey. PARTICIPANTS Physiotherapy managers from 37 principal referral hospitals and specialist women's and children's hospitals as identified from the Australian Institute of Health and Welfare (2011). MAIN OUTCOME MEASURES A purpose-designed predominantly open-response questionnaire investigating site demographics, research activity and research support was developed, piloted and administered. RESULTS Thirty-seven surveys were completed (54% response rate). Median [IQR] respondent equivalent full-time staffing was 23.8 (19-39). Respondents represented a median [IQR] 6.5 (3-20) publication output in the past 2 years. Twelve respondents (32%) reported that staff had completed a doctorate in the past 5 years and 49% of respondents reported no staff had completed higher degrees. A total of 71 grants had been received and 73% of respondents indicated they had no allocated staffing for research activity. The most common indicators of research culture were organization-led research dissemination events and research training (i.e. manager attending research events and celebrating research achievements). CONCLUSIONS This is the first study to report on research activity in hospital-based Australian physiotherapy departments. Few sites allocate staff to conduct or support research. Despite this, physiotherapy departments regularly publish and present research results. Future studies could investigate how hospital-based physiotherapy departments can optimize research culture and output.
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Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, Lim PS, Vij S, Acs R, Fealy N, Skinner EH. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care 2014; 18:R161. [PMID: 25069952 PMCID: PMC4262200 DOI: 10.1186/cc14001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023]
Abstract
Introduction Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population. Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. Results No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar. Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011) Electronic supplementary material The online version of this article (doi:10.1186/cc14001) contains supplementary material, which is available to authorized users.
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Skinner EH, Foster M, Mitchell G, Haynes M, O'Flaherty M, Haines TP. Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis. Aust J Prim Health 2014; 20:9-19. [PMID: 24079301 DOI: 10.1071/py13092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/07/2013] [Indexed: 11/23/2022]
Abstract
Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasi-experimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16-1.52; P<0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46-15.79; P=0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81-2.91; P=0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy, Monash Health, 246 Clayton Road, Clayton, Melbourne, Vic. 3168, Australia
| | - Michele Foster
- Postgraduate Research Studies, School of Social Work and Human Services, The University of Queensland, Mansfield Place, St Lucia, Brisbane, Qld 4072, Australia
| | - Geoffrey Mitchell
- General Practice and Palliative Care, MBBS Program, The University of Queensland, Building 12, Ipswich Campus, Salisbury Road, Ipswich, Qld 4305, Australia
| | - Michele Haynes
- Institute for Social Science Research, General Purpose North Building 4, The University of Queensland, Mansfield Place, St Lucia, Brisbane, Qld 4072, Australia
| | - Martin O'Flaherty
- Institute for Social Science Research, General Purpose North Building 4, The University of Queensland, Mansfield Place, St Lucia, Brisbane, Qld 4072, Australia
| | - Terry P Haines
- Department of Physiotherapy, Monash Health, 246 Clayton Road, Clayton, Melbourne, Vic. 3168, Australia
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