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Levinger P, Dreher BL, Dow B, Batchelor F, Hill KD. Older people's views and usage of recreational spaces in parks with age-friendly outdoor exercise equipment. Int J Environ Health Res 2024:1-13. [PMID: 38628030 DOI: 10.1080/09603123.2024.2342021] [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] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
Recreational spaces are important public spaces for people of all ages to engage in leisure and physical activities, however older people remain one of the lowest users of park. This study investigated older people's perceptions and reasons for visiting parks that have undergone refurbishment with the installation of age-friendly outdoor exercise equipment, the Seniors Exercise Park. On-site intercept surveys took place in six parks in Victoria, Australia. Seniors Exercise Park equipment usage was audited over 12 months using on-site Quick Response (QR). A total of 139 older people were surveyed, 55.4% reported visiting to exercise, 25.9% for walking and 21.5% for fresh air/nature. Proximity to home/family (37.4%) and the availability of the Seniors Exercise Park equipment (36.7%) were the main reasons for visiting these parks. The availability of age-suitable exercise equipment in recreational spaces can support and encourage older people to access local parks and engage in physical activity.
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Affiliation(s)
- Pazit Levinger
- Clinical Gerontology, National Ageing Research Institute, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
- Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Bronwyn L Dreher
- Clinical Gerontology, National Ageing Research Institute, Melbourne, Australia
- Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Briony Dow
- Clinical Gerontology, National Ageing Research Institute, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Frances Batchelor
- Clinical Gerontology, National Ageing Research Institute, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Keith D Hill
- Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
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Levinger P, Dreher BL, Dunn J, Garratt S, Abfalter E, Dow B, Batchelor F, Hill KD. Parks Visitation, Physical Activity Engagement, and Older People's Motivation for Visiting Local Parks. J Aging Phys Act 2024; 32:141-150. [PMID: 37883646 DOI: 10.1123/japa.2022-0416] [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: 12/17/2022] [Revised: 06/14/2023] [Accepted: 08/05/2023] [Indexed: 10/28/2023]
Abstract
Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Melbourne, VIC, Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC, Australia
| | | | - Jeremy Dunn
- National Ageing Research Institute, Melbourne, VIC, Australia
| | | | - Emma Abfalter
- National Ageing Research Institute, Melbourne, VIC, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Deakin University, Waurn Ponds, VIC, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Melbourne, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC, Australia
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Levinger P, Fearn M, Dreher B, Bauman A, Brusco NK, Gilbert A, Soh SE, Burton E, James L, Hill KD. The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol. Arch Public Health 2024; 82:43. [PMID: 38532524 DOI: 10.1186/s13690-024-01262-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia. METHOD The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities. DISCUSSION Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people. TRIAL REGISTRATION This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
| | - Marcia Fearn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Bronwyn Dreher
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Adrian Bauman
- School of Public Health, and the Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
| | - Andrew Gilbert
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
- Department of Social Inquiry, La Trobe University, Melbourne, Australia
| | - Sze-Ee Soh
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lisa James
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
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Visvanathan R, Lange K, Selvam J, Dollard J, Boyle E, Jones K, Ingram K, Shibu P, Wilson A, Ranasinghe DC, Karnon J, Hill KD. Findings from three methods to identify falls in hospitals: Results from the Ambient Intelligent Geriatric Management system fall prevention trial. Australas J Ageing 2024; 43:199-204. [PMID: 37861202 DOI: 10.1111/ajag.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To (a) compare characteristics of patients who fall with those of patients who did not fall; and (b) characterise falls (time, injury severity and location) through three fall reporting methods (incident system reports, medical notes and clinician reports). METHODS A substudy design within a stepped-wedge clinical trial was used: 3239 trial participants were recruited from two inpatient Geriatric Evaluation and Management Units and one general medicine ward in two Australian states. To compare the characteristics of patients who had fallen with those who had not, descriptive tests were used. To characterise falls through three reporting methods, bivariate logistic regressions were used. RESULTS Patients who had fallen were more likely than patients who had not fallen to be cognitively impaired (51% vs. 29%, p < 0.01), admitted with falls (38% vs. 28%, p = 0.01) and have poor health outcomes such as prolonged length of stay (24 [16-34] vs. 12 [8-19] days [IQR], p < 0.01) and less likely to be discharged directly to the community (62% vs. 47%, p < 0.01). Most falls were captured from medical notes (93%), with clinician (71%) and incident reports (68%) missing 21%-25% of falls. The proportion of injurious falls identified through incident reports was higher than medical records or clinician reports (40% vs. 34% vs. 37%). CONCLUSIONS This study reaffirms the need to improve reporting falls in incident systems and at clinical handover to the team leader. Research should continue to use more than one method of identifying falls, but include data from medical records. Many falls cause injury, resulting in poor health outcomes.
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Affiliation(s)
- R Visvanathan
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - K Lange
- Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Selvam
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - J Dollard
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - E Boyle
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Jones
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
| | - K Ingram
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - P Shibu
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Woodville South, Adelaide, South Australia, Australia
| | - A Wilson
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - D C Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - K D Hill
- School of Allied Health, Curtin University, Western Australia, Perth, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
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Sari YM, Hill KD, Burton E, Lee DCA, Lalor AF. Experiences of Indonesian people with dementia and carers undertaking an online-delivered exercise program. Dementia (London) 2024:14713012241235688. [PMID: 38406858 DOI: 10.1177/14713012241235688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Participating in physical activity is beneficial for older people with dementia. Little is known however about the perceptions of people living with dementia undertaking an online-delivered exercise program. This study aimed to explore the experiences and perceptions of older people with dementia and their carers in Indonesia participating in an online-delivered exercise program, and factors that may influence acceptability to the program. An exploratory qualitative study design using semi-structured interviews was used. Data were recorded, transcribed verbatim, translated into English, and analyzed thematically. Twelve participants with dementia (mean age = 63.3 years) and 30 carers (26 family carers and 4 paid carers) (mean age = 37.9 years) were interviewed separately. Seven themes were identified: (i) Motivating factors to participate; (ii) Benefits for people with dementia; (iii) Impacts on carers; (iv) Challenges and enablers to exercising; (v) Carers' strategies for exercise engagement; (vi) Roles, relationships and supports; and (vii) Participants' receptiveness to online delivery of the exercise program. This study illustrated that an online-delivered exercise program was acceptable for people with dementia and their carers in Indonesia and reinforced the importance of carers' support for the exercise program. These findings can help physiotherapists and other exercise practitioners in considering the aspects of delivery that people with dementia and their carers value in participating in online-delivered exercise programs.
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Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Australia
- Herb Feith Indonesian Engagement Centre, Monash University, Indonesia
- Alzheimer's Indonesia, Indonesia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Australia
- EnAble Institute, Curtin University, Australia
| | - Den-Ching A Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Australia
| | - Aislinn F Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Australia
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Australia
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Loi SM, Gaffy E, Malta S, Russell MA, Williams S, Ames D, Hill KD, Batchelor F, Cyarto EV, Haines T, Lautenschlager NT, Mackenzie L, Moore KJ, Savvas SM, Dow B. Effects of physical activity on depressive symptoms in older caregivers: The IMPACCT randomized controlled trial. Int J Geriatr Psychiatry 2024; 39:e6058. [PMID: 38279894 DOI: 10.1002/gps.6058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care-recipients. The aim of this single-blind randomized controlled trial was to investigate the effect of a 6-month tailored PA program on depressive symptoms in older caregivers. METHOD Caregivers were included if they had scores of ≥5 on the 15-item geriatric depression scale (GDS-15). Care-recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago-Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. RESULTS Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social-control, and usual-care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS-15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini-mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social-control (p < 0.02) and usual-care groups (p < 0.02). CONCLUSIONS A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment.
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Affiliation(s)
- Samantha M Loi
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ellen Gaffy
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Sue Malta
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa A Russell
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Susan Williams
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - David Ames
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
- St Georges Hospital, Kew, Victoria, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Frances Batchelor
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | | | - Terence Haines
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Nicola T Lautenschlager
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Royal Melbourne Hospital Mental Health Services, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | - Kirsten J Moore
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Steven M Savvas
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Briony Dow
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- National Ageing Research Institute, Parkville, Victoria, Australia
- Deakin University, Waurn Ponds, Victoria, Australia
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Lee DCA, Callisaya ML, Haines TP, Hill KD. Program Evaluation and Refinement of the "Safe Functional Home Exercise" Program for Improving Physical Activity in Older People with Dementia Who Receive Home Care. Healthcare (Basel) 2024; 12:166. [PMID: 38255055 PMCID: PMC10815054 DOI: 10.3390/healthcare12020166] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION People with dementia who receive home care have low levels of physical activity participation. OBJECTIVES To evaluate and refine a co-designed exercise program for home care clients with dementia, led by trained care support workers. METHODS An action research cycle whereby support workers, clients and carers (each n = 26) from the "Safe Functional Home Exercise" feasibility study were invited to complete an evaluation survey. Participants rated statements using Likert-style scales on (1) staff training, (2) staff confidence, (3) program support and (4) satisfaction. The participants could provide comments for situations that affected exercise performance, suggested improvements for staff training, program support and exercises. The co-design panel (original program designers) was reconvened to refine the exercise program. RESULTS Support workers (n = 19), clients (n = 15) and carers (n = 13) returned their surveys. Support workers (74-90%), carers (77-92%) and clients (100%) rated program support positively and were overall satisfied. Support workers (>80%) agreed that the training course was relevant and were confident in delivering the exercises to clients. Situations included "Covid isolation", the client's "poor medical condition" and "mood fluctuations" that made exercising difficult. Improvements included "making a client video" and "providing tips to motivate clients". The co-design panel modified the exercise program. CONCLUSIONS The "Safe Functional Home Exercise" program is the first exercise program co-designed for people with dementia. It is well accepted by support workers, people with dementia and carers. Utilising support workers to facilitate physical activity participation is potentially low-cost and scalable in home care. Future studies are needed to evaluate the refined program in home care.
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Affiliation(s)
- Den-Ching A. Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Peninsula Campus, Frankston, VIC 3199, Australia;
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia; (M.L.C.); (T.P.H.)
| | - Michele L. Callisaya
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia; (M.L.C.); (T.P.H.)
- Peninsula Clinical School, Monash University, Frankston, VIC 3199, Australia
| | - Terry P. Haines
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia; (M.L.C.); (T.P.H.)
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Peninsula Campus, Frankston, VIC 3199, Australia;
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia; (M.L.C.); (T.P.H.)
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Salihu AT, Hill KD, Jaberzadeh S. Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis. J Mot Behav 2024; 56:373-391. [PMID: 38189442 DOI: 10.1080/00222895.2023.2299706] [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: 04/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Yau L, Soutter K, Ekegren C, Hill KD, Ashe M, Soh SE. Response to Letter to the Editor on "Adherence to Exercise Programs in Community-dwelling Older Adults Post-discharge for Hip Fracture: A Systematic Review and Meta-analysis". Arch Phys Med Rehabil 2023; 104:2172-2173. [PMID: 37643672 DOI: 10.1016/j.apmr.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Lucinda Yau
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Kate Soutter
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Christina Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Maureen Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, Monash University, Melbourne, Australia.
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Dyer SM, Suen J, Kwok WS, Dawson R, McLennan C, Cameron ID, Hill KD, Sherrington C. Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses. Age Ageing 2023; 52:afad217. [PMID: 38109410 PMCID: PMC10727475 DOI: 10.1093/ageing/afad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND There is strong evidence that exercise reduces falls in older people living in the community, but its effectiveness in residential aged care is less clear. This systematic review examines the effectiveness of exercise for falls prevention in residential aged care, meta-analysing outcomes measured immediately after exercise or after post-intervention follow-up. METHODS Systematic review and meta-analysis, including randomised controlled trials from a Cochrane review and additional trials, published to December 2022. Trials of exercise as a single intervention compared to usual care, reporting data suitable for meta-analysis of rate or risk of falls, were included. Meta-analyses were conducted according to Cochrane Collaboration methods and quality of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS 12 trials from the Cochrane review plus 7 new trials were included. At the end of the intervention period, exercise probably reduces the number of falls (13 trials, rate ratio [RaR] = 0.68, 95% confidence interval [CI] = 0.49-0.95), but after post-intervention follow-up exercise had little or no effect (8 trials, RaR = 1.01, 95% CI = 0.80-1.28). The effect on the risk of falling was similar (end of intervention risk ratio (RR) = 0.84, 95% CI = 0.72-0.98, 12 trials; post-intervention follow-up RR = 1.05, 95% CI = 0.92-1.20, 8 trials). There were no significant subgroup differences according to cognitive impairment. CONCLUSIONS Exercise is recommended as a fall prevention strategy for older people living in aged care who are willing and able to participate (moderate certainty evidence), but exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).
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Affiliation(s)
- Suzanne M Dyer
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jenni Suen
- Rehabilitation, Aged and Extended Care, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Wing S Kwok
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Rik Dawson
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Charlotte McLennan
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
- Kolling Institute, The University of Sydney, St Leonards, New South Wales, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Peninsula Campus, Monash University, Frankston, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
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Hill KD, Meyer C, Burton E, Hunter SW, Suttanon P, Dawes H, Lee DCA. Examining gait aid use and user safety by older people with dementia: Perspectives of informal carers to inform practice. Disabil Rehabil 2023; 45:4279-4287. [PMID: 36444878 DOI: 10.1080/09638288.2022.2148302] [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: 08/04/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine gait aid use and decision-making related to usage in people with dementia, and examine factors influencing (1) gait aid use or not; and (2) falls in past year. MATERIALS AND METHODS A survey of informal carers of older people with dementia in the community. Closed questions on gait aid use, falls, timing and sources of gait aid acquisition, and advice received to support use were used. Chi-squared tests (Fisher's Exact) compared: (1) gait aid users vs non-users and carers' report of (i) unsteadiness in walking/turning, (ii) dementia severity, (iii) falls in past year, and (2) fallers vs non-fallers and (i) timing of gait aid commencement relative to dementia diagnosis, (ii) whether health professional advice was received regarding use, and iii) regularity of use. RESULTS Forty-seven completed surveys, 63.8% of care recipients used a gait aid; 56.9% had ≥2 falls in past year; 66.7% commenced use after dementia diagnosis; 25% acquired their aids from non-health professionals; and 37% did not receive advice regarding use. Gait aid users and non-users differed on carer ratings of unsteadiness in walking/turning (p = 0.02). CONCLUSION Carers reported important aspects regarding gait aid acquisition, safe gait aid use and benefits which warrant further investigation.IMPLICATIONS FOR REHABILITATIONIn our small sample, use of gait aids by people with dementia was related to the level of unsteadiness in walking and/or turning, and not associated with falling in the past year.People with dementia do not routinely receive professional advice about how to use gait aids, highlighting the potential value of maximizing health professional involvement in gait aid prescription and training.Deterioration in the ability of gait aid use after the diagnosis of dementia indicates a need for re-assessment or re-training of gait aid use over time.Clinical guidelines to facilitate decision-making regarding under what conditions gait aids are beneficial, what duration and aspects require instruction to ensure effective use by people with dementia are needed.
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Affiliation(s)
- Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- Bolton Clarke Research Institute, Brisbane, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani, Thailand
| | - Helen Dawes
- Intersect@Exeter, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Den-Ching A Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
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Layton N, Lalor A, Slatyer S, Lee DA, Bryant C, Watson M, Khushu A, Burton E, Oliveira D, Brusco NL, Jacinto A, Tiller E, Hill KD. Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia. Health Expect 2023; 26:2644-2654. [PMID: 37680165 PMCID: PMC10632619 DOI: 10.1111/hex.13863] [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: 05/09/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.
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Affiliation(s)
- Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
- Department of Occupational Therapy, School of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Susan Slatyer
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Den‐Ching A Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Christina Bryant
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Moira Watson
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Anjali Khushu
- Department of Geriatric MedicinePeninsula HealthFrankstonVictoriaAustralia
| | - Elissa Burton
- Curtin School of Allied HealthCurtin UniversityBentleyWestern AustraliaAustralia
- enAble Institute, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
| | - Déborah Oliveira
- Faculty of Nursing, Universidad Andrés BelloCampus Viña del MarViña del MarChile
- Millennium Institute for Care Research (MICARE)SantiagoChile
| | - Natasha L. Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Alessandro Jacinto
- Programa de Pós‐Graduação em Medicina Translacional, Faculty of Geriatric MedicineFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Elizabeth Tiller
- Department of Geriatrics (Falls Prevention Service)Peninsula HealthFrankstonVictoriaAustralia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
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Silva ECGE, Schmitt ACB, de Godoy CG, de Oliveira DB, Tanaka C, Toufen C, de Carvalho CRR, Carvalho CRF, Fu C, Hill KD, Pompeu JE. Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study. Int J Environ Res Public Health 2023; 20:7057. [PMID: 37998288 PMCID: PMC10671138 DOI: 10.3390/ijerph20227057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/04/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients' medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients' reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.
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Affiliation(s)
- Erika Christina Gouveia e Silva
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Ana Carolina Basso Schmitt
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Caroline Gil de Godoy
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Danielle Brancolini de Oliveira
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Clarice Tanaka
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Carlos Toufen
- Division of Pulmonology, Heart Institute (InCor), School of Medicine—University of Sao Paulo, Brazil. Av. Dr. Eneas Carvalho de Aguiar, 44-Cerqueira Cesar, São Paulo 05403-900, Brazil (C.R.R.d.C.)
| | - Carlos Roberto Ribeiro de Carvalho
- Division of Pulmonology, Heart Institute (InCor), School of Medicine—University of Sao Paulo, Brazil. Av. Dr. Eneas Carvalho de Aguiar, 44-Cerqueira Cesar, São Paulo 05403-900, Brazil (C.R.R.d.C.)
| | - Celso R. F. Carvalho
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Carolina Fu
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC 3199, Australia;
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine—University of Sao Paulo, Brazil. R. Cipotanea, 51-Vila Butanta, São Paulo 05360-160, Brazil; (A.C.B.S.); (C.G.d.G.); (D.B.d.O.); (C.T.); (C.R.F.C.); (C.F.); (J.E.P.)
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Scully AE, Tan D, Oliveira BIRD, Hill KD, Clark R, Pua YH. Scoring festination and gait freezing in people with Parkinson's: The freezing of gait severity tool-revised. Physiother Res Int 2023; 28:e2016. [PMID: 37199289 DOI: 10.1002/pri.2016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND AND PURPOSE To improve existing clinical assessments for freezing of gait (FOG) severity, a new clinician-rated tool which integrates the varied types of freezing (FOG Severity Tool-Revised) was developed. This cross-sectional study investigated its validity and reliability. METHODS People with Parkinson's disease who were able to independently ambulate eight-metres and understand study instructions were consecutively recruited from outpatient clinics of a tertiary hospital. Those with co-morbidities severely affecting gait were excluded. Participants were assessed with the FOG Severity Tool-Revised, three functional performance tests, the FOG Questionnaire, and outcomes measuring anxiety, cognition, and disability. The FOG Severity Tool-Revised was repeated for test-retest reliability. Exploratory factor analysis and Cronbach's alpha were computed for structural validity and internal consistency. Reliability and measurement error were estimated with ICC (two-way, random), standard error of measurement, and smallest detectable change (SDC95 ). Criterion-related and construct validity were calculated with Spearman's correlations. RESULTS Thirty-nine participants were enrolled [79.5% (n = 31) male; Median (IQR): age-73.0 (9.0) years; disease duration-4.0 (5.8) years], with fifteen (38.5%) who reported no medication state change contributing a second assessment for reliability estimation. The FOG Severity Tool-Revised demonstrated sufficient structural validity and internal consistency (α = 0.89-0.93), and adequate criterion-related validity compared to the FOG Questionnaire (ρ = 0.73, 95% CI 0.54-0.85). Test-retest reliability (ICC = 0.96, 95%CI 0.86-0.99) and random measurement error (%SDC95 = 10.4%) was acceptable in this limited sample. DISCUSSION AND CONCLUSIONS The FOG Severity Tool-Revised appeared valid in this initial sample of people with Parkinson's. While its psychometric properties remain to be confirmed in a larger sample, it may be considered for use in the clinical setting.
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Affiliation(s)
- Aileen E Scully
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Dawn Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | | | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Ross Clark
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
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15
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Ekegren CL, Clark-Ash M, Callaway L, Hill KD, Gabbe BJ, Kunstler B, Keeves J, Kimmel L, Reeder SC. Perspectives of telehealth access and implementation in people recovering from serious transport injury, health care providers and compensation system staff during the COVID-19 pandemic in Australia. Injury 2023; 54:110987. [PMID: 37574380 DOI: 10.1016/j.injury.2023.110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/05/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Before the COVID-19 pandemic, few injury compensation schemes supported access to service-delivery via telehealth. The aim of this qualitative study was to explore the perspectives of people recovering from serious transport injury, health care providers, and senior staff of a transport injury compensation scheme, in relation to the uptake and implementation of telehealth during the COVID-19 pandemic, and its ongoing use. METHODS Semi-structured interviews were undertaken with 35 participants, including 15 seriously injured patients, 16 health care providers and 4 compensation scheme staff. A thematic analysis was performed using a framework approach. RESULTS Themes identified included the need to provide continuity of care via telehealth during the pandemic for patients recovering from injury, and the associated organisational and technical support needs. It was noted that some types of services worked well via telehealth, including psychology, while others did not, including physical assessments. The convenience of telehealth was highlighted, in relation to reduced travel. However, there were often safety fears relating to falls, and communication issues with injured people. CONCLUSIONS This research found that the majority of injured patients and health care providers had benefitted from the introduction of service delivery via telehealth during the pandemic for some types of services. Participants saw opportunities for continued benefit post-pandemic, particularly for improving equity of access to health care for people with barriers to mobility and travel.
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Affiliation(s)
- Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia.
| | - Megan Clark-Ash
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC, 3199 Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Breanne Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, VIC, 3800 Australia
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Lara Kimmel
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia; The Alfred, Commercial Rd, Melbourne, VIC, 3004 Australia
| | - Sandra C Reeder
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia; Central Clinical School, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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Oskouei ST, Malliaras P, Hill KD, Clark R, Perraton L. Monitoring physical activity using wearable technology in people with Achilles tendinopathy undergoing physiotherapy treatment: A feasibility prospective cohort study. Physiotherapy 2023; 120:38-46. [PMID: 37364446 DOI: 10.1016/j.physio.2023.04.001] [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: 03/23/2022] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Physical activity modification is an important part of the management of Achilles tendinopathy. However, to our knowledge, there is a lack of evidence on objective physical activity assessment in Achilles tendinopathy. The purpose of this study is to (1) assess feasibility of using an inertial measurement unit (IMU) to monitor physical activity and IMU-derived biomechanical measures over 12-week treatment course by a physiotherapist; (2) conduct a preliminary analysis of changes in physical activity over 12-weeks. DESIGN A feasibility prospective cohort study SETTING: A community setting. PARTICIPANTS People with Achilles tendinopathy who had recently commenced (≤2 sessions), or were about to commence, treatment with a physiotherapist MAIN OUTCOME MEASURES: Participants wore a shank-mounted IMU on the affected side for one week at baseline, 6-, and 12-week follow-ups. The outcomes were pain/symptom severity, IMU-derived physical activity and biomechanical measures (stride rate, peak shank angular velocity, and peak shank acceleration). RESULTS Thirty participants were recruited. There was a high retention rate (97%), response rate (97%), and IMU wear compliance at each timepoint (>93%). For pain/symptom severity, a significant time effect was observed between baseline and 12-week follow-up. Physical activity and IMU-derived biomechanical measures did not change over 12 weeks. Physical activity decreased at the 6-week follow-up but only returned to the baseline level at 12-week follow-up. CONCLUSIONS A larger-scale cohort study assessing clinical outcomes and physical activity appears feasible. Preliminary data indicate that physical activity may not change significantly over 12-weeks in people undergoing physiotherapy management for Achilles tendinopathy. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Sanam Tavakkoli Oskouei
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Victoria, Australia.
| | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Queensland, Australia.
| | - Luke Perraton
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
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Hill KD, Sari YM. Fall prevention from an Asia-Pacific regional perspective: The importance of local context. Australas J Ageing 2023; 42:445-447. [PMID: 37726922 DOI: 10.1111/ajag.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Yulisna Mutia Sari
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- Alzheimer's Indonesia, Indonesia
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Ng YL, Hill KD, Levinger P, Jacques A, Burton E. A seniors exercise park program for older adults with mild balance dysfunction - a feasibility study. Disabil Rehabil 2023; 45:3143-3154. [PMID: 36031870 DOI: 10.1080/09638288.2022.2112984] [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: 04/09/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the feasibility of a multimodal exercise program conducted at a Seniors Exercise Park among older adults with mild balance dysfunction. METHODS Participants (aged ≥65 years) with mild balance dysfunction underwent 18 weeks of gradual reduction of supervised training followed by six weeks of independent training at the Seniors Exercise Park. Feasibility and safety were assessed at baseline, 18 and 24 weeks. RESULTS Seventy-five participants expressed interest in the program. Of the 46 participants enrolled in the study, 36 (78.3%) completed the 18 week intervention, and 32 (69.6%) were followed-up at 24 weeks. The median adherence to supervised training was 90.9%, and independent practice was 26.3% (weeks 19-24). All the supervised training sessions were completed within 18 weeks. No falls, or adverse events occurred. All physical performance (e.g., balance, lower body strength, and mobility), psychosocial health outcomes (e.g., mental wellbeing) and quality of life improved significantly at 18 and 24 weeks. CONCLUSIONS This initially supervised Seniors Exercise Park program which progressed to independent practice is feasible, safe, and improved health outcomes in older adults with mild balance dysfunction. Strategies are needed to improve adherence to independent practice and minimise dropouts. Implications for rehabilitationGradually reduced supervision in a Seniors Exercise Park program progressing to independent practice is feasible and safe for older adults with mild balance dysfunction.Seniors Exercise Parks can assist older adults with mild balance dysfunction to improve their balance, lower body strength, mobility, and psychosocial health.There is a need for more Seniors Exercise Parks in community parks to enable greater access to this novel exercise approach by older people, including those with mild balance dysfunction.
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Affiliation(s)
- Yoke Leng Ng
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Pazit Levinger
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
- National Ageing Research Institute, Melbourne, Australia
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Angela Jacques
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
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Scully AE, Neo K, Lim E, Manharlal PK, de Oliveira B, Hill KD, Clark R, Pua YH, Tan D. Reliability and variability of physiotherapists scoring freezing of gait through video analysis. Physiother Theory Pract 2023:1-11. [PMID: 37639503 DOI: 10.1080/09593985.2023.2252059] [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: 05/27/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The "gold standard" marker for freezing of gait severity is percentage of time spent with freezing observed through video analysis. OBJECTIVE This study examined inter- and intra-rater reliability and variability of physiotherapists rating freezing of gait severity through video analysis and explored the effects of experience. METHODS Thirty physiotherapists rated 14 videos of Timed Up and Go performance by people with Parkinson's and gait freezing. Ten videos were unique, while four were repeated. Freezing frequency, total duration, and percentage of time spent with freezing were computed. Reliability and variability were estimated using ICC (2,1) and mean absolute differences. Between-group differences were calculated with the one-way ANOVA. RESULTS Inter- and intra-rater reliability ranged from moderate to good (ICC: inter-rater frequency = 0.63, duration = 0.78, percentage = 0.50; intra-rater frequency = 0.84, duration = 0.89, percentage = 0.50). Variability for freezing frequency was two episodes. Inter- and intra-rater variability for total freezing duration was 18.8 and 12.3 seconds, respectively. For percentage of time spent with freezing, this was 15.2% and 13.5%. Physiotherapy experience had no effect. CONCLUSION Physiotherapists demonstrated sufficient reliability, but variability was large enough to cause changes in severity classifications on existing rating scales. Percentage of time spent with freezing was the least reliable marker, supporting the use of freezing frequency or total duration instead.
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Affiliation(s)
- Aileen E Scully
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Kenneth Neo
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Eunice Lim
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Prakash K Manharlal
- Department of Neurology (SGH Campus), National Neuroscience Institute @Singapore General Hospital, Singapore
| | - Beatriz de Oliveira
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Ross Clark
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Dawn Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Department of Physiotherapy, Singapore General Hospital, Singapore
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20
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Bainbridge L, Briffa K, Burton E, Hill KD, Fary R. Physiotherapists' decision-making about transition to independent walking in hospital after stroke: a qualitative study. Disabil Rehabil 2023:1-9. [PMID: 37578096 DOI: 10.1080/09638288.2023.2245757] [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: 02/28/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. METHODS A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. RESULTS Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. CONCLUSIONS Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making.IMPLICATIONS FOR REHABILITATIONRegaining independence in walking after a stroke comes with the potential risk of falls.Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition.Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence.Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe.
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Affiliation(s)
- Liz Bainbridge
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Kathy Briffa
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Robyn Fary
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
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21
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Ng YL, Hill KD, Burton E. Experiences of Older Adults With Mild Balance Dysfunction Who Participated in a Supervised Seniors Exercise Park Program Progressing to Independent Practice. J Aging Phys Act 2023; 31:600-610. [PMID: 36638811 DOI: 10.1123/japa.2022-0131] [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: 04/11/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 01/15/2023]
Abstract
Older adults with mild balance dysfunction can benefit from early intervention. This research explored the experiences of older adults with mild balance dysfunction participating in an 18-week supervised outdoors Seniors Exercise Park program and 6 weeks of unsupervised independent practice. Factors influencing attendance and independent practice were also explored. Semistructured face-to-face interviews were conducted with 24 participants (mean age = 77.4 years, SD = 5.4) and 22 participants (mean age = 77.5 years, SD = 5.6) after 18 and 24 weeks, respectively. The data were analyzed using reflexive thematic analysis. Many participants perceived improvements in health and responded positively to the supervised Seniors Exercise Park program. Factors supporting attendance included building social connections and positive instructor personality. Barriers to training included competing time demands and poor health. These insights suggest that a group-based Seniors Exercise Park supervised program was well accepted and can be an option to improve the health of older adults with mild balance dysfunction.
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Affiliation(s)
- Yoke Leng Ng
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA,Australia
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore,Singapore
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC,Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA,Australia
- enAble Institute, Curtin University, Perth, WA,Australia
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22
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Levinger P, Goh AMY, Dunn J, Katite J, Paudel R, Onofrio A, Batchelor F, Panisset MG, Hill KD. Exercise interveNtion outdoor proJect in the cOmmunitY - results from the ENJOY program for independence in dementia: a feasibility pilot randomised controlled trial. BMC Geriatr 2023; 23:426. [PMID: 37438710 DOI: 10.1186/s12877-023-04132-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/25/2023] [Indexed: 07/14/2023] Open
Abstract
The Seniors Exercise Park program is an evidence-based outdoor physical and social activity program designed originally for older people with no cognitive impairment. This study aimed to pilot this program for people living with dementia in residential aged care. We examined the feasibility of delivering the program, evaluating its structure, safety, and supervision needs. In addition, physical, social, health and cognitive benefits of participation were examined. Method This was a feasibility pilot randomised controlled design. Adults aged ≥ 60 years with symptoms of dementia and/or diagnoses of dementia were recruited from an aged care facility in Australia. Participants allocated to the intervention underwent a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase, while the controls received usual care programs. Assessments occurred at baseline, 12 and 24-weeks. Feasibility evaluation included recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, program delivery modifications and supervision requirements. A suite of cognitive and health-related questionnaires and physical function measures were also collected. Results Sixteen participants were recruited (recruitment rate: 58.6%), eight for the intervention (83.3 ± 7.5 years, 87.5% women) and eight for the control (age 87.5 ± 3.0 years, 87.5% women). Eighty-eight percent completed the 12-week structured program, with 75% retention at 24-weeks. Across the 24-week period, 84.3% participation adherence was reported. No falls or adverse events occurred. Modifications of the program mainly related to method of communication, cueing and adjustments to suit individual personality and characteristics. A ratio of one trainer to two participants was practical and safe. There were no significant changes over time between groups in any of the secondary outcomes. High level of engagement, enjoyment and mood was reported throughout the exercise program. Conclusion The Seniors Exercise Park physical activity program was safe and feasible for people living with dementia in residential care, with high levels of enjoyment, positive attitude, and engagement reported in the intervention group. Individualised communication during program delivery was needed to facilitate motivation and participation. Further research is needed to assess the program effectiveness on physical and cognitive function on a larger scale. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry-Registry Number ACTRN12620000733976 . Registered on the 13/07/2020.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia.
| | - Anita M Y Goh
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
- The University of Melbourne, Melbourne, Australia
| | - Jeremy Dunn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | | | | | | | - Frances Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, Victoria, 3050, Australia
| | | | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
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Morris RL, Hill KD, Ackerman IN, Ayton D, Arendts G, Brand C, Cameron P, Etherton-Beer CD, Flicker L, Hill AM, Hunter P, Lowthian JA, Morello R, Nyman SR, Redfern J, Smit DV, Barker AL. Correction: A mixed methods process evaluation of a person-centred falls prevention program. BMC Health Serv Res 2023; 23:695. [PMID: 37370149 DOI: 10.1186/s12913-023-09743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Rebecca L Morris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darshini Ayton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Glenn Arendts
- University of Western Australia, Perth, Australia
- Harry Perkins Institute of Medical Research, Perth, Australia
| | - Caroline Brand
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | | | - Leon Flicker
- University of Western Australia, Perth, Australia
- Royal Perth Hospital, Perth, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Peter Hunter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Judy A Lowthian
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Australia
| | - Renata Morello
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, now at Department of Medical Science and Public Health, Bournemouth University, Dorset, UK
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, the George Institute for Global Health, University of Sydney, Sydney, Australia
| | - De Villiers Smit
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Liu JYW, Yin YH, Kor PPK, Kwan RYC, Lee PH, Chien WT, Siu PM, Hill KD. Effects of an individualised exercise programme plus Behavioural Change Enhancement (BCE) strategies for managing fatigue in frail older adults: a cluster randomised controlled trial. BMC Geriatr 2023; 23:370. [PMID: 37328797 PMCID: PMC10273765 DOI: 10.1186/s12877-023-04080-0] [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: 11/24/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND To the best of our knowledge, although ageing-induced fatigue could cause adverse outcomes such as frailty, there is currently no intervention for it. This study evaluated the effects of an individualised exercise programme with/without BCE strategies on reducing fatigue in older adults. METHODS A three-armed cluster-randomised controlled trial (RCT) was conducted with 184 participants (mean age: 79.1 ± 6.4; mean frailty score: 2.8 + 0.8) from 21 community centres (ClinicalTrials.gov: NCT03394495). They were randomised into either: the COMB group (n = 64), receiving 16 weeks of exercise training plus the BCE programme; the EXER group (n = 65), receiving exercise training and health talks; or the control group (n = 55), receiving only health talks. Fatigue was assessed using the Multi-dimensional Fatigue Inventory (range: 20 to 100, with higher scores indicating higher fatigue levels) at baseline, and immediately, 6 months, and 12 months post-intervention. RESULTS The GEE analyses showed significant interaction (time x group) between the COMB and control groups immediately (p < 0.001), 6 months (p < 0.001), and 12 months (p < 0.001) post-intervention. Comparing the COMB and EXER groups, there was a significant interaction immediately (p = 0.013) and at 12 months post-intervention (p = 0.007). However, no significant difference was seen between the EXER group and control group at any time point. CONCLUSIONS The COMB intervention showed better immediate and sustainable effects (i.e., 12 months after the intervention) on reducing fatigue in frail older adults than exercise training or health education alone. TRIAL REGISTRATION ClinicalTrials.gov (NCT03394495), registered on 09/01/2018.
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Affiliation(s)
- Justina Y W Liu
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Yue-Heng Yin
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Patrick P K Kor
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Rick Y C Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Wai Tong Chien
- Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Parco M Siu
- Division of Kinesiology, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, 3800, Australia
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25
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Birnbaum M, Brock K, Clark R, Burton E, Hill KD. Six-month outcomes and patterns of recovery for people with lateropulsion following stroke. Disabil Rehabil 2023:1-9. [PMID: 37312557 DOI: 10.1080/09638288.2023.2222644] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors. MATERIALS AND METHODS Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke. RESULTS Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (-0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently. CONCLUSIONS Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.IMPLICATIONS FOR REHABILITATIONIndividuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.
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Affiliation(s)
- Melissa Birnbaum
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kim Brock
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ross Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Queensland, Australia
| | - Elissa Burton
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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26
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Sari YM, Hill KD, Lee DCA, Burton E. Effectiveness of exercise programmes in improving physical function and reducing behavioural symptoms of community living older adults with dementia living in Asia, and impact on their informal carers: A systematic review and meta-analysis. Hong Kong Physiother J 2023; 43:3-17. [PMID: 37584051 PMCID: PMC10423677 DOI: 10.1142/s101370252350004x] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 08/17/2023] Open
Abstract
Background There is a growing evidence on the benefits of exercise for older people living with dementia in developed countries. However, cultural, health-care systems and environmental differences may impact on the uptake of exercise and outcomes in different regions of the world. Objective This study synthesised the available evidence examining the effectiveness of exercise interventions on improving physical function and reducing behavioural symptoms in community-dwelling older people living with dementia in Asia, and the impact on their informal carers. Methods Six databases were searched to November 2021. Randomised controlled trials (RCTs) or quasi-experimental studies evaluating exercise interventions for community-dwelling older people with dementia living in Asia were included. The Cochrane risk-of-bias tool for randomised trials and Downs and Black checklist had been used to assess methodological quality of the studies. Meta-analyses using a fixed effects model assessed the effects of exercise interventions where sufficient data were available. Mean difference (MD) with 95% confidence interval (CI) was used to pool results. Results Nine studies (five RCTs) were included (Hong Kong-4, China-1, South Korea-2, Taiwan-1, Indonesia-1). Exercise improved dynamic balance [Functional Reach (2 studies, n = 111 people with dementia), MD = 2 . 61 , 95% CI (1.55, 3.67)], but not for the Berg Balance Scale (MD = 1 . 10 , 95% CI [-2.88, 5.07]), Timed Up and Go (MD =- 3 . 47 , 95% CI [-7.27, 0.33]) and 5 times sit to stand tests (MD =- 1 . 86 , 95% CI [-5.27, 1.54]). Single studies where data could not be pooled showed no effect of exercise on behavioural symptoms or impact on informal carers. Conclusion Exercise appeared to have a beneficial effect on improving balance performance among older people with dementia living in Asia, however, this evidence is limited and inconsistent, and should be interpreted with caution. Further high-quality large RCTs are necessary for advancing the evidence base of exercise interventions for this population.
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Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Den-Ching A Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
- School of Primary and Allied Health Care Monash University, Melbourne, Victoria, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University Perth, Western Australia, Australia
- enAble Institute, Curtin University Perth, Western Australia, Australia
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27
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Salihu AT, Usman JS, Hill KD, Zoghi M, Jaberzadeh S. Mental fatigue does not affect static balance under both single and dual task conditions in young adults. Exp Brain Res 2023:10.1007/s00221-023-06643-4. [PMID: 37219602 DOI: 10.1007/s00221-023-06643-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
The ability to control balance and prevent falls while carrying out daily life activities may require a predominantly controlled (cognitive) or automatic processing depending on the balance challenge, age, or other factors. Consequently, this process may be affected by mental fatigue which has been shown to impair cognitive abilities. Controlling static balance in young adults is a relatively easy task that may proceed automatically with minimal cognitive input making it insusceptible to mental fatigue. To investigate this hypothesis, static single and dual task (while concurrently counting backward by seven) balance was assessed in 60 young adults (25.2 ± 2.4 years) before and after 45 min of Stroop task (mental fatigue condition) and watching documentary (control), presented in a randomized counterbalanced order on separate days. Moreover, because mental fatigue can occur due to task underload or overload, participants carried out two different Stroop tasks (i.e., all congruent, and mainly incongruent trials) on separate days in the mental fatigue condition. Results of the study revealed a significantly higher feeling of mental fatigue after the mental fatigue conditions compared to control (p < 0.001). Similarly, the performance on congruent Stroop trials decreases with time indicating objective mental fatigue (p < 0.01). However, there was no difference in balance or concurrent task performance under both single and dual task assessments between the three conditions (p > 0.05) indicating lack of effect of mental fatigue on static balance in this population. Therefore, future studies investigating this phenomenon in occupational or sport settings in similar population should consider using more challenging balance tasks.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia.
| | - Jibrin Sammani Usman
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Maryam Zoghi
- Discipline of Physiotherapy, Institute of Health and Wellbeing, Federation University Australia, Gippsland, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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28
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Bainbridge L, Fary RE, Briffa K, Hill KD, Burton E. Health Care Professionals' Decision Making Related to Mobility and Safety for People in the Hospital: A Scoping Review. Phys Ther 2023; 103:7069114. [PMID: 37249531 DOI: 10.1093/ptj/pzad024] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/19/2022] [Accepted: 12/22/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Mobility dysfunction can have an impact on safety, and this fact is particularly relevant to hospital settings. There are no clear standards for how health care professionals should approach the aim to encourage mobility without compromising safety. The objective of this scoping review was to identify factors that shape health care professionals' decision making for people in hospitals, in situations in which mobility and safety are taken into consideration. METHODS For this scoping review, 4 databases (Medline, CINAHL, PubMed, and Scopus) were searched. Terms previously agreed upon were used to identify peer-reviewed articles related to decision making by health care professionals in hospital settings (acute and rehabilitation), in which safety and mobility were factors for consideration. An initial screening of titles and abstracts was conducted by a single reviewer. Two reviewers independently screened the full texts of the remaining articles. The key findings of the articles were synthesized to determine common themes. RESULTS After 10,717 articles were screened, 28 met the inclusion criteria. Ten themes influencing decision making were identified: Clinical factors assessed; health care professional experience; limited use of standardized tests; impact of institutional governance; risk/benefit trade-off; capacity for decision making; role of the multidisciplinary team; families and others; communication; and fear of negative outcomes. CONCLUSION A wide range of factors influence health care professionals' decision making. The decisions can be complex, and individual priorities may vary in the balancing of safety with promotion of independence. Health care professionals rely on experience, clinical judgment, and shared decision making. IMPACT This review brings attention to many factors that contribute to decision making when mobility and safety are the factors. Health care professionals should include patients' values and monitor the impact of their personal preferences on this process.
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Affiliation(s)
- Liz Bainbridge
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Robyn E Fary
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
- enAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Kathy Briffa
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Allied Health and Primary Health Care, Monash University, Victoria, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
- enAble Institute, Curtin University, Bentley, Western Australia, Australia
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Brusco NK, Hill KD, Haines T, Dunn J, Panisset MG, Dow B, Batchelor F, Biddle SJH, Duque G, Levinger P. Cost-Effectiveness of the ENJOY Seniors Exercise Park for Older People: A Pre-Post Intervention Study. J Phys Act Health 2023; 20:555-565. [PMID: 37024105 DOI: 10.1123/jpah.2022-0380] [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: 07/15/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) Seniors Exercise Park program uses specialized outdoor equipment and a physical activity program to engage older people in physical activity, with multiple health benefits. We determined the cost-effectiveness of the ENJOY program. METHODS The economic evaluation compared health care utilization costs 6 months prior to and 6 months post ENJOY program participation. Incremental cost-utility analysis for the primary aim (quality of life) and incremental cost-effectiveness analysis for the secondary aim (falls) were used. Analyses took a societal perspective inclusive of Australian government-funded health care and pharmaceuticals in addition to hospitalizations, community-based nursing and allied health, and community services. Productivity costs were also calculated. RESULTS Fifty participants (average age 72.8 y [SD 7.4] and 78.0% [n = 39/50] women) were included. Participation in the ENJOY program reduced health care costs in the 6 months following the program: preintervention, $9764.49 (SD $26,033.35); postintervention, $5179.30 (SD $3826.64); observed postintervention reduction -$4.585.20 (95% confidence interval, -$12,113.99 to $2943.59; P = .227) without compromising quality of life (mean difference [MD] 0.011; 95% confidence interval, -0.034 to 0.056; P = .631) or increasing the likelihood of a fall (-0.5; 95% confidence interval, 0.00 to -0.50; P = .160). The ENJOY intervention is likely cost-effective. CONCLUSIONS Planning for shared community spaces should consider the benefits of a Seniors Exercise Park as part of the built environment.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, VIC,Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, VIC,Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC,Australia
| | - Jeremy Dunn
- National Ageing Research Institute, Melbourne, VIC,Australia
| | - Maya G Panisset
- Department of Medicine, University of Melbourne, Melbourne, VIC,Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, VIC,Australia
- Centre for Health Policy, University of Melbourne, Melbourne, VIC,Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC,Australia
| | - Frances Batchelor
- National Ageing Research Institute, Melbourne, VIC,Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, VIC,Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC,Australia
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield, QLD,Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, VIC,Australia
| | - Pazit Levinger
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, VIC,Australia
- National Ageing Research Institute, Melbourne, VIC,Australia
- Institute for Health and Sport, Victoria University, Melbourne, VIC,Australia
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Talevski J, Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Hill KD, Sanders KM, Daly RM. Effects of an 18-month community-based, multifaceted, exercise program on patient-reported outcomes in older adults at risk of fracture: secondary analysis of a randomised controlled trial. Osteoporos Int 2023; 34:891-900. [PMID: 36862193 PMCID: PMC10104917 DOI: 10.1007/s00198-023-06693-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
UNLABELLED This study identified that an 18-month community-based, multifaceted, exercise program consisting of resistance, weight-bearing impact, and balance/mobility training combined with osteoporosis education and behavioural support can improve health-related quality of life (HRQoL) and osteoporosis knowledge in older adults at risk of fracture, but only for those adherent to the exercise regime. PURPOSE To evaluate the effects of an 18-month community-based exercise, osteoporosis education and behaviour change program (Osteo-cise: Strong Bones for Life) on HRQoL, osteoporosis knowledge and osteoporosis health beliefs. METHODS This was a secondary analysis of an 18-month randomised controlled trial in which 162 older adults aged ≥ 60 years with osteopenia or increased falls/fracture risk were randomized to the Osteo-cise program (n = 81) or control group (n = 81). The program consisted of progressive resistance, weight-bearing impact and balance training (3 days/week); osteoporosis education to facilitate self-management of musculoskeletal health and behavioural support to enhance adherence to exercise. HRQoL, osteoporosis knowledge and osteoporosis health beliefs were assessed using the EuroQoL questionnaire (EQ-5D-3L), Osteoporosis Knowledge Assessment Tool and Osteoporosis Health Belief Scale, respectively. RESULTS Overall, 148 participants (91%) completed the trial. Mean exercise adherence was 55% and mean attendance for the three osteoporosis educational sessions ranged from 63-82%. After 12 and 18 months, there were no significant effects of the Osteo-cise program on HRQoL, osteoporosis knowledge or health beliefs relative to controls. Per protocol analyses (≥ 66% exercise adherence; n = 41) revealed a significant net benefit in EQ-5D-3L utility for the Osteo-cise group relative to controls after 12 months (P = 0.024) and 18 months (P = 0.029) and a significant net improvement in osteoporosis knowledge scores at 18 months (P = 0.014). CONCLUSION This study supports the importance of adherence to exercise regimes, as adherence to the Osteo-cise: Strong Bones for Life program was associated with improvements in HRQoL and osteoporosis knowledge in older adults at increased risk for falls and fractures. TRIAL REGISTRATION NUMBER ACTRN12609000100291.
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Affiliation(s)
- Jason Talevski
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - Jenny Gianoudis
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Christine A Bailey
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Lee DCA, Haines TP, Callisaya ML, Hill KD. A Scalable Program for Improving Physical Activity in Older People with Dementia Including Culturally and Linguistically Diverse (CALD) Groups Who Receive Home Support: A Feasibility Study. Int J Environ Res Public Health 2023; 20:3662. [PMID: 36834355 PMCID: PMC9959901 DOI: 10.3390/ijerph20043662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Home care clients with dementia/cognitive impairment are typically functionally dependent and physically inactive. We pilot-tested a co-designed physical exercise program for its feasibility, safety, adherence and potential for benefits on physical activity, physical function, healthcare use and falls. Trained community care support workers delivered a 12-week home exercise program to clients with dementia/cognitive impairment, once weekly for 15 min during care shifts, supplemented by carers' supervision of exercises for 30 min, three times weekly. A physiotherapist provided fortnightly phone support to ensure safety and exercise progression. Baseline and Week 12 assessments using validated scales for physical activity, physical function, daily living independence, falls efficacy, quality of life, self-reported healthcare use, falls and sleep quality were undertaken. Differences were examined with regression analyses. Care support workers (n = 26) and client/carer dyads (n = 26 and 80.8% culturally and linguistically diverse) participated. Participants recorded adverse events/falls and exercises in dairies. Fifteen dyads completed the program. No falls/adverse events occurred with the exercises. The adherence rates against targets for exercise time completed and days in which exercise were undertaken for support workers were 137%/79.6%, and for client/carer dyads were 82%/104.8%, respectively. Physical activity participation, physical function and falls efficacy significantly improved at Week 12 compared to baseline. The feasibility, safety and adherence of the co-designed physical exercise program were demonstrated. Strategies to minimise dropouts in future effectiveness studies are required.
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Affiliation(s)
- Den-Ching A. Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston 3199, Australia
- National Centre for Healthy Ageing (NCHA), Monash University and Peninsula Health, Frankston 3199, Australia
| | - Terry P. Haines
- National Centre for Healthy Ageing (NCHA), Monash University and Peninsula Health, Frankston 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston 3199, Australia
| | - Michele L. Callisaya
- National Centre for Healthy Ageing (NCHA), Monash University and Peninsula Health, Frankston 3199, Australia
- Peninsula Clinical School, Monash University, Frankston 3199, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston 3199, Australia
- National Centre for Healthy Ageing (NCHA), Monash University and Peninsula Health, Frankston 3199, Australia
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Lee DCA, Burton E, Meyer C, Haines TP, Hunter S, Dawes H, Suttanon P, Fullarton S, Connelly F, Stout JC, Hill KD. The Potential for Effect of a Six-Week Training Program for Gait Aid Use in Older People with Dementia with Unsteadiness of Gait: A Pilot Study. J Clin Med 2023; 12:jcm12041574. [PMID: 36836110 PMCID: PMC9967216 DOI: 10.3390/jcm12041574] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
This study examined the potential for effect of a six-week gait aid training program for people with dementia on spatiotemporal gait outcomes, perception of use, and falls with gait aid use. The program utilised four 30-min physiotherapy home visits, scheduled at weeks 1/2/3/6, and was enhanced by carer-supervised practice. Falls and the physiotherapist's clinical judgement of participants achieving safe gait aid use during and after the program were described. Perception ratings at each visit were measured using Likert scales which, along with the spatiotemporal outcomes using the gait aid (Time-Up-and-Go-Test, 4-m-walk-test, Figure-of-8-Walk-Test with/without a cognitive task) at weeks 1 and 6, and at weeks 6 and 12 (6-week post-program), were examined with ordinal logistic regression analyses. Twenty-four community-dwelling older people with dementia and their carers participated. Twenty-one (87.5%) older people achieved safe gait aid use. Twenty falls occurred, and only one faller was using their gait aid when they fell. Walking speed, step length, and cadence significantly improved when walking with the gait aid at week 6 compared with week 1. No significant improvements in spatiotemporal outcomes were retained at week 12. Physiotherapists were more likely to agree that gait aid use had improved walking safety among older people with dementia with subsequent training visits. Larger studies of the gait aid training program are needed for this clinical group.
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Affiliation(s)
- Den-Ching A. Lee
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
- Correspondence: ; Tel.: +613-9904-4662
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- Bolton Clarke Research Institute, Forest Hill VIC 3131, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, VIC 3086, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Terry P. Haines
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
| | - Susan Hunter
- School of Physical Therapy, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Helen Dawes
- NIHR Exeter BRC, Medical School, University of Exeter, Exeter EX1 2LU, UK
| | - Plaiwan Suttanon
- Thammasat University Research Unit in Health, Physical Performance, Movement, and Quality of Life for Longevity Society, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand
| | - Stephanie Fullarton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Fiona Connelly
- Department of Geriatric Medicine, Armadale Kalamuda Group, Armadale Health Service, Perth, WA 6112, Australia
| | - Julie C. Stout
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
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Burton E, Hill KD, Davey P, Ng YL, Williams SA. The Biomechanics of Healthy Older Adults Rising from the Floor Independently. Int J Environ Res Public Health 2023; 20:3507. [PMID: 36834201 PMCID: PMC9958992 DOI: 10.3390/ijerph20043507] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
A third of older adults will fall each year and many will not be injured. Getting up from the floor in a timely manner is important, however it is unclear what technique older adults use to get themselves up off the ground unassisted, whether there are differences between men and women in getting up and what functional joint kinematics are used to rise from the floor. This study included a convenience sample of 20 older adults (65+ years) to answer these questions. Participants completed a series of movement tasks (i.e., rising from the floor using their own technique, a specified technique, walking 10 m and five repeated sit-to-stands), with temporospatial and joint kinematic data captured using an 18-camera 3D Vicon motion analysis system. Results found three techniques preferred by participants; the sit-up (n = 12), side-sit (n = 4) and the roll over (n = 4), with no differences found between sexes. The sit-up technique requires a higher degree of hip and knee flexion to complete compared to the side-sit and roll over. It may be beneficial for health professionals to work with older adults to identify their preferred technique for rising from the floor and encourage regular practice of this skill.
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- enAble Institute, Curtin University, Perth, WA 6102, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
| | - Paul Davey
- Curtin School of Nursing, Curtin University, Perth, WA 6102, Australia
| | - Yoke Leng Ng
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Sîan A. Williams
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Liggins Institute, University of Auckland, Auckland 1010, New Zealand
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Sari YM, Burton E, Lee DCA, Hill KD. A Telehealth Home-Based Exercise Program for Community-Dwelling Older People with Dementia in Indonesia: A Feasibility Study. Int J Environ Res Public Health 2023; 20:3397. [PMID: 36834093 PMCID: PMC9966659 DOI: 10.3390/ijerph20043397] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: This study aimed to evaluate the feasibility of a telehealth home-based exercise program for older people with dementia living in Indonesia with support from their informal carers. (2) Methods: Pre-post intervention single group study with three assessment time-points (baseline, 12 and 18 weeks). Participants with dementia underwent a 12-week physiotherapist-delivered telehealth exercise program, with informal carer supervision between supervised online sessions, and continued the exercises for a further six weeks without physiotherapist online supervision. (3) Results: Thirty dyads of older people with dementia and their informal carers were recruited; four (13.3%) withdrew across the 12-week intervention and one (3.3%) in the 6-week self-maintenance period. Median adherence was 84.1% (IQR [25, 75] = 17.1) during the 12-week intervention, and 66.7% (IQR [25, 75] = 16.7) in the self-maintenance period. No falls/adverse events were reported. Physical activity level, some aspects of function and disability, health-related benefits of exercise, exercise enjoyment and quality of life of older people with dementia improved significantly at 12 and 18 weeks. (4) Conclusions: The telehealth exercise program is feasible and safe and may have benefits for the health outcomes of community-living older people with dementia in Indonesia. Additional strategies are necessary to enhance longer-term adherence to the program.
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Affiliation(s)
- Yulisna Mutia Sari
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth 6102, Australia
- enAble Institute, Curtin University, Perth 6845, Australia
| | - Den-Ching A. Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne 3800, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne 3199, Australia
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Burton E, Hill KD, Codde J, Jacques A, Ng YL, Hill AM. Encouraging Adults Aged 65 and over to Participate in Resistance Training by Linking Them with a Peer: A Pilot Study. Int J Environ Res Public Health 2023; 20:3248. [PMID: 36833942 PMCID: PMC9963296 DOI: 10.3390/ijerph20043248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/27/2023]
Abstract
Resistance training (RT) is beneficial for older adults, particularly to support living independently in their home. However, fewer than 25% of older adults in Australia participate in the recommended, twice-weekly sessions. Reasons older adults do not participate in RT include not having anyone to go with or not knowing what to do. Our study linked older adults with a peer (i.e., older person already participating in RT) to help them overcome these barriers. The aim of our study was to determine whether peer support was suitable for older adults participating in RT for the first time in the home or gymnasium setting. Each group (home vs. gymnasium) received a 6 week, twice-weekly program. Twenty-one participants completed the 6 week intervention: 14 in the home group and seven in the gymnasium group. The home group completed significantly more sessions per week (2.7 vs. 1.8) than the gymnasium group. Although both groups significantly improved on many physical assessments, no between-group differences were found. However, it is suitable to link a peer for support with novice older people participating in a RT program for the first time in the home or gymnasium. It is recommended that future studies explore whether peer support improves sustainability.
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- enAble Institute, Curtin University, Perth, WA 6845, Australia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC 3199, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, VIC 3199, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Australia, Perth, WA 6160, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame Australia, Perth, WA 6160, Australia
| | - Yoke Leng Ng
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Anne-Marie Hill
- School of Allied Health, The University of Western Australia, Perth, WA 6000, Australia
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Salihu AT, Hill KD, Jaberzadeh S. Neural mechanisms underlying state mental fatigue: a systematic review and activation likelihood estimation meta-analysis. Rev Neurosci 2022; 33:889-917. [PMID: 35700454 DOI: 10.1515/revneuro-2022-0023] [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: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 12/14/2022]
Abstract
Sustained performance of cognitive tasks could lead to the development of state mental fatigue characterized by subjective sensation of mental weariness and decrease in cognitive performance. In addition to the occupational hazards associated with mental fatigue, it can also affect physical performance reducing endurance, balance, and sport-specific technical skills. Similarly, mental fatigue is a common symptom in certain chronic health conditions such as multiple sclerosis affecting quality of life of the patients. Despite its widely acknowledged negative impact, the neural mechanisms underlining this phenomenon are still not fully understood. We conducted a systematic review and activation likelihood estimation (ALE) meta-analysis of functional neuroimaging studies investigating the effect of mental fatigue due to time-on-task (TOT) on brain activity to elucidate the possible underlying mechanisms. Studies were included if they examined change in brain activity induced by experimental mental fatigue (TOT effect) or investigated the relationship between brain activity and subjective mental fatigue due to TOT. A total of 33 studies met the review's inclusion criteria, 13 of which were included in meta-analyses. Results of the meta-analyses revealed a decrease in activity with TOT in brain areas that constitute the cognitive control network. Additionally, an increased activity with TOT, as well as negative relationship with subjective mental fatigue was found in parts of the default mode network of the brain. The changes in cognitive control and the default mode networks of the brain due to state mental fatigue observed in this study were discussed in relation to the existing theories of mental fatigue.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
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Omana HA, Madou E, Divine A, Wittich W, Hill KD, Johnson AM, Holmes JD, Hunter SW. The effect of first-time 4-wheeled walker use on the gait of younger and older adults. PM R 2022; 14:1333-1342. [PMID: 34464511 DOI: 10.1002/pmrj.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required. OBJECTIVE To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults. DESIGN Cross-sectional, repeated-measures. SETTING Community-dwelling. PARTICIPANTS Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses. RESULTS Velocity was lower when walking using a walker while completing a cognitive task (p < .001), in the figure-of-8 Walk Test (p < .001), and in older adults (p = .001). Stride time variability increased with walking path and condition difficulty (p < .001) for the straight path versus the figure-of-8 Walk Test. CONCLUSIONS Using a 4-wheeled walker resulted in a slower and more inconsistent gait pattern across both age groups. Walking more complex configurations resulted in the prioritization of gait over the cognitive task while performing the dual-task conditions. No evidence of an age-related difference in the effect of initial walker use on gait was observed. Nonetheless, walkers are cognitively demanding and their introduction should warrant a clinical follow-up.
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Affiliation(s)
- Humberto A Omana
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Edward Madou
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Alison Divine
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Walter Wittich
- École d'optométrie, Université de Montréal, Montreal, Quebec, Canada
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living Research Centre, Monash University, Clayton, Victoria, Australia
| | - Andrew M Johnson
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey D Holmes
- School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
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Lee DCA, Burton E, Slatyer S, Jacinto A, Oliveira D, Bryant C, Khushu A, Tiller E, Lalor A, Watson M, Layton N, Brusco N, Hill KD. Understanding the Role, Quality of Life and Strategies Used by Older Carers of Older People to Maintain Their Own Health and Well-Being: A National Australian Survey. Clin Interv Aging 2022; 17:1549-1567. [PMID: 36304174 PMCID: PMC9594879 DOI: 10.2147/cia.s384202] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Carers play a critical role in supporting older people with health problems to remain living at home. This study aimed to understand the role and quality of life of older carers of older people and identify strategies used to manage their own health and well-being. Methods Older carers (aged ≥50 years) of older people (aged ≥65 years) in Australia participated in a cross-sectional survey focused on carer roles, self-rated health, information and activities used to maintain their carer role and health, barriers to accessing health care, and assessment of quality of life (QoL) using the Dementia Quality of Life Scale for Older Family Carers. Multiple regression analysis examined relationships between variables and the QoL outcome. Results The survey was completed by 189 older carers (mean age: 68 years; SD = 9.3). Most were female (83.5%), 80.2% providing care daily and 47.8% provided ≥six hours care daily. Almost half (45.1%) self-reported their health as average or below. Despite rating ensuring personal health as very important (mean importance 8/10), only 46.3% reported receiving support from their general practitioner for their carer role. The most common barrier to accessing care for themselves was “not having enough time”. Factors independently associated with poorer carer QoL were living with the care-recipient, caring for someone with depression/anxiety and poor care-recipient health. Factors independently associated with higher carer QoL were placing high importance on personal health, receiving assistance from a specialist clinic as a carer, and older age. Conclusion Older carers of older people provide high levels of care and experience reduced quality of life. Innovative approaches that provide integrated care and support for older carers to promote their QoL are urgently needed.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, 3199, Australia,Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, 3199, Australia,Correspondence: Den-Ching A Lee, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, Victoria, 3199, Australia, Tel +613 9904 4662, Email
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia,enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, 6102, Australia
| | - Susan Slatyer
- Centre for Healthy Ageing, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Alessandro Jacinto
- Faculty of Geriatric Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Déborah Oliveira
- Medical School, Faculty Postgraduate Department of Psychiatry, Federal University of Sao Paulo – UNIFESP, Sao Paulo-SP, Brazil
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Anjali Khushu
- Department of Geriatrics (Falls Prevention Service), Peninsula Health, Frankston, Victoria, 3199, Australia
| | - Elizabeth Tiller
- Department of Geriatrics (Falls Prevention Service), Peninsula Health, Frankston, Victoria, 3199, Australia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, 3199, Australia,Department of Occupational Therapy, Monash University, Melbourne, Victoria, 3199, Australia
| | - Moira Watson
- Centre for Healthy Ageing, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, 3199, Australia
| | - Natasha Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, 3199, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, 3199, Australia,National Centre for Healthy Ageing, Monash University and Peninsula Health, Frankston, Victoria, 3199, Australia
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Gidgup MJR, Kickett M, Hill KD, Francis‐Coad J, Weselman T, Coombes J, Ivers R, Bowser N, Palacios V, Hill A. Connecting and reconnecting to a community, with a sense of belonging - Exploring Aboriginal Elders' perspectives of engaging in a physical activity program. Health Promot J Austr 2022; 33 Suppl 1:138-149. [PMID: 35170128 PMCID: PMC9790223 DOI: 10.1002/hpja.582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
ISSUE ADDRESSED Culturally appropriate physical activity (PA) programs have values and principles that respect local community culture and knowledge. However, in Western Australia (WA) there were no opportunities for older Aboriginal peoples to engage in a culturally appropriate PA program. The study objective was to explore how engaging in a culturally appropriate PA program impacted on the lived experiences of Aboriginal Elders. METHODS A qualitative exploratory study was conducted using an Indigenous methodology. Participants were Aboriginal Elders in Noongar Country in WA . Two groups, engaged in the Ironbark program, which consisted of weekly exercise and a yarning circle. The program was developed in NSW specifically for older Aboriginal and Torres Strait peoples and adapted for use in WA. Semi-structured interviews utilising a yarning approach were facilitated by a Noongar Wadjuk researcher. Inductive thematic analysis was undertaken. RESULTS Nineteen Elders were interviewed. The overarching theme was that participation led to connecting and reconnecting to community with a sense of belonging. Elders affirmed the program as being appropriate and comfortable. They described experiences that were grouped into three main themes of Positive mental and emotional changes, Physical improvements and Social benefits. CONCLUSIONS Aboriginal Elders valued the opportunity to engage in a culturally appropriate PA program. Benefits were appreciated as holistic in nature, with Elders seeing improvements in their mental, physical and emotional health. SO WHAT?: Increasing access to culturally appropriate, decolonised PA programs is a fundamental health promotion approach for working with older Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Margaret J. R. Gidgup
- School of Allied HealthFaculty of Health ScienceCurtin UniversityPerthWestern AustraliaAustralia,Centre for Aboriginal StudiesCurtin UniversityPerthWestern AustraliaAustralia
| | | | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research CentreSchool of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | | | - Tammy Weselman
- School of Allied HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Julieann Coombes
- The George Institute for Global HealthSydneyNew South WalesAustralia
| | - Rebecca Ivers
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nicole Bowser
- South West Aboriginal Medical Service Aboriginal CorporationBunbury Western AustraliaAustralia
| | - Vilma Palacios
- North Metropolitan Public Health UnitWA North Metropolitan Health ServicePerthWestern AustraliaAustralia
| | - Anne‐Marie Hill
- School of Allied HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Scully AE, de Oliveira BIR, Hill KD, Tan D, Pua YH, Clark R, Burton E. Developing the Freezing of Gait Severity Tool: A Delphi consensus study to determine the content of a clinician-rated assessment for freezing of gait severity. Clin Rehabil 2022; 36:1679-1693. [DOI: 10.1177/02692155221121180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives There is no standardisation of tasks or measures for evaluation of freezing of gait severity in people with Parkinson's disease. This study aimed to develop a clinician-rated tool for freezing of gait severity (i.e. Freezing of Gait Severity Tool), through determining clinicians’ ratings of the most important triggering circumstances to be examined and aspects of freezing of gait to be measured. Design A three-round, web-based Delphi study. Participants Healthcare professionals, with at least five years’ experience in managing freezing of gait in people with Parkinson. Main outcome measures Round 1 required participants ( n = 28) to rate items on a 5-point Likert scale, based on priority for inclusion in the Freezing of Gait Severity Tool. In Round 2, participants ( n = 18) ranked the items based on priority for inclusion. In Round 3, participants ( n = 18) confirmed or rejected the shortlisted items by judging their ability, on a binary scale, to screen for freezing of gait, detect changes in freezing severity, and discriminate between degrees of severity. Results Participants agreed with the triggering circumstances of turning hesitation, narrow space hesitation, start hesitation, cognitive dual-tasking, and open space hesitation should be assessed; and the aspects of gait freezing to be measured included freezing type, number of freezing episodes during a task, and average duration of freezing episodes. Conclusions This study attained a consensus for the items to be included in a clinician-rated tool for freezing of gait severity. Future studies should investigate psychometric properties and clinical feasibility of the Freezing of Gait Severity Tool.
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Affiliation(s)
- Aileen E Scully
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Beatriz IR de Oliveira
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Dawn Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Ross Clark
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Bentley, Western Australia, Australia
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Jepson M, Whittaker GA, Robins L, Long KM, Williams CM, Russell G, Hill KD, Callaway L, Hlavac J, Willoughby L, Haines TP. Australian public health COVID-19 messaging is missing its mark in some vulnerable communities and people who reject COVID-19 safety advice. J Glob Health 2022; 12:05037. [PMID: 36057910 PMCID: PMC9441129 DOI: 10.7189/jogh.12.05037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background There are groups in our community who may be more vulnerable to contracting, transmitting, or experiencing negative health impacts of COVID-19 than the general community. They may also have greater difficulty accessing, accepting, and acting upon COVID-19 public health information. Our aim was to understand if vulnerable communities and those who express "COVID-risk" behavioural intentions seek and respond differently to COVID-19 public health information. Methods This observational, cross-sectional study recruited adults aged over 18 years from the Australian general community and six community groups (people with disabilities and their caregivers, Aboriginal and Torres Strait Islanders, aged care workers, street-based sex workers, refugees and asylum seekers, and the deaf and hard of hearing). We investigated attitudes and beliefs about COVID-19 public health messages. We identified factors associated with the respondent's perception of the ease of finding information and understanding it, and its relevance to them. We also examined latent classes that were developed based on attitudes to public health measures and vulnerable group categories, along with demographic variables. Results We received 1444 responses (n = 1121 general community; n ≥50 for each vulnerable group). The vulnerable groups examined found COVID-19 public health messages as easy, if not easier, to find and understand than the general community. Four latent classes were identified: COVID-safe mask wearers (10% of sample), COVID-safe test takers (56%), COVID-risk isolators (19%) and COVID-risk visitors (15%). The COVID-risk classes (34% of sample) were less likely to consider COVID-19 information easy to find, understandable, and relevant. Conclusions Additional public health messaging strategies may be needed for targeting people with "COVID-risk" beliefs and attitudes who appear across the community (general and vulnerable groups) rather than just targeting specific cultural or other groupings that we think may be vulnerable. COVID-risk classes identified through this study were not defined by demographic characteristics or cultural groupings, but were spread across vulnerable communities and the general community. Different approaches for tailoring and delivery of specific public health information for these groups are needed.
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Affiliation(s)
- Megan Jepson
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Glen A Whittaker
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Lauren Robins
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Katrina M Long
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Cylie M Williams
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia.,Peninsula Health, Allied Health, Victoria, Australia
| | - Grant Russell
- Department of General Practice, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia
| | - Libby Callaway
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia.,Occupational Therapy Department, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria
| | - Jim Hlavac
- Translation and Interpreting Studies, Faculty of Arts, Monash University, Victoria, Australia
| | - Louisa Willoughby
- Linguistics, Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Frankston, Victoria, Australia
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Lee DCA, Burton E, Meyer C, Hunter SW, Suttanon P, Hill KD. Gait aid use for people with and without dementia: A comparison of practice between health and non-health professionals among Australian community care staff. Health Soc Care Community 2022; 30:e1721-e1733. [PMID: 34617351 DOI: 10.1111/hsc.13600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Gait aid provision is a standard approach to improve mobility and balance for older people. This research aims to understand and compare community care staff practice (health vs. non-health professionals) for gait aid use by people with and without dementia. A cross-sectional survey was conducted with Australian community care staff between October 2020 and February 2021. Survey items consisted of closed/open-ended questions to explore staff practice for people with/without dementia, and assessments/procedures health professionals used for people with dementia. Likert-scale items gauged staff agreement on factors that influenced their decisions regarding gait aid use for people with dementia. Univariate logistic regression analyses were used to examine staff practice for people with/without dementia and their interaction effects, and factors that influenced decision-making regarding gait aid use for people with dementia. Content analyses were used to collate responses on assessments/procedures used for people with dementia. Health (n = 109) and non-health professionals (n = 138) completed the survey. Compared with non-health professionals, health professionals were more likely to (1) refer the person without dementia [odds ratio, 95% CI: 23.9 (12.1, 47.3), p < .01] and person with dementia [27.8 (12.5, 61.7), p < .01] to a physiotherapist for gait aid assessment, (2) agree with gait aid use if the person with dementia: (a) lives with someone who can monitor gait aid safety [coefficient, 95% CI: -0.75 (-1.29, -0.21), p = .01], (b) performs well on a cognitive functional screen [-0.68 (-1.20, -0.16), p = .01] and (c) gives feedback about gait aid use [-0.64 (-1.15, -0.12), p = .02]. No interaction effects existed between health/non-health professionals and whether the person had dementia/no dementia on the practice options examined. Health professionals infrequently reported using single/dual task, simple/complex gait or motor sequence testing to assess people with dementia for gait aid use. Strategies such as developing decision aid tool(s) may guide mobility practice for community care staff.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Claudia Meyer
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, Australia
| | - Susan W Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Plaiwan Suttanon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani, Thailand
| | - Keith D Hill
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria, Australia
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Yau L, Soutter K, Ekegren C, Hill KD, Ashe M, Soh SE. Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2022; 103:1827-1838.e2. [PMID: 35143745 DOI: 10.1016/j.apmr.2022.01.145] [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: 09/30/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy. DATA SOURCES Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020. STUDY SELECTION Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers. DATA EXTRACTION Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies. DATA SYNTHESIS Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes. CONCLUSIONS Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.
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Affiliation(s)
- Lucinda Yau
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Kate Soutter
- Physiotherapy Department, Alfred Health, Melbourne, Australia
| | - Christina Ekegren
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing, and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Maureen Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, Monash University, Melbourne, Australia.
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Gidgup MJR, Kickett M, Jacques A, Weselman T, Hill KD, Coombes J, Ivers R, Bowser N, Palacios V, Hill AM. Translating and Evaluating a Physical Activity Program for Aboriginal Elders on Noongar Boodjar (Country) — A Longitudinal Study. Front Public Health 2022; 10:904158. [PMID: 35937226 PMCID: PMC9355611 DOI: 10.3389/fpubh.2022.904158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The primary aim of the study was to translate and evaluate the impact of a Physical Activity (PA) program on the physical function of older Aboriginal Elders on Noongar Boodjar (Country). Methods A longitudinal design framed within an Indigenous methodology. Two groups, one metropolitan and one regional, of Aboriginal Elders, aged ≥45 years, participated in the Ironbark PA program. This comprised weekly strength and balance exercises followed by yarning circles. Physical function (primary outcome) and functional ability, cardiovascular risk factors (weight, waist circumference), falls efficacy and health-related quality of life were measured at baseline 6, 12 and 24 months. Data were analyzed using generalized linear mixed effects modeling. Results Fifty-two Elders initially enrolled and of those, n = 23 (44.2%) Elders participated regularly for 24 months. There was a 6-month gap in program delivery due to the COVID-19 pandemic. Participants made significant improvement in physical function at 12 months compared to baseline: [short physical performance battery (SPPB) at baseline, 8.85 points (95% CI 8.10, 9.61); 12 months 10.28 (95% CI 9.44, 11.13), p = 0.001: gait speed at baseline 0.81 ms−1 (95% CI 0.60, 0.93); 12 months 1.14 (95% CI 1.01, 1.27), p < 0.001]. Some sustained improvement compared to baseline was still evident at 24 months after the 6-month gap in attendance [SPPB 9.60 (8.59, 10.60) p = 0.14, gait speed 1.11 (0.95, 1.26) p < 0.001]. Cardiovascular risk factors showed a non-significant improvement at 12 and 24 months compared to baseline. All participants reported that they enjoyed the program, found it culturally appropriate and would recommend it to others. Conclusion Older Aboriginal people showed sustained improvements in physical function after engaging in a culturally appropriate PA program. Culturally appropriate PA programs provide safety, security and choice for older Aboriginal people to engage in evidence-based PA.
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Affiliation(s)
- Margaret J. R. Gidgup
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
- *Correspondence: Margaret J. R. Gidgup
| | | | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Tammy Weselman
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
| | - Julieann Coombes
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Sydney, NSW, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicole Bowser
- South West Aboriginal Medical Service Aboriginal Corporation, Bunbury, WA, Australia
| | - Vilma Palacios
- North Metropolitan Public Health Unit, WA North Metropolitan Health Service, Perth, WA, Australia
| | - Anne-Marie Hill
- School of Allied Health, WA Centre for Health and Ageing, The University of Western Australia, Perth, WA, Australia
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Williams N, Haines T, Williams C, Bowles KA, Hill KD. Age Differences in Preferred Methods of Obtaining and Understanding Health Related Information During the COVID-19 Pandemic in Australia. Front Public Health 2022; 10:912188. [PMID: 35910912 PMCID: PMC9326317 DOI: 10.3389/fpubh.2022.912188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/10/2022] [Indexed: 11/13/2022] Open
Abstract
Methods of communications and the nature of messaging are critically important in influencing public behavior. The COVID-19 pandemic has resulted in major disruptions to all aspects of life globally and has triggered multiple approaches of health messaging to the general public to communicate COVID-19 preventative measures. This study aimed to identify: (1) differences between age groups in the main avenues used by people to obtain COVID-19 related information; and (2) whether age and information sources were associated with correct interpretation of government messaging relating to how people understand or interpret the terms “self-isolation” and “social distancing.” An online survey was conducted in 2020. Participants were aged over 18 years and grouped into age group decades. Differences in sources of COVID-19 information were compared visually between age groups. Logistic regression was used to determine whether age and each of the various methods of communication of COVID-19 information were independently associated with correct response to the self-isolation, or the social distancing statements. There were 3,300 survey respondents 85% female; age sub-groups: 18–29 (7.4%); 30–39 (10.6%); 40–49 (17.6%); 50–59 (22.9%); 60–69 (25.9%); 70–79 (13.9%); and 80+ (1.7%). People accessed public health messaging information from a wide variety of sources that changed as they aged (e.g., older people were more likely to be exposed to COVID-19 information via television news programs and less likely via social media platforms). Age was frequently associated with whether the message key terms were interpreted correctly or incorrectly, but in some cases, it promoted more correct responses whereas in others, fewer correct responses. There was no difference between being exposed to COVID-19 information via mainstream media, compared with social media, or compared with Government sources of information, in terms of whether COVID-19 messages were interpreted correctly. In order to improve future public health messaging, there is a need for multiple avenues of communication to meet the needs and preferences across and within age groups. Further investigation is warranted into the clarity of the content and method of delivery of public health messages, to ensure optimal understanding of public health messages by vulnerable populations and across the community.
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Affiliation(s)
- Nathan Williams
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, VIC, Australia
- *Correspondence: Nathan Williams
| | - Terry Haines
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, VIC, Australia
| | - Cylie Williams
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, VIC, Australia
| | - Kelly-Ann Bowles
- School of Primary and Allied Health Care & National Centre for Healthy Ageing, Monash University, Frankston, VIC, Australia
- Department of Paramedicine, Monash University, Frankston, VIC, Australia
| | - Keith D. Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, VIC, Australia
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Levinger P, Cerin E, Milner C, Hill KD. Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here? Int J Environ Health Res 2022; 32:1329-1336. [PMID: 33682531 DOI: 10.1080/09603123.2021.1879739] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Melbourne Australia
- Institute for Health and Sport, Victoria University, Melbourne Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne Australia
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne Australia
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Colin Milner
- International Council on Active Aging, Vancouver, BC Canada
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne Australia
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Levinger P, Dunn J, Abfalter E, Dow B, Batchelor F, Garratt S, Diamond NT, Hill KD. The ENJOY MAP for HEALTH: Exercise interveNtion outdoor proJect in the cOmmunitY for older people-More Active People for HEALTHier communities: a study protocol. BMC Public Health 2022; 22:1027. [PMID: 35597934 PMCID: PMC9124389 DOI: 10.1186/s12889-022-13335-1] [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: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Physical activity is important to maintain health in older age, with physical activity in the outdoors providing mental and physical health benefits for all age groups. One way by which older people can engage in physical activity in the outdoors is through using suitable age-friendly outdoor exercise equipment, the Seniors Exercise Park. The ENJOY MAP for HEALTH aims to evaluate the effect of the Seniors Exercise Park installation and associated capacity building activities on park visitation, park-based physical activity by older people and delivery of community physical activity programs. Method This study is a quasi-experimental (natural experiment) with pre and post study design evaluating the effect of age-friendly outdoor spaces with specialised outdoor exercise equipment on older people’s physical activity and wellbeing in six Victorian municipalities (local governments/councils). Each council will undergo four stages (site construction and development, promotion and marketing, capacity building and training, evaluation and sustainability). Several activities and methods will be employed from stage one through stage four to evaluate the potential impact of the age-friendly outdoor spaces on physical activity and wellbeing and will comprise the following elements: site observation and equipment utilisation, face to face intercept surveys, development of an online access monitor and community building activities. Discussion The project is expected to result in a significant change in the physical outdoor environment for the participating councils and communities whereby older people and other community members will be able to engage in safe physical and social activity programs, socialise more and hence improve the overall wellbeing of older people. Trial registration This trial is retrospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. Date registered 23/07/2021.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia. .,Institute for Health and Sport, Victoria University, Melbourne, Australia. .,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.
| | - Jeremy Dunn
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Emma Abfalter
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | - Briony Dow
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Deakin University, Waurn Ponds, Geelong, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia.,School of Nursing and Midwifery, Deakin University, Waurn Ponds, Geelong, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Stephanie Garratt
- National Ageing Research Institute, Royal Melbourne Hospital, PO Box 2127, Melbourne, VIC, 3050, Australia
| | | | - Keith D Hill
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
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Levinger P, Dunn J, Panisset MG, Haines T, Dow B, Batchelor F, Biddle S, Duque G, Hill KD. The Effect of the ENJOY Seniors Exercise Park Physical Activity Program on Falls in Older People in the Community: A Prospective Pre-Post Study Design. J Nutr Health Aging 2022; 26:217-221. [PMID: 35297462 PMCID: PMC8727466 DOI: 10.1007/s12603-021-1724-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The ENJOY project (Exercise interveNtion outdoor proJect in the cOmmunitY for older people) is a community-based research project actively promoting physical activity engagement through the delivery of an exercise program using outdoor multimodal exercise equipment. This study investigated the impact of the physical activity program on falls in older people. METHOD This study was a multi-site prospective study with a pre-post intervention design and 12-month follow up. Eighty older people with increased falls risk underwent a 12-week supervised outdoors exercise program followed by a 6-month maintenance phase. The proportion of fallers and falls incidence were compared between the preceding and the prospective years. RESULTS A sample of 54 (age 72.4±7.3, 79.6% women) was available for the 12 months analysis (due to COVID19 lockdowns, data of 19 participants were excluded and 4 dropped out). Number of fallers (from 51.8% to 31.4%, p=0.03) and falls incidence (from 42 to 29 falls, p<0.01) were significantly reduced at the 12-months follow up. CONCLUSION The ENJOY Seniors Exercise Park program integrates outdoor multimodal exercise stations including specific exercises designed to challenge dynamic balance during functional daily movements. The outcomes provide preliminary evidence for the potential positive impact of the ENJOY Seniors Exercise Park in reducing falls for older people.
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Affiliation(s)
- P Levinger
- Professor Pazit Levinger, National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Victoria 3050 Australia, T +61 3 8387 2626 | F +61 3 9387 4030
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49
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Dollard J, Hill KD, Wilson A, Ranasinghe DC, Lange K, Jones K, Boyle EM, Zhou M, Ng N, Visvanathan R. Patient Acceptability of a Novel Technological Solution (Ambient Intelligent Geriatric Management System) to Prevent Falls in Geriatric and General Medicine Wards: A Mixed-Methods Study. Gerontology 2022; 68:1070-1080. [PMID: 35490669 PMCID: PMC9501724 DOI: 10.1159/000522657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction As effective interventions to prevent inpatient falls are lacking, a novel technological intervention was trialed. The Ambient Intelligent Geriatric Management (AmbIGeM) system used wearable sensors that detected and alerted staff of patient movements requiring supervision. While the system did not reduce falls rate, it is important to evaluate the acceptability, usability, and safety of the AmbIGeM system, from the perspectives of patients and informal carers. Methods We conducted a mixed-methods study using semistructured interviews, a pre-survey and post-survey. The AmbIGeM clinical trial was conducted in two geriatric evaluation and management units and a general medical ward, in two Australian hospitals, and a subset of participants were recruited. Within 3 days of being admitted to the study wards and enrolling in the trial, 31 participants completed the pre-survey. Prior to discharge (post-intervention), 30 participants completed the post-survey and 27 participants were interviewed. Interview data were thematically analyzed and survey data were descriptively analyzed. Results Survey and interview participants had an average age of 83 (SD 9) years, 65% were female, and 41% were admitted with a fall. Participants considered the AmbIGeM system a good idea. Most but not all thought the singlet and sensor component as acceptable and comfortable, with no privacy concerns. Participants felt reassured with extra monitoring, although sometimes misunderstood the purpose of AmbIGeM as detecting patient falls. Participants' acceptability was strongly positive, with median 8+ (0–10 scale) on pre- and post-surveys. Discussion/Conclusion Patients' acceptability is important to optimize outcomes. Overall older patients considered the AmbIGeM system as acceptable, usable, and improving safety. The findings will be important to guide refinement of this and other similar technology developments.
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Affiliation(s)
- Joanne Dollard
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- *Joanne Dollard,
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Anne Wilson
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Damith C. Ranasinghe
- School of Computer Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Kylie Lange
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine Jones
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Eileen Mary Boyle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Washington, Australia
| | - Mengqi Zhou
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicholas Ng
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged & Extended Care Services, The Queen Elizabeth Hospital & Basil Hetzel Institute for Translational Health Research, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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50
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Knightbridge L, Bourke-Taylor HM, Hill KD. Healthy ageing through participation in community situated activities: A scoping review of assessment instruments to support occupational therapy practice. Aust Occup Ther J 2022; 69:493-509. [PMID: 35445413 PMCID: PMC9546241 DOI: 10.1111/1440-1630.12802] [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: 10/13/2021] [Revised: 03/24/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
Introduction The occupational therapy profession has an essential role to play in healthy ageing that includes enabling participation, a construct that according to The International Classification of Functioning, Disability and Health (ICF), incorporates an environmental context. Environmental barriers and enablers of participation in community‐situated activities for people over the age of 65 have been identified. To support practice, occupational therapists require assessments with demonstrated content validity including comprehensive coverage of the construct. The purpose of this scoping review study was to investigate what instruments are available to assess community participation for people over the age of 65 that included environmental factors. Methods A scoping review of the literature was conducted, utilising the Joanna Briggs Institute (JBI) scoping review methodology. The evidence source was review articles and inclusion criteria were that they reviewed instruments to assess participation that could be used for people over the age of 65. Items extracted from included instruments were evaluated against a preset list of community‐participation and environment categories that had been developed from the ICF. Results Twenty‐three review studies met inclusion criteria and from these 240 instruments were extracted. Twenty instruments were retained after exclusions and from these, 540 instrument items were extracted. Of these, 280 (47%) were coded as community‐participation, and only 20 (3.4%) as environment items. Fourteen of the instruments included no environment items. Conclusions No instrument was identified that comprehensively assessed community participation including the related environmental factors. Such an instrument is required to enable occupational therapy practitioners to support healthy ageing. The development of such an instrument will strengthen the profession's capacity to develop new ways of delivering services to older adults in line with emerging ways that aged care will be delivered and to advance its essential role in healthy ageing.
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Affiliation(s)
- Lisa Knightbridge
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, VIC, Australia
| | - Helen M Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University-Peninsula Campus, Frankston, VIC, Australia
| | - Keith D Hill
- School of Primary and Allied Health Care, Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Faculty Medicine Nursing and Health Sciences, Monash University (Peninsula Campus), Frankston, VIC, Australia
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