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Ashcroft SK, Ironside DD, Johnson L, Kuys SS, Thompson-Butel AG. Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke 2022; 53:3706-3716. [DOI: 10.1161/strokeaha.122.039919] [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
BACKGROUND:
BDNF (brain-derived neurotrophic factor) is a biomarker of neuroplasticity linked with better functional outcomes after stroke. Early evidence suggests that increased concentrations after exercise may be possible for people with stroke, however it is unclear how exercise parameters influence BDNF concentration.
METHODS:
This systematic review and meta-analysis searched 7 electronic databases. Experimental or observational studies measuring changes in BDNF concentration after exercise in people poststroke were included. Data were extracted including characteristics of the study, participants, interventions, and outcomes. Several fixed and random effects meta-analyses were completed.
RESULTS:
Seventeen studies including a total of 687 participants met the eligibility criteria (6 randomized trials). Significant improvements were observed in BDNF concentration following a single session (mean difference, 2.49 ng/mL; [95% CI, 1.10–3.88]) and program of high intensity aerobic exercise (mean difference, 3.42 ng/mL; [95% CI, 1.92–4.92]).
CONCLUSIONS:
High intensity aerobic exercise can increase circulating BDNF concentrations, which may contribute to increased neuroplasticity.
REGISTRATION:
URL:
https://www.crd.york.ac.uk/PROSPERO/
; Unique identifier: CRD42021251083.
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Affiliation(s)
- Sarah K. Ashcroft
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW, Australia (A.S.K., I.D.D., T.-B.A.G.)
| | - Daniel D. Ironside
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW, Australia (A.S.K., I.D.D., T.-B.A.G.)
| | - Liam Johnson
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia (J.L.)
- Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia (J.L.)
| | - Suzanne S. Kuys
- School of Allied Health, Australian Catholic University, Banyo, QLD, Australia (K.S.S.)
| | - Angelica G. Thompson-Butel
- School of Behavioural and Health Sciences, Australian Catholic University, Strathfield, NSW, Australia (A.S.K., I.D.D., T.-B.A.G.)
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Caruana EL, Rowell D, Kuys SS, Brauer SG. Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study. BMC Health Serv Res 2022; 22:617. [PMID: 35534853 PMCID: PMC9082956 DOI: 10.1186/s12913-022-07727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 04/16/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background The first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility. Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs. Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group. After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively. Conclusions Implementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07727-7.
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Affiliation(s)
- Erin L Caruana
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,St Andrew's War Memorial Hospital, Brisbane, Australia
| | - David Rowell
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, Australia
| | - Suzanne S Kuys
- School of Allied Health, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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3
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Brauer SG, Kuys SS, Paratz J, Ada L. IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: a randomised trial. Int J Stroke 2022; 17:1137-1144. [DOI: 10.1177/17474930221078121] [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
Aim: To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training. Method: A prospective, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40-60% heart rate reserve) and self-management education for 30 minutes, three times a week for 8 weeks and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life. Results: After 8 weeks, the experimental group took 1436 more steps/day (95% CI 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI -385 to 2129) than the control group. There was no difference between groups in any other outcome. Conclusions: In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible. Trial Registration: ACTRN12613000744752. Data Access: Data are available from the corresponding author.
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Affiliation(s)
- Sandra G Brauer
- The University of Queensland, Division of Physiotherapy, Brisbane, Australia
| | - Suzanne S Kuys
- Australian Catholic University, School of Physiotherapy, Faculty of Health Sciences, Banyo, Australia
| | - Jenny Paratz
- Griffith University Faculty of Health, School of Health Sciences and Social Work, Gold Coast, Australia
| | - Louise Ada
- The University of Sydney Faculty of Medicine and Health, Sydney, Australia
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4
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Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud 2021; 7:215. [PMID: 34876235 PMCID: PMC8650326 DOI: 10.1186/s40814-021-00941-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).
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Affiliation(s)
- Sandra G Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Abstract
Background: Sensorimotor adaptation, or the capacity to adapt movement to changes in the moving body or environment, is a form of motor learning that is important for functional independence (e.g., regaining stability after slips or trips). Aerobic exercise can acutely improve many forms of motor learning in healthy adults. It is not known, however, whether acute aerobic exercise has similar positive effects on sensorimotor adaptation in stroke survivors as it does in healthy individuals. Objective: The aim of this study was to determine whether acute aerobic exercise promotes sensorimotor adaptation in people post stroke. Methods: A single-blinded crossover study. Participants attended two separate sessions, completing an aerobic exercise intervention in one session and a resting control condition in the other session. Sensorimotor adaptation was assessed before and after each session, as was brain derived neurotrophic factor. Twenty participants with chronic stroke completed treadmill exercise at moderate to high intensity for 30 minutes. Results: Acute aerobic exercise in chronic stroke survivors significantly increased sensorimotor adaptation from pre to post treadmill intervention. The 30-minute treadmill intervention resulted in an averaged 2.99 ng/ml increase in BDNF levels (BDNF pre-treadmill = 22.31 + /–2.85 ng/ml, post-treadmill was = 25.31 + /–2.46 pg/ml; t(16) = 2.146, p = 0.048, cohen’s d = 0.521, moderate effect size). Conclusions: These results indicate a potential role for aerobic exercise to promote the recovery of sensorimotor function in chronic stroke survivors.
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Affiliation(s)
- Christopher P Mackay
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Sandra G Brauer
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Australian Catholic University, School of Allied Health, Brisbane, Queensland, Australia
| | - Mia A Schaumberg
- University of the Sunshine Coast, School of Health and Sport Sciences, Maroochydore, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Queensland, Australia.,The University of Queensland, School of Human Movement and Nutrition Science, Brisbane, Queensland, Australia
| | - Li-Ann Leow
- The University of Queensland, School of Human Movement and Nutrition Science, Brisbane, Queensland, Australia.,The University of Queensland, School of Psychology, Brisbane, Queensland, Australia
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Hendrickx W, Riveros C, Askim T, Bussmann JBJ, Callisaya ML, Chastin SFM, Dean C, Ezeugwu V, Jones TM, Kuys SS, Mahendran N, Manns PJ, Mead G, Moore SA, Paul L, Pisters MF, Saunders DH, Simpson DB, Tieges Z, Verschuren O, English C. An Exploration of Sedentary Behavior Patterns in Community-Dwelling People With Stroke: A Cluster-Based Analysis. J Neurol Phys Ther 2021; 45:221-227. [PMID: 33867457 DOI: 10.1097/npt.0000000000000357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Long periods of daily sedentary time, particularly accumulated in long uninterrupted bouts, are a risk factor for cardiovascular disease. People with stroke are at high risk of recurrent events and prolonged sedentary time may increase this risk. We aimed to explore how people with stroke distribute their periods of sedentary behavior, which factors influence this distribution, and whether sedentary behavior clusters can be distinguished? METHODS This was a secondary analysis of original accelerometry data from adults with stroke living in the community. We conducted data-driven clustering analyses to identify unique accumulation patterns of sedentary time across participants, followed by multinomial logistical regression to determine the association between the clusters, and the total amount of sedentary time, age, gender, body mass index (BMI), walking speed, and wake time. RESULTS Participants in the highest quartile of total sedentary time accumulated a significantly higher proportion of their sedentary time in prolonged bouts (P < 0.001). Six unique accumulation patterns were identified, all of which were characterized by high sedentary time. Total sedentary time, age, gender, BMI, and walking speed were significantly associated with the probability of a person being in a specific accumulation pattern cluster, P < 0.001 - P = 0.002. DISCUSSION AND CONCLUSIONS Although unique accumulation patterns were identified, there is not just one accumulation pattern for high sedentary time. This suggests that interventions to reduce sedentary time must be individually tailored.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A343).
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Affiliation(s)
- Wendy Hendrickx
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (W.H., M.F.P.); School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia (W.H., D.B.S., C.E.); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (W.H., M.F.P.); Bioinformatics, Hunter Medical Research Institute, and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia (C.R.); Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway (T.A.); Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands (J.B.J.B.); Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia (M.L.C.); School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom (S.F.M.C., L.P., Z.T.); Department of Movement and Sports Sciences, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium (S.F.M.C.); Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (C.D., T.M.J.); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada (V.E., P.J.M.); National Head, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia (S.S.K.); Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia (N.M.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.M.); Stroke Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.); Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (M.F.P.); Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); Department of Geriatric Medicine, University of Edinburgh, United Kingdom (Z.T.); UMC Utrecht Brain Center, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (O.V.); and Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience and Hunter Medical Research Institute, Newcastle, Australia (C.E.)
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7
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Hendrickx W, Riveros C, Askim T, Bussmann JBJ, Callisaya ML, Chastin SFM, Dean CM, Ezeugwu VE, Jones TM, Kuys SS, Mahendran N, Manns TJ, Mead G, Moore SA, Paul L, Pisters MF, Saunders DH, Simpson DB, Tieges Z, Verschuren O, English C. Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies. Top Stroke Rehabil 2019; 26:327-334. [PMID: 31025908 DOI: 10.1080/10749357.2019.1601419] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/17/2022]
Abstract
Background: High levels of sedentary time increases the risk of cardiovascular disease, including recurrent stroke. Objective: This study aimed to identify factors associated with high sedentary time in community-dwelling people with stroke. Methods: For this data pooling study, authors of published and ongoing trials that collected sedentary time data, using the activPAL monitor, in community-dwelling people with stroke were invited to contribute their raw data. The data was reprocessed, algorithms were created to identify sleep-wake time and determine the percentage of waking hours spent sedentary. We explored demographic and stroke-related factors associated with total sedentary time and time in uninterrupted sedentary bouts using unique, both univariable and multivariable, regression analyses. Results: The 274 included participants were from Australia, Canada, and the United Kingdom, and spent, on average, 69% (SD 12.4) of their waking hours sedentary. Of the demographic and stroke-related factors, slower walking speeds were significantly and independently associated with a higher percentage of waking hours spent sedentary (p = 0.001) and uninterrupted sedentary bouts of >30 and >60 min (p = 0.001 and p = 0.004, respectively). Regression models explained 11-19% of the variance in total sedentary time and time in prolonged sedentary bouts. Conclusion: We found that variability in sedentary time of people with stroke was largely unaccounted for by demographic and stroke-related variables. Behavioral and environmental factors are likely to play an important role in sedentary behavior after stroke. Further work is required to develop and test effective interventions to address sedentary behavior after stroke.
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Affiliation(s)
- Wendy Hendrickx
- a Department of Rehablilitation, Physiotherapy Science & Sport, Brain Center Rudolf Magnus , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands.,b School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine , University of Newcastle , Newcastle , Australia.,c Center for Physical Therapy Research and Innovation in Primary Care , Julius Health Care Centers , Utrecht , The Netherlands
| | - Carlos Riveros
- d Bioinformatics , Hunter Medical Research Institute , Newcastle , Australia
| | - Torunn Askim
- e Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science , NTNU, Norwegian University of Science and Technology , Trondheim , Norway
| | - Johannes B J Bussmann
- f Department of Rehabilitation Medicine Erasmus , MC University Medical Center , Rotterdam , The Netherlands
| | - Michele L Callisaya
- g Menzies Institute for Medical Research , University of Tasmania , Hobart , Australia
| | - Sebastien F M Chastin
- h School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK.,i Department of Movement and Sports Sciences, Faculty of Medicine and Health Science , Ghent University , Ghent , Belgium
| | - Catherine M Dean
- j Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Victor E Ezeugwu
- k Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Taryn M Jones
- j Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Suzanne S Kuys
- l National Head, School of Physiotherapy , Faculty of Health Sciences Australian Catholic University , Brisbane , Australia
| | - Niruthikha Mahendran
- m Discipline of Physiotherapy, Faculty of Health , University of Canberra , Canberra , Australia
| | - Trish J Manns
- k Faculty of Rehabilitation Medicine , University of Alberta , Edmonton , Canada
| | - Gillian Mead
- n Centre for Clinical Brain Sciences , University of Edinburgh , Edinburgh , UK
| | - Sarah A Moore
- o Stroke Research Group , Institute of Neuroscience and Newcastle University Institute for Ageing Newcastle University , UK
| | - Lorna Paul
- p School of Health and Life Sciences , Glasgow Caledonian University , Glasgow , UK
| | - Martijn F Pisters
- a Department of Rehablilitation, Physiotherapy Science & Sport, Brain Center Rudolf Magnus , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands.,c Center for Physical Therapy Research and Innovation in Primary Care , Julius Health Care Centers , Utrecht , The Netherlands
| | - David H Saunders
- q Physical Activity for Health Research Centre, Institute for Sport, Physical Education and Health Sciences , University of Edinburgh , Edinburgh , UK
| | - Dawn B Simpson
- g Menzies Institute for Medical Research , University of Tasmania , Hobart , Australia
| | - Zoë Tieges
- r Department of Geriatric Medicine , University of Edinburgh , Edinburgh , UK
| | - Olaf Verschuren
- s Brain Center Rudolf Magnus, Center of Excellence for Rehabilitation Medicine, De Hoogstraat Rehabilitation , University Medical Center Utrecht, Utrecht University , Utrecht , The Netherlands
| | - Coralie English
- b School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, Faculty of Health and Medicine , University of Newcastle , Newcastle , Australia
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Abstract
BACKGROUND: The relationship between gait speed and prosthetic potential (K-level classifications) and function has not been explored among people transitioning from hospital rehabilitation to the community. OBJECTIVES: To examine gait speed at discharge from inpatient rehabilitation among people prescribed a prosthetic leg after unilateral lower limb amputation, and associations between gait speed, prosthetic potential and functional ability. STUDY DESIGN: Cohort. METHODS: Gait speed (10-m walk test), K-level (Amputee Mobility Predictor) and Functional Independence Measure motor were compared for 110 people (mean (standard deviation) age: 63 (13) years, 77% male, 71% transtibial amputation, 70% dysvascular causes). RESULTS: Median (interquartile range) gait speed and Functional Independence Measure motor were 0.52 (0.37-0.67) m/s and 84 (81, 85), respectively. Median (IQR) gait speed scores for each K-level were as follows: K1 = 0.17 (0.15-0.19) m/s, K2 = 0.38 (0.25-0.54) m/s, K3 = 0.63 (0.50-0.71) m/s and K4 = 1.06 (0.95-1.18) m/s. Median (IQR) FIM-Motor scores for each K-level were as follows: K1 = 82 (69-84), K2 = 83 (79-84), K3 = 85 (83-87) and K4 = 87 (86-89). Faster gait speed was associated with higher K-level, higher FIM-Motor, being younger, male and having transtibial amputation with nonvascular aetiology. CONCLUSION: Gait speed was faster among each higher K-level classification. However, gait speeds observed across all K-levels were slower than healthy populations, consistent with values indicating high risk of morbidity and mortality. CLINICAL RELEVANCE Factors associated with faster gait speed are useful for clinical teams considering walking potential of people with lower limb prostheses and those seeking to refine prosthetic rehabilitation programmes.
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Affiliation(s)
- Heather R Batten
- 1 Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,3 The University of Queensland, Brisbane, QLD, Australia
| | - Steven M McPhail
- 2 Queensland University of Technology, Brisbane, QLD, Australia.,5 Centre for Functioning and Health Research, Buranda, QLD Australia
| | | | - Paulose N Varghese
- 1 Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,3 The University of Queensland, Brisbane, QLD, Australia
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Mahendran N, Kuys SS, Brauer SG. Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke? Disabil Rehabil 2019; 42:763-769. [PMID: 30724628 DOI: 10.1080/09638288.2018.1508513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To determine which impairments, activity limitations and personal factors at hospital discharge poststroke predict volume, frequency, and intensity of walking activity 1, 3, and 6 months later.Materials and Methods: Prospective longitudinal observational study. Thirty-six people with stroke (71 SD 14 years, 69% male) were recruited at hospital discharge and predictors including fatigue, mood, executive function, walking speed, walking endurance, age, prestroke activity, self-efficacy, and perceived stroke recovery and health were collected. At 1, 3, and 6 months follow-up, participants wore an ActivPAL™ accelerometer to collect measures of walking activity.Results: At 1 month, walking endurance predicted all walking activity (R2 > 0.29, p < 0.01). At 3 months, walking endurance and prestroke activity predicted activity volume and intensity (R2 = 0.46-0.61, p < 0.001), and prestroke activity predicted activity frequency (R2 = 0.31, p = 0.004). At 6 months, age-predicted activity volume and frequency (R2 = 0.34-0.35, p < 0.003), while prestroke activity, discharge walking endurance, and executive function together predicted activity intensity (R2 = 0.79, p < 0.001).Conclusion: Walking endurance contributes to walking activity outcomes across the first 6 months following hospital discharge poststroke. After 1 month of discharge, factors other than poststroke changes also contribute to activity outcomes, and should be considered when targeting poststroke physical activity.Implications for rehabilitationWalking endurance should be addressed during stroke rehabilitation as higher scores are linked to more walking activity in the first month after discharge.Prestroke factors such as low prestroke activity levels and older age predict reduced walking activity after stroke, so approaches to address barriers these factors may pose are needed in people with stroke.Physical activity interventions should be tailored to the individual, their environment, and context, and take into consideration prestroke factors.
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Affiliation(s)
- Niruthikha Mahendran
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - Suzanne S Kuys
- Discipline of Physiotherapy, School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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10
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Adsett JA, Morris NR, Kuys SS, Paratz JD, Mudge AM. Motivators and barriers for participation in aquatic and land-based exercise training programs for people with stable heart failure: A mixed methods approach. Heart Lung 2018; 48:287-293. [PMID: 30528166 DOI: 10.1016/j.hrtlng.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aquatic exercise training may be suitable for people with stable heart failure (HF) to engage in physical activity. OBJECTIVES Acceptability, experiences and preferences regarding aquatic and traditional land-based exercise training, were explored in people with HF. METHODS As part of a comparative intervention study, participants completed a questionnaire assessing acceptability, benefits and challenges of aquatic compared to land-based programs. Semi-structured interviews explored participant experiences in greater depth. RESULTS Forty-eight participants, (mean age 70 + /- 11 years), completed the questionnaire and 14 participated in semi structured interviews. Aquatic exercise was regarded as acceptable and beneficial. Motivators were similar for both programs and included: a skilled and compassionate workforce, tailored care, perceived health benefit, sense of safety and an inclusive and enjoyable environment. Few barriers were identified for either program. CONCLUSIONS Aquatic and land-based exercise training are equally acceptable for people with stable HF and motivators are similar for both programs.
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Affiliation(s)
- Julie A Adsett
- Heart Support Service, Royal Brisbane and Women's Hospital, Heart Support Service, Level 3, James Mayne Building, Butterfield St, Herston, 4029 Brisbane, Australia; Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4029 Brisbane, Australia; School of Allied Health Sciences and Menzies Institute, Griffith University, Parklands Drive, Southport, 4215 Gold Coast, Australia.
| | - Norman R Morris
- School of Allied Health Sciences and Menzies Institute, Griffith University, Parklands Drive, Southport, 4215 Gold Coast, Australia; Metro North Hospital and Health Service, The Prince Charles Hospital. Allied Health, Research Collaborative, Rode Rd, Chermside 4032 Brisbane, Australia
| | - Suzanne S Kuys
- School of Allied Health, Australian Catholic University, 1100 Nudgee Rd, Banyo, 4014 Brisbane, Australia
| | - Jennifer D Paratz
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4029 Brisbane, Australia; School of Allied Health Sciences and Menzies Institute, Griffith University, Parklands Drive, Southport, 4215 Gold Coast, Australia
| | - Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4029 Brisbane, Australia; University of Queensland Faculty of Medicine, St Lucia, 4072 Brisbane, Australia
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Lynch EA, Jones TM, Simpson DB, Fini NA, Kuys SS, Borschmann K, Kramer S, Johnson L, Callisaya ML, Mahendran N, Janssen H, English C. Activity monitors for increasing physical activity in adult stroke survivors. Cochrane Database Syst Rev 2018; 7:CD012543. [PMID: 30051462 PMCID: PMC6513611 DOI: 10.1002/14651858.cd012543.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stroke is the third leading cause of disability worldwide. Physical activity is important for secondary stroke prevention and for promoting functional recovery. However, people with stroke are more inactive than healthy age-matched controls. Therefore, interventions to increase activity after stroke are vital to reduce stroke-related disability. OBJECTIVES To summarise the available evidence regarding the effectiveness of commercially available, wearable activity monitors and smartphone applications for increasing physical activity levels in people with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, and the following clinical trial registers: WHO International Clinical Trials Registry Platform, Clinical Trials, EU Clinical Trial Register, ISRCTN Registry, Australian and New Zealand Clinical Trial Registry, and Stroke Trials Registry to 3 March 2018. We also searched reference lists, Web of Science forward tracking, and Google Scholar, and contacted trial authors to obtain further data if required. We did not restrict the search on language or publication status. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and randomised cross-over trials that included use of activity monitors versus no intervention, another type of intervention, or other activity monitor. Participants were aged 18 years or older with a diagnosis of stroke, in hospital or living in the community. Primary outcome measures were steps per day and time in moderate-to-vigorous intensity activity. Secondary outcomes were sedentary time, time spent in light intensity physical activity, walking duration, fatigue, mood, quality of life, community participation and adverse events. We excluded upper limb monitors that only measured upper limb activity. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodology to analyse and interpret the data. At least two authors independently screened titles and abstracts for inclusion. We resolved disagreements by consulting a third review author. We extracted the following data from included studies into a standardised template: type of study, participant population, study setting, intervention and co-interventions, time-frame, and outcomes. We graded levels of bias as high, low, or unclear, and assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS We retrieved 28,098 references, from which we identified 29 potential articles. Four RCTs (in 11 reports) met the inclusion criteria.The sample sizes ranged from 27 to 135 (total 245 participants). Time poststroke varied from less than one week (n = 1), to one to three months (n = 2), or a median of 51 months (n = 1). Stroke severity ranged from a median of one to six on the National Institutes of Health Stroke Scale (NIHSS). Three studies were conducted in inpatient rehabilitation, and one was in a university laboratory. All studies compared use of activity monitor plus another intervention (e.g. a walking retraining programme or an inpatient rehabilitation programme) versus the other intervention alone. Three studies reported on the primary outcome of daily step counts.There was no clear effect for the use of activity monitors in conjunction with other interventions on step count in a community setting (mean difference (MD) -1930 steps, 95% confidence interval (CI) -4410 to 550; 1 RCT, 27 participants; very low-quality evidence), or in an inpatient rehabilitation setting (MD 1400 steps, 95% CI -40 to 2840; 2 RCTs, 83 participants; very low-quality evidence). No studies reported the primary outcome moderate-to-vigorous physical activity, but one did report time spent in moderate and vigorous intensity activity separately: this study reported that an activity monitor in addition to usual inpatient rehabilitation increased the time spent on moderate intensity physical activity by 4.4 minutes per day (95% CI 0.28 to 8.52; 1 RCT, 48 participants; low-quality evidence) compared with usual rehabilitation alone, but there was no clear effect for the use of an activity monitor plus usual rehabilitation for increasing time spent in vigorous intensity physical activity compared to usual rehabilitation (MD 2.6 minutes per day, 95% CI -0.8 to 6; 1 RCT, 48 participants; low-quality evidence). The overall risk of bias was low, apart from high-risk for blinding of participants and study personnel. None of the included studies reported any information relating to adverse effects. AUTHORS' CONCLUSIONS Only four small RCTs with 274 participants (three in inpatient rehabilitation and one in the community) have examined the efficacy of activity monitors for increasing physical activity after stroke. Although these studies showed activity monitors could be incorporated into practice, there is currently not enough evidence to support the use of activity monitors to increase physical activity after stroke.
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Affiliation(s)
- Elizabeth A Lynch
- The University of AdelaideAdelaide Nursing SchoolAdelaideSouth AustraliaAustralia
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Taryn M Jones
- Macquarie UniversityFaculty of Medicine and Health SciencesSydneyAustralia2109
| | - Dawn B Simpson
- University of TasmaniaMenzies Institute for Medical ResearchHobartAustralia
| | - Natalie A Fini
- The University of MelbournePhysiotherapy DepartmentLevel 7, Alan Gilbert BuildingMelbourneVICAustralia3010
- La Trobe UniversitySchool of Allied HealthMelbourneAustralia
| | - Suzanne S Kuys
- Australian Catholic UniversitySchool of PhysiotherapyBrisbaneQLDAustralia4114
| | - Karen Borschmann
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergVICAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | | | - Niruthikha Mahendran
- University of CanberraDiscipline of Physiotherapy, Faculty of HealthCanberraAustralia2617
| | - Heidi Janssen
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- University of NewcastlePriority Research Centre for Stroke and Brain InjuryNewcastleAustralia
- Hunter New England HealthCommunity Aged Care and Hunter Stroke ServiceNew Lambton HeightsNSWAustralia2305
| | - Coralie English
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- University of NewcastlePriority Research Centre for Stroke and Brain InjuryNewcastleAustralia
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Kuys SS, Ada L, Paratz J, Brauer SG. Steps, duration and intensity of usual walking practice during subacute rehabilitation after stroke: an observational study. Braz J Phys Ther 2018; 23:56-61. [PMID: 29937125 DOI: 10.1016/j.bjpt.2018.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/21/2017] [Revised: 05/28/2018] [Accepted: 06/04/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Duration of therapy time is an inadequate indicator of stroke rehabilitation. Steps, duration, and intensity of active therapy time may provide a better indicator of practice. OBJECTIVE This study quantified usual walking practice in terms of steps, duration and intensity of active therapy time, and distance walked during physical therapy sessions in people with sub-acute stroke undertaking inpatient rehabilitation and to examine whether usual walking practice differed depending on walking ability. METHODS A prospective observational study was conducted across two metropolitan rehabilitation units in Australia. Twenty-four stroke survivors were observed over three physical therapy sessions. Walking ability was categorized as unassisted or assisted based on Item 5 of the Motor Assessment Scale. Walking practice was categorized as basic or advanced. Steps, duration, intensity and distance walked were measured during physical therapy sessions. RESULTS Overall, participants took 560 steps (SD 309) over 13min (SD 6) at an intensity of steps 44 steps/min (SD 17) and walked 222m (SD 143) in physical therapy. Unassisted walkers (n=6, 25%) undertook more (or trended towards more) practice of advanced walking than assisted walkers in terms of steps (MD 254 steps, 95% CI 48-462), duration (MD 5min, 95% CI 0-10), intensity (MD 18steps/min, 95% CI -8 to 44) and distance (MD 112m, 95% CI -12 to 236). CONCLUSION Stroke survivors undergoing inpatient rehabilitation spent approximately 20% of physical therapy actively engaged in walking practice. Those able to walk without assistance took more steps for longer, at a higher intensity. TRIAL REGISTRATION ACTRN12613000764730 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364545).
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Affiliation(s)
- Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Australia.
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Jennifer Paratz
- Principal Research Fellow, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Affiliation(s)
- Erin L Caruana
- School of Health and Rehabilitation Sciences; University of Queensland; Brisbane Queensland Australia
- Department of Physiotherapy; St Andrew's War Memorial Hospital; Uniting Care Health; Brisbane Queensland Australia
| | - Suzanne S Kuys
- School of Physiotherapy; Australian Catholic University; Brisbane Queensland Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences; University of Queensland; Brisbane Queensland Australia
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Brauer SG, Kuys SS, Paratz JD, Ada L. Improving physical activity after stroke via treadmill training and self management (IMPACT): a protocol for a randomised controlled trial. BMC Neurol 2018; 18:13. [PMID: 29382298 PMCID: PMC5791375 DOI: 10.1186/s12883-018-1015-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The level of physical activity undertaken by stroke survivors living in the community is generally low. The main objectives of the IMPACT trial are to determine, in individuals undergoing rehabilitation after stroke, if 8 weeks of high-intensity treadmill training embedded in self-management education (i) results in more physical activity than usual physiotherapy gait training and (ii) is more effective at increasing walking ability, cardiorespiratory fitness, self-efficacy, perception of physical activity, participation, and health-related quality of life as well as decreasing cardiovascular risk, and depression, at 8 and 26 weeks. METHODS A prospective, two-arm, parallel-group, randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis, will be conducted. 128 stroke survivors undergoing rehabilitation who are able to walk independently will be recruited and randomly allocated to either the experimental or control group, who will both undergo gait training for 30 min, three times a week for 8 weeks under the supervision of a physiotherapist. Outcomes will be measured at baseline (Week 0), on completion of the intervention (Week 8) and beyond the intervention (Week 26). This study has obtained ethical approval from the relevant Human Research Ethics Committees. DISCUSSION Improving stroke survivors' walking ability and cardiorespiratory fitness is likely to increase their levels of physical activity. Furthermore, if education in self-management results in sustained high levels of physical activity, this should result in improved participation and quality of life. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000744752 ) on 4th July, 2013.
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Affiliation(s)
- Sandra G. Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Suzanne S. Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD Australia
| | - Jennifer D. Paratz
- School of Allied Health Sciences, Griffith University, Southport, QLD Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW Australia
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Caruana EL, Kuys SS, Clarke J, Brauer SG. Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions. AUST HEALTH REV 2017; 43:29-35. [PMID: 29151432 DOI: 10.1071/ah17107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit. Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data. Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment. Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback. What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS. What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support. What are the implications for practitioners? Staff engagement and open communication are important to successfully implement a new service in rehabilitation.
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Affiliation(s)
- Erin L Caruana
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Qld, 4072, Australia. Email
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, 1100 Nudgee Rd, Banyo, QLD, 4014, Australia.
| | - Jane Clarke
- School of Physiotherapy, Australian Catholic University, 1100 Nudgee Rd, Banyo, QLD, 4014, Australia.
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Qld, 4072, Australia. Email
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Gesch JM, Low Choy NL, Weeks BK, Nascimento M, Steele M, Kuys SS. Inter- and intra-tester reliability of the acute brain injury physiotherapy assessment (ABIPA) in patients with acquired brain injury. Brain Inj 2017; 31:1799-1806. [PMID: 29115864 DOI: 10.1080/02699052.2017.1346298] [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: 10/18/2022]
Abstract
BACKGROUND The Acute Brain Injury Physiotherapy Assessment (ABIPA) is a new outcome measure with face validity and sensitivity to change in the early stages of neuromotor recovery after acquired brain injury (ABI). Reliability of physiotherapists using the tool has not been established. OBJECTIVE Determine inter- and intra-tester reliability of physiotherapists using the ABIPA. METHODS An observational study using video-recorded assessments of patient performance (n = 7) was undertaken with two cohorts of physiotherapists: those receiving training (n = 23) and those provided with guidelines only (n = 7) to administer the ABIPA. RESULTS Across all physiotherapists (n = 30), inter-tester reliability was excellent (α ≥ 0.9) for total ABIPA score. All individual items, except trunk alignment in supine (α = 0.5), showed excellent or good internal consistency (α ≥ 0.7). For intra-tester reliability, substantial or perfect agreement was achieved for eight items (weighted Kappa Kw ≥ 0.6), moderate agreement for four items (Kw = 0.4-0.6) and three items achieved fair agreement (alignment head supine: Kw = 0.289; alignment trunk supine: Kw = 0.387 and tone left upper limb: Kw = 0.366). CONCLUSION Physiotherapists are highly consistent using the ABIPA but several items may need revision to improve intra-tester reliability.
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Affiliation(s)
- Janelle M Gesch
- a Brain Injury Rehabilitation Unit , Department of Physiotherapy, Princess Alexandra Hospital , Woolloongabba, Brisbane , QLD , Australia.,b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia
| | - Nancy L Low Choy
- b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia.,c The Prince Charles Hospital , Brisbane , QLD , Australia
| | - Benjamin K Weeks
- d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
| | - Margarida Nascimento
- a Brain Injury Rehabilitation Unit , Department of Physiotherapy, Princess Alexandra Hospital , Woolloongabba, Brisbane , QLD , Australia
| | - Michael Steele
- d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
| | - Suzanne S Kuys
- b Australian Catholic University, (Brisbane Campus) , Brisbane , QLD , Australia.,c The Prince Charles Hospital , Brisbane , QLD , Australia.,d Menzies Health Institute Queensland, Griffith University , Gold Coast , QLD , Australia
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Abstract
OBJECTIVES This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination. DESIGN A longitudinal cohort study was conducted. SETTING Australian tertiary hospital subacute rehabilitation wards. PARTICIPANTS Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion. INTERVENTIONS Usual care (multidisciplinary inpatient hospital rehabilitation). PRIMARY AND SECONDARY OUTCOME MEASURES Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility. RESULTS At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92). CONCLUSIONS Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.
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Affiliation(s)
- Saira A Mathew
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Paul Varghese
- School of Medicine, The University of Queensland, Queensland, Australia
- Geriatric Assessment and Rehabilitation Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia
| | - Kristiann C Heesch
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. Foot Complications in a Representative Australian Inpatient Population. J Diabetes Res 2017; 2017:4138095. [PMID: 29164152 PMCID: PMC5661067 DOI: 10.1155/2017/4138095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.
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Affiliation(s)
- Peter A. Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, QLD, Australia
| | - Sheree E. Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Suzanne S. Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
- Faculty of Health Sciences, School of Physiotherapy, Australian Catholic University, Brisbane, QLD, Australia
| | - Maarten C. Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD, Australia
| | - Ewan M. Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Michael C. d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD, Australia
| | - Lloyd F. Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Wills J, Kinnear EM, d'Emden MC, Reed LF. The silent overall burden of foot disease in a representative hospitalised population. Int Wound J 2016; 14:716-728. [PMID: 27696693 DOI: 10.1111/iwj.12683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 07/22/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 12/19/2022] Open
Abstract
The aims of this study were to investigate the point prevalence, and associated independent factors, for foot disease (ulcers, infections and ischaemia) in a representative hospitalised population. We included 733 (83%) of 883 eligible adult inpatients across five representative Australian hospitals on one day. We collected an extensive range of self-reported characteristics from participants. We examined all participants to clinically diagnose foot disease (ulcers, infections and ischaemia) and amputation procedures. Overall, 72 participants (9·8%) [95% confidence interval (CI):7·2-11·3%] had foot disease. Foot ulcers, in 49 participants (6·7%), were independently associated with peripheral neuropathy, peripheral arterial disease, previous foot ulcers, trauma and past surgeon treatment (P < 0·05). Foot infections, in 24 (3·3%), were independently associated with previous foot ulcers, trauma and past surgeon treatment (P < 0·01). Ischaemia, in 33 (4·5%), was independently associated with older age, smokers and past surgeon treatment (P < 0·01). Amputation procedures, in 14 (1·9%), were independently associated with foot infections (P < 0·01). We found that one in every ten inpatients had foot disease, and less than half of those had diabetes. After adjusting for diabetes, factors linked with foot disease were similar to those identified in diabetes-related literature. The overall inpatient foot disease burden is similar in size to well-known medical conditions and should receive similar attention.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,Wound Management Innovation Cooperative Research Centre, Brisbane, QLD,, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia.,School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD,, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, QLD,, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, QLD,, Australia
| | - Jude Wills
- Department of Podiatry, Central Queensland Hospital & Health Service, Rockhampton, QLD,, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Michael C d'Emden
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Endocrinology & Diabetes, Metro North Hospital & Health Service, Brisbane, QLD,, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Mahendran N, Kuys SS, Brauer SG. Accelerometer and Global Positioning System Measurement of Recovery of Community Ambulation Across the First 6 Months After Stroke: An Exploratory Prospective Study. Arch Phys Med Rehabil 2016; 97:1465-1472. [DOI: 10.1016/j.apmr.2016.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/11/2016] [Accepted: 04/22/2016] [Indexed: 01/07/2023]
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Abstract
Stroke survivors commonly adopt sedentary activity behaviours by the chronic phase of recovery. However, the change in activity behaviours from the subacute to chronic phase of stroke is variable. This study explored the recovery of ambulation activity (volume and bouts) at one, three and six months after hospital discharge post-stroke. A total of 42 stroke survivors were recruited at hospital discharge and followed up one, three and six months later. At follow-up, ambulation activity was measured over four days using the ActivPAL™ accelerometer. Measures included volume of activity and frequency and intensity of ambulation activity bouts per day. Linear mixed effects modelling was used to determine changes over time. There was wide variation in activity. Total step counts across all time points were below required levels for health benefits (mean 4592 SD 3411). Most activity was spread across short bouts. While most number of bouts was of low intensity, most time was spent in moderate intensity ambulation across all time points. Daily step count and time spent walking and sitting/lying increased from one month to three and six months. The number of and time spent in short and medium duration bouts increased from one to six months. Time in long duration bouts increased at three months only. Time spent in moderate intensity ambulation increased over time. No change was observed for any other measures. In future, it would be valuable to identify strategies to increase engagement in activity behaviours to improve health outcomes after stroke.
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Affiliation(s)
- Niruthikha Mahendran
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Caruana EL, Kuys SS, Clarke J, Bauer SG. A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit. Disabil Rehabil 2016; 39:1738-1743. [DOI: 10.1080/09638288.2016.1211181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Erin L. Caruana
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Department of Physiotherapy, St Andrew’s War Memorial Hospital, Brisbane, Australia
| | - Suzanne S. Kuys
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia
| | - Jane Clarke
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia
| | - Sandra G. Bauer
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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Lazzarini PA, Hurn SE, Kuys SS, Kamp MC, Ng V, Thomas C, Jen S, Kinnear EM, d'Emden MC, Reed L. Direct inpatient burden caused by foot-related conditions: a multisite point-prevalence study. BMJ Open 2016; 6:e010811. [PMID: 27324710 PMCID: PMC4916592 DOI: 10.1136/bmjopen-2015-010811] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aims of this point-prevalence study were to investigate a representative inpatient population to determine the prevalence of people admitted to hospital for the reason of a foot-related condition, and identify associated independent factors. METHODS Participants were adult inpatients in 5 different representative hospitals, admitted for any reason on the day of data collection. Maternity, mental health and cognitively impaired inpatients were excluded. Participants were surveyed on a range of self-reported demographic, social determinant, medical history, foot disease history, self-care, footwear, past foot treatment prior to hospitalisation and reason for admission variables. Physical examinations were performed to clinically diagnose a range of foot disease and foot risk factor variables. Independent factors associated with being admitted to hospital for the primary or secondary reason of a foot-related condition were analysed using multivariate logistic regression. RESULTS Overall, 733 participants were included; mean (SD) age 62 (19) years, male 55.8%. Foot-related conditions were the primary reason for admission in 54 participants (7.4% (95% CI 5.7% to 9.5%)); 36 for foot disease (4.9%), 15 foot trauma (2.1%). Being admitted for the primary reason of a foot-related condition was independently associated with foot infection, critical peripheral arterial disease, foot trauma and past foot treatment by a general practitioner and surgeon (p<0.01). Foot-related conditions were a secondary reason for admission in 28 participants (3.8% (2.6% to 5.6%)), and were independently associated with diabetes and current foot ulcer (p<0.01). CONCLUSIONS This study, the first in a representative inpatient population, suggests the direct inpatient burden caused by foot-related conditions is significantly higher than previously appreciated. Findings indicate 1 in every 13 inpatients was primarily admitted because of a foot-related condition with most due to foot disease or foot trauma. Future strategies are recommended to investigate and intervene in the considerable inpatient burden caused by foot-related conditions.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
- Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Vanessa Ng
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
| | - Courtney Thomas
- Department of Podiatry, North West Hospital & Health Service, Mount Isa, Queensland, Australia
| | - Scott Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - Ewan M Kinnear
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Michael C d'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lloyd Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg 2016; 86:157-61. [DOI: 10.1111/ans.13429] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jack J. Bell
- Metro North Hospital and Health Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Ranjeev C. Pulle
- Metro North Hospital and Health Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Alisa M. Crouch
- Metro North Hospital and Health Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Suzanne S. Kuys
- School of Physiotherapy; Australian Catholic University; Brisbane Queensland Australia
| | - Rebecca L. Ferrier
- Metro North Hospital and Health Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Sarah L. Whitehouse
- Metro North Hospital and Health Service; The Prince Charles Hospital; Brisbane Queensland Australia
- Orthopaedic Research Unit; Institute of Health and Biomedical Innovation; Queensland University of Technology; The Prince Charles Hospital; Brisbane Queensland Australia
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Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ Open 2015; 5:e008544. [PMID: 26597864 PMCID: PMC4663442 DOI: 10.1136/bmjopen-2015-008544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity). METHODS A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available. RESULTS Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001). CONCLUSIONS This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
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Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Scott D Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Abstract
AIM Postoperative delirium is common among elderly hip surgery patients. We aimed to pragmatically evaluate whether type of anaesthesia influenced postoperative delirium in an orthogeriatric population following hip fracture. METHOD This observational study comprises prospectively collected data on hip fracture patients admitted between October 2010 and November 2011. Delirium was diagnosed clinically by geriatricians. RESULTS Of the 344 patients admitted, seven managed conservatively and 19 with incomplete data were excluded; 318 patients were analysed. Average age was 81.6 (SD 9.8) years; 28% were men and 167 (53%) were administered general anaesthesia. Mean length of stay was 18 (SD 9.4) days. Overall, 172 patients (54%) experienced delirium. There was no apparent difference in postoperative delirium by anaesthetic type (88 vs 84, P = 0.15). CONCLUSION Delirium was common in both general and spinal anaesthetic patients. Further randomised controlled trials would be required to determine whether anaesthesia type influenced delirium rates.
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Affiliation(s)
- Sivarajah Ilango
- Internal Medical Services, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Ranjeev Chrys Pulle
- Internal Medicine and Geriatric Medicine Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jack Bell
- Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
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McPhail SM, O'Hara M, Gane E, Tonks P, Bullock-Saxton J, Kuys SS. Nintendo Wii Fit as an adjunct to physiotherapy following lower limb fractures: preliminary feasibility, safety and sample size considerations. Physiotherapy 2015. [PMID: 26209909 DOI: 10.1016/j.physio.2015.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Nintendo Wii Fit integrates virtual gaming with body movement, and may be suitable as an adjunct to conventional physiotherapy following lower limb fractures. This study examined the feasibility and safety of using the Wii Fit as an adjunct to outpatient physiotherapy following lower limb fractures, and reports sample size considerations for an appropriately powered randomised trial. METHODOLOGY Ambulatory patients receiving physiotherapy following a lower limb fracture participated in this study (n=18). All participants received usual care (individual physiotherapy). The first nine participants also used the Wii Fit under the supervision of their treating clinician as an adjunct to usual care. Adverse events, fracture malunion or exacerbation of symptoms were recorded. Pain, balance and patient-reported function were assessed at baseline and discharge from physiotherapy. RESULTS No adverse events were attributed to either the usual care physiotherapy or Wii Fit intervention for any patient. Overall, 15 (83%) participants completed both assessments and interventions as scheduled. For 80% power in a clinical trial, the number of complete datasets required in each group to detect a small, medium or large effect of the Wii Fit at a post-intervention assessment was calculated at 175, 63 and 25, respectively. CONCLUSIONS The Nintendo Wii Fit was safe and feasible as an adjunct to ambulatory physiotherapy in this sample. When considering a likely small effect size and the 17% dropout rate observed in this study, 211 participants would be required in each clinical trial group. A larger effect size or multiple repeated measures design would require fewer participants.
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Affiliation(s)
- S M McPhail
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - M O'Hara
- The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - E Gane
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - P Tonks
- The Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - J Bullock-Saxton
- Faculty of Health, Australian Catholic University, Brisbane, Queensland, Australia
| | - S S Kuys
- Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia; The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
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28
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Hayward KS, Kuys SS, Barker RN, Brauer SG. Can stroke survivors with severe upper arm disability achieve a clinically important change in arm function during inpatient rehabilitation? A multicentre, prospective, observational study. NeuroRehabilitation 2015; 35:17-23. [PMID: 24990005 DOI: 10.3233/nre-141096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Severe arm disability is considered to indicate poor potential to recover arm function. OBJECTIVE Determine if stroke survivors with severe upper arm disability can achieve a clinically important change in arm function on discharge from inpatient rehabilitation. METHODS 618 stroke survivors from 16 inpatient rehabilitation units were assessed on admission and discharge using the Motor Assessment Scale Item 6 Upper Arm Function (MAS6). Admission scores defined participants with severe (MAS6 ≤2) and mild/moderate (MAS6 >2) upper arm disability. A clinically important change was evaluated according to: 1) statistical significance; 2) minimal clinical importance difference (MCID); and 3) shift in disability status i.e., severe to mild/moderate. Achievers of a MCID and shift were compared to non-achievers. RESULTS Stroke survivors with severe upper arm disability (n = 226) demonstrated a significant improvement in arm function (p < 0.001) at discharge. A MCID was achieved by 68% (n = 155) and a shift from severe to mild/moderate upper arm disability on discharge by 45% (n = 102) of participants. Achievers had a significantly shorter interval from stroke onset to inpatient rehabilitation admission (p < 0.002). CONCLUSION Stroke survivors with severe upper arm disability can achieve a clinically important change during inpatient rehabilitation.
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Affiliation(s)
- Kathryn S Hayward
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Suzanne S Kuys
- Griffith Health Institute, Griffith University, Gold Coast, Australia; and Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Ruth N Barker
- Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, Australia Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, QLD, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Dolecka UE, Ownsworth T, Kuys SS. Comparison of sit-to-stand strategies used by older adults and people living with dementia. Arch Gerontol Geriatr 2015; 60:528-34. [DOI: 10.1016/j.archger.2014.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/15/2014] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
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Batten HR, Kuys SS, McPhail SM, Varghese PN, Nitz JC. Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: a 7-year series. AUST HEALTH REV 2015; 39:76-84. [DOI: 10.1071/ah14042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/21/2014] [Indexed: 11/23/2022]
Abstract
Objective To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. Methods In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Results Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25–76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P < 0.001) and recorded lower functional independence measure – motor scores at admission (z = 3.61, P < 0.001) and discharge (z = 4.52, P < 0.001). More non-vascular amputees worked before amputation (43% vs 11%; P < 0.001), were prescribed a prosthesis by discharge (73% vs 52%; P < 0.001) and had a shorter length of stay (7 days, 95% confidence interval: –3 to 17), although this was not statistically significant. Conclusions Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees. What is known about the topic? Lower limb amputation occurs due to various aetiologies. What does this paper add? Lower limb amputee rehabilitation over 7 years was investigated, comprising 425 admissions, 80% due to dysvascular aetiology. Personal and social demographics, and discharge outcomes are compared by aetiology. What are the implications for practitioners? Demographic and discharge outcome differences exist between dysvascular and non-vascular lower limb amputees. Twenty-one percent were required to change residence and 28% required additional social supports. Discharge planning should begin as soon as possible to limit time spent waiting for new accommodation or major modifications for current homes. Lower limb amputees are not homogeneous, so care should be taken if extrapolating from combined amputee aetiologies or from one aetiology to another.
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Hayward KS, Kuys SS, Barker RN, Brauer SG. Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: a prospective observational study. NeuroRehabilitation 2014; 34:773-9. [PMID: 24796436 DOI: 10.3233/nre-141076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A good motor outcome after stroke is often equated with independence in functional performance. However, for patients with severe motor disability a good outcome is unlikely, but an important change may be achievable. OBJECTIVE Determine if patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function. METHODS A prospective observational study of 239 patients with stroke admitted to inpatient rehabilitation in Brisbane, Australia was conducted. On admission and discharge, participants were assessed using the motor items of the Functional Independence Measure (m-FIM). The importance of change achieved on the m-FIM was evaluated according to: 1) a statistical significant outcome; 2) achievement of a MCID based on a physician-anchored rating of change; and 3) shift in disability status e.g., severe to moderate disability. RESULTS Patients with severe motor disability achieved a significant improvement in motor function (p < 0.001), which saw up to 83% achieve a MCID and 85% shift out of 'severe' to either moderate or mild motor disability on discharge from inpatient rehabilitation. CONCLUSION This study demonstrates that patients admitted to inpatient rehabilitation with severe motor disability can achieve clinically important improvements in motor function on discharge from inpatient rehabilitation.
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Affiliation(s)
- Kathryn S Hayward
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Suzanne S Kuys
- School of Rehabilitation Sciences, Griffith University, Gold Coast, Australia Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Ruth N Barker
- Discipline of Physiotherapy, School of Public Health Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Lazzarini PA, Ng V, Kinnear EM, Kamp MC, Kuys SS, Hurst C, Reed LF. The Queensland high risk foot form (QHRFF) - is it a reliable and valid clinical research tool for foot disease? J Foot Ankle Res 2014; 7:7. [PMID: 24468080 PMCID: PMC3906769 DOI: 10.1186/1757-1146-7-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/22/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Foot disease complications, such as foot ulcers and infection, contribute to considerable morbidity and mortality. These complications are typically precipitated by "high-risk factors", such as peripheral neuropathy and peripheral arterial disease. High-risk factors are more prevalent in specific "at risk" populations such as diabetes, kidney disease and cardiovascular disease. To the best of the authors' knowledge a tool capturing multiple high-risk factors and foot disease complications in multiple at risk populations has yet to be tested. This study aimed to develop and test the validity and reliability of a Queensland High Risk Foot Form (QHRFF) tool. METHODS The study was conducted in two phases. Phase one developed a QHRFF using an existing diabetes foot disease tool, literature searches, stakeholder groups and expert panel. Phase two tested the QHRFF for validity and reliability. Four clinicians, representing different levels of expertise, were recruited to test validity and reliability. Three cohorts of patients were recruited; one tested criterion measure reliability (n = 32), another tested criterion validity and inter-rater reliability (n = 43), and another tested intra-rater reliability (n = 19). Validity was determined using sensitivity, specificity and positive predictive values (PPV). Reliability was determined using Kappa, weighted Kappa and intra-class correlation (ICC) statistics. RESULTS A QHRFF tool containing 46 items across seven domains was developed. Criterion measure reliability of at least moderate categories of agreement (Kappa > 0.4; ICC > 0.75) was seen in 91% (29 of 32) tested items. Criterion validity of at least moderate categories (PPV > 0.7) was seen in 83% (60 of 72) tested items. Inter- and intra-rater reliability of at least moderate categories (Kappa > 0.4; ICC > 0.75) was seen in 88% (84 of 96) and 87% (20 of 23) tested items respectively. CONCLUSIONS The QHRFF had acceptable validity and reliability across the majority of items; particularly items identifying relevant co-morbidities, high-risk factors and foot disease complications. Recommendations have been made to improve or remove identified weaker items for future QHRFF versions. Overall, the QHRFF possesses suitable practicality, validity and reliability to assess and capture relevant foot disease items across multiple at risk populations.
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Affiliation(s)
- Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Vanessa Ng
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Ewan M Kinnear
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Maarten C Kamp
- School of Medicine, The University of Queensland, Brisbane, Australia
- Department of Endocrinology, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Rode Road, Chermside, Brisbane, QLD 4032, Australia
- Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Cameron Hurst
- Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Kuys SS, Peel NM, Klein K, Slater A, Hubbard RE. Gait speed in ambulant older people in long term care: a systematic review and meta-analysis. J Am Med Dir Assoc 2013; 15:194-200. [PMID: 24388775 DOI: 10.1016/j.jamda.2013.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gait speed, recently proposed as the sixth vital sign of geriatric assessment, is a strong predictor of adverse outcomes. Walking faster than 1.0 m/s is associated with better survival in community-dwelling older adults, and a recent meta-analysis of older adults in clinical settings estimated usual gait speed to be 0.58 m/s. Here, we aimed to review gait speed values for long term care residents. METHODS Relevant databases were systematically searched for original research studies published prior to December 2012. Inclusion criteria were participants living in long term care, mean age >70 years, and gait speed measured over a short distance. Meta-analysis determined gait speed data adjusting for covariates including age, sex, and cognition. RESULTS Final data included 2888 participants from 34 studies. The percentage of residents ineligible because of inability to mobilize was stated in only 1 study. Of the 34 studies, 22 reported cognitive status using the Mini-Mental State Examination. Usual pace and maximal pace gait speeds were determined separately using a random effects model. No association between gait speed and covariates was found. Usual pace gait speed was 0.475 m/s (95% confidence interval 0.396-0.554) and maximal pace was 0.672 m/s (95% confidence interval 0.532-0.811). CONCLUSIONS In ambulant older people in long term care, gait speed is slow but remains functional. However, since many residents are likely to have been ineligible to participate in assessments, these results cannot be generalized to the long term care population as a whole.
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Affiliation(s)
- Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Health Service District, Queensland Health, Queensland, Australia; School of Rehabilitation Science, Griffith Health Institute, Griffith University, Australia.
| | - Nancye M Peel
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
| | - Kerenaftali Klein
- Queensland Clinical Trials & Biostatistics, School of Population Health, The University of Queensland, Queensland, Australia
| | - Alexandra Slater
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
| | - Ruth E Hubbard
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Queensland, Australia
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Kuys SS, Bew PG, Lynch MR, Brauer SG. Activity limitations experienced by people with stroke who receive inpatient rehabilitation: differences between 2001, 2005, and 2011. Arch Phys Med Rehabil 2013; 95:741-6. [PMID: 24365092 DOI: 10.1016/j.apmr.2013.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/26/2013] [Accepted: 12/05/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether there were differences in characteristics and activity limitations relevant to physiotherapists among people receiving inpatient rehabilitation after stroke in 2001, 2005, and 2011. DESIGN A multicenter observational study of 3 periods. SETTING Inpatient rehabilitation units (N=15). PARTICIPANTS Adult stroke survivors (N=738) admitted over 3 periods (2001, 2005, 2011). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Characteristics, hospital metrics, and Motor Assessment Scale (MAS) scores were recorded on admission and discharge. RESULTS All 3 cohorts were similar in terms of sex, side affected by stroke, and length of time from stroke onset to rehabilitation admission. Stroke participants in the 2005 cohort were older than those in the 2011 and 2001 cohorts. Participants in the 2011 cohort had a longer inpatient rehabilitation length of stay, experienced lower average MAS gains per day (F>3.298, P<.038), and experienced more activity limitations in basic functional tasks involving bed mobility, standing up, and sitting balance on admission and discharge, and in walking and arm function at discharge only compared with earlier cohorts. CONCLUSIONS In 2011, on average, people admitted for rehabilitation after stroke were approximately the same age as patients in 2005 and 2001 and it took approximately 2 weeks for all of these patients to be admitted to a rehabilitation unit, but patients in 2011 had a longer inpatient rehabilitation length of stay compared with patients in 2005 and 2001. In addition, activity limitations at inpatient rehabilitation admission and discharge appear to be worse, particularly for activities such as rolling, sitting up over the edge of the bed, and balanced sitting.
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Affiliation(s)
- Suzanne S Kuys
- Griffith Health Institute, Griffith University, Gold Coast, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
| | - Paul G Bew
- Brighton Health Campus, Brisbane, Australia
| | - Mary R Lynch
- Australian Catholic University, Brisbane, Australia
| | - Sandra G Brauer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Tyack Z, Frakes KA, Cornwell P, Kuys SS, Barnett AG, McPhail SM. The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia: protocol for a longitudinal cohort investigation. BMC Health Serv Res 2013; 13:410. [PMID: 24119303 PMCID: PMC3852613 DOI: 10.1186/1472-6963-13-410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. METHODS This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs; as well as individual consultations involving single professions. DISCUSSION Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000724976.
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Affiliation(s)
- Zephanie Tyack
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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McClanachan NJ, Gesch J, Wuthapanich N, Fleming J, Kuys SS. Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury. Brain Inj 2013; 27:1402-8. [PMID: 24102295 DOI: 10.3109/02699052.2013.823654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine feasibility of gaming console exercise and its effect on endurance, gait and balance in people following acquired brain injury (ABI). METHOD Twenty-one people following ABI were recruited to an 8-week randomized cross-over trial where 4 weeks of gaming console exercise in addition to usual therapy and 4 weeks of usual therapy alone were received. Feasibility measures included compliance, session duration and adverse events. Measures included endurance measured using a 6-minute walk test, spatiotemporal gait parameters (GAITRite) and balance using Balance Outcome Measure for Elder Rehabilitation (BOOMER). Motivation was measured using the Change Assessment Questionnaire. RESULTS Compliance with gaming console exercise was high (99%), the majority of sessions reached duration target (82%) and there were no adverse events. There were small, though non-significant increases in 6-minute walk distance (18 metres, 95% CI = -33 to 69), gait speed (0.11 m s(-1), 95% CI = -0.18 to 0.29) and balance compared to after usual therapy after gaming console exercise. CONCLUSIONS Gaming console exercise appears feasible in people with ABI. Four weeks of gaming console exercise in addition to usual therapy appears to result in similar improvements in endurance, gait and balance compared to usual therapy alone and may enhance active engagement in therapy.
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Affiliation(s)
- Nelson J McClanachan
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
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Abstract
OBJECTIVES To quantify, using accelerometry, walking activity of older rehabilitation inpatients and to examine the relationship between walking activity and functional outcomes. DESIGN Prospective cohort study. SETTING Inpatient geriatric rehabilitation unit. PARTICIPANTS Of 74 consecutive eligible patients, aged 60 years or older and able to walk independently or with assistance, 60 participants (32 males, 28 females) with a mean (SD) length of stay of 37 (26) days completed the study. Intervention Measures: An accelerometer was worn in daytime hours from study recruitment until discharge to monitor daily walking minutes. RESULTS On study entry, patients spent a median (IQR) of 33 (20 to 48) minutes (7%) of the daily monitored eight hour period walking. By discharge, this had increased to 43 (30 to 56) minutes (9%) (p< 0.001). Average daily walking activity over the week prior to discharge correlated with change in gait speed from admission to discharge (p<0.05). Walking activity prior to discharge was significantly different (p<0.05) between the slowest gait speed group (≤0.4 m/s) and the fastest gait speed group (≥0.8 m/s). Those with discharge gait speeds ≥0.8 m/s (associated with ability to be ambulant in the community) had median (IQR) daily walking times at discharge of 51 (33 to 78) minutes. CONCLUSION Activity monitoring has the potential to assist clinicians and patients set goals around activity levels to achieve better outcomes.
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Affiliation(s)
- N M Peel
- Dr Nancye Peel, Research Fellow, Centre for Research in Geriatric Medicine, Level 2 Building 33, Princess Alexandra Hospital, Ipswich Road, Brisbane, Queensland 4102, Australia, Ph: +61 7 3176 7402, Fax: +61 7 3176 6945,
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Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. J Gerontol A Biol Sci Med Sci 2012; 68:39-46. [PMID: 22923430 DOI: 10.1093/gerona/gls174] [Citation(s) in RCA: 337] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gait speed is a quick, inexpensive, reliable measure of functional capacity with well-documented predictive value for major health-related outcomes. Numerous epidemiological studies have documented gait speed in healthy, community-dwelling older people. The purpose of this study is to undertake a systematic review and meta-analysis of gait speed in a specific group with mobility limitations-geriatric patients in clinical settings. METHODS Relevant databases were searched systematically for original research articles published in February 2011 measuring gait speed in persons aged 70 or older in hospital inpatient or outpatients settings. Meta-analysis determined gait speed data for each setting adjusting for covariates. RESULTS The review included 48 studies providing data from 7,000 participants. Across the hospital settings, the gait speed estimate for usual pace was 0.58 m/s (95% confidence interval [CI]: 0.49-0.67) and for maximal pace was 0.89 m/s (95% CI: 0.75-1.02). These estimates were based on most recent year of publication (2011) and median percentage of female participants (63%). Gait speed at usual pace in acute care settings was 0.46 m/s (95% CI: 0.34-0.57), which was significantly slower than the gait speed of 0.74 m/s (95% CI: 0.65-0.83) recorded in outpatient settings. CONCLUSIONS Gait speed is an important measure in comprehensive geriatric assessment. The consolidation of data from multiple studies reported in this meta-analysis highlights the mobility limitations experienced by older people in clinical settings and the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community.
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Affiliation(s)
- Nancye M Peel
- Centre for Research in Geriatric Medicine, Alexandra Hospital, Woolloongabba, Queensland, Australia.
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Lazzarini PA, O'Rourke SR, Russell AW, Clark D, Kuys SS. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? J Foot Ankle Res 2012; 5:12. [PMID: 22647678 PMCID: PMC3464163 DOI: 10.1186/1757-1146-5-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations. METHODS Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p < 0.05 was used throughout. RESULTS One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p < 0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables. CONCLUSIONS This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.
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Affiliation(s)
- Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Health Service District & Queensland University of Technology, The Prince Charles Hospital, Rode Road, Chermside QLD, 4032 Brisbane, Australia.
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Kuys SS, Dolecka UE, Guard A. Activity level of hospital medical inpatients: an observational study. Arch Gerontol Geriatr 2012; 55:417-21. [PMID: 22417401 DOI: 10.1016/j.archger.2012.02.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 02/11/2012] [Accepted: 02/14/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the activity level of people admitted for an acute hospital medical admission and to describe the location of and people present at the activity. DESIGN Prospective observational behavioral mapping study. PARTICIPANTS 102 patients admitted to general medical wards. INTERVENTION Participants were observed 1min every 10min during a working day from 8.30am to 4.30pm. OUTCOME MEASURES Highest level of activity was recorded; location, activity and person/s attending the participant. RESULTS Data from 76 participants were analyzed; mean age 67 (SD 19) years, 38 (50%) male. Participants were observed for 450min. They spent 394 (88%) min in their rooms, 18 (4%) min in the bathroom and 27 (6%) min off the ward. Of the time in their rooms, participants spent a median 315 (IQR 205-398) min lying in bed, 10 (IQR 0-38) min sitting on or out of bed and 1 (IQR 0-20) min standing or walking. Participants spent a median 115 (IQR 70-158) min doing nothing, 80 (IQR 43-160) min resting or sleeping and 75 (IQR 40-168) min talking, reading or watching television. Participants were alone 280 (IQR 230-340) min and with one person 90 (IQR 50-130) min. Participants were with staff a median 120 (IQR 73-180) min; nurses 35 (IQR 20-60) min, medical staff 10 (IQR 0-18) min and allied health staff 10 (IQR 0-20) min. CONCLUSION People admitted to general medical wards are inactive during hospital stay; spending the majority of the working day in their rooms, in bed and alone.
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Affiliation(s)
- Suzanne S Kuys
- Allied Health Research Collaborative, Metro North (Northern) Health Service District, Brisbane, Australia.
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Constantinou M, Kuys SS. Physiotherapy students find guided journals useful to develop reflective thinking and practice during their first clinical placement: a qualitative study. Physiotherapy 2012; 99:49-55. [PMID: 23219653 DOI: 10.1016/j.physio.2011.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 12/31/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study evaluated physiotherapy students' perception of a reflective journal in developing reflective thinking and practice and identified the main concepts recorded by students in the journal. DESIGN A mixed methods study with qualitative content analysis of student journals and quantitative analysis of questionnaire responses. PARTICIPANTS 131 (74 female, 57 male) physiotherapy students undergoing their first clinical placement. INTERVENTIONS On completion of their placement, students submitted a reflective journal electronically and completed a questionnaire of closed and open ended questions. MAIN OUTCOME MEASURES Questionnaires were analysed using frequencies for the responses of the closed questions and thematic analysis of the open ended questions. Journals were de-indentified and underwent a content analysis using Leximancer software to obtain a concept map and frequencies of the main concepts identified in the journals, with specific examples. RESULTS The majority (88%, 79/90) of respondents found the journal useful in assisting them to learn from their experiences, and to develop reflective thinking and practice. 54% (49/90) indicated they would continue to use the journals. The most frequently identified concepts were residents, time and exercises; representing more than 5000 of the total concepts identified in the journals. Analysis of the reflective journals indicated that students demonstrated improvements in the three stages of reflective practice: awareness of thoughts and feelings, critical analysis of situation, and development of new perspectives. CONCLUSIONS Guided journal writing may be a useful tool in facilitating reflective thinking and practice during clinical placements of physiotherapy students.
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Affiliation(s)
- Maria Constantinou
- School of Physiotherapy and Exercise Science, Griffith University, Gold Coast campus, Australia.
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Kuys SS, Dolecka UE, Morrison CA. Appropriate seating for medical patients: an audit. AUST HEALTH REV 2011; 35:316-9. [PMID: 21871193 DOI: 10.1071/ah10943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 10/28/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the number and types of chairs available for patient use; to establish minimum criteria of appropriate chairs; and to assess the suitability of available chairs to seat patients admitted to medical wards. METHODS Audit of chairs available in medical wards in a tertiary referral public hospital was conducted. All chairs relevant to patient use were photographed and counted. An expert panel determined minimum criteria of appropriate seating for older patients from functional, occupational health and safety, ergonomic, infection control and usability viewpoints. The number of chairs meeting the minimum criteria level was recorded and was expressed as a percentage of the number of required chairs (hospitalised patients able to be sat out of bed). RESULTS A total of 270 chairs of 36 different types were identified. The majority of chairs, 231 (85%), did not meet the minimum criteria. Thirty-nine chairs met the minimum criteria for patients to sit in with 113 (66%) patients unable to sit out of bed. CONCLUSION This study identified that there were insufficient appropriate chairs available for patients to sit out of bed in this facility. This has potential implications for functional ability of the patients, particularly for the older person.
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Affiliation(s)
- Suzanne S Kuys
- Princess Alexandra Hospital, Woollongabba, QLD 4102, Australia.
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Morrison G, Lee HL, Kuys SS, Clarke J, Bew P, Haines TP. Changes in falls risk factors for geriatric diagnostic groups across inpatient, outpatient and domiciliary rehabilitation settings. Disabil Rehabil 2011; 33:900-7. [DOI: 10.3109/09638288.2010.514019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE To determine the test-retest reliability of the GAITRite system in measuring spatio-temporal gait parameters in people with stroke undergoing inpatient rehabilitation and to investigate whether walking ability influences test-retest reliability. METHOD A within-subject repeated measures study was conducted. Twenty-one individuals with first stroke undergoing inpatient rehabilitation participated. The Motor Assessment Scale Item 5 score was used to categorise participants into poorer (score 3 or 4) or better walkers (score 5 or 6). Participants made two passes at a self-selected gait speed over the GAITRite mat on two separate occasions. Intra-class correlation coefficients (ICC(2,1)) and 95% limits of agreement for spatio-temporal gait parameters between the two occasions and groups were determined. RESULTS No differences in gait parameters between the two sessions (p > 0.15) were found. Test-retest reliability for the whole group was good to excellent, ICC(2,1) ranging from 0.72 to 0.94. Walking ability did influence these findings with fair to good reliability demonstrated for both poorer (ICC(2,1) > 0.57) and better walkers (ICC(2,1) > 0.41). CONCLUSIONS It appears that the GAITRite has good test-retest reliability in this group of people with first stroke undergoing rehabilitation. Test reliability seems to be slightly higher for poorer walkers than better walkers.
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Affiliation(s)
- Suzanne S Kuys
- Division of Physiotherapy, University of Queensland, Brisbane, Australia.
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Simmons NC, Kuys SS. Trial of an allied health workload allocation model. AUST HEALTH REV 2011; 35:168-75. [DOI: 10.1071/ah09860] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 10/07/2010] [Indexed: 11/23/2022]
Abstract
Allied health (AH) managers need to be able to quantify workloads to effectively manage the increasing demands on the health system. Workload allocation models provide a means of monitoring, evaluating and determining manageable workloads. This allows managers to ensure equitable distribution of duties and maximise the existing AH workforce output, which will lead to more efficient health service delivery and better patient outcomes. The purpose of this study was to develop and trial an AH workload allocation model incorporating the National Allied Health Casemix Committee Health Activity Classification. A workload allocation model was developed that included a staff workload mapping tool, data analysis spreadsheet and guidelines for calculating procedure times. The model was trialled across three AH professions (occupational therapy, physiotherapy and speech pathology), in two hospital districts, and across inpatient, outpatient and community settings. A total of 30 participants completed the trial. Staff and managers completed a post-trial survey to provide feedback on the workload allocation model. Survey results indicated that staff and managers found the model useful for evaluating and quantifying workloads. Managers believed the model would be useful for preparing business cases and benchmarking staff workloads. Recommendations for improvements to the workload mapping tool were also identified.
What is known about the topic?
Workload allocation models have been identified as a valuable means of evaluating and managing AH workloads. Current models do not account for all tasks undertaken by AH clinicians or are applicable to only a specific AH discipline. There is a paucity of workload allocation models suitable for use across AH disciplines.
What does this paper add?
This paper demonstrates the effectiveness of an AH workload allocation model that incorporates the NAHCC Health Activity Classification that can be used across AH disciplines and work sites.
What are the implications for practitioners?
This new workload allocation model provides AH managers with a mapping tool that provides a high level of detail of non-patient activities, and guidelines for calculating procedure times that can be used to effectively manage staff workloads, benchmark existing services and plan for new services. Critical evaluation of staff workloads will allow managers to maximise allied health human resources and hence provide better patient outcomes.
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Kuys SS, Brauer SG, Ada L. Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial. Clin Rehabil 2010; 25:316-26. [DOI: 10.1177/0269215510382928] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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
Objective: To determine whether higher-intensity treadmill walking during rehabilitation in those newly able to walk after stroke is feasible, is detrimental to walking or is beneficial. Design: A single-blind, randomized trial. Setting: Two rehabilitation units. Participants: Thirty people with first stroke. Interventions: Experimental group received 30 minutes of higher-intensity treadmill walking, three times per week for six weeks, in addition to usual physiotherapy. Control group received usual physiotherapy only. Main outcome measures: Feasibility was measured by examining compliance and adverse events. Detriment to walking was measured by examining pattern and quality. Benefit to walking was measured as capacity using six-minute walk test and speed, at baseline (Week 0), immediately after (Week 6) and at three months (Week 18). Results: Overall compliance was 89%, with no adverse events reported. There was no between-group difference in walking pattern and quality. By Week 6, the experimental group improved walking capacity by 62 m (95% confidence interval (CI) 10 to 114), comfortable walking speed by 0.18 m/s (95% CI 0.07 to 0.29) and fast walking speed by 0.18 m/s (95% CI 0.03 to 0.35) more than the control group. By Week 18, the experimental group was still walking 0.26 m/s (95% CI 0.12 to 0.41) faster than the control group. Conclusions: Higher-intensity treadmill walking during rehabilitation after stroke is feasible and not detrimental to walking pattern and quality in those newly able to walk. 94 participants are required to detect a between-group difference of 75 m on six-minute walk test (α 0.05, β 0.90) in future trials. Trial registration: ACTRN12607000412437
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Affiliation(s)
- Suzanne S Kuys
- School of Physiotherapy and Exercise Science, Griffith University and Division of Physiotherapy, University of Queensland
| | - Sandra G Brauer
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Australia
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Kuys SS, Bew PG, Lynch MR, Morrison G, Brauer SG. Measures of activity limitation on admission to rehabilitation after stroke predict walking speed at discharge: an observational study. ACTA ACUST UNITED AC 2010; 55:265-8. [PMID: 19929769 DOI: 10.1016/s0004-9514(09)70006-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
QUESTION Which measures of activity limitation on admission to rehabilitation after stroke best predict walking speed at discharge? DESIGN Prospective observational study. PARTICIPANTS 120 people with stroke undergoing inpatient rehabilitation. OUTCOME MEASURES Predictors were admission walking speed, Timed Up and Go, Motor Assessment Scale, Modified Elderly Mobility Scale, and Functional Independence Measure scores measured on admission to rehabilitation. The outcome of interest was walking speed at discharge from inpatient rehabilitation. RESULTS Admission walking speed (B 0.47, 95% CI 0.27 to 0.67) and Item 2 of the Motor Assessment Scale, ie, moving from supine lying to sitting over the side of a bed (B 0.05, 95% CI 0.01 to 0.09) predicted walking speed on discharge from rehabilitation. These two predictors explained 36% of the variance in discharge walking speed. CONCLUSION Walking speed at discharge from inpatient rehabilitation was best predicted by admission walking speed and Motor Assessment Scale Item 2.
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Affiliation(s)
- Suzanne S Kuys
- Physiotherapy, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.
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Kuys SS, Brauer SG, Ada L, Russell TG. Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study. Clin Rehabil 2008; 22:931-9. [DOI: 10.1177/0269215508094245] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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
Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability? Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility. Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke. Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively. Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5). Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.
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Affiliation(s)
- Suzanne S Kuys
- School of Physiotherapy and Exercise Science, Griffith University, , Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Division of Physiotherapy, University of Queensland
| | | | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney
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Haines T, Kuys SS, Morrison G, Clarke J, Bew P. Balance impairment not predictive of falls in geriatric rehabilitation wards. J Gerontol A Biol Sci Med Sci 2008; 63:523-8. [PMID: 18511758 DOI: 10.1093/gerona/63.5.523] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Falls are common among hospital inpatients, particularly in rehabilitation wards. Standing balance impairment is widely held to be a contributing factor to falls, is a component of several falls risk screening tools, and has motivated the development of balance retraining programs for the reduction of in-hospital falls. Little rigorous investigation of the link between standing balance impairment and in-hospital falls has been undertaken. METHODS We identified optimal cut-off points of four commonly used balance measures (functional reach, Timed Up and Go, step test, and timed static stance) in a prospective multicenter cohort study. Admission data (n = 1373) were clustered and matched by center then randomly allocated to development and validation data sets. RESULTS Optimal cut-off points for each test were identified from the development data set. The predictive accuracy of all four balance tests was poor when the optimal cut-off was applied to the validation data set (Youden Index scores ranged between 0.02 and 0.15). CONCLUSIONS These findings do not support an association between admission standing balance and falls in a geriatric rehabilitation setting. This result has implications for content of falls risk screening tools and interventions to prevent falls in a geriatric rehabilitation population.
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Affiliation(s)
- Terry Haines
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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