Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

Background. Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients’ future health states are accurate. Methods. A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists’ (n=23) prediction of patients’ discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n=272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results. Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37–0.57 (58%–83%) across EQ-5D-3L domains in the lower cognition group and 0.53–0.68 (81%–85%) in the better cognition group. Conclusions. Physiotherapists in this subacute rehabilitation setting predicted their patients’ discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition

Educators\u27 perspectives about how older hospital patients can engage in a falls prevention education programme: a qualitative process evaluation

Objectives: Falls are the most frequent adverse event reported in hospitals. Patient and staff education delivered by trained educators significantly reduced falls and injurious falls in an older rehabilitation population. The purpose of the study was to explore the educators’ perspectives of delivering the education and to conceptualise how the programme worked to prevent falls among older patients who received the education. Design: A qualitative exploratory study. Methods: Data were gathered from three sources: conducting a focus group and an interview (n=10 educators), written educator notes and reflective researcher field notes based on interactions with the educators during the primary study. The educators delivered the programme on eight rehabilitation wards for periods of between 10 and 40 weeks. They provided older patients with individualised education to engage in falls prevention and provided staff with education to support patient actions. Data were thematically analysed and presented using a conceptual framework. Results: Falls prevention education led to mutual understanding between staff and patients which assisted patients to engage in falls prevention behaviours. Mutual understanding was derived from the following observations: the educators perceived that they could facilitate an effective three-way interaction between staff actions, patient actions and the ward environment which led to behaviour change on the wards. This included engaging with staff and patients, and assisting them to reconcile differing perspectives about falls prevention behaviours. Conclusions: Individualised falls prevention education effectively provides patients who receive it with the capability and motivation to develop and undertake behavioural strategies that reduce their falls, if supported by staff and the ward environment

Clinicians' perceptions of rationales for rehabilitative exercise in a critical care setting: A cross-sectional study

Australian College of Critical Care Nurses Ltd. Background: Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. Objective: To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians. Methods: A cross-sectional study was undertaken among clinicians (nursing, medical, physiotherapy) working in a mixed medical surgical ICU in an Australian metropolitan tertiary hospital. Participants completed a customised web-based questionnaire developed by a clinician working-group. The questionnaire consisted of 11 plausible rationales for commencing rehabilitative exercise in ICUs based on prior literature and their own clinical experiences grouped into 4 over-arching categories (musculoskeletal, respiratory, psychological and facilitation of discharge). Participants rated their perceived importance for each potential rationale on a 5-point Likert scale. Results: Participants (n = 76) with a median (interquartile range) 4.8 (1.5, 15.5) years of experience working in ICUs completed the questionnaire. Responses were consistent across professional disciplines. Clinicians rated rehabilitative exercise as either 'very much' or 'somewhat' important for facilitating discharge (n = 76, 100%), reducing muscle atrophy (n = 76, 100%), increasing muscle strength (n = 76, 100%), prevention of contractures (n = 73, 96%), reducing the incidence of ICU acquired weakness (n = 62, 82%), increasing oxygenation (n = 71, 93%), facilitating weaning (n = 72, 97%), reducing anxiety (n = 60, 80%), reducing depression (n = 64, 84%), reducing delirium (n = 53, 70%), and increasing mental alertness (n = 65, 87%). Conclusions: Any shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence rehabilitation practices in ICUs. It is noteworthy that this study examined self-reported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice

Frequency of a very brief intervention by physiotherapists to increase physical activity levels in adults:A pilot randomised controlled trial

Background: There is evidence that brief physical activity interventions by health professionals can increase physical activity levels. In addition, there is some evidence that simply measuring physical activity alone can increase physical activity behaviour. However, preliminary work is required to determine the effects of potential measurement frequency. The aim of this pilot study was to examine whether frequency of physical activity measurement, with very brief advice from a physiotherapist, influenced objectively measured physical activity in insufficiently active adults. Methods: Using concealed allocation and blinded assessments, eligible participants (n = 40) were randomised to a lower-measurement-frequency (baseline and 18-weeks) or higher-measurement-frequency group (baseline, 6, 12 and 18-weeks). The primary outcome was daily minutes of moderate-to-vigorous physical activity (accelerometry). Secondary outcomes included functional aerobic capacity (STEP tool), quality-of-life (AQoL-6D), body mass index, waist circumference, waist-to-hip ratio and blood pressure. Results: Between-group comparisons were not significant in intention-to-treat analyses. However, there was a trend for the higher-measurement-frequency group to complete more daily minutes of moderate-to-vigorous physical activity at 18-weeks (mean difference 19.6 vs - 11.9 mins/week, p = 0.084), with a medium effect size (Cohen's d = 0.58). This was significant in per-protocol analysis (p = 0.049, Cohen's d = 0.77). Within-group comparisons indicated both groups increased their aerobic fitness (p ≤ 0.01), but only the higher-measurement-frequency group decreased their waist circumference (mean decrease 2.3 cm, 95%CI 0.3-4.3, p = 0.024), diastolic blood pressure (mean decrease 3.4 mmHg, 95%CI 0.03-6.8, p = 0.048) and improved their quality-of-life for independent living (mean increase 3.3, 95%CI 0.2-6.4, p = 0.031). Conclusion: Very brief physical activity interventions by physiotherapists may be an efficient approach to increase physical activity in community-dwelling adults. A larger trial is warranted. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000566437, http://www.ANZCTR.org.au/ACTRN12616000566437.aspx, registered 2 May 2016.</p

Job strain and psychological distress in office workers: The role of coping

BACKGROUND:Work-related psychosocial factors such as job strain are thought to contribute to elevated psychological stress in office workers. One factor that may impact the relationship between job strain and psychological distress is the individual’s coping resources. OBJECTIVE:The purpose of this study is to examine the interaction effect of coping resources on the relationship between job strain and psychological distress in office workers. METHODS:220 office workers in Australia and Korea completed the Job Content Questionnaire (to evaluate job strain and social support at work), the Depression, Anxiety, and Stress Scale, (DASS-21, a measure of psychological distress), and the Coping with Job Stress Scale to assess control and escape coping. Hierarchical regression analyses were executed to examine the interaction and moderating effect of coping resources. RESULTS:Job strain had a direct positive relationship with all three domains of psychological distress. The relationship between job strain and depression was positively moderated by escape coping, but negatively moderated by social support. Use of higher levels of escape coping predicted higher levels of depression and anxiety symptoms when higher levels of job strain were perceived. CONCLUSIONS:Findings suggest there may be a direct relationship between job strain and psychological distress in office workers. This relationship, however, may be moderated by the office workers coping resources (coping strategies and social support). It is suggested that the evaluation of coping might be a key consideration in the elements of the assessment of psychological distress in office workers

Factors influencing research engagement: research interest, confidence and experience in an Australian speech-language pathology workforce

Background: Recent initiatives within an Australia public healthcare service have seen a focus on increasing the research capacity of their workforce. One of the key initiatives involves encouraging clinicians to be research generators rather than solely research consumers. As a result, baseline data of current research capacity are essential to determine whether initiatives encouraging clinicians to undertake research have been effective. Speech pathologists have previously been shown to be interested in conducting research within their clinical role; therefore they are well positioned to benefit from such initiatives. The present study examined the current research interest, confidence and experience of speech language pathologists (SLPs) in a public healthcare workforce, as well as factors that predicted clinician research engagement

Valid and reliable assessment of wellness among adolescents: Do you know what you’re measuring?

Measuring wellness among adolescents is an emerging trend among professionals and researchers endeavouring to influence youth as they establish lifestyle patterns in this critical period of life. This discussion highlights instruments used to measure adolescents’ wellness, and considers the empirical data supporting the validity and reliability of those instruments. In summary, adolescents’ wellness is an important indicator of future health and lifestyle habits. There are a number of tools available to measure wellness, each with its own focus, depending on the definition or model from which it was developed. This might cause debate regarding the appropriateness of some instruments for evaluating wellness. The majority of wellness evaluation approaches used with adolescent populations have less than ideal validation. A ‘gold standard’ definition could lead to the standardisation of a theoretical model against which wellness instruments could be validated. The absence of peer-reviewed studies reporting psychometric testing for wellness evaluation instruments used with adolescents is of concern given their growing popularity and highlights a priority area for future research in this field

Averting uncertainty: A practical guide to physical activity research in Australian schools

Preventative health has become central to contemporary health care, identifying youth physical activity as a key factor in determining health and functioning. Schools offer a unique research setting due to distinctive methodological circumstances. However, school-based researchers face several obstacles in their endeavour to complete successful research investigations; often confronted with complex research designs and methodological procedures that are not easily amenable to school contexts. The purpose of this paper is to provide a practical guide for teachers (both teacher educators and teaching practitioners) seeking to conduct physical activity-based research in Australian school settings, as well as discuss research practices. The research enabling process has been divided into six phases: preparation; design; outcome measures; procedures; participants; and feedback. Careful planning and consideration must be undertaken prior to the commencement of, and during the research process, due to the complex nature of school settings and research processes that exist in the Australian context

Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: Protocol for a prospective observational cohort study

Introduction: The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Method and analyses: A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥ 60 years who are admitted for elective major joint replacement (n = 267 total hip replacement, n = 267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination: The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number: ACTRN12615000653561; Pre-results

The relationship between physical impairments, quality of life and disability of the neck and upper limb in patients following neck dissection

The purpose of this study was to examine the relationship between physical impairments, quality of life and disability in patients following neck dissection, with consideration of patient and clinical characteristics.Cross-sectional study of patient