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

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

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

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

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

Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: Protocol for a process evaluation

Introduction: Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. Methods and analyses: This prospective observational cohort study is a process evaluation of a randomized controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring greater than 7/10 on the Abbreviated Mental Test Score. Participants are being discharged from hospital rehabilitation wards in Perth, Western Australia, and followed up for 6 months postdischarge. Primary outcome measures for the process evaluation are engagement in falls prevention strategies, including exercise, home modifications and receiving assistance with activities of daily living. Secondary outcomes will measure capability, motivation and opportunity to engage in falls prevention strategies, based on the constructs of the Capability Opportunity Motivation Behaviour system. Quantitative data are collected at baseline, then at 6 months postdischarge using structured phone interviews. Qualitative data are collected from a purposive sample of the cohort, using semistructured in-depth phone interviews. Quantitative data will be analysed using regression modelling and qualitative data will be analysed using interpretive phenomenological analysis. Ethics and dissemination: Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees

The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children

Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers.Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged &lt;5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics.Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95$991 (95%CI 514–1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation.Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections

Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial

Background: Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people’s preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. Methods: A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as ‘at-risk’ and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. Results: In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of − 0.08; 95% CI: − 0.12 to − 0.04 and − 0.14; 95% CI: − 0.21 to − 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of − 0.20; 95% CI: − 0.28 to − 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of − 0.01, 0.02 and 0.04. Discussion: The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life. Trial registration: Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).</p