Towards enhancing national capacity for evidence informed policy and practice in falls management: a role for a "Translation Task Group"?

There has been a growing interest over recent years, both within Australia and overseas, in enhancing the translation of research into policy and practice. As one mechanism to improve the dissemination and uptake of falls research into policy and practice and to foster the development of policy-appropriate research, a Falls Translation Task Group has formed to facilitate linkage and exchange. There has been a growing interest over recent years, both within Australia and overseas, in enhancing the translation of research into policy and practice. As one mechanism to improve the dissemination and uptake of falls research into policy and practice and to foster the development of policy-appropriate research, a Falls Translation Task Group was formed as part of an NHMRC Population Health Capacity Building grant. This paper reports on the group\u27s first initiative to address issues around the research to policy and practice interface, and identifies a continuing role for such a group. MethodA one day forum brought together falls researchers and decision-makers from across the nation to facilitate linkage and exchange. Observations of the day\u27s proceedings were made by the authors. Participants were asked to complete a questionnaire at the commencement of the forum (to ascertain expectations) and at its completion (to evaluate the event). Observer notes and the questionnaire responses form the basis of analysis. Results: Both researchers and decision-makers have a desire to bridge the gap between research and policy and practice. Significant barriers to research uptake were highlighted and included both health system barriers (for example, a lack of financial and human resources) as well as evidence barriers (such as insufficient economic data and implementation research). Solutions to some of these barriers included the identification of clinical champions within the health sector to enhance evidence uptake, and the sourcing of alternative funding to support implementation research and encourage partnerships between researchers, decision-makers and other stakeholders. Conclusion: Participants sought opportunities for ongoing networking and collaboration. Two activities have been identified as priorities: establishing a policy-sensitive research agenda and partnering researchers and decision-makers in the process; and establishing a National Translation Task Group with a broad membership

Managing the interface between acute care and rehabilitation: can utilisation review assist?

Aims and methods: We piloted the InterQual Criteria tool in a large regional acute hospital in NSW to determine the utility of this tool in the Australian context. In particular to compare the current gold standard of physician assessment for the selection of patients for rehabilitation and the timing of transfer, with the guidance provided by the tool. Consecutive acute care patients with a diagnosis of stroke, hip fracture or amputation, and patients referred for rehabilitation assessment, were followed using the InterQual Criteria.Results: Results on 242 acute episodes, representing 2698 days in acute care, were analysed. In accordance with overseas studies, we found that high levels of inappropriate days of stay in acute care were suggested by the tool. Using the InterQual Criteria almost all patients were deemed appropriate for transfer to rehabilitation much earlier than current practice.Conclusion: We conclude that the InterQual Criteria may have a useful role in patient selection for rehabilitation, in facilitating the transfer of patients from acute to subacute care, and in improving patient flow within acute care. The reasons for the variation between the results obtained from the tool and current clinical practice requires further investigation, and may indicate a lack of validity of the tool in the Australian setting, inefficiencies in processes of acute care, or the lack of suitable alternative care settings or level of support available in these settings

The performance of instrumental activities of daily living scale in screening for cognitive impairment in elderly community residents.

A retrospective analysis of Short Orientation-Memory-Concentration (OMC) and Lawton's IADL data was performed to assess the association between instrumental activities of daily living (IADL) and a rating of cognitive impairment, and to test whether IADL measures can be used to screen for dementia. The study analyzed data from 1,095 elderly community residents who were regarded as potentially benefiting from care coordination. Three IADL items (telephone use, self-medication, and handling finances) were statistically associated with cognitive impairment (OMC cutoff 10/11), independent of age and sex. An IADL indicator based on these items had only modest power in predicting cognitive impairment, its highest sensitivity being 0.71. Specificity was 0.75 at this point, but increased to 0.97 if higher indicator scores were used to define a positive result. In conclusion, the usefulness of an IADL indicator seems limited to ruling out further cognitive assessment rather than positively identify those with dementia

Injury risk perception in taekwondo : a cross-sectional study

The purpose of this study was to examine the perception of injury risk in the taekwondo community. Members of the taekwondo community (N=298) completed an online survey in which they rated the perceived risk of injury across a range of different sports, including taekwondo. Overall, the respondents perceived the risk of injury in their own sport to be lower than that in other collision and contact sports, including popular combat sports such as boxing, mixed martial arts, judo, and karate. Males (odds ratio 0.50; P=0.006) and instructors/coaches (odds ratio 0.34; P<0.001) perceived the risk of injury to be significantly less compared to their female and athlete counterparts. Because behaviour is determined by perceived rather than actual risk, underestimation of injury risk and concomitant overestimation of ability to negotiate risk may lead to an increased frequency of injury. Therefore, a comprehensive injury prevention strategy for combat sports such as taekwondo should ensure that erroneous beliefs and attitudes about injury risk among participants are addressed.14 page(s

Exposure-adjusted incidence rates and severity of competition injuries in Australian amateur taekwondo athletes : a 2-year prospective study

Background/aim: The main purposes of this study were to determine the injury incidence and severity in Australian amateur taekwondo athletes, and to investigate potential risk factors for injury in competition taekwondo. Methods: Data were collected at New South Wales State Championships in 2010 and 2011. Injuries were diagnosed by onsite sports medicine personnel and the actual number of days lost from full participation was used to determine injury severity. Injury incidence rates were calculated per 1000 athlete-exposures (injury incidence rate (IIRAE)) and per 1000 min of exposure (IIRME) and presented with 95% CI. Results: The overall IIR AE and IIRME were 59.93 (95% CI 51.16 to 69.77) and 16.32 (95% CI 13.93 to 19.00), respectively. Children under 10 years had significantly lower IIRAE compared with older age groups and black belts had significantly higher IIRAE compared with yellow belts, however, after accounting for the exposure time it was revealed that 10-year-olds to 14-year-olds and red belts incurred higher IIRME. This study highlights the importance of including IIRs that account for exposure-time. In contrast with previous estimates, the current data indicated that one-third of injuries were moderate to severe. Relative to other body regions the upper limb had a higher proportion of moderate-to-severe injuries, and compared with the lower limb there was a disproportionate number of upper limb injuries resulting in fractures. Conclusions: The findings suggest that the impact of injury on taekwondo athletes is significant, and should serve as an impetus to stakeholders to develop and implement injury prevention activities within the sport.6 page(s

Psychosocial factors and injury risk in Taekwondo : an exploratory prospective cohort study

The purpose of this study was to examine the psychological profile of Taekwondo athletes competing at the 2011 Australian National Championships and to explore the potential relationship between psychosocial variables and injury risk. Forty-five athletes aged 16 years and older consented to complete a pre-tournament survey comprising demographic information and a battery of questionnaires designed to quantify four separate psychosocial factors (i.e., life-changing events, competition anxiety, coping skills, and social support). Older athletes had significantly lower competition anxiety (p = 0.035) and greater satisfaction with social support (p = 0.019) relative to younger athletes. Female athletes reported significantly fewer positive life events (p = 0.039) compared to their male counterparts. These findings indicate that younger or inexperienced athletes and females may be at greater risk from psychosocial stressors. Targeted programs to address these stressors may be beneficial; however, further research is needed to elucidate the relationships between injury risk and psychosocial factors in Taekwondo athletes.8 page(s

Arts on prescription for community‐dwelling older people with a range of health and wellness needs

Published evidence for the role of participatory art in supporting health and well‐being is growing. The Arts on Prescription model is one vehicle by which participatory art can be delivered. Much of the focus of Arts on Prescription has been on the provision of creative activities for people with mental health needs. This Arts on Prescription program, however, targeted community‐dwelling older people with a wide range of health and wellness needs. Older people were referred to the program by their healthcare practitioner. Professional artists led courses in visual arts, photography, dance and movement, drama, singing, or music. Classes were held weekly for 8-10 weeks, with six to eight participants per class, and culminated with a showing of work or a performance. Program evaluation involved pre‐ and postcourse questionnaires, and focus groups and individual interviews. Evaluation data on 127 participants aged 65 years and older were available for analysis. We found that Arts on Prescription had a positive impact on participants. Quantitative findings revealed a statistically significant improvement in the Warwick-Edinburgh Mental Well‐being Scale (WEMWBS) as well as a statistically significant increase in the level of self‐reported creativity and frequency of creative activities. Qualitative findings indicated that the program provided challenging artistic activities which created a sense of purpose and direction, enabled personal growth and achievement, and empowered participants, in a setting which fostered the development of meaningful relationships with others. This evaluation adds to the evidence base in support of Arts on Prescription by expanding the application of the model to older people with a diverse range of health and wellness needs