Evaluation of a new evidence based outpatient program for Parkinson’s disease.

Ms Kim Eckersley1, Mr Scott MacMillan1, Ms Jessica Mao1, Mr Dylan Mercieca1

1North Eastern Rehabilitation Centre, Ivanhoe, Australia

Abstract: 

Title: Evaluation of a new evidence based outpatient program for Parkinson’s disease.

Aim: To evaluate the outcomes of a new evidence based interdisciplinary health and wellbeing program for people living with idiopathic Parkinson’s disease.

Method: Data was collected and analysed for our new eight week exercise and wellbeing program for Parkinson’s disease. Allied health clinicians delivered intensive strength and strategy training, falls prevention education and provided social support for three hours per visit, twice weekly. Groups consisted of 4-8 people and were located at North Eastern Rehabilitation Centre.

Results: There was increased patient confidence in analysis and management of their own falls risk, increased confidence implementing movement and risk management strategies in the community, improved symptom management, and reduced objective falls risk. Data from questionnaires (FES-1, PDQ-39), objective testing (UPDRS, TUG, 6 metre walk test) and patient satisfaction forms uniformly showed positive and clinically significant improvements for the patients that attended the program.

Significance of the findings to allied health: Current results indicate potential for intensive multi-disciplinary training to improve health and wellbeing in people living with Parkinson’s disease. A larger randomised trial is required to confirm results.

Biography

Allied Health clinicians at North Eastern Rehabilitation Centre with a special interest in the management of Parkinson’s Disease.

Development and evaluation of a Community of Practice (CoP) to reduce waiting time for community outpatient services

Ms Annie Lewis1,2, Professor Nicholas Taylor1,2, Dr Katherine Harding1,2

1Eastern Health, Box Hill , Australia, 2La Trobe University, Bundoora, Australia

Abstract: 

Aim: To determine whether a CoP promotes translation of an innovative, effective model of access and triage, and improves timely access to community outpatient services.

Method: This is part of a broader study which found wait times could be reduced by 34% using the Specific Timely Appointments for Triage (STAT) model. The CoP aimed to promote engagement for uptake of research evidence with three components: a shared goal, social engagement and availability of resources. The CoP was developed after a series of STAT implementation workshops from participants who expressed a desire for ongoing engagement. Workshop participants were invited to join a CoP through an email or Facebook group. Initial analysis measured the engagement interaction, reach and impact of the CoP.

Results: A total of 174 people have attended workshops from 35 Victorian health services. Of these 95 have engaged in the CoP in an email group (n=95) and a closed Facebook group (n=15). In the first 3months interaction has included a total of 32 Facebook posts, with 122 views. Positive feedback from participants indicates that the CoP has started to have reach and impact, with strong interest expressed in implementing the model in two health services.

Significance of the findings to allied health: Changing practice, based on evidence, is a challenge for researchers. This provides an example of how a CoP, with a common goal of reducing wait times for community outpatient services, social engagement and sharing of resources can be used to translate research findings into practice.

Biography:

Annie is a project officer working on the STAT model of Access and Triage. She is currently undertaking a Masters by Research investigating the outcomes of waiting for health services. Her interests lie in health service development particularly in the area of ambulatory care. Her background is in Occupational Therapy with experience in acute, sub-acute, community and educational settings.

Implementing evidence based education and exercise for knee osteoarthritis

Mr Matthew Francis1, Dr Jo Kemp1, Mr Matthew Francis1, Mrs Karen Dundeles1, Dr Jason Wallis1,3, Prof Ewa Roos4, A/Prof Soren Skou4, Prof Kay Crossley1, Dr Christian Barton1,2

1La Trobe Sport and Exercise Medicine Research Centre, , , 2Deparment of Surgery, St Vincents Hospital, University of Melbourne, , , 3Cabrini Hospital, , , 4University of Southern Denmark, ,

Abstract: 

Aim: Evaluate the feasibility of implementing an evidence based physiotherapy led 8-week education and exercise program for people with of knee OA – Good Life with osteoArthritis (GLA:D®).

Method: 40 physiotherapists (public and private) were trained to deliver GLA:D®, and implementation was supported where necessary. Knowledge and confidence to deliver evidence-based education and exercise was evaluated before and after. Patients attending a subset of GLA:DTM Australia programs completed outcomes at baseline and 3-months, including worst pain in the previous week and the knee osteoarthritis outcome score quality of life subscale (KOOS-QoL).

Results: The proportion of physiotherapists with adequate confidence to implement elements of evidence based care for knee OA increased from before to after the workshop, including prescription of resistance (80% to 100%), aerobic (69 to 88%) and functional (44 to 100%) exercise; and tailor education on self-management (84 to 100%), physical activity (61 to 100%), and weight management (64 to 80%) to people with knee OA improved following the workshop. GLA:DTM Australia was implemented in private practice, private hospital, public hospital and community health settings. Data from 69 patients (across all settings) indicated a 37% reduction in pain and a 12 point improvement in KOOS-QoL at 3-months.

Significance of the findings to allied health: GLA:DTM Australia improves physiotherapist knowledge and confidence to provide evidence-based education and exercise. Implementation of GLA:DTM Australia is feasible in public and private settings and leads to clinically meaningful improvements in pain and joint related quality of life.

Biography: 

Dr Barton works in both research and private practice treating sports and musculoskeletal patients in Melbourne. He currently holds a Post-Doctoral Research Fellow and is the Communications Manager at La Trobe’s Sport and Exercise Medicine Research Centre. He is currently studying a Communications Masters focussed on Journalism Innovation. Dr Barton is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine. Locally, he is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, is a guest lecturer at La Trobe University and the University of Melbourne, and provides regularly workshops to physiotherapy groups.

Dr Barton’s research interests focus on knee, running injuries and knowledge translation including the use of innovative digital technologies. He is regularly an invited speaker both nationally and internationally, presenting on these topics. Additionally, he runs popular courses on knee pain and running injury management in Australia, the United Kingdom, Europe and Scandinavia.

Measuring research translation: Introducing evidence briefs.

Dr Tilley Pain1,2

1Queensland Health, Townsville, Australia, 2James Cook University, Townsville, Australia

Abstract: 

Aim: The aim of this work was to document change in clinical practice from allied health research. Allied health professionals are emerging researchers. However, metrics for their success is the same as other research –  papers and citations. These metrics are important but they do not measure an important aspect – practice change.

Method: The Townsville Hospital and Health Service (THHS) is building research capacity with the aim of improving clinical practice. Therefore, an instrument to measure the impact of research on clinical practice was sought by the Research Fellow employed in the role.

Results: Our solution was to imitate the Deeble Institute’s Health Policy Evidence Brief – a one page document to help policy makers quickly find what evidence exists in a topic area, describe how compelling it is and the implication for policy.

THHS named the document Health Practice Evidence Brief. The purpose of the Evidence Brief is to provide a one page summary for THHS decision makers describing the clinical problem or gap, the research evidence to solve the problem or fill the gap and the resulting practice change.

Significance of findings: Six Health Practice Evidence Briefs have been developed to date. They document a wide variety of practice change including: removal of a week’s delay between simulation and treatment for prostate cancer patients; all patients on fluid only diets referred to a dietitian if length of stay is 3 days or more; and patients continue wearing antibiotic infusion pumps during concurrent hyperbaric treatment.

Biography: 

Dr Tilley Pain is a Principal Research Fellow at Townsville Hospital and Health Service. Her role includes building the research capacity of allied health professionals and conducting relevant research. Her research interests include building allied health research capacity, healthy aging and health economics.

Reducing the cancer malnutrition burden: highlights of state-wide collaborations in Victoria

Ms Jenelle Loeliger1, Ms Jane Stewart1, Ms Belinda  Steer1, Dr Nicole Kiss2

1Peter Maccallum Cancer Centre, Melbourne, Australia, 2Deakin University, Burwood, Australia

Abstract: 

Aim: Cancer malnutrition is common and associated with poor outcomes. The Victorian Cancer Malnutrition Collaborative (VCMC) program of work is a state-wide collaboration between Peter Mac, Victorian state government, Victorian health services and other interested parties. VCMC projects aimed to increase understanding and knowledge, and promote strategies for action in order to address cancer malnutrition.

Method: VCMC projects consisted of repeat biennial malnutrition point prevalence studies (PPS), local health service and state-wide projects developing/evaluating resources for patients and health professionals, targeted clinical redesign/implementation projects and system-wide improvements.

Results: Work over the past 8 years has identified the extent of cancer malnutrition in health services, identified service gaps and developed and evaluated resources (including eLearning packages targeting cancer care clinicians, nutrition governance toolkit for practical health service application). More than 22 local and targeted state-wide projects were conducted 2013-16, focused on improving clinical pathways of care, sustainability of resources, improving malnutrition screening in culturally and linguistically diverse populations and hospital food service models. Cancer malnutrition PPS were conducted in each phase and demonstrated a state-wide reduction in malnutrition prevalence from 31% (2012, n=1693), 26% (2014, n=1913) to 25% in 2016 (n=1351). Work in 2017-18 has highlighted clinical practice and education needs in the primary care and community sector in regards to cancer malnutrition.

Significance of the findings to allied health: State-wide collaboration has led to measurable improvements in patient and organisational outcomes, reduced variation through sharing/delivering best practice nutrition approaches and improved multidisciplinary awareness of cancer malnutrition.

Biography:

Jenelle Loeliger is an Advanced Accredited Practising Dietitian and currently the Interim Director of Allied Health at Peter MacCallum Cancer Centre. She is passionate about implementing evidence based practice into usual care and ensuring patients with cancer have access to high quality allied health services. Jenelle conducts projects/research across various areas within cancer and provides state-wide leadership to the Victorian Cancer Malnutrition Collaborative program of work which helps to reduce the burden of malnutrition on patients with cancer.

SENSe Partnership: A Network of sites and ‘up-skilled’ therapists to deliver best-practice stroke rehabilitation of the upper limb

Prof. Leeanne Carey1,2, Ms Liana Cahill1,2,3, Mr Brendon Haslam1,2, Ms Yvonne Mak-Yuen1,2, Dr Megan Turville1,2, Ms Cheryl Neilson1, A/Professor Natasha Lannin1,4, Professor Vincent  Thijs2,5, Professor Susan Hillier6, Professor Michael Nilsson2,7

1La Trobe University, Occupational Therapy, Bundoora, Melbourne, Australia, 2Florey Institute of Neuroscience and Mental Health, Heidelberg, Melbourne, Australia, 3Australian Catholic University, Melbourne, Australia, 4Alfred Health, Prahran, Melbourne, Australia, 5Austin Health, Heidelberg, Melbourne, Australia, 6University of South Australia, Adelaide, Australia, 7The University of Newcastle, Newcastle, Australia

Abstract: 

Aim: Effective therapies are available to improve hand function. However, our national survey found that stroke survivors with impaired touch sensation are not receiving recommended best-practice therapy. We aim, through our partnership of clinicians, health providers, consumers, researchers and academics, to increase access to best-practice upper-limb rehabilitation and thus achieve better outcomes for stroke survivors.

Method: We developed a ‘knowledge transfer’ intervention, guided by the Theoretical Domain Framework and Behaviour Change Wheel, to change clinician behaviour and increase access.  A network of 12 sites and approximately 100 ‘upskilled’ therapists will participate in the implementation intervention, delivering best-practice upper-limb therapy to 336 stroke survivors. This pragmatic before-after study design involves 8 Australian health organisations and 4 specialist therapy centres. Outcomes will be analysed in relation to generalist and specialist sites of delivery and skill level of therapists.

Results: 87 therapists from 8 health organisations reported low confidence in their skill level to assess (mean 4.5/10 on visual analogue scale) and treat (mean 3.8/10) sensory loss, supporting the need for upskilling. Therapists identified competing workload demands and priorities as organisational barriers within the current system.

Significance of the findings to allied health: Findings support a role for upskilling of therapists and complementary services to help increase access to best-practice stroke rehabilitation. This partnership project will deliver a knowledge translation hub, specialist therapy centres, a community of upskilled therapists and an exemplar implementation intervention for translating recommended best-practice interventions into the clinic and community environment.

Biography: 

Professor Leeanne Carey is Professor of Occupational Therapy and Discipline Lead, School of Allied Health, La Trobe University and Clinical Research Lead and Head of the Neurorehabilitation and Recovery research group in the Stroke Division, Florey Institute of Neuroscience and Mental Health in Australia. Dr Carey’s research program focuses on stroke rehabilitation and recovery: in particular how the brain adapts and how we might harness that potential in rehabilitation. She has developed successful neuroscience and learning-based sensorimotor interventions and evidence-based assessments. An important focus has been to translate these discoveries into clinical practice and better outcomes for stroke survivors.

Engaging in an evidence-based osteoarthritis management program: Referrer and patient perspectives

Dr Christian Barton1,2, Mr James Sherwood3, A/Prof  Ilana Ackerman3,4, Dr Tash Brusco3, Ms Sophie Jennnings3, Mr Kirby Young3, Prof Kay Crossley1, Dr Jo Kemp1, Dr Jason Wallis1,3

1La Trobe Sport And Exercise Medicine Research Centre, , , 2Deparment of Surgery, St Vincents Hospital, University of Melbourne, , , 3Cabrini Hospital, , , 4Monash University, ,

Abstract: 

Aim: To explore barriers and enablers (from referrer and patient perspectives) to engagement with an evidence-based, 8-week physiotherapy-led education and exercise program for knee osteoarthritis (OA).

Method: Semi-structured individual interviews were conducted with people with knee OA and potential referrers (GPs, surgeons, rheumatologists) to physiotherapy care. We explored barriers and enablers to participation in a specific 8-week OA education and exercise program – Good Life with osteoArthritis from Denmark (GLA:D®), as well as other non-surgical and surgical care for knee OA. Initial framework analysis was followed by an inductive and grounded approach, supported by NVivo software, until no new themes emerged.

Results: Twenty people with knee OA (including 10 who had completed GLA:D®), and 15 doctors (5 GPs, 5 surgeons, 5 Rheumatologists) participated in the interviews. Key barriers to education and exercise participation perceived by both patients and referrers included financial and physical access issues, and beliefs that other treatments would be more beneficial (pharmaceuticals, surgery). Key enablers perceived by both patients and referrers included a doctors’ recommendation and program availability. Patients also highlighted time constraints as a key barrier, and that understanding OA and the potential benefits of exercise was a key enabler.

Significance of the findings to allied health: Participation in evidence-based knee OA programs such as GLA:D® may be increased by improving access (funding and service availability), and developing resources to educate patients and doctors about the value of education and exercise for knee OA management.

Biography: 

Dr Barton works in both research and private practice treating sports and musculoskeletal patients in Melbourne. He currently holds a Post-Doctoral Research Fellow and is the Communications Manager at La Trobe’s Sport and Exercise Medicine Research Centre. He is currently studying a Communications Masters focussed on Journalism Innovation. Dr Barton is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine. Locally, he is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, is a guest lecturer at La Trobe University and the University of Melbourne, and provides regularly workshops to physiotherapy groups.

Dr Barton’s research interests focus on knee, running injuries and knowledge translation including the use of innovative digital technologies. He is regularly an invited speaker both nationally and internationally, presenting on these topics. Additionally, he runs popular courses on knee pain and running injury management in Australia, the United Kingdom, Europe and Scandinavia.

Factors influencing current Evidence-Based Practice in Allied Health and Community Services

Dr Tamara Tse1,2, Dr Robyn O’Halloran1,2, Ms Sophie Heywood2, Dr Lyndal Hickey1, Ms Natalie Simmance1, Dr Stephan Maloney3

1St Vincent’s Hospital Melbourne, Fitzroy, Australia, 2School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora , Australia, 3School of Primary and Allied Health Care, Faculty Medicine Nursing and Health Sciences, Monash University, Frankston, Australia

Abstract: 

Aim: to map the factors influencing current Evidence-Based Practice (EBP) across Allied Health and Community Services (AH&CS) in a tertiary hospital to inform the development of a hospital AH&CS EBP plan.

Method: a mixed methods study was conducted within and across AH&CS.  All AH&CS clinicians and managers were invited to participate in a survey using visual analogue scales (0=not at all, 10=completely) and free text responses about the influence of EBP components: research evidence, clinical expertise, patient values, and organisational expectations, on clinical practice. Managers also completed an audit of current EBP activities underway in their respective departments.

Results: 160 surveys and 11 departmental audits were completed. Clinicians reported that clinical practice was largely influenced by clinical experience (mean=8.0 SD=1.3), followed by research evidence (mean=7.5 SD 1.5), patient values (mean=7.5 SD 1.6), and finally by organisational expectations (mean=7.1 SD 1.8). The range of EBP activities included; clinical practice skills (24%), research skills (16%), teaching and education (12%), communication skills (15%), leadership skills (14%), other skills (11%) and career development (7%). Grade 4 clinicians had the most time dedicated to research and project work (116 hours per week) and grade 1 clinicians the least (11 hours).

Significance of findings to allied health:

EBP is a key competency for AH professionals and an attribute of a developed research culture. Understanding current practice is an essential first step in the development of a sustainable EBP workforce and culture for Allied Health.

Biography: 

Tamara Tse is an occupational therapist with over 10 years clinical experience in junior, senior and management positions, over 7 years research experience and two years in academia.  As an occupational therapist and occupational scientist, her research interests and expertise have concentrated on understanding what people do and why they do what they do. Her doctoral research explored the consequences of stroke, including depressive symptoms and cognitive impairment using a mixed methodology to understand occupational participation after stroke.

Tamara committed to capacity building of health professionals, and teaching and mentoring post-graduate occupational therapists to undertake research and quality projects to improve the service they provide and the care they provide to their patients.  She is the project officer and associate investigator of the funded research project being presented today.

Ethnography in nutrition and dietetics research shows opportunities for allied health

Mrs Ella Ottrey1,2, Miss Jessica Jong1, A/Prof Judi Porter1,2

1Monash University, Notting Hill, Australia, 2Eastern Health, Box Hill, Australia

Abstract: 

Aim:

Ethnography is a qualitative research approach traditionally used in anthropology to learn about people and their culture. This systematic review evaluated the extent, range, nature and contribution of ethnographic methodology in nutrition and dietetics research.

Methods:

Eight databases were searched from inception until November 2017. Original articles were included when reporting on empirical studies using ethnographic methodology (at least observation) to inform dietetic practice. A supplementary hand-search of reviews identified in the database search was undertaken. Independent assessors screened 1,008 titles and abstracts, with 284 full texts reviewed. Of these, 92 studies were included. Quality was appraised using the Critical Appraisal Skills Programme tool.

Results:

Use of ethnography has accelerated over the past two decades. Ethnography has been applied to public health nutrition (n=72), clinical nutrition (n=13) and foodservice (n=7) research. Inquiry commonly focused on infant/child feeding, food choice, diabetes, nutrition in schools and food security. Interview (n=85), focus groups (n=17) and document analysis (n=10) were commonly used to collect data in combination with observation. Ethnographic studies illuminated sociocultural factors that underpin dietary beliefs and practices, informed training opportunities, programs and interventions, and identified target areas for policy and guidelines. Rigour and the quality of reporting varied considerably.

Significance of the findings to allied health:

Ethnography can strengthen understanding of complex health issues and their determinants, advancing efforts to improve health and wellbeing. Many opportunities exist to apply ethnographic approaches in allied health research contexts, such as to explain health inequalities, direct policy and inform intervention design and delivery.

Biography: 

Ella Ottrey is a clinical dietitian with 10 years of experience across a number of Victorian healthcare services. She is currently undertaking her PhD at Monash University exploring mealtimes in subacute care.

Cost effectiveness of a model to improve access to community outpatient services

Dr David Snowdon1, Prof Nicholas Taylor1,2, Dr Katherine Harding1,2, Prof Sandra Leggat2, Prof Bridie Kent3, Ms Annie Lewis1, Dr Jennifer Watts4

1Eastern Health, Box Hill, Australia, 2La Trobe University, Melbourne, Australia, 3Plymouth University, Plymouth, England, 4Deakin University, Melbourne, Australia

Abstract: 

Aim: An alternative model for access and triage (Specific Timely Appointments for Triage: STAT) reduces time from referral to first appointment for community outpatient services by 34%. We aimed to determine from a health service and societal perspective whether STAT was cost effective compared to a waitlist management model.

Method: Cost effectiveness analyses were completed alongside a multi-service, stepped wedge randomised controlled trial. Participants were patients referred to community outpatient services. During the experimental period patients were triaged to services using the STAT model. During the control period patients were triaged using a waitlist management model. Waiting time was the key outcome and incremental cost effectiveness ratios (ICERs) were reported from societal and health service perspectives.

Results: Economic data were collected from 278 patients in the control period and 279 patients in the experimental period. The ICER from a societal perspective showed a saving of $AUD 203 (95%CI -43 to 501) per day of reduction in waiting in the experimental group compared to the control group. Cost savings were mainly due to lower personal care costs and a reduction in loss of income. There were no significant differences in costs from the health service perspective.

Significance of findings to allied health: STAT significantly reduced waiting times and likely reduced costs associated with waiting for patients referred to community outpatient services at no cost to the health service, which increases the likelihood of translating STAT into practice.

Biography: 

David Snowdon is the Sub-acute Allied Health Research Lead at Peninsula Health and recently submitted his PhD thesis on the effectiveness of clinical supervision of allied health professionals. As a qualified Physiotherapist, he has worked in the healthcare sector for approximately 10 years.

David’s research has primarily investigated the effectiveness of clinical supervision in supporting allied health professionals and its effect on patient quality of care. He has also worked as a project officer on an NHMRC funded project investigating the effects of a new model of access and triage on waiting times for patients referred to community outpatient services.

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