Group exercise following hip or knee arthroplasty in inpatient rehabilitation

Ms Angel Ching1, Dr Jodie McClelland1, Dr Kate Webster1

1La Trobe University, Bundoora, Australia

Aim: To evaluate whether group exercise does not lead to inferior self-reported, impairments and functional outcomes compared to one-to-one exercise in an inpatient rehabilitation setting for patients with hip or knee arthroplasty.

Method: Eighty-eight patients were allocated to either group-based exercise (n=48) or one-to-one exercise (n=40) during their inpatient rehabilitation.  Participants in the one-to-one exercise group received two sessions of one-to-one exercise whilst participants in the group-based exercise group received one session of one-to-one exercise and one session of group exercise. The primary outcome of Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to determine non-inferiority of the study. Non-inferiority margin was set at 10 for WOMAC. Other measures included quadriceps strength, the Time Up and Go, 10 Meter Walk Test , Six Minute Walk Test, cadence, velocity, stride length, hospital length of stay and patients’ satisfaction were used as secondary outcomes. Outcomes were assessed on admission, at hospital discharge and at six months.

Results: Group exercise was shown to be non-inferior to one-to-one exercise in WOMAC. The upper limit of 95% confidence interval of the mean change between admission and discharge (p= 0.23), and between admission and at six month (p=0.97) lied between zero and the non-inferiority margin.  Group exercise was also shown to be non-inferior to one-to-one exercise in secondary outcomes both at hospital discharge and at six month post-operatively.

Significance of the findings to allied health: Rehabilitation service providers may consider implementing more group exercise programs to improve the efficiency of the services and without compromising patients’ clinical outcomes at hospital discharge.

Exercise physiology for chronic disease management

Dr Natalie Saunders1, Prof Steve  Selig1, Ms Niamh Mundell1, Mr  Steve Foulkes1, Mr Dan Van Den Hoek1

1Deakin University, Burwood, Australia

Aim: This symposium aims to showcase the importance of a multi-disciplinary approach to the management of chronic disease with the integration of an Accredited Exercise Physiologist (AEP) exercise intervention.

Significance of the findings to allied health: Exercise intervention is a critical component in the management of chronic disease. The cases presented demonstrate the role of exercise intervention for managing chronic and complex conditions and the importance of AEP led exercise prescription, in the multi-disciplinary setting. Case studies include:

  1. Establishing safe exercise for severe labile hypertension and hypotension
    Exercise physiology for a 56 year male with severe labile hypertension and hypotension. The challenge of prescribing exercise in this case was that exercise increases blood pressure (BP) and the client experiences episodes of unpredictable excursions of BP daily. With high BP small bursts of moderate intensity exercise as a warmup engendered rapid onset hypotensive responses that provided a window to prescribe interval training; low BP and asymptomatic, allowed for continuous exercise to raise BP.
  2. Multimodal exercise for advanced prostate cancer
    Multimodal exercise for a 76 year old man with castrate resistant prostate cancer: Prostate cancer treatments are associated with a number of comorbidities. A multimodal exercise training program was implemented to preserve bone mineral density, lean mass and cognitive function with considerations for fatigue, T2D, depression and multiple metastases.
  3. Exercise during very low calorie diet: Body composition, strength and function changes
    Exercise in conjunction with diet restrictions for a 40 year old obese female with PCOS: Rapid weight loss is associated with a significant decline in lean mass and in turn, functional capacity. An exercise program was implemented to preserve lean mass during rapid weight loss and to improve functional capacity.

Enabling better life outcomes for stroke survivors

Ms Fiona McKinnon1, Dr Kim Brock1, Dr Tamara Tse1, Dr  Carol Silberberg1, Dr Christine Graven1

1St Vincent’s Hospital, Melbourne, Melbourne, Australia

Aim: To promote clinical review and evidence based interventions for chronic stroke survivors and their carers through interdisciplinary capacity building using an eLearning package and competency evaluation.

Method: This project involved development of the Chronic Stroke Review Tool and Intervention Guide (Chronic Stroke Rev-TIG). In the first stage, a document was developed focusing on 10 domains, including participation, functional decline, mood, secondary stroke prevention, carer concerns and goal setting.  For each domain, the tool provided background information, a screening assessment and evidence based interventions and referral options. In the pilot implementation phase, this document was utilised at 8 community rehabilitation centres and feedback obtained from stroke survivors and clinicians. Revisions were made, most importantly inclusion of emotional adjustment to life after stroke. In the third phase of the project, the tool has been transformed into an eLearning package, inclusive of a competency assessment to become an accredited assessor. The eLearning package will be hosted on Inform me, the Stroke Foundation’s dedicated website for health professionals.

Results: The Chronic Stroke Rev-TIG eLearning tool has developed into an interdisciplinary practice guide. The four presenters will provide an overview of the interdisciplinary components of the Rev-TIG, then focus on 4 specific areas; participation, mood,  emotional adjustment to life after stroke and goal setting as key domains for conducting post stroke reviews.

Significance of the findings to allied health: The Chronic Stroke Rev TIG eLearning package enables allied health clinicians to conduct comprehensive chronic stroke reviews and formulate plans for appropriate interventions and referrals.