Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a Randomised Controlled Trial

Ms Lucia Michailidis1,2, Dr Shan Bergin2,3, Prof. Terry Haines3, Dr Cylie Williams1,3

1Peninsula Health, Frankston, Australia, 2Monash Health, Clayton, Australia, 3Monash University, Frankston, Australia

Abstract:

Aims:
This study aimed to determine the proportion of DFUs healed using non-surgical sharps debridement versus low frequency ultrasonic debridement (LFUD).  Secondary aims included quality of life and assessment of ulcer pain.

Method:
Individuals with DFUs attending the Podiatry Department 2013-2015, at a major metropolitan health network in Melbourne, were screened against study eligibility criteria.  Eligible participants were randomly allocated to either the non-surgical sharps debridement (control) group or the LFUD (intervention) group and received weekly treatment for 6 months.  Participants also completed a quality of life questionnaire and visual analogue pain scale at regular time points.

Results:
Ten participants with 14 ulcers received weekly debridement for 6 months.  Results were analysed using a survival analysis approach.  Ulcers treated with non-surgical sharps debridement healed more quickly (61.6 days ± 24.4) compared with those treated with LFUD (117.6 days ± 40.3).  In both groups, quality of life was observed to improve as ulcers healed and pain reduced after treatment.

Conclusion:
This study resulted in an interesting observation that non-surgical sharps debridement may lead to faster healing of DFUs when compared to LFUD.   However, the small sample size makes it challenging to draw conclusions that will impact clinical practice.  The greatest limitation of this study was the difficulty recruiting participants.   Further research is required to investigate the clinical and economic efficacy of these two debridement modalities in the management of DFUs.

Biography:

Lucia completed a Bachelor of Podiatry at La Trobe University in 2008.  On completion of the degree she was the recipient of an Award for Excellence in clinical practice by the Australian Podiatry Association (Vic) and attained inclusion on the La Trobe University Dean’s Honours List.

She has worked at three of Victoria’s largest health networks over the past eight years and is well experienced in managing the high-risk foot population in the Melbourne Metropolitan area.

Lucia has recently submitted her PhD investigating the use of low frequency ultrasonic debridement compared with non-surgical sharps debridement in the management of diabetes-related foot ulcers.

Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a Randomised Controlled Trial.

The success of video and written implementation strategies for knowledge translation in nursing and allied health: a novel helix randomised study

Mr Mitchell Sarkies1, A/Prof Stephen Maloney1, Dr Mark Symmons1, Prof Terry Haines1

1Monash University, Melbourne, Australia

Abstract:

Aim:
Allied health and nursing professionals are involved in the management of hospital presentations and the prevention of adverse clinical events. Ensuring these services are informed by high quality, contemporaneous evidence supports allied health to consistently provide the best patient outcomes through efficient use of available resources. In order to maintain evidence-informed practice in an increasingly complicated healthcare environment, allied health professionals may benefit from more effective dissemination of research findings. This study will present a novel helix counterbalanced RCT to investigate the effectiveness of video and written research implementation strategies compared to a no-information control across three health contexts.

Methods:
The three contexts related to the benefits of exercise following deep vein thrombosis, use of bedside alarms to prevent falls, and falls prevention education materials without follow-up to reduce falls. The study was performed via an online survey to allied health and nursing staff at Monash Health. A knowledge test measuring alignment between respondent perceived benefit of the healthcare intervention and conclusions listed in the journal article was the primary outcome.

Results:
There were 119 participants recruited. Exposure to the video-modality increased the likelihood of a knowledge-test response that was aligned with the research evidence compared to the no information control (OR 2.61; 95% CI 1.40, 4.89; p=0.003), but this was not the case for exposure to written-modality (OR 1.39; 95% CI 0.75, 2.57; p=0.294).

Significance:
Providing video-based evidence summaries to allied health and nursing staff increases the likelihood they will understand the main findings from research articles.

Biography:

Mitchell Sarkies is a physiotherapist and health services researcher with an interest in implementation science. He practices clinically at Monash Health and is completing his PhD candidature at Monash University.

An exploration of Social Work practice in Emergency Departments (ED) of leading Australian Trauma hospitals

Ms Sharon Wells1, Ms Joanne Maret1

1Royal Melbourne Hospital, Parkville, Australia

Abstract:

Aim:
Best practice Social Work includes timely, client-centred and strength-based interventions and processes. With little published research on Social Work services in response to major traumas in ED settings, this study aims to explore current Social Work practice in this context.

Method:
Mixed-method, cross-sectional survey and interviews with Social Workers.

Results:

  • Social Work service standards were associated with: 24-hour Social Work service provision; mean EFT of 4; formalised referral and assessment processes; continuity of care.
  • The hours of Social Work service and number of rostered professionals did not always correspond to peak times, or numbers of ED presentations.
  • Data analysis highlighted the high rates of major trauma and bereavement in ED, and specialist Social Work involvement in crisis-intervention, psychological first aid and bereavement support.

Significance:
Published studies indicate the significant immediate and long-term psychosocial impacts of major trauma on the lives of patients and families. Social Workers are equipped with a specialised skill set to mitigate these effects.

This study found a mismatch between the peak times of major traumas, and Social Work service provision, suggesting a risk for patient and family outcomes, as well as placing an additional burden on medical teams.

Reaching benchmarked standards of service provision, as well as creating a dedicated Social Work role to respond to traumas, may improve patient and family outcomes, and ensure the simultaneous duty of care responsibilities in ED are not compromised.

Biography:

Sharon Wells is a graduate of Master of Social Work (RMIT). With a background in Strategic Management and Communications, Sharon has initiated social and cultural change projects including the protection and enhancement of significant Aboriginal cultural heritage sites. Joanne Maret has recently completed a Bachelor of Social Work (Honours) and Psychology. With previous experience in the homelessness sector, Joanne has worked on relevant projects including Rooming House Closure Projects and her Honours research.  Sharon and Joanne jointly undertook a research placement at the Royal Melbourne Hospital examining the role of Social Work in response to major traumas in Emergency Departments.

Not just surviving, but thriving in a PhD and beyond!

Professor Robin Daly & Professor Terry Haines

This concurrent session provides research higher degree students with an opportunity to present their work in a supportive and positive environment in order to network, gain feedback and gain skills in public speaking and presentation of research projects. Doctoral, masters and honours research projects are a vehicle for research training and research translation. We suggest helpful tips and tricks and strategies to survive and thrive in higher degree studies and beyond. We focus particularly on the importance of knowledge generation, thinking time, time-management, planning and getting the most out of the supervisory team.  Making the research journey enjoyable and low stress  is promoted, as well as successfully transitioning to post-doctoral roles.

The feasibility of conducting a randomised controlled trial of the effectiveness of home visits by occupational therapists after hip fracture

Ms Kylee Lockwood1,2, Professor Nicholas Taylor1,2, Ms Jude Boyd2, Dr  Katherine Harding1,2

1La Trobe University, Melbourne, Australia, 2Eastern Health, Melbourne, Australia

Aim

To examine the feasibility of conducting a randomised controlled trial of the effectiveness of pre-discharge home visits by occupational therapists in patients after hip fracture.

Method

The planning and implementation of a randomised controlled trial was explored within a feasibility framework. The key areas explored included: acceptability, demand, implementation, practicality, adaptation, integration, expansion and efficacy. Consideration was given to the potential ethical dilemma associated with the withdrawal of such an established and accepted intervention for those allocated to the control group.

Results

The trial aimed to recruit 74 participants and was supported by a small grant. There were high levels of acceptability from clinicians and patients including those allocated to the control group. There was a demonstrated demand with recruitment completed within 6 months. The trial was successfully implemented over a large geographical area and practicality was demonstrated with over 95% of home visits completed before discharge. The trial adapted usual practice by building in formal evaluation and follow-up, and the process was well integrated into the health service. Data on efficacy will be presented and the potential for expansion evaluated with economic evaluation.

Significance of the findings to allied health

It was feasible to conduct a randomised controlled trial of home visits after hip fracture in a large health service. Key to the feasibility was resources and planning put into the project.The feasibility of studying this intervention needed to be evaluated as evidence-based practice is important in the delivery of health care.

 

Patient perceptions of telerehabilitation consultations post-stroke

Ms Melissa Prause1,2, Dr Kathleen Bagot1

1The Florey Institue of Neuroscience and Mental Health, Melbourne, Australia, 2The University of Melbourne, Melbourne, Australia

Aim: To determine stroke patients’ perceptions of consultation with health professionals through telerehabilitation in their home environment.

Method: The databases Cinahl, Medline, PsycINFO, Embase, PubMed, Cochrane Database of Systematic Reviews, Web of Science and Proquest were searched during May 2016. Reference lists from systematic reviews and individual articles were hand searched. Studies were included if they were published in English, recruited participants who were stroke survivors, involved telerehabilitation through synchronised consultation between the participant and the researcher/therapist and assessed the participant’s perceptions of telerehabilitation. Studies were excluded if they were not published in English, focussed on acute stroke treatment, recruited participants other than stroke survivors, did not assess participant perception of telerehabilitation, provided rehabilitation through virtual reality/ robotic therapies or focussed solely on the perceptions of therapists or carers. The quality of included studies was assessed using the Effective Public Health Practice Project tool.

Results: A total of seven studies across eight articles were eligible for analysis. These included three cohort studies, one qualitative focus group and three descriptive study designs. The disciplines involved included Speech Therapy, Neuropsychology, Occupational Therapy and Physiotherapy. While the quality of the studies was low, participants were highly satisfied with telerehabilitation and were agreeable to future use. However, participants felt it was still important to have some face to face contact with their therapists. These findings were limited to chronic stroke patients with mild impairments.

Significance of the findings to allied health: Based on participant’s perceptions, there is potential for the use of telerehabilitation in home-based stroke rehabilitation. However, if future research is to guide practice, it should involve patients in the first 6-12 months of their rehabilitation and consider potential barriers to telerehabilitation in the home.

 

Cancer-related fatigue guidelines in Australia

Ms Elizabeth Pearson1, Professor Meg Morris2,3, Dr  Carol McKinstry1

1La Trobe University, Bendigo, Australia, 2La Trobe University, Melbourne, Australia, 3Healthscope, Bundoora, Australia

Aim: Cancer-related fatigue (CRF) impacts activities of daily living, causing distress for people living with cancer. Evidence-based guidelines for CRF are available, yet inconsistently implemented. This study aimed to identify barriers and enablers to applying a CRF guideline in Australia and develop implementation strategies.

Method: A mixed-method study explored the feasibility of implementing the Canadian Association for Psychosocial Oncology (CAPO) cancer fatigue guideline. Australian health professionals, managers and consumers with relevant experience of CRF participated in a modified Delphi study with two survey rounds. A reference group contributed to the study design and reviewed questionnaires.

Results: 45 health practitioners and managers, and 68 cancer survivors completed one or two surveys. More than 75% of participants endorsed the CAPO fatigue guidelines. Barriers included a perceived lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation were its complexity, limited practical details for some elements, and lack of assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of professional disciplines in CRF management, (3) to integrate CRF management into policy and practice, (4) ensuring a consumer-focused approach to CRF.

Significance of findings to allied health: Allied health professionals in many settings have key roles in applying CRF guideline recommendations. Implementation may be enhanced by professional education, integration with existing practices, operationalizing and simplifying recommendations, designating roles and access to implementation tools.

Development and factor structure of the Classroom Environment Questionnaire (CEQ)

Ms Carissa Lyons1, Dr Ted Brown1, Dr Helen Bourke-Taylor1

1Monash University, Frankston, Australia

Aim:

Occupational therapists offer a unique perspective regarding the environment’s contribution to occupational performance, and as such, would benefit from an assessment tool that measures the unique characteristics of the primary school classroom environment where children complete their schoolwork activities. The aim of this study was to develop and psychometrically evaluate a new teacher report questionnaire to measure characteristics of the physical, social, temporal, institutional and cultural primary school classroom environment.

Method:

The Classroom Environment Questionnaire (CEQ) utilises a 4 point rating scale where teachers rate 51 environmental characteristics of their classroom.  Teachers also rate, on a 10 point scale, the extent to which they believe the five environmental domains mentioned above contribute to students’ schoolwork performance.  Principal components analysis was undertaken to examine the factor structure and construct validity of the CEQ, utilising a sample of 117 participants.

Results:

The CEQ was found to be multi-dimensional, with items loading onto nine viable factors representing characteristics of the classroom environment. Based on the analysis results, 20 items were removed from the scale and 31 items were retained. The factor structure of the CEQ conceptually links with occupational therapy theory and definitions regarding the constructs of the environment, with the unique nature of the classroom environment supporting a multi-dimensional scale.

Significance of the findings to allied health:

Overall, the identified factor structure of the CEQ indicates supporting evidence that the CEQ items fit together in measuring the unique, multi-dimensional construct of primary school classroom environments, and therefore has the potential to be a valuable scale for healthcare professionals.

 

Effect of pre-discharge home visits following hip fracture on readmissions

Ms Kylee Lockwood1,2, Professor Nicholas Taylor1,2, Ms Jude Boyd2, Dr  Katherine Harding1,2

1La Trobe University, Melbourne, Australia, 2Eastern Health, Melbourne, Australia

 

Aim

To investigate the rate of readmissions to hospital in the 12 months following hip fracture in patients receiving a pre-discharge home visit by an occupational therapist compared to those who did not receive a home visit.

Method

A retrospective cohort study was conducted with patients admitted to a large health service following hip fracture over a 12 month period. Routinely collected patient medical record data were analysed to determine the rate of readmissions to hospital in the 12 month period following discharge in patients receiving a home visit compared to patients who did not receive a home visit.

Results

There were 268 patients discharged over the 12 month period who met the inclusion criteria. Of these patients, 157 returned to a private residence. Twelve patients were readmitted within 30 days post discharge and 49 patients were readmitted within 12 months. Patients were 4 times more likely to be admitted for medical versus surgical complications. There was no difference in readmission rates between those who received a home visit (n=55) and those that did not (n=102) (incidence rate ratio=1.02; 95% CI 0.31-3.38).

Significance of the findings to allied health

After hip fracture transition back into the community is often difficult and hospital readmission rates are high. Home visits by occupational therapists aim to facilitate a safe and successful discharge from hospital. Home visits were not associated with a reduction in readmission to hospital in patients following hip fracture. Home visits may have other benefits not investigated in this study.

Management of older adult’s sleep post-hospitalisation

Miss Aislinn Lalor1, Associate Professsor Ted Brown1, Professor Terry Haines1

1Monash University, Melbourne, Australia

Aim: To examine what consultations and discussions older adults have with health professionals regarding their sleep quality and the management of any sleep impairments during and following hospitalisation.

Method: A mixed methods prospective longitudinal cohort study of hospitalised older adults (n=311) was completed. The Pittsburgh Sleep Quality Index was used to gather self-reported sleep quality of older participants. Open ended questions regarding discussions of the management of sleep impairments were also examined. Participants were surveyed whilst they were an inpatient and at 3- and 6-months post-discharge from hospital.

Results: Less than 20% of participants discussed sleep at any time point with the health professionals they engaged with and discussions were predominantly initiated by the participants themselves. Medication-based outcomes were opted for more frequently at each time point than evidence-based non-pharmacological options.

Significance of the findings to allied health: Allied health professionals have considerable scope to consider and discuss sleep with older adults as part of their clinical practice and to provide older clients with evidence-based non-pharmacological interventions that could assist them to reduce, minimise or prevent sleep issues.