Quality of life of children with calcaneal apophysitis

Ms Alicia James1,2, Dr.  Cylie  Williams1,2, Professor  Terry Haines2,3

1Peninsula Health , Frankston, Australia, 2Monash University, Peninsula Campus, Australia, 3Monash Health, Cheltenham, Australia

Aim:

The aim of this study was to assess and compare the child and parent perceptions of health related quality of life (HRQOL) associated with calcaneal apophysitis.

Methods

This is a longitudinal repeated measure study nested within a randomized comparative effectiveness trial. Children who had symptoms of calcaneal apophysitis were recruited from the caseload of podiatrists. The Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) was completed at five time points by both child and parent.

The demographic data were summarised with means and standard deviations and OxAFQ-C summarised with medians and interquartile ranges. The intraclass correlation coefficient (ICC) (Model 2 (2)) analysis was undertaken to compare the inter rater reliability between the child and parent proxy report. Criterion validity between parent and child for the domains of the OxAFQ-C was explored with the Bland Altman plot and the mean difference.

Results

A total of 124 participated in the study with 101 completing the OxAFQ-C at all five time points. The inter-rater reliability between the child and parent for the physical domain ranged between poor (0.06) to good (0.77) agreement, and the footwear domain ranged between poor (0.09) to good (0.66) across the time points. Both the school and emotional domains had moderate (0.46) to good (0.77) agreement.

Conclusion

Children with calcaneal apophysitis have differing perceptions of health related HRQOL impact compared to their parents. Parents initially reported greater impact than their child however there was convergence of agreement over time. These findings suggest understanding the impact from both child and parent perspective is imperative during treatment.

Transferring weekend allied health services from the acute to sub-acute setting

Ms Romi Haas1,2, Dr Kelly-Ann Bowles1,3, Dr Lisa O’Brien1,4, Professor Terry Haines1,2

1Monash University Department of Physiotherapy, Frankston, Australia, 2Monash Health Allied Health Research Unit, Cheltenham, Australia, 3Monash University Department of Community Emergency Health and Paramedics, Frankston, Australia, 4Monash University Department of Occupational Therapy, Frankston, Australia

Aim: To investigate the effect of transferring weekend allied health services from the acute to sub-acute setting on patient and service outcomes following hip and knee replacement surgery.

Method: A quasi-experimental study was conducted at a public tertiary hospital in Melbourne, Victoria, Australia.  Patient and service outcomes for patients undergoing elective or revision total hip and knee replacement (N=276) were compared during a six-month period of acute weekend allied health services (n=130) followed by a subsequent six-months when these services were transferred to the sub-acute setting (n=146). Outcome measures included mobility, functional independence, quality of life and pain (at six weeks postoperatively) and hospital length of stay, adverse events, unplanned hospital readmission and profession of staff assisting with first postoperative transfer.

Results: Approximately 20% more of first postoperative transfers were assisted by nurses rather than physiotherapists when acute weekend allied health services were not available [x2 (4, N=276)=16.94, p=0.002]. There was no difference in total length of stay between the two phases [log transformed coefficient=-0.011 (95% CI -0.038 to 0.015), p=0.396].  The reduction in acute length of stay observed when acute weekend allied health services were not available was not significant [log transformed coefficient=0.019 (95% CI -0.001 to 0.039), p=0.069].

Significance of the findings to allied health: Transferring weekend allied health services from the acute to sub-acute setting may have provided a stimulus for increased nurse involvement in early postoperative mobilisation without affecting patient outcomes.  Further research

Music-cued exercises for dementia

Miss Yasmine Gomaa1, Professor Meg Morris2

1Faculty of Physical therapy, Cairo University, , Egypt, 2Healthscope, Melbourne, Australia

Aim: To conduct a systematic review and critical appraisal of the dementia literature to understand the extent to which music facilitates movement in people with dementia.

Method: systematic review of the studies involved the use of music cued exercises aiming to improve motor and non-motor signs of dementia was conducted. The search was performed using MEDLINE, CINAHL, EMBASE, PSYCHINFO, PUBMED, SCOPUS and WEB OF SCIENCE. Two groups of keywords were searched: the first group included Alzheimer OR dementia, and the second pertaining to music and exercises.

Results: As preliminary findings, the initial search yielded 1800 citations. Applying inclusion/exclusion criteria to the title and abstract of each citation resulted in retaining of 19 papers which were limited to 12 papers after full text assessment for eligibility and to be included in the review, six of which were RCTs. Preliminary results suggested that rhythmical music can enhance motor performance in people with early dementia.

Significance of the findings to allied health: Based on the preliminary findings, evidence was built regarding the effectiveness of using music coupled with exercise in enhancing not only physical abilities of the people with dementia, but also psychological and other non-motor signs of the disease. The body of knowledge obtained from this review will provide guidance to patients, caregivers and specialists in the decision-making process.

 

Monitoring activity in the acute inpatient setting

Mrs Sarah Gilmore1,2, Dr  Jodie McClelland2, Dr  Megan Davidson2

1St Vincent’s Private Hospital Melbourne, Fitzroy, Australia, 2La Trobe University, Melbourne, Australia

Title:

Monitoring activity in the acute inpatient setting: how accurate are activity monitors?

Aim:

To evaluate the validity of the ActivPAL3, Fitbit Flex (FF) and Jawbone UP Move (JUM) in measuring step count immediately  following lumbar fusion.

Method:

Forty patients admitted to St Vincent’s Private Hospital Melbourne wore the ActivPAL3, FF and JUM on the thigh, and the FF and JUM on the wrist, while walking at a comfortable pace for two minutes. Twenty tests were completed with each monitor in each position. The number of steps taken were counted, and the number of steps detected by each monitor was recorded. Accuracy was determined by calculating the steps detected as a proportion of the observed step count.

Results:

The ActivPAL3 had a mean accuracy of 85% (SD 27%). The FF detected significantly more steps when worn on the thigh (mean accuracy 66%, SD 35%) than on the wrist (mean accuracy 24%, SD 34%). The JUM had a low mean accuracy on both the thigh (22%, SD 35%) and wrist (17%, SD 40%). When worn on the wrist, the FF and JUM had a lower accuracy when participants used a walking aid.

Significance of the findings to allied health:

There is increasing interest in measuring activity levels of hospital inpatients. This research indicates the ActivPAL3 provides an accurate measure of step count following lumbar fusion. While consumer grade activity monitors are a low cost alternative to research grade monitors, they have low accuracy in lumbar surgery patients who typically have a slow paced and irregular gait, and in patients using walking aids.

Treating children with speech sound disorders

Mrs Lisa Furlong1, Professor Meg Morris1,2, Dr. Shane Erickson1, Dr. Tanya Serry1

1La Trobe University, Melbourne, Australia, 2Healthscope Northpark Private Hospital, Melbourne, Australia

Aim

This research explored the intervention practices of paediatric SLPs in the management of childhood SSD, including their beliefs about what works, the influence of their clinical experiences and the impact of client and service-related variables on their clinical decision making.

Method

Semi-structured, in-depth interviews were conducted with 11 Australian SLPs about how they approach intervention with children who have an SSD. Analysis comprised both a content analysis to identify common factors and an inductive thematic analysis to identify key themes emerging from the interviews.

Results

Preliminary results suggest that rather than adhering to one core approach, SLPs engage in eclectic practices, whereby they combine elements from a range of intervention approaches. Insight into the perceived roles and responsibilities of the parent/caregiver, child and SLP in the intervention process was gained. The reciprocal relationship between these roles as well as with the core dimensions of reflective practice, knowledge and; organisational barriers and facilitators, provided an understanding of SLPs’ clinical decision making for this client population.

Significance of the findings to allied health

In clinical settings, a host of factors influence the decision making and subsequent standard of care provided by SLPs to children with SSD. Preliminary findings have revealed challenges unique to practising SLPs; challenges which are less common in a research environment. To facilitate evidence-based practice, SLPs need to play a role in the research process. Clinician, client and service-related barriers need to be reduced or eliminated and strategies to support knowledge translation and exchange need to be implemented.

Nurses’ on-shift physical activity levels

Miss Stephanie Chappel1, Miss Simone Verswijveren1, Dr Brad Aisbett1, Professor Julie Considine2,3, Dr  Nicola Ridgers1

1Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia, 2Deakin University, School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Geelong, Australia, 3Eastern Health – Deakin University Nursing and Midwifery Research Centre, Box Hill, Australia

Aim: To examine nurses’ on-shift physical activity levels and explore how nurses accumulate their physical activity during a shift.

Methods: A systematic search was performed using seven databases in May 2016. Articles were included if they measured nurses’ on-shift physical activity objectively and/or subjectively. Two researchers independently screened studies, extracted data, and assessed the quality of data from identified articles. A narrative synthesis was performed. The review is registered with PROSPERO and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

Results: From the 8,752 articles identified, 14 studies were included. The majority of studies objectively-measured on-shift physical activity (79%). Nurses typically engage in light-intensity physical activity (LPA) on-shift, but can accumulate up to 58% of the weekly recommended activity across one shift. Eight studies reported on nurses’ accumulation of physical activity, finding that the majority of a shift was spent standing or walking and completing direct patient care activities, some of which were of a moderate-intensity.

Significance of findings to allied health: During a shift, nurses typically engage in LPA, interspersed with moderate-intensity tasks. Interestingly, on-shift physical activity accounts for up to 58% of weekly recommended physical activity levels. However, little is known about how nurses’ accumulate this activity across a shift, and how shift patterns (e.g. rotating shifts) may impact on their activity. This would be the first step towards understanding how nurses’ cope with the physical workplace demands and possible effects this may have on workplace and patient safety.

 

The most beneficial music used in a therapeutic dance intervention

Ms Winifred Beevers1, Professor Meg Morris1,2

1La Trobe University, Melbourne, Australia, 2Healthscope, Melbourne, Australia

Aim: The effects of music and movement exercise interventions have been measured and examined, but an examination of the music used has been minimal. This research aimed to determine what it is about music that motivates and sustains people in exercising.

Method: 15 pieces of music used in therapeutic dance classes for people living with Parkinson’s Disease were analyzed. Analysis required collaboration with acoustic engineers, physiotherapists and use of specialized acoustic software. The music was all pre-recorded with no sheet music available. We investigated the music as an acoustic event, that is the tempo, key, harmonic and melodic features, fluctuations and decibel levels.

Results: The results of this interdisciplinary clinical research showed the most effective music ranged in tempo between 108 – 130 bpm, a very clear downbeat, melodic interest and minimal key modulations.

Significance of the findings to allied health: Music can support, direct and motivate movement. Music therapists advocate that music for exercise is most effective when it suits the preferences of participants and the exercise. The right music can improve exercise performance and physical activity, and reduce the perception of fatigue. Choosing music has been difficult as there are few guidelines. This research looked at the music that was most beneficial, identifies the music’s features, and provides a process for selecting similarly effective music.

Health literacy barriers and enablers in the stroke rehabilitation

Miss Jaclyn Allwood1, Dr Kylie Murphy1, Dr Lucie Shanahan2

1Charles Sturt University, Thurgoona, Australia, 2Albury Wodonga Health, Wodonga, Australia

Aim: The aim of the first phase of this study is to identify the health literacy barriers and enablers from the perspective of stroke patients during their inpatient rehabilitation at Albury Wodonga Health (AWH). The aim of the second phase is to document how allied health practitioners at AWH work to optimise the health literacy environment for stroke patients, and their ideas regarding how identified barriers can be overcome.

Method: The first phase involves semi-structured in-depth interviews with four stroke patients to explore their experiences. The second phase involves a focus group with 6-8 practitioners in the inpatient rehabilitation unit.

Results: Data collection is currently underway, but the results to be presented will uncover barriers and enablers experienced by stroke patients during their rehabilitation, and practitioner reflections on the patients’ perspectives.

Significance of the findings to allied health: The findings from this research will add to the findings of previous research which suggest that environmental factors important for health literacy vary, depending on the patient group and the disease being treated or action to be taken. This study will identify factors which may apply in other similar health services, and suggest ways in which identified enablers can be achieved and barriers can be overcome.

 

Behaviour change techniques used by physiotherapists for physical activity promotion

Ms Breanne Kunstler1, Professor Jill Cook2, Dr Nicole Freene3, Professor Caroline Finch1, Dr Joanne Kemp2, Dr Paul O’Halloran4, Dr James Gaida5

1Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP) and Federation University Australia

2Latrobe Sports and Exercise Medicine Research Centre, School of Allied Health, Latrobe University, Melbourne, Australia

3Department of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia

4School of Psychology and Public Health, La Trobe University, Melbourne, Australia

5University of Canberra Research Institute for Sport and Exercise (UC-RISE), Canberra, Australia

Aim: Identify the behaviour change techniques (BCTs) physiotherapists use when promoting physical activity (PA) experimentally and clinically.

Methods: Twelve online databases were searched for experimental and observational studies. Experimental studies reporting the efficacy of physiotherapist-led PA (PLPA) interventions delivered to adults in clinic-based private practice and outpatient settings with, or at risk of, non-communicable diseases were included. Observational studies reporting the techniques used by physiotherapists when promoting PA in these settings were also included. Experimental interventions and observational study results were coded using the BCT Taxonomy to identify the BCTs used by physiotherapists when delivering PLPA interventions and promoting PA clinically. The BCTs used in efficacious interventions were identified.

Results: Eleven studies, ranging from low to high risk of bias, were retained from the search yield of 4140. Two study types were identified: experimental studies (n=8) reporting the efficacy of PLPA interventions; and observational studies (n=3) reporting the techniques used when promoting PA clinically. Seven BCTs were used when promoting PA clinically, whereas 26 BCTs were used in interventions. Four BCTs were used in both settings. Social support (unspecified) was the most frequently identified BCT in both study types. Efficacious PA interventions used more BCTs (n=24), and functioned in more ways (n=6) than inefficacious interventions and interventions without a true control group (BCTs=12 and functions=2).

Significance of the findings to allied health: Experimental studies show that physiotherapists can increase patient PA levels by using interventions with many BCTs and functions. However, physiotherapists report using a small number of BCTs when promoting PA clinically, potentially producing poor ‘real world’ outcomes.