A New Policy Framework For Translating Allied Health Research Into Practice

Professor Meg Morris 

Physiotherapist and Professor of Clinical and Rehabilitation Practice

Abstract:

In the Victorian healthcare sector there are more than 35 allied health disciplines and allied health professionals work in public and private sectors, community organisations, tertiary education, health promotion, the sport industry and private practice. A new policy, the allied health research framework, will be presented as well as the evidence based that informed its design. The framework is now being implemented state-wide and an update will be given on progress.

Biography:

Professor Meg Morris is a physiotherapist and Professor of Clinical and Rehabilitation Practice, a partnership with Healthscope hospitals.  Her strategic leadership in allied health research, education and clinical practice is evidenced by her role as inaugural chair of the Dept Health allied Health Therapy Research Network, where she has worked on policies and systems to embed a research culture in allied health. Professor Morris is a Fellow of the Australian College of Physiotherapists and has a particular interest in allied health management of Parkinson’s disease, inter-professional practice, therapy outcomes, falls and disability.  She leads a large research team and has published more than 300 publications and has supervised more than 45 doctoral students and 5 postdoctoral students in allied health.

 

 

Improving evidence-based management and outcomes in community-acquired pneumonia: Effectiveness of a multidisciplinary bundle of care

Ms Melanie Lloyd1, Dr Amalia Karahalios2, Professor Edward Janus1, Ms Stephanie Lowe1, Ms Melina Shackell1, Professor  Terry Haines3, Dr Elizabeth Skinner1, Dr  So Ko1, Dr Lucy Desmond1, Dr Anurika De Silva2, Associate Professor Harin Karunajeewa1

1Western Health, St Albans, Australia, 2University of Melbourne, Parkville, Australia, 3Monash University, Frankston, Australia

Abstract:

Aim:
To evaluate a multidisciplinary approach to management of hospitalised patients with community-acquired pneumonia (CAP), designed to improve adherence to interventions with prior proven efficacy (early mobilisation, routine malnutrition screening, routine corticosteroids, and early switch to oral antibiotics).

Design:
Pragmatic, stepped-wedge, randomised effectiveness study.

Method:
Patients hospitalised under a General Internal Medical (GIM) unit meeting a standard case-definition for CAP were eligible. Eight GIM units at two Australian hospitals were randomised to either: i) usual care, or ii) care supported by a dedicated “CAP Service”: a multidisciplinary team deploying algorithm-based implementation of four evidence-based interventions. Outcome measures included: i) length of hospital stay (LOS), ii) mortality, iii) readmission rates, and iv) compliance with evidence-based practice.

Results:
415 and 401 individuals were randomised to usual care and the CAP Service respectively. Under the CAP Service, adherence to evidence-based protocols improved across all four interventions (early mobilisation: 19% (usual care) vs. 72% (CAP Service), malnutrition screening: 55% vs. 83%, corticosteroids: 2% vs. 53%, switch to oral antibiotics: 69% vs. 77%). However, no difference in outcome was observed for LOS (predicted mean 3.5 vs 3.4 days, odds ratio [95% CI] 0.95 [0.79-1.16]), 90-day mortality (16% vs 16%, 0.92 [0.49-1.75]) or 90-day readmissions (26% vs 30%, 1.17 [0.70-1.94]).

Conclusion:
This study demonstrates an innovative, analytically robust approach to translational health services research, where effectiveness can be evaluated in a generalisable “real-world” setting. A multidisciplinary team was able to significantly increase adherence to evidence-based practice, however, there was no associated improvement in study outcomes.

Biography:

Melanie has over 10 years experience working as a Physiotherapist in Melbourne, Brisbane and the UK. Her clincial interest areas include acute illness in multimorbid individuals, exercise rehabilitation and vestibular rehabilitation. She is currently leading a program of research that aims to explore novel methodologies for evaluating interventions in highly representative patient groups, and is a PhD candidate at the University of Melbourne.

 

When do allied health professionals lose confidence to perform evidence-based practice activities? A cross-sectional study

Dr Marlena Klaic1,2, Associate Professor Fiona McDermott2, Professor Terry Haines2

1Royal Melbourne Hospital, Parkville, Australia, 2Monash University, Frankston, Australia

Abstract:

Background:
Australian allied health professional groups typically have accreditation or registration requirements which mandate training in EBP skills within undergraduate courses. It is likely that recent Australian graduates from the allied health professions are equipped to undertake a range of EBP activities. However, published research continues to find that clinicians report a lack of skills as a significant barrier to EBP, despite the commitment of education providers and registration bodies to facilitate this.

Aim:
To examine the relationship between allied health professionals’ confidence to perform a range of EBP activities and the number of years worked clinically and highest level of qualification received.

Method:
Analytical cross-sectional survey using a validated instrument that measured attitudes, skills and behaviour. Allied health professionals from two  metropolitan hospitals in Australia were eligible to participate in the study. A multivariable regression with adjustment for the highest level of qualification received was completed.

Results:
288 surveys were completed, representing a 58% response rate. Allied health professionals begin to lose confidence related to EBP activities within the first five years of practice, particularly for critical analysis of published studies. Higher level qualifications protect against the effect of degradation of EBP skills and confidence over time

Significance:
Recently graduated allied health professionals are equipped with the knowledge and skills to confidently participate in EBP activities. However, these skills degrade quickly. If allied health professionals are to provide a practice that is evidence based, there must be investment in strategies which ensure maintenance of EBP skills.

Biography:

Dr Marlena Klaic is the DHHS appointed Allied Health Research & Translation Leader at the Royal Melbourne Hospital. She has 20 years’ experience working clinically in neurological rehabilitation, research and project management. Marlena completed her PhD on “Enhancing the uptake of evidence-based practice with allied health professionals: A quasi-experimental study”.

Transforming the teaching and use of evidence-based practice with CrowdCARE: Crowdsourcing Critical Appraisal of Research Evidence

Dr Laura Downie1, Dr Michael Pianta1

1Department of Optometry and Vision Sciences, The University Of Melbourne, Parkville, Australia

Abstract:

Aim:
We developed a free, online tool that teaches critical appraisal and facilitates the sharing of appraisals amongst a global community (CrowdCARE, crowdcare.unimelb.edu.au). Our aim was to investigate the rigour of crowdsourced appraisals from trained novice raters.

Method:
Systematic reviews (n=71) were appraised in CrowdCARE by five trained novices and two expert raters. Appraisals were performed using a validated tool (AMSTAR) to yield: (i) an aggregate quality score, and (ii) domain-specific responses for each of the 11 assessment items. Appraisal quality was investigated by assessing the variability in AMSTAR scoring and calculating the concordance of ratings using Cohen’s Kappa (κ).

Results:
Variability in aggregate AMSTAR scores was similar between expert raters, and between the expert consensus and mean novice ratings. A strong correlation was evident between the expert consensus and mean novice rating (r2=0.89, p<0.0001). There was good agreement (κ=0.67, 95%CI: 0.61 to 0.73) between the aggregate score of the expert consensus rating and mean novice rating.

Significance of the findings to allied health:
These data demonstrate the merit of our novel crowdsourcing approach for appraising research quality. Allied health students can be trained to critically appraise systematic reviews and there is moderate agreement between expert and novice raters. CrowdCARE provides students and clinicians with the skills to appraise research quality and contributes to making evidence-based practice more efficient by removing the substantial duplication of effort made by individual clinicians across the globe.

Biography:

Dr Laura Downie is a tenured Senior Lecturer in the Department of Optometry and Vision Sciences at the University of Melbourne. In this role, she provides didactic and clinical training to Doctor of Optometry students, leads the sub-specialty cornea clinic at University of Melbourne eyecare clinic and heads her own research laboratory, the ‘Downie Anterior Eye, Clinical Trials and Research Translation Unit.’ Laura completed both her undergraduate optometry degree (2003) and doctorate (2008) at the University of Melbourne. In 2014, she was awarded two fellowships from the National Health and Medical Research Council and achieved international recognition for her clinical research achievements with the award of the Irvin and Beatrice Borish Award from the American Academy of Optometry. Dr Downie’s research laboratory adopts an integrated approach to research in ocular disease that combines laboratory, clinical and behavioural science as a foundation for evidence-based practice, to improve clinical outcomes. She possesses high level expertise in critical appraisal, research synthesis, translation and implementation science.

Dr Michael Pianta is a Senior Lecturer in the Department of Optometry and Vision Sciences and the Director of Learning and Teaching in the Melbourne School of Health Sciences at the University of Melbourne. Michael completed his undergraduate degree (1991), masters degree (1994), and doctorate (2000) at the University of Melbourne. He is the coordinator of the Doctor of Optometry (OD) program, and has led innovative curriculum design in that program, including use of the CrowdCARE platform. His reputation in competency-based assessment led to his appointment as a consultant for the Optometric Council of Australia & New Zealand, the independent accreditation body for optometry programs in the region.

Risk factors for medication non-adherence among Victorian patients receiving Home Medicine Reviews (HMRs)

Mr Kyrillos Guirguis1

1PharmaceuCare, Tarneit, Australia

Abstract:

Aim:
To identify risk factors that predict non-adherence among patients receiving HMRs.

Method:
Retrospective study of 109 patients who received HMRs in 2014/2015. Patients’ medication lists and HMR reports were reviewed for comments on non-adherence to medications. Factors considered as possible predictors of non-adherence were age, gender, CALD status, number of drugs, number of medical conditions, number of Over the Counter (OTC) products, number of complimentary & alternative medicines (CAM), availability of carers/family support, the use of pillboxes, patients’ need for education on their medicines, CHF, diabetes, pain, respiratory conditions and dyslipidaemia. Multiple logistic regression analysis was conducted, and a model developed to identify the most significant predictors.

Results:
The regression model (p<0.00001) demonstrated that three factors were related to patients’ non-adherence. Respiratory conditions inferred a five-fold increase in the risk of non-adherence, while the use of OTC products was associated with a two-fold increase. The odds of non-adherence were almost threefold among male patients.

Significance:
Medication non-adherence is a major cause of morbidity and hospitalisation. Outreach allied health clinicians could screen patients with identified risk factors and refer them to receive HMR services, which improve compliance to medications and optimise health outcomes. This supports patients in the community, before medication-related problems worsen and hospital visits become unavoidable. Furthermore, the referral criteria for HMRs should be re-evaluated, to accurately define patient cohorts that would benefit the most from the service and improve its economic sustainability.

Biography:

Kyrillos is a practising consultant pharmacist with extensive clinical experience. He is the Principal Consultant Pharmacist at PharmaceuCare, and Manager, Performance & Quality at MCCC GP Training. He is affiliated with the School of Medicine (UTAS) as a casual academic. Kyrillos has valuable research experience, having managed various research projects that led to publications in international peer-reviewed journals. He is a reviewer for Patient Education & Counselling and the American Journal of Health-System Pharmacy. He has years of experience in education, and has published two books: Successful Online Study and Community to Hospital Pharmacy: making the transition! to support pharmacists’ professional development and career progression. Kyrillos is ultimately passionate about the quality use of medicines, aiming to optimise health outcomes for patients with chronic disease.

 

Comparison of spatiotemporal measures of gait in soft versus hard soled footwear

Ms Simone Cranage1, Dr Luke Perraton2, Dr Kelly-Ann Bowles2, Dr. Cylie Williams2

1Peninsula Health, Frankston, Australia, 2Monash University, Melbourne, Australia

Abstract:

Aim:
There is little evidence to guide recommendations of footwear for young children. The aim of this study was to investigate the difference in spatiotemporal measures of gait in young children during walking and running in soft and hard soled footwear.

Method:
Demographic and lower limb anthropometric data was collected. Participants walked and ran along a GAITrite mat in a randomised order. Conditions of interest were soft and hard soled boots, sandals and runners and a comparison of barefoot to soft soled footwear. Gait spatiotemporal measures were extracted from the GAITrite. Linear regression clustered by participant was used to understand the different gait variables.

Results:
There were 47 typically developing children aged 2-4 years recruited. Soft soled sandals increased stride length significantly greater than hard soled footwear (Coef= -2.07, CI95%=-4.01 to -0.08, p=0.04) during walking only. There were no other differences between walking or running in soft or hard soled sandals, boots or runners. There was a small increase in tripping in soft soled sandals during walking only.

Significance of the findings to allied health:
Current perception is that the sole hardness is an important feature in young children’s shoes. These findings infer that sole hardness has a limited effect on children’s gait. Parents seeking advice from health professionals about footwear can be informed that this feature has limited impact on walking and running in young children which can therefore guide both clinician and industry recommendations.

Biography:

Simone currently works in a multidisciplinary Children’s team at Peninsula Health working in joint podiatry and physiotherapy clinics. She is currently undertaking a Masters by Research degree through Monash University on the impact of different types of footwear on toddler’s gait.

Translating evidence for the rehabilitation of post-stroke sensory loss: perspectives of occupational therapists and physiotherapists

Ms Liana Cahill1,2,3, Ms  Yvonne  Mak-Yuen1,2, Dr Annie McCluskey4,5, Ms Cheryl Neilson1, Dr  Denise O’Connor6,7, A/Prof Natasha Lannin1,8, Prof  Leeanne  Carey1,2

1La Trobe University , Melbourne, Australia, 2The Florey Institute of Neuroscience and Mental Health, Melbourne , Australia , 3Australian Catholic University, Melbourne , Australia, 4The University Of Sydney, Sydney, Australia , 5The StrokeEd Collaboration , Sydney, Australia , 6Monash University, Melbourne, Australia, 7Australasian Satellite of Cochrane Effective Practice and Organisation of Care Group, Melbourne, Australia, 8Alfred Health , Melbourne , Australia

Abstract:

Aim:
To determine the barriers and enablers for translation of evidence-based practice for rehabilitation of upper limb sensory loss with stroke survivors.

Method:
A written questionnaire (30 items) and 1-hour focus group interview were conducted with occupational therapists and physiotherapists working with stroke survivors at 8 health organisations in Victoria and NSW.  Quantitative data were analysed in relation to frequency, central tendency and variance.  Qualitative data were analysed inductively, then further coded to domains of the Theoretical Domains Framework.

Results:
Eighty therapists (n=87, 78.7% occupational therapists and 21.3% physiotherapists) completed questionnaires and participated in focus groups.  Therapist self-reported skill level in treating sensory loss (rated 0-10 via visual analogue scale) was low across sites (mean 3.82, SD 2.2).  Most therapists (93.7%) agreed there was a need to change practice, and most (93.7%) reported barriers to change; barriers included lack of knowledge, skills and resources in addition to system pressures.

Significance of findings to allied health:
Allied health perspectives provide vital insights regarding practice and context to support behaviour change.  Identified barriers and enablers are relevant for areas of allied health outside of stroke rehabilitation.

Biography:

Liana Cahill is an occupational therapist, researcher and lecturer.  She has practiced in neurological rehabilitation for over a decade in Australia, the United Kingdom and South Africa.  She holds a Masters of Public Health and is currently completing her PhD in the area of evidence translation and upper limb stroke rehabilitation.  Her research base is at The Florey Institute of Neuroscience and Mental Health and La Trobe University and she lectures in the School of Allied Health at Australian Catholic University.

Do supports and barriers to routine clinical assessment for children with cerebral palsy change over time? A mixed methods study

Professor Christine Imms1

Professor of Occupational Therapy, Australian Catholic University

Aim: To investigate changes over time in allied health professional’s (AHP) perceptions of supports and barriers to implementing routine clinical assessment for children with cerebral palsy.

Method: Longitudinal mixed method approach. AHP (occupational therapists, physiotherapists and speech pathologists) employed in five disability service organisations were recruited. Participants completed the Supports and Barriers Questionnaire (SBQ; measuring organisational structures, resources, therapists, assessment tools, children and families) and participated in focus groups at baseline, 6, 12 and 24 months following introduction of routine clinical assessment procedures. Quantitative data were analysed descriptively. Baseline qualitative data were analysed inductively and a thematic framework developed. This framework was applied longitudinally using a constant comparative approach, facilitating identification of framework elements that emerged, or became less dominant, over time.

Results: 447 AHP participated (baseline n=227, 6m n=227; 12m n=224; 24m n=189). Mean SBQ ratings on all domains remained positive over time indicating that overall AHP felt supported in implementing routine clinical assessment. Five themes emerged at baseline: ‘motivated to adopt routine clinical assessment’, ‘ensuring effective ongoing communication’, ‘acquiring and utilising expertise’, ‘availability and distribution of resources’ and ‘therapist perceptions of child and families’ wishes’. Longitudinally, themes demonstrated how routine assessment practices and clinical expertise were embedded and maintained. Critical reflection on the utility and costs of routine assessment were evident over time, attributable in part to national changes in funding of disability services.

Significance of the findings to allied health: Organisational commitment, adequate resourcing and effective communication are required to implement and embed change in AHP services.

Using audit and feedback to change practice: Embedding clinical practice guidelines in acquired brain injury rehabilitation

Ms Laura Jolliffe1,2, Ms Rebecca Nicks2, A/Prof Natasha Lannin1,2, Prof Tammy Hoffmann3, Ms. Jacqui Morarty1

1La Trobe University, Melbourne, Australia

2Alfred Health, Melbourne, Australia

3Bond University, Gold Coast, Australia

 

AIM: To evaluate the effects of a sustained program of audit-feedback on therapists’ adherence to acquired brain injury (ABI) rehabilitation CPGs.

 

METHOD: Using a periodic service review method, inpatient rehabilitation care was audited fortnightly for 46 weeks (61 cases) against ABI rehabilitation CPGs (137 observable criteria), using medical record review, observation, and staff, patient and family interviews. Each fortnight, a facilitator-led multidisciplinary feedback session provided clinicians with a summary of observed adherence to CPGs, and positive behaviour feedback strategies were used to encourage clinicians to assess and adjust their performance. Three months after withdrawal of the audit-feedback, 20 randomly selected cases were audited to determine if adherence to CPGs was maintained.

 

RESULTS: Immediately following the intervention, there was a significant improvement in adherence to CPG criteria from 47% to 82% (35% improvement, 95% CI 25 to 46) (p=0.0001). Three months after intervention withdrawal adherence was lower and reduced to 73% (9% reduction, 95% CI -19 to 0.5) (p=0.002). Details of the clinical practice areas more susceptible to feedback withdrawal will be discussed.

 

SIGNIFICANCE OF FINDINGS TO ALLIED HEALTH: There are gaps between clinical practice guideline (CPG) recommendations and clinical practice provided. Studies outside of rehabilitation suggest audit and feedback is an effective behaviour-change intervention, however rehabilitation studies have demonstrated only minimal improvements. Our study demonstrates that intensive audit and feedback can improve adherence to rehabilitation CPGs. For sustainable change, audit and feedback needs to be incorporated into usual rehabilitation processes.

Development of the Translating Allied Health Knowledge (TAHK) benchmarking tool

Dr Danielle Hitch1, Associate Professor Genevieve Pepin1

1Deakin University, Geelong, Australia

 

Aim: This presentation aims to provide an overview of the formulation of a benchmarking tool from the Translating Allied Health Knowledge (TAHK) framework.

 

Method: Benchmarking is a systematic process for measuring and comparing work processes, which has been found to be an effective approach to improving quality and effectiveness in clinical health care. The Translating Allied Health Knowledge (TAHK) framework was initially proposed in 2013, as part of a larger study on knowledge translation in occupational therapy. It developed from a comprehensive literature review of the knowledge translation literature in allied health, and was designed to highlight processes and practice characteristics rather than specific methods.

 

Results: The results from each stage of this tools development will be presented. The framework was initially piloted via consultation with a steering committee, along with a pilot mixed methods feasibility study with clinicians. Testing of the psychometric properties is currently underway, as is a qualitative study to understand the perceptions of clinicians who completed the tool.

 

Significance:

The TAHK benchmarking tool is the only measure currently available which addresses implementation processes and mechanisms across different contexts in allied health. The

comprehensive process of development described in this presentation, and the findings of evaluations to date, supports its broader adoption across allied health disciplines and services. The standardized benchmarking tool will be distributed across Victoria to build a baseline of allied health knowledge translation activities, and explore their relationship to a range of organizational contexts.