Physiotherapy - Theses
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ItemUsing behaviour change theory to understand and promote physical activity in adults with chronic lower limb joint pain( 2023-07)Although guidelines recommend physical activity for people with osteoarthritis, most people with osteoarthritis do not meet the recommended levels of physical activity necessary to achieve positive health benefits. This thesis uses behaviour change theory to: - assess integrated dual-process models, including associations between physical activity and non-conscious process of physical activity (prospective study); - evaluate effectiveness of financial incentives to motivate physical activity (systematic review and meta-analysis, plus a narrative case study); -determine patient preferences for physical activity rewards programs (discrete choice experiment). Findings can inform development of physical activity programs for people with osteoarthritis.
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ItemPelvic floor disorders in exercising women( 2023-09)Physical inactivity is a global societal and economic burden, increasing the risk of chronic disease. Women participate in organised sports at lower rates than men and 86% of Australian women do not meet all components of the National Physical Activity Guidelines. Sport and exercise activities may provoke symptoms of pelvic floor (PF) disorders. Pelvic floor symptoms are highly prevalent in exercising women. One in three women report symptoms of urinary incontinence (UI) across all sports and up to 80% of women engaging in high impact sports or heavy weight-lifting report UI and/or anal incontinence (AI). It is therefore important to understand how PF symptoms limit or stop exercise participation in women. The thesis research aimed to: establish the impact of female PF symptoms (UI, AI and pelvic organ prolapse) on sport and exercise participation; determine current PF symptom screening and management within Australian sport and exercise settings; and explore the preferences, barriers and enablers for future PF symptom screening and management within sport and exercise settings from the perspectives of exercising women and health or exercise professionals. Study One was a systematic review of the impact of PF symptoms on sport and exercise. Whilst UI adversely impacted exercise in one in two women, the evidence certainty was low. Important gaps in the knowledge of other PF symptoms (beyond UI) and the degree and nature of impact of all PF symptoms on participation were established. Study Two, an observational, cross-sectional study of 4,556 Australian women with PF symptoms, examined the research gaps determined by systematic review. One in two women stopped a form of exercise they had previously participated in, secondary to PF symptoms. A secondary data analysis (Study Two, Part B) found that women with more severe UI symptoms (OR=4.77; 95% CI:7.24 to 14.37), and higher bother (UI: OR=10.19; 95% CI:7.24 to 14.37; POP: OR=22.38; 95% CI:13.0 to 36.60; AI: OR=29.66; 95% CI: 7.21 to 122.07) were at greater odds of identifying their PF symptoms as a barrier stopping participation (often or all the time). Study Three, a qualitative descriptive study, interviewed symptomatic women (n=23) about their experience of PF symptoms within sport and exercise settings. Symptoms inhibited their ability to participate in exercise in the manner they wanted. Restrictive and complex coping strategies were used to avoid symptom provocation, which limited their spontaneity and enjoyment of sport and exercise. Study Four, an observational, cross-sectional survey study completed by Australian health and exercise professionals (n=636), found that PF symptom screening was not common practice within Australian sports and exercise settings, especially in at-risk groups such as high-impact athletes. Professionals were willing to engage in future screening and management, but required training, resources and access to referral networks prior to implementation. Study Five, an explanatory-sequential mixed methods design, synthesised quantitative and qualitative data (‘following a thread’) exploring symptomatic women’s experience of PF symptom disclosure and screening within sports and exercise settings. Most women had not told anyone about their symptoms due to embarrassment, limited pelvic health knowledge or not being asked. Women conveyed important preferences for future screening and management of PF symptoms within sports settings, including recommendations for how to start a conversation on pelvic health in an acceptable manner. Additional factors to facilitate disclosure, and make sports and exercise settings safer and more inclusive for symptomatic women were explored. Together, this thesis established that PF symptoms stop women from participating in sports and exercise in their preferred manner, limiting enjoyment and increasing the odds of physical inactivity. Currently, women are not usually provided the opportunity to seek help for their symptoms within sports and exercise settings. However, women and professionals felt that the provision of screening, education and management would be acceptable if appropriate support was provided and sensitively and safely implemented.
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ItemDetermining discharge destination in acute general medicine( 2022)The field of general medicine (also known as internal medicine) utilises a patient-centred, multidisciplinary approach to manage acutely unwell, complex patients. This heterogeneous medical discipline is known for its increased hospital admissions (500,000 admissions per year in Australia), longer length of hospital stays (1.83 million days per year in Australia), and high 28-day readmission rates (up to 21% globally). Notably, up to a third of general medical bed days consist of patients who are “medically ready for discharge”, but remain in hospital for non-medical reasons, such as waiting for post-acute facilities, clinician indecision and co-ordination of services. Thus, early, and accurate identification of such patient needs may allow for timelier discharge. The primary aim of this thesis was to identify predictors of discharge destination from acute general medical units and the secondary aim was to explore physical activity in the context of a general medicine hospital admission. In the first section of this thesis (Determining Discharge Destination), two systematic reviews were undertaken. The first systematic review identified 23 assessment tools and 44 patient factors associated with discharge destination in acute general medicine. The second systematic review evaluated the psychometric properties of these assessment tools and identified that the de Morton Mobility Index (DEMMI), Alpha Functional Independence Measure (AlphaFIM), the Barthel Index and the Mini Mental State Examination (MMSE) had the strongest psychometric properties. This section of the thesis identified a paucity in recent literature in an Australian context. Thus, the third study in this section of the thesis was a prospective observational study involving 417 acute general medical patients from a large tertiary hospital in Australia. This study found 54 factors associated with discharge destination and created two models to predict patients who were discharged home or “not home”. The models included the “DEMMI and toilet transfers” and the “AlphaFIM and walking independence”. The second section of this thesis (Physical Activity in General Medicine) consists of a prospective observational study involving 50 acute general medical inpatients. Physical activity was found to be low prior to and during an acute general medical admission. The tool used to measure pre-hospitalisation physical activity demonstrated a floor effect and indicates the need for a valid and reliable assessment tool that is appropriate for frail older people. No relationship was found between pre-hospital and in-hospital physical activity levels. A fair and significant association was found between both pre-hospital and in-hospital physical activity and mobility performance meaning that patients who had better mobility scores on admission had higher physical activity levels prior to and during their hospital admission. The findings of this thesis provide a comprehensive examination of tools to assist early identification of discharge destination, supplemented by an exploration of physical activity prior to and during an acute general medical hospital admission. This may facilitate a timelier discharge which has potential to improve both patient and hospital outcomes. Areas for translation of known research into clinical practice include a development of a core acute assessment tool set and promotion of physical activity. This thesis also highlights future directions for research, especially regarding further analysis of psychometric properties of known assessment tools associated with discharge (including validation of the two created models), and the creation of a valid and reliable assessment tool for physical activity in frail older people.
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ItemNo Preview AvailableUnderstanding and promoting physical activity participation for children born preterm( 2021)Children born preterm are at greater risk of motor impairment, including cerebral palsy (CP) and developmental coordination disorder, compared with children born at term. Despite the important role participation, including participation in physical activity (PA), plays in promoting motor development, very little is known about participation for children born preterm at preschool age. Participation includes two components: attendance and involvement. It is a complex phenomenon, influenced by environmental and personal factors, and is recognised as an important outcome for children with motor impairment. This thesis aims to better understand correlates of participation for preschool age children born preterm, as well as means of promoting participation for this group. Study one focused on correlates of participation. It compared community participation for preschool age children born at <30 weeks’ gestation (VP) and at term, and explored motor impairment and social risk as possible correlates of participation. Perceived environmental barriers and facilitators of community participation were also assessed. Children born VP participated less frequently in community activities compared with children born at term. Higher social risk was associated with poorer participation outcomes for children born VP but not term, while there was little evidence motor impairment was associated with community participation. Finally, parents of children born VP perceived greater environmental barriers to participation compared with parents of children born at term. Study two was a systematic review exploring the efficacy of movement-based interventions for preschool age children (3-6 years), with or at risk of motor impairment, including children born preterm (<37 weeks’ gestation). This review highlighted the scarcity of randomised controlled trials (RCTs) or quasi RCTs exploring movement-based interventions for this age group. Overall, movement-based interventions did not significantly improve body structure and function or activity outcomes, while the heterogeneity of intervention design and study quality made it difficult to establish definite conclusions. In particular, there were no studies that assessed participation as an outcome. Study three explored the feasibility and acceptability of a novel intervention known as Dance PREEMIE (a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age), which aimed to improve PA participation for preschool age children born extremely preterm (<28 weeks’ gestation) or extremely low birthweight (<1000g), with motor impairment. Children enrolled in Dance PREEMIE were allocated to a weekly community dance class (8 weeks duration) taught by dance teachers who received study-specific training. Dance PREEMIE was feasible to implement in Melbourne, Australia. Classes were well-attended and enjoyable for children, while dance teachers reported improved self-efficacy for teaching children with motor impairment after the training. Overall, Dance PREEMIE was acceptable to both parents of participating children and dance teachers. Findings from this thesis indicate that preschool age children born preterm have poorer participation outcomes compared with their term born peers, and present evidence on the feasibility and acceptability of Dance PREEMIE, a novel PA participation intervention.