Physiotherapy - Theses
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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.