Physiotherapy - Research Publications

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    What is real change in submaximal cardiorespiratory fitness in older adults? Retrospective analysis of a clinical trial
    Hall, M ; Lima, YL ; Huschtscha, Z ; Dobson, F ; Costa, RJS (SPRINGER, 2022-12-01)
    OBJECTIVE: To assess the test-retest reliability of submaximal cardiorespiratory fitness in healthy active older adults. METHODS: This was a retrospective analysis of 41 adults enrolled in a clinical trial [mean (sd) aged 59 yrs (7); 29% females; and body mass index 24.5 kg/m2 (3.3)]. Cardiorespiratory fitness was assessed using a cycle ergometer 6 weeks apart. The initial workload was 1 W per kilogram of free fat mass (W/kg FFM) and increased by 0.5 W/kg FFM every 3 min until participants could not maintain the speed at ≥ 60 rpm, they reached a rating of perceived exertion of 15-17, and/or obtained a respiratory exchange ratio (RER) of 1.000. Reliability of [Formula: see text], heart rate and RER was assessed for each workload, and for [Formula: see text], when RER reached 1.00. Reliability was examined as the intraclass correlation coefficient (ICC(2,1)), Bland-Altman plots, standard error of measurement (SEM and SEM%), and the minimal detectable change (MDC). RESULTS: Test-retest agreement ranged between (ICC(2,1) 0.44-0.84) with no discernible systematic differences between assessments. The SEM% for absolute and relative [Formula: see text] ranged between 13.0 to 20.2%, and 13.8 to 26.3%, respectively. The MDC90% for absolute and relative [Formula: see text] ranged between 30.4% to 47.1%, and 32.2% to 61.4%, respectively. The lowest SEMs% and MDCs% for both absolute and relative [Formula: see text] were observed for workloads at 2.5 W kg/FFM (~ 13% and ~ 31%, respectively). CONCLUSIONS: Although at least modest relative reliability was consistently demonstrated, the smaller measurement error associated with absolute and relative [Formula: see text] at 2.5 W kg/FFM may indirectly suggest that submaximal cardiorespiratory fitness can be monitored more confidently at higher workloads. Findings provide critical information to determine how much change is considered 'real change' in repeated measures of cardiorespiratory fitness using a submaximal graded exercise testing protocol in healthy active older adults.
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    Delivering multidisciplinary neuromuscular care for children via telehealth
    Carroll, K ; Adams, J ; de Valle, K ; Forbes, R ; Kennedy, RA ; Kornberg, AJ ; Vandeleur, M ; Villano, D ; Woodcock, IR ; Yiu, EM ; Ryan, MM ; Davidson, Z (WILEY, 2022-04-29)
    INTRODUCTION/AIMS: In response to coronavirus disease 2019 (COVID-19) pandemic restrictions int 2020, our face-to-face (F2F) multidisciplinary neuromuscular clinic (NMC) transitioned to widespread use of telehealth (TH). This study aimed to (1) understand parent/guardian, child, and clinician perceptions of TH; (2) examine TH-related changes in clinical activity; and (3) use these findings to inform a future model of care for the NMC. METHODS: A clinical audit was undertaken to examine clinical activity throughout 2018-2020. Online surveys were distributed to clinicians and parents of children attending the NMC via TH in 2020. A working group of clinicians created a checklist to guide a future hybrid model of TH and F2F care. RESULTS: Total clinical activity in 2020 was maintained from previous years; 62.8% of all appointments occurred via TH, and 82.3% of patients attended NMC by TH at least once. Ninety-nine parents (30.6% response rate), 52 children, and 17 clinicians (77% response rate) responded to the survey. All groups reported better interaction when F2F compared to TH. Eighty percent of parents identified advantages of TH and reported lower levels of stress. A lack of "hands-on" physical assessment was identified by parents and clinicians as a TH limitation. Most families (68.1% of parents; 58.8% of children) and all clinicians indicated a preference for a mix of TH and F2F NMC appointments in the future. DISCUSSION: This study has informed a checklist to guide future TH use in a new hybrid model of care. Further investigation is required to assess health impacts of TH use in pediatric neuromuscular care.
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    Exercise alone impacts short-term adult visual neuroplasticity in a monocular deprivation paradigm
    Virathone, L ; Nguyen, BN ; Dobson, F ; Carter, OL ; McKendrick, AM (ASSOC RESEARCH VISION OPHTHALMOLOGY INC, 2021-10-01)
    Adult homeostatic visual plasticity can be induced by short-term patching, heralded by a shift in ocular dominance in favor of the deprived eye after monocular occlusion. The potential to boost visual neuroplasticity with environmental enrichment such as exercise has also been explored; however, the results are inconsistent, with some studies finding no additive effect of exercise. Studies to date have only considered the effect of patching alone or in combination with exercise. Whether exercise alone affects typical outcome measures of experimental estimates of short-term visual neuroplasticity is unknown. We therefore measured binocular rivalry in 20 healthy young adults (20-34 years old) at baseline and after three 2-hour interventions: patching (of the dominant eye) only, patching with exercise, and exercise only. Consistent with previous work, the patching interventions produced a shift in ocular dominance toward the deprived (dominant) eye. Mild- to moderate-intensity exercise in the absence of patching had several effects on binocular rivalry metrics, including a reduction in the dominant eye percept. The proportion of mixed percept and the time to first switch (onset rivalry) did not change from baseline across all interventions. Thus, we demonstrate that exercise alone can impact binocular rivalry outcomes measures. We did not observe a synergistic effect between patching and exercise in our data.
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    Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials
    Stewart, S ; Wiley, JF ; Ball, J ; Chan, Y-K ; Ahamed, Y ; Thompson, DR ; Carrington, MJ (LIPPINCOTT WILLIAMS & WILKINS, 2016-05-10)
    BACKGROUND: We sought to determine the overall impact of a nurse-led, multidisciplinary home-based intervention (HBI) adapted to hospitalized patients with chronic forms of heart disease of varying types. METHODS AND RESULTS: Prospectively planned, combined, secondary analysis of 3 randomized trials (1226 patients) of HBI were compared with standard management. Hospitalized patients presenting with heart disease but not heart failure, atrial fibrillation but not heart failure, and heart failure, as well, were recruited. Overall, 612 and 614 patients, respectively, were allocated to a home visit 7 to 14 days postdischarge by a cardiac nurse with follow-up and multidisciplinary support according to clinical need or standard management. The primary outcome of days-alive and out-of-hospital was examined on an intention-to-treat basis. During 1371 days (interquartile range, 1112-1605) of follow-up, 218 patients died and 17 917 days of hospital stay were recorded. In comparison with standard management, HBI patients achieved significantly prolonged event-free survival (90.1% [95% confidence interval, 88.2-92.0] versus 87.2% [95% confidence interval, 85.1-89.3] days-alive and out-of-hospital; P=0.020). This reflected less all-cause mortality (adjusted hazard ratio, 0.67; 95% confidence interval, 0.50-0.88; P=0.005) and unplanned hospital stay (median, 0.22 [interquartile range, 0-1.3] versus 0.36 [0-2.1] days/100 days follow-up; P=0.011). Analyses of the differential impact of HBI on all-cause mortality showed significant interactions (characterized by U-shaped relationships) with age (P=0.005) and comorbidity (P=0.041); HBI was most effective for those aged 60 to 82 years (59%-65% of individual trial cohorts) and with a Charlson Comorbidity Index Score of 5 to 8 (36%-61%). CONCLUSIONS: These data provide further support for the application of postdischarge HBI across the full spectrum of patients being hospitalized for chronic forms of heart disease. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifiers: 12610000221055, 12608000022369, 12607000069459.
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    Early Detection and Classification of Patient-Ventilator Asynchrony Using Machine Learning
    Gao, E ; Ristanoski, G ; Aickelin, U ; Berlowitz, D ; Howard, M (Springer International Publishing, 2022-01-01)
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    Hospital clinicians' psychosocial well-being during the COVID-19 pandemic: longitudinal study
    Wynter, K ; Holton, S ; Trueman, M ; Bruce, S ; Sweeney, S ; Crowe, S ; Dabscheck, A ; Eleftheriou, P ; Booth, S ; Hitch, D ; Said, CM ; Haines, KJ ; Rasmussen, B (OXFORD UNIV PRESS, 2022-03-19)
    BACKGROUND: Hospital clinicians report poor psychosocial well-being during the COVID-19 pandemic. Few studies have reported data at more than one time point. AIMS: To compare psychosocial well-being among hospital clinicians at two different time points during the COVID-19 pandemic in 2020. METHODS: Participants included doctors, nurses, midwives and allied health clinicians at a multi-site, public health service in Melbourne, Australia. Data were collected via two cross-sectional, online surveys: May to June (wave 1; n = 638) and October to December 2020 (wave 2; n = 358). The Depression, Anxiety and Stress Scale (DASS-21) assessed psychological well-being in the past week. Investigator-devised questions assessed COVID-19 concerns and perceived work impacts. General linear models were used to assess impact of wave on psychological distress. RESULTS: There were no significant demographic differences between the two groups. Both positive (e.g. learning experience) and negative (e.g. risk of getting COVID-19) impacts were reported. In both waves, staff were most concerned about health risks to family members. Wave 2 respondents were significantly more likely than wave 1 respondents to indicate concerns about colleagues having COVID-19, increased workloads, leave cancellation and increased conflict at work (all P < 0.001). Adjusting for sex, age, self-rated health and discipline group, depression, anxiety and stress scores were significantly higher for respondents in the second than the first wave (all P < 0.001). CONCLUSIONS: Psychological well-being of hospital clinicians was significantly worse during the second wave of the COVID-19 pandemic than the first. Sustained occupational and psychosocial support is recommended even when immediate COVID-19 concerns and impacts resolve.
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    "I Give It Everything for an Hour Then I Sleep for Four." The Experience of Post-stroke Fatigue During Outpatient Rehabilitation Including the Perspectives of Carers: A Qualitative Study.
    Bicknell, ED ; Said, CM ; Haines, KJ ; Kuys, S (Frontiers Media SA, 2022)
    Background: Fatigue is a debilitating post-stroke symptom negatively impacting rehabilitation. Lack of acknowledgment from carers can be additionally distressing. The purpose of this study was to describe the experience of post-stroke fatigue during outpatient rehabilitation, including the perspectives of carers. Methods: This qualitative study was guided by descriptive phenomenology within a constructivist paradigm. Semi-structured interviews were conducted with stroke survivors experiencing fatigue (Fatigue Assessment Scale >23) and attending outpatient rehabilitation. Carers were also interviewed where identified, providing insight into their own and stroke survivor experiences. Data were analyzed according to Colaizzi's analytic method. Results: Fourteen stroke survivors (50% culturally and linguistically diverse), and nine carers participated. Six themes were identified: 1. The unpredictable and unprepared uncovering of fatigue; 2. Experience and adjustment are personal 3. Being responsible for self-managing fatigue; 4. The complex juggle of outpatient stroke rehabilitation with fatigue; 5. Learning about fatigue is a self-directed problem-solving experience; 6. Family and carers can support or constrain managing fatigue. Conclusion: Despite engaging in outpatient rehabilitation, stroke survivors largely learnt to manage fatigue independent of healthcare professionals. Carers often facilitated learning, monitoring rehabilitation, daily routines and fatigue exacerbation. Conversely, family could be dismissive of fatigue and possess unrealistic expectations. Post-stroke fatigue must be considered by clinicians when delivering outpatient rehabilitation to stroke survivors. Clinicians should consistently screen for fatigue, provide flexible session scheduling, and educate about individual indicators and strategies for management. Clinicians should also explicitly engage carers who play a critical role in the management of fatigue.
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    A comparison of psychological characteristics in people with knee osteoarthritis from Japan and Australia: A cross-sectional study.
    Uritani, D ; Campbell, PK ; Metcalf, B ; Egerton, T ; Tan, MP (Public Library of Science (PLoS), 2022)
    The aim of this study was to investigate differences in psychological characteristics between people with knee osteoarthritis (OA) from Japan and Australia. Sixty-two adults from Japan and 168 adults from Australia aged over 50 years with knee pain were included. Japanese data were collected from patients with knee OA diagnosed by medical doctors. Australian data were baseline data from a randomized controlled trial. Participants were not exercising regularly or receiving physiotherapy at the time. Psychological characteristics evaluated were depressive symptoms, fear of movement, and pain catastrophizing. These psychological characteristics were compared between the Japanese and Australian cohorts by calculating 95% confidence intervals (CIs) for difference of the mean. To test for equivalence, an equivalence margin was set at 0.5 standard deviations (SD) of the mean, where these SDs were based on the Australian data. When the 95%CI for the difference of the mean value lay entirely within the range of equivalence margin (i.e. between -0.5 and 0.5 times the Australian SD), the outcome was considered equivalent. There were no differences between the groups from Japan and Australia for depressive symptoms and the two groups were considered equivalent. There was no difference between groups for fear of movement, however the criteria for equivalence was not met. People from Japan with knee OA had higher scores for pain catastrophizing than people from Australia. The findings should be confirmed in other samples of people with knee OA from Japan and Australia due to the limitations of the participant recruitment strategy in this study. However, our findings suggest there may be a greater need to consider pain catastrophizing and build pain self-efficacy when managing Japanese people with knee OA. Implementation of international clinical practice guidelines for OA management may require different strategies in different countries due to different psychological profiles.
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    A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study.
    Dennett, AM ; Tang, CY ; Chiu, A ; Osadnik, C ; Granger, CL ; Taylor, NF ; Campbell, KL ; Barton, C (JMIR Publications Inc., 2022-04-21)
    BACKGROUND: Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. OBJECTIVE: To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. METHODS: A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. RESULTS: Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals' knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. CONCLUSIONS: The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors.
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    An international core capability framework for physiotherapists delivering telephone-based care.
    Davies, L ; Hinman, RS ; Russell, T ; Lawford, B ; Bennell, K (Elsevier BV, 2022-04)
    QUESTION: What are the core capabilities that physiotherapists need in order to deliver quality telephone-based care? DESIGN: Three-round modified e-Delphi survey. PARTICIPANTS: An international Delphi panel comprising experts in the field, including consumers, physiotherapy researchers, physiotherapy clinicians and representatives of physiotherapy organisations. METHODS: A modified e-Delphi survey was conducted. A draft framework was adapted from a previously developed core capability framework for physiotherapists delivering care via videoconferencing. The panel considered the draft framework of 39 individual capabilities across six domains. Over three rounds, panellists rated their agreement (via Likert or 0-to-10 numerical rating scales) on whether each capability was essential (core) for physiotherapists to deliver telephone-based care. Capabilities achieving consensus, defined as 75% of the panel rating the item at least 7 out of 10 in Round 3, were retained. RESULTS: Seventy-one panellists from 17 countries participated in Round 1, with retention of 89% in Round 2 and 82% in Round 3. The final framework comprised 44 capabilities across six domains: compliance (n = 7 capabilities); patient privacy and confidentiality (n = 4); patient safety (n = 7); telehealth delivery (n = 9); assessment and diagnosis (n = 7); and care planning and management (n = 10). CONCLUSION: This framework outlines the core capabilities that physiotherapists need to provide telephone-based care. It can help inform content of physiotherapy curricula and professional development initiatives in telehealth delivery and provide guidance for physiotherapists providing care over the telephone.