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Background Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. Objective This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. Methods Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14–0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05–0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11–0.60) were independently associated with increased physical activity. Conclusions Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital. [ABSTRACT FROM AUTHOR]

Introduction: A range of activities are conducted in health care settings aiming to improve health care processes and outcomes. In many settings, these activities are classified into two broad domains of "quality improvement" and "health services research" each with its own methods, continuing education, support structures, and governance systems. We aimed to explore differences and similarities in the purpose, methods, and outcomes of approved allied health projects conducted under each of these domains at a large metropolitan health network. Method: Using observational methods, we evaluated allied health quality improvement and research projects approved through the relevant governance systems in a single health network during a 12-month reporting period. Project leaders were surveyed, and project documentation was evaluated using the SQUIRE tool. Results: Allied health professionals were motivated to undertake both quality improvement (n = 13) and research projects (n = 15) to improve health care. Research projects were more likely to be disseminated externally, but quality improvement projects were more frequently reported to result in internal practice change. Methods were well documented for research projects, but this information was frequently lacking for quality improvement projects. Research projects were also more likely to be supported by external funding than quality improvement projects. Implications: Allied health clinicians conducting improvement activities using research and quality improvement projects share common goals. There are likely to be opportunities to enhance value and implementation of findings into practice by bridging the divide between health service research and quality improvement activities in health networks. [ABSTRACT FROM AUTHOR]

To compare resources required to provide paper-based versus videoed instructions for home exercises in rehabilitation. An observational cohort study included twenty-two allied health professionals (physiotherapists [n = 13], occupational therapists [n = 6] and speech pathologists [n = 3]), providing exercise instructions for n = 110 patients within a community rehabilitation program of a large metropolitan health service. Home exercise instructions were provided to patients with various health conditions. Patients chose between receiving paper-based home exercise instructions, or using their own smart technology to video their home exercises. The primary outcome measure was cost from a health service perspective, based on health professional time, paper used, and printing. A total of 128 initial home exercise instructions were provided to 110 patients, with 36 patients reviewed at least once. Each initial exercise instruction provided using electronic devices saved 5.5 min (95% CI 0.5 to 10.5) with a cost saving of Australian dollar $4.70 (95% CI −8.89 to −0.52) compared with paper-based instructions. There were no significant cost differences (MD $1.16 95% CI −3.87 to 6.18) between modes for exercise review. Home exercise instructions provided on electronic devices cost less than paper-based instructions when patients are using their own smart devices. Costs are minimised when home exercise instructions are provided using the video function of the patient's own electronic devices compared with paper-based instructions. Since patient outcomes appear to be similar with instructions provided in electronic or paper-based mode, exercise instructions in community rehabilitation should be provided using the video function of electronic devices where these are available. [ABSTRACT FROM AUTHOR]

Purpose: To determine if the addition of direct supervision to usual clinical supervision practice of physiotherapists can improve compliance with clinical practice guidelines and post-surgical outcomes for inpatients with hip fracture. Methods: A controlled before-and-after study was conducted on two acute orthopedic wards. Junior and mid-level physiotherapists on one ward were provided with direct supervision during their post-operative management of patients with hip fracture. Physiotherapists on the comparison ward received usual reflective supervision. The primary outcome was patient compliance with the hip fracture guideline to mobilize on the day following surgery. Secondary patient outcomes included physical function on the fifth post-operative day. Results: Data were collected from 290 patients with acute hip fracture. Patients at the direct supervision site were more likely to mobilize on the day after surgery [OR 3.14, 95% confidence interval (CI) 1.41–7.01; p = 0.005] and by the second post-operative day (OR 4.62, 95% CI 2.31–9.23; p < 0.001) compared to patients at the comparison site. Patients walked further on the fifth post-operative day (p < 0.001) with less assistance from therapists (p = 0.044). Conclusions: The addition of direct supervision improved physiotherapists' compliance with hip fracture guidelines and walking endurance and independence in hospitalized patients with hip fracture. The addition of a direct supervision model, where physiotherapists are directly observed in their management of patients with hip fracture, to usual practice supervision improved early mobilization of patients with hip fracture Direct supervision appears to be an effective guideline implementation strategy that can improve care and outcomes for hospitalized patients with hip fracture [ABSTRACT FROM AUTHOR]

Introduction: As part of hospital discharge planning, occupational therapists often provide recommendations to improve the interaction between a person and their home environment. The aim of this study was to investigate the number and type of recommendations made by occupational therapists during a home assessment visit compared to hospital‐based assessment for patients recovering from hip fracture. A secondary aim was to explore adherence rates to the different types of recommendations. Methods: Process evaluation of a randomised controlled trial of 65 participants recovering from hip fracture, returning to community living after hospital discharge. All participants received inpatient multidisciplinary rehabilitation and hospital‐based assessment by an occupational therapist (usual care). In addition, the intervention group participated in a single home visit with an occupational therapist prior to hospital discharge. Analysis included the number and type of occupational therapy recommendations, adherence to recommendations at 30 days after discharge, and mediation analysis. Results: Participants in the home visit group received more recommendations than the usual care group (mean difference [MD] 2.8, 95% CI 1.6 to 3.9) and adhered to a greater proportion of recommendations for assistive technologies (MD 11.4%, 95% CI 2.6 to 20.2) and task modifications (MD 10.0%, 95% CI 0.7 to 19.3). Participants in both groups had lower rates of adherence to recommendations for home modifications compared with other types of recommendations. Adherence to recommendations was a mediator in the relationship between participants' involvement in a pre‐discharge home visit and reduced hospital readmissions. Conclusion: There was greater adherence to occupational therapy recommendations when patients recovering from hip fracture participated in a home visit compared to hospital‐based assessment, contributing to reduced readmissions to hospital in the first 30 days. Home visits offer additional benefits to hospital‐based assessment through the use of a collaborative approach to decision making in the home environment. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of Saturday allied health services on a geriatric evaluation and management ward. Methods: A controlled before‐and‐after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre‐intervention (N = 331) and intervention (N = 462). Results: Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7‐10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6‐5.7) and no difference in the proportion discharged home. Cost‐effectiveness demonstrated no significant difference in cost ($2639, 95% CI $‐386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8‐6.5) favouring the experimental ward. Conclusion: These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hip fracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home. Design: A randomized controlled trial was conducted. Setting: The study setting included hospital wards and the community. Participants: The study included adults 50 years and over recovering from hip fracture (n = 77). Intervention: Both groups received inpatient rehabilitation and hospital-based discharge planning. In addition, the intervention group received a home assessment visit by an occupational therapist prior to discharge from hospital. Main measures: Primary outcomes were falls and hospital readmissions. Secondary outcome measures included Functional Independence Measure, Functional Autonomy Measurement Scale, Nottingham Extended Activities of Daily Living Scale, EuroQol five dimension scale questionnaire and Falls Efficacy Scale-International. Results: The intervention group had fewer hospital readmissions in the first 30 days compared to the control group (intervention n = 1, control n = 10; odds ratio (OR) 12.9, 95% confidence interval (CI) 1.5 to 99.2). The intervention group was observed to have fewer falls than controls in the 30 days after discharge (intervention n = 6, control n = 14; incidence rate ratio (IRR) = 0.41, 95% CI 0.15 to 1.11). Between-group differences favoured the intervention group for functional independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences. Conclusion: Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hip fracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to determine the rate of readmission to hospital after hip fracture. The relationship between readmission to hospital and a range of social and functional variables, including receiving a home visit by an occupational therapist prior to discharge from hospital, was explored. Method: A retrospective cohort study was conducted of 154 patients returning to community living following hip fracture. Multivariate logistic regression identified variables associated with risk of readmission to hospital. Results: One in three patients was readmitted to hospital within 12 months after discharge, with 7% readmitted within 30 days. The most common reason for readmission was another fall. A low level of mobility prior to hip fracture was the strongest independent predictor of risk of readmission to hospital. There was no association between receiving a pre-discharge home visit by an occupational therapist and risk of readmission to hospital. Conclusion: Rates of readmission to hospital are high after hip fracture, and falls are the single most common reason for readmission. Interventions provided by occupational therapists, including home visits, should emphasise and incorporate evidence-based falls prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. Design: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes. Setting: A community rehabilitation programme within a large metropolitan health service. Subjects: Patients with stroke with upper limb deficits, referred for outpatient rehabilitation. Interventions: Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks. Main measures: The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction. Results: A total of 62 participants were allocated to the intervention (n = 30) and control groups (n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI −12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI −0.1 to 0.1). There were no between-group differences in how participants found instructions (p = 0.452), whether they remembered to do their exercises (p = 0.485), or whether they enjoyed doing their exercises (p = 0.864). Conclusions: The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke. This trial design was registered prospectively with the Australian and New Zealand Clinical Trials Register, ID: ACTRN 12613000786796. http://www.anzctr.org.au/trialSearch.aspx [ABSTRACT FROM AUTHOR]

Background A trial of a new model of triage (Specific and Timely Appointments for Triage: STAT) at a community rehabilitation program (CRP) reduced the mean time to first appointment from 17.5 to 10.0 days. However, quantitative findings reveal little about the impact of the system on those who used it. We aimed to explore the experiences of patients and clinicians following the introduction of STAT. Method Qualitative study within a convergent mixed-methods design applied to a controlled before and after trial at a CRP. Semi-structured interviews (n = 32) were conducted with clinicians who experienced the change to STAT, patients admitted to the CRP using STAT and patients who attended rehabilitation via a triaged wait list at another site. Results Clinicians reported shorter waiting times, more flexibility and increased efficiency with STAT, and noted the importance of effective change management. Patients reported a more efficient and consistent pathway to rehabilitation with STAT. Waiting had negative consequences for some patients at the triaged wait list site. Conclusions The qualitative data provide context to the quantitative results by showing that the changes that reduced waiting times were also well accepted and perceived to be beneficial by both patients and clinicians. What is known about the topic? Triage systems are widely used but can contribute to inefficiencies in health care. An alternative method of triage (STAT) using early allocation to face-to-face appointments has been shown to reduce waiting times in a community rehabilitation service. What does this paper add? This paper explains and adds important context to the quantitative findings by exploring the perceptions of the staff and patients who experienced both the existing and alternative models of triage. What are the implications for practitioners? The STAT model was well received by staff and patients, suggesting that this simple intervention was a feasible and effective method of reducing waiting times for community rehabilitation, and may be applicable to other services that share similar features. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of formal training on agreement between clinicians making decisions on client priority.Setting: A centralized intake service receiving referrals for a community rehabilitation programme.Design: Agreement was measured between the priority categories allocated to consecutive referrals by one of five clinicians in the referral office compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating. Data collection followed the implementation of four 1-hour workshops involving all raters, designed to increase consistency of triage decisions. Results were compared to a previous study conducted prior to the training.Participants: Two hundred and one consecutive referrals received for community rehabilitation services, triaged by experienced clinicians with allied health or nursing qualifications.Outcome measure: Agreement using weighted kappa (κw).Results: There was no change in agreement between clinicians after training, compared with a previous study in the same setting. Agreement remained moderate (κw = 0.50), with clinicians disagreeing on approximately 30% of referrals.Conclusions: Three out of 10 clients will receive a different priority rating and waiting time for rehabilitation services depending on which clinician in the referral office made the rating. This result was not improved by conducting a training programme. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate agreement between independent clinician raters using a triage protocol to prioritize referrals for occupational therapy and physiotherapy within a community rehabilitation program. Design: The priority category allocated to consecutive referrals by one of six clinicians in the referral office was compared with a second rating made by an independent occupational therapist, blinded to the initial priority rating. Setting: A centralized referral office staffed by allied health and nursing professionals designed as a single point of access for sub acute and ambulatory services within a large metropolitan health network. Participants: 214 referrals for adults requiring community based occupational therapy or physiotherapy rehabilitation for orthopaedic, neurological or other conditions (such as falls or cardio-respiratory conditions). Main Measure: Agreement (weighted kappa=κw) between the two ratings. Results: Overall agreement was moderate (κw=0.60), but disagreement occurred in 30% of cases. Professional discipline of the raters did not affect agreement. Agreement varied between diagnostic subgroups, with significantly lower agreement for referrals for rehabilitation following elective orthopaedic surgery (κw=0.25) than the other categories combined. Differences in agreement were observed between the four triage categories, with the lowest observed agreement in the most urgent category. Conclusions: Clinicians in a centralized model of triage showed only moderate agreement when making decisions about client priority for community rehabilitation for occupational therapy and physiotherapy. [ABSTRACT FROM AUTHOR]