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Purpose: To determine the prevalence of benign paroxysmal positional vertigo without dizziness, a treatable falls risk factor in people attending outpatient falls clinics. Methods: Over 6 years, 618 people at risk of falls attending 2 falls clinics were assessed for benign paroxysmal positional vertigo, whether dizzy or non dizzy. Data regarding demographics, canal location of positive tests and comorbidities were collected from medical records. Results: Thirty-nine percent (238) of people with falls risk tested positive for benign paroxysmal positional vertigo; 62 (26%) or 1 in 4 of those testing positive were not dizzy. Thirty-nine of 104 (38%) testing positive for single canal benign paroxysmal positional vertigo and twenty-four of 134 (18%) testing positive for multiple canal benign paroxysmal positional vertigo were not dizzy. Comorbidities were common for all with falls risk but did not differentiate for benign paroxysmal positional vertigo on testing. Conclusions: Benign paroxysmal positional vertigo is common in people attending falls clinics and contributes to falls risk. Dizziness is common in BPPV though 26% or 1 in 4 people testing positive were not dizzy and would be missed without mandatory testing. Testing should also include all semicircular canals as multiple-canal involvement was high. IMPLICATIONS FOR REHABILITATION: Benign paroxysmal positional vertigo is a common and treatable falls risk factor, however screening for benign paroxysmal positional vertigo in people who fall usually only occurs if they are dizzy. 1 in 4 people with falls risk who have benign paroxysmal positional vertigo do not report symptoms of dizziness Screening for benign paroxysmal positional vertigo in all people who fall whether dizzy or not, is required to comprehensively identify and treat benign paroxysmal positional vertigo All semicircular canals should be screened for benign paroxysmal positional vertigo as the incidence of multiple-canal involvement is high [ABSTRACT FROM AUTHOR]

Objective. My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods. This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability, reach and demand, practicality, integration, limited efficacy testing and adaptations. Results. Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical, and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion. My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation. [ABSTRACT FROM AUTHOR]

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations' adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery. [ABSTRACT FROM AUTHOR]

We assessed the ability of patients discharging home from inpatient rehabilitation to meet criteria for community ambulation. Cross-sectional observational study design. Participants were assessed, within 48-hours of discharge on their ability to: ascend/descend three steps, walk at a speed of 0.44 m/s, ascend/descend a slope, ascend/descend a kerb, and walk 315 m continuously. Demographic data were collected from medical records. Multiple logistic regression determined factors predictive of meeting criteria. Of 200 participants (mean 73 years, 66% women, mixed diagnosis), 64 (32%) met all criteria. The least commonly met criteria were walking 315 m continuously (37%) and ascending/descending steps (70%). Participants who were female (OR: 0.27, 95%CI: 0.12–0.61), with a high comorbidity index (OR: 0.71, 95%CI: 0.56–0.91) or a traumatic orthopaedic diagnosis (OR: 0.22, 95%CI: 0.05–0.96) were less likely to meet all criteria. Participants with a higher admission functional independence walk item score (OR: 1.37, 95%CI: 1.05–1.78) or higher ambulatory self-confidence (OR: 1.02, 95%CI: 1.01–1.04) were more likely to meet all criteria. Approximately, one-third of inpatients discharged home from a publicly funded rehabilitation centre met the community ambulation criteria, suggesting many may not be physically prepared to participate in their community. Only about one in three inpatients discharging home from a publicly funded rehabilitation centre met physical criteria for community ambulation. Patients discharging home from inpatient rehabilitation have most difficulty walking long distances (≥315 m) compared to other criteria required for community ambulation (i.e., walking at a speed of 0.44 m/s, stepping up/down a kerb, ascending/descending a slope and ascending/descending three steps) and rehabilitation during this phase may require an increased focus on improving walking endurance/physical activity. Women with a high co-morbidity index, traumatic orthopaedic diagnosis, low self-confidence with ambulation on discharge and who require more assistance with walking on admission are least likely to meet the physical criteria for community ambulation at discharge, and therefore may require additional rehabilitation or supports. [ABSTRACT FROM AUTHOR]

Communication disability, including aphasia, is prevalent in the stroke population and impacts service delivery. This study explored the experiences of the multidisciplinary stroke team in delivering healthcare to patients with aphasia. A phenomenological approach was used to understand the experiences of delivering healthcare services in the presence of aphasia. Healthcare professionals (n = 16) were recruited across acute and subacute stroke care, with a range of discipline backgrounds and experience. Participants took part in focus groups and data were analysed using an inductive thematic approach. Five themes were evident: 1) aphasia is time consuming, 2) health professionals do not know how to help, 3) health professionals limit conversations with patients with aphasia, 4) health professionals want to know how to help, and 5) health professionals feel good after successful communication. Aphasia disrupts usual care. Health professionals want to help but are working in a non-optimal environment where communication and patient-centred care are not adequately resourced. A video abstract is available in . Current hospital systems and ward culture make it difficult to offer patient-centred care to patients with aphasia. Health professionals want to help patients with aphasia but are working in an environment where patient-provider communication is not adequately resourced. As a result, health professionals dread, limit or avoid talking with patients with aphasia. Health professionals need support which may include ongoing education and on-the-job training, and a change in ward culture including key performance indicators focusing on patient-provider communication. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of conducting a single videoconferencing session (telerehabilitation) instead of a face‐to‐face home visit for a review appointment in a community rehabilitation program. Design: A feasibility study based on Bowen's framework was used to determine demand, acceptability, limited efficacy and practicality of telerehabilitation. The study involved qualitative and quantitative data analysis. Setting: Two Victorian community rehabilitation programs providing services to large geographical catchment zones in the outer fringe of a metropolitan area. Participants: Ten adult clients receiving home‐based therapy and 5 allied health clinicians working in the program. Interventions: Clients participated in a single review therapy appointment (telerehabilitation) from physiotherapy, dietetics or speech pathology using the health network's videoconferencing platfrom and the client's own electronic device. Main outcome measures: Demand was assessed by calculating the percentage of eligible clients able to participate compared to total number of home‐based clients. Acceptability, practicality and limited efficacy were explored through qualitative analysis of semi‐structured interviews. Results: Nearly one quarter of clients screened met eligibility criteria, indicating a large potential demand for telerehabilitation. Telerehabilitation was highly acceptable for clinicians and clients participating in speech pathology and dietitian sessions as these contain targeted education and talking‐based therapy. It was less accepted in physiotherapy, where there is a more hands‐on approach. Telerehabilitation was practical and efficient for both clinicians and clients, especially when time was allowed for training and initial troubleshooting. Conclusion: Telerehabilitation is a feasible modality for review sessions in community rehabilitation and helps improve efficient use of clinician and client time. It is more appropriate for disciplines that use education and talking‐based therapy compared with hands‐on therapy. Older clients are accepting of new technology with support and education. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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]

Objectives Wait lists are common in ambulatory and community-based services. The aim of the present study was to explore managers' perceptions of factors that contribute to wait times. Methods A qualitative study was conducted using semi-structured interviews with managers and team leaders of ambulatory and community health services within a large health network. Interviews were transcribed and coded, and the codes were then grouped into themes and subthemes. Results Representatives from 26 services participated in the project. Four major themes were identified. Three themes related to reasons and factors contributing to increased wait time for services (inefficient intake and scheduling processes; service disruptions due to human resource issues; and high service demand). A fourth theme related to staff attitudes towards wait times and acceptance and acknowledgement of wait lists. Conclusions Service providers perceive high demand to be a key driver of wait times, but a range of other factors also contributes and may represent opportunities for improving access to care. These other factors include improving process efficiencies, greater consistency of service delivery through more efficient management of human resources and shifting to more consumer-centred approaches in measuring wait times in order to drive improvements in patient flow. [ABSTRACT FROM AUTHOR]

Background: Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders.Methods: This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models.Results: Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone.Conclusions: 10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant.Clinical Trial Registration: ACTRN12609000834257. [ABSTRACT FROM AUTHOR]

Purpose: To generate an understanding of the opinions of key people associated with a program for older people transitioning from hospital back to the community and explore their thoughts around training family members to help provide physiotherapy.Method: A qualitative study using focus groups and semi-structured interviews was conducted. Participants included patients admitted to a transitional care program, their family members, physiotherapists working in transitional care and members of a consumer group from the health service where the transitional care program was based. Data were transcribed verbatim and a thematic analysis was conducted.Results: Four patients, four family members, four consumer group members and eight physiotherapists participated in this study. Three themes emerged: family members providing physiotherapy may improve outcomes for patients; training family members to provide physiotherapy should include key elements and be individualised; and involving family members in physiotherapy may impact positively and negatively on people and relationships.Conclusions: Older people transitioning from hospital to the community are at risk of functional decline and may receive very little physiotherapy. Training family members to assist with physiotherapy was perceived as a way to improve patient outcomes and relationships between patients and their family, although there were concerns raised about caregiver stress. Evaluation of the feasibility and effectiveness of this approach is warranted.Implications for RehabilitationOlder people transitioning from hospital to the community are at risk of functional decline and often receive very little physiotherapy.Training family members to assist with simple physiotherapy programs may increase the amount of physiotherapy patients transitioning from hospital to the community can receive and improve functional outcomes for patients.Stakeholders perceive that individualising a program to patient and family member needs is important.Involving family members in physiotherapy may not increase caregiver stress and may improve relationship dynamics between patients and family members. [ABSTRACT FROM AUTHOR]

Purpose: To identify the main characteristics, based on available evidence, of stabilizer muscles to inform the development of a definition of stabilizer muscles. Methods: Electronic databases were systematically searched for relevant literature from the databases' inception to June 2013 using keywords related to stability, muscles, and characteristics of stabilizer muscles. Studies that provided at least one characteristic of a stabilizer muscle were included. For the quality assessment, all included articles were categorized as either experimental or opinion-based studies. Methodological quality was assessed using a customized checklist, and data were analyzed with a narrative synthesis involving content analysis. The number of articles providing either direct evidence supporting a link between the characteristic and joint stability or indirect evidence that a muscle considered to be a stabilizer has that characteristic determined the level of significance of that characteristic for stabilizer muscles. Results: A total of 77 studies met the inclusion criteria. The highest number of articles providing supporting evidence that a particular muscle characteristic plays a stabilizing role related to biomechanical characteristics (27 articles), followed by neurological characteristics (22 articles) and anatomical/physiological characteristics (4 articles). Conclusion: Based on a synthesis of supporting evidence from the literature, stabilizer muscles can be defined as muscles that contribute to joint stiffness by co-contraction and show an early onset of activation in response to perturbation via either a feed-forward or a feedback control mechanism. These results may guide researchers to investigate which muscles exhibit these characteristics to determine whether particular muscles have a stabilizer rather than a prime mover role during normal functioning. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE. We examined the interrater reliability and clinical utility of the Personal Care Participation Assessment and Resource Tool (PC-PART) in a rehabilitation setting. METHOD. Ninety-six patients were recruited from the caseload of four occupational therapists. Patients were assessed on admission. Clinical utility was based on time to complete assessments. RESULTS. Interrater reliability for the total score was very high (intraclass correlation coefficient = .91). Limits of agreement for the program indicated aggregate data from individual scores were within 1.3 units (range = 21.3 to 0.5) but individual scores would be within 10 units (range = 29.3 to 0.2). The PC- PART took 27 min to complete. CONCLUSION. The PC-PART may have sufficient interrater reliability and clinical utility to evaluate program outcomes. The limits of agreement for rating individuals were relatively large, suggesting that it may be difficult to use the PC-PART to make clinical inferences about an individual patient. [ABSTRACT FROM AUTHOR]

Background: Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. Purpose: To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Study Design: Case control study; Level of evidence, 3. Methods: Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. Results: In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete's estimate of the number of months it would take to return to sport, as measured preoperatively (x2 2 = 18.3, P\.001, classification accuracy = 70%) and at 4 months postoperatively (x2 4 = 38.7, P\.001, classification accuracy = 86%). Conclusion: Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months. [ABSTRACT FROM AUTHOR]

Background and Purpose The purpose of this paper was to determine if the Six-minute Walk Test (6MWT) was a reliable exercise test for patients referred to cardiac rehabilitation when up to three tests were performed and to determine if test scores differed according to between-test time interval. Methods Thirty adults aged 63 ± 7.9 years referred to cardiac rehabilitation participated in a repeated measures reliability trial. Participants completed three 6MWTs within a one-week period. Participants were randomly allocated to one of three groups: on the first day, Group A completed three walks, Group B completed two walks and Group C completed one walk. Relative reliability was expressed in a ratio (ICC2,1), and absolute reliability was expressed in metres (95% confidence intervals) for group and individuals. Results The 6MWT demonstrated a high level of relative reliability (intraclass correlation coefficients [ICC] = 0.94) across the three walks. There was no statistically significant difference between the test scores of the three groups. However, there was an increase in distance walked from the first to the second to the third 6MWT. Absolute reliability indicated that a change of at least 44 m would be required to be interpreted as true change in a group, and at least 95 m to be interpreted as true change in an individual with 95% confidence. Conclusion Three 6MWTs completed in relatively short timeframes were not sufficient for reliable results as there was an increase in the distance walked, and relatively large increases in distances would be required to be interpreted as change. It did not make any difference whether the tests were all completed on one day or over one week. This study highlighted problems that may arise when relying on reliability coefficients alone to interpret reliability. These results suggest that the 6MWT may not have sufficient reliability to be a suitable test to evaluate exercise tolerance in patients referred to cardiac rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months’ follow-up may be too early to assess return-to-sport outcomes accurately.Purpose: This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery.Study Design: Case series; Level of evidence, 3.Methods: A self-report questionnaire was used to collect data at 2 to 7 years after ACL reconstruction surgery regarding preinjury sports participation, postoperative sports participation, and subjective knee function. The main inclusion criteria were participation in regular sports activity before injury and the attendance at routine surgical follow-up appointments.Results: A total of 314 participants (mean age, 32.5 ± 10.2 years) were included at a mean 39.6 ± 13.8 months after ACL reconstruction surgery. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Those who had not attempted their preinjury level of sport by 12 months after surgery were just as likely to have returned to preinjury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 1.1; 95% confidence interval, 0.76-1.6).Conclusion: Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation. [ABSTRACT FROM PUBLISHER]

Objective. To investigate factors that predict discharge destination for patients making the transition from hospital to the community. Methods. Using a prospective cohort design, 696 patients from 11 Transition Care Programs were recruited. Baseline patient and program characteristics were considered for predicting discharge destination, functional status, and patient length of stay. Results. An increased physiotherapy staffing ratio in Transition Care Program was associated with an increased likelihood that a patient was discharged home, with an improved functional or mobility status, and after a shorter length of stay. The other factor that predicted discharge to home included having an Aged Care Assessment Service classification of low level care or home with a support package. An increased physiotherapy staffing level also reduced the likelihood of discharge to low level or high level care. The other factors that predicted discharge to low level care were having higher mobility status and older age; the other factor associated with increased likelihood of predicting discharge to high level care was having an Aged Care Assessment Service classification of high level care. Conclusions. Factors on admission that predicted discharge destination were program physiotherapy staffing ratios, Aged Care Assessment Service assessment, age and mobility status. [ABSTRACT FROM AUTHOR]

Background: Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays., Objectives: To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation., Methods: This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge., Results: 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13)., Conclusions: My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation., Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Gaps in discharge planning are experienced by 41% of hospital patients in Australia. There is an established body of knowledge regarding the features of the discharge process that need to be improved to avoid subsequent hospital readmission and enhance the discharge experience. However, many of these studies have focused solely on factors related to unplanned hospital readmissions and there has been limited success in operationalising improvements to the discharge process. The aim of this study was to explore and describe the factors that influence the decision to discharge adult medical patients from hospital, from patient, carer and staff perspectives., Methods: A qualitative descriptive study was conducted in one acute medical ward in Melbourne, Australia. The study data were collected by observations of clinical practice and semi-structured interviews with patients, carers and staff. Participants were: i) English-speaking adults identified for discharge home, ii) patient carers, and iii) staff involved in the discharge process. Observation data were analysed using content analysis and interviews data were analysed using thematic analysis., Results: Twenty-one discharges were observed, and 65 participants were interviewed: 21 patients, two carers, and 42 staff. Most patients (76%) were identified as being ready for discharge during morning medical rounds, and 90% of discharge decisions were made collaboratively by the medical team and the patient. Carers were observed to be notified in 15 discharges by the patient (n = 8), doctors (n = 4), or nursing staff (n = 3). Five themes were constructed from thematic analysis of interviews: Readiness for Home, Fragmented Collaboration, Health Literacy, Unrealistic Expectations, and Care beyond Discharge. A collaborative team and supportive carers were considered to enhance risk assessment and discharge planning, however fragmented communication between clinicians, and between clinicians and patients/carers was a barrier to discharge decision-making., Conclusions: Our study highlights the need for a more coordinated approach to discharge decision-making that optimises communication with patients and carers and multidisciplinary workflows and reduces fragmentation. The importance of patient-centred care and a personalised approach to care are well established. However, there is a need to design systems to customise the entirety of the patient journey, including the approach to discharge decision making., (© 2024. The Author(s).)

Background: Proximal humeral fractures are amongst the most common fractures. Functional recovery is often slow and many people have ongoing disability during activities of daily life. Unidimensional measurement of activity limitations is required to monitor functional progress during rehabilitation. However, current shoulder measures are multidimensional incorporating constructs such as activities, range of motion and pain into a single scale. Psychometric information of these measures is scarce in this population, and indicate measurement issues with reliability. Therefore, the aim was to develop the clinician-observed Shoulder Function Index (SFInX), a unidimensional, interval-level measure of 'shoulder function' based on actual performance of activities, reflecting activity limitations following a proximal humeral fracture., Methods: An outcome measure development study was performed including item generation (existing shoulder measures, focus groups) and item selection (selection criteria, importance and feasibility ratings, pilot testing, Rasch analysis). Clinicians (n=15) and people with a proximal humeral fracture (n=13) participated in focus groups. Items were pilot tested (n=12 patients) and validated in a Rasch study. The validation study sample (n=92, 86% female) were recruited between 5 and 52 weeks post-fracture and had a mean age of 63.5 years (SD13.9). Measurements at recruitment and 6 and 7 weeks later were taken in three public metropolitan hospitals or during home visits. Raw SFInX data were analysed with WINSTEPS v3.74 using polytomous Rasch models., Results: From 282 generated items, 42 items were selected to be rated by clinicians and patients; 34 items were pilot tested and 16 items were included for Rasch analysis. The final SFInX, developed with the Partial Credit Model, contains 13 items and has the response categories: 'unable', 'partially able' and 'able'. It is unidimensional measuring 'shoulder function', and can measure from early functional use (drinking from a cup) to independence around the house (lifting items above head, carrying heavy items)., Conclusions: The SFInX is a promising outcome measure of shoulder function for people with a proximal humeral fracture. It has content relevant to patients and clinicians, is unidimensional and feasible for use in clinical and home settings. In its current form, the SFInX is ready for further psychometric evaluation, and for subsequent use in clinical settings and research.

Background: The Personal Care Participation Assessment and Resource Tool (PC-PART) is a 43-item, clinician-administered assessment, designed to identify patients' unmet needs (participation restrictions) in activities of daily living (ADL) required for community life. This information is important for identifying problems that need addressing to enable, for example, discharge from inpatient settings to community living. The objective of this study was to evaluate internal construct validity of the PC-PART using Rasch methods., Methods: Fit to the Rasch model was evaluated for 41 PC-PART items, assessing threshold ordering, overall model fit, individual item fit, person fit, internal consistency, Differential Item Functioning (DIF), targeting of items and dimensionality. Data used in this research were taken from admission data from a randomised controlled trial conducted at two publically funded inpatient rehabilitation units in Melbourne, Australia, with 996 participants (63% women; mean age 74 years) and with various impairment types., Results: PC-PART items assessed as one scale, and original PC-PART domains evaluated as separate scales, demonstrated poor fit to the Rasch model. Adequate fit to the Rasch model was achieved in two newly formed PC-PART scales: Self-Care (16 items) and Domestic Life (14 items). Both scales were unidimensional, had acceptable internal consistency (PSI =0.85, 0.76, respectively) and well-targeted items., Conclusions: Rasch analysis did not support conventional summation of all PC-PART item scores to create a total score. However, internal construct validity of the newly formed PC-PART scales, Self-Care and Domestic Life, was supported. Their Rasch-derived scores provided interval-level measurement enabling summation of scores to form a total score on each scale. These scales may assist clinicians, managers and researchers in rehabilitation settings to assess and measure changes in ADL participation restrictions relevant to community living., Trial Registration: Data used in this research were gathered during a registered randomised controlled trial: Australian and New Zealand Clinical Trials Registry ACTRN12609000973213. Ethics committee approval was gained for secondary analysis of data for this study.

Introduction: Evidence-based practice (EBP) is a key principle in the delivery of effective and high-quality health care. Existing research suggests that allied health professionals are generally supportive of EBP but rarely participate in activities associated with EBP., Methods: This mixed-method study used 8 focus groups of allied health professionals and managers and a questionnaire of all participants to explore the attitudes and barriers to EBP in a large metropolitan health service. Qualitative data were analyzed using a thematic analysis of focus group transcriptions. Questionnaire data were analyzed descriptively., Results: Fifty clinicians and 10 managers across 7 allied health disciplines participated in the study. The questionnaire identified that clinicians have a positive attitude but low participation in EBP. Qualitative data revealed that EBP was not highly valued by clinicians and managers or viewed as a core component of clinical care, with activities directly related to maintaining patient flow viewed as higher priorities. Lack of skills and resources and difficulty associated with implementing evidence into practice were further barriers., Discussion: Achieving higher uptake of EBP among allied health clinicians requires a cultural shift, placing higher value on these activities despite the challenging context of constant pressures to increase patient flow. Addressing EBP through small group projects rather than considering it to be an individual responsibility may be more acceptable to both clinicians and managers, with added benefits of peer support for both evaluating evidence and translation into practice., (© 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.)

Background: The high incidence of falls associated with Parkinson's disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson's has not been convincingly demonstrated., Methods/design: 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined., Discussion: This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD., Trial Registration: The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).

Background: Low back disorders are a common and costly cause of pain and activity limitation in adults. Few treatment options have demonstrated clinically meaningful benefits apart from advice which is recommended in all international guidelines. Clinical heterogeneity of participants in clinical trials is hypothesised as reducing the likelihood of demonstrating treatment effects, and sampling of more homogenous subgroups is recommended. We propose five subgroups that allow the delivery of specific physiotherapy treatment targeting the pathoanatomical, neurophysiological and psychosocial components of low back disorders. The aim of this article is to describe the methodology of a randomised controlled trial comparing specific physiotherapy treatment to advice for people classified into five subacute low back disorder subgroups., Methods/design: A multi-centre parallel group randomised controlled trial is proposed. A minimum of 250 participants with subacute (6 weeks to 6 months) low back pain and/or referred leg pain will be classified into one of five subgroups and then randomly allocated to receive either physiotherapy advice (2 sessions over 10 weeks) or specific physiotherapy treatment (10 sessions over 10 weeks) tailored according to the subgroup of the participant. Outcomes will be assessed at 5 weeks, 10 weeks, 6 months and 12 months following randomisation. Primary outcomes will be activity limitation measured with a modified Oswestry Disability Index as well as leg and back pain intensity measured on separate 0-10 Numerical Rating Scales. Secondary outcomes will include a 7-point global rating of change scale, satisfaction with physiotherapy treatment, satisfaction with treatment results, the Sciatica Frequency and Bothersomeness Scale, quality of life (EuroQol-5D), interference with work, and psychosocial risk factors (Orebro Musculoskeletal Pain Questionnaire). Adverse events and co-interventions will also be measured. Data will be analysed according to intention to treat principles, using linear mixed models for continuous outcomes, Mann Whitney U tests for ordinal outcomes, and Chi-square, risk ratios and risk differences for dichotomous outcomes., Discussion: This trial will determine the difference in outcomes between specific physiotherapy treatment tailored to each of the five subgroups versus advice which is recommended in guidelines as a suitable treatment for most people with a low back disorder., Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000834257.