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To investigate if a 12-week community-based exercise program (FitSkills) fostered positive attitudes towards disability among university student mentors. A stepped-wedge cluster randomised trial was completed with 4 clusters. Students were eligible to be a mentor if enrolled in an entry-level health degree (any discipline, any year) at one of three universities. Each mentor was matched with a young person with a disability and the pair exercised together at the gym twice a week for an hour (24 sessions total). At 7 times over 18 months, mentors completed the Disability Discomfort Scale to indicate their level of discomfort when interacting with people with disability. Data were analysed according to the intention to treat principles using linear mixed-effects models to estimate changes in scores over time. A total of 207 mentors completed the Disability Discomfort Scale at least once, of whom 123 participated in FitSkills. Analysis found an estimated reduction of 32.8% (95% confidence interval (CI) −36.8 to −28.4) in discomfort scores immediately after exposure to FitSkills across all four clusters. These decreases were sustained throughout the remainder of the trial. Mentors reported more positive attitudes towards interacting with people with disability after completing FitSkills with changes retained for up to 15 months. Participating in a 12-week community physical activity program fostered lower levels of discomfort in interacting with young people with disability among university student mentors. Student mentor's positive attitudes to disability were sustained for up to 15 months following the program. Mentors with no previous experience of disability had a larger reduction in discomfort scores than mentors who had previous disability experience. We recommend short-duration (24 hours over 12 weeks) community-based experiences such as FitSkills to positively impact how entry-level health professional students relate to young people with disability. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodResultConclusionThe purpose of this systematic review was to examine safety-related outcomes for patients with tracheostomy after flexible endoscopic evaluation of swallowing (FEES) to assess and manage their swallow, when compared to other non-instrumental swallow assessments such as clinical swallowing examination (CSE) and/or a modified Evans blue dye test (MEBDT).Three databases were searched for articles referring to safety-related outcome data for adults with a tracheostomy, who underwent FEES and CSE and/or MEBDT. Articles were screened using predefined inclusion/exclusion criteria.The search strategy identified 2097 articles; following abstract and full-text screening, seven were included for review. The summary of evidence found low to very low certainty that FEES was associated with improved outcomes across swallow safety, physiological outcomes, tracheostomy cannulation duration, functional outcomes, and detection of upper airway pathologies.This systematic review demonstrated low to very low certainty evidence from seven heterogeneous studies with low sample sizes that incorporating FEES may be associated with improved safety-related outcomes. There is less evidence supporting the accuracy of other swallow assessments conducted at the point of care (i.e. CSE and MEBDT). Future research requires studies with larger sample sizes and routine reporting of safety-related outcomes with use of FEES. [ABSTRACT FROM AUTHOR]

Music listening is widely used during exercise, but effects on physical activity are unknown. This review aimed to examine the effectiveness of music listening on physical activity of adults. Searches were conducted until September 2022. Eligible randomised controlled trials examined intentional music listening to enhance physical activity in adults. Trials were assessed using the Revised Cochrane risk-of-bias tool. The GRADE approach assessed certainty of evidence. One high and two low risk-of-bias trials (113 participants, 63–68 years) from cardiac and pulmonary rehabilitation programs were included. Moderate certainty evidence favoured music listening for total amounts of physical activity (n = 112, δ = 0.32, 95% CI = −0.06–0.70) and weekly moderate intensity physical activity (n = 88, MD = 52 min, 95% CI = −8–113). Low certainty evidence favoured music listening for exercise capacity (6-min walk test) (n = 79, MD = 101 metres, 95% CI = 2.32–199.88). There is imprecise, moderate certainty evidence that music listening increases physical activity by a small amount in older adults. Future research including adults of all ages with and without health conditions might investigate music listening with focussed behaviour change interventions. There is uncertainty in the current evidence but listening to music may lead to small increases physical activity in older adults with health conditions. Listening to music while walking may lead to improved exercise capacity. Rehabilitation professionals might consider using music listening as an adjunct with focussed behaviour change interventions aiming to increase physical activity. [ABSTRACT FROM AUTHOR]

Background: Waiting lists for community‐based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings. Aims: To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment. Methods: Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal–Wallis test. Employee satisfaction and perception of the model were explored using surveys. Results: Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre‐intervention (median 57 days) to the post‐intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery. Conclusion: Waiting lists are a major challenge across the health system. STAT provides a practical, low‐cost, data‐driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale. [ABSTRACT FROM AUTHOR]

Background: Inadequate physical activity is a problem for people with Down syndrome and objective monitoring using accelerometers may be inaccurate in this population. Method: This was a cross-validation and reliability study comparing two triaxial accelerometers (the SenseWear and RT3) to a criterion measure (the OxyCon Mobile) in 10 young people (M age = 20 ± 2) with Down syndrome. A ROC curve analysis was conducted to determine intensity thresholds from RT3 activity counts. Results: During self-selected pace walking, the accelerometers overestimated energy expenditure and had large limits of agreement (SenseWear: -0.5-3.6 METs; RT3: -0.2-2.7 METs). At this pace, SenseWear armband step counts were highly correlated with observed steps (r = .98) but underestimated steps by up to 12%. We developed RT3 thresholds that demonstrated good to excellent sensitivity and specificity in classifying physical activity intensity. Conclusions: SenseWear steps and RT3 activity count thresholds can be used to monitor physical activity in young people with Down syndrome, although energy expenditure estimates should be used with caution in this population.

Background: Foot problems may limit physical activity in children with Down syndrome. This prospective cohort study investigated the association of foot posture, deformity, and footwear fit with activity.Method Foot posture of 50 children with Down syndrome (22 girls, 28 boys; M age = 10.5 years) was assessed using the arch index and deformities were documented. Footwear fit compared the difference in length and width of shoes with participants' feet. Physical activity was measured using accelerometers. Results: Mean arch index (0.29 ± 0.08) was indicative of flat feet. Footwear fit was too short for five participants, too long for 26 participants, and too narrow for 29 participants. Regression analysis for the 20 participants adherent with wearing an accelerometer found no association of foot posture or deformity with activity. Footwear fit was negatively associated with activity (p = .03). Conclusion: Preliminary data suggest poor footwear fit is associated with reduced physical activity in children with Down syndrome.

Background Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these 2 research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. Methods and findings This multicentre, single-blinded (data collection and analysis), 3-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control [beta] 18.11 [95% CI -8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control [beta] 1.24 [95% CI -6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker [beta] -9.12 [95% CI -3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control [beta] 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control [beta] -0.12 [95% CI -0.54 to 0.30] p = 0.581; recommendation versus knowledge broker [beta] -0.19 [-1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control [beta] 2.19 [95% CI -1.36 to 5.74] p = 0.219; knowledge broker versus control [beta] -0.55 [95% CI -1.16 to 0.06] p = 0.075; recommendation versus knowledge broker [beta] -3.75 [95% CI -8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. Conclusions Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000029291., Author(s): Mitchell N. Sarkies 1,2,3,*, Lauren M. Robins 3, Megan Jepson 3, Cylie M. Williams 3, Nicholas F. Taylor 4,5, Lisa O'Brien 6, Jenny Martin 7, Anne Bardoel 8, Meg [...]

Background: Self‐directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self‐directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self‐directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. Methods: My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open‐ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free‐text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM‐B model). Results: Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self‐directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self‐directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. Conclusion: Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale‐up the implementation of the My Therapy programme and evaluate its effectiveness. [ABSTRACT FROM AUTHOR]