Rehabilitation & Aged Care Collected Works

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Interventions for treating psoriatic arthritis (Review)
(Cochrane Database of Systematic Reviews, 2000-07-24) Jones, Graham; Crotty, Maria; Brooks, Peter
Background It has been estimated that arthritis occurs in 5‐7% of those with psoriasis. Relatively few clinical trials of treatment are available for psoriatic arthritis and data presentation in these trials is far from uniform making comparison difficult. Objectives To assess the effects of sulfasalazine, auranofin, etretinate, fumaric acid, IMI gold, azathioprine, efamol marine and methotrexate, in psoriatic arthritis. Search methods We searched MEDLINE up to February 2000, and Excerpta Medica (June 1974‐95). Search terms were psoriasis, arthritis, therapy and/or controlled trial. This was supplemented by manually searching bibliographies of previously published reviews, conference proceedings, contacting drug companies and referring to the Cochrane Clinical Trials Register. All languages were included in the initial search. Selection criteria All randomized trials comparing sulfasalazine, auranofin, etretinate, fumaric acid, IMI gold, azathioprine, and methotrexate, in psoriatic arthritis. Following a published a priori protocol, the main outcome measures included individual component variables derived from Outcome Measures in Rheumatology Clinical Trials (OMERACT). These include acute phase reactants, disability, pain, patient global assessment, physician global assessment, swollen joint count, tender joint count and radiographic changes of joints in any trial of one year or longer [Tugwell 1993], and the change in pooled disease index (DI). Only English trials were included in the review. Data collection and analysis Data were independently extracted from the published reports by two of the reviewers (MC, GJ). An independent blinded quality assessment was also performed. Main results Twenty randomized trials were identified of which thirteen were included in the quantitative analysis with data from 1022 subjects. Although all agents were better than placebo, parenteral high dose methotrexate (not included), sulfasalazine, azathioprine and etretinate were the agents that achieved statistical significance in a global index of disease activity (although it should be noted that only one component variable was available for azathioprine and only one trial was available for etretinate suggesting some caution is necessary in interpreting these results). Analysis of response in individual disease activity markers was more variable with considerable differences between different medications and responses. In all trials the placebo group improved over baseline (pooled improvement 0.39 DI units, 95% CI 0.26‐0.54). There was insufficient data to examine toxicity. Authors' conclusions Parenteral high dose methotrexate and sulfasalazine are the only two agents with well demonstrated published efficacy in psoriatic arthritis. The magnitude of the effect seen with azathioprine, etretinate, oral low dose methotrexate and perhaps colchicine suggests that they may be effective but that further multicentre clinical trials are required to establish their efficacy. Furthermore, the magnitude of the improvement observed in the placebo group strongly suggests that uncontrolled trials should not be used to guide management decisions in this condition.
Waking cervical pain and stiffness, headache, scapular or arm pain: Gender and age effects
(Elsevier, 2002) Gordon, Susan J; Trott, P; Grimmer, K A
A random population-based study using a structured telephone questionnaire was undertaken to determine the frequency, duration and prevalence of waking cervical spine pain and stiffness, headache, and aching between the scapulae or in the arm and their relationship to age and gender. Seventy-six per cent of households contacted completed the questionnaire, yielding a total of 812 questionnaires. Subjects most commonly reported waking with scapular or arm pain (27%) followed by headache (19%), cervical pain (18%) and cervical stiffness (17%). The majority of subjects reported that symptoms lasted for more than an hour on one or two occasions during the week. Subjects who reported the presence of one type of waking symptom were significantly more likely to report other waking symptoms. Females were significantly more likely to wake with a headache than males (OR 2.5, 95% CI 1.6 to 4.0), while all subjects aged over 60 years were significantly less likely to wake with a headache than subjects in other age groups (OR 0.6, 95% CI 0.4 to 1.0). Females exhibited a decline in waking cervical pain, stiffness and headache with increasing age. In contrast, males exhibited a peak prevalence of waking cervical pain, stiffness and headache in the 40 to 59 year age group. The prevalence of waking with aching between the scapulae or in the arm behaved differently from the other symptom groups in both genders.
Self-Reported Versus Recorded Sleep Position: An Observational Study
(Nova Southeastern University, 2004-01) Gordon, Susan J; Grimmer, K A; Trott, P
Background: Patient reports of ‘usual’ and ‘recent’ sleep positions are used by allied health professionals to direct the management of waking and nocturnal musculoskeletal symptoms. However no published studies have determined if self reports of sleep position are valid, consistent or reliable. An observational study was conducted at the Centre for Sleep Research of the University of South Australia. Twelve subjects, four in each of the age groups 18 to 39 years, 40 to 59 years and 60 years and over, without any known sleep disorders or sleep-disturbing medical or emotional problems participated in the study. Subjects spent two non-consecutive nights in a sleep laboratory, where an infra-red light source allowed their sleep position during the night to be recorded on video. Prior to retiring, subjects recorded the position in which they believed they spent the most time during a ‘usual’ nights sleep. In the morning, they recorded the position in which they believed they spent the most time during the recorded nights sleep. Videos were viewed in order to count the number of position shifts per night and to calculate the total amount of time each subject spent lying prone, supine and on their side. Subjects’ pre- and post-sleep questionnaire responses were then compared to the video record to determine validity, the amount of time spent in each sleep position was compared across the two nights to determine consistency and pre-and post-sleep questionnaire responses were compared to determine reliability of self reported sleep position. High correlation was found when comparing subjects’ self report of their common sleep positions with the video record. The sensitivity of self reported ‘usual’ night side lying sleep position was 89% and ‘last’ night reports 95%. Sleep position was consistent across repeated nights’ sleep, and there was good reliability between subjects’ self report of ‘usual’ (92%) and ‘last night’ (83%) sleep positions. This study reports high validity, reliability and consistency in self reports of ‘usual’ and ‘recent’ sleep positions
Can volunteer companions prevent falls among inpatients? A feasibility study using a pre-post comparative design
(2006) Giles, Lynne Catherine; Bolch, Denise; Rouvray, Robyn; McErlean, Beth; Whitehead, Craig Hamilton; Phillips, Paddy Andrew; Crotty, Maria
Background : Falls in hospital are frequent and their consequences place an increased burden on health services. We evaluated a falls prevention strategy consisting of the introduction of volunteers to 'sit' with patients identified as being at high risk of falling. Methods : Two four bed 'safety bays' located on medical wards in two hospitals within southern Adelaide were used. Ward fall rates (expressed as falls per 1000 occupied bed days) were compared in the baseline period (February-May 2002) with the implementation period (February – May 2003) using incident rate ratios and 95% confidence intervals. The number of hours of volunteered time was also collected. Results : No patient falls occurred on either site when volunteers were present. However, there was no significant impact on overall ward fall rates. In the baseline period, there were 70 falls in 4828 OBDs (14.5 falls per 1000 OBDs). During the implementation period, there were 82 falls in 5300 OBDs (15.5 falls per 1000 OBD). The IRR for falls in the implementation versus baseline period was 1.07 (95%CI 0.77 – 1.49; P = 0.346). Volunteers carried out care activities (e.g. cutting up food), provided company, and on occasions advocated on behalf of the patients. Volunteers donated 2345 hours, at an estimated value to the hospitals of almost $57,000. Conclusion : Volunteers may play an important and cost-effective role in enhancing health care and can prevent falls in older hospital patients when they are present. Full implementation of this program would require the recruitment of adequate numbers of volunteers willing to sit with all patients considered at risk of falling in hospital. The challenge for future work in this area remains the sustainability of falls prevention strategies.
Establishment of and first 20 months of operating an outreach geriatric clinic in a regional centre
(2006) Whitehead, Craig Hamilton; Harding, Stephen; Giles, Lynne Catherine; Crotty, Maria
Sleep Position, Age, Gender, Sleep Quality and Waking Cervico-Thoracic Symptoms
(Nova Southeastern University, 2007-01) Gordon, Susan J; Grimmer, K A; Trott, P
Purpose: An epidemiological study was undertaken to investigate the association between sleep position, age, gender, sleep quality and prevalence of waking cervical pain and stiffness, headache and aching between the scapulae and/or in the arm. Method: A randomly administered telephone survey was completed by 76% of prospective participants, yielding 812 completed surveys. Results: This study confirmed that the majority of subjects sleep in the side lying position and that this sleep position significantly protected against waking cervical, scapular and arm pain and significantly promoted high sleep quality ratings. Anecdotally, supine sleep position has been recommended for the prevention of cervical symptoms however, this study identified no advantage in adopting the supine sleep position in relation to the prevalence of waking symptoms. The adoption of an upright sleep position was significantly associated with increased prevalence of all waking symptom categories and low sleep quality ratings. These findings were of greater significance in the presence of medication use, or a medical condition which affected sleep quality. Prone sleep position was not significantly related to waking symptom reports. Small subject numbers confounded this analysis and further research in this area with larger subject numbers is required. Conclusions: The findings of this study support the need for health professionals to consider individuals’ sleep position and waking symptom history when developing a management plan for troublesome waking symptoms.
Understanding Sleep Quality and Waking Cervico-Thoracic Symptoms
(Nova Southeastern University, 2007-04) Gordon, Susan J; Grimmer, K A; Trott, P
Purpose: Using data from an epidemiological study described elsewhere (Gordon et al 2002 & 2007), multivariate logistic regression models were constructed to explore the association between sleep position, factors related to sleep quality, and the prevalence of waking symptoms (cervical spine pain and stiffness, headache, and aching in scapulae or arm regions). Method: A causal model was developed in which putative exposures were tested for their association with sleep quality, which was considered as an antecedent cause of waking cervico-thoracic symptoms. Results: Factors which significantly constrained sleep quality were identified as the presence of a medical condition, past history of injury or accident to the cervical spine, sleep position, and nocturnal bruxism. Poor sleep quality was significantly related to waking cervico-thoracic symptoms. Conclusions: The significant relationships between these factors highlight the need for assessment of all possible causes of waking cervico-thoracic symptoms in the clinical setting.
Do social networks affect the use of residential aged care among older Australians?
(BioMed Central - http://www.biomedcentral.com, 2007-10-04) Giles, Lynne Catherine; Glonek, Gary F V; Luszcz, Mary Alice; Andrews, Gary
Background Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants) and total social networks upon use of low-level residential care and nursing homes. Methods Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks. Results Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75). Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90). Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use. Discussion Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.
Nutritional status of adults participating in ambulatory rehabilitaion
(2008) Kaur, Supreet; Miller, Michelle Deanne; Halbert, Julie Anne; Giles, Lynne Catherine; Crotty, Maria
Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals
(Elsevier, 2008-08-08) Nielsen, I; Gordon, Susan J; Selby, S
Breast cancer-related lymphoedema (BCRL) is a debilitating, distressing condition affecting approximately one in five breast cancer survivors (Clark B, Sitzia J, Harlow W. Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study. QJM 2005;98:343–8). The evidence-base for breast cancer-related lymphoedema risk reduction advice is scant and contradictory, with most studies in the area limited by small numbers, retrospective design and other methodological inadequacies. Current advice has the capacity to profoundly alter quality of life following treatment for breast cancer. Health professionals should review the risk reduction advice they provide to reflect the current understanding of aetiology and risk factors. Further research is required to provide more evidence for the content, to identify optimal methods of precautionary education delivery and to determine the effect of the advice on the patient’s quality of life and perception of recovery.
Age and Lateral Sleep Position: A Pilot Study
(Nova Southeastern University, 2009) Gordon, Susan J; Buethtner, P G
Purpose: Previous research, undertaken using a Super 8 camera and non-continuous data, has reported that with increasing age, people are more likely to sleep in the right lateral position. It has been postulated that this is due to age related alterations in cardiovascular function. This pilot study was undertaken to determine if collection and analysis of continuous sleep data was a feasible method for further investigation of this topic and to determine the sample size required for an adequately powered study. Increased understanding of age related changes in sleep position may provide valuable information to improve sleep quality and nursing care of the elderly person. Method: Research at the Centre for Sleep Research, University of South Australia, investigated the association between age and sleep position. Infra-red illumination and video cameras recorded the sleep patterns of 12 subjects for two nights. Videos were examined and the amount of time spent in each sleep position was calculated in seconds. Results: In a one-way analysis of variance, sample sizes of 19, 19, and, 19 are necessary from the three age groups whose means are to be compared. The expected means are 20, 25 and 45 for the three age groups respectively. The total sample of 57 subjects achieves 82% power to detect differences among the means versus the alternative of equal means using an F test with a 0.05 significance level.Conclusions: The results of this pilot study support further investigation of the relationship between age and lateral sleep position preference, and particularly the physiological parameters which may underpin the adoption of different sleep positions with increasing age. The described method is appropriate and modifications are suggested to further improve future studies.
Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people (Protocol)
(Cochrane Collaboration, 2009-01-21) Crotty, Maria; Unroe, Kathleen; Cameron, Ian D; Miller, Michelle Deanne; Ramirez, Gilbert
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the short (four months or less) and longer term effects of interventions, including programmes, specifically aimed at improving and restoring physical and psychosocial functioning after a hip fracture in older people. The primary comparison will be between any relevant intervention versus no or placebo (sham) intervention, or conventional or usual care.
Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people (Protocol)
(Cochrane Collaboration, 2009-04-15) Crotty, Maria; Unroe, Kathleen; Cameron, Ian D; Miller, Michelle Deanne; Ramirez, Gilbert; Couzner, Leah
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the short (four months or less) and longer term effects of interventions, including programmes, specifically aimed at improving and restoring physical and psychosocial functioning after a hip fracture in older people. The primary comparison will be between any relevant intervention versus no or placebo (sham) intervention, or conventional or usual care.
Body position and cardio-respiratory variables in older people
(Elsevier, 2009-11-30) Gordon, Susan J; Jones, A; Sealey, R; Buettner, Petra
What effect does body position have on cardio-respiratory variables in active older people? An experimental laboratory study was undertaken measuring heart rate, systolic and diastolic blood pressure and oxygen saturation when 26 active people aged 60 years and over adopted five standardized body positions. Measurements were taken every 2 min over a 10-min period in sitting, right side lying, left side lying, supine and supine with the head 20° below the level of the body. Rate pressure product and mean arterial pressure were calculated. Smoking history, medication use, health conditions and activity level were recorded. Height, weight and body fat were measured. Left and right side lying produced significantly lower diastolic and systolic blood pressure, rate pressure product and mean arterial pressure than supine with the head down. Excluding oxygen saturation mean values for all variables remained within recommended normal limits in all positions. Significant differences in cardio-respiratory variables occur when active older people change body position. Positioning as a treatment intervention appears safe in supine, side lying and sitting for this population. Head down supine position should be adopted with caution.
Riding position and lumbar spine angle in recreational cyclists: A pilot study
(Western Kentucky University, 2010) Schultz, S J; Gordon, Susan J
This pilot study investigated the reliability of an inclinometer to assess lumbar spine angle in three different cycling positions, and explored the relationship between lumbar spine angle and riding position, anthropometry, bike measures and low back pain (LBP). Cyclists were recruited from two cycle clubs. Anthropometric variables and bike setup were measured before participants’ bikes were secured in a wind trainer. Cyclists then adopted three positions for riding, upright on the handlebars, on the brake levers and on the drops, according to a random allocation. The angle of the lumbar spine was measured; using an inclinometer, at zero minutes and after cyclists had completed 10 minutes of cycling. Intrameasurer reliability for inclinometer use to measure lumbar spine angle in each position was excellent (ICC=0.97). The angle of the lumbar spine changed significantly over 10 minutes in the brake position (p=0.004). Lumbar spine angle at 10 minutes was significantly different between the brake and drop positions (p=0.018, p<0.05), and between upright and drop positions (p=0.012, p<0.05). Lumbar spine angle was not related to anthropometric measures. The change in lumbar spine angle varied from one degree of extension to 12 degrees of flexion, with increased flexion occurring in 95% of trials. An inclinometer has excellent intra-measurer reliability to measure lumbar spine angle in cycling positions. Future research with a sample of 72 or more participants is required to determine if there is a significant relationship between LBP and lumbar spine angle in different cycling positions.
Recreational cyclists: The relationship between low back pain and training characteristics
(Western Kentucky University, 2010) Schultz, S J; Gordon, Susan J
This study investigated the relationship between low back pain (LBP) and training characteristics in recreational cyclists. Purposive sampling was used to recruit sixty-six recreational cyclists from nine cycling clubs. Participants completed a survey reporting training characteristics and LBP behaviour during a usual week of cycling. This included percent of time spent cycling in three common riding positions, cycling terrain, average cycling pace, number of gears, days per week cycled and number of cycling events per year. Fifty percent reported LBP during or after cycling or smoking and LBP. Cyclists who reported LBP cycled significantly further in a usual week of cycling than cyclists who did not report LBP (p=0.022). An odds ratio indicated that people who cycle 160 km or more per week are 3.6 times as likely to experience LBP compared with people who cycle less than 160 km per week (OR=3.6, CI=1.29- 10.15). Preference for riding with the hands on the brakes approached significance with respect to LBP reports (P=0.06). No other significant relationship between LBP and training characteristics was identified. In order to reduce the risk of LBP recreational cyclists
Virtual reality for stroke rehabilitation (Protocol)
(Cochrane Database of Systematic Reviews, 2010-02-17) Laver, Kate; George, Stacey; Thomas, Susie; Deutsch, Judith E; Crotty, Maria
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective To determine the effectiveness of virtual reality compared with alternative or no intervention on: upper limb function and activity; gait and balance function and activity; global motor function. Secondary objective To determine the effectiveness of virtual reality compared with alternative or no intervention on: cognitive function; activity limitation; participation restriction and quality of life; imaging studies; adverse events. Additionally, we aim to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment.
Pillow use: the behavior of cervical stiffness, headache and scapular/arm pain
(Dove Press, 2010-08-10) Gordon, Susan J; Grimmer, K A; Trott, P H
Background: Pillows are intended to support the head and neck in a neutral position to minimize biomechanical stresses on cervical structures whilst sleeping. Biomechanical stresses are associated with waking cervical symptoms. This paper adds to the scant body of research investigating whether different pillow types produce different types and frequencies of waking symptoms in asymptomatic subjects. Methods: A random-allocation block-design blinded field trial was conducted in a large South Australian regional town. Subjects were side-sleepers using one pillow only, and not receiving treatment for cervicothoracic problems. Waking cervical stiffness, headache and scapular/arm pain were recorded daily. Five experimental pillows (polyester, foam regular, foam contour, feather, and latex) were each trialed for a week. Subjects’ ‘own’ pillow was the control (a baseline week, and a washout week between each experimental pillow trial week). Subjects reported waking symptoms related to known factors (other than the pillow), and subjects could ‘drop out’ of any trial pillow week. Results: Disturbed sleep unrelated to the pillow was common. Waking symptoms occurring at least once in the baseline week were reported by approximately 20% of the subjects on their ‘own’ pillow. The feather trial pillow performed least well, producing the highest frequency of waking symptoms, while the latex pillow performed best. The greatest number of ‘drop outs’ occurred on the feather pillow. The foam contour pillow performed no better than the foam regular pillow. Conclusion: ‘Own’ pillows did not guarantee symptom-free waking, and thus were a questionable control. The trial pillows had different waking symptom profiles. Latex pillows can be recommended over any other type for control of waking headache and scapular/arm pain. Keywords: pillow type, cervical stiffness, arm pain, headache
What is normal isokinetic shoulder strength or strength ratios? A systematic review
(iOS Press, 2011) Land, H; Gordon, Susan J
Abstract. Purpose: To systematically review the literature regarding isokinetic testing to identify values for isokinetic shoulder strength and agonist/antagonist ratios in the general population which may be used as reference values when assessing, planning and implementing shoulder rehabilitation. Methods: Electronic databases were systematically searched and reference lists of all retrieved papers were hand searched and nine relevant studies were identified. Two independent reviewers assessed methodological quality and extracted data. Results: Seven studies reported the effect of limb dominance on strength with four reporting no significant difference between the dominant and non-dominant limbs. The studies which compared muscle strength with gender concluded that men were significantly stronger than women at all speeds in all directions. Age was reported to have no significant effect on muscle strength. Four studies agreed that adduction and extension muscle strength were greater than other directions and flexion, abduction, internal rotation and external rotation were the next strongest in that order. Conclusions: Nine low and moderate quality research papers have attempted to establish isokinetic shoulder strength in a general population. Poor consistency with respect to sample sizes, randomization and selection of testing velocities and positions did not allow direct comparison of the results. Future research involving symptomatic subjects will need to be matched to a group of subjects from the general population of the same age, gender and physical profile with adequate sample sizes representative of the symptomatic population.
Are Vision-Specific Quality of Life Questionnaires Important in Assessing Rehabilitation for Patients With Hemianopia Post Stroke?
(Informa UK Ltd, trading as Taylor & Francis Group, 2011) George, Stacey; Hayes, Allison; Chen, Celia Shin Wen; Crotty, Maria
Objective: To explore the relationship between disability and functional measures with vision-specific quality of life (QoL) measures for people with hemianopia and stroke. Method: The Behavioral Inattention Test (BIT) and the Mayo-Portland Adaptability Inventory (MPAI) were compared with scores on 2 vision-specific QoL measures, the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and Veteran Low Vision Visual Function Questionnaire (VA LV VFQ-48). Setting: Rehabilitation hospitals in Adelaide, South Australia. Participants: Stroke patients (n = 24) with homonymous hemianopia. Results: Most of the BIT and MPAI scores were significantly associated with the NEI VFQ-25 and VA LV VFQ-48 scores. Behavioral test scores of the BIT and the MPAI total score correlated with more aspects of the QoL measures than the other components of the BIT and the MPAI. Conclusion: BIT and MPAI measure constructs associated with QoL for people with hemianopia following stroke. Vision-specific QoL questionnaires can complement the functional instruments by identifying the domains of difficulty, based on the instrument’s subscale, that can guide rehabilitation therapists to address the person’s deficit.

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