Rehabilitation & Aged Care Collected Works

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Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: A pilot double-blind randomized trial
(Endorium Journals, 2017-03-15) Scott, Hayley; Lannin, Natasha A; English, Coralie; Ada, Louise; Levy, Tamina; Hart, Rhiannon; Crotty, Maria
Aims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity? Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting. Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant. Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted.
Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data
(Elsevier, 2016) English, Coralie; Shields, Nora; Brusco, Natasha Kareem; Taylor, Nicholas F; Watts, Jennifer J; Peiris, Casey L; Bernhardt, Julie; Crotty, Maria; Esterman, Adrian Jeffrey; Segal, Leonie; Hillier, Susan
Questions: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? Design: This study pooled individual data from two randomised, controlled trials (n = 350) using an individual patient data meta-analysis and multivariate regression. Participants: People with stroke admitted to inpatient rehabilitation facilities. Intervention: Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Outcome measures: Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Results: Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD –5.7 days, 95% CI –13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (b = 7.5, 95% CI 1.7 to 13.4, p = 0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI –2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI –0.15 to 0.04) or health-related quality of life (SMD –0.04, 95% CI –0.26 to 0.19) at discharge. Discussion: Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. Clinical Trial Registration: ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data. Journal of Physiotherapy 62: 124–129]
Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting
(Springer Nature, 2016) Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents’ quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
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.
Anabolic steroids for rehabilitation after hip fracture in older people
(Cochrane Database of Systematic Reviews, 2014-10-06) Farooqi, Vaqas; van den Berg, Maayken; Cameron, Ian D; Crotty, Maria
Background Hip fracture occurs predominantly in older people, many of whom are frail and undernourished. After hip fracture surgery and rehabilitation, most patients experience a decline in mobility and function. Anabolic steroids, the synthetic derivatives of the male hormone testosterone, have been used in combination with exercise to improve muscle mass and strength in athletes. They may have similar effects in older people who are recovering from hip fracture. Objectives To examine the effects (primarily in terms of functional outcome and adverse events) of anabolic steroids after surgical treatment of hip fracture in older people. Search methods We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (10 September 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013 Issue 8), MEDLINE (1946 to August Week 4 2013), EMBASE (1974 to 2013 Week 36), trial registers, conference proceedings, and reference lists of relevant articles. The search was run in September 2013. Selection criteria Randomised controlled trials of anabolic steroids given after hip fracture surgery, in inpatient or outpatient settings, to improve physical functioning in older patients with hip fracture. Data collection and analysis Two review authors independently selected trials (based on predefined inclusion criteria), extracted data and assessed each study's risk of bias. A third review author moderated disagreements. Only very limited pooling of data was possible. The primary outcomes were function (for example, independence in mobility and activities of daily living) and adverse events, including mortality.
Appendicular skeletal muscle in hospitalised hip-fracture patients: development and cross-validation of anthropometric prediction equations against dual-energy X-ray absorptiometry
(Oxford University Press on behalf of the British Geriatrics Society, 2014-07-21) Villani, Anthony M; Crotty, Maria; Cameron, Ian D; Kurrle, Susan E; Skuza, Pawel P; Cleland, Leslie G; Cobiac, Lynne; Miller, Michelle Deanne
Background: accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of clinical importance for the diagnosis of geriatric syndromes associated with skeletal muscle wasting. Objectives: the purpose of this study was to develop and cross-validate novel anthropometric prediction equations for the estimate of ASM in older adults post-surgical fixation for hip fracture, using dual-energy X-ray absorptiometry (DEXA) as the criterion measure. Subjects: community-dwelling older adults (aged ≥65 years) recently hospitalised for hip fracture. Setting: participants were recruited from hospital in the acute phase of recovery. Design: validation measurement study. Measurements: a total of 79 hip fracture patients were involved in the development of the regression models (MD group). A further 64 hip fracture patients also recruited in the early phase of recovery were used in the cross-validation of the regression models (CV group). Multiple linear regression analyses were undertaken in the MD group to identify the best performing prediction models. The linear coefficient of determination (R2) in addition to the standard error of the estimate (SEE) were calculated to determine the best performing model. Agreement between estimated ASM and ASMDEXA in the CV group was assessed using paired t-tests with the 95% limits of agreement (LOA) assessed using Bland–Altman analyses. Results: the mean age of all the participants was 82.1 ± 7.3 years. The best two prediction models are presented as follows: ASMPRED-EQUATION_1: 22.28 – (0.069 * age) + (0.407 * weight) – (0.807 * BMI) – (0.222 * MAC) (adjusted R2: 0.76; SEE: 1.80 kg); ASMPRED-EQUATION_2: 16.77 – (0.036 * age) + (0.385 * weight) – (0.873 * BMI) (adjusted R2: 0.73; SEE: 1.90 kg). The mean bias from the CV group between ASMDEXA and the predictive equations is as follows: ASMDEXA – ASMPRED-EQUATION_1: 0.29 ± 2.6 kg (LOA: −4.80, 5.40 kg); ASMDEXA – ASMPRED-EQUATION_2: 0.13 ± 2.5 kg (LOA: −4.77, 5.0 kg). No significant difference was observed between measured ASMDEXA and estimated ASM (ASMDEXA: 16.4 ± 3.9 kg; ASMPRED-EQUATION_1: 16.7 ± 3.2 kg (P = 0.379); ASMPRED-EQUATION_2: 16.6 ± 3.2 kg (P = 0.670)). Conclusions: we have developed and cross-validated novel anthropometric prediction equations against DEXA for the estimate of ASM designed for application in older orthopaedic patients. Our equation may be of use as an alternative to DEXA in the diagnosis of skeletal muscle wasting syndromes. Further validation studies are required to determine the clinical utility of our equation across other settings, including hip fracture patients admitted from residential care, and also with a longer-term follow-up.
Are there missed opportunities for occupational therapy for people with dementia? An audit of practice in Australia
(Wiley, 2018-09-06) Rahja, Miia; Comans, Tracy A; Clemson, Lindy; Crotty, Maria; Laver, Kate
Background/aim Randomised trials have demonstrated that occupational therapy can delay functional decline, improve quality of life and increase leisure participation in people with dementia. However, surveys conducted with occupational therapists suggest that clinical practice does not reflect the type of intervention shown to be effective in research studies. Case note audits can be used to quantify practice and demonstrate how and where provision of care could improve without the potential bias associated with self‐report. Method A total of 87 occupational therapy case notes were audited from different service contexts in two states in Australia. The case notes were reviewed against criteria including duration of service, assessments conducted and interventions used. Descriptive statistics were used to present the data and examine associations between intervention, age of the person with dementia and whether or not the person lived alone. Results Services tended to be short‐term with an average of 2.1 consultations per referral. The most common assessments related to home safety, falls risk and function. Intervention most commonly focussed on referrals to other services, environmental modification advice and assistive device prescription. Conclusion This audit reveals that current occupational therapy practice for people with dementia focusses on assessment and management of risk and is usually limited to a couple of consultations. Future work should seek to evaluate if such approaches to care are effective for people with dementia.
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.
Assessing Gait Variability in Transtibial Amputee Fallers Based on Spatial-Temporal Gait Parameters Normalized for Walking Speed
(Elsevier, 2014-12-03) Hordacre, Brenton; Barr, Christopher; Patritti, Benjamin Lorenzo; Crotty, Maria
An assessment of the construct validity of the icecap-o index of capability in Australian national transition care and clinical rehabilitation programmes : Paper presented to the MRC HTMR Workshop on The use of ICECAP measures in clinical trials and economic evaluation
(Flinders University, 2011-02-15) Ratcliffe, Julie; Laver, Kate; Couzner, Leah; Quinn, Stephen; Crotty, Maria
Aims: The ICECAP-O index of capability is a new instrument designed to measure and value the quality of life of older people. Advantages of the ICECAP-O include its focus upon a broader concept of quality of life than health alone and its potential for application in economic evaluation across health, transition care and aged care sectors. This study aimed to determine the construct validity of the ICECAP-O in care transition and clinical rehabilitation programmes for older people. Methods: A questionnaire containing the ICECAP-O was administered using a face to face interview mode of administration with patients participating in in-patient medical rehabilitation (n=100), out-patient day rehabilitation (n=55) and the Australian National Transition Care Programme (n=26). The relationships between the ICECAP and other instruments including the EQ-5D, Herth Hope Index, Modified Rankin Scale (a measure of disability completed by the health care professional), CTM-3 (quality of care transitions) and socio-demographic characteristics were examined. Results: The mean ICECAP-O scores for all three groups were broadly similar (in-patient; mean 0.759, range 0.390-1.000; out-patient mean 0.815, range 0,410-1.000; transition care mean 0.788, range 0.436-1.000). The ICECAP-O was found to be inversely correlated with the Modified Rankin Scale (Spearman’s r = -0.286; P < 0.01) indicating that as the level of disability increased, capability decreased. The ICECAP was also found to be positively correlated with the EQ5D (Spearman’s r = 0.418; P<0.01) and the Herth Hope index (Spearman’s r =0.402; P<0.01) and positively correlated with the quality of care transitions as measured by the CTM-3 instrument (Spearman’s r = 0.259; P=0.0291). The distribution of responses to the ICECAP-O indicated that whilst the majority of participants reported high levels of love and friendship, many participants expressed some concern about their future and reported limitations in their independence and ability to do things that made them feel valued. In general, participants reported more problems in relation to the physical dimensions of the EQ-5D (mobility, self care and usual activities) and EQ-5D values were on average well below general population norm levels for this age group (mean 0.53, SD 0.32). Conclusion: The findings from this study demonstrate the strong empirical relationships between the concepts of health, disability, hope and capability and provide support for the construct validity of the ICECAP-O in clinical rehabilitation and transition care settings. Relationships between the ICECAP-O and other measures were mostly as anticipated indicating that whilst health related Page 3 of 26quality of life and hope were positively associated with capability, the level of disability and older person’s perceptions of poor quality care transitions impacted negatively upon capability. The ICECAP-O shows promise in providing a new and rigorous approach to the measurement and valuation of quality of life for future application in economic evaluation across health, transition care and aged care sectors.
An assessment of the relationship between informal caring and quality of life in older community-dwelling adults - more positives than negatives?
(John Wiley &Sons ltd, 2013-01) Ratcliffe, Julie; Lester, Laurence Howard; Couzner, Leah; Crotty, Maria
The main objective of the study was to apply the recently developed Index of Capability (ICECAP-O) instrument to measure and value the quality of life of a representative sample of the older South Australian population (aged > 65 years) according to carer status. A Health Omnibus survey including the ICECAP-O instrument, carer status (informal carer vs non-carer) and several socio-demographic questions was administered in 2009 as a face to face interview to 789 individuals aged 65 year or older in their own homes. A total of 671 individuals (85%) characterised themselves as a non-carer and 115 individuals (15%) characterised themselves as an informal carer. In general, carers exhibited relatively high quality of life as measured by the ICECAP-O, with carers having comparable mean ICECAP-O scores to non-carers in the general population (carers: mean (sd) 0.848 (0.123), non-carers: mean (sd) 0.838 (0.147)). The results of the multivariate regression model for the total sample indicated statistically significant variations in overall ICECAP-O scores according to age (with younger participants tending to have slightly higher scores on average), country of birth (with those participants who were born in Australia having higher scores on average than those who were born elsewhere) and household income (with participants with higher income levels having higher scores on average). The results of the multivariate regression model differentiated by carer status also indicated some important differences. Specifically, average ICECAP-O scores were noticeably lower for carers who are 2 separated or divorced and for carers who lived alone and these differences were statistically significant. The study findings provide support for the existence of process utility in informal care-giving. The provision of informal care may be associated with a positive impact upon quality of life for many care-givers which may mediate the negative aspects arising from the burden associated with informal care giving.
Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia
(Journal of Geriatric Cardiology, 2017-06-28) Liu, Enwu; Dyer, Suzanne M; O’Donnell, Lisa Kouladjian; Milte, Rachel; Bradley, Clare Eileen; Harrison, Stephanie L; Gnanamanickam, Emmanuel; Whitehead, Craig Hamilton; Crotty, Maria
Objective To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. Methods As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Results Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale–Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = -3.7; 95% CI: -5.2 to -2.2; P < 0.0001] and a lower probability of a dementia diagnosis (OR = 0.44; 95% CI: 0.26 to 0.75, P = 0.0022). Analysis by subgroups of medications showed cardiac therapy medications (C01), beta blocking agents (C07), and renin-angiotensin system agents (C09) were associated with lower PAS-Cog scores (better cognition) and lower dementia diagnosis probability. Conclusions This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.
Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care
(Springer, 2018-01) Harrison, Stephanie L; O'Donnell, Lisa Kouladjian; Bradley, Clare Eileen; Milte, Rachel; Dyer, Suzanne M; Gnanamanickam, Emmanuel; Liu, Enwu; Hilmer, Sarah N; Crotty, Maria
Background Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. Objective The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia. Methods We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy. Results In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): − 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [− 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [− 0.034 (0.017), p = 0.049]. Conclusion Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
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.
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.
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.
Caregivers' Perspectives on the Use of Long-Term Oxygen Therapy for the Treatment of Refractory Breathlessness: A Qualitative Study
(Elsevier, 2016-11-11) Collier, Aileen; Breaden, Katrina Margaret; Phillips, Jane L; Agar, Meera Ruth; Litster, Caroline; Currow, David Christopher
Context Despite limited clinical evidence, long-term oxygen therapy (LTOT) is used for the management of refractory breathlessness in people with life-limiting illnesses who are not necessarily hypoxemic. Objectives The aim of this study was to understand caregiver factors associated with caring for someone with LTOT from the perspectives and experiences of caregivers themselves. Methods The qualitative study used semistructured interviews. The study was conducted in two states in Australia. Participants (n = 20) were self-nominated caregivers of people receiving LTOT for refractory breathlessness in the palliative setting. Results Data analyses established one overarching theme titled: “Oxygen giveth (something to help caregivers relieve breathlessness) and oxygen taketh away (from patients who lose some autonomy).” The theme captured caregivers' feelings of extreme distress in response to witnessing refractory breathlessness, and oxygen fulfilling several critical and beneficial roles in this context. In parallel, caregivers also explicitly and implicitly articulated several downsides to the use of LTOT. Conclusion Caregivers find caring for someone with refractory breathlessness extremely distressing. The benefits of LTOT are often overestimated, whereas its potential harms are underestimated. As significant stakeholders of people receiving LTOT, caregivers should be provided with opportunities to collaborate with clinicians in evidence-based decision making, efforts should be made to provide them with information and education about the most effective pharmacological and nonpharmacological strategies to manage refractory breathlessness in a palliative care setting including the appropriate use of LTOT to enable them to do so.
The chaotic journey: Recovering from hip fracture in a nursing home
(Elsevier, 2016-07-25) Killington, Maggie; Walker, Ruth Ballance; Crotty, Maria
Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups
(BMJ Publishing Group, 2017-03-29) Currow, David Christopher; Dal Grande, Eleonora; Ferreira, Diana; Johnson, Miriam J; McCaffrey, Nicola; Ekstrom, Magnus
Little is known about the impact of chronic breathlessness (modified Medical Research Council (mMRC) score ≥2 for most days, at least three of the last six months) on health-related quality of life (Short Form-12 (SF-12)). 3005 adults from randomly selected households were interviewed face-to-face in South Australia. mMRC ≥2 community prevalence was 2.9%. Adjusted analyses showed clinically meaningful and statistically significant decrements of physical and mental components of SF-12 (mean SF-12 summary scores in physical (−13.0 (−16.0 to −10.2)) and mental (−10.7 (−13.7 to −7.8)) components compared with people with mMRC=0) as chronic breathlessness severity increased, across five age groupings.
Circuit class therapy or seven-day week therapy for increasing rehabilitation intensity of therapy after stroke (CIRCIT): a randomized controlled trial
(SAGE Publications, 2015-03-19) English, Coralie; Bernhardt, Julie; Crotty, Maria; Esterman, Adrian Jeffrey; Segal, Leonie; Hillier, Susan
BACKGROUND: Increased therapy has been linked to improvements in functional ability of people with stroke. AIM: To determine the effectiveness of two alternative models of increased physiotherapy service delivery (seven-day week therapy or group circuit class therapy five days a week) to usual care. METHOD: Three-armed randomized controlled trial with blinded assessment of outcome. People admitted with a diagnosis of stroke, previously independently ambulant and with a moderate level of disability were recruited. 'Usual care' was individual physiotherapy provided five-days a week. Seven-day week therapy was usual care physiotherapy provided seven-days a week. Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions, five-days a week. Primary outcome was distance walked on the six-minute walk test at four-weeks post-randomization. RESULTS: Two hundred eighty-three participants were randomized; primary outcome data were available for 259 (92%). In the seven-day arm participants received an additional three hours of physiotherapy and those in the circuit class arm an additional 22 h. There were no significant between-group differences at four-weeks in walking distance (P = 0.72). Length of stay was shorter for seven-day (mean difference -2.9 days, 95% confidence interval -17.9 to 12.0) and circuit class participants (mean difference -9.2 days, 95% confidence interval -24.2 to 5.8) compared to usual care, but this was not significant. CONCLUSIONS: Both seven-day therapy and group circuit class therapy increased physiotherapy time, but walking outcomes were equivalent to usual care.

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