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Item Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross‐sectional study(Wiley, 2019-01-17) Liu, Enwu; Dyer, Suzanne M; Whitehead, Craig Hamilton; O'Donnell, Lisa Kouladjian; Gnanamanickam, Emmanuel; Harrison, Stephanie L; Milte, Rachel; Crotty, MariaCurrent information on the patterns of medication use in nursing home residents living with dementia is conflicting. The aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents.Item Trends in Prevalence of Dementia for People Accessing Aged Care Services in Australia(Oxford Academic, 2019-03-15) Harrison, Stephanie L; Lang, Catherine; Whitehead, Craig Hamilton; Crotty, Maria; Ratcliffe, Julie; Wesselingh, Steven L; Inacio, Maria C SStudies in some high-income countries have reported a potential decline in the prevalence of dementia. Improvements in cardiovascular health may be contributing to this decline. The objective was to examine trends in prevalence of dementia and survival with dementia for people accessing aged care in Australia.Item Health Professional Perspectives on Rehabilitation for People With Dementia(Oxford Academic, 2019-02-13) Cations, Monica; May, Natalie; Crotty, Maria; Low, Lee-Fay; Clemson, Lindy; Whitehead, Craig Hamilton; McLoughlin, James; Swaffer, Kate; Laver, KateMultidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia.Item Walking aid use after discharge following hip fracture is rarely reviewed and often inappropriate: an observational study(Elsevier, 2011-02-25) Thomas, Susie; Halbert, Julie Anne; Cameron, Ian D; Whitehead, Craig Hamilton; Miller, Michelle Deanne; Crotty, MariaQuestions What walking aid prescription occurs at discharge after hip fracture? What changes in walking aid use occur in the following six months? Who initiates changes in walking aids and why? Design Prospective longitudinal observational study. Participants 95 community-dwelling older adults who had undergone surgical treatment of a hip fracture. Outcome measures Range of walking aids prescribed at discharge and participants’ recall of advice about progression were recorded. Progression of walking aids was observed fortnightly over 6 months. With any change in walking aid use, an independent physiotherapist determined if it was appropriate and participants reported the reason for the change. Results Most participants were discharged from their final inpatient setting with a wheeled frame (92%). Eighty-two (86%) participants were not aware of any goals set by the physiotherapist for the first 6 months and 89 (94%) stated that a review time had not been set. Despite this, 78 (82%) participants changed their walking aid, on average 8 weeks (SD 6) after discharge. However, 32% of those who changed their walking aids were using an inappropriate aid or using it incorrectly. Six months after discharge, 40% of participants had not returned to using their pre-morbid indoor aid and 50% their outdoor aid. Conclusion A review of walking aid by a physiotherapist is rare within six months after discharge following hip fracture. Most patients make their own decision about what walking aid is most appropriate. This has safety implications in a group at high risk of falls.Item Virtual reality for stroke rehabilitation (Review)(Cochrane Collaboration, 2011-09-07) Laver, Kate; George, Stacey; Thomas, Susie; Deutsch, Judith; Crotty, MariaBackground Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. Objectives To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. Search methods We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. Selection criteria Randomised and quasi‐randomised trials of virtual reality ('an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. Main results We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcomes: results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. Secondary outcomes: results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited. Authors' conclusions We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).Item Virtual reality for stroke rehabilitation (Review)(Cochrane Collaboration, 2015-02-12) Laver, Kate; George, Stacey; Thomas, Susie; Deutsch, Judith; Crotty, MariaBackground Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. Objectives Primary objective: To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Secondary objective: To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. Search methods We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. Selection criteria Randomised and quasi‐randomised trials of virtual reality ("an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. Main results We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. Primary outcome: results were statistically significant for upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49 based on 12 studies with 397 participants). Secondary outcomes: there were no statistically significant effects for grip strength, gait speed or global motor function. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.43, 95% CI 0.18 to 0.69 based on eight studies with 253 participants); however, we were unable to pool results for cognitive function, participation restriction, quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 26% of participants screened were recruited. Authors' conclusions We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.Item Virtual reality for stroke rehabilitation (Review)(Cochrane Collaboration, 2017-11-20) Laver, Kate; Lange, Belinda; George, Stacey; Deutsch, Judith; Saposnik, Gustavo; Crotty, MariaBackground Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Objectives Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. Search methods We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Selection criteria Randomised and quasi‐randomised trials of virtual reality ("an advanced form of human‐computer interface that allows the user to 'interact' with and become 'immersed' in a computer‐generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Data collection and analysis Two review authors independently selected trials based on pre‐defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. Main results We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard‐care approach. Primary outcome: results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) ‐0.05 to 0.20, 22 studies, 1038 participants, low‐quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low‐quality evidence). Secondary outcomes: when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate‐quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty‐three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. Authors' conclusions We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.Item 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, GilbertThis 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.Item 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, LeahThis 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.Item 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, MariaAims: 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.Item Virtual reality for stroke rehabilitation (Protocol)(Cochrane Database of Systematic Reviews, 2010-02-17) Laver, Kate; George, Stacey; Thomas, Susie; Deutsch, Judith E; Crotty, MariaThis 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.Item 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, MariaBackground 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.Item Interventions for treating psoriatic arthritis (Review)(Cochrane Database of Systematic Reviews, 2000-07-24) Jones, Graham; Crotty, Maria; Brooks, PeterBackground 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.Item How Widely are Supportive and Flexible Food Service Systems and Mealtime Interventions Used for People in Residential Care Facilities? A Comparison of Dementia-Specific and Nonspecific Facilities(MDPI, 2018-12-03) Milte, Rachel; Bradley, Clare Eileen; Miller, Michelle Deanne; Farrer, Olivia; Crotty, MariaWhile improved mealtime practices can reduce agitation, improve quality of life, and increase food intake for people in aged care, the degree of implementation of these strategies is unknown. This study describes food service practices in residential aged care facilities, focusing on units caring for people with dementia. An online survey was distributed to residential aged care facilities for completion by the food service manager (n = 2057). Of the 204 responses to the survey, 63 (31%) contained a dementia-specific unit. Most facilities used adaptive equipment (90.2%) and commercial oral nutritional supplements (87.3%). A higher proportion of facilities with a dementia-specific service used high-contrast plates (39.7%) than those without (18.4%). The majority of facilities had residents make their choice for the meal more than 24 h prior to the meal (30.9%). Use of high contrast plates (n = 51, 25%) and molds to reform texture-modified meals (n = 41, 20.1%) were used by one-quarter or less of surveyed facilities. There is a relatively low use of environmental and social strategies to promote food intake and wellbeing in residents, with a focus instead on clinical interventions. Research should focus on strategies to support implementation of interventions to improve the mealtime experience for residents.Item A systematic review of measures of adherence to physical exercise recommendations in people with stroke(Sage, 2018-10-17) Levy, Tamina; Laver, Kate; Killington, Maggie; Lannin, Natasha A; Crotty, MariaObjective: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. Data sources: Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. Review methods: Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. Results: In phase 1, seven methods of adherence measurement were identified, including logbooks (n = 16), diaries (n = 18), ‘record of practice’ (n = 3), journals (n = 1), surveys (n = 2) and questionnaires (n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities (n = 4). In phase 2, no eligible studies were identified. Conclusion: There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.Item Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study(Public LIbrary of Science, 2019-03-13) Jolliffe, Laura; Morarty, Jacqui; Hoffmann, Tammy; Crotty, Maria; Hunter, Peter; Cameron, Ian D; Li, Xia; Lannin, Natasha AObjective This study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation. Design A before and after study design. Setting A metropolitan inpatient brain injury rehabilitation unit. Participants Clinicians; medical, nursing and allied health staff. Interventions Fortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators. Main outcome measure Adherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis. Results Clinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, p<0.01). Findings suggest that there are individual indicators which are more amenable to change using an audit and feedback program. Conclusion A fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.Item Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial(Oxford Academic, 2019-02-22) Crotty, Maria; Killington, Maggie; Liu, Enwu; Cameron, Ian D; Kurrle, Susan E; Kaambwa, Billingsley; Davies, Owen; Miller, Michelle Deanne; Chehade, Mellick J; Ratcliffe, JulieTo determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care.Item Rehabilitation environments: Service users’ perspective(Wiley, 2019-01-10) Killington, Maggie; Fyfe, Dean; Patching, Allan; Habib, Paul; McNamara, Annabel; Bach, Rachael Kay; Kochiyil, Venugopal; Crotty, MariaDesign of rehabilitation environments is usually “expert” driven with little consideration given to the perceptions of service users, especially patients and informal carers. There is a need to engage with consumers of services to gain their insights into what design aspects are required to facilitate optimum physical activity, social interaction and psychological responses when they are attempting to overcome their limitations and regain function.Item “Just another piece of paperwork”: perceptions of clinicians on delirium screening following hip fracture repair elicited in focus groups(Cambridge University Press, 2018-10-15) Oberai, Tarandeep; Killington, Maggie; Laver, Kate; Crotty, MariaBackground: Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians’ from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium. Methods: This was a qualitative study using in-depth focus groups discussions with clinical staff of one orthopedic unit within a level 1 trauma center, south of Adelaide, South Australia. Results: A total number of 17 individuals (14 nurses, 1 geriatric registrar, 1 nursing manager, and 1 speech therapist) participated in the focus groups. Four major themes were identified: (1) Delirium is important but can be hard to recognize and validate; (2) ambiguity on the use of delirium screening tool; (3) need of designated delirium care pathway; and (4) vital role of the family. Despite the initial lack of agreement on use of the objective tool to screen delirium, nurses did propose a number of ways that formal delirium screening could be included in routine nursing duties and existing nursing documentation. Conclusion: Although orthopedic nurses aim to provide effective care to patients experiencing delirium symptoms following hip fracture, they are doing so in the absence of structured screening, assessment, and multidisciplinary team approach. This study emphasizes the various barriers which need to be considered before attempting to change practice in this important area.Item Evaluating the performance of amputee services at neighbouring hospitals: a risk adjusted performance analysis.(SERDI Publisher, 2016-06) Hordacre, Brenton; Crotty, Maria; Pham, Clarabelle; Karnon, JonathanBackground: Despite advances in vascular surgery techniques, ageing populations and increasing rates of vascular disease and diabetes have contributed to relatively steady amputation rates. Older amputees have limited life expectancies and often require expensive rehabilitation interventions on top of vascular procedures. Services warrant scrutiny with view to reducing clinical practice variations, improving hospital performance and securing the best patient outcomes. Objective: This study employed a novel methodology to assess 12-month hospital performance associated with provision of lower-limb amputee services at three neighbouring hospitals. Design and Setting: Routinely collected data on individuals having an initial lower-limb amputation from July 2001 to June 2008 at three hospital networks in Adelaide, South Australia were analysed. Observed and expected lengths of stay and patient outcomes were generated, from which relative performance across hospitals were compared. Results: Following amputation we observed a short time-to-death (0.8 years, IQR 0.21-2.12) and 12-month mortality rate of 25% (unadjusted). Riskadjusted analyses indicated that one hospital with co-located vascular and rehabilitation services had greater performance with lower re-amputation rates and fewer deaths. However, length of stay at this hospital was longer than expected. Conclusion: The risk-adjusted performance analysis provided an approach which could inform further investigations around variation in hospital performance to inform best practice service delivery.