Image Alt Text

The Allied Health Clinical Research Office

Image Alt Text

+


Improving Rehabilitation Outcomes

This broad program of research aims to improve outcomes for people returning to the community after rehabilitation following an illness or injury. Multi-disciplinary in focus, it includes research related to planning for discharge, oncology rehabilitation, recovering from joint replacement, translation of evidence into practice, and use of technology to support home based programs. In 2016, a grant funded jointly by the La Trobe University Sport, Exercise and Rehabilitation Research Focus Area and the Eastern Health Foundation enabled a substantial expansion of this research program.

Key areas of research within this program include:

  1. Effectiveness of home visits following hip fracture 
  2. Improving outcomes of oncology rehabilitation
  3. Effectiveness of clinical supervision in improving patient outcomes
  4. Video home exercise programs after stroke
  5. Involving family care givers in rehabilitation
  6. Increasing physical activity in patients with hip and knee osteoarthritis


Effectiveness of home visits following hip fracture

Led by Kylee Lockwood, this work is investigating what happens to patients who return to the community after hip fracture, and the role that a pre-discharge home visit from an occupational therapist can play in improving outcomes. Her research has shown that one in three patients at Eastern Health are readmitted within 12 months, and patients with lower levels of mobility prior to the fracture have twice the odds of being readmitted to hospital compared to those who were able to walk independently. Kylee has gone on to conduct a randomised controlled trial involving 77 participants to compare the outcomes of patients who receive pre-discharge home visits with a group that received hospital discharge planning alone. Results indicate that the patients who received home visits have fewer readmissions to hospital and fewer falls in the post discharge period.

Publications
  1. Lockwood K, Taylor, NF, Boyd, JN, Harding, KE. Reasons for readmission to hospital after hip fracture: Implications for occupational therapy. . British Journal of Occupational Therapy. (in press). http://journals.sagepub.com/doi/abs/10.1177/0308022618756000
  2. Lockwood K, Taylor N, Harding K. Pre-discharge home assessment visits in assisting patients' return to community living: A systematic review and meta-analysis. Journal of Rehabilitation Medicine. 2015;47(4):289-99. https://www.ncbi.nlm.nih.gov/pubmed/25782842
  3. Lockwood KJ, Taylor NF, Boyd JN, Harding KE. Pre-discharge home visits by occupational therapists completed for patients following hip fracture. Aust Occup Ther J. 2016;64(1):41-8. https://onlinelibrary.wiley.com/doi/abs/10.1111/1440-1630.12311

Improving outcomes of oncology rehabilitation

Cancer survivors who are more physically active have a greater chance of survival and less risk of cancer recurrence. Rehabilitation improves quality of life, mood, strength and fitness, and reduces the side effects of treatment. This series of projects led by Amy Dennett and funded by the Eastern Health Foundation and La Trobe University, aims to optimise physical activity levels of cancer survivors.

An initial nation-wide survey of access to oncology rehabilitation found that less than 0.5% of cancer survivors have access to oncology rehabilitation programs. A second study has shown that modifiable factors such as walking capacity and BMI are strongly related to physical activity, reinforcing the importance of access to rehabilitation. The team was then able to establish through a randomized controlled trial that motivational interviewing added to oncology rehabilitation may help people be less sedentary, and a supplementary qualitative study demonstrated that oncology rehabilitation helps people ‘return to normal’ during and after cancer treatment through improving functional ability, social well-being and quality of life. Findings from this research will help inform the design of future oncology rehabilitation programs.

Publications
  1. Dennett AM, Peiris CL, Shields N, Prendergast LA, Taylor NF. Cancer survivors awaiting rehabilitation rarely meet recommended physical activity levels: An observational study. Rehabilitation Oncology. 2018; 36:214-22.
  2. Dennett AM, Peiris CL, Taylor NF, Reed MS, Shields N. 'A good stepping stone to normality': a qualitative study of cancer survivors' experiences of an exercise-based rehabilitation program. Supportive Care in Cancer. 2018.
  3. Dennett AM, Shields N, Peiris CL, Prendergast LA, O'Halloran PD, Parente P, et al. Motivational interviewing added to oncology rehabilitation did not improve moderate-intensity physical activity in cancer survivors: a randomised trial. Journal of Physiotherapy. 2018; 64:255-63.
  4. Dennett A, Peiris C, Shields N, Prendergast L, Taylor NF . Moderate intensity exercise reduces fatigue and improves mobility in adult cancer survivors: a systematic review and meta-regression. . Journal of Physiotherapy. 2016;62(2):68-82. https://www.ncbi.nlm.nih.gov/pubmed/26996098
  5. Dennett A, Shields N, Peiris C, Reed M, O'Halloran P, Taylor N. Does psycho-education added to oncology rehabilitation improve physical activity and other health outcomes? A systematic review. Rehabilitation Oncology. (in press). https://journals.lww.com/rehabonc/Abstract/2017/04000/Does_Psychoeducation_Added_to_Oncology.5.aspx
  6. Dennett AM, Peiris CL, Shields N, Morgan D, Taylor NF. Exercise therapy in oncology rehabilitation in Australia: A mixed‐methods study. Asia‐Pacific Journal of Clinical Oncology. 2017;13(5). https://www.ncbi.nlm.nih.gov/pubmed/28004526

Effectiveness of clinical supervision in improving patient outcomes

Clinical supervision is a process that involves an experienced health professional guiding the clinical practice of a less experienced health professional. The Australian Commission on Safety and Quality in Health Care recommends that clinical supervision be provided to health professionals to ensure the safety of patients and maintain a high quality of care. Research investigating the effects of clinical supervision on patient care has found that supervision is associated with improved care when health professionals are directly supervised during their patient interactions. However, allied health professions typically use a model of “reflective supervision” that involves reflecting on practice with a supervisor away from the patient.

This body of work led by David Snowdon involved a comparison of physiotherapist’s adherence to hip fracture clinical guidelines when they were provided with direct supervision sessions as an addition to reflective supervision, compared with reflective supervision alone. The results showed that direct supervision significantly enhanced physiotherapist compliance and led to a higher proportion of patients with hip fracture mobilising on the day following surgery and improved walking independence by the 5th day after surgery. These results demonstrate that a direct model of clinical supervision can influence both the quality of physiotherapy care and patient outcomes.

Publications
  1. Snowdon D, Leggat S, Harding K, Scroggie G, Taylor N. Direct supervision of physiotherapists improves compliance with clinical practice guidelines for patients with hip fracture: a controlled before-and-after study. Disability and Rehabilitation. 2019; [Epub ahead of print].
  2. Snowdon D, Leggat SG, Harding KE, Boyd J, Scroggie G, Taylor NF. The association between effectiveness of clinical supervision of allied health professionals and improvement in patient function in an inpatient rehabilitation setting AU - Snowdon, David A. Disability and Rehabilitation. 2019:1-10.
    Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health Care. 2016; 28:447-55.
  3. Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC Health Services Research. 2017; 17:786
  4. Snowdon D, Millard G, Taylor N. Effectiveness of clinical supervision of physiotherapists: a survey. Australian Health Review. 2015;39(2):190-6. http://www.publish.csiro.au/ah/AH14020
  5. Snowdon D, Millard G, Taylor N. Effectiveness of clinical supervision of allied health professionals: a survey. J Allied Health. 2016;45(2):113-21. http://www.ingentaconnect.com/contentone/asahp/jah/2016/00000045/00000002/art00008
  6. Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health Care. 2016;28(4):447-55. https://academic.oup.com/intqhc/article/28/4/447/2572375
  7. Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC health services research. 2017;17(1):786. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2739-5

Video home exercise programs after stroke

Smart technology is increasingly accessible. Tools that are readily available on the smart phones and tablets that patients are commonly carrying in their pockets or handbags have potential to improve the experience and outcomes of rehabilitation. This research is testing whether the video and reminder functions on these devices can be used to improve adherence and outcomes of home exercise programs. A trial led by Kellie Emmerson randomly allocated people recovering from stroke to receive home exercise programs using video on a tablet device or with traditional paper instruction.

The trial showed that both methods of home exercise prescription were equally effective in relation to adherence and patient outcomes. However, qualitative data obtained through interviews with people in the intervention group indicated that there were other benefits to using technology, such as the ability to look back on progress, share the rehabilitation experience with family and benefits for patients with visual or cognitive deficits who require support to follow a written program. Patients who already owned and used these devices in daily life were particularly receptive to the use of technology. A further study has demonstrated that, when patients own their own devices, there are likely to be small cost savings in using these devices to provide exercise instructions compared to using paper-based instructions.

Publications
  1. Emmerson K, Harding K, Taylor N. Providing exercise instructions using multimedia may improve adherence but not patient outcomes: A systematic review and meta-analysis. Clinical Rehabilitation. 2019; 33:607-18.
  2. Emmerson KB, Harding KE, Taylor NF. Home exercise programmes supported by video and automated reminders compared with standard paper-based home exercise programmes in patients with stroke: a randomized controlled trial. Clinical rehabilitation. 2017;31(8):1068-77. https://www.ncbi.nlm.nih.gov/pubmed/27920262
  3. Emmerson KB, Harding KE, Lockwood KJ, Taylor NF. (in press). Home exercise programs supported by video and automated reminders for patients with stroke: A qualitative analysis. Australian Occupational Therapy Journal https://www.ncbi.nlm.nih.gov/pubmed/29527686

Involving family care givers in rehabilitation

Older people admitted to hospital are at high risk of functional decline. This may be due to a combination of the illness or injury they were admitted with, the treatments undertaken and the effects of prolonged immobilisation. Physiotherapy can help, but staffing ratios in aged care programs such as Transition Care are typically low. This research led by Kate Lawler aims to understand the feasibility of training family members to assist with physiotherapy and whether this approach can improve levels of physical activity, falls-related self-efficacy, health-related quality of life and caregiver strain.

Publications
  1. Lawler K, Shields N, Taylor NF. Training family to assist with physiotherapy for older people transitioning from hospital to the community: a pilot randomized controlled trial. Clin Rehabil. 2019 [Epub ahead of print]
  2. Lawler K, Taylor NF, Shields N. Family-assisted therapy empowered families of older people transitioning from hospital to the community: a qualitative study. J Physiother. 2019; 65:166-71.
  3. Lawler K, Taylor N, Shields N. Involving family members in physiotherapy for older people transitioning from hospital to the community: a qualitative analysis. Disability and Rehabilitation. 2015: 37: 2061-2069. https://www.ncbi.nlm.nih.gov/pubmed/25586797
  4. Lawler K, Taylor NF, Shields N. 2013. Outcomes after caregiver-provided speech and language or other allied health therapy: a systematic review. Archives of Physical Medicine and Rehabilitation 94:1139-1160. https://www.ncbi.nlm.nih.gov/pubmed/23187042

Increasing physical activity in patients with hip and knee osteoarthritis

People with osteoarthritis of the knee and hip may not participate in physical activities due to pain and fear of harming their joints, leading to increased risk of heart attack or stroke.

Jason Wallis is investigating how to help patients with severe osteoarthritis of the knee be more active and reduce their health risks. In a randomised controlled trial Jason found that participants who walked for 70 minutes each week for 12 weeks, were six times more likely to lower their blood pressure to a healthy level than a control group who did not participate in a walking program. In other words, 10 minutes of walking per day was enough to make meaningful changes to the health of osteoarthritis patients while also improving mood and mobility.

Total joint replacement is a common operation for people with severe hip and knee osteoarthritis. Despite these operations often being very successful in reducing pain, levels of physical activity typically do not improve after surgery with continuing low levels of physical activity and increased risk of cardiovascular disease. PhD student Lyndon Hawke is investigating interventions that might be used to improve physical activity and other outcomes after lower-limb total joint replacement.

Publications
  1. Hawke LJ, Shields N, Dowsey MM, Choong PFM, Taylor NF. Physical activity levels after hip and knee joint replacement surgery: an observational study. Clin Rheumatol. 2018; [Epub ahead of print].
  2. Wallis J, Webster K, Levinger P, Fong C, Taylor N. A pre-operative group rehabilitation programme provided limited benefit for people with severe hip and knee osteoarthritis. Disability & Rehabilitation. 2014;36:2085-90. https://www.ncbi.nlm.nih.gov/pubmed/24597936
  3. Wallis J, Webster K, Levinger P, Singh P, Fong C, Taylor N. The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2015. https://www.ncbi.nlm.nih.gov/pubmed/25882926
  4. Wallis J, Webster K, Levinger P, Singh P, Fong C, Taylor N. A walking program for people with severe knee osteoarthritis did not reduce pain but may have benefits for cardiovascular health: a phase II randomised controlled trial. Osteoarthritis and cartilage. 2017;25(12):1969-79. https://www.ncbi.nlm.nih.gov/pubmed/28011099
  5. Wallis JA, Webster KE, Levinger P, Singh PJ, Fong C, Taylor NF. Perceptions about participation in a 12-week walking program for people with severe knee osteoarthritis: a qualitative analysis. Disabil Rehabil. 2017:1-7. https://www.ncbi.nlm.nih.gov/pubmed/29188750