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Raymer M, Swete Kelly P, O'Leary S. Developing and embedding an advanced practice musculoskeletal physiotherapy service in public specialist outpatient services in Queensland: A health service masterclass. Musculoskelet Sci Pract 2024; 70:102917. [PMID: 38309180 DOI: 10.1016/j.msksp.2024.102917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 02/05/2024]
Abstract
INTRODUCTION The Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service (MPSC&MDS) is an advanced practice physiotherapist-led model of care developed initially to address overburdened specialist orthopaedic outpatient public hospital services across Queensland, Australia. PURPOSE This Masterclass explores the experiences and success of embedding the MPSC&MDS state-wide across the Queensland public health system and its expansion in scale and reach to other specialist services. Key characteristics and development strategies are described that have collectively underpinned the expansion and sustainability of the service, using relevant stream sections and themes from a recommended musculoskeletal model of care framework. IMPLICATIONS The aim of this masterclass is to be informative for readers involved in the future development or refinement of similar models of care.
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Affiliation(s)
- Maree Raymer
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Patrick Swete Kelly
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
| | - Shaun O'Leary
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia; University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD 4072, Australia.
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Nehme R, Puchkova A, Parlikad A. A predictive model for the post-pandemic delay in elective treatment. OPERATIONS RESEARCH FOR HEALTH CARE 2022; 34:100357. [PMID: 36090954 PMCID: PMC9446608 DOI: 10.1016/j.orhc.2022.100357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/07/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022]
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Mondal PK, Norman BA. Enhancing staffing methods and improving the admission process of a psychiatric hospital using simulation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pritom Kumar Mondal
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
| | - Bryan A. Norman
- Department of Industrial, Manufacturing & Systems Engineering, Texas Tech University, Lubbock, TX, USA
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Simulation modeling to assess performance of integrated healthcare systems: Literature review to characterize the field and visual aid to guide model selection. PLoS One 2021; 16:e0254334. [PMID: 34242350 PMCID: PMC8270171 DOI: 10.1371/journal.pone.0254334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The guiding principle of many health care reforms is to overcome fragmentation of service delivery and work towards integrated healthcare systems. Even though the value of integration is well recognized, capturing its drivers and its impact as part of health system performance assessment is challenging. The main reason is that current assessment tools only insufficiently capture the complexity of integrated systems, resulting in poor impact estimations of the actions taken towards the ‘Triple Aim’. We describe the unique nature of simulation modeling to consider key health reform aspects: system complexity, optimization of actions, and long-term assessments. Research question How can the use and uptake of simulation models be characterized in the field of performance assessment of integrated healthcare systems? Methods A systematic search was conducted between 2000 and 2018, in 5 academic databases (ACM D. Library, CINAHL, IEEE Xplore, PubMed, Web of Science) complemented with grey literature from Google Scholar. Studies using simulation models with system thinking to assess system performance in topics relevant to integrated healthcare were selected for revision. Results After screening 2274 articles, 30 were selected for analysis. Five modeling techniques were characterized, across four application areas in healthcare. Complexity was defined in nine aspects, embedded distinctively in each modeling technique. ‘What if?’ & ‘How to?’ scenarios were identified as methods for system optimization. The mean time frame for performance assessments was 18 years. Conclusions Simulation models can evaluate system performance emphasizing the complex relations between components, understanding the system’s adaptability to change in short or long-term assessments. These advantages position them as a useful tool for complementing performance assessment of integrated healthcare systems in their pursuit of the ‘Triple Aim’. Besides literacy in modeling techniques, accurate model selection is facilitated after identification and prioritization of the complexities that rule system performance. For this purpose, a tool for selecting the most appropriate simulation modeling techniques was developed.
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Raymer M, Mitchell L, Window P, Cottrell M, Comans T, O’Leary S. Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services. Healthcare (Basel) 2021; 9:healthcare9030278. [PMID: 33802624 PMCID: PMC7999298 DOI: 10.3390/healthcare9030278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 01/12/2023] Open
Abstract
This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described. Variations in these outcomes between facilities were explored with a regression analysis adjusting for known patient- and service-related characteristics. The findings showed substantial positive impacts of the advanced practice model across all facilities, with 69.4% of patients discharged without a need for medical specialist review (primary service outcome), consistent with 68.9% of patients reporting clinically important improvements in their condition (primary clinical outcome). However, 15 facilities significantly varied from the state average for the primary service outcome (despite only three facilities varying in the primary clinical outcome). While this disparity in the primary service outcomes appears to be influenced by potentially modifiable differences in the service-related processes between facilities, these process differences only explained part of the variation. This study described the subsequent development of a new, more comprehensive set of service evaluation metrics to better inform future service planning.
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Affiliation(s)
- Maree Raymer
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Louise Mitchell
- Department of Health Queensland, Epidemiology and Research, Aboriginal and Torres Strait Islander Health Division, Brisbane, QLD 4001, Australia;
| | - Peter Window
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Michelle Cottrell
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4106, Australia
- Correspondence: ; Tel.: +61-7-334-65-345
| | - Shaun O’Leary
- Department of Physiotherapy, Metro North Hospital Health Service, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia; (M.R.); (P.W.); (M.C.); (S.O.)
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
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Analysis of the Installed Productive Capacity in a Medical Angiography Room through Discrete Event Simulation. Processes (Basel) 2020. [DOI: 10.3390/pr8060660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The installed productive capacity of a healthcare center’s equipment limits the efficient use of its resources. This paper, therefore, analyzes the installed productive capacity of a hospital angiography room and how to optimize patient demand. For this purpose, a Discrete Event Simulation (DES) model based on historical variables from the current system was created using computer software. The authors analyzed 2044 procedures performed between 2014 and 2015 in a hospital in San José, Costa Rica. The model was statistically validated to determine that it does not significantly differ from the current system, considering the DMAIC stages for continuous process improvement. In the current scenario, resource utilization is 0.99, and the waiting list increases every month. The results showed that the current capacity of the service could be doubled, and that resource utilization could be reduced to 0.64 and waiting times by 94%. An increase in service efficiency could be achieved by shortening maximum waiting times from 6.75 days to 3.70 h. DES simulation, therefore, allows optimizing of the use of healthcare systems’ resources and hospital management.
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Moretto N, Stute M, Sam S, Bhagwat M, Raymer M, Buttrum P, Banks M, Comans TA. A uniform data set for determining outcomes in allied health primary contact services in Australia. Aust J Prim Health 2020; 26:58-69. [PMID: 31954431 DOI: 10.1071/py18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The project aim was to develop and implement a set of metrics to capture and demonstrate the performance of newly established allied health primary contact services. Selection of the metrics and performance indicators was guided by an existing state-wide data collection system and from a review of the published literature. The metrics were refined after consultation with a working group of health service managers and clinicians. The data collection and reporting framework were developed for use in allied health primary contact services and implemented at public health facilities in Queensland, Australia. The set of metrics consists of 18 process and outcome measures. Patient-reported metrics include the global rating of change scale and patient satisfaction. Service metrics include wait times; referral source; triage category; diagnosis; occasions of service; referrals and investigations initiated; effects; care duration; discharge status; waitlist reinstatement reasons; treatment non-completion reasons; and expedited care. Safety, patient demographics and service improvement metrics were included. The metrics will enable analysis of the effectiveness of allied health primary contact services and will facilitate reporting, advocacy, service improvement, service continuity and research. The metrics are suitable for use by all providers of allied health primary contact services in hospital and primary care settings.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia; and Corresponding author
| | - Michelle Stute
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Sonia Sam
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Marita Bhagwat
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Peter Buttrum
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Merrilyn Banks
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
| | - Tracy A Comans
- Centre for Health Services Research, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Qld 4102, Australia; and Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia
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Carter HE, Knowles D, Moroney T, Holtmann G, Rahman T, Appleyard M, Steele N, Zanco M, Graves N. The use of modelling studies to inform planning of health services: case study of rapidly increasing endoscopy services in Australia. BMC Health Serv Res 2019; 19:608. [PMID: 31464609 PMCID: PMC6716875 DOI: 10.1186/s12913-019-4438-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Demand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population. More services are required to meet demand and ensure patients are seen within clinically recommended timeframes. Methods A discrete event simulation model was developed to project endoscopy waiting list outcomes for two large metropolitan health services encompassing 8 public hospitals in Australia. The model applied routinely collected health service data to forecast the impacts of future endoscopic demand over 5 years and to identify the level of service activity required to address patient waiting times and meet key policy targets. The approach incorporated evidence from the literature to produce estimates of cost-effectiveness by showing longer term costs and Quality Adjusted Life Years (QALYs) associated with service expansion. Results The modelling revealed that doing nothing would lead to the number of patients waiting longer than clinically recommended doubling across each health service within 5 years. A 38% overall increase in the number of monthly procedures available was required to meet and maintain a target of 95–98% of patients being seen within clinically recommended timeframes to the year 2021. This was projected to cost the funder approximately $140 million in additional activity over a 5 year period. Due to improved patient outcomes associated with timely intervention, it was estimated that the increased activity would generate over 22,000 additional QALYs across the two health services. This translated to an incremental cost-effectiveness ratio of $6467 and $5974 per QALY for each health service respectively. Conclusions Discrete event simulation modelling provided a rational, data based approach that allowed decision makers to quantify the future demand for endoscopy services and identify cost-effective strategies to meet community needs. Electronic supplementary material The online version of this article (10.1186/s12913-019-4438-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Dylan Knowles
- Anthrodynamics Simulation Services Australia, Homebush, NSW, 2140, Australia
| | - Timothy Moroney
- Healthcare Purchasing and System Performance, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Gerald Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - Tony Rahman
- The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Mark Appleyard
- Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - Nick Steele
- Healthcare Purchasing and System Performance, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Michael Zanco
- Health systems innovation branch, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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Moretto N, Comans TA, Chang AT, O’Leary SP, Osborne S, Carter HE, Smith D, Cavanagh T, Blond D, Raymer M. Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services. Implement Sci 2019; 14:78. [PMID: 31399105 PMCID: PMC6688348 DOI: 10.1186/s13012-019-0923-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/09/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. METHODS Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. RESULTS Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). CONCLUSIONS To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.
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Affiliation(s)
- Nicole Moretto
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Queensland 4102 Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029 Australia
| | - Tracy A. Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Queensland 4102 Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029 Australia
| | - Angela T. Chang
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029 Australia
| | - Shaun P. O’Leary
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029 Australia
- School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland 4067 Australia
| | - Sonya Osborne
- School of Nursing and Midwifery, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Ipswich, Queensland 4305 Australia
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059 Australia
| | - Hannah E. Carter
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059 Australia
| | - David Smith
- West Moreton Health, Ipswich, Queensland 4305 Australia
| | - Tania Cavanagh
- Cairns and Hinterland Hospital and Health Service, Cairns, Queensland 4870 Australia
| | - Dean Blond
- Gold Coast Health, Southport, Queensland 4215 Australia
| | - Maree Raymer
- Metro North Hospital and Health Service, Royal Brisbane and Women’s Hospital, Butterfield Street, Herston, Queensland 4029 Australia
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Cottrell M, Judd P, Comans T, Easton P, Chang AT. Comparing fly-in fly-out and telehealth models for delivering advanced-practice physiotherapy services in regional Queensland: An audit of outcomes and costs. J Telemed Telecare 2019; 27:32-38. [PMID: 31280639 DOI: 10.1177/1357633x19858036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. METHODS A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. RESULTS A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. DISCUSSION Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.
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Affiliation(s)
- Michelle Cottrell
- Physiotherapy Department, Royal Brisbane & Women's Hospital, Australia
| | - Perry Judd
- Physiotherapy Department, Royal Brisbane & Women's Hospital, Australia
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Australia
| | - Paula Easton
- Physiotherapy Department, Mackay Base Hospital, Australia
| | - Angela T Chang
- Centre for Allied Health Research, Royal Brisbane & Women's Hospital, Australia
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