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D’Souza AN, Merrett M, Griffin H, Tran-Duy A, Struck C, Fazio TN, Juj G, Granger CL, Peiris CL. Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:958. [PMID: 39063534 PMCID: PMC11277266 DOI: 10.3390/ijerph21070958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. METHODS A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage). RESULTS During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]). CONCLUSIONS A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.
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Affiliation(s)
- Aruska N. D’Souza
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Myvanwy Merrett
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Hilda Griffin
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Methods and Implementation Support for Clinical and Health Research (MISCH) Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Carly Struck
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | - Timothy N. Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Electronic Medical Records, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- Melbourne Medical School, The University of Melbourne, Parkvillle, VIC 3010, Australia
| | - Genevieve Juj
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
| | | | - Casey L. Peiris
- Allied Health, The Royal Melbourne Hospital, Parkvillle, VIC 3050, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Sim A, McNeilage AG, Gholamrezaei A, Rebbeck T, Ashton-James C. Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews. BMJ Open 2024; 14:e085778. [PMID: 39025825 PMCID: PMC11261706 DOI: 10.1136/bmjopen-2024-085778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress. OBJECTIVES This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions. DESIGN We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis. RESULTS From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis. CONCLUSION A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.
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Affiliation(s)
- Alison Sim
- The University of Sydney, Sydney, Australia
| | | | - Ali Gholamrezaei
- Faculty of Medicine and Health, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Claire Ashton-James
- Pain Management, The University of Sydney, Sydney, New South Wales, Australia
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Orr E, Perera R, Sayner A, Thompson A, Pang M, Entesari-Tatafi D, Dalgleish G, Nguyen L, Cliffe L, McDonald I, Than K, Keage M, Clapham RP. Impacts of a Dysphagia Screening Questionnaire on Speech Pathology Input Using a Transdisciplinary Approach for Patients with Chronic Obstructive Pulmonary Disease in a Pulmonary Rehabilitation Program. Dysphagia 2024:10.1007/s00455-024-10713-2. [PMID: 38951236 DOI: 10.1007/s00455-024-10713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/19/2024] [Indexed: 07/03/2024]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) in pulmonary rehabilitation programs (PRPs) are not routinely screened for dysphagia. An Australian regional health service audit revealed that patients with COPD are frequently referred to speech pathology during acute admissions, rather than proactively to mitigate the risk of dysphagia-related consequences. Referral patterns to speech pathology using a novel transdisciplinary approach for identifying at risk for dysphagia patients in a PRP were explored. The aim of this study was to investigate the impact of a transdisciplinary dysphagia screening questionnaire on speech pathology referrals within a cohort of patients with COPD enrolled in a PRP. This quasi-experimental study introduced a dysphagia screening questionnaire in a PRP using a transdisciplinary approach. A retrospective audit of PRP patients (n = 563) between 01/01/2014 and 31/12/2018 was conducted to identify the frequency of referrals to speech pathology for dysphagia. Data was compared to a cohort of patients (n = 50) enrolled in the PRP (from 01/02/21 to 30/11/21) after introduction of the questionnaire using Fisher's exact test. Less than 1% (n = 4/563) of PRP patients were referred to speech pathology prior to implementation of the questionnaire. Following the implementation, referrals to speech pathology significantly increased to 16% (8/50) (X2 = 7.72, P < 0.05; odds ratio = 7.89 95% CI [1.94, 32.1]). Introducing a dysphagia screening questionnaire increased referrals to speech pathology from a PRP. This study demonstrated the potential for a transdisciplinary approach in early screening for patients at risk of dysphagia for patients with COPD. Further research is encouraged to explore patient motivation towards speech pathology input with COPD-related dysphagia and clinicians' perceived self-efficacy in using the questionnaire.
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Affiliation(s)
- Ellie Orr
- Speech Pathology Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia.
| | - Rishni Perera
- Speech Pathology Department, Austin Health, Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
| | - Alesha Sayner
- Primary and Community Care, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
- Deakin Rural Health, Warrnambool, VIC, Australia
| | - Acushla Thompson
- Speech Pathology Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Michael Pang
- Physiotherapy Department, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Damoon Entesari-Tatafi
- Specialist Outpatient Clinics, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Gerard Dalgleish
- Specialist Outpatient Clinics, Grampians Health-Ballarat, 1 Drummond St., Ballarat, VIC, 3350, Australia
| | - Lisa Nguyen
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Lucy Cliffe
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Isobel McDonald
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Kylie Than
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Megan Keage
- Audiology and Speech Pathology, Melbourne University, 550 Swanston St., Melbourne, VIC, 3000, Australia
| | - Renee P Clapham
- Speech Pathology Department, St. Vincent's Health, 41 Victory Parade, Fitzroy, VIC, 3065, Australia
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Martin AK, Griffin A, McCarthy AL, Green TL, Sowa PM, Laakso EL. Does an allied health transdisciplinary stroke assessment save time, improve quality of care, and save costs? Results of a pre-/post- clinical study. Eur Stroke J 2024:23969873241258000. [PMID: 38859574 DOI: 10.1177/23969873241258000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
PURPOSE Demand for stroke services is increasing. To save time and costs, stroke care could be reorganised using a transdisciplinary assessment model embracing overlapping allied health professional skills. The study compares transdisciplinary assessment to discipline-specific allied health assessment on an acute stroke unit, by evaluating assessment time, quality of care, and cost implications. METHOD The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use. FINDINGS When the transdisciplinary assessment was used (N = 116), compared to usual assessment (N = 63), the average time saving was 37.6 min (95% CI -47.5, -27.7; p < 0.001) for staff and 62.2 min (95% CI -74.1, -50.3; p < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4-23) to 5 (interquartile range 3-10; p = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI -487.15, -271.48). DISCUSSION AND CONCLUSION Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services.
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Affiliation(s)
- Aleysha K Martin
- Faculty of Medicine, Mater Research Institute - University of Queensland, Mater Hospital Brisbane, Raymond Terrace, South Brisbane, QLD, Australia
| | - Alison Griffin
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Alexandra L McCarthy
- Griffith Health Executive, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia
| | - Theresa L Green
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - P Marcin Sowa
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - E-Liisa Laakso
- Allied Health, Mater Research Institute - University of Queensland, Mater Hospital Brisbane, Raymond Terrace, South Brisbane, QLD, Australia
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Martin AK, Green TL, McCarthy AL, Sowa PM, Laakso EL. Transdisciplinary allied health assessment for patients with stroke: a pre-/post- mixed methods study protocol. BMC Health Serv Res 2022; 22:1578. [PMID: 36564771 PMCID: PMC9789550 DOI: 10.1186/s12913-022-08926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/03/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transdisciplinary approaches can streamline processes and build workforce capacity by blurring traditional responsibilities and integrating aspects of care. Emerging evidence shows transdisciplinary approaches can improve time-efficiency, quality of care and cost-effectiveness across various healthcare settings, however no empirical study is based on an acute stroke unit. METHODS The SPIRIT checklist was used to guide the content of the research protocol. The study is a pragmatic pre-/post- mixed methods four-phase study with a 3-month follow up, based at the Mater Hospital Brisbane. Participants experiencing stroke symptoms will be recruited as they are admitted to the acute stroke unit. Patients presenting with mild stroke symptoms or Transient Ischaemic Attack will be allocated to Phase 1 (baseline) or Phase 2 (implementation), while patients presenting with moderate to severe stroke symptoms will be allocated to Phase 3 (baseline) or Phase 4 (implementation). Participants in baseline Phases 1 and 3 will receive standard allied health assessment, while participants in implementation Phases 2 and 4 will receive the novel transdisciplinary assessment. For the primary aim, allied health professionals will time their assessments to evaluate time taken to administer a novel transdisciplinary assessment, compared to usual discipline-specific assessments. Non-inferiority of the novel transdisciplinary assessment will also be explored in terms of patient safety, compliance to national standards, use of the assessment, and stakeholder perceptions. A retrospective medical record audit, staff focus group, patient/staff surveys, and patient phone interviews at 3-months will be completed. Quantitative results will be estimated using general linear and logistic regression models in Stata 15.1. Qualitative results will be analysed using frequency counts and NVivo software. An economic evaluation will be performed using three scopes including the allied health assessment, hospital admission, and patient outcomes at 3-months. DISCUSSION When designing the study, pragmatic factors related to staff willingness to be involved, patient safety, and existing clinical pathways/processes were considered. To address those factors, a co-design approach was taken, resulting in staff buy-in, clinically relevant outcome measures, and the pre-/post- four-phase study design. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12621000380897. Registered 06 April 2021 - retrospectively registered, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381339&isReview=true.
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Affiliation(s)
- Aleysha K. Martin
- grid.1003.20000 0000 9320 7537Faculty of Medicine, Mater Research Institute – University of Queensland, QLD, Brisbane, Australia
| | - Theresa L. Green
- grid.1003.20000 0000 9320 7537School of Nursing, Midwifery and Social Work, The University of Queensland, QLD, Brisbane, Australia
| | - Alexandra L. McCarthy
- grid.1003.20000 0000 9320 7537School of Nursing, Midwifery and Social Work, Mater Research Institute – University of Queensland, QLD, Brisbane, Australia
| | - P. Marcin Sowa
- grid.1003.20000 0000 9320 7537Centre for the Business and Economics of Health, The University of Queensland, QLD, Brisbane, Australia
| | - E-Liisa Laakso
- grid.1003.20000 0000 9320 7537Allied Health, Mater Research Institute – University of Queensland, QLD, Brisbane, Australia
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Martin AK, Green TL, McCarthy AL, Sowa PM, Laakso EL. Healthcare Teams: Terminology, Confusion, and Ramifications. J Multidiscip Healthc 2022; 15:765-772. [PMID: 35422626 PMCID: PMC9005079 DOI: 10.2147/jmdh.s342197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
One strategy to meet increasing consumer demand for healthcare services in the pandemic era has been to reorganize the healthcare workforce. This can be achieved by reorganizing healthcare teams, which are associated with improved workforce productivity and better patient outcomes. However, healthcare teams are described using numerous terminologies and labels, which has led to conceptual confusion for researchers and research users. In this paper, we explore the disparate nature of healthcare team terminology, ramifications of conceptual confusion, and we propose standardized terminology with synthesized definitions focused on characteristics of clinically based healthcare teams including unidisciplinary, multidisciplinary, interprofessional, and transdisciplinary teams.
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Affiliation(s)
- Aleysha K Martin
- Faculty of Medicine, Mater Research Institute – The University of Queensland, Brisbane, QLD, Australia
- Correspondence: Aleysha K Martin, Faculty of Medicine, Mater Research Institute – The University of Queensland, Level 2 Aubigny Place, Raymond Terrace, South Brisbane, QLD, 4101, Australia, Tel +61 457 993 248; +61 7 3163 2550, Email
| | - Theresa L Green
- School of Nursing, Midwifery and Social Work, The University of Queensland – MNHHS Surgical Treatment and Rehabilitation Service, Brisbane, QLD, Australia
| | - Alexandra L McCarthy
- School of Nursing, Midwifery and Social Work, Mater Research Institute – The University of Queensland, Brisbane, QLD, Australia
| | - P Marcin Sowa
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - E-Liisa Laakso
- Allied Health, Mater Research Institute – The University of Queensland, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Gold Coast, Australia
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