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Whittaker SL, Brusco NK, Hill KD, Taylor NF. Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1946-1960. [PMID: 38729404 DOI: 10.1016/j.apmr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. DATA SOURCES Six databases were searched until December 2023. STUDY SELECTION Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. DATA EXTRACTION After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). CONCLUSIONS Self-management as an intervention is low cost and could improve health-related quality of life.
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Affiliation(s)
- Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria.
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria; Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
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Brusco NK, Ekegren CL, Morris ME, Hill KD, Lee AL, Somerville L, Lannin NA, Abdelmotaleb R, Callaway L, Whittaker SL, Taylor NF. Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial. Ann Phys Rehabil Med 2024; 67:101867. [PMID: 39173328 DOI: 10.1016/j.rehab.2024.101867] [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: 12/19/2023] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. OBJECTIVES To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation. METHODS This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. RESULTS 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). CONCLUSIONS My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Meg E Morris
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC 3004 Australia; Alfred Health, Melbourne, VIC 3004 Australia
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia; Occupational Therapy Department, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Nicholas F Taylor
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia; Eastern Health, 2/5 Arnold Street, Box Hill, VIC 3128 Australia
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Dorward E, Devlin A, Brusco NK, Dulfer F, Whittaker SL, Reeder S, Ekegren CL. Patients' perceptions of participating in self-directed activities outside supervised occupational and physiotherapy within inpatient and home-based rehabilitation settings: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38625404 DOI: 10.1080/09638288.2024.2341872] [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: 09/01/2023] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To investigate patients' perceptions of participating in self-directed activities, outside supervised occupational and physiotherapy, within rehabilitation settings. METHODS Semi-structured interviews were undertaken with 16 patients and in three instances, their carers, from three health services in Victoria, Australia, two offering inpatient and one offering home-based rehabilitation care. A thematic analysis was performed using a framework approach. RESULTS Themes identified included the role of the clinicians in encouraging patients and instilling confidence, giving feedback and "just being there"; considerations in program delivery, including different formats, support from peers and relatives, and program familiarity and flexibility; patients' different intrinsic driving and limiting forces, including following orders, seeing results, desiring autonomy and having an "inner athlete"; and the environment, including functional activities, space, equipment, time and availability. CONCLUSIONS Patients and their carers reported positive experiences of participating in self-directed therapy programs within rehabilitation settings, with programs perceived as beneficial in optimising recovery. Patients reported a range of driving and limiting factors in relation to completing self-directed activities. Understanding these factors, relating to the patient, their environment and other people, is critical for clinicians so that they can modify their delivery accordingly, ensuring uptake and sustained implementation of self-directed activities in rehabilitation care.
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Affiliation(s)
- Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Peter James Centre, Eastern Health, Burwood East, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Fiona Dulfer
- Physiotherapy Department, Cabrini Health, Malvern, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Sandra Reeder
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
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Brusco N, Ekegren C, Rawson H, Taylor NF, Morphet J, Hill K, Anderson J, Stephen K, Crabtree A, Levinger P, Whittaker SL, Soh SE, Dulfer F, Lawler K. Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study. AUST HEALTH REV 2024; 48:66-81. [PMID: 38245911 DOI: 10.1071/ah23206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Objective My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability , reach and demand , practicality , integration , limited efficacy testing and adaptations . Results Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach ), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand ). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical , and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.
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Affiliation(s)
- Natasha Brusco
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Christina Ekegren
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Helen Rawson
- Nursing and Midwifery, Monash University, Vic., Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Vic., Australia; and School of Allied Health Human Services and Sport La, Trobe University, Vic., Australia
| | - Julia Morphet
- Nursing and Midwifery, Monash University, Vic., Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | | | - Kelly Stephen
- murrenda Residential Aged Care, Eastern Health, Vic., Australia
| | - Amelia Crabtree
- Division of Aged Care and Rehabilitation, Monash Health, Vic., Australia; and Monash Ageing Research Centre, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Vic., Australia; and National Centre for Healthy Ageing, Monash University and Peninsula Health, Vic., Australia
| | | | - Sara L Whittaker
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Vic., Australia
| | - Katherine Lawler
- School of Allied Health Human Services and Sport La, Trobe University, Vic., Australia; and Wicking Dementia Research and Education Centre, University of Tasmania, Tas., Australia
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Brusco NK, Walpole B, Kugler H, Tilley L, Thwaites C, Devlin A, Dorward E, Dulfer F, Lee AL, Morris ME, Taylor NF, Dawes H, Whittaker SL, Ekegren CL. Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings. Aust Occup Ther J 2023; 70:617-626. [PMID: 37291993 DOI: 10.1111/1440-1630.12891] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. METHODS My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). RESULTS Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. CONCLUSION Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Brianna Walpole
- Safer Care Victoria, Victorian Government, Melbourne, Australia
| | - Helen Kugler
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Louise Tilley
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Claire Thwaites
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Victoria, Australia
| | - Annemarie L Lee
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Meg E Morris
- The Victorian Rehabilitation Centre and La Trobe University ARCH and CERI, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Dawes
- Clinical Rehabilitation, University of Exeter, Exeter, UK
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Brusco NK, Ekegren CL, Taylor NF, Hill KD, Lee AL, Somerville L, Lannin NA, Wade D, Abdelmotaleb R, Callaway L, Whittaker SL, Morris ME. Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial. BMC Health Serv Res 2021; 21:811. [PMID: 34384427 PMCID: PMC8361638 DOI: 10.1186/s12913-021-06462-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. METHODS This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios. DISCUSSION The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs. TRIAL REGISTRATION This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia.
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Nicholas F Taylor
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Eastern Health, 5 Arnold St, 3128, Box Hill, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Annemarie L Lee
- Cabrini Health, 154 Wattletree Rd, 3144, Malvern, Australia
- School of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Lisa Somerville
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
| | - Natasha A Lannin
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Alfred Health, 55 Commercial Rd, 3004, Melbourne, Australia
- Department of Neuroscience, Monash University, Central Clinical School, 99 Commercial Rd, 3004, Melbourne, Australia
| | - Derick Wade
- Physiotherapy and Rehabilitation, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, OX3 0BP, Oxford, United Kingdom
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
- School of Occupational Therapy, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, 47-49 Moorooduc Hwy, VIC, 3199, Frankston, Australia
| | - Meg E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, Plenty Road & Kingsbury Drive, 3086, Bundoora, Australia
- Healthscope ARCH, The Victorian Rehabilitation Centre, 499 Springvale Road, 3150, Glen Waverley, Australia
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