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Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Brusco NK, Wang YT, Taylor NF. Allied health assistant management of people with hip fracture is feasible and may improve patient adherence to hip fracture mobilisation guidelines: a feasibility randomised controlled trial. Physiotherapy 2024; 124:51-64. [PMID: 38870622 DOI: 10.1016/j.physio.2024.05.002] [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: 04/12/2023] [Revised: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Determine the feasibility of allied health assistant (AHA) management of people with hip fracture an acute hospital. DESIGN Assessor-blind, parallel, feasibility randomised controlled trial with qualitative component. SETTING Acute orthopaedic ward. PARTICIPANTS People with surgically-managed hip fracture, who walked independently pre-fracture and had no cognitive impairment. INTERVENTIONS Rehabilitation from an AHA, under the supervision of a physiotherapist, compared with rehabilitation from a physiotherapist. MAIN OUTCOME MEASURES Feasibility was evaluated according to focus areas of demand, acceptability, practicality and implementation. Secondary outcomes included estimates of effect of adherence to hip fracture mobilisation guidelines, discharge destination, 30-day readmission, functional activity, and length of stay. RESULTS Fifty people were allocated to receive rehabilitation from an AHA (n = 25) or physiotherapist (n = 25). AHA rehabilitation had high demand with 60% of eligible participants recruited. Satisfaction with AHA rehabilitation was comparable with physiotherapy rehabilitation (acceptability). The AHA group received an average of 11 min (95% CI 4 to 19) more therapy per day than the physiotherapy group (implementation). The AHA group may have had lower cost of acute care (MD -$3 808 95% CI -7 651 to 35) and adverse events were comparable between groups (practicality). The AHA group may have been 22% (HR 1.22, 95% CI 0.92 to 1.61) more likely to walk on any day and may have had a shorter length of stay (MD -0.8 days, 95% CI -2.3 to 0.7). CONCLUSIONS AHA management of patients with hip fracture was feasible and may improve adherence to mobilisation guidelines and reduce cost of care and length of stay. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12620000877987. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia.
| | - Peggy Vincent
- Physiotherapy Department, Peninsula Health, Frankston, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia; Academic Unit, Peninsula Health, Frankston Australia
| | - Taya A Collyer
- Peninsula Clinical School, Monash University, Frankston Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia
| | - Yi Tian Wang
- Physiotherapy Department, Peninsula Health, Frankston, 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, Bundoora, Australia
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Snowdon DA, Wang YT, Callisaya ML, Collyer TA, Jolliffe L, Johns N, Vincent P, Pragash N, Taylor NF. Staying Active with Multimorbidity In Acute hospital settings (StAMInA) trial: protocol for a feasibility randomised controlled trial of allied health assistant mobility rehabilitation for patients with multimorbidity. BMJ Open 2024; 14:e078843. [PMID: 38216182 PMCID: PMC10806632 DOI: 10.1136/bmjopen-2023-078843] [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: 08/14/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Key to improving outcomes for patients with multimorbidity is increasing mobility through prescription of a physical activity programme, but this can be difficult to achieve in acute hospital settings. One approach that would assist physiotherapists to increase levels of physical activity is delegation of rehabilitation to allied health assistants. We aim to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient mobility rehabilitation for patients with multimorbidity. METHODS AND ANALYSIS Using a parallel group randomised controlled design, participants will be allocated to allied health assistant mobility rehabilitation or physiotherapist mobility rehabilitation. Adult inpatients (n=60) in an acute hospital with a diagnosis of multimorbidity who walked independently preadmission will be included. The experimental group will receive routine mobility rehabilitation, including daily mobilisation, from an allied health assistant under the supervision of a physiotherapist. The comparison group will receive routine rehabilitation from a physiotherapist. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: Acceptability (patient satisfaction); demand (proportion of patients who participate); implementation (time allied health assistant/physiotherapist spends with participant, occasions of service); and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant rehabilitation will be interviewed to explore their perspectives on feasibility. Secondary outcomes include: Physical activity (daily time spent walking); daily mobilisation (Y/N); discharge destination; hospital readmission; falls; functional activity (Modified Iowa Level of Assistance Scale); and length of stay. Descriptive statistics will be used to describe feasibility. Secondary outcomes will be compared between groups using Poisson or negative binomial regression, Cox proportional hazards regression, survival analysis, linear regression or logistic regression. ETHICS AND DISSEMINATION Ethics approval was obtained from Peninsula Health (HREC/97 431/PH-2023). Findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry ACTRN12623000584639p.
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Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Yi Tian Wang
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Laura Jolliffe
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Nathan Johns
- Department of Rehabilitation Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Peggy Vincent
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nandhinee Pragash
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
- Department of Physiotherapy, Peninsula Health, Frankston, Victoria, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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King OA, Pinson J, Dennett A, Williams C, Davis A, Snowdon DA. Allied health assistants' perspectives of their role in healthcare settings: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4684-e4693. [PMID: 35689419 PMCID: PMC10084421 DOI: 10.1111/hsc.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/05/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.
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Affiliation(s)
- Olivia A. King
- Barwon HealthGeelongVicAustralia
- Monash Centre for Scholarship in Health EducationMonash UniversityClaytonVicAustralia
| | - Jo‐Anne Pinson
- Monash Health, Department of Medical ImagingClaytonVicAustralia
- Peninsula Health, Department of Medical ImagingFrankstonVicAustralia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVicAustralia
| | - Amy Dennett
- Allied Health Clinical Research OfficeEastern HealthBox HillVicAustralia
- School of Allied Health Human Services and SportLa Trobe UniversityBundooraVicAustralia
| | - Cylie Williams
- School of Primary and Allied Health CareMonash UniversityFrankstonVicAustralia
- Academic Unit, Peninsula HealthFrankstonVicAustralia
| | - Annette Davis
- Allied Health Workforce Innovation Strategy Education Research (WISER) UnitMonash HealthClaytonVicAustralia
| | - David A. Snowdon
- Academic Unit, Peninsula HealthFrankstonVicAustralia
- Peninsula Clinical School, Central Clinical SchoolMonash UniversityFrankstonVicAustralia
- National Centre for Healthy AgeingFrankstonVicAustralia
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