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Juckett LA, Wengerd LR, Banhos M, Darragh AR. Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design. Neurorehabil Neural Repair 2022; 36:770-776. [PMID: 36398961 DOI: 10.1177/15459683221138747] [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: 11/19/2022]
Abstract
As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.
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Affiliation(s)
- Lisa A Juckett
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Lauren R Wengerd
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Meredith Banhos
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amy R Darragh
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
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2
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Thayabaranathan T, Andrew NE, Grimley R, Stroil-Salama E, Grabsch B, Hill K, Cadigan G, Purvis T, Middleton S, Kilkenny MF, Cadilhac DA. Understanding the Role of External Facilitation to Drive Quality Improvement for Stroke Care in Hospitals. Healthcare (Basel) 2021; 9:healthcare9091095. [PMID: 34574869 PMCID: PMC8471416 DOI: 10.3390/healthcare9091095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
The use of external facilitation within the context of multicomponent quality improvement interventions (mQI) is growing. We aimed to evaluate the influence of external facilitation for improving the quality of acute stroke care. Clinicians from hospitals participating in mQI (Queensland, Australia) as part of the Stroke123 study were supported by external facilitators in a single, on-site workshop to review hospital performance against eight clinical processes of care (PoCs) collected in the Australian Stroke Clinical Registry (AuSCR) and develop an action plan. Remote support (i.e., telephone/email) after the workshop was provided. As part of a process evaluation for Stroke123, we recorded the number and mode of contacts between clinicians and facilitators; type of support provided; and frequency of self-directed, hospital-level stroke registry data reviews. Analysis: We measured the association between amount/type of external facilitation, (i) development of action plans, and (ii) adherence to PoCs before and after the intervention using AuSCR data from 2010 to 2015. In total, 14/19 hospitals developed an action plan. There was no significant difference in amount or type of external facilitator support provided between hospitals that did, and did not, develop an action plan. There was no relationship between the amount of external facilitation and change in adherence to PoCs. Most (95%) hospitals accessed stroke registry performance data. In the Stroke123 study, the amount or type of external facilitation did not influence action plan development, and the amount of support did not influence the changes achieved in adherence to PoCs. Remote support may not add value for mQI.
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Affiliation(s)
- Tharshanah Thayabaranathan
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Correspondence: ; Tel.: +61-3-8572-2646; Fax: +61-3-9902-4245
| | - Nadine E. Andrew
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC 3199, Australia
| | - Rohan Grimley
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
- Sunshine Coast Clinical School, Griffith University, Birtinya, QLD 4575, Australia
| | - Enna Stroil-Salama
- Metro South Research, Metro South Health, Brisbane, QLD 4102, Australia;
| | - Brenda Grabsch
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia;
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Brisbane, QLD 4000, Australia;
| | - Tara Purvis
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
| | - Sandy Middleton
- Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne, Australia and Australian Catholic University, Sydney, NSW 2010, Australia;
| | - Monique F. Kilkenny
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
| | - Dominique A. Cadilhac
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia; (N.E.A.); (R.G.); (T.P.); (M.F.K.); (D.A.C.)
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3052, Australia;
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Phan HT, Gall S, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley R, Castley HC, Kilkenny MF, Cadilhac DA. Sex Differences in Causes of Death After Stroke: Evidence from a National, Prospective Registry. J Womens Health (Larchmt) 2021; 30:314-323. [DOI: 10.1089/jwh.2020.8391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hoang T. Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Department of Public Health Management, Pham Ngoc Thach University of Medicine, Hồ Chí Minh, Vietnam
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Craig S. Anderson
- Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | | | - Monique F. Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Sui Y, Luo J, Dong C, Zheng L, Zhao W, Zhang Y, Xian Y, Zheng H, Yan B, Parsons M, Ren L, Xiao Y, Zhu H, Ren L, Fang Q, Yang Y, Liu W, Xu B. Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months. Stroke Vasc Neurol 2020; 6:87-94. [PMID: 32973114 PMCID: PMC8005897 DOI: 10.1136/svn-2020-000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/05/2020] [Accepted: 07/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area. Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis. Results Compared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged. Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.
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Affiliation(s)
- Yi Sui
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Jianfeng Luo
- Department of Biostatistics, Fudan University School of Public Health, Shanghai, China
| | - Chunyao Dong
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weijin Zhao
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Yao Zhang
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Ying Xian
- Department of Neurology, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Huaguang Zheng
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Bernard Yan
- Department of Neurology at Melbourne Brain Center, The University of Melbourne Medicine at Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark Parsons
- Department of Neurology at Melbourne Brain Center, The University of Melbourne Medicine at Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Li Ren
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Ying Xiao
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Haoyue Zhu
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
| | - Lijie Ren
- Department of Neurology, Shenzhen University 1st Affiliated Hospital, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Weidong Liu
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Bing Xu
- Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China
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5
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Andrew NE, Kim J, Cadilhac DA, Sundararajan V, Thrift AG, Churilov L, Lannin NA, Nelson M, Srikanth V, Kilkenny MF. Protocol for evaluation of enhanced models of primary care in the management of stroke and other chronic disease (PRECISE): A data linkage healthcare evaluation study. Int J Popul Data Sci 2019; 4:1097. [PMID: 34095531 PMCID: PMC8142961 DOI: 10.23889/ijpds.v4i1.1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The growing burden of chronic diseases means some governments have been providing financial incentives for multidisciplinary care and self-management support delivered within primary care. Currently, population-based evaluations of the effectiveness of these policies are lacking. AIM To outline the methodological approach for our study that is designed to evaluate the effectiveness (including cost) of primary care policies for chronic diseases in Australia using stroke as a case study. METHODS Person-level linkages will be undertaken between registrants from the Australian Stroke Clinical Registry (AuSCR) and (i) Government-held Medicare Australia claims data, to identify receipt or not of chronic disease management and care coordination primary care items; (ii) state government-held hospital data, to define outcomes; and (iii) government-held pharmaceutical and aged care claims data, to define covariates. N=1500 randomly selected AuSCR registrants will be sent surveys to obtain patient experience information. In Australia, unique identifiers are unavailable. Therefore, personal-identifiers will be submitted to government data linkage units. Researchers will merge the de-identified datasets for analysis using a project identifier. An economic evaluation will also be undertaken. ANALYSIS The index event will be the first stroke recorded in the AuSCR. Multivariable competing risks Poisson regression for multiple events, adjusted by a propensity score, will be used to test for differences in the rates of hospital presentations and medication adherence for different care (policy) types. Our estimated sample size of 25,000 patients will provide 80% estimated power (ɑ>0.05) to detect a 6-8% difference in rates. The incremental costs per Quality-adjusted life years gained of community-based care following the acute event will be estimated from a health sector perspective. CONCLUSION Completion of this study will provide a novel and comprehensive evaluation of the effectiveness and cost-effectiveness of Australian primary care policies. Its success will enable us to highlight the value of data-linkage for this type of research.
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Affiliation(s)
- NE Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - J Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - DA Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - V Sundararajan
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - AG Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - L Churilov
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
| | - NA Lannin
- School of Allied Health, Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - M Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Victoria, Australia
| | - V Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - MF Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg Victoria, Australia
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Cadilhac DA, Grimley R, Kilkenny MF, Andrew NE, Lannin NA, Hill K, Grabsch B, Levi CR, Thrift AG, Faux SG, Wakefield J, Cadigan G, Donnan GA, Middleton S, Anderson CS. Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care. Stroke 2019; 50:1525-1530. [PMID: 31084337 PMCID: PMC6553516 DOI: 10.1161/strokeaha.118.023075] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods— A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results— There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%–24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%–20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%–17%). The national score (4 indicators) improved by 17% (95% CI, 13%–20%) versus 0% change in other Australian hospitals (95% CI, −0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals (P<0.001). Conclusions— The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.
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Affiliation(s)
- Dominique A Cadilhac
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Rohan Grimley
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia (R.G.).,Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Monique F Kilkenny
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Nadine E Andrew
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia (N.E.A.)
| | - Natasha A Lannin
- College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.).,Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia (N.A.L.)
| | - Kelvin Hill
- Clinical Services, Stroke Foundation, Melbourne, Victoria, Australia (K.H.)
| | - Brenda Grabsch
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | | | - Amanda G Thrift
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)
| | - Steven G Faux
- University of New South Wales, Sydney, Australia (C.R.L., S.G.F.).,Department of Rehabilitation Medicine, St. Vincent's Health Australia (Sydney), New South Wales (S.G.F.)
| | - John Wakefield
- Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Greg Cadigan
- Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Geoffrey A Donnan
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Sandy Middleton
- Nursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia (S.M.)
| | - Craig S Anderson
- George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.).,The George Institute China at Peking University Health Science Center, Beijing, PR China (C.S.A.)
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Schadewaldt V, McElduff B, D’Este C, McInnes E, Dale S, Gunaratne A, Squires J, Cadilhac DA, Middleton S. Validating the Alberta Context Tool in a multi-site Australian Emergency Department nurse population. PLoS One 2019; 14:e0215153. [PMID: 30964916 PMCID: PMC6456203 DOI: 10.1371/journal.pone.0215153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/27/2019] [Indexed: 11/26/2022] Open
Abstract
The organisational context of healthcare settings has an essential role in how research evidence is used in clinical practice. The Alberta Context Tool (ACT) measures 10 concepts of organisational context with higher scores indicating a more positive work environment and potentially better use of research evidence in patient care. We assessed the psychometric properties of the ACT in Emergency Departments (EDs). This validation study was conducted as part of a multi-centre trial of triage, treatment and transfer (T3 Trial) of patients with stroke admitted to EDs. Stratified sampling with proportional allocation was used to recruit ED nurses from 26 participating hospitals at baseline. Nurses completed a survey containing the ACT. Structural validity was investigated by exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients. Item-rest correlations and the average inter-item correlations were also assessed. 558 ED nurses completed the survey, comprised of 433 surveys without missing data. Our exploratory factor analysis produced a 14-factor structure, explaining 62% of variance of organisational context. For eight of ten concepts, item loadings matched the factor structure of the original ACT. Confirmatory factor analysis of the 10 ACT concepts showed moderate model fit (p = 0.001, root mean square error of approximation: 0.049, standardised root mean squared residual: 0.048). Cronbach’s alphas showed very good internal consistency for nine of ten ACT concepts (α>0.7; 0.45–0.90). Item-rest correlations indicated that most ACT items (50 of 56 items) within any concept related well to the total score of the concept. Average inter-item correlations indicated potential redundant items for three concepts (feedback processes, leadership, staffing) that were above the threshold of 0.5. While identifying a few shortcomings for some ACT concepts in an ED context, the majority of findings confirm reliability and validity of the original ACT in an Australian population of ED nurses.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Benjamin McElduff
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Anoja Gunaratne
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy Middleton
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
- * E-mail:
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9
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Grimley RS, Rosbergen ICM, Gustaffson L, Horton E, Green T, Cadigan G, Cadilhac DA, Kuys S. Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia. Clin Rehabil 2019; 33:1252-1263. [DOI: 10.1177/0269215519837585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rohan S Grimley
- Sunshine Coast Clinical School, The University of Queensland, Birtinya, QLD, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Ingrid CM Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Louise Gustaffson
- School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Eleanor Horton
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Theresa Green
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, VIC, Australia
| | - Suzanne Kuys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
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10
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Chapman C, Cadilhac DA, Morgan P, Kilkenny MF, Grimley R, Sundararajan V, Purvis T, Johnston T, Lannin NA, Andrew NE. Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry. Int J Stroke 2019; 15:390-398. [PMID: 30789321 DOI: 10.1177/1747493019833008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. METHODS Patient-level data from the Australian Stroke Clinical Registry (2010-13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. RESULTS Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). CONCLUSION Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
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Affiliation(s)
- Chantelle Chapman
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria Australia
| | - Prue Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria Australia
| | - Rohan Grimley
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Sunshine Coast Clinical School, University of Queensland, Birtinya, Queensland Australia
| | - Vijaya Sundararajan
- Department of Medicine, St. Vincent's Hospital, Melbourne University, Melbourne, Victoria Australia.,Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria Australia
| | - Tara Purvis
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia
| | - Trisha Johnston
- Health Statistics Branch, Queensland Department of Health, Brisbane, Queensland Australia
| | - Natasha A Lannin
- College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria Australia.,Occupational Therapy Department, Alfred Health, Prahran, Victoria Australia
| | - Nadine E Andrew
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria Australia
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11
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Andrew NE, Middleton S, Grimley R, Anderson CS, Donnan GA, Lannin NA, Stroil-Salama E, Grabsch B, Kilkenny MF, Squires JE, Cadilhac DA. Hospital organizational context and delivery of evidence-based stroke care: a cross-sectional study. Implement Sci 2019; 14:6. [PMID: 30658654 PMCID: PMC6339367 DOI: 10.1186/s13012-018-0849-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 12/07/2018] [Indexed: 01/19/2023] Open
Abstract
Background Organizational context is one factor influencing the translation of evidence into practice, but data pertaining to patients with acute stroke are limited. We aimed to determine the associations of organizational context in relation to four important evidence-based stroke care processes. Methods This was a mixed methods cross-sectional study. Among 19 hospitals in Queensland, Australia, a survey was conducted of the perceptions of stroke clinicians about their work using the Alberta Context Tool (ACT), a validated measure covering 10 concepts of organizational context, and with additional stroke-specific contextual questions. These data were linked to the Australian Stroke Clinical Registry (AuSCR) to determine the relationship with receipt of evidence-based acute stroke care (acute stroke unit admission, use of thrombolysis for those with acute ischemic stroke, receipt of a written care plan on discharge, and prescription of antihypertensive medications on discharge) using quantile regression. Exploratory cluster analysis was used to categorize hospitals into high and low context groups based on all of the 10 ACT concepts. Differences in adherence to care processes between the two groups were examined. Results A total of 215 clinicians completed the survey (50% nurses, 37% allied health staff, 10% medical practitioners), with 81% being in their current role for at least 1 year. There was good reliability (∞ 0.83) within the cohort to allow pooling of professional groups. Greater ACT scores, especially for social capital (μ 9.00, 95% confidence interval [CI] 4.86 to 13.14) and culture (μ 7.33, 95% CI 2.05 to 12.62), were associated with more patients receiving stroke unit care. There was no correlation between ACT concepts and other care processes. Working within higher compared to lower context environments was associated with greater proportions of patients receiving stroke unit care (88.5% vs. 69.0%) and being prescribed antihypertensive medication at discharge (62.5% vs. 52.0%). Staff from higher context hospitals were more likely to value medical and/or nursing leadership and stroke care protocols. Conclusions Overall organizational context, and in particular aspects of culture and social capital, are associated with the delivery of some components of evidence-based stroke care, offering insights into potential pathways for improving the implementation of proven therapies. Electronic supplementary material The online version of this article (10.1186/s13012-018-0849-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadine E Andrew
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Sunshine Coast Clinical School, The University of Queensland, Birtinya and Statewide Stroke Clinical Network, Queensland Health, Brisbane, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Natasha A Lannin
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Enna Stroil-Salama
- Australian Bronchiectasis Registry, Lung Foundation Australia, Brisbane, Australia
| | - Brenda Grabsch
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia. .,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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12
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Lynch EA, Mackintosh S, Luker JA, Hillier SL. Access to rehabilitation for patients with stroke in Australia. Med J Aust 2018; 210:21-26. [DOI: 10.5694/mja2.12034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 09/28/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Elizabeth A Lynch
- Adelaide Nursing SchoolUniversity of Adelaide Adelaide SA
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery Melbourne VIC
- Florey Institute of Neuroscience and Mental HealthUniversity of Melbourne Melbourne VIC
| | | | - Julie A Luker
- Florey Institute of Neuroscience and Mental HealthUniversity of Melbourne Melbourne VIC
- University of South Australia Adelaide SA
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13
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Thayabaranathan T, Andrew NE, Kilkenny MF, Stolwyk R, Thrift AG, Grimley R, Johnston T, Sundararajan V, Lannin NA, Cadilhac DA. Factors influencing self-reported anxiety or depression following stroke or TIA using linked registry and hospital data. Qual Life Res 2018; 27:3145-3155. [DOI: 10.1007/s11136-018-1960-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
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14
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Cadilhac DA, Fisher R, Bernhardt J. How to do health services research in stroke: A focus on performance measurement and quality improvement. Int J Stroke 2018; 13:166-174. [PMID: 29299958 DOI: 10.1177/1747493017750924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The objective of this "How to" research series article is to provide guidance on getting started in Health Services Research. The purpose of health services research is to contribute knowledge that can be used to help improve health systems and clinical services through influencing policy and practice. The methods used are broad, have varying levels of rigor, and may require different specialist skills. This paper sets out practical steps for undertaking health services research. Importantly, use of the highlighted techniques can identify solutions to address inadequate knowledge translation or promote greater access to evidence-based stroke care to optimize patient outcomes.
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Affiliation(s)
- Dominique A Cadilhac
- 1 Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,2 Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Rebecca Fisher
- 3 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Julie Bernhardt
- 2 Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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