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He F, Mnatzaganian G, Rutherford D, Njovu M, Blackberry I. Weekend / holiday effect on stroke mortality in regional Australia: A ten-year retrospective study. J Stroke Cerebrovasc Dis 2024; 33:107739. [PMID: 38703876 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107739] [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: 11/22/2023] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND There is a deficiency in the evidence from rural and regional centres in Australia on the weekend effect following presentation with acute stroke. OBJECTIVE To estimate the association between admission over a weekend/holiday and all-cause mortality 3-day, 7-day, 14-day, 1-month, 3-month, 6-month, and 12-month following acute stroke. METHODS The records of stroke patients admitted to a main regional hospital in Australia from 2010 to 2020 were linked with the National Death Index. Time to death following ischaemic, haemorrhagic, and total stroke at different time points was modelled using Weibull, Exponential, or Gompertz regression based on best model fit determined by Akaike's information criterion. RESULTS Of 1669 patients, 1273 (76.3%) were admitted on a weekday, and 396 (23.7%) on a weekend/ or holiday. After adjusting for age, sex, and Charlson Comorbidity Index, stroke type and country of birth, admissions over a weekend/holiday following total stroke were significantly associated with an increased risk of dying within three days from admission [hazard ratio (HR): 1.59, 95% confidence interval: 1.01-2.50]. In haemorrhagic stroke, increased risk of death was significantly higher at three days (HR: 2.19, 95% confidence interval: 1.17-4.08), 14 days (HR: 1.73, 95% confidence interval: 1.02-2.93), and 1 month (HR: 1.82, 95% confidence interval: 1.09-3.03) following admission on the weekend/ or holiday compared to those admitted during the weekdays. CONCLUSIONS This study reports a short-term adverse weekend/holiday effect following admission for haemorrhagic stroke or total stroke. No significant weekend/holiday effect was found in ischaemic stroke.
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Affiliation(s)
- Fan He
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
| | - David Rutherford
- Division of Medicine, Albury Wodonga Health, Albury, New South Wales, Australia
| | - Michael Njovu
- Rehabilitation Medicine Department, Albury Wodonga Health, Wodonga, Victoria, Australia; School of Clinical Medicine, University of New South Wales, Albury Campus, Albury, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Victoria, Australia; Care Economy Research Institute, La Trobe University, Albury-Wodonga, Victoria, Australia
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Jolliffe L, Williams CM, Bozyk N, Collyer TA, Caspers K, Snowdon DA. Consumer perspectives of allied health involvement in a public hospital setting: cross-sectional survey and electronic health record review. AUST HEALTH REV 2024; 48:191-200. [PMID: 38373740 DOI: 10.1071/ah23225] [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: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
Objective Consumer-centred care is fundamental to high-quality health care, with allied health professionals playing a pivotal role in hospital settings. Allied health typically operates within standard weekday working-hours. Consumer preferences for receiving allied health services are largely unexplored but could inform whether weekend and/or out-of-hours services are required. This study aims to understand consumer preferences for hospital-based inpatient and outpatient allied health services. Methods Using a cross-sectional survey and convenience sampling approach, consumers of a public health service in Melbourne, Australia were surveyed about preferences for allied health service delivery. Electronic health record reviews compared the accuracy of self-reported service delivery times. Descriptive statistics, concordance and predictive values were calculated. Responses to free-text survey items were analysed using content analysis. Results Of 120 participants (79% response rate), most (69%) received allied health services, however, almost half of inpatient responders (44%) were unsure of the specific allied health professional involved. Audit results found moderate-high concordance overall (range, 77-96%) between self-reported and audit-identified allied health services by profession. Most inpatient responders had no strong day of week preference, equally selecting weekdays and weekend days, with most preferring services between 8 am and 4 pm. Outpatient responders (81%) preferred a weekday appointment between 8 am and 12 pm or before 8 am (29%) to complete scheduled activities early in the day. Conclusion While provision of allied health services during standard working-hours was preferred by most consumers, some inpatient and outpatient consumers are receptive to receiving weekend and out-of-hours services, respectively. Decisions about offering these services should consider operational capacity and research evidence.
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Affiliation(s)
- Laura Jolliffe
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and School of Primary and Allied Health Care, Department of Occupational Therapy, Monash University, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | - Cylie M Williams
- School of Primary and Allied Health Care, Department of Podiatry, Monash University, Melbourne, Vic., Australia
| | - Natalie Bozyk
- Allied Health, Peninsula Health, Melbourne, Vic., Australia
| | - Taya A Collyer
- National Centre for Healthy Ageing, Melbourne, Vic., Australia
| | | | - David A Snowdon
- Allied Health, Peninsula Health, Melbourne, Vic., Australia; and National Centre for Healthy Ageing, Melbourne, Vic., Australia
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3
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Gray R, Lacey K, Whitehouse C, Dance R, Smith T. What factors affect early mobilisation following hip fracture surgery: a scoping review. BMJ Open Qual 2024; 12:e002281. [PMID: 38253357 PMCID: PMC10806593 DOI: 10.1136/bmjoq-2023-002281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES Identify and evaluate factors affecting early mobilisation on the day following hip fracture surgery. DESIGN Mixed methods, scoping review. DATA SOURCES MEDLINE, AMED, CINAHL, APA PsycINFO, APA PsycArticles, ISRCTN, Clinical Trials registry and grey literature accessed in November 2022 with publication dates between 2001 and November 2022. ELIGIBILITY CRITERIA English language publications that:1. Include patient populations who sustain a fragility hip fracture managed surgically2. Include patient populations who are mobilised out of bed on the day following their hip fracture surgery3. Report factors which influence the ability to undergo early mobility postsurgery DATA EXTRACTION AND SYNTHESIS: One reviewer screened all titles and abstracts for inclusion. Two reviewers performed data extraction and quality assessments using the relevant Critical Appraisal Skills Programme tools and the Mixed Methods Appraisal Tool. RESULTS 3337 papers were identified, of which 23 studies were eligible for review, representing 210 811 patients. The heterogeneity in the types of study included, the definition of early mobilisation and the outcome measures used precluded meta-analysis. 13 factors were identified as having an effect on whether people were mobilised on day 1 post-hip fracture surgery, grouped into 5 principal themes: (1) healthcare setting or worker-related factors, (2) patient psychological factors, (3) acute patient health factors, (4) non-acute patient health factors and (5) surgical factors. CONCLUSIONS There was a paucity of robust research investigating day 1 mobilisation post-hip fracture surgery.Each of the five factors identified is potentially modifiable through service improvement change and innovation strategies. There is an opportunity to explore how service provision change could be implemented to improve outcomes for all patients following hip fracture surgery demonstrating the clinical and cost benefits of these changes against the cost of delivering the change.
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Affiliation(s)
- Rene Gray
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | - Kate Lacey
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | - Claire Whitehouse
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | - Rachel Dance
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | - Toby Smith
- University of Warwick, Coventry, West Midlands, UK
- University of East Anglia, Norwich, UK
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Horvey K, Nairn Pederson L, Bath B, St Pierre D. "The right thing for our patients": perspectives of physical therapists transitioning to a 7 day a week service in an urban acute care center in Canada. Physiother Theory Pract 2023; 39:2377-2390. [PMID: 35587372 DOI: 10.1080/09593985.2022.2078254] [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: 10/11/2021] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND True seven day a week acute care physical therapy (PT) coverage is rare. Our facility is one of a few in Canada that has increased weekend PT coverage on medicine units to seven days of full PT staffing levels. OBJECTIVE This article investigates the perspectives of physical therapists involved in the change with the focus on the emotional experiences of those therapists. METHODS Thematic analysis of interview and focus group transcripts with 18 physical therapist and 2 manager participants were aligned with four themes of: 1) optimism, hope and excitement; 2) frustration, guilt, and resentment; 3) fear, anxiety, uncertainty, and vulnerability; and 4) ambivalence, neutrality, and impartiality. RESULTS Although there were several perceived benefits to quality of care and work/life balance, participants' comments also reflected: frustration, guilt, and resentment related to the rapid implementation of the change and the impact of altered work schedules. CONCLUSIONS Participants emphasized the need to discuss large changes with staff prior to implementation in order to prevent frustration and resentment. Participants also felt that increased acute care PT coverage over seven days is valuable, but other allied health professions also need a proportional increase in staffing to improve hospital flow.
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Affiliation(s)
- Karla Horvey
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Lacey Nairn Pederson
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Sciece, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denise St Pierre
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
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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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Davies L, Lanyon L, O'Halloran R. The role of speech-language pathology weekend service in inpatient subacute care: A national survey. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:437-445. [PMID: 34547973 DOI: 10.1080/17549507.2021.1970226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Limited evidence is available on speech-language pathology (SLP) weekend services within the subacute inpatient setting. This study aimed to describe Australian SLP weekend services for stroke adult inpatients in subacute units and to explore clinicians' perspectives on factors that influence the delivery of the service. METHOD Speech-language pathologists who worked in Australian subacute hospital-based units participated in an online cross-sectional survey. Descriptive statistics and content analysis were undertaken to analyse quantitative and qualitative data. RESULT From the total of 83 participating clinicians, 20 (24%) worked in rehabilitation units that provided an SLP weekend service. Assessments and reviews were the main clinical activities provided to stroke inpatients by this service. Workforce and evidence were commonly cited as facilitators and barriers to both the implementation of a new service and the continuation of an existing service. The "ideal" SLP weekend subacute service to stroke inpatients was typically described as a combination of assessment, therapy, education and training. CONCLUSION Findings from this study's sample indicate that an SLP weekend inpatient rehabilitation service to stroke inpatients was not standard practice. Different perspectives regarding the purpose and need of an SLP weekend service were reported.
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Affiliation(s)
- Lidia Davies
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Speech Pathology Department, Barwon Health, Geelong, Australia
| | - Lucette Lanyon
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Centre of Research Excellence for Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- Centre of Research Excellence for Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Australia
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7
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Khurana B, Prakash J, Loder RT. Assault related injury visits in US emergency departments: An analysis by weekday, month and weekday-by-month. Chronobiol Int 2022; 39:1068-1077. [PMID: 35535524 DOI: 10.1080/07420528.2022.2065285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study investigated the temporal variation (month and day) in assault-related injuries presenting to the US Emergency Departments (ED). An IRB exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System Database from 2005 to 2017 for six categories of assault-related injuries-altercation, sexual assault, robbery, intimate partner violence (IPV), other specified assaults and unknown assault types. National estimates of injuries and associated variables were obtained using SUDAAN software, followed by cosinor analyses for the variation of month and weekday of injury. Three-dimensional topographic representations for weekday-by-month analyses were also created. Over this 13-year time span, there were more than 21 million injury visits due to assault, accounting for 6.57% of all ED visits. While there was no change in the incidence of total number of assaults over the study period, there was a significant increase in the annual percentage incidence of IPV (1.17%; p = .0094) and robbery (2.56%; p = .0001). Cosinor analyses demonstrated a mid-summer peak for all assault types except for robberies (late summer). All assault types showed a weekend peak (late Saturday or early Sunday). Topographical contours exhibited a peak in July and August on early Sunday for all assaults, however the month varied by the type of assault, with weekend peaks in the spring and winter for IPV. This information can be used in prospective resource planning for management and prevention strategies.
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Affiliation(s)
- Bharti Khurana
- Department of Radiology and Medicine, Radiology, Harvard Medical School, Trauma Imaging Research and Innovation Center, Boston, Massachusetts, USA
| | - Jaya Prakash
- Harvard Medical School, Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Randall T Loder
- Orthopedic Surgery, Indiana University School of Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana, USA
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8
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Dür M, Wenzel C, Simon P, Tucek G. Patients' and professionals' perspectives on the consideration of patients' convenient therapy periods as part of personalised rehabilitation: a focus group study with patients and therapists from inpatient neurological rehabilitation. BMC Health Serv Res 2022; 22:372. [PMID: 35313879 PMCID: PMC8939130 DOI: 10.1186/s12913-022-07755-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Research on the optimal period for administering health services, especially rehabilitation interventions, is scarce. The aims of this study were to explore the construct of patients' convenient therapy periods and to identify indicators based on the perspectives of patients and different health professionals from inpatient neurological rehabilitation clinics. METHODS This study was part of a larger project on patients' convenient therapy periods following a mixed methods approach. In the current study a grounded theory approach was employed based on the use of focus group interviews. Focus group interviews were conducted in three different inpatient neurological rehabilitation clinics. Patients and therapists from inpatient neurological rehabilitation clinics who were able to speak and to participate in conversations were included. RESULTS A total of 41 persons, including 23 patients and 18 therapists, such as music and occupational therapists, participated in a total of six focus group interviews. The analysis of the focus group interviews resulted in the identification of a total of 1261 codes, which could be summarised in fifteen categories. However, these categories could be divided into five indicators and ten impact factors of convenient therapy periods. Identified indicators were verbal and non-verbal communication, mental functions, physiological needs, recreational needs, and therapy initiation. CONCLUSIONS The results provide initial evidence that convenient therapy periods are clinically relevant for patients and therapists. Different states of patients' ability to effectively participate in a rehabilitation intervention exist. A systematic consideration of patients' convenient therapy periods could contribute to a personalised and more efficient delivery of intervention in neurological rehabilitation. To our knowledge, this study is one of the first attempts to research convenient therapy periods.
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Affiliation(s)
- Mona Dür
- Department of Health Sciences, IMC University of Applied Sciences, Applied Health Sciences Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria. .,IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria. .,Duervation, Spitalgasse 6/1, 3500, Krems, Austria.
| | - Claudia Wenzel
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
| | - Patrick Simon
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
| | - Gerhard Tucek
- IMC University of Applied Sciences, Josef Ressel Centre for Horizons of personalised music therapy, University of Applied Sciences Krems, Piaristengasse 1, 3500, Krems, Austria.,Department of Health Sciences, IMC University of Applied Sciences, Music Therapy Bachelor and Master Degree Programme, Piaristengasse 1, 3500, Krems, Austria
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9
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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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10
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Jepson M, Sarkies M, Haines T. Variation in inpatient allied health service provision in Australian and New Zealand hospitals. Australas J Ageing 2021; 41:70-80. [PMID: 34346159 DOI: 10.1111/ajag.12988] [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: 11/10/2020] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the variability of allied health services on weekends, relative to weekdays, throughout Australian and New Zealand hospitals. METHODS A prospective, cross-sectional observational study embedded within a cluster randomised control trial. Allied health managers provided administrative data relating to allied health service events. RESULTS In one month, there were a total of 243 549 allied health service events recorded from 91 sampled hospitals. The mean difference between weekday and weekend allied health service events (daily, per ward) for physiotherapy was 6.52 (95% CI 5.65 to 7.40), acute wards 12.03 (95% CI 10.25 to 13.82) and for metropolitan hospitals 14.47 (95% CI 12.22 to 16.73), revealing more allied health service events of longer duration on weekdays compared to weekends. CONCLUSIONS This research is the first of its kind to describe variation in allied health service provision and potential research to practice gaps across weekday and weekend days in various inpatient settings.
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Affiliation(s)
- Megan Jepson
- Department of Paramedicine, Monash University Peninsula Campus, Melbourne, Vic., Australia.,School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia
| | - Mitchell Sarkies
- School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia.,Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Melbourne, NSW, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Vic., Australia
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11
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Improving before-noon discharges in the acute medical ward. PROCEEDINGS OF SINGAPORE HEALTHCARE 2021. [DOI: 10.1177/20101058211011189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Mismatch in admission and discharge rates with poor coordination of bed availability to prepare for peak admission time do not favor patient flow in any healthcare situation. In order to meet the admissions demand from the emergency department, early discharge is advocated. Aim: The purpose of this study was to increase the 11:30 discharge rate in the acute medical ward to 20% within 5 months in order to facilitate patient transfers from the emergency department. Method and intervention: A nurse-led multidisciplinary team discussion at 10:00 was formed empowering nurses and aims to prioritize early discharges or transfer patients who require a longer stay in the hospital. The indication of expected discharge date was determined by team doctors on either day 1 or 2 of admission, to facilitate and prioritize allied health intervention or even prescription processing. Physical transfer to the discharge lounge was to occur earlier, awaiting preparation of prescription and documentation. Dedicated nursing staff who manage the discharge lounge processes, were to ensure the transfers and care arrangements to be smooth and coordinated with enhanced communication to next of kin. Results: The overall median rate for discharges before 11:30 in the acute medical ward was at 17%, compared to baseline median discharge rate of 12% ( p=0.05) and evening discharges that remained. With the implementation of a framework for multidisciplinary team discussion, the mean time spent on multidisciplinary team reduced to 40 min from the pre-intervention stage, ranging approximately 57–68 min. Conclusion: The discharge process is complex and requires multidisciplinary team collaboration and coordination. This project also created an opportunity for more relevant project targeting evening discharges that addresses another emergency department peak admission time.
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12
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Translating evidence into practice: a longitudinal qualitative exploration of allied health decision-making. Health Res Policy Syst 2021; 19:38. [PMID: 33736670 PMCID: PMC7977245 DOI: 10.1186/s12961-020-00662-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background Health policy and management decisions rarely reflect research evidence. As part of a broader randomized controlled study exploring implementation science strategies we examined how allied health managers respond to two distinct recommendations and the evidence that supports them. Methods A qualitative study nested in a larger randomized controlled trial. Allied health managers across Australia and New Zealand who were responsible for weekend allied health resource allocation decisions towards the provision of inpatient service to acute general medical and surgical wards, and subacute rehabilitation wards were eligible for inclusion. Consenting participants were randomized to (1) control group or (2) implementation group 1, which received an evidence-based policy recommendation document guiding weekend allied health resource allocation decisions, or (3) implementation group 2, which received the same policy recommendation document guiding weekend allied health resource allocation decisions with support from a knowledge broker. As part of the trial, serial focus groups were conducted with a sample of over 80 allied health managers recruited to implementation group 2 only. A total 17 health services participated in serial focus groups according to their allocated randomization wave, over a 12-month study period. The primary outcome was participant perceptions and data were analysed using an inductive thematic approach with constant comparison. Thematic saturation was achieved. Results Five key themes emerged: (1) Local data is more influential than external evidence; (2) How good is the evidence and does it apply to us? (3) It is difficult to change things; (4) Historically that is how we have done things; and (5) What if we get complaints? Conclusions This study explored implementation of strategies to bridge gaps in evidence-informed decision-making. Results provide insight into barriers, which prevent the implementation of evidence-based practice from fully and successfully occurring, such as attitudes towards evidence, limited skills in critical appraisal, and lack of authority to promote change. In addition, strategies are needed to manage the risk of confirmation biases in decision-making processes. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618000029291). Universal Trial Number (UTN): U1111-1205-2621.
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13
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Marinova M, Bell LM, Watkin S, Bell D. A prospective audit of bed utilisation and delays in care across London. J R Coll Physicians Edinb 2021; 50:365-371. [PMID: 33469610 DOI: 10.4997/jrcpe.2020.404] [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] Open
Abstract
BACKGROUND A prospective bed utilisation census of acute London hospitals using an established Day of Care Survey (DoCS), which quantified adult patients not meeting criteria for in-hospital care. METHODS Twenty-three hospitals were surveyed over two weeks in October/November 2017 using supervised trained hospital staff. Pairs of staff visited wards, reviewed all patients and identified those not meeting inpatient care criteria, recording reasons for delay. Patient demographics, length of stay (LOS), ward specialty and delay reasons were collected. RESULTS Overall - In total, 8,656 in-patients were studied (overall occupancy 96%, range 82-117%): 800 definite discharges were excluded, leaving 7,856 patients for analysis; seven hospitals had °100% occupancy; 1,919/7,856 patients (24%, range 12-43%) did not meet criteria; 56% of patients were over 70 years; five hospitals had higher number of patients <70yo 56% patients had LOS 0˛7days. Delayed patients - Number of delayed patients increased with age, but three hospitals had more patients <70yo; 53% had LOS˛14 days and 47% LOS<14 days; 13 hospitals had greater/equal number of patients in ˛14 days LOS. For delayed patients in ˛14 days group, most were within seven days of admission (627 ˛7days, 393 8-14 days). In total 34% (range 11-54%) of delays were related to acute hospital reasons (AHR) and 61% (range 46-83%) to wider system reasons (WSR). Eight common themes accounted for 67% of recorded reasons and were equally split between AHR and WSR. CONCLUSION Data showed high occupancy levels with insufficient discharges. This study suggests policies selecting age and/or LOS alone as cut offs to tackle delays in care may miss a large proportion of patients requiring more timely interventions. Adopting a proactive thematic approach to improvement using the top eight delay reasons provides an obvious opportunity to reduce delays while noting the inter site variation. All metrics analysed emphasized the need for informed local data to help support local change.
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Affiliation(s)
- Milka Marinova
- Clinical Research Fellow at NIHR CLAHRC North West London, Imperial College, London, UK,
| | | | - Simon Watkin
- Department of Respiratory Medicine, Borders General Hospital, Melrose, UK
| | - Derek Bell
- NIHR CLAHRC North West London, Imperial College, London, UK
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14
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Kilkenny MF, Lannin NA, Levi C, Faux SG, Dewey HM, Grimley R, Hill K, Grabsch B, Kim J, Hand P, Crosby V, Gardner M, Rois-Gnecco J, Thijs V, Anderson CS, Donnan G, Middleton S, Cadilhac DA. Weekend hospital discharge is associated with suboptimal care and outcomes: An observational Australian Stroke Clinical Registry study. Int J Stroke 2018; 14:430-438. [PMID: 30346259 DOI: 10.1177/1747493018806165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The quality of stroke care may diminish on weekends. AIMS We aimed to compare the quality of care and outcomes for patients with stroke/transient ischemic attack discharged on weekdays compared with those discharged on weekends. METHODS Data from the Australian Stroke Clinical Registry from January 2010 to December 2015 (n = 45 hospitals) were analyzed. Differences in processes of care by the timing of discharge are described. Multilevel regression and survival analyses (up to 180 days postevent) were undertaken. RESULTS Among 30,649 registrants, 2621 (8.6%) were discharged on weekends (55% male; median age 74 years). Compared to those discharged on weekdays, patients discharged on weekends were more often patients with a transient ischemic attack (weekend 35% vs. 19%; p < 0.001) but were less often treated in a stroke unit (69% vs. 81%; p < 0.001), prescribed antihypertensive medication at discharge (65% vs. 71%; p < 0.001) or received a care plan if discharged to the community (47% vs. 53%; p < 0.001). After accounting for patient characteristics and clustering by hospital, patients discharged on weekends had a 1 day shorter length of stay (coefficient = -1.31, 95% confidence interval [CI] = -1.52, -1.10), were less often discharged to inpatient rehabilitation (aOR = 0.39, 95% CI = 0.34, 0.44) and had a greater hazard of death within 180 days (hazard ratio = 1.22, 95% CI = 1.04, 1.42) than those discharged on weekdays. CONCLUSIONS Patients with stroke/transient ischemic attack discharged on weekends were more likely to receive suboptimal care and have higher long-term mortality. High quality of stroke care should be consistent irrespective of the timing of hospital discharge.
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Affiliation(s)
- Monique F Kilkenny
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | | | - Chris Levi
- 4 University of Newcastle, Newcastle, Australia
| | - Steven G Faux
- 5 St Vincent's Healthcare (Sydney), Sydney, Australia
| | - Helen M Dewey
- 2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,6 Eastern Health Clinical School, Box Hill, Monash University, Australia
| | - Rohan Grimley
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,7 Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia
| | | | - Brenda Grabsch
- 2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Joosup Kim
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Peter Hand
- 9 Royal Melbourne Hospital, Parkville, Australia
| | | | - Michele Gardner
- 11 Wide Bay Hospital and Health Service, Bundaberg, Australia
| | | | - Vincent Thijs
- 2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,13 Austin Health, Heidelberg, Australia
| | - Craig S Anderson
- 14 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Geoffrey Donnan
- 2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Sandy Middleton
- 5 St Vincent's Healthcare (Sydney), Sydney, Australia.,15 Australian Catholic University, Sydney, Australia
| | - Dominique A Cadilhac
- 1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,2 Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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15
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Haas R, O'Brien L, Bowles KA, Haines T. Health professionals' perceptions of the allied health role in the acute setting following hip and knee joint replacement surgery: a qualitative study. Disabil Rehabil 2018; 42:93-101. [PMID: 30183431 DOI: 10.1080/09638288.2018.1493542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: To describe health professionals' perceptions of the role of allied health during the acute phase following elective lower limb joint replacement surgery to inform the development of efficient allied health service models.Methods: This was a qualitative descriptive study conducted using semi-structured focus groups and thematic analysis. Participants were 25 medical, nursing, and allied health professionals working on two orthopaedic wards in a tertiary hospital in Victoria, Australia. Focus groups elicited staff perceptions regarding the aims and roles of acute allied health intervention following hip and knee replacement, how these services are currently provided, and how these services can best be provided. This study was undertaken alongside two stepped wedge cluster randomised controlled trials during which existing weekend allied health services were to be temporarily removed with opportunity to contribute to a stakeholder-driven model of these services.Results: The main theme that emerged was a sense of unrealised potential amongst health professionals in terms of patient outcomes following hip and knee joint replacement surgery arising from tension between perceptions of actual versus ideal allied health practice. Assessing function and planning for discharge accordingly was perceived to be a higher priority than intervening to improve functional independence.Conclusion: Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in patients following lower limb replacement surgery than current practice in this setting that prioritises discharge.Implications for RehabilitationAllied health service delivery in the acute phase following hip and knee joint replacement needs to balance the needs of the health service with those of the patients.Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in this population than current practice, which is to prioritise discharge.There may be more scope for nurses to be involved in promoting early postoperative mobilisation following joint replacement surgery, especially in uncomplicated cases.
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Affiliation(s)
- Romi Haas
- Physiotherapy Department, Monash University and Monash Health Allied Health Research Unit, Melbourne, Australia
| | - Lisa O'Brien
- Occupational Therapy Department, Monash University and Monash Health Allied Health Research Unit, Melbourne, Australia
| | - Kelly-Ann Bowles
- Department of Community Emergency Health and Paramedics, Monash University and Monash Health Allied Health Research Unit, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University and Monash Health Allied Health Research Unit, Melbourne, Australia
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16
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Haas R, O’Brien L, Bowles KA, Haines T. Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study. Clin Rehabil 2018; 32:1493-1508. [DOI: 10.1177/0269215518779647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Romi Haas
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Terry Haines
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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