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Brown RCC, Keating SE, Owen PJ, Jansons PS, McVicar J, Askew CD, Clanchy KM, Maddison R, Maiorana A, Robinson SM, Mundell NL. Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study. J Med Internet Res 2023; 25:e46370. [PMID: 38127430 PMCID: PMC10767626 DOI: 10.2196/46370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/21/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. OBJECTIVE This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). METHODS Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. RESULTS A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the "relational space" are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. CONCLUSIONS Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted.
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Affiliation(s)
- Riley C C Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Paul S Jansons
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jenna McVicar
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Christopher D Askew
- VasoActive Research Group, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Kelly M Clanchy
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Menzies Institute of Health, Griffith University, Gold Coast, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Andrew Maiorana
- Allied Health Department, Fiona Stanley Hospital, Perth, Australia
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Suzanne M Robinson
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, Australia
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Niamh L Mundell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Owen PJ, Keating SE, Askew CD, Clanchy KM, Jansons P, Maddison R, Maiorana A, McVicar J, Robinson S, Neason C, Clarkson MJ, Mundell NL. The Effectiveness of Exercise Physiology Services During the COVID-19 Pandemic: A Pragmatic Cohort Study. Sports Med Open 2023; 9:2. [PMID: 36617585 PMCID: PMC9826725 DOI: 10.1186/s40798-022-00539-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic. METHODS This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling. RESULTS Most (59%, n = 82) clients received in-person delivery only, whereas 8% (n = 11) received telehealth delivery only and 33% (n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed > 80% of exercise sessions. Exercise physiology improved mobility by 14% (β = 0.23, P = 0.003), capacity to complete usual activities by 18% (β = 0.29, P < 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% (β = 2.46, P < 0.001), current pain intensity by 16% (β = - 0.55, P = 0.038) and goal attainment scaling t-scores by 50% (β = 18.37, P < 0.001). Effectiveness did not differ between delivery modes (all: P > 0.087). CONCLUSIONS Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.
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Affiliation(s)
- Patrick J. Owen
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Shelley E. Keating
- grid.1003.20000 0000 9320 7537School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD Australia
| | - Christopher D. Askew
- grid.1034.60000 0001 1555 3415VasoActive Research Group, School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD Australia ,grid.510757.10000 0004 7420 1550Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Birtinya, QLD Australia
| | - Kelly M. Clanchy
- grid.1022.10000 0004 0437 5432School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD Australia ,grid.1022.10000 0004 0437 5432Menzies Health Institute, Griffith University, Gold Coast, QLD Australia
| | - Paul Jansons
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC Australia
| | - Ralph Maddison
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Andrew Maiorana
- grid.459958.c0000 0004 4680 1997Allied Health Department, Fiona Stanley Hospital, Perth, WA Australia ,grid.1032.00000 0004 0375 4078Curtin School of Allied Health, Curtin University, Perth, WA Australia
| | - Jenna McVicar
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
| | - Suzanne Robinson
- grid.1032.00000 0004 0375 4078Curtin School of Population Health, Curtin University, Perth, WA Australia ,grid.1021.20000 0001 0526 7079Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christopher Neason
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia ,Better Exercise Physiology, Healesville, VIC Australia
| | - Matthew J. Clarkson
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, VIC Australia
| | - Niamh L. Mundell
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC Australia
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Owen PJ, Keating SE, Askew CD, Clanchy KM, Jansons P, Maddison R, Maiorana A, McVicar J, Robinson S, Mundell NL. Impact of the COVID-19 Pandemic on Exercise Physiology Services in Australia: A Retrospective Audit. Sports Med - Open 2022; 8:94. [PMID: 35867168 PMCID: PMC9306237 DOI: 10.1186/s40798-022-00483-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
Introduction The COVID-19 pandemic has led to a shift in healthcare towards telehealth delivery, which presents challenges for exercise physiology services. We aimed to examine the impact of the COVID-19 pandemic on the reach, efficacy, adoption and implementation of telehealth delivery for exercise physiology services by comparing Australian practises before (prior to 25 January 2020) and during the COVID-19 pandemic (after 25 January 2020).
Methods This retrospective audit included 80 accredited exercise physiology clinicians. We examined relevant dimensions of the RE-AIM framework (reach, effectiveness, adoption and implementation) from the clinician perspective. Results During the COVID-19 pandemic, 91% (n = 73/80) of surveyed clinicians offered telehealth delivery service, compared to 25% (n = 20/80) prior. Mean (SD) telehealth delivery per week doubled from 5 (7) to 10 (8) hours. In-person delivery decreased from 23 (11) to 15 (11) hours per week. Typical reasons for not offering telehealth delivery were client physical/cognitive incapacity (n = 33/80, 41%) and safety (n = 24/80, 30%). Clinician-reported reasons for typical clients not adopting telehealth delivery were personal preference (n = 57/71, 80%), physical capacity (n = 35/71, 49%) and access to reliable delivery platforms (n = 27/71, 38%). Zoom (n = 54/71, 76%) and telephone (n = 53/71, 75%) were the most commonly used platforms. Of the reasons contributing to incomplete treatment, lack of confidence in delivery mode was sevenfold higher for telehealth compared to in-person delivery. No serious treatment-related adverse events were reported. Conclusions During the COVID-19 pandemic, telehealth delivery of exercise physiology services increased and in-person delivery decreased, which suggests the profession was adaptable and agile. However, further research determining comparative efficacy and cost-effectiveness is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00483-2.
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Clanchy KM, Baque E, Headrick J, Irvine-Brown L, Sulek R. Thinking beyond impairment: Recommendations from contemporary models of care for working with children and disability. Aust J Gen Pract 2022; 51:316-320. [PMID: 35491466 DOI: 10.31128/ajgp-03-21-5898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The National Disability Insurance Scheme emphasises the use of models that move beyond an impairment focus to a holistic and individualised approach to disability. Application of specific biopsychosocial models supports general practitioners (GPs) to advance best practice in disability care within these schemes by meeting the complex care needs of their clients. OBJECTIVE The aims of this article are to: 1) review current biopsychosocial models that underpin the health and functioning of children living with a disability in order to identify common elements of relevance to the paediatric sector, and 2) provide considerations for applying a biopsychosocial approach to paediatric care in practice. DISCUSSION A succinct summary of common concepts within biopsychosocial models used in the paediatric setting, and recommendations for how these models can be best applied in practice, are presented in this article. The GP plays a crucial part in initiating and supporting children and adolescents who have complex care needs. Understanding these key concepts is fundamental to this process.
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Affiliation(s)
- Kelly M Clanchy
- PhD, Lecturer, Exercise Science, School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Qld
| | - Emmah Baque
- PhD, Lecturer, Physiotherapy, School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Qld
| | - Jonathon Headrick
- PhD, Lecturer, Exercise and Sport, School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Qld
| | - Laura Irvine-Brown
- BOccThy, MIntl@ComnDev, Associate Lecturer, Occupational Therapy, Exercise Science, School of Health Sciences and Social Work, Griffith University, Qld
| | - Rhylee Sulek
- PhD, Postdoctoral Research Fellow, Exercise Science, School of Health Sciences and Social Work, Griffith University, Qld
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Buchan J, Clanchy KM. Changes in professional self-efficacy and competency knowledge following participation in a student-led exercise clinic. Educ Health (Abingdon) 2021; 34:128-129. [PMID: 35488665 DOI: 10.4103/efh.efh_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jena Buchan
- Department of Discipline of Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Kelly M Clanchy
- Department of Discipline of Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
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Karinharju KS, Boughey AM, Tweedy SM, Clanchy KM, Trost SG, Gomersall SR. Validity of the Apple Watch ® for monitoring push counts in people using manual wheelchairs. J Spinal Cord Med 2021; 44:212-220. [PMID: 30811310 PMCID: PMC7952070 DOI: 10.1080/10790268.2019.1576444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: A recent Apple Watch® activity-monitoring innovation permits manual wheelchair users to monitor daily push counts. This study evaluated the validity of the Apple Watch® push count estimate.Design: Criterion validity.Setting: Southern Finland and Southeast Queensland, Australia.Participants: Twenty-six manual wheelchair users from Finland and Australia were filmed completing a standardized battery of activities while wearing the Apple Watch® (dominant wrist).Outcome Measures: Wheelchair pushes as determined by the Apple Watch® were compared to directly observed pushes.Results: Agreement between Apple Watch® push counts and directly observed pushes was evaluated using Intraclass correlation coefficients (ICC), Pearson correlations and Bland-Altman analyses. Apple Watch® pushes and directly observed push counts were strongly correlated (ICC = 0.77, P < 0.01) (r = 0.84, P < 0.01). Bland Altman plots indicated that the Apple Watch® underestimated push counts (M = -103; 95% ULoA = 217; LLoA = -423 pushes). Mean absolute percentage error was 13.5% which is comparable to studies evaluating agreement between pedometer-based step counts and directly observed steps.Conclusion: Apple Watch® push-count estimates are acceptable for personal, self-monitoring purposes and for research entailing group-level analyses, but less acceptable where accurate push-count measures for an individual is required.
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Affiliation(s)
- Kati S. Karinharju
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- Satakunta University of Applied Sciences, Pori, Finland
| | - Alexandra M. Boughey
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Sean M. Tweedy
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kelly M. Clanchy
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia
| | - Stewart G. Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children’s Health, Research, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Sjaan R. Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
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Abstract
Background. Individuals with brain impairment (BI) are less active than the general population and have increased risk of chronic disease. Objective. This controlled trial evaluated the efficacy of a physical activity (PA) intervention for community-dwelling adults with BI. Methods. A total of 43 adults with BI (27 male, 16 female; age 38.1 ± 11.9 years; stage of change 1-3) who walked as their primary means of locomotion were allocated to an intervention (n = 23) or control (n = 20) condition. The intervention comprised 10 face-to-face home visits over 12 weeks, including a tailored combination of stage-matched behavior change activities, exercise prescription, community access facilitation, and relapse prevention strategies. The control group received 10 face-to-face visits over 12 weeks to promote sun safety, healthy sleep, and oral health. Primary outcomes were daily activity counts and minutes of moderate-to-vigorous-intensity PA (MVPA) measured with the ActiGraph GT1M at baseline (0 weeks), postintervention (12 weeks) and follow-up (24 weeks). Between-group differences were evaluated for statistical significance using repeated-measures ANOVA. Results. MVPA for the intervention group increased significantly from baseline to 12 weeks (20.8 ± 3.1 to 31.2 ± 3.1 min/d; P = .01), but differences between baseline and 24 weeks were nonsignificant (20.8 ± 3.1 to 25.3 ± 3.2 min/d; P = .28). MVPA changes for the control group were negligible and nonsignificant. Between-group differences for change in MVPA were significant at 12 weeks ( P = .03) but not at 24 weeks ( P = .49). Conclusion. The 12-week intervention effectively increased adoption of PA in a sample of community-dwelling adults with BI immediately after the intervention but not at follow-up. Future studies should explore strategies to foster maintenance of PA participation.
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Affiliation(s)
- Kelly M. Clanchy
- Griffith University, Southport, QLD, Australia
- The University of New England, Armidale, NSW, Australia
| | | | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology - Centre for Children’s Health Research South Brisbane QLD, Australia
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Abstract
AIM This systematic review compares the validity, reliability, and clinical use of habitual physical activity (HPA) performance measures in adolescents with cerebral palsy (CP). METHOD Measures of HPA across Gross Motor Function Classification System (GMFCS) levels I-V for adolescents (10-18 y) with CP were included if at least 60% of items reported HPA performance in the domains of intensity, frequency, duration, and mode. RESULTS Seven measures of HPA performance met the criteria: StepWatch, pedometers, Uptimer, heart rate flex method, accelerometers, and self-report measures including the Children's Activity Participation and Enjoyment (CAPE) scale and the Physical Activity Questionnaire for Adolescents. The CAPE scale had the strongest validity and reliability but was limited by its inability to measure activity intensity. No study was identified that evaluated the psychometric properties of physical activity measures in non-ambulant adolescents with CP (GMFCS levels IV and V). INTERPRETATION When deciding on an appropriate measure of HPA in adolescents with CP, clinicians need to consider their research question including the domains of HPA they are evaluating and the population they wish to assess. Accelerometers provide the most robust information about the patterns of HPA, with some evidence of validity but limited data on reliability. Further research is needed to compare the use of tri- and uniaxial accelerometers.
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Affiliation(s)
- Kelly M Clanchy
- School of Human Movement Studies, The University of Queensland, Australia.
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