School of Clinical Sciences - Te Kura Mātai Haumanu

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https://hdl.handle.net/10292/1241

The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Educati
(Ovid Technologies (Wolters Kluwer Health), 2023-12-12) Berg, KM; Bray, JE; Ng, KC; Liley, HG; Greif, R; Carlson, JN; Morley, PT; Drennan, IR; Smyth, M; Scholefield, BR; Weiner, GM; Cheng, A; Djärv, T; Abelairas-Gómez, C; Acworth, J; Andersen, LW; Atkins, DL; Berry, DC; Bhanji, F; Bierens, J; Couto, TB; Borra, V; Böttiger, BW; Bradley, RN; Breckwoldt, J; Cassan, P; Chang, WT; Charlton, NP; Chung, SP; Considine, J; Costa-Nobre, DT; Couper, K; Dainty, KN; Dassanayake, V; Davis, PG; Dawson, JA; de Almeida, MF; De Caen, AR; Deakin, CD; Dicker, B; Douma, MJ; Eastwood, K; El-Naggar, W; Fabres, JG; Fawke, J; Fijacko, N; Finn, JC; Flores, GE; Foglia, EE; Folke, F; Gilfoyle, E; Goolsby, CA; Granfeldt, A; Guerguerian, AM; Guinsburg, R; Hatanaka, T; Hirsch, KG; Holmberg, MJ; Hosono, S; Hsieh, MJ; Hsu, CH; Ikeyama, T; Isayama, T; Johnson, NJ; Kapadia, VS; Kawakami, MD; Kim, HS; Kleinman, ME; Kloeck, DA; Kudenchuk, P; Kule, A; Kurosawa, H; Lagina, AT; Lauridsen, KG; Lavonas, EJ; Lee, HC; Lin, Y; Lockey, AS; Macneil, F; Maconochie, IK; Madar, RJ; Hansen, CM; Masterson, S; Matsuyama, T; McKinlay, CJD; Meyran, D; Monnelly, V; Nadkarni, V; Nakwa, FL; Nation, KJ; Nehme, Z; Nemeth, M; Neumar, RW; Nicholson, T; Nikolaou, N; Nishiyama, C; Norii, T; Nuthall, GA; Ohshimo, S; Olasveengen, TM
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces
(Elsevier BV, 2023-11-09) Berg, KM; Bray, JE; Ng, KC; Liley, HG; Greif, R; Carlson, JN; Morley, PT; Drennan, IR; Smyth, M; Scholefield, BR; Weiner, GM; Cheng, A; Djärv, T; Abelairas-Gómez, C; Acworth, J; Andersen, LW; Atkins, DL; Berry, DC; Bhanji, F; Bierens, J; Bittencourt Couto, T; Borra, V; Böttiger, BW; Bradley, RN; Breckwoldt, J; Cassan, P; Chang, WT; Charlton, NP; Chung, SP; Considine, J; Costa-Nobre, DT; Couper, K; Dainty, KN; Dassanayake, V; Davis, PG; Dawson, JA; Fernanda de Almeida, M; De Caen, AR; Deakin, CD; Dicker, B; Douma, MJ; Eastwood, K; El-Naggar, W; Fabres, JG; Fawke, J; Fijacko, N; Finn, JC; Flores, GE; Foglia, EE; Folke, F; Gilfoyle, E; Goolsby, CA; Granfeldt, A; Guerguerian, AM; Guinsburg, R; Hatanaka, T; Hirsch, KG; Holmberg, MJ; Hosono, S; Hsieh, MJ; Hsu, CH; Ikeyama, T; Isayama, T; Johnson, NJ; Kapadia, VS; Daripa Kawakami, M; Kim, HS; Kleinman, ME; Kloeck, DA; Kudenchuk, P; Kule, A; Kurosawa, H; Lagina, AT; Lauridsen, KG; Lavonas, EJ; Lee, HC; Lin, Y; Lockey, AS; Macneil, F; Maconochie, IK; John Madar, R; Malta Hansen, C; Masterson, S; Matsuyama, T; McKinlay, CJD; Meyran, D; Monnelly, V; Nadkarni, V; Nakwa, FL; Nation, KJ; Nehme, Z; Nemeth, M; Neumar, RW; Nicholson, T; Nikolaou, N; Nishiyama, C; Norii, T; Nuthall, GA; Ohshimo, S; Olasveengen, TM
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
A Six-Month Telerehabilitation Programme Delivered via Readily Accessible Technology Is Acceptable to People Following Stroke: A Qualitative Study
(Elsevier BV, 2023-05-19) Saywell, Nicola L; Mudge, Suzie; Kayes, Nicola M; Stavric, Verna; Taylor, Denise
Objective To explore the experiences of participants during a six-month, post-stroke telerehabilitation programme. Design A qualitative descriptive study to investigate participant experiences of ACTIV (Augmented Community Telerehabilitation Intervention), a six-month tailored exercise programme delivered by physiotherapists primarily using readily accessible telecommunication technology. Semi-structured, in-depth interviews were used to collect data, which were analysed using thematic analysis. Setting Interviews conducted in participants’ homes or a community facility. Participants Participants were eligible if they had a stroke in the previous 18 months and had participated in ACTIV. Results Twenty-one participants were interviewed. Four key themes were constructed from the data: 1. ‘ACTIV was not what I call physio’ (it differed from participants’ expectations of physiotherapy, but they reported many positive aspects to the programme). 2. ‘There’s somebody there’ (ongoing support from the physiotherapists helped participants find strategies to continue improving). 3. ‘Making progress’ (in the face of barriers, small improvements were valued). 4. ‘What I really want’ (participant goals were frequently more general than therapy goals and involved progress towards getting back to ‘normal’). Conclusions Although ACTIV was not what participants expected from physiotherapy, the majority found contact from a physiotherapist reduced the feeling of being left to struggle alone. Most participants found a programme with minimal face-to-face contact augmented by phone calls and encouraging text messages to be helpful and acceptable.
A Systematic Review of Fear of Falling and Related Constructs After Hip Fracture: Prevalence, Measurement, Associations with Physical Function, and Interventions
(Springer Science and Business Media LLC, 2023-06-23) Gadhvi, Chandini; Bean, Debbie; Rice, David
Background Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF? Methods A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the ‘Risk of Bias Tool for Prevalence Studies’, ‘COSMIN Risk of Bias checklist for Patient-reported outcome measures’, modified version of the ‘Appraisal Tool for Cross-sectional studies’, and the ‘Cochrane Risk of Bias 2’ tools for each research question, respectively. Results 36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The ‘Falls Efficacy Scale – International’ (FES-I) and ‘Fear of Falling Questionnaire – Revised’ (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition. Conclusion FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice.
An Updated Systematic Review and Meta-Analysis of Randomised Controlled Trials on the Effects of Urate-Lowering Therapy Initiation During a Gout Flare
(Elsevier BV, 2024-01-07) Tai, Vicky; Gow, Peter; Stewart, Sarah; Satpanich, Panchalee; Li, Changgui; Abhishek, Abhishek; Dalbeth, Nicola
Background: There is uncertainty about the optimal time to start urate-lowering therapy (ULT) in the setting of a gout flare. The aim was to perform a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing the effects of ULT initiation during a gout flare. Methods: This systematic review was conducted in accordance with PRISMA methodology. MEDLINE, EMBASE and The Cochrane Library were searched for studies published between database inception to 1 March 2023. RCTs published in English that examined ULT initiation during a gout flare in adults ≥18 years were included. The quality of included studies was assessed using the revised Cochrane Risk of Bias tool 2.0. Data were extracted for the following outcomes: patient-rated pain score, duration of gout flare, recurrent gout flares, time to achieve target serum urate, adherence to ULT, patient satisfaction with treatment and adverse events. Meta-analyses were performed using Review Manager v5.4. This study is registered on PROSPERO, number CRD42023404680. Results: A total of 972 studies were identified and of these, six RCTs met the criteria for inclusion in the analysis. Three studies were assessed as having high risk of bias, one study as having some concerns, and two studies as having low risk of bias. In total, there were 445 pooled participants; 226 participants randomised to early initiation of ULT and 219 to placebo or delayed initiation of ULT. Allopurinol was used in three studies, febuxostat in two studies and probenecid in one study. Few participants (n = 62, 13.9 %) had tophaceous gout. Participants with renal impairment were excluded from most studies. There were no differences in patient-rated pain scores at baseline, days 3–4, days 7–8, day 10 or days 14–15 (p ≥ 0.42). Additionally, there was no significant difference in time to resolution of gout flare (standardised mean difference 0.77 days; 95 % CI -0.26 to 1.79; p = 0.14) or the risk of recurrent gout flare in the subsequent 28 to 30 days (RR 1.06; 95 % CI 0.59 to 1.92; p = 0.84). Adverse events were similar between groups. The included studies did not report time to achieve target serum urate, long-term adherence to ULT, or patient satisfaction with treatment. Conclusion: There appears to be no evidence for harm or for benefit to initiating ULT during a gout flare. These findings have limited applicability to patients with tophaceous gout, or those with renal impairment.
Aotearoa New Zealand Physiotherapists’ Perspectives of Potential Expanded Roles for Sports-Related Concussion Management: A Qualitative Study
(Physiotherapy New Zealand, 2024-07-26) Dalton, Mya; Galea, Olivia; Blyth, Rebecca; Reid, Duncan; Quinn, Dusty; Chua, Jason; Sole, Gisela
Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.
Burnout Among the Podiatry Profession: A Survey of Podiatrists in Aotearoa New Zealand
(BMC, 2024-06-10) Clarke, Mia; Frecklington, Mike; Stewart, Sarah
Introduction Burnout and occupational stress have not yet been explored within the Aotearoa New Zealand (AoNZ) podiatry workforce despite research suggesting an increased risk among this population. This study aimed to: (i) determine the prevalence and severity of burnout risk and occupational stress among AoNZ podiatrists; (ii) determine the factors associated with burnout risk and occupational stress among AoNZ podiatrists; and (iii) examine the relationship between burnout risk and occupational stress. Methods A cross-sectional online survey study was undertaken involving registered podiatrists practicing in AoNZ. Personal and professional demographic characteristics were captured. Participants also completed the Maslach Burnout Inventory (assessing three domains of emotional exhaustion, depersonalisation and personal accomplishment) and the Workplace Stress Scale as measures of burnout risk and occupational stress, respectively. Descriptive statistics, multiple regression analyses and correlation analyses were performed to address the research aims. Results Responses from 112 AoNZ podiatrists were included in the analyses. High levels of emotional exhaustion were identified in 43.8% of practitioners and were associated with physical activity status, sector of work, working in isolation and work hours (R2 = 0.304, F (8, N = 110) = 5.519, p < 0.001). High levels of depersonalisation were seen in 13.4% of practitioners and were associated with patient caseload and work hours, (R2 = 0.183, F (4, N = 108) = 5.770, p < 0.001). Low levels of personal accomplishment were observed in 8.9% of practitioners and associated with ethnicity, physical activity status and patient caseload, (R2 = 0.152, F (5, N = 106) = 3.577, p < 0.005). A total of 27.7% of practitioners exhibited an overall moderate to high risk of developing burnout. Over a fifth of practitioners exhibited stress at severe or dangerous levels. Stress levels were significantly associated with physical activity status, sector of work and management responsibility, (R2 = 0.282, F (5, N = 47) = 3.218, p = 0.15). A strong positive relationship was found between emotional exhaustion and stress (rho = 0.59, p < 0.001). Conclusions The findings reflect a moderate to severe risk of developing burnout within the workforce, with high workloads and collegial isolation constituting the primary modifiable factors driving burnout development. To maintain retention and well-being within the workforce, mitigation strategies must be implemented to address this issue.
Chinese and Indian Interpretations of Pain: A Qualitative Evidence Synthesis To Facilitate Chronic Pain Management
(Wiley, 2023-04-18) Lewis, Gwyn; Shaikh, Nusratnaaz; Wang, Grace; Chaudhary, Shikha; Bean, Debbie; Terry, gareth
Objective People from minority ethnicities often have a greater impact of chronic pain, are underrepresented at pain services, and may not benefit from treatment to the same extent as dominant cultures. The aim of this study was to review Indian and Chinese cultural views of pain and pain management, as a basis for improving management of chronic pain in migrant populations from these ethnicities. Methods A systematic review of qualitative studies addressing pain beliefs and experiences involving Indian and Chinese participants was conducted. Thematic synthesis was used to identify themes across the studies, and the quality of the articles was appraised. Results Twenty-six articles were included, most of which were appraised as high quality. Five themes were identified: Making meaning of pain described the holistic interpretation of the meaning of pain; Pain is disabling and distressing described the marked physical, psychological, and spiritual impact of pain; Pain should be endured described the cultural expectation to suppress responses to pain and not be a burden; Pain brings strength and spiritual growth described the enrichment and empowerment some people experienced through living with pain, and Management of pain goes beyond a traditional or Western approach described the factors that guided people in their use of healthcare. Discussion The review identified a holistic interpretation and impact of pain in Indian and Chinese populations, with pain management guided by multiple factors that transcended a single cultural framework. Several strength-based management strategies are recommended based on preferences for traditional treatments and respect for Western healthcare.
Critical Physiotherapy: A Ten-Year Retrospective
(Informa UK Limited, 2023-09-09) Nicholls, DA; Ahlsen, B; Bjorbækmo, W; Dahl-Michelsen, T; Höppner, H; Rajala, AI; Richter, R; Hansen, LS; Sudmann, T; Sviland, R; Maric, F
Critical physiotherapy has been a rapidly expanding field over the last decade and could now justifiably be called a professional sub-discipline. In this paper we define three different but somewhat interconnected critical positions that have emerged over the last decade that share a critique of physiotherapy’s historical approach to health and illness, while also diverging in the possibilities for new forms of practice and thinking. These three positions broadly align with three distinctive philosophies: approaches that emphasize lived experience, social theory, and a range of philosophies increasingly referred to as the “posts”. In this paper we discuss the origins of these approaches, exploring the ways they critique contemporary physiotherapy thinking and practice. We offer an overview of the key principles of each approach and, for each in turn, suggest readings from key authors. We conclude each section by discussing the limits of these various approaches, but also indicate ways in which they might inform future thinking and practice. We end the paper by arguing that the various approaches that now fall under the rubric of critical physiotherapy represent some of the most exciting and opportune ways we might (re)think the future for the physiotherapy profession and the physical therapies more generally.
Development of an Ultrasound Imaging Atlas (AUTUSI Atlas) for Grading Osteoarthritis in the First Metatarsophalangeal Joint
(Wiley, 2024-07-22) Molyneux, Prue; Bowen, Catherine; Ellis, Richard; Rome, Keith; Fitzgerald, Kate; Clark, Phillip; Whittaker, Jackie L; Dando, Charlotte; Gee, Richard; Carroll, Matthew
Objective Ultrasound (US) imaging may play a fundamental role in the earlier detection and assessment of first metatarsophalangeal joint (MTPJ) osteoarthritis (OA) due to its ability to depict tissue-specific morphological changes before the point of irreversible structural damage. However, the role of US in supporting the diagnosis of OA in foot joints has not been clearly defined. The aims of the study were to develop a semiquantitative US atlas (the AUTUSI atlas) to grade the degree of osteoarthritic change in the first MTPJ and to evaluate the intra-examiner and inter-examiner reproducibility of using the atlas. Design Ultrasound images were obtained from 57 participants (30 participants with radiographically confirmed first MTPJ OA). The AUTUSI atlas supports the examination of grading joint effusion, synovial hypertrophy, synovitis, osteophytes, joint space narrowing, and cartilage thickness. Six examiners used the atlas to independently grade 24 ultrasound images across two sessions. Intra-examiner and inter-examiner reproducibility were determined using percentage agreement and Gwet's AC2. Results Observations using the AUTUSI atlas demonstrated almost perfect-to-perfect inter-examiner agreement (percentage agreement ranged from 96% to 100%, and Gwet's AC2 values ranged from 0.81 to 1.00) and moderate-to-perfect intra-examiner agreement (percentage agreement ranged from 67% to 100%, and Gwet's AC2 values ranged from 0.54 to 1.00). Conclusion The AUTUSI atlas demonstrated excellent intra-examiner and inter-examiner reproducibility for evaluating first MTPJ joint effusion, synovial hypertrophy, synovitis, joint space narrowing, osteophytes, and cartilage thickness. The AUTUSI atlas affords an opportunity to detect prognostic markers of OA earlier in the disease cascade and has the potential to advance understanding of the pathological process of first MTPJ OA.
Did Lockdown Influence Bystanders’ Willingness To Perform Cardiopulmonary Resuscitation? A Worldwide Registry-Based Perspective
(Elsevier BV, 2023-03-17) Tjelmeland, Ingvild BM; Wnent, Jan; Masterson, Siobhan; Kramer-Johansen, Jo; Eng Hock Ong, Marcus; Smith, Karen; Skogvoll, Eirik; Lefering, Rolf; Lynn Lim, Shir; Liu, Nan; Dicker, Bridget; Swain, Andrew; Ball, Stephen; Gräsner, Jan-Thorsten; Lockdown, bystander CPR group
AIM: Bystander cardiopulmonary resuscitation (CPR) significantly increases the survival rate after out-of-hospital cardiac arrest. Using population-based registries, we investigated the impact of lockdown due to Covid-19 on the provision of bystander CPR, taking background changes over time into consideration. METHODS: Using a registry network, we invited all registries capable of delivering data from 1. January 2017 to 31. December 2020 to participate in this study. We used negative binominal regression for the analysis of the overall results. We also calculated the rates for bystander CPR. For every participating registry, we analysed the incidence per 100000 inhabitants of bystander CPR and EMS-treated patients using Poisson regression, including time trends. RESULTS: Twenty-six established OHCA registries reported 742 923 cardiac arrest patients over a four-year period covering 1.3 billion person-years. We found large variations in the reported incidence between and within continents. There was an increase in the incidence of bystander CPR of almost 5% per year. The lockdown in March/April 2020 did not impact this trend. The increase in the rate of bystander CPR was also seen when analysing data on a continental level. We found large variations in incidence of bystander CPR before and after lockdown when analysing data on a registry level. CONCLUSION: There was a steady increase in bystander CPR from 2017 to 2020, not associated with an increase in the number of ambulance-treated cardiac arrest patients. We did not find an association between lockdown and bystanders' willingness to start CPR before ambulance arrival, but we found inconsistent patterns of changes between registries.
Does Physiotherapy Research in South Korea Match International Best-practice Osteoarthritis Guidelines? A Narrative Review
(New Zealand Journal of Physiotherapy, 2024-03-28) La Park, ML; Magni, N; O’brien, DW
The aim of this study was to explore physiotherapy-based osteoarthritis (OA) research conducted in South Korea, focusing on the utilisation of non-surgical management and its alignment with international clinical practice guidelines (CPGs). Databases (MEDLINE, EMBASE, CINAHL and SPORTDiscus – accessed via EBSCOhost) and Google Scholar were searched to identify clinical articles and trials focused on research related to OA management in physiotherapy conducted in South Korea. A total of 11 studies met the inclusion criteria – nine were randomised controlled trials, one utilised a prospective design and one adopted a quasi-experimental approach. These studies employed various interventions such as kinesiology tape, electrotherapies, and exercise. None of the studies implemented education, self-management, and weight control as management. There is a discrepancy between research-based physiotherapy for OA management in South Korea and international CPGs. These findings may be explained by factors such as education, healthcare systems, and cultural differences.
Donor-Linking Provisions in New Zealand: Counselling Roles, Concerns and Needs.
(Informa UK Limited, 2024-04-25) Goedeke, Sonja; Gamble, Heather
Donor-linking where those genetically related through donor conception (e.g. donor-conceived persons (DCP), donors and siblings), or recipient parents, search for and connect with each other, is increasingly common, both in identity-release jurisdictions where donors' identifying information may be released to DCP, usually when they become adults - and in anonymous jurisdictions, e.g. as a result of direct-to-consumer DNA testing. In this paper, we explore New Zealand fertility clinic counsellors' views regarding their donor-linking roles and their concerns and needs in relation to current and anticipated service provision. Counsellors believed that fertility service providers had a longer-term responsibility to offer donor-linking services to ensure the wellbeing of all parties affected by donor conception. They perceived their role as complex and multifaceted, encompassing psychoeducation, mediation, advocacy, facilitation, relationship counselling, and therapeutic intervention. They identified significant service provision challenges however, including inadequate staffing, training, time and prioritisation of donor-linking, and inadequate legislative provisions to support practice. Counsellors called for clarity in legislation addressing different contexts of donation and providing measures to ensure the recording of and access to identifying information. They expressed a need for comprehensive, funded donor-linking services, therefore facilitating choice, and services staffed by professionally trained and supported staff.
Drivers and Barriers to the Development of Musculoskeletal Advanced Physiotherapy Practitioner Roles in New Zealand
(New Zealand Society of Physiotherapists Inc, 2023-07-12) Naik, Leena; Reid, Duncan; White, Steven; Neville, Stephen
Faced with the burden of musculoskeletal care in New Zealand, this study explores 19 participants’ views on the drivers and barriers to developing musculoskeletal advanced physiotherapy practitioner (APP) roles in New Zealand. An exploratory case study methodology was applied, and semi-structured interviews were conducted as one of the multiple data sources. A purposive sampling strategy was used. Data were analysed using qualitative content analysis. This publication primarily focuses on the results of the semi-structured interviews. The results of this research identify unique drivers for the APP role development in the New Zealand context, such as surgeon engagement, legislative requirements, and profession-led issues, in addition to global drivers. Interviewees identified that the barriers relate to New Zealand’s dual healthcare system and its nuances that impact patients and physiotherapists. Additional barriers include a lack of title and recognition, funding and career pathway, training, and inter-professional and intra-professional barriers. This research explores the reasons for the limited uptake of APP roles in the New Zealand context despite strong drivers. Interviewees advocate the development of APP roles as first-contact practitioners for patients presenting with musculoskeletal complaints to improve patient journey, streamline services, and provide timely, effective, and efficient care. They recommend that APP roles are tailored to meet New Zealand’s unique healthcare drivers.
Effects of an Exercise Program to Reduce Falls in Older People Living in Long-Term Care: A Randomized Controlled Trial
(Elsevier BV, 2023-11-29) Taylor, LM; Parsons, J; Moyes, SA; Binns, E; Cavadino, A; Taylor, D; Lord, S; Del Din, S; Klenk, J; Rochester, L; Kerse, N
Objectives: To investigate the effect of an exercise program on falls in intermediate and high-level long-term care (LTC) residents and to determine whether adherence, physical capacity, and cognition modified outcomes. Design: Randomized controlled trial. Setting and Participants: Residents (n = 520, aged 84 ± 8 years) from 25 LTC facilities in New Zealand. Methods: Individually randomized to Staying UpRight, a physical therapist–led, balance and strength group exercise program delivered for 1 hour, twice weekly over 12 months. The control arm was dose-matched and used seated activities with no resistance. Falls were collected using routinely collected incident reports. Results: Baseline fall rates were 4.1 and 3.3 falls per person-year (ppy) for intervention and control groups. Fall rates over the trial period were 4.1 and 4.3 falls ppy respectively [P = .89, incidence rate ratio (IRR) 0.98, 95% CI 0.76, 1.27]. Over the 12-month trial period, 74% fell, with 63% of intervention and 61% of the control group falling more than once. Risk of falls (P = .56, hazard ratio 1.08, 95% CI 0.85, 1.36) and repeat falling or fallers sustaining an injury at trial completion were similar between groups. Fall rates per 100 hours walked did not differ between groups (P = .42, IRR 1.15, 95% CI 0.81, 1.63). Program delivery was suspended several times because of COVID-19, reducing average attendance to 26 hours over 12 months. Subgroup analyses of falls outcomes for those with the highest attendance (≥50% of classes), better physical capacity (Short Physical Performance Battery scores ≥8/12), or cognition (Montreal Cognitive Assessment scores ≥ 18/30) showed no significant impact of the program. Conclusions/Implications: In intermediate and high-level care residents, the Staying UpRight program did not reduce fall rates or risk compared with a control activity, independent of age, sex, or care level. Inadequate exercise dose because of COVID-19–related interruptions to intervention delivery likely contributed to the null result.
Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study
(Springer, 2024-02-12) Taylor, Tamasin; Beban, Grant; Yi, Elaine; Veukiso, Michael; Sang-Yum, Genevieve; Dewes, Ofa; Wrapson, Wendy; Taufa, Nalei; Campbell, Andrew RT; Siegert, Richard; Shepherd, Peter
Purpose: Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. Materials and Methods: This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. Results: Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. Conclusion: This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery. Graphical Abstract: (Figure presented.)
Environmental Physiotherapy and the Case for Multispecies Justice in Planetary Health
(Taylor & Francis, ) Maric, F; Nicholls, DA
Background: Global environmental change is fundamentally altering the composition and functioning of our planetary ecosystem. Effectively presenting the largest threat to the health of present and future generations, these changes and their health impacts are forcing us to think and practice healthcare in much broader terms than ever before. Objective: In this article, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy developed through a succession of carefully developed arguments. Discussion: We show how an underpinning belief in human exceptionalism has engendered an exploitative relationship with our natural planetary environment that has both shaped Western science and healthcare and led to our current environmental health crisis. Building on the dependence of human health on our planetary ecosystem, approaches like planetary health hold great promise for a corresponding, paradigmatic turn in healthcare. They fall short of this however, where they perpetuate anthropocentric interests and interventionist practices that have underpinned healthcare to date. Drawing on ethical and post-human philosophies we argue against human exceptionalism and for a solidarity that includes other-than-humans as the primary characteristic of planetary existence. Conclusion: Building on this foundation, we provide an early outline for a radically otherwise, yet strangely familiar, environmental physiotherapy, grounded in ecological awareness, multispecies justice, and a range of consonant practices of passivity and accompaniment, conceived as an alternative to the commonplace interventionism of healthcare.
Ethnic Differences of the Care Pathway Following an Out-of-Hospital Cardiac Event: A Systematic Review
(Elsevier, 2023-10-27) Newport, Rochelle; Grey, Corina; Dicker, Bridget; Ameratunga, Shanthi; Harwood, Matire
AIM: This systematic review aimed to determine to what extent and why the care pathways for acute cardiac events in the community might differ for minoritised ethnic populations compared to non-minoritised populations. It also sought to identify the barriers and enablers that could influence variations in access to care for minoritised populations. METHODS: A multi-database search was conducted for articles published between 1 January 2000 and 1 January 2023. A combination of MeSH terms and keywords was used. Inclusion criteria for papers were published in English, adult population, the primary health condition was an acute cardiac event, and the primary outcomes were disaggregated by ethnicity or race. A narrative review of extracted data was performed, and findings were reported according to the PRISMA 2020 guidelines. RESULTS: Of the 3552 articles identified using the search strategy, 40 were deemed eligible for the review. Studies identified a range of variables in the care pathway that differed by ethnicity or race. These could be grouped as time to care, transportation, event related-variables, EMS interactions and symptoms. A meta-analysis was not performed due to heterogeneity across the studies. CONCLUSION: The extent and reasons for differences in cardiac care pathways are considerable. There are several remediable barriers and enablers that require attention to achieve equitable access to care for minoritised populations.
Exercise Therapy for Knee Osteoarthritis Pain: How Does It Work? A Study Protocol for a Randomised Controlled Trial
(BMJ, 2024-01-10) Beckwée, D; Nijs, J; Bierma-Zeinstra, SMA; Leemans, L; Leysen, L; Puts, S; Rice, D; Schiphof, D; Bautmans, I
INTRODUCTION: Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS: The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION: This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER: NCT04362618.
Experiences of Participating in a Group-Based Sensory Modulation Intervention for Mental Health Service Users
(Informa UK Limited, 2023-12-19) Forsberg, Klara; Sutton, Daniel; Stjernswärd, Sigrid; Bejerholm, Ulrika; Argentzell, Elisabeth
Background People with mental health issues often experience difficulties with sensory modulation affecting occupational engagement. Research conducted in inpatient units has shown positive effects of individual sensory modulation interventions, however, research on experiences of group-based interventions in outpatient units is limited. Hence, a group-based sensory modulation intervention was adapted and tested within Swedish mental health outpatient units. Aim To explore the experiences of participating in a group-based sensory modulation intervention for service users in mental health outpatient units. Material and methods This qualitative study involved interviews with 25 informants who had participated in the intervention. The interview data were analysed using reflexive thematic analysis. Results Synthesis of the interviews resulted in one overarching theme of ‘Embodied awareness facilitates improved coping and sense of self’ organised into four themes: (1) ‘Developing embodied awareness and strategies’, (2) ‘Taking control of everyday life’, (3) ‘Creating a stronger sense of self’, and (4) ‘From alienation to belonging’. Conclusion and significance The informants experienced the intervention to provide new embodied coping strategies that had previously been neglected. This understanding may enrich occupational therapy practice in new ways to support service users’ engagement in occupations.

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