Alyse Lennox

Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury.

Study design:Exploratory qualitative.Objectives:The aim of this study was to describe the experiences of bowel and bladder dysfunction on social activities and relationships in people with spinal cord injury living in the community.Setting:People living with spinal cord injury experiencing bowel and bladder dysfunction.Methods:Participants were recruited through the Australian Quadriplegic Association Victoria. Semi-structured in-depth interviews were undertaken with purposively selected participants to ensure representation of age, gender, spinal cord injury level and compensation status. A thematic analysis was performed to interpret patient experiences.Results:Twenty-two participants took part in the study. Bladder and bowel dysfunction altered relationships because of issues with intimacy, strained partner relationships and role changes for family and friends. A lack of understanding from friends about bladder and bowel dysfunction caused frustration, as this impairment was often responsible for variable attendance at social activities. Issues with the number, location, access and cleanliness of bathrooms in public areas and in private residences negatively affected social engagement. Social activities were moderated by illness, such as urinary tract infections, rigid and unreliable bowel routines, stress and anxiety about incontinence and managing the public environment, and due to continuous changes in plans related to bowel and bladder issues. Social support and adaptation fostered participation in social activities.Conclusion:Tension exists between managing bowel and bladder dysfunction and the desire to participate in social activities. Multiple intersecting factors negatively affected the social relationships and activities of people with spinal cord injury and bowel and bladder dysfunction.

Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis

The psychological impacts of injury have significant long-term implications on injury recovery. This review examined the effectiveness of interventions delivered within three months of injury on reducing the severity of posttraumatic stress disorder (PTSD), anxiety and depression symptoms. A systematic search of seven databases (PsycINFO, Medline, Web of Science, CINAHL, Embase, Scopus and Cochrane Library) identified 15,224 records. 212 full-text articles were retrieved, 26 studies were included in narrative synthesis, and 12 studies with lower risk of bias were included in meta-analyses. Prolonged exposure, and cognitive and behavioural interventions elicited improvements in PTSD, anxiety and depression symptoms; multidisciplinary interventions improved PTSD and depression symptoms; and education-based interventions had little impact on any psychological symptoms. Studies comprising risk stratified or stepped care methods showed markedly greater population impact through better reach, implementation and adoption. Meta-analyses revealed small-medium reductions in PTSD symptoms over the first 12 months postinjury (SMD = 0.32 to 0.49) with clinically meaningful effects in 64% of studies; reduced depression symptoms at 0-3 (small effect; SMD = 0.34) and 6-12 months postinjury (medium effect; SMD = 0.60), with clinically meaningful effects in 40% of studies; but no pooled effects on anxiety symptoms at any time. Altogether, exposure- and CBT-based psychological interventions had the greatest impact on PTSD and depression symptoms postinjury when delivered within three months of injury, with risk-stratified, stepped care having the greatest population impact potential.

HOspitals and patients WoRking in Unity (HOW R U?): Protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge

Introduction Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be delivered by hospital-based volunteers. Methods and analysis A multicentre prospective uncontrolled feasibility study will enrol 50 community-dwelling patients aged ≥70 years with symptoms of loneliness or depression who are discharged home within 72 hours from the ED or acute medical ward. Participants will receive weekly supportive telephone calls over a 3-month period from a volunteer-peer. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in level of loneliness (UCLA-3 item Loneliness Scale), mood (Geriatric Depression Scale-5 item) and health-related quality of life (EQ-5D-5L and EQ-VAS) will also be measured postintervention (3 months). Ethics and dissemination Research ethics and governance committee approval has been granted for this study by each participating centre (reference: 432/15 and 12-09-11-15). Study findings will inform the design and conduct of a future multicentre randomised controlled trial of a postdischarge volunteer-peer telephone support programme to improve social isolation, loneliness or depressive symptoms in older patients. Results will be disseminated through peer-reviewed journal publication, and conference and seminar presentation. Trial registration number ACTRN12615000715572, Pre-results.

Experiences with Navigating and Managing Information in the Community Following Spinal Cord Injury

Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.

Caring for older patients in the emergency department: Health professionals’ perspectives from Australia - The Safe Elderly Emergency Discharge project: CARING FOR OLDER PATIENTS IN THE ED

To explore health professionals’ perspectives about caring for community‐dwelling older patients in the ED.

Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs

Abstract Purpose: The purpose of this study is to explore the needs of people living with spinal cord injury, receiving formal carer and hospital services. Materials and methods: This exploratory qualitative study was undertaken with people living with spinal cord injury in metropolitan or regional Victoria. Participants were recruited through the Australian Quadriplegic Association. Twenty-two in-depth interviews were conducted between September and October 2015. Participants were purposely selected based on their age, gender, level of injury, and compensation status. A thematic analysis was undertaken using a framework approach. Results and conclusions: With respect to hospitalization, the findings highlighted the need for improved access to spinal cord injury specialist care and greater personalization of care delivery for people with spinal cord injury. When receiving formal care services, participants reported the need for carers to be educated in preventing and managing secondary conditions, and for information about managing carers in their life and home. A more reliable and accessible supply of carers was also required to reduce the anxiety associated with an actual or potential absence of their assistance. To improve the independence and quality of care and life for people living with spinal cord injury, more responsive and individualized care is needed in the hospital, rehabilitation, and community settings. Implications for rehabilitation Understanding the individualized needs of people living with spinal cord injury and their families with respect to carer management is necessary to provide tailored rehabilitation education and ensure appropriate community supports are in place. The development of individualized plans by rehabilitation health professionals for obtaining spinal cord injury specialist care post-discharge could reduce anxiety and improve safety and quality of care. Integrating peer support into rehabilitation processes could offer benefits in managing carer issues. Greater family involvement in the rehabilitation process and follow-up psychological support could assist with adjustment and quality of life post-discharge.

HOspitals and patients WoRking in Unity (HOW R U?): Telephone peer support to improve older patients' quality of life after emergency department discharge in Melbourne, Australia - A multicentre prospective feasibility study

Objectives To ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED). Design A multicentre prospective mixed-methods feasibility study. Setting Two tertiary hospital EDs in metropolitan Melbourne, Australia. Participants A convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression. Intervention The HOW R U? intervention comprised weekly social support telephone calls delivered by volunteer peers for 3 months following ED discharge. Primary and secondary outcome measures The primary outcomes were feasibility of study processes, intervention acceptability to participants and retention in the programme. Secondary outcomes were changes in loneliness level (UCLA-3—3-item Loneliness Scale), mood (5-item Geriatric Depression Scale) and health-related quality of life (EQ-5D-5L and EQ-VAS) postintervention. Results Recruitment was feasible, with 30% of eligible patients successfully recruited. Seventeen volunteer peers provided telephone support to patient participants, in addition to their usual hospital volunteer role. HOW R U? was well received, with 87% retention in the patient group, and no attrition in the volunteer group. The median age of patients was 84 years, 64% were female, and 82% lived alone. Sixty-eight per cent of patients experienced reductions in depressive symptoms, and 53% experiencing reduced feelings of loneliness, and these differences were statistically significant Patient feedback was positive and volunteers reported great satisfaction with their new role. Conclusion HOW R U? was feasible in terms of recruitment and retention and was acceptable to both patients and volunteers. The overall results support the potential for further research in this area and provide data to support the design of a definitive trial to confirm the observed effects. Trial registration number ANZCTRN12615000715572; Results.