Gail Kingston

A critical review of the evidence on the use of videotapes or DVD to promote patient compliance with home programmes

Purpose. The purpose of this paper is to critically review published research in order to evaluate the evidence surrounding the provision of video or DVD technology to promote patient compliance with home exercise or health programmes. Method. A literature search of the MEDLINE, CINAHL and Cochrane databases was undertaken. Critical appraisal of selected studies was undertaken using a previously validated tool. Inclusion criteria were: research related to DVD or videotape technology to improve compliance; published in peer-reviewed journals and full-text English language articles. Compliance was the main outcome measure. Results. Eleven eligible studies were reviewed. All but one, which used a before–after design, were randomised controlled trials. Study quality tended medium to high in the critical appraisal scoring system, but an overall low quality on the Jadad score for randomisation; with only one study from 11 scoring well on both these measures. Research into the use of video or DVD showed mainly positive effects on compliance; however, methodological issues limit clinical applicability. Conclusions. Future well-designed randomised controlled trials with adequate sample sizes and reliable outcome measures will provide clearer evidence into the effectiveness of this technology in improving home exercise or health programme compliance, particularly for rural and remote populations.

The functional impact of a traumatic hand injury on people who live in rural and remote locations

Purpose. This study aimed to gain an understanding of the functional impact of a traumatic hand injury on a rural and remote Australian population. Method. A retrospective, exploratory design was used. Patients who had experienced a traumatic hand injury were samples and were treated at the occupational therapy department at a major regional Australian hospital between January 2003 and February 2007 (n = 198). A mail-out survey was utilized, with 65 respondents included in the study. Questions focused on the impact on specific areas of occupational performance and on compliance to home exercises. The upper extremity functional index was also incorporated in the survey. Results. The results revealed that almost 90% of survey respondents had residual difficulties as a result of the traumatic hand injury. The overall impact these difficulties have on ‘day-to-day’ life was moderate to extreme for over half of the respondents. In the areas of occupational performance, the most affected were work and leisure with less impact reported in self-care and rest. Comments were at times contrary with closed question data, with many respondents expressing relative satisfaction with their outcome despite highlighting the functional difficulties. Conclusion. A significant impact on occupational performance has been highlighted, which reflects common issues within this rural and remote population. Confirmation of the extent of these identified issues within the larger rural and remote Australian population will contribute to the formulation of policy and consequent improvements in health for this traditionally underserved population.

Does a DVD improve compliance with home exercise programs for people who have sustained a traumatic hand injury? Results of a feasibility study

Abstract Purpose: This feasibility study sought to determine if compliance and understanding of a home exercise program following a traumatic hand injury is improved when patients are provided with a DVD and a brochure when compared to using brochures only. Method: Patients who presented with a traumatic hand injury and commenced on a hand therapy protocol were randomly assigned into two groups. The control group received brochures while the experimental group were provided with exercise instructions on DVD as well as brochures. Compliance was measured through the use of exercise diaries, clinic attendance, a checklist to measure correctness and understanding of exercises and a follow-up survey. Results: No significant improvement was found in the mean exercise compliance score (p = 0.344) between the intervention and control groups. From the survey results almost half of all participants reported that pain interfered in their ability to perform their home exercises and a third acknowledged that time limited their ability to perform their exercises. Conclusion: Findings demonstrate the multidimensional nature of compliance. The provision of DVD technology, while not shown to cause a statistically significant change in overall compliance, did help improve understanding of exercises; as such DVDs could be utilised as part of a program that facilitates the patient--therapist relationship. Implications for Rehabilitation Limited time and level of pain are highlighted as reasons for non compliance with exercise and treatment programs. The use of DVDs can improve understanding and execution of exercises and can be part of a treatment program that facilitates increased patient therapist contact for rural and remote clients.

The experience of medical and rehabilitation intervention for traumatic hand injuries in rural and remote North Queensland: a qualitative study

Abstract Introduction: This research explored the experience of receiving medical and rehabilitation intervention for rural and remote residents in North Queensland, Australia who had experienced a traumatic hand injury. This study contributes to larger project that seeks to propose a model of service delivery to rural and remote residents who have sustained a traumatic injury. Methods: Utilising an interpretive phenomenological research design, data was gathered through in-depth, semi-structured interviews. Fifteen participants were recruited into this study and questions were designed to explore the experience of receiving medical and rehabilitation intervention following a traumatic hand injury for residents in rural and remote areas of North Queensland. Results: The major themes that emerged were experience of medical intervention, experience of rehabilitation, travel, and technology. Participants felt that medical practitioners had a lack of local knowledge and were concerned that delays in medical intervention resulted in ongoing impairment. They reported following the exercise program they were given, often modifying it to fit with their daily routine. Metropolitan therapists appeared to have limited understanding of issues relevant to rural and remote lifestyles. There was, quite often, no occupational therapist or physiotherapist at their local facility due to staff turnover, and, when available, they had limited experience in hand injuries. The distance and cost of travel to appointments were of significant concern. The use of telehealth or telerehabilitation received a mixed response. Conclusion: Findings highlight the concerns regarding the provision of healthcare to rural and remote residents following a traumatic hand injury. These results provide the basis for recommendations surrounding the development of programs and service delivery models to address diverse needs in rural and remote areas. Implications for Rehabilitation Timely medical and rehabilitation interventions for rural and remote residents with a hand injury will reduce the impact of a traumatic hand injury on function and livelihood. Rural and remote therapists with limited skills in hand injuries should identify a mentor or specialist in hand injuries to ensure clinical practice concerns can be addressed. Developing an appreciation of rural issues is vital to ensure effective communication and collaboration with rural and remote residents. Alternate models of care such as telehealth, shared care and “hub and spoke” or outreach services should be adapted to the skills of the local therapists and the needs and preferences of the patient.

Hand therapy services for rural and remote residents: Results of a survey of Australian occupational therapists and physiotherapists

OBJECTIVE The aim of this study was to explore how interventions were provided to meet the needs of rural/remote residents who have had a traumatic hand injury, including the coordination of services between rural/remote and metro/regional therapists. Barriers to providing services, use of technology and professional support provided to therapists in rural/remote areas were also explored. DESIGN Cross-sectional survey. SETTING Metropolitan/regional and rural/remote public health facilities in Australia. PARTICIPANTS Occupational therapists and physiotherapists who provide hand therapy to rural/remote patients. MAIN OUTCOME MEASURE Quantitative and qualitative questionnaire responses analysed with descriptive statistics and inductive analysis. RESULTS There were 64 respondents out of a possible 185. Over half of rural/remote respondents provided initial splinting and exercise prescriptions, and over 85% reported that they continued with exercise protocols. Videoconferencing technology for patient intervention and clinical review was used by 39.1% respondents. Barriers to providing services in rural/remote locations included transport, travelling time, limited staff, and lack of expert knowledge in hand injuries or rural/remote health care. Four major themes emerged from the open-ended questions: working relationships, patient-centred care, staff development and education, and rural and remote practice. CONCLUSION The use of technology across Australia to support rural/remote patient intervention requires attention to achieve equity and ease of use. Flexible and realistic goals and interventions should be considered when working with rural/remote patients. A shared care approach between metropolitan/regional and rural/remote therapists can improve understanding of rural/remote issues and provide support to therapists. Further research is recommended to determine the suitability of this approach when providing hand therapy to rural/remote residents.Objective The aim of this study was to explore how interventions were provided to meet the needs of rural/remote residents who have had a traumatic hand injury, including the coordination of services between rural/remote and metro/regional therapists. Barriers to providing services, use of technology and professional support provided to therapists in rural/remote areas were also explored. Design Cross-sectional survey. Setting Metropolitan/regional and rural/remote public health facilities in Australia. Participants Occupational therapists and physiotherapists who provide hand therapy to rural/remote patients. Main outcome measure Quantitative and qualitative questionnaire responses analysed with descriptive statistics and inductive analysis. Results There were 64 respondents out of a possible 185. Over half of rural/remote respondents provided initial splinting and exercise prescriptions, and over 85% reported that they continued with exercise protocols. Videoconferencing technology for patient intervention and clinical review was used by 39.1% respondents. Barriers to providing services in rural/remote locations included transport, travelling time, limited staff, and lack of expert knowledge in hand injuries or rural/remote health care. Four major themes emerged from the open-ended questions: working relationships, patient-centred care, staff development and education, and rural and remote practice. Conclusion The use of technology across Australia to support rural/remote patient intervention requires attention to achieve equity and ease of use. Flexible and realistic goals and interventions should be considered when working with rural/remote patients. A shared care approach between metropolitan/regional and rural/remote therapists can improve understanding of rural/remote issues and provide support to therapists. Further research is recommended to determine the suitability of this approach when providing hand therapy to rural/remote residents.

How are allied health notes used for inpatient care and clinical decision-making? A qualitative exploration of the views of doctors, nurses and allied health professionals

Background: Inpatient care is dependent upon the effective transfer of clinical information across multiple professions. However, documented patient clinical information generated by different professions is not always successfully transferred between them. One obstacle to successful information transfer may be the reader’s perception of the information, which is framed in a particular professional context, rather than the information per se. Objective: The aim of this research was to investigate how different health professionals perceive allied health documentation and to investigate how clinicians of all experience levels across medicine, nursing and allied health perceive and use allied health notes to inform their decision-making and treatment of patients. Method: The study used a qualitative approach. A total of 53 speech pathologists, nurses, doctors, occupational therapists, dieticians and social workers (8 males; 43 females) from an Australian regional tertiary hospital participated in eleven single discipline focus groups, conducted over 4 months in 2012. Discussions were recorded and transcribed verbatim and coded into themes by content analysis. Findings: Six themes contributing to the efficacy of clinical information transference emerged from the data: day-to-day care, patient function, discharge and discharge planning, impact of busy workloads, format and structure of allied health documentation and a holistic approach to patient care. Discussion: Other professions read and used allied health notes albeit with differences in focus and need. Readers searched for specific pieces of information to answer their own questions and professional needs, in a process akin to purposive sampling. Staff used allied health notes to explore specific aspects of patient function but did not obtain a holistic picture. Conclusion: Improving both the relationship between the various health professions and interpretation of other professions’ documented clinical information may reduce the frequency of communication errors, thereby improving patient care.