Susie Thomas

Virtual Reality for Stroke Rehabilitation

Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. These approaches may be advantageous because they provide the opportunity to practice activities that are not or cannot be practiced within the clinical environment. Furthermore, virtual reality programs are often designed to be more interesting and enjoyable than traditional therapy tasks, thereby encouraging higher numbers of repetitions. The use of specialized virtual reality programs designed for rehabilitation is not yet commonplace in clinical settings. However, gaming consoles are ubiquitous. The primary objective of this review was to evaluate the effects of virtual reality and interactive video gaming compared with an alternative intervention or no intervention on upper limb, lower limb, and global motor function after stroke. Secondary outcomes included activity limitation and adverse events. We also explored feasibility of the approach by examining recruitment rates. ### Search Strategy We searched the Cochrane Stroke Trials Register (March 2010), the …

Targeted individual exercise programmes for older medical patients are feasible, and may change hospital and patient outcomes: a service improvement project

BackgroundThe aim of this project was primarily to assess the feasibility of individual exercise programs for older hospitalised patients at risk of functional decline, and secondarily to evaluate impact on discharge outcomes.MethodsDesign: Cohort service improvement projectSetting: 500 bed acute metropolitan hospitalSubjects: Patients aged 70 and older admitted to Flinders Medical Centre under the general medical, aged care and respiratory units from June to November 2006, at intermediate or high risk of functional decline, and able to commence exercise within 48 hours of admissionIntervention: Functional Maintenance Program (FMP); an individually tailored exercise program to maintain functional mobility, prescribed and progressed by a physiotherapist, and supervised by an Allied Health Assistant (AHA), provided in addition to usual physiotherapy careOutcome measures: Feasibility (number of admissions suitable, commencing and complying with FMP). Impact (length of hospital stay (LOS), Aged Care Assessment Team (ACAT) referrals and approvals, hospital readmissions within 28 days, and functional mobility (Elderly Mobility Scale))Data Analysis: Descriptive and logistic regression analysisResultsOf 1021 admissions of patients aged 70 or older to general medical, aged care and respiratory units, 22% (n = 220) were identified within 48 hours as suitable for FMP: 196 (89%) commenced FMP within 48 hours of admission (FMP patients); 24 (11%) received usual physiotherapy (usual care patients). Feasibility of individually tailored exercise programs for older medical patients was supported by high uptake (89%), low withdrawal (17%) shown by those who commenced FMP, and good compliance with exercise sessions (70%). Logistic regression analysis showed a statistically significant decreased likelihood of referral for nursing home admission (OR = 0.228, 95% CI 0.088–0.587) and decreased likelihood of approval for admission to residential care (OR = 0.307, 95% CI 0.115–0.822) in favour of FMP. Although trends of an average 15.7% LOS reduction, 8% fewer readmissions and improved functional mobility were demonstrated in favour of FMP patients, these results were not statistically significant.ConclusionIt is feasible to identify older medical patients likely to benefit from an exercise program to maintain functional abilities, and to commence within 48 hours of admission.

Sociodemographic factors associated with self-reported exercise and physical activity behaviors and attitudes of South Australians: results of a population-based survey.

Objective: To determine self-reported physical activity barriers, behaviors, and beliefs about exercise of a representative sample and to identify associated sociodemographic factors. Method: Face-to-face interviews conducted between September and December 2008, using a random stratified sampling technique. Results: Barriers injury and illness were associated with being older, single, and not engaged in full-time work; lack of time was associated with being married, younger, female, and working full-time; and lack of motivation and cost were associated with being younger than 65 years. Advancing age was significantly associated (p < .001) with reduced physical activity. Factors including age, education, marital status, and area of residence were all associated with preferences for environment to exercise in, while all age groups (74%) felt that walking was the most important type of exercise for older adults. Discussion Barriers to physical activity participation are multifaceted with different sociodemographic factors associated with different barriers. A better understanding of these factors may improve uptake of and adherence to exercise programs across the ages.

Determining Current Physical Therapist Management of Hip Fracture in an Acute Care Hospital and Physical Therapists' Rationale for This Management

Background Physical therapy has an important role in hip fracture rehabilitation to address issues of mobility and function, yet current best practice guidelines fail to make recommendations for specific physical therapy interventions beyond the first 24 hours postsurgery. Objectives The aims of this study were: (1) to gain an understanding of current physical therapist practice in an Australian acute care setting and (2) to determine what physical therapists consider to be best practice physical therapist management and their rationale for their assessment and treatment techniques. Design and Methods Three focus group interviews were conducted with physical therapists and physical therapist students, as well as a retrospective case note audit of 51 patients who had undergone surgery for hip fracture. Results Beyond early mobilization and a thorough day 1 postoperative assessment, great variability in what was considered to be best practice management was displayed. Senior physical therapists considered previous clinical experience to be more important than available research evidence, and junior physical therapists modeled their behavior on that of senior physical therapists. The amount of therapy provided to patients during their acute inpatient stay varied considerably, and none of the patients audited were seen on every day of their admission. Conclusions Current physical therapist management in the acute setting for patients following hip fracture varies and is driven by system pressures as opposed to evidence-based practice.

Use of the Theoretical Domains Framework to Develop an Intervention to Improve Physical Therapist Management of the Risk of Falls After Discharge

Background and Purpose Older adults have an increased risk of falls after discharge from the hospital. Guidelines to manage this risk of falls are well documented but are not commonly implemented. The aim of this case report is to describe the novel approach of using the Theoretical Domains Framework (TDF) to develop an intervention to change the clinical behavior of physical therapists. Case Description This project had 4 phases: identifying the evidence-practice gap, identifying barriers and enablers that needed to be addressed, identifying behavior change techniques to overcome the barriers, and determining outcome measures for evaluating behavior change. Outcomes The evidence-practice gap was represented by the outcome that few patients who had undergone surgery for hip fracture were recognized as having a risk of falls or had a documented referral to a community agency for follow-up regarding the prevention of falls. Project aims aligned with best practice guidelines were established; 12 of the 14 TDF domains were considered to be relevant to behaviors in the project, and 6 behavior change strategies were implemented. Primary outcome measures included the proportion of patients who had documentation of the risk of falls and were referred for a comprehensive assessment of the risk of falls after discharge from the hospital. Discussion A systematic approach involving the TDF was useful for designing a multifaceted intervention to improve physical therapist management of the risk of falls after discharge of patients from an acute care setting in South Australia, Australia. This framework enabled the identification of targeted intervention strategies that were likely to influence health care professional behavior. Early case note audit results indicated that positive changes were being made to reduce the evidence-practice gap.

COST-EFFECTIVENESS OF INDIVIDUALIZED NUTRITION AND EXERCISE THERAPY FOR REHABILITATION FOLLOWING HIP FRACTURE

OBJECTIVE To undertake a cost-utility analysis of the Individual Nutrition Therapy and Exercise Regime: A Controlled Trial of Injured, Vulnerable Elderly (INTERACTIVE) trial. DESIGN Cost-utility analysis of a randomized controlled trial. SUBJECTS A total of 175 patients following a hip fracture were allocated to receive either alternate weekly visits from a physical therapist and dietitian (intervention group), or social visits for 6 months (control group). METHODS Costs for utilization of hospitals, health and community services were compared with quality-adjusted life years gained, calculated from responses to the Assessment of Quality of Life instrument. RESULTS There were minimal differences in mean costs between the intervention (

Virtual reality for stroke rehabilitation

AUD 45,331 standard deviation (SD):

Cochrane review: virtual reality for stroke rehabilitation.

AUD 23,012) and the control group (

Virtual reality for stroke rehabilitation: an abridged version of a Cochrane review.

AUD 44,764 SD:

Walking aid use after discharge following hip fracture is rarely reviewed and often inappropriate: an observational study.

AUD 20,712, p = 0.868), but a slightly higher mean gain in quality-adjusted life years in the intervention group (0.155, SD: 0.132) compared with the control group (0.139, SD: 0.149, p = 0.470). The incremental cost-effectiveness ratio was