Trentham Furness

Influence of whole body vibration platform frequency on neuromuscular performance of community-dwelling older adults.

Furness, TP and Maschette, WE. Influence of whole body vibration platform frequency on neuromuscular performance of community-dwelling older adults. J Strength Cond Res 23(5): 1508-1513, 2009-The purpose of this study was to progressively overload vibration platform frequency to describe sea-saw whole body vibration influence on neuromuscular performance of community-dwelling older adults. Seventy-three community-dwelling older adults (aged 72 ± 8 years) were randomly assigned to 4 groups (zero, one, 2, and 3 whole body vibration sessions per week). Quantifiers of neuromuscular performance such as the 5-Chair Stands test, the Timed Up and Go (TUG) test, and the Tinetti test were recorded. Furthermore, Health-related quality of life was qualified with the SF-36 Health Survey. A 6-week whole body vibration intervention significantly improved the quantifiers of neuromuscular performance in a community-dwelling older adult sample. Whole body vibration was shown to significantly reduce time taken to complete the 5-Chair Stands test (p < 0.05) and the TUG test (p < 0.05). Tinetti test scores significantly improved (p < 0.05). as did all components of health-related quality of life (p < 0.05). Overall, progressively overloaded frequency elicited more beneficial improvement for the 3 whole body vibration sessions per week group. It was concluded that progressively overloaded frequency was effective in improving quantifiable measures of neuromuscular performance in the sample and that practitioners may confidently prescribe 3 whole body vibration sessions per week with more precise knowledge of the effects of whole body vibration on neuromuscular performance and health-related quality-of-life effects.

Efficacy of a Whole-Body Vibration Intervention on Functional Performance of Community-Dwelling Older Adults

OBJECTIVE The objective of this study was to investigate efficacy of a whole-body vibration (WBV) intervention on functional performance of community-dwelling older adults. DESIGN The study was designed as a randomized controlled trial. SETTING The setting was in community centers. SUBJECTS There were 37 total subjects (21 women and 16 men) (age 69 +/- 8 years; mean +/- standard deviation). INTERVENTION Participants were randomized to a WBV intervention (INT) group and control (CON) group. Whole-body vibration was administered for five 1-minute bouts per session, 3 days per week, for 6 weeks. The CON group was asked not to commence any form of physical training. OUTCOME MEASURES Functional performance was measured with the timed-up-and-go-test (TUG) and sit-to-stand-test (STS). RESULTS After WBV, TUG and STS time was less for INT than CON (INT, TUG 7.6 +/- 0.3 seconds, STS 11.9 +/- 2.0 seconds; CON, TUG 8.6 +/- 0.9, STS 13.5 +/- 1.1 seconds; p < 0.05). Within INT, TUG improved 0.9 +/- 0.4 seconds; p = 0.01 and STS improved 3.0 +/- 0.9 seconds; p = 0.05). CONCLUSIONS The efficacy of this WBV intervention was established. Functional performance improvement after WBV may be attributed to a number of biological mechanisms that remain speculative. Further research is required to mechanistically understand the effects of WBV on older adults.

Recovery-Oriented Care in Acute Inpatient Mental Health Settings: An Exploratory Study

Australian mental health nurses will need to care with consumers of mental health services, within the domains of recovery. However, in acute inpatient mental health settings, nurses are without a clear description of how to be recovery-oriented. The intent of this qualitative study was to ask nurses to reflect on and describe current practice within acute inpatient services that are not overtly recovery-oriented. Results show that nurses can identify recovery and articulate with pragmatic clarity how to care within a recovery-oriented paradigm. Pragmatic modes of care described by nurses support using “champions” to assist with eventual system transformation in the delivery of mental health services.

The effectiveness of specialist roles in mental health metabolic monitoring a retrospective cross-sectional comparison study

BackgroundPeople with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases.MethodsA retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 - August 2013).ResultsA total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options.ConclusionsThe results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.

Benefits of whole-body vibration to people with COPD: a community-based efficacy trial

BackgroundBenefits of community-based whole-body vibration (WBV) as a mode of exercise training for people with chronic obstructive pulmonary disease (COPD) have not been investigated. The low skill demand of WBV may enhance habitual sustainability to physical activity by people with COPD, provided efficacy of WBV can be established. The purpose of this trial was to compare a community-based WBV intervention with a sham WBV (SWBV) intervention and monitor exacerbations, exercise tolerance, and functional performance of the lower limbs of people with COPD.MethodsCommunity-dwelling adults with a GOLD clinical diagnosis of COPD were recruited to the trial. This was a Phase II efficacy trial with crossover to sham intervention interspersed with two-week washout. Each six-week intervention consisted of two sessions per week of either WBV or SWBV. The interventions were completed in the home of each participant under supervision. The outcome measures were selected psychological (perceived dyspnoea) and physiological (heart rate and oxygen saturation) responses to exercise, simulated activities of daily living (timed-up-and got test and 5-chair stands test), and selected kinematic variables of gait across the 14-week trial.ResultsSixteen adults with stable COPD were recruited to the trial. No exacerbations were reported during the WBV or SWBV interventions. After WBV, performance of activities of daily living (ADLs) and gait improved (p ≤ 0.05), while there was no change after SWBV (p > 0.05). Despite five withdrawals during the washout period, a 100% compliance to each six-week intervention was noted.ConclusionsResults showed that WBV did not exacerbate symptoms of COPD that can be associated with physical inactivity. The WBV intervention improved tests to simulate ADLs such as rising from a chair, turning, and walking gait with greater effect than a SWBV intervention. If a placebo effect was systemic to the WBV intervention, the effect was negligible. As a standalone community-based intervention, WBV was an efficacious mode of exercise training for people with stable COPD that did not negatively effect exercise tolerance or exacerbate the disease, while concurrently improving functional performance of the lower limbs.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000508875.

Efficacy of a whole-body vibration intervention to effect exercise tolerance and functional performance of the lower limbs of people with chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a respiratory condition characterised by dyspnoea, excessive sputum production, chronic cough, bronchitis and emphysema. Functionally, exercise tolerance is poor for people with COPD and is linked to difficulty in performing daily tasks. More specifically, exercise difficulties are due partly to dyspnoea and lower limb skeletal muscle dysfunction. The benefit of exercise that does not exacerbate the disease while improving exercise tolerance is salient. Whole-body vibration (WBV) is a mode of physical activity known to improve muscular function of the lower limbs, yet efficacy has not been investigated for a WBV intervention conducted in a home-based setting for people with COPD.Methods/designThis clinically registered trial is a non-randomised placebo cross-over intervention based in the home of each participant (ACTRN12612000508875). Participants diagnosed with COPD will complete a six-week WBV intervention and then after a two-week washout period, will complete a six-week placebo training intervention. Participants will complete sessions twice a week. The duration of the trial is 14 weeks. Community-dwelling older adults with COPD will provide informed voluntary consent to participate. Outcome measures will include immediate, acute, and long-term responses to exercise.DiscussionQuantifying responses to WBV among people with COPD will allow discussion of efficacy of WBV as a mode of physical activity. The skill required by the participant to perform physical activity with WBV is not demanding and may enhance habitual sustainability. The results of this trial could be used to support further research in both clinical and community settings.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR12612000508875)

Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: a pilot study.

BackgroundPracticing with trauma informed care (TIC) can strengthen nurses’ knowledge about the association of past trauma and the impact of trauma on the patient’s current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed.MethodsThis project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study.ResultsA total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p < 0.01, r ≥ 0.35) in 9 of the 18-items after TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education.ConclusionEmergency department nurses became more informed of the interplay of trauma on an individual’s mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of patients with potentially multiple and complex presentations. Despite this, nurses understood the effect of TIC to reduce the likelihood of re-traumatisation and expressed a desire to use a TIC framework.

Whole-body vibration as a mode of dyspnoea free physical activity: a community-based proof-of-concept trial

BackgroundThe potential of whole-body vibration (WBV) as a mode of dyspnoea free physical activity for people with chronic obstructive pulmonary disease (COPD) is unknown among community-based settings. Furthermore, the acute effects of WBV on people with COPD have not been profiled in community-based settings. The aim of this community-based proof-of-concept trial was to describe acute effects of WBV by profiling subjective and objective responses to physical activity.FindingsSeventeen community-dwelling older adults with COPD were recruited to participate in two sessions; WBV and sham WBV (SWBV). Each session consisted of five one-minute bouts interspersed with five one-minute passive rest periods. The gravitational force was ~2.5 g for WBV and ~0.0 g for SWBV. Reliability of baseline dyspnoea, heart rate, and oxygen saturation was first established and then profiled for both sessions. Acute responses to both WBV and SWBV were compared with repeated measures analysis of variance and repeated contrasts. Small changes in dyspnoea and oxygen saturation lacked subjective and clinical meaningfulness. One session of WBV and SWBV significantly increased heart rate (p ≤ 0.02), although there was no difference among WBV and SWBV (p = 0.67).ConclusionsThis community-based proof-of-concept trial showed that a session of WBV can be completed with the absence of dyspnoea for people with COPD. Furthermore, there were no meaningful differences among WBV and SWBV for heart rate and oxygen saturation. There is scope for long-term community-based intervention research using WBV given the known effects of WBV on peripheral muscle function and functional independence.

When reduction strategies are put in place and mental health consumers are still secluded: An analysis of clinical and sociodemographic characteristics

Internationally, seclusion practices continue to be the subject of intense clinical health service and academic scrutiny. Despite extensive efforts to reduce and eliminate this controversial practice, seclusion remains a clinical intervention widely used in contemporary mental health service settings. Early identification of people who are at risk for seclusion and the timely application of alternative evidence-based interventions are critical for reducing incidents of seclusion in real-world practice settings. This retrospective study aimed to determine the relationship between sociodemographic and clinical characteristics, and the use of seclusion for those mental health consumers for whom evidence-based seclusion-reduction initiatives had little impact. A 12-month centred moving average was fitted to seclusion data from a psychiatric inpatient unit over 2 years to determine stabilization in seclusion reduction. The number of consumers admitted was calculated from the point of stabilization for 1 year (n = 469). In this cohort, univariate analysis sought to compare the characteristics of those who were secluded and those who were not. A multivariate logistic regression model was undertaken to associate future seclusion based on significant independent variables. Of those people admitted, 88 (19%) were secluded. The majority of seclusions occurred in the first 5 days (70/88, 79%). Multivariate logistic regression indicated that three variables maintained their independent associative risk of seclusion: (i) age less than 35 years; (ii) assessment of risk of violence to others; and (iii) a history of seclusion. The implications of these findings for nursing practice are discussed.

Association of methamphetamine use and restrictive interventions in an acute adult inpatient mental health unit: A retrospective cohort study

The aim of the present study was to describe incidences of restrictive interventions and the association of methamphetamine use at an acute adult inpatient mental health unit in metropolitan Melbourne, Victoria, Australia. A total of 232 consecutive consumer admissions to the inpatient unit across a 3-month period were described for illicit substance use and the use of restrictive interventions (seclusion, mechanical restraint, and physical restraint) prior to and during admission. Of all admissions, 25 (10.8%) involved consumers subjected to a restrictive intervention. Methamphetamine use was either self-reported or detected by saliva test for 71 (30.6%) consumers. Following multivariate analyses, methamphetamine use (odds ratio (OR): 7.83, 95% confidence interval (CI): 2.33-26.31) and restrictive intervention in the emergency department prior to admission (OR: 8.85, 95% CI: 2.83-27.70) were significant independent predictors of the use of restrictive interventions after inpatient admission. Anecdotal observations provided by clinical mental health staff that consumers intoxicated with methamphetamine appear to require restrictive intervention more frequently than other consumers was confirmed with the results of the current study. As the state of Victoria in Australia is on a pathway to the elimination of the use of restrictive interventions in mental health services, clinicians need to develop management strategies that provide specialist mental health care using the least-restrictive interventions. Although 26.8% of methamphetamine users were secluded after admission, restrictive interventions should not be the default management strategy for consumers who present with self-report or positive screen for methamphetamine use.