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Objectives To determine in women with clinically stable chronic lung disease (CLD) and healthy women; (1) prevalence of urinary incontinence; (2) risk factors for urinary incontinence; (3) effects of a standard course of specialised physiotherapy treatment (PT) in women with CLD. Design Prospective prevalence study; PT study in CLD subgroup. Setting Tertiary metropolitan public hospital. Participants Women with cystic fibrosis (CF, n = 38), chronic obstructive pulmonary disease (COPD, n = 27) and 69 healthy women without CLD. PT study — 10 women with CLD. Interventions Five continence PT sessions over 3 months. Main outcome measures Prevalence and impact of incontinence (questionnaire), number of leakage episodes (7-day accident diary), pelvic floor muscle function (ultrasound imaging) and quality of life (King’s Health Questionnaire). Results The majority of women in all three groups reported episodes of incontinence (CF 71%; COPD 70%; healthy women 55%). Compared to age-matched healthy controls, women with CF reported more episodes of incontinence (P = 0.006) and more commonly reported stress incontinence (P = 0.001). A logistic regression model revealed that women with CLD were twice as likely to develop incontinence than healthy women (P = 0.05). Women with COPD reported significantly more ‘bother’ with incontinence than age-matched women with incontinence. There was a significant reduction in incontinence episodes following treatment, which was maintained after three months. Conclusions The presence of CLD is an independent predictor of incontinence in women. In older women this is associated with more distress than in age-matched peers without CLD. Larger treatment studies are indicated for women with CLD and incontinence.

Objective To evaluate the inter-rater and intra-rater reliability of the hand held dynamometer in measuring muscle strength in people with interstitial lung disease (ILD). Design Test retest reliability of hand-held dynamometry for elbow flexor and knee extensor strength between two independent raters and two testing sessions. Setting Physiotherapy department within a tertiary hospital. Participants Thirty participants with ILD of varying aetiology were included. Twenty participants completed the inter-rater reliability protocol (10 idiopathic pulmonary fibrosis, mean (SD) age 73 (10) years, 11 male) and 21 participants completed the intra-rater reliability protocol (10 idiopathic pulmonary fibrosis, mean age 71 (10) years, 11 male). Main outcome measures Mean muscle strength (kg). Agreement between the two raters and testing sessions was analyzed using Bland–Altman plots and reliability was estimated using intraclass correlation coefficients (ICC). Results For elbow flexor strength there was a mean difference between raters of −0.6kg (limits of agreement (LOA) −5.6 to 4.4kg) and within raters of −0.3kg (LOA −2.8 to 2.3kg). The ICCs were 0.95 and 0.98, respectively. For knee extensor strength there was a mean difference between raters of −1.5kg (LOA −6.9 to 3.9kg) and within raters of −0.7kg (LOA −3.9 to 2.4kg). The ICCs were 0.95 and 0.97, respectively. Conclusions Hand-held dynamometry is reliable in measuring elbow flexor and knee extensor strength in people with ILD.

Objectives To determine the prevalence and impact of urinary incontinence (UI) in men with cystic fibrosis (CF). Design Prospective observational study. Setting Adult CF clinics at tertiary referral centres. Participants Men with CF ( n =80) and age-matched men without lung disease ( n =80). Interventions Validated questionnaires to identify the prevalence and impact of UI. Main outcome measures Prevalence of UI and relationship to disease specific factors, relationship of UI with anxiety and depression. Results The prevalence of UI was higher in men with CF (15%) compared to controls (10%) ( p =0.339). Men with CF and UI had higher scores for anxiety than those without UI (mean 9.1 (SD 4.8) vs 4.7 (4.1), p =0.003), with similar findings for depression (6.8 (4.6) vs 2.8 (3.4), p =0.002) using the Hospital Anxiety and Depression Scale. Conclusions Incontinence is more prevalent in adult men with CF than age matched controls, and may have an adverse effect on mental health. The mechanisms involved are still unclear and may differ from those reported in women.

Objectives To examine the predictive validity, minimal important difference (MID) and responsiveness of the PRAISE tool. Design Retrospective data analysis from HomeBase trial of home vs centre-based pulmonary rehabilitation. Setting Tertiary health service. Participants One hundred and sixty-six participants with COPD (100 men) with mean age 69 (SD 9) years, FEV1% predicted 50% (19). Interventions Eight-week pulmonary rehabilitation program, conducted at the hospital or at home. Main outcome measures The 15-item PRAISE tool comprising 10 general and five pulmonary rehabilitation-specific self-efficacy questions. Predictive validity was examined by exploring the relationship between baseline PRAISE score and objective change in physical activity following pulmonary rehabilitation using the SenseWear Armband. The MID was evaluated using anchor-based and distribution-based methods. Responsiveness was assessed with effect sizes. Results A higher baseline PRAISE score (indicating better self-efficacy) was an independent predictor of reduced sedentary time following pulmonary rehabilitation (P = 0.03). A one point increase in PRAISE was associated with a decrease in sedentary time of 4 minutes/day (95% confidence interval −7.8 to −0.4 minutes/day). Anchor-based estimates of the MID were 0.5 to 1.5 points; however sensitivity and specificity were modest (area under the curve Conclusions The PRAISE tool has predictive validity and may be useful to identify those with high self-efficacy who are more likely to achieve important health behaviour changes with pulmonary rehabilitation. The small effect size suggests that the PRAISE tool was not responsive to changes following pulmonary rehabilitation. Trial registration number NCT01423227, clinicaltrials.gov .

Objective To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. Design and setting A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. Main outcome measures The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). Results 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. Conclusions The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models.

Objectives To identify urinary incontinence and its impact on men with stable chronic obstructive pulmonary disease (COPD) and men without lung disease. Design Prospective questionnaire study. Setting Outpatients attending a public metropolitan hospital. Participants Men with COPD ( n =49) and age-matched men without lung disease ( n =36). Interventions Validated questionnaires to identify the prevalence and impact of urinary incontinence. Main outcome measures Prevalence of urinary incontinence and relationship with disease-specific factors, and relationship of urinary incontinence with anxiety and depression. Results The prevalence of urinary incontinence was higher in men with COPD ( n =19/49) compared with men without lung disease ( n =6/36; P =0.027). In men with COPD, symptoms of urgency were more prevalent in men with urinary incontinence ( P =0.005), but this was not evident in men without lung disease ( P =0.101). Only men with COPD reported symptoms of urgency associated with dyspnoea, and this did not vary between men with and without urinary incontinence ( P =0.138). In men with COPD, forced expiratory volume in 1 second (FEV 1 ) was lower in those with urinary incontinence compared with those without urinary incontinence {mean 38 [standard deviation (SD) 14] % predicted vs 61 (SD 24) % predicted; P =0.002}. The impact of urinary incontinence did not differ between the two groups ( P =0.333). Conclusions Incontinence is more prevalent in men with COPD than in men without lung disease. The prevalence of urinary incontinence increases with greater disease severity, as reflected by lower FEV 1 . Screening for urinary incontinence should be considered in men with COPD and compromised lung function.