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Background: It is unknown whether ultra-early physiotherapy commenced during neonatal intensive care unit admission is of value for optimising developmental outcomes in preterm/term infants at high-risk of cerebral palsy or motor-delay., Aims: To determine whether ultra-early parent-administered physiotherapy to preterm/term high- risk infants commenced at earliest from 34-weeks post menstrual age, improves motor outcomes at 16-weeks corrected age (CA) compared to usual care., Methods: Single-blind randomised controlled pilot study with 30 infant participants. The primary outcome was the Alberta Infant Motor Scale (AIMS) total score at 16-weeks CA. Secondary outcomes included (i) parent Depression Anxiety and Stress Score and Parent Perceptions Survey at 16-weeks CA; and (ii) Bayley Scales of Infant Development at 12-months CA., Results: There were no clinically worthwhile effects at 16-weeks CA on the AIMS (mean between-group difference, 95% CI: -0.2, -2.4 to 2.0) or most secondary outcomes. However, the parents' "perception of treatment effectiveness" and "perception of change" favoured the experimental group., Conclusions: In this pilot trial, there was no clinically worthwhile effect of ultra-early parent-administered physiotherapy over usual care on the AIMS. However, the intervention was feasible for infants, acceptable to parents and parents perceived a benefit of treatment. Whilst this trial did not demonstrate treatment effectiveness using the AIMS, these findings should be interpreted cautiously because of the small sample size, the low responsivity of the AIMS to change in motor performance and the heterogeneity of the participants. Therefore, the intervention should not be abandoned on the basis of this trial, but rather further evaluated in a larger trial that addresses some of the learnings from this one., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Question: Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions?, Design: Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis., Participants: A total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney., Intervention: One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting., Outcome Measures: The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of -15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks., Results: The mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (-3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences., Conclusion: Remotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions., Trial Registration: ACTRN12619000065190., (Copyright © 2024 Australian Physiotherapy Association. All rights reserved.)

This study aims to identify residential fire risk factors and their health outcomes in terms of hospital admissions from burns and smoke inhalation together with related readmissions, length of hospital stay (LOS), costs of hospitalisation and mortality within 30 days of the fire incidence. Residential fire-related hospitalisations from 2005 to 2014 in New South Wales, Australia were identified using linked data. Univariate and multivariable Poisson regression analyses were performed to determine factors associated with residential fires on hospital admission and loss of life. During the study period, 1862 individuals were hospitalised due to residential fires. In terms of prolonged LOS, high hospitalisation cost or mortality, fire incidents' that damaged both contents and structures of the property; were ignited by smokers' materials and/or due to mental or physical impairment of the residents had more adverse outcomes. Individuals aged 65 and over with comorbidities and/or acquired severe injuries from the fire incident were at a higher risk of long-term hospitalisation and death. This study provides information to response agencies in communicating fire safety messages and intervention programs to target vulnerable population. In addition, it also supplies indicators on hospital usage and LOS following residential fires to health administrators., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Question: Does intensive sit-to-stand training in addition to usual care improve sit-to-stand ability in people who are unable to stand up independently after stroke?, Design: A multi-centre randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis., Participants: Thirty patients from two Sydney hospitals, < 3 months after stroke, with a mean Modified Rankin Scale score of 4 points (SD 0.5)., Intervention: All participants received usual care. Participants in the experimental group attended two additional sessions of physiotherapy per day for 2 weeks. These sessions were individualised to the needs of each participant in order to increase the amount and intensity of sit-to-stand training., Outcome Measures: Outcome measures were taken at baseline and at 2 weeks. The primary outcome was clinicians' impressions of sit-to-stand change, measured using videos and a 15-point Global Impressions of Change Scale. Secondary outcomes were sit-to-stand ability, composite strength of key muscles of the affected lower limb, gross lower limb extension strength, the Goal Attainment Scale, and ranking of change in ability to move from sitting to standing., Results: All participants completed the trial. The mean between-group difference for clinicians' impressions of sit-to-stand change was 1.57/15 points (95% CI 0.02 to 3.11). The secondary outcomes that indicated a treatment effect were gross lower limb extension strength and ranking of change in ability to move from sitting to standing, with mean between-group differences of 6.2 deg (95% CI 0.5 to 11.8) and -7 (95% CI -1 to -13), respectively., Conclusion: Two weeks of intensive sit-to-stand training in addition to usual care improves sit-to-stand ability in people who are unable to stand up independently after stroke., Trial Registration: ANZCTR 12616001288415., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Questions: Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity?, Design: Systematic review of randomised trials with meta-analysis., Participants: Adults who have had a stroke., Intervention: Any intervention involving repetitive practice compared with no intervention or a sham intervention., Outcome Measures: The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity., Results: Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I 2 =44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I 2 =50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I 2 =36%) in favour of repetitive practice on lower limb activity., Conclusion: Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity., Review Registration: PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221]., (Copyright © 2018 Australian Physiotherapy Association. All rights reserved.)

Objective: To systematically review the delivery and effectiveness of rehabilitation for burn survivors in low and middle income countries (LMIC)., Methods: We systematically searched the literature through 11 electronic databases and the reference lists of relevant studies. Studies were suitable for inclusion if they were primary research with a focus on burns rehabilitation in LMIC settings describing either service delivery or treatment effectiveness. No time, design or other limitations were applied, except English language., Results: Of 226 studies identified, 17 were included in the final review, including 7 from India. The results were summarised in a narrative synthesis as the studies had substantial heterogeneity and small sample sizes, with many relying on retrospective data from non-representative samples with no control groups. Most studies (12) described service delivery and 5 examined the effectiveness of different types of rehabilitation. Multiple studies stressed the need for rehabilitation and multidisciplinary teams for burns management., Conclusions: The published research on burns rehabilitation is very limited and little is known about current practices in LMIC settings. In order to inform policy and service delivery, the effectiveness, feasibility and sustainability of current services needs to be investigated., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Question: What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia?, Design: A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention., Participants: Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand., Intervention: Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15minutes of one-to-one hand therapy three times per week without functional electrical stimulation., Outcome Measures: The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks., Results: Sixty-six (94%) participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean (SD) modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0) and 33.2 points (SD 17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI -4.1 to 5.9)., Conclusion: Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve hand function in people with sub-acute tetraplegia., Registration: Australian and New Zealand Trial Registry ACTRN12609000695202 and ClinicalTrials.gov NCT01086930. [Harvey LA, Dunlop SA, Churilov L, Galea MP, Spinal Cord Injury Physical Activity (SCIPA) Hands On Trial Collaborators (2017) Early intensive hand rehabilitation is not more effective than usual care plus one-to-one hand therapy in people with sub-acute spinal cord injury ('Hands On'): a randomised trial. Journal of Physiotherapy 63: 197-204]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Question: Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts?, Design: Randomised, parallel-group trial with intention-to-treat analysis., Participants: Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n=40) or control (n=40) groups., Intervention: Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com. They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout., Outcome Measures: Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence., Results: Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes., Conclusion: People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear., Trial Registration: ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161-167]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Question: Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions?, Design: A Cochrane Systematic Review with meta-analyses of randomised trials., Participants: People with or at risk of contractures., Intervention: Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in any way., Outcome Measures: The outcome of interest was joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta-analyses was assessed using GRADE., Results: Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean difference was 2 deg (95% CI 0 to 3) favouring stretch. This was equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidence was high for both sets of meta-analyses., Conclusion: Stretch does not have clinically important effects on joint mobility. [Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K (2017) Stretch for the treatment and prevention of contracture: an abridged republication of a Cochrane Systematic Review. Journal of Physiotherapy 63: 67-75]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objectives: To translate, validate, and compare performance of an International Classification of Diseases, 10th revision (ICD-10) version of the Multipurpose Australian Comorbidity Scoring System (MACSS) against commonly used comorbidity measures in the prediction of short- and long-term mortality, 28-day all-cause readmission, and length of stay (LOS)., Study Design and Setting: Hospitalization and death data were linked for 25,374 New South Wales residents aged 65 years and older, admitted with a hip fracture between 2008 and 2012. Comorbidities were identified according to the MACSS, Charlson, and Elixhauser definitions using ICD-10 coding algorithms. Regression models were fitted and area under the curve (AUC) and Akaike Information Criterion assessed., Results: The ICD-10 MACSS had excellent discriminating ability in predicting inhospital mortality (AUC = 0.81) and 30-day mortality (AUC = 0.80), acceptable prediction of 1-year mortality (AUC = 0.76) but poor discrimination for 28-day readmission and LOS. The MACSS algorithm provided better model fit than either Charlson or Elixhauser algorithm for all outcomes., Conclusion: This work presents a rigorous translation of the ICD-9 MACSS for use with ICD-10 coded data. The updated ICD-10 MACSS outperformed both Charlson and Elixhauser measures in an older population and is recommended for use with large administrative data sets in predicting mortality outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Question: Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma?, Design: Multi centre, randomised, controlled trial., Participants: Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points., Intervention: Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care., Outcome Measures: Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors., Results: All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were -0.3/21 points (95% CI -3.2 to 2.7) and 7.5 Nm (95% CI -5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8)., Conclusion: Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear., Trial Registration: ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial.Journal of Physiotherapy62: 203-208]., (Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objective: This population-based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall-related injury in older adults, adjusting for age, sex and comorbidities., Methods: A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall-related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths-of-stay, 28-day readmissions, and 30-day mortalities. These were standardised for age, sex, comorbidity, and remoteness., Results: Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28-day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30-day mortality (5.0% vs 4.9%, p=0.0046)., Conclusions: Over the study period, rural residents of NSW had lower rates of fall-related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length-of-stay, but higher rates of readmission and mortality. These differences existed following standardisation., Implications: This study highlights the need for further research to characterise and explain this variability., (© 2016 Public Health Association of Australia.)

Question: What is the effect of adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy in people with sub-acute tetraplegia?, Design: A parallel group, randomised, controlled trial. Participants were randomly assigned (1:1) via a computer-generated concealed block randomisation procedure to either a control or experimental intervention., Participants: Seventy people with C2 to T1 motor complete or incomplete tetraplegia within 6 months of injury. Participants were recruited from seven spinal units in Australia and New Zealand., Intervention: Experimental participants received intensive training for one hand. Intensive training consisted of training with an instrumented exercise workstation in conjunction with functional electrical stimulation for 1 hour per day, 5 days per week for 8 weeks. Both groups received usual care and 15 minutes of one-to-one hand therapy three times per week without functional electrical stimulation., Outcome Measures: The primary outcome was the modified Action Research Arm Test reflecting arm and hand function, which was assessed at the end of the intervention, that is, 11 weeks after randomisation. Secondary outcomes were measured at 11 and 26 weeks., Results: Sixty-six (94%) participants completed the post-intervention assessment and were included in the primary intention-to-treat analysis. The mean modified Action Research Arm Test score for experimental and control participants at the post-intervention assessment was 36.5 points (SD 16.0) and 33.2 points (SD 17.5), respectively, with an adjusted mean between-group difference of 0.9 points (95% CI -4.1 to 5.9)., Conclusion: Adding an intensive task-specific hand-training program involving functional electrical stimulation to a combination of usual care plus three 15-minute sessions per week of one-to-one hand therapy does not improve hand function in people with sub-acute tetraplegia., Registration: Australian and New Zealand Trial Registry ACTRN12609000695202 and ClinicalTrials.gov NCT01086930., (Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

To combat the risk of nightwear burns a mandatory standard regulating the design, flammability and labelling requirements of children's nightwear was introduced in Australia in 1987. This population-based study examined the trends, characteristics and causes of clothing-related burns to inform a review of the current standard, and to facilitate the development of targeted prevention strategies. Clothing-related burns for 1998-2013 were identified from hospitalisation data for all hospitals in NSW and detailed information regarding circumstance of injury from a burn data registry. To investigate percentage annual change (PAC) in trends negative binomial regression analysis was performed. There were 541 hospitalisations for clothing-related burns, 18% were nightwear-related and 82% were for other clothing. All clothing burns decreased by an estimated 4% per year (95% CI -6.2 to -2.1). Nightwear-related burns decreased by a significantly higher rate (PAC -7.4%; 95% CI -12.5 to -2.1) than other clothing (PAC -2.5%; 95%CI -4.7 to -0.1). Exposure to open heat source (campfire/bonfire) was the most common cause, followed by cooking. Of factors known to be associated with clothing burns, accelerant use was reported in 27% of cases, cigarettes 17%, loose skirt or dress 8%, and angle grinders in 6% of cases. Hospitalisations for clothing burns are relatively uncommon in NSW and rates, particularly of nightwear burns, have decreased over the last 15 years. Strategies for continued reduction of these injuries include increasing the scope of the current clothing standard or developing new standards to include all children's clothing and adult nightwear, and increasing community awareness of the risk associated with open heat sources, accelerant use and loose clothing., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Objectives: To evaluate the performance of the Charlson Comorbidity Index (CCI) in the prediction of mortality, 30-day readmission, and length of stay (LOS) in a hip fracture population using algorithms designed for use in International Classification of Diseases, 10th Revision (ICD-10)--coded administrative data sets., Study Design and Setting: Hospitalization and death data for 47,698 New South Wales residents aged 65 years and over, admitted for hip fracture, were linked. Comorbidities were ascertained using ICD-10 coding algorithms developed by Sundararajan (2004) and Quan (2005). Regression models were fitted, and area under the receiver operating curve (AUC) and Akaike information criterion were assessed., Results: Both algorithms had acceptable discrimination in predicting in-hospital (AUC, 0.72-0.76), 30-day (0.72-0.75), and 1-year mortality (0.69-0.75) but poor ability to predict 30-day readmission (0.54-0.57) or LOS (adjusted R(2), 0.007-0.045). The Quan algorithm provided better model fit than the Sundararajan algorithm. Models incorporating comorbidities as individual variables performed better than the Charlson weighted or updated Quan weighted score. Including a 1-year lookback period increased predictive ability for 1-year mortality only., Conclusion: The CCI is a valid tool for predicting mortality but not resource utilization after hip fracture. We recommend the use of the Quan algorithm rather than Sundararajan algorithm and to model individual conditions rather than categorized weighted scores., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Question: Does a massive open online course (MOOC) based around an online learning module about spinal cord injuries improve knowledge or confidence among physiotherapy students more than if physiotherapy students are left to work through the online learning module at their own pace. Which method of presenting the content leads to greater satisfaction among the students?, Study Design: Randomised controlled trial with concealed allocation and intention-to-treat analysis., Participants: Forty-eight physiotherapy students in Bangladesh., Intervention: Participants randomised to the control group were instructed to work at their own pace over a 5-week period through a physiotherapy-specific online learning module available at www.elearnSCI.org. Experimental participants were enrolled in a 5-week MOOC. The MOOC involved completing the same online learning module but experimental participants' progress through the module was guided each week and they were provided with the opportunity to engage in online discussion through Facebook., Outcome Measures: The primary outcome was knowledge, and the secondary outcomes were perceived confidence to treat people with spinal cord injuries and satisfaction with the learning experience., Results: The mean between-group difference for knowledge was 0.7 points (95% CI -1.3 to 2.6) on a 0 to 20-point scale. The equivalent results for perceived confidence and satisfaction with the learning experience were 0.4 points (95% CI -1.0 to 1.8) and 0.0 points (95% CI -1.1 to 1.2) on a 0 to 10-point scale., Conclusion: The MOOC was no better for students than working at their own pace through an online learning module for increasing knowledge, confidence or satisfaction. However, students in the MOOC group highlighted positive aspects of the course that were unique to their group, such as interacting with students from other countries through the MOOC Facebook group., Trial Registration: ACTRN12614000422628., (Copyright © 2014. Published by Elsevier B.V.)

Objective: To examine the age-specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population., Methods: A total of 5,681 respondents were asked questions on fall prevention activities as part of the 2009 NSW Falls Prevention Survey. RESULTS were weighted to represent the NSW population. Regression analysis was used to determine factors associated with uptake of interventions., Results: Overall, 28.9% of the older population have modified their home, and 35.1% increased exercise to prevent falls. Main predictors of home modification were being aged 85+ (RR 2.04, 95% CI 1.76-2.35) and physiotherapy/occupational therapy intervention (RR 1.57, 95% CI 1.22-2.01). Main predictors of increasing exercise were physiotherapy/OT intervention (RR 2.12, 95% CI 1.86-2.42) and medical advice (RR 1.45, 95% CI1.32-1.60). Older respondents (RR 0.68, 95% CI 0.57-0.81) and those with fair/poor health (RR 0.86, 95% CI 0.77-0.96) were less likely to report increased exercise., Conclusion: More than one-quarter of the older population of NSW report having made modifications to their home and one-third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise., Implication: Although fall prevention initiatives are having an impact at the population level, targeted strategies for high-risk groups are still required., (© 2014 Public Health Association of Australia.)

Question: Is a combination of standing, electrical stimulation and splinting more effective than standing alone for the management of ankle contractures after severe brain injury?, Design: A multi-centre randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis., Participants: Thirty-six adults with severe traumatic brain injury and ankle plantarflexion contractures., Intervention: All participants underwent a 6-week program. The experimental group received tilt table standing, electrical stimulation and ankle splinting. The control group received tilt table standing alone., Outcome Measures: The primary outcome was passive ankle dorsiflexion with a 12Nm torque. Secondary outcomes included: passive dorsiflexion with lower torques (3, 5, 7 and 9Nm); spasticity; the walking item of the Functional Independence Measure; walking speed; global perceived effect of treatment; and perceived treatment credibility. OUTCOME MEASURES were taken at baseline (Week 0), end of intervention (Week 6), and follow-up (Week 10)., Results: The mean between-group differences (95% CI) for passive ankle dorsiflexion at Week 6 and Week 10 were -3 degrees (-8 to 2) and -1 degrees (-6 to 4), respectively, in favour of the control group. There was a small mean reduction of 1 point in spasticity at Week 6 (95% CI 0.1 to 1.8) in favour of the experimental group, but this effect disappeared at Week 10. There were no differences for other secondary outcome measures except the physiotherapists' perceived treatment credibility., Conclusion: Tilt table standing with electrical stimulation and splinting is not better than tilt table standing alone for the management of ankle contractures after severe brain injury., Trial Registration: ACTRN12608000637347. [Leung J, Harvey LA, Moseley AM, Whiteside B, Simpson M, Stroud K (2014) Standing with electrical stimulation and splinting is no better than standing alone for management of ankle plantarflexion contractures in people with traumatic brain injury: a randomised trial.Journal of Physiotherapy60: 201-208]., (Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Objectives: To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers., Methods: A representative sample of community-based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period., Results: Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity., Conclusions: Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight., Implications: A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese individuals., (© 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.)

Unlabelled: Routinely collected hospitalisation data are widely used to monitor injury trends, provide estimates of the burden of injury and healthcare costs, and to inform policy. This study examined the impact of different ICD-10 based case selection criteria commonly used by Australian and international reporting bodies on the number and nature of burn-related hospitalisations identified., Methods: Burn cases from a state-wide administrative hospitalisation dataset were identified and compared using three different case selection criteria: (1) principal diagnosis code of burn 'T20-T31', (2) first external cause code denoting burn 'X00-X19' and (3) both principal diagnosis code of community acquired injury 'S00-T98' and first external cause code denoting burn 'X00-X19'., Results: Principal diagnosis codes 'T20-T31' and first external cause codes 'X00-X19' identified a similar number of cases, however only 78% of these were captured by both definitions. Principal diagnosis codes identified chemical, electrical and contact burns not identified as burns using external cause codes. First external cause codes identified readmission cases which were not identified by principal diagnosis codes. Using principal diagnosis codes of community acquired injury combined with external cause code of burn under-numerated hospitalisations by forty percent., Conclusion: The development, implementation and evaluation of health policy and prevention measures rely on good quality, consistent data. Current methods for identifying burn cases in hospitalisation data provide wide differences in estimation of number and nature of cases. It is important for clinicians to understand the implications of coding on the epidemiology and measurement of the burden of burn., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Questions: What is the incidence of recovery of ambulation and upper limb function six months after stroke? Can measures such as age and the National Institutes of Health Stroke Scale (NIHSS) be used to develop models to predict the recovery of ambulation and upper limb function?, Design: Prospective cohort study., Participants: Consecutive sample of 200 people with stroke admitted to a Sydney Hospital., Outcome Measures: Ambulation was measured with item 5 of the Motor Assessment Scale (MAS); patients scoring ≥3 could ambulate independently. Upper limb function was measured with items 7 and 8 of the MAS; patients scoring ≥5 could move a cup across the table and feed themselves with a spoonful of liquid with the hemiplegic arm., Results: Of the 114 stroke survivors who were unable to ambulate initially, 80 (70%) achieved independent ambulation at six months. Of the 51 stroke survivors who could not move a cup across the table initially, 21 (41%) achieved the upper limb task at six months. Of the 56 stroke survivors who were unable to feed themselves initially, 25 (45%) could feed themselves at six months. Models containing age and severity of stroke (measured with NIHSS) predicted recovery of ambulation and ability to move a cup across the table, whilst a model containing severity of stroke predicted ability to feed oneself. All prediction models showed good discrimination (AUC 0.73 to 0.84)., Conclusion: More than two-thirds of people after stroke recovered independent ambulation and less than half recovered upper limb function at six months. Models using age and NIHSS can predict independent ambulation and upper limb function but these prediction models now require external validation before use in clinical practice., (Copyright © 2013 Australian Physiotherapy Association. Published by .. All rights reserved.)

Introduction: Traumatic brain injury is of particular concern in the older population. We aimed to examine the trends in hospitalisations, causes and consequences of TBI in older adults in New South Wales, Australia., Methods: TBI cases from 1 July 1998 to 30 June 2011 were identified from hospitalisation data for all public and private hospitals in NSW. Direct aged standardised admission rates were calculated. Negative binomial regression modelling was used to examine the statistical significance of changes in trend over time., Results: There were 12,564 hospitalisations for TBI over the 13 year study period. Hospitalisation rates for TBI among the older population increased by 7.2% (95% CI 6.4-8.0, p<.0001) per year from 65.3/100,000 to 151.8/100,000. [corrected]. Males had a consistently higher hospitalisation rate. Just under one third of all hospitalisations were for adults aged 85 years and over. Traumatic subdural haemorrhage (42.9%), concussive injury (24.1%) and traumatic subarachnoid haemorrhage (12.7%) were the most common type of injury. Falls were the most common cause of TBI (82.9%). Rates of fall-related TBI increased by 8.4% (95% CI 7.5-9.3, p<.001) per year, whilst non-fall related head injury increased by 2.1% (95% CI 0.9-3.3, p<.0001) per year. The majority of falls were as a result of a fall on the same level and occurred at home. 13% of hospitalisations resulted in death, and the majority occurred in those who sustained a traumatic subdural haemorrhage., Conclusions: The rapid increase in hospitalised TBI is being predominantly driven by falls in the oldest old and the greatest increase predominantly in intracranial haemorrhages, highlighting the need for future research to quantify the risk versus benefit of anticoagulant therapies., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Question: Do dynamic splints reduce contracture following distal radial fracture?, Design: Assessor-blinded, randomised controlled trial., Participants: Forty outpatients with contracture following distal radial fracture., Intervention: The control group received routine care consisting of exercises and advice for 8 weeks. In addition to routine care, during the day the experimental group received a dynamic splint, which stretched the wrist into extension but allowed intermittent movement., Outcome Measures: The primary outcomes were passive wrist extension and the Patient Rated Hand Wrist Evaluation (PRHWE). The secondary outcomes were active wrist extension, flexion, radial deviation, and ulnar deviation, and the performance and satisfaction items of the Canadian Occupational Performance Measure (COPM). All outcomes were measured at commencement, at the end of 8 weeks of treatment, and at 12 weeks (ie, 1 month follow-up)., Results: The mean between-group difference for passive wrist extension and PRHWE at 8 weeks were 4 deg (95% CI -4 to 12) and -2 points (95% CI -8 to 4), respectively. The corresponding values at 12 week follow-up were 6 deg (95% CI 1 to 12) and 2 points (95% CI -5 to 9). There were no sufficiently important between-group differences for any of the secondary outcome measures at 8 or 12 weeks., Conclusion: It is unclear whether dynamic splints following distal radial fracture have therapeutic effects on passive wrist extension or PRHWE, but they clearly do not have any therapeutic effects on active wrist extension, flexion, radial or ulnar deviation, or on the performance or satisfaction items of the COPM. The ongoing use of dynamic splints following distal radial fracture is difficult to justify., Trial Registration: ACTRN12608000309381., (Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.)

Question: Is electrical stimulation and splinting more effective than splinting alone for the management of wrist contracture following acquired brain injury?, Design: A multi-centre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis., Participants: Thirty-six adults with first stroke or traumatic brain injury and mild to moderate wrist flexion contractures., Intervention: The experimental group received electrical stimulation to the wrist and finger extensor muscles for 1 hour a day over 4 weeks while the control group did not. Both groups wore a splint for 12 hours a day during this 4-week period., Outcome Measures: The primary outcome was passive wrist extension measured with a 3Nm torque and with the fingers in extension. Secondary outcomes included passive wrist extension, wrist and finger extensor strength, wrist flexor spasticity, motor control of the hand, and Global Perceived Effect of Treatment, and perception of treatment credibility. Outcome measures were taken at baseline, at the end of the intervention period (4 weeks), and after a 2-week follow-up period (6 weeks)., Results: At 4 and 6 weeks, the mean between-group difference (95% CI) for passive wrist extension was 7 degrees (-2 to 15) and -3 degrees (-13 to 7), respectively. Secondary outcomes were statistically non-significant or were of borderline statistical significance., Conclusion: It is not clear whether electrical stimulation and splinting is more effective than splinting alone for the management of wrist contracture after acquired brain injury. Therapists' confidence in the efficacy of electrical stimulation for contracture management is not yet justified., (Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.)

Questions: What is the incidence of contractures six months after stroke? Can factors measured within four weeks of stroke predict the development of elbow, wrist, and ankle contractures six months later?, Design: Prospective cohort study., Participants: Consecutive sample of 200 adults with stroke admitted to a Sydney hospital., Outcome Measures: Loss of range of motion in major joints of the body was measured using a 4-point ordinal contracture scale. In addition, elbow extension, wrist extension, and ankle dorsiflexion range of motion were measured using torque-controlled procedures. Potential predictors of contracture were age, pre-morbid function, severity of stroke, muscle strength, spasticity, motor function, and pain. Measurements were obtained within four weeks of stroke and at six months after stroke., Results: 52% of participants developed at least one contracture. Incidence of contracture varied across joints from 12% to 28%; shoulders and hips were most commonly affected. Muscle strength was a significant predictor of elbow, wrist, and ankle joint range. Prediction models explained only 6% to 20% of variance in elbow, wrist, and ankle joint range., Conclusion: About half of all patients with stroke develop at least one contracture within six months of stroke. Incidence of contractures across all joints ranged from 12% to 28%. Muscle strength is a significant predictor of elbow, wrist, and ankle contractures but cannot be used to accurately predict contractures in these joints., (Copyright © 2012 Australian Physiotherapy Association. Published by .. All rights reserved.)

Regulations to restrict the temperature of domestic hot tap water were introduced in NSW in 1999. This study investigates the impact of the regulations on the knowledge, attitude and practice of workforce professionals responsible for their uptake and enforcement. Telephone surveys were conducted with a random sample of 110 plumbers and 30 regulating authorities. Surveys were recorded, transcribed and coded. Written questionnaires were completed by 151 plumbing students. The regulations are well known and supported by the majority of plumbers, students and regulators; however 75% of plumbers reported customer dissatisfaction with them. Only a minority of plumbers (11%), students (7%) and regulators (27%) correctly appreciated the impact of a decrease in water temperature in reducing burns. This study identifies the need to improve plumbers and students' understanding of the safety issues underlying the regulations in order to promote more effective advocacy for homes not currently covered by the regulations, and to provide more public education to increase acceptance of them. As only houses built or substantially renovated after June 1999 are likely to have been impacted by the current regulations, there is a need to increase the scope of the regulations to include not only new installations, but also the replacement of existing heated water units if the goal of universal protection is to be achieved., (Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.)

Question: Do people with recently acquired paraplegia benefit from a six-week motor retraining program aimed at improving their ability to sit unsupported?, Design: A randomised controlled trial with concealed allocation, assessor blinding, and intention-totreat analysis., Participants: 32 people with recently acquired paraplegia and limited ability to sit unsupported., Intervention: All participants undertook standard inpatient rehabilitation over a six-week period. Experimental participants received three additional 30-minute sessions per week of motor retraining directed at improving their ability to sit unsupported., Outcome Measures: The three primary outcomes were the Maximal Lean Test, Maximal Sideward Reach Test, and the Performance Item of the Canadian Occupational Performance Measure (COPM). The secondary outcomes were the Satisfaction Item of the COPM, Participants' Impressions of Change, Clinicians' Impressions of Change, the T-shirt Test, and the Spinal Cord Injury Falls Concern Scale., Results: The mean between-group differences for the Maximal Lean Test, Maximal Sideward Reach Test and the Performance Item of the COPM were -20 mm (95% CI -64 to 24), 5% arm length (95% CI -3 to 13) and 0.5 points (95% CI -0.5 to 1.5), respectively. The secondary outcomes did not differ significantly between groups., Conclusion: People with recently acquired paraplegia do not benefit from a six-week motor retraining program directed specifically at improving their ability to sit unsupported. Their ability to sit unsupported does, however, improve over time, suggesting that the practice of activities of daily living has important carry-over effects on unsupported sitting, rendering additional training redundant., Trial Registration: ACTRN12608000464369., (Copyright © 2011 Australian Physiotherapy Association. Published by .. All rights reserved.)

Scalds from hot tap water are serious injuries that are potentially preventable by restricting the temperature of hot tap water delivery. In July 1999, regulations were introduced in NSW to require that all new hot water installations deliver water at temperatures not exceeding 50 degrees C to sanitary fixtures. This study investigates trends in hot tap water scald injury hospitalisations following the introduction of these regulations. Hot tap water scald cases for 1999-2007 were identified from hospitalisation data for all public and private hospitals in NSW. To investigate hot tap water scald hospitalisations over time, negative binomial regression analysis was performed. There were 845 hospitalisations for hot tap water scalds in NSW over the period of the study. Hospital admission rates for hot tap water scalds decreased by an estimated 6% (3.2-8.5, 95%CI) per year since the introduction of regulations. While those most at risk were infants, toddlers and the elderly, almost a third of hospitalisations were for adults (25-64 years). The majority of hot tap water scalds were sustained at home and a further 4% occurred in a residential institute or school. The majority of scalds were severe, and a quarter required admission for longer than a week. The introduction of regulations in NSW appears to have had a positive impact on the rates of hospitalisations for hot tap water scalds; however, scalds continue to cause significant morbidity and mortality. This highlights the need for a review of the scope and implementation of the existing regulations and ongoing education of the general public to the dangers of hot tap water., (2009 Elsevier Ltd and ISBI. All rights reserved.)

Objective: The objectives of this study were to measure patient satisfaction with the results of hysterectomy and to determine factors associated with dissatisfaction., Study Design: A total of 1299 women who underwent hysterectomy at 28 hospitals in Maryland were interviewed before and at 3, 6, 12, 18, and 24 months after the operation., Results: At 12 and 24 months after the hysterectomy 95.8% and 96.0%, respectively, reported that the hysterectomy had completely or mostly resolved the problems or symptoms they had before surgery; 93.3% and 93.7%, respectively, reported that the results were better than or about what they expected; 85.3% and 81. 6%, respectively, reported that their health was better than before the hysterectomy; and 87.9% and 93.1%, respectively, reported being totally recovered. The factor most strongly and consistently associated with patient reports of negative outcomes was readmission because of a postdischarge complication., Conclusion: Postdischarge complication necessitating readmission plays an important role in patient dissatisfaction with the results of hysterectomy.