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Background: Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. Aims: To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. Methods: This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. Results: This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. Conclusion: Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted. [ABSTRACT FROM AUTHOR]

This mixed-methods observational pilot study compared clinician-supervisor and student satisfaction (surveys and semi-structured interviews), and final placement scores for two different physiotherapy clinical placement models: hybrid (half-onsite, half-remote) and traditional (onsite). All supervisors and students involved were invited to participate; ten supervisors and seven students completed the survey, and nine supervisors and one student participated in interviews. Qualitative data were analyzed using reflexive thematic analysis. Students and supervisors reported similar levels of satisfaction for either model. Supervisors reported some reservations and higher workloads with the hybrid model. The interviews identified three themes for satisfying placements: it is structure, not location that matters; managing competing demands on clinician-supervisors; and learning requires psychologically safe relationships. Final scores for both placement models were comparable. This pilot study with a small sample found the hybrid model was acceptable and achieved comparable outcomes to the traditional model. Remote structured learning has potential to innovate and support sustainable clinical placements. [ABSTRACT FROM AUTHOR]

Hand rehabilitation delivered to underserved South African communities is often the responsibility of novice or generalist occupational therapists. Novice therapists typically work with restricted supervision, support, and resources. Little is known about how these therapists should be supported in order to strengthen the services that they deliver. This study is aimed at understanding how novice occupational therapists in their first year of practice describe their experience of delivering hand rehabilitation in order to identify their support and development needs and propose interventions to address these needs. A qualitative instrumental case study design was used. Data were collected from novice occupational therapists (n = 9) who participated in an online community of practice. Data collection techniques included photoelicitation, facilitated reflection activities, and case discussion. Reflexive thematic analysis was employed. Trustworthiness strategies included reflexive writing, prolonged engagement, data source triangulation, member checking, and peer audit. Analysis generated three themes: (1) "submerged: I had to drown a little" captured participants' experience of being saturated by contextual features including poverty and poor basic management of hand injuries. (2) "Starting somewhere" captured participants' journey of treating patients with hand injuries. They transitioned from an initial sense of having "no idea" to developing "some idea"; their clinical reasoning was challenged when working with no diagnosis, unfamiliar presentations, or when contextual features rendered traditional approaches to therapy inappropriate. Finally, (3) "dynamics of 'surthrival'" captured elements that contributed to participants either thriving or merely surviving their hand rehabilitation experience. The proposed strategies identified in this study to address the support and development needs of novice therapists include interventions focused on systems and health services; learning opportunities to support competency and physical resources; and emotional support. Beyond application to the South African context, these strategies may be considered for supporting generalist or novice therapists delivering hand rehabilitation in other low- to middle-income countries. [ABSTRACT FROM AUTHOR]

Weekend physical therapy services in the acute and/or sub-acute setting may optimize postoperative recovery following hip and knee arthroplasty, though evidence supporting these services is limited. To explore the change in patient and service outcomes of transferring a weekend physical therapy service from the acute to the sub-acute setting following hip and knee arthroplasty. This was a quasi-experimental research design nested within two stepped-wedge cluster randomized controlled trials. Acute weekend physical therapy services were sequentially discontinued and reallocated to the sub-acute setting in a random order from one ward at a time within the broader trial. Patient and service outcomes for participants 6 weeks following hip and knee arthroplasty (N = 247) were compared during 6 months of acute weekend physical therapy services (Phase 1, n = 117) followed by 6 months of sub-acute services (Phase 2, n = 130). Intention-to-treat statistical analyses were conducted. The intervention had a negligible effect on medium-term outcomes. The only statistically significant difference observed was slightly higher ratings of "worst pain experienced over the past week" [coefficient 0.865 (0.123 to 1.606), p =.022] during Phase 2. No interaction effects were observed despite a 2.4-day reduction in length of stay amongst complex patients during Phase 2 (18.28 and 15.86 days in Phase 1 and 2, respectively). No comparative advantage or disadvantage was observed by reallocating a weekend physical therapy budget from the acute to sub-acute setting following hip and knee arthroplasty. Further research investigating the cost-effectiveness of these services in the sub-acute setting may be warranted for complex patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine perceived barriers and facilitators to adopting and sustaining functional maintenance initiatives for acutely hospitalised older adults. Methods: A qualitative descriptive study using semi-structured interviews and initiative observations was conducted at five international and four Victorian acute hospitals. Purposive snowball sampling was used to recruit clinical, research, managerial, and volunteer staff who were involved in implementing and/or sustaining the initiatives. Emergent themes from audio-recorded interviews were developed and categorised as staff-perceived barriers or facilitators to adopting and sustaining initiatives using inductive thematic analysis. Results: Twenty-seven medical, nursing, allied health, and volunteer staff participated in interviews. Staff resistance and turnover, especially the loss of staff considered to be change drivers, were commonly reported barriers. A lack of professional autonomy was perceived to threaten longevity in allied health assistant led initiatives. Facilitators included support from change drivers, use of collaborative approaches and opinion leaders, integration of initiatives into usual care, alignment with institutional priorities, use of "internal" evidence to justify ongoing institutional investment, and use of an accompanying training and evaluation strategy. Conclusions: Successful adoption and sustainability of functional maintenance initiatives for acutely hospitalised older adults are influenced by a range of "non-clinical" factors, such as the ongoing effectiveness of change drivers. These factors should be considered when deciding upon future innovations to address functional decline and its associated economic impact. Considering barriers and facilitators to successful adoption of functional maintenance initiatives is important for implementing evidence-based practice targeting the prevention of functional decline in acutely hospitalised older adults. Change drivers who remain actively involved are core facilitators of successful functional maintenance initiative adoption. Credible "internal" evaluation data are essential for ongoing sustainability of functional maintenance initiatives. Continual staff training is a key feature of successful functional maintenance initiatives. Perceived financial barriers to adopting functional maintenance initiatives can be overcome by other facilitating influences. [ABSTRACT FROM AUTHOR]

Background: Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design.Methods and Findings: We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses.Conclusions: In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796. [ABSTRACT FROM AUTHOR]

Purpose: To describe health professionals' perceptions of the role of allied health during the acute phase following elective lower limb joint replacement surgery to inform the development of efficient allied health service models. Methods: This was a qualitative descriptive study conducted using semi-structured focus groups and thematic analysis. Participants were 25 medical, nursing, and allied health professionals working on two orthopaedic wards in a tertiary hospital in Victoria, Australia. Focus groups elicited staff perceptions regarding the aims and roles of acute allied health intervention following hip and knee replacement, how these services are currently provided, and how these services can best be provided. This study was undertaken alongside two stepped wedge cluster randomised controlled trials during which existing weekend allied health services were to be temporarily removed with opportunity to contribute to a stakeholder-driven model of these services. Results: The main theme that emerged was a sense of unrealised potential amongst health professionals in terms of patient outcomes following hip and knee joint replacement surgery arising from tension between perceptions of actual versus ideal allied health practice. Assessing function and planning for discharge accordingly was perceived to be a higher priority than intervening to improve functional independence. Conclusion: Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in patients following lower limb replacement surgery than current practice in this setting that prioritises discharge. Allied health service delivery in the acute phase following hip and knee joint replacement needs to balance the needs of the health service with those of the patients. Prioritising allied health intervention to low functioning and complex patients could be a more efficient use of allied health expertise in this population than current practice, which is to prioritise discharge. There may be more scope for nurses to be involved in promoting early postoperative mobilisation following joint replacement surgery, especially in uncomplicated cases. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of an acute weekend physiotherapy service compared to no physiotherapy service on short-term outcomes following lower limb joint replacement. Design: Pre-post intervention (quasi-experimental) study nested within two stepped-wedge cluster randomized controlled trials. Setting: Public tertiary hospital in Melbourne, Australia. Subjects: Consecutive patients undergoing hip and knee replacement. Interventions: This study analysed a subgroup of one cluster of the parent trials where acute weekend physiotherapy services were sequentially discontinued in random order from one cluster at a time. Intervention (at the ward level) included six months of existing acute weekend physiotherapy services (Phase 1; n = 130) followed by six months when these services were discontinued (Phase 2; n = 146). Main measures: Acute hospital length of stay and other short-term patient and hospital measures. Results: Availability of weekend physiotherapy was associated with increased odds of discharge directly home (odds ratio (95% confidence interval): 3.151 (1.039–9.555), P = 0.043) and improved mobility (coefficient: 4.301 (1.500–7.101), P = 0.003). However, hospitalization was perceived as less helpful (coefficient: –1.743 (−2.417 to −1.069), P = 0.013) and acute length of stay was longer, only in multivariable analyses (coefficient: 1.003 (0.105–1.890), P = 0.020) than when weekend physiotherapy services were unavailable. Similar results were observed when examining data according to receipt of weekend physiotherapy services rather than the intervention phase to which each patient was allocated. Conclusion: The weekend physiotherapy service appears to have had beneficial impacts on discharge destination and patient mobility that may outweigh the unfavourable impacts on acute length of stay and patient-perceived helpfulness of hospitalization. [ABSTRACT FROM AUTHOR]

Study Design Descriptive Epidemiological Study. Introduction Ligament tears between carpal bones are easily missed on initial presentation, but can have potentially debilitating effects on the patient if they progress to an instability. They are usually the result of a fall onto an outstretched hand with the wrist in hyperextension. Current incidence of carpal instability after these falls is unknown. Purpose of the Study Using established clinical and radiological measures, we sought to establish the cumulative incidence of carpal instability in people who have fallen onto an outstretched hand in the second year after injury. We also sought to describe its relationship with functional impairment. Methods We used emergency department records of an inner-urban tertiary hospital to contact all patients who presented with wrist pain following fall onto outstretched hand who were between one and two years after injury. Carpal instability was defined by blinded radiological evaluations and provocative clinical tests, including Scaphoid Shift (Watson’s) test, Ballottement, and mid-carpal shift test. Wrist-related pain and disability was measured using the Patient-Rated Wrist and Hand Evaluation. Results Of the 279 potentially eligible cases, only 146 were contactable, and fifty (28 male, 22 female; mean age of 48 years) attended for assessment. We found a cumulative incidence of 44% of carpal instability within the second year after injury. Of these, 12 (24%) cases had scapho-lunate instability, 12 (24%) had luno-triquetral instability and 7 (14%) had mid-carpal instability. There were no significant correlations between clinically confirmed carpal instability and pain, function, or work participation. Discussion and Conclusion This study found a higher than anticipated cumulative incidence of carpal instability in the second year after injury, which may reflect volunteer bias. Patients should be advised to monitor symptoms in the year after injury and seek a review if symptoms of pain, clicking or clunking arise. Level of Evidence II [ABSTRACT FROM AUTHOR]

Introduction This study aimed to determine whether an 8-week online training program for developing skills in short-course development and delivery was effective in establishing locally driven, sustainable, evidence-based training for local occupational or physical therapists. Methodology Five Bangladeshi therapists from a rehabilitation center participated in the course, which was facilitated online by an Australian university. They completed 8 prerecorded modules over a 3-month period, and were assessed in situ on their ability to deliver a tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from precourse and 1-year follow-up surveys, observations (including interactions during the course and final participant presentations), and a postcourse focus group. Results The course achieved 6 of its 9 objectives, with all participants satisfactorily planning and delivering an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence and developing and executing a teaching plan. This was sustained at 1-year review. The key theme was a shift in participants' capacity for teaching and learning. Enablers were multimodal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable Internet services and late delivery of course materials. Discussion Online distance education can be effective in producing sustainable change in practitioner skills in developing countries. Future programs would benefit from a blended learning approach incorporating 'face-to-face' instructor contact. [ABSTRACT FROM AUTHOR]

Introduction: It has been difficult for occupational therapists in Asia to use occupational therapy assessments, such as the Occupational Self Assessment (OSA) version 2.2, that are not validated in the local language. This study aimed to produce and assess the psychometric properties of a Malaysian version of the 21-item OSA.Method: The translation process involved the forward and back translation from the original English version into the Malaysian version, followed by field tests conducted with a small group of occupational therapists and workers to confirm the translation's equivalence and appropriateness. A total of 35 Malaysian injured workers with musculoskeletal disorders who were not involved in a return to work programme were assessed using the Malaysian version of the OSA. Twenty-three were reassessed 7-14 days later to determine test-retest reliability.Results: The Malaysian version of the OSA showed acceptable reliability (internal consistency, corrected item correlation and test-retest reliability) and validity (convergent and discriminant validity). Conclusion: The results suggest that the OSA is reliable and valid in assessing occupational functioning for injured Asian workers with musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Heartburn and acid reflux increase the severity of nausea and vomiting of pregnancy, and may lead to more serious medical conditions. The fetal safety of histamine 2 (H2) blockers, the most common antireflux medication, during pregnancy needs to be determined. The aim herein is to determine the fetal safety of H2 blockers during pregnancy through systematic review. All original research assessing the safety of H2 blockers in pregnancy was sought. Data included congenital malformations, spontaneous abortions, preterm delivery, and small for gestational age. A random-effects model combined results. With data from 2,398 exposed and 119,892 nonexposed to H2 blockers, overall odds ratio was 1.14 [0.89, 1.45]. Further analysis revealed no increased risks for spontaneous abortions, preterm delivery, and small for gestational age with odds ratios and 95% confidence intervals (CIs) of 0.62 [0.36-1.05], 1.17 [0.94, 1.147], and 0.28 [0.06, 1.22], respectively. H2 blockers can be used safely in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementation phase of knowledge transfer, as differences between individual and organisational readiness for change combined with small sample sizes can lead to imbalances in factors that impede or facilitate change between intervention and control groups. Within-cluster repeated measure designs could control for variance between intervention and control groups by allowing the same clusters to receive a sequence of conditions. Although in implementation settings, they can contaminate the intervention and control groups after the initial exposure to interventions. We propose the novel application of counterbalanced design to implementation research where repeated measures are employed through crossover, but contamination is averted by counterbalancing different health contexts in which to test the implementation strategy.Methods: In a counterbalanced implementation study, the implementation strategy (independent variable) has two or more levels evaluated across an equivalent number of health contexts (e.g. community-acquired pneumonia and nutrition for critically ill patients) using the same outcome (dependent variable). This design limits each cluster to one distinct strategy related to one specific context, and therefore does not overburden any cluster to more than one focussed implementation strategy for a particular outcome, and provides a ready-made control comparison, holding fixed. The different levels of the independent variable can be delivered concurrently because each level uses a different health context within each cluster to avoid the effect of treatment contamination from exposure to the intervention or control condition.Results: An example application of the counterbalanced implementation design is presented in a hypothetical study to demonstrate the comparison of 'video-based' and 'written-based' evidence summary research implementation strategies for changing clinical practice in community-acquired pneumonia and nutrition in critically ill patient health contexts.Conclusion: A counterbalanced implementation study design provides a promising model for concurrently investigating the success of research implementation strategies across multiple health context areas such as community-acquired pneumonia and nutrition for critically ill patients. [ABSTRACT FROM AUTHOR]

Background At present there is no clear evidence to support any one particular intervention for engaging adults with chronic health issues in ongoing exercise. An understanding of consumer perceptions and preferences is important, because low rates of exercise adherence are likely to limit any benefits obtained. Objective To identify and compare participants’ perceptions about their own motivation, capacity and opportunity to adhere to an allocated exercise program during either a gym-based or a home-based exercise program with telephone follow-up. Method/design This qualitative study used convenience sampling to recruit participants (adults with chronic health issues) immediately after a randomised controlled trial comparing gym-and home-based exercise programs conducted for 12 months. Ten people, five from each intervention group, attended face–to- face semi-structured interviews at a local Community Health Service. Thematic analysis methods were used to analyse the dataset. Results Improved social interaction in the gym-based program was seen to contribute to adherence, however home-based programs were perceived as more convenient and easily integrated into daily routines. Individualized exercise prescription by a health professional with regular follow up (in person or by telephone) promoted an active practitioner-participant relationship. Health coaching combined with exercise was perceived to improve self-efficacy and assisted with the removal of intrinsic and extrinsic exercise barriers. Conclusion This research presented many common and different themes in participant’s motivation, capacity and opportunity in sustained adherence to a gym or home-based exercise program. However, this study found no superior intervention or individual preference to improve ongoing exercise adherence. [ABSTRACT FROM AUTHOR]