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Despite well-documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long-term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate-certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time.

Objective To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. Design A randomized controlled trial with embedded qualitative analysis. Setting Community. Participants Aged at least 60 years and living in the community after hip fracture. Interventions In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. Main outcome measures Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. Results Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2–13). There were no between-group differences in mobility, walking confidence or quality of life. Conclusion A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.

Background Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID) PRR1-10.2196/38553

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise–based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. OBJECTIVE We aimed to evaluate the efficacy of a group exercise–based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. RESULTS The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr INTERNATIONAL REGISTERED REPORT PRR1-10.2196/38553

Introduction As part of hospital discharge planning, occupational therapists often provide recommendations to improve the interaction between a person and their home environment. The aim of this study was to investigate the number and type of recommendations made by occupational therapists during a home assessment visit compared to hospital-based assessment for patients recovering from hip fracture. A secondary aim was to explore adherence rates to the different types of recommendations. Methods Process evaluation of a randomised controlled trial of 65 participants recovering from hip fracture, returning to community living after hospital discharge. All participants received inpatient multidisciplinary rehabilitation and hospital-based assessment by an occupational therapist (usual care). In addition, the intervention group participated in a single home visit with an occupational therapist prior to hospital discharge. Analysis included the number and type of occupational therapy recommendations, adherence to recommendations at 30 days after discharge, and mediation analysis. Results Participants in the home visit group received more recommendations than the usual care group (mean difference [MD] 2.8, 95% CI 1.6 to 3.9) and adhered to a greater proportion of recommendations for assistive technologies (MD 11.4%, 95% CI 2.6 to 20.2) and task modifications (MD 10.0%, 95% CI 0.7 to 19.3). Participants in both groups had lower rates of adherence to recommendations for home modifications compared with other types of recommendations. Adherence to recommendations was a mediator in the relationship between participants' involvement in a pre-discharge home visit and reduced hospital readmissions. Conclusion There was greater adherence to occupational therapy recommendations when patients recovering from hip fracture participated in a home visit compared to hospital-based assessment, contributing to reduced readmissions to hospital in the first 30 days. Home visits offer additional benefits to hospital-based assessment through the use of a collaborative approach to decision making in the home environment.

Background Long waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system. Methods A stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network. Results The intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments. Conclusions Broad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations.

Background: Waiting lists are often thought to be inevitable in healthcare, but strategies that address patient flow by reducing complexity, combining triage with initial management, and/or actively managing the relationship between supply and demand can work. One such model, Specific Timely Appointments for Triage (STAT), brings these elements together and has been found in multiple trials to reduce waiting times by 30–40%. The next challenge is to translate this knowledge into practice.Method: A multi-faceted knowledge translation strategy, including workshops, resources, dissemination of research findings and a community of practice (CoP) was implemented. A mixed methods evaluation of the strategy was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, drawing on an internal database and a survey of workshop and CoP participants.Results: Demonstrating reach, at July 2020 an internal database held details of 342 clinicians and managers from 64 health services who had participated in the workshop program (n = 308) and/or elected to join an online CoP (n = 227). 40 of 69 (58%) respondents to a survey of this population reported they had adopted the model, with some providing data demonstrating that the STAT model had been efficacious in reducing waiting time. Perceived barriers to implementation included an overwhelming existing waiting list, an imbalance between supply and demand and lack of resources.Conclusion: There is high quality evidence from trials that STAT reduces waiting time. Using the RE-AIM framework, this evaluation of a translation strategy demonstrates uptake of evidence to reduce waiting time in health services.

BACKGROUND Access to rehabilitation to support cancer survivors to exercise is poor. Exercise-based rehabilitation may be delivered remotely but it is unknown how it compares to in-person cancer rehabilitation. OBJECTIVE To evaluate the effectiveness of an exercise-based cancer rehabilitation program delivered via telehealth compared to a traditional in-person model for improving quality of life of cancer survivors. METHODS A parallel, assessor-blinded, pragmatic, non-inferiority randomised controlled trial with embedded cost-effectiveness and qualitative analysis will be completed. One-hundred and twenty-four cancer survivors will be recruited from a metropolitan health network in Melbourne, Australia. The experimental group will attend an 8-week, twice weekly, 60-minute, exercise group supervised via videoconferencing supplemented by an online home exercise program and information portal. The comparison group will attend an 8-week, twice weekly, 60-minute, supervised exercise group in person, supplemented by a written home exercise program and information booklets. Assessments will be completed at week 0 (baseline), week 9 (post-intervention) and week 26 (follow-up). The primary outcome will be health related quality of life measured by the EORTC QLQ-C30 at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire) and recording of adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semi-structured interviews will be completed and analysed using a framework approach to determine the impact of delivery mode on patient experience. The primary outcome will be analysed using linear mixed effects models. RESULTS Trial not yet recruiting. Anticipated commencement January 2022. CONCLUSIONS This trial will inform the future implementation of cancer rehabilitation by providing important data about safety, effectiveness, cost and patient experience. CLINICALTRIAL The TeleCaRe Trial has been approved by the Eastern Health Human Research Ethics Committee (E21-012-74698) and is funded by the Victorian Cancer Agency. This trial is prospectively registered with the Australian New Zealand Clinical Trials Registry ACTRN12621001417875. Registered 21st October, 2021.

BACKGROUND Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. OBJECTIVE Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. METHODS A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. RESULTS The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). CONCLUSIONS Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation.

INTRODUCTION A range of activities are conducted in health care settings aiming to improve health care processes and outcomes. In many settings, these activities are classified into two broad domains of "quality improvement" and "health services research" each with its own methods, continuing education, support structures, and governance systems. We aimed to explore differences and similarities in the purpose, methods, and outcomes of approved allied health projects conducted under each of these domains at a large metropolitan health network. METHOD Using observational methods, we evaluated allied health quality improvement and research projects approved through the relevant governance systems in a single health network during a 12-month reporting period. Project leaders were surveyed, and project documentation was evaluated using the SQUIRE tool. RESULTS Allied health professionals were motivated to undertake both quality improvement (n = 13) and research projects (n = 15) to improve health care. Research projects were more likely to be disseminated externally, but quality improvement projects were more frequently reported to result in internal practice change. Methods were well documented for research projects, but this information was frequently lacking for quality improvement projects. Research projects were also more likely to be supported by external funding than quality improvement projects. IMPLICATIONS Allied health clinicians conducting improvement activities using research and quality improvement projects share common goals. There are likely to be opportunities to enhance value and implementation of findings into practice by bridging the divide between health service research and quality improvement activities in health networks.

IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation.Methods and analysisAn assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews.Ethics and disseminationEthical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars.Trial registration numberACTRN12619000936123.

Background Managing demand for services is a problem in many areas of healthcare, including specialist medical outpatient clinics. Some of these clinics have long waiting lists with variation in access for referred people. A model of triage and appointment allocation has been developed and tested that has reduced waiting times by about a third in community outpatient services. This study aims to determine whether the model can be applied in the setting of a specialist medical outpatient clinic to reduce wait time from referral to first appointment. Methods A pre-post study will collect data before and after implementing the Specific Timely Appointments for Triage (STAT) model of access and triage. The study will incorporate a pre-implementation period of 12 months, an implementation period of up to 6 months and a post STAT-implementation period of 6 months. The setting will be the epilepsy clinic at a metropolitan health service in Melbourne. Included will be all people referred to the clinic, or currently waiting, during the allocated periods of data collection (total sample estimated n = 975). Data routinely collected by the health service and qualitative data from staff will be analysed to determine the effects of introducing the STAT model. The primary outcome will be wait time, measured by number of patients on the wait list at monthly time points and the mean number of days waited from referral to first appointment. Secondary outcomes will include patient outcomes, such as admission to hospital while waiting, and service outcomes, including rate of discharge. Analysis of the primary outcome will include interrupted time series analysis and simple comparisons of the pre and post-implementation periods. Process evaluation will include investigation of the fidelity of the intervention, adaptations required and qualitative analysis of the experiences of clinic staff. Discussion Prompt access to service and optimum patient flow is important for patients and service providers. Testing the STAT model in a specialist medical outpatient clinic will add to the evidence informing service providers and policy makers about how the active management of supply and demand in health care can influence wait times. The results from this study may be applicable to other specialist medical outpatient clinics, potentially improving access to care for many people.

Background Specific Timely Appointments for Triage (STAT) is an intervention designed to reduce waiting time in community outpatient health services, shown to be effective in a large stepped wedge cluster randomised controlled trial. STAT combines initial strategies to reduce existing wait lists with creation of a specific number of protected appointments for new patients based on demand. It offers an alternative to the more traditional methods of demand management for these services using waiting lists with triage systems. This study aimed to explore perceptions of clinicians and administrative staff involved in implementing the model. Method Semi-structured interviews with 20 staff members who experienced the change to STAT were conducted by an independent interviewer. All eight sites involved in the original trial and all professional disciplines were represented in the sample. Data were coded and analysed thematically. Results Participants agreed that shorter waiting time for patients was the main advantage of the STAT model, and that ongoing management of caseloads was challenging. However, there was variation in the overall weight placed on these factors, and therefore the participants’ preference for the new or previous model of care. Perceptions of whether the advantages outweighed the disadvantages were influenced by five sub-themes: staff perception of how much waiting matters to the patient, prior exposure to the management of waiting list, caseload complexity, approach and attitude to the implementation of STAT and organisational factors. Conclusions The STAT model has clear benefits but also presents challenges for staff members. The findings of this study suggest that careful preparation and management of change and active planning for known fluctuations in supply and demand are likely to help to mitigate sources of stress and improve the likelihood of successful implementation of the STAT model for improving waiting times for patients referred to community outpatient services.

Background Falls in hospital are common and serious complications of stroke. Associations have been found between communication disorders and increased rates of falls, but have received relatively little consideration as a risk factor for falls among stroke survivors. Objectives To investigate whether there is an association between severe communication impairment and falls among patients receiving inpatient rehabilitation after stroke. Methods A retrospective audit of 149 records of consecutive patients admitted to an inpatient rehabilitation facility after stroke over a two-year period was conducted. The relationship between falls and severe communication impairment was explored using (1) direct comparison of falls in patients with and without functional communication for the inpatient ward environment and (2) multivariate logistic regression to examine factors that may predict falls, including presence or absence of functional communication. In each analysis, falls were examined both as a binary outcome (fall or no fall), and the rate of falls per day. Results The 32 patients in the sample (21.7%) who were unable to communicate their basic needs were almost twice as likely to fall in hospital as those with functional communication (RR 1.94, 95% CI 1.15 to 3.24). Several commonly assessed factors were not significant predictors of falls (including falls history, polypharmacy, and cognitive impairment) in this population. Lack of functional communication was the strongest independent predictor of falls rate. Conclusions Findings suggest that severe communication disorders may be under recognized as a falls risk factor after stroke.

Purpose: Clinical supervision is widely accepted as an important element of practice for allied health professionals to ensure a high quality of patient care. However, it is unknown whether effecti...

Objective: To determine whether patients have better outcomes when exercise instructions are provided using multimedia approaches compared with verbal or written instructions. Data sources: Electronic databases (MEDLINE, EMBASE, CINAHL, and PsychInfo) searched up to October 2018. Study selection: Randomized controlled trials exploring exercise-based interventions for health conditions, and comparing instructions provided using multimedia approaches with conventional verbal or written instructions. Results: Fourteen trials from seven countries were included, with a total of 2156 participants. Diagnoses included orthopaedic, neurological, pulmonary, cardiac, and women’s health conditions. A meta-analysis of three trials (140 participants) provided very low-quality evidence that multimedia exercise instructions may be more effective than written instructions in improving exercise adherence (standardized mean difference (SMD) 0.60, 95% confidence interval (CI) –0.06 to 1.25). Two of nine trials that could not be included in the meta-analysis for adherence due to heterogeneity reported that multimedia exercise instructions were more effective than written instructions in improving exercise adherence. Four other meta-analyses (three trials each) found low- to high-quality evidence that provision of exercise instructions using multimedia is no more beneficial than paper-based instructions for patient-related outcomes of pain intensity (SMD 0.09, 95% CI –0.47 to 0.28); uptake of physical activity (SMD 0.07, 95% CI −0.08 to 0.23); or physical (SMD 0.21, –0.21 to 0.64) or emotional (SMD 0.16, 95% CI −0.04 to 0.36) domains of health-related quality of life. Conclusion: Multimedia approaches to exercise instruction may result in increased adherence compared with instructions provided in written or verbal format, but there is insufficient evidence to determine whether this results in improved patient outcomes.

Objective To determine the association between delays in access to specialist epilepsy care and patient outcomes. Methods Three databases were searched using eligibility criteria related to the concepts of timely access, epilepsy, and clinical outcome. Comparative data on patient outcomes by time to treatment was required for inclusion. Studies were selected independently by two researchers who reviewed title/abstract, then full text articles. Data were extracted and risk of bias was evaluated. Results were synthesized in random effects model meta-analyses, and strength of the body of evidence was evaluated. Descriptive analysis was conducted for studies not included in meta-analyses. Results Thirty-five studies, reported in 40 papers, were included. The studies investigated impact of delays in diagnosis, commencement of medication, or surgery for children and adults. Early diagnosis and access to specialist neurology care was associated with improvements in seizure status, development, and/or intelligence quotients. Meta-analyses provided low to high certainty evidence of increased odds of improved seizure outcome with early commencement of medication depending on follow-up period and individual risk factors. There was moderate certainty evidence that people with favorable seizure outcomes wait less time (MD 2.8 years, 95% CI 1.7–3.9) for surgery compared to those with unfavorable outcomes. Significance This review provides evidence that earlier access to specialist epilepsy care for diagnosis, commencement of medication, and surgery is associated with better patient outcomes.

Background Low physical activity levels are a major problem for people in hospital and are associated with adverse outcomes. Objective This systematic review, meta-analysis and meta-regression aimed to determine the effect of behaviour change interventions on physical activity levels in hospitalised patients. Methods Randomised controlled trials of behaviour change interventions to increase physical activity in hospitalised patients were selected from a database search, supplemented by reference list checking and citation tracking. Data were synthesised with random-effects meta-analyses and meta-regression analyses, applying Grades of Recommendation, Assessment, Development and Evaluation criteria. The primary outcome was objectively measured physical activity. Secondary measures were patient-related outcomes (e.g. mobility), service level outcomes (e.g. length of stay), adverse events and patient satisfaction. Results Twenty randomised controlled trials of behaviour change interventions involving 2,568 participants (weighted mean age 67 years) included six trials with a high risk of bias. There was moderate-certainty evidence that behaviour change interventions increased physical activity levels (SMD 0.34, 95% CI 0.14–0.55). Findings in relation to mobility and length of stay were inconclusive. Adverse events were poorly reported. Meta-regression found behaviour change techniques of goal setting (SMD 0.29, 95% CI 0.05–0.53) and feedback (excluding high risk of bias trials) (SMD 0.35, 95% CI 0.11–0.60) were independently associated with increased physical activity. Conclusions Targeted behaviour change interventions were associated with increases in physical activity in hospitalised patients. The trials in this review were inconclusive in relation to the patient-related or health service benefits of increasing physical activity in hospital.

Introduction There is growing interest in developing research culture and opportunities for allied health professionals working in medical imaging. However, little attention has been given to identifying the research interest and needs of this group relative to the other allied health professions. We aimed to measure self‐reported research participation, interest, experience and confidence of allied health professionals working in medical imaging and compare the findings to clinicians working in allied health therapies. Methods A cross‐sectional survey of allied health professionals from medical imaging (radiographers, sonographers and nuclear medicine technologists) was conducted. The primary outcome, the Research Spider survey, measures 10 domains of research interest/experience/confidence on a 5‐point Likert scale. Results were compared to allied health therapy data. Results Responses were received by 82 medical imaging allied health professionals (65% response rate). Overall, medical imaging professionals rated themselves as having ‘some interest’ and ‘little experience or confidence’ in research. There was no difference in interest, experience and confidence among different imaging professions (interest P = 0.099, experience P = 0.380, confidence P = 0.212) or allied health therapists (interest P = 0.137, experience P = 0.363, confidence P = 0.791). Participants reported greatest interest in finding and reviewing literature and lowest interest in applying for funding. Conclusion There are strong similarities between medical imaging allied health professionals and allied health therapy professionals. Therefore, strategies used to promote research culture in allied health therapy professions could be leveraged to provide opportunities for medical imaging allied health professionals., Allied health professionals working in medical imaging have low levels of participation in research. They report having some research interest, but low levels of experience or confidence. Therefore, medical imaging professionals who are interested in research may benefit from training and support in clinical research that have been proven successful in other allied health professions

PurposeLong waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.Design/methodology/approachThis observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).FindingsOver an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.Practical implicationsThis waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.Originality/valueAlthough there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.

Background Timely access is a challenge for providers of outpatient and community-based health services, as seen by the often lengthy waiting lists to manage demand. The Specific Timely Appointments for Triage (STAT) model, an alternative approach for managing access and triage, reduced waiting time by 34% in a stepped wedge cluster randomised controlled trial involving 8 services and more than 3000 participants. Follow up periods ranged from 3 to 10 months across the participating services in accordance with the stepped wedge design. This study aimed to determine whether outcomes were sustained for a full 12 months after implementation of the STAT model at each site. Methods Routinely collected service data were obtained for a total of 12 months following implementation of the STAT model at each of the 8 services that participated in a stepped wedge cluster randomised controlled trial. The primary outcome was time to first appointment. Secondary outcomes included non-attendance rates, time to second appointment and service use over 12 weeks. Outcomes were compared to pre-intervention data from the original trial, modelled using generalised linear mixed effects models accounting for clustering of sites. Results A 29% reduction in waiting time could be attributed to STAT over 12 months, compared to 34% in the original trial. A reduction in variability in waiting time was sustained. There were no significant changes in time to second appointment or in the number of missed appointments in the extended follow up period. Conclusions STAT is an effective strategy for reducing waiting time in community-based outpatient services. At 12 months, small reductions in the overall effect are apparent, but reductions in variability are sustained, suggesting that people who previously waited the longest benefit most from the STAT model. Trial registration This is a 12-month follow up of a stepped wedge cluster randomised controlled trial that was registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12615001016527).

Background and purpose To investigate whether physical activity levels are predictive of short-term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short-term recovery in physical activity, physical function, walking confidence, health-related quality of life and walking participation. Methods This prospective cohort study comprised 57 older adults (39 females, mean age 80.4, SD 8.4 years) living independently in the community after hip fracture. Accelerometer-based physical activity, physical function (Functional Independence Measure [FIM], de Morton Mobility Index, Frenchay Activities Index and Participation in outdoor walking), walking confidence and health-related quality of life were measured after discharge from rehabilitation services (baseline) and 12 weeks later. Multiple linear regression analyses determined the ability of physical activity (daily steps), walking self-confidence, health-related quality of life and demographic factors (age, sex and time since fracture) to predict Week 12 physical function using Week 0 physical function as a covariate. Results Participants at baseline averaged 4439 daily steps which did not change 12 weeks later. There were small increases in all measures of physical function and walking confidence, but not health-related quality of life. Increased walking self-confidence was associated with an increase in FIM total, FIM mobility and de Morton Index scores. Physical activity did not predict change in measures of physical function. Conclusions Walking confidence of adults discharged from rehabilitation services after hip fracture had a greater association with short-term recovery of physical function than level of physical activity. Community-dwelling adults continue to make small short-term improvements in physical function and walking confidence after discharge home and withdrawal of rehabilitation services.

BackgroundFalls are a common safety incident in people with stroke. Studies report that between 14% and 65% of people with stroke fall at least once during their hospital admission. Risk factors for falls in people with stroke have been reported to include neglect, balance and dependence for activities of daily living. Communication disability has been identified as a risk factor for patient safety incidents in hospital that has not been closely examined as a potential risk factor for falls in people with stroke.AimTo determine the association between communication disability secondary to stroke and falls in people with stroke in hospital.Methods & proceduresSystematic searches of five electronic databases were conducted in June 2019 using the key concepts of 'falls' and 'stroke' (PROSPERO CRD 42019137199). Included studies provided comparative data of falls in patients with stroke with and without communication disability. The methodological quality of the studies was examined using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Both a narrative synthesis and a meta-analysis were completed.Main contributionA total of 15 studies met the criteria for inclusion and 11 were included in a meta-analysis. Three studies found people with communication disability had an increased rate of falls in hospital. However, a meta-analysis showed no significant association between a non-specific classification of communication disability and an increased risk of falls. There was some indication from individual studies that higher risk of falls may be associated with severe communication disability, but there were insufficient data reported on the severity of the communication disability to draw robust conclusions.Conclusion & implicationsThe results of this systematic review suggest that a generic classification of communication disability following stroke is not a risk factor for falls. However, further research that is inclusive of this population and considers severity of communication disability more specifically is required. What this paper adds What is already known on the subject The association between communication disability following stroke and falls in hospital is unclear. The literature reports mixed results regarding the impact of a communication disability following stroke on falls risk or rates of falls during hospital admission. What this paper adds to existing knowledge This review is the first to bring together this diverse literature to examine the association between communication disability following stroke and falls in hospital. The results suggest that a generic classification of communication disability following stroke is not a risk factor for falls. What are the potential or actual clinical implications of this work? There is a possibility that moderate to severe communication disability may be related to falls in patients in hospital. Further research is indicated to be more inclusive of people with communication disability, including those with severe communication disability.

Background/aim The National Stroke Foundation recommends that Occupational Therapists use Constraint-Induced Movement Therapy (CIMT) with stroke survivors that experience an upper limb deficit. CIMT involves constraining the unaffected upper limb coupled with intensive therapy. The aim of this study was to evaluate the feasibility and effectiveness of a modified, low intensity version of CIMT (mCIMT) provided within usual resources of an Australian community rehabilitation setting. Methods A pilot randomised control trial (n = 19) was conducted with stroke survivors referred for community rehabilitation. Participants were randomly assigned to either mCIMT or usual care. Both groups received six one-hour outpatient Occupational Therapy sessions (focussed on upper limb rehabilitation) over a two-week period. The intervention group (mCIMT) were asked to wear a constraint device on their unaffected hand for 90% of their waking hours and were provided with a home exercise program based on CIMT principles. Participants were included if they had some active upper limb movement, no significant cognitive deficits and sufficient balance. Outcome measures included upper limb function (WMFT) and participation (MAL) evaluated at baseline, immediately following the two-week intervention period and at four-week follow-up. Results Only a very small proportion of patients met the eligibility criteria. There were no differences between groups, with the exception of a small increase in reported upper extremity use in functional tasks at post-intervention assessment when compared to the usual care group. Conclusions Modified CIMT can be applied to a typical Australian community rehabilitation setting, to treat upper limb deficits in stroke survivors. The resources used for mCIMT largely equalled usual care, with no differences in outcomes, suggesting that the intervention is feasible and potentially beneficial. However, there were very few stroke survivors who met participation criteria, indicating that demand for the intervention is limited.

Introduction The aim of this study was to determine the rate of readmission to hospital after hip fracture. The relationship between readmission to hospital and a range of social and functional variables, including receiving a home visit by an occupational therapist prior to discharge from hospital, was explored. Method A retrospective cohort study was conducted of 154 patients returning to community living following hip fracture. Multivariate logistic regression identified variables associated with risk of readmission to hospital. Results One in three patients was readmitted to hospital within 12 months after discharge, with 7% readmitted within 30 days. The most common reason for readmission was another fall. A low level of mobility prior to hip fracture was the strongest independent predictor of risk of readmission to hospital. There was no association between receiving a pre-discharge home visit by an occupational therapist and risk of readmission to hospital. Conclusion Rates of readmission to hospital are high after hip fracture, and falls are the single most common reason for readmission. Interventions provided by occupational therapists, including home visits, should emphasise and incorporate evidence-based falls prevention strategies.

Background Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). Conclusions Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation.

ObjectivesTimely access to outpatient services is a major issue for public health systems. To address this issue, we aimed to establish the return on investment to the health system of the implementation of an alternative model for access and triage (Specific Timely Appointments for Triage: STAT) compared with a traditional waitlist model.DesignUsing a prospective pre–post design, an economic analysis was completed comparing the health system costs for participants who were referred for community outpatient services post-implementation of STAT with a traditional waitlist comparison group.SettingEight community outpatient services of a health network in Melbourne, Australia.ParticipantsAdults and children referred to community outpatient services.InterventionsSTAT combined targeted activities to reduce the existing waiting list and direct booking of patients into protected assessment appointments. STAT was compared with usual care, in which new patients were placed on a waiting list and offered appointments as space became available.OutcomesHealth system costs included STAT implementation costs, outpatient health service use, emergency department presentations and hospital admissions 3 months before and after initial outpatient appointment. Waiting time was the primary outcome. Incremental cost-effectiveness ratios (ICERs) were estimated from the health system perspective.ResultsData from 557 participants showed a 16.9 days or 29% (pConclusionsThere was a significant reduction in waiting time with the introduction of STAT at minimal cost to the health system.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12615001016527).

Objective Personal computers provide an increasingly accessible resource for leisure, social engagement and activities of daily living. This systematic review aimed to explore preventative or therapeutic benefits of such technology in people at risk of, or living with, dementia. Methods A systematic search of health databases combined key concepts of dementia and computer use. Inclusion criteria were applied, studies appraised for quality and results synthesised descriptively. Results Nine studies met inclusion criteria: Four population-based studies and five small observational/intervention studies. Findings show an association between computer use in older age and decreased risk of dementia and provide preliminary evidence that computer-based activity interventions are feasible and enjoyable for people with dementia. Conclusion Early findings are promising, but more rigorous studies are required to examine the nature of the relationship between computer use and dementia risk, and the potential of computer activities to improve outcomes for people experiencing cognitive decline.

Objective: To determine whether patients with stroke receiving rehabilitation for upper limb deficits using smart technology (video and reminder functions) demonstrate greater adherence to prescribed home exercise programmes and better functional outcomes when compared with traditional paper-based exercise prescription. Design: Randomized controlled trial comparing upper limb home exercise programmes supported by video and automated reminders on smart technology, with standard paper-based home exercise programmes. Setting: A community rehabilitation programme within a large metropolitan health service. Subjects: Patients with stroke with upper limb deficits, referred for outpatient rehabilitation. Interventions: Participants were randomly assigned to the control (paper-based home exercise programme) or intervention group (home exercise programme filmed on an electronic tablet, with an automated reminder). Both groups completed their prescribed home exercise programme for four weeks. Main measures: The primary outcome was adherence using a self-reported log book. Secondary outcomes were change in upper limb function and patient satisfaction. Results: A total of 62 participants were allocated to the intervention ( n = 30) and control groups ( n = 32). There were no differences between the groups for measures of adherence (mean difference 2%, 95% CI −12 to 17) or change in the Wolf Motor Function Test log transformed time (mean difference 0.02 seconds, 95% CI −0.1 to 0.1). There were no between-group differences in how participants found instructions ( p = 0.452), whether they remembered to do their exercises ( p = 0.485), or whether they enjoyed doing their exercises ( p = 0.864). Conclusions: The use of smart technology was not superior to standard paper-based home exercise programmes for patients recovering from stroke. This trial design was registered prospectively with the Australian and New Zealand Clinical Trials Register, ID: ACTRN 12613000786796. http://www.anzctr.org.au/trialSearch.aspx

Assess the barriers and facilitators to implementing an exercise-based rehabilitation program in an acute setting for cancer survivors receiving treatment. A qualitative study using individual semi-structured interviews and focus groups was completed with 25 clinicians working in oncology and 9 patients receiving cancer treatment who were purposively sampled at a tertiary hospital. Interviews were audio-recorded and transcribed verbatim with coding completed independently by two reviewers and confirmed by a third reviewer, followed by thematic analysis. The main theme was finding the ‘right time’ for rehabilitation. Exercise-based rehabilitation was seen as important to deliver in the acute cancer treatment setting but challenging due to patient factors such as feeling overwhelmed and health service constraints. Barriers and facilitators to acute exercise-based rehabilitation were raised under four sub-themes: attitudes, knowledge, convenience and resources. There was agreement among both patients and clinicians around the main themes. Implementing exercise-based rehabilitation in the acute cancer treatment setting is viewed as necessary but challenging to implement. Positive attitudes towards exercise-based cancer rehabilitation services from staff and patients in this study are at odds with current levels of service delivery. This study provides evidence for why this might be the case, and can be used to inform the design of future models of rehabilitation in the acute treatment setting to meet the needs of this patient group.

To compare resources required to provide paper-based versus videoed instructions for home exercises in rehabilitation.An observational cohort study included twenty-two allied health professionals (physiotherapists [A total of 128 initial home exercise instructions were provided to 110 patients, with 36 patients reviewed at least once. Each initial exercise instruction provided using electronic devices saved 5.5 min (95% CI 0.5 to 10.5) with a cost saving of Australian dollar $4.70 (95% CI -8.89 to -0.52) compared with paper-based instructions. There were no significant cost differences (MD $1.16 95% CI -3.87 to 6.18) between modes for exercise review.Home exercise instructions provided on electronic devices cost less than paper-based instructions when patients are using their own smart devices.Implications for rehabilitationCosts are minimised when home exercise instructions are provided using the video function of the patient's own electronic devices compared with paper-based instructions.Since patient outcomes appear to be similar with instructions provided in electronic or paper-based mode, exercise instructions in community rehabilitation should be provided using the video function of electronic devices where these are available.

Purpose: To determine if the addition of direct supervision to usual clinical supervision practice of physiotherapists can improve compliance with clinical practice guidelines and post-surgical out...

Objective: The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hip fracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home. Design: A randomized controlled trial was conducted. Setting: The study setting included hospital wards and the community. Participants: The study included adults 50 years and over recovering from hip fracture ( n = 77). Intervention: Both groups received inpatient rehabilitation and hospital-based discharge planning. In addition, the intervention group received a home assessment visit by an occupational therapist prior to discharge from hospital. Main measures: Primary outcomes were falls and hospital readmissions. Secondary outcome measures included Functional Independence Measure, Functional Autonomy Measurement Scale, Nottingham Extended Activities of Daily Living Scale, EuroQol five dimension scale questionnaire and Falls Efficacy Scale-International. Results: The intervention group had fewer hospital readmissions in the first 30 days compared to the control group (intervention n = 1, control n = 10; odds ratio (OR) 12.9, 95% confidence interval (CI) 1.5 to 99.2). The intervention group was observed to have fewer falls than controls in the 30 days after discharge (intervention n = 6, control n = 14; incidence rate ratio (IRR) = 0.41, 95% CI 0.15 to 1.11). Between-group differences favoured the intervention group for functional independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences. Conclusion: Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hip fracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge.

Purpose Prompt access to specialist assessment is critical after a first suspected seizure. We aimed to test the feasibility of providing this service via telehealth, compared with usual care (face-to-face appointment) in patients referred to a first seizure clinic. Method This feasibility study was a prospective mixed-methods non-randomised controlled design in a single centre. Patients referred to the first seizure clinic chose to receive their consultation by telehealth (intervention group) or face-to-face (usual care). Demand, practicality, acceptability and limited-efficacy testing were assessed using recruitment and routinely collected clinic data, participant surveys and a clinician focus group. Results Telehealth in the first seizure clinic was feasible; however, internet connection, computer hardware and software, patient confidence and organisational support impacted on practicality. Of patients who were eligible for telehealth, 25 % chose to use telehealth for their appointment, with more women taking up the opportunity. Geography and age were not factors in likelihood of uptake. There was no significant between-group difference found in acceptability and limited efficacy measures conducted. Conclusion Telehealth is a responsive and convenient way to reach some patients who face barriers in access to specialist neurology assessment following a first suspected seizure.

Background/aim Home visits by occupational therapists are a routine part of practice, but there remains little understanding about factors that are associated with the decision to complete a home visit. The aim of this study was to investigate the rate of pre-discharge home visits by occupational therapists for patients following hip fracture and explore factors associated with their occurrence. Methods A retrospective cohort study including 293 patients admitted to a metropolitan health service following hip fracture. Multi-variate logistic regression was used to identify significant variables associated with receiving a home visit. Results Home visits were conducted by occupational therapists for 28% of patients admitted from a private residence, and for less than 5% of patients admitted from low-level residential care facilities. The variables significantly associated with receiving a home visit at a private residence were older age and being admitted to a rehabilitation ward, but the model only explained between 9% and 13% of the variance. Other clinical and socio-demographic variables evaluated were not associated with the provision of a home visit. Conclusions About one in four people admitted to hospital from a private residence following hip fracture receive a home visit. The results suggest that whether or not a patient receives a home visit has little to do with socio-demographic or clinical factors at the time of admission to hospital. There remains much unexplained variation in whether or not a patient receives a home visit and this study highlights the diversity that exists in clinical practice.

© 2020 AHHA Open Access. Objective: This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods: A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results: In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%) researchers affiliated with health services were less likely to report access to statisticians (P < 0.001), economists (P < 0.001), librarians (P = 0.02) and practice change experts (P = 0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions: The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic?: HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add?: Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners?: Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR.

Objective: To assess the effect of Saturday allied health services on a geriatric evaluation and management ward. Methods: A controlled before‐and‐after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre‐intervention (N = 331) and intervention (N = 462). Results: Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7‐10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6‐5.7) and no difference in the proportion discharged home. Cost‐effectiveness demonstrated no significant difference in cost ($2639, 95% CI $‐386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8‐6.5) favouring the experimental ward. Conclusion: These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay.

Background Allied health professionals working in rehabilitation often prescribe home exercise programs. Smart technology offers an alternative format for presentation of home exercise programs with potential advantages over traditional paper-based programs, but how do patients feel about this? Design This qualitative analysis was part of a convergent mixed methods design, using in depth, semi-structured interviews to explore the lived experience of patients utilising touch screen tablets to support an upper limb home exercise program post stroke. Methods Ten male participants with stroke and upper limb impairment who received home exercise programs using video and reminders on tablet computers participated. Interviews were transcribed and analysed thematically. Results There were three main themes: (1) exercises on the tablet helped patients’ recovery in a variety of ways; (2) everyone could use the tablet for their home exercise program; but (3) not everyone liked using the tablet. Conclusions and significance of the study Smart technology is increasingly accessible and provides a novel, convenient way to provide home exercise programs post stroke with a number of benefits. This technology is not for everyone, but may be well suited to patients who already own and use these devices in daily life. Automated reminders were not viewed as a useful reminder tool.

Aim: Measuring outcomes is important in community rehabilitation programs (CRPs), both at the individual and service level. Identifying global outcome measures that can be used for all patients is challenging given the diversity of this client group. Method: This observational study explored measurement properties of the Modified Efficacy Scale (MES), which is an adaptation of the Modified Falls Efficacy Scale. The MES was used to assess patient confidence in performing activities without reference to falls and was trialled with 221 CRP patients. Floor and ceiling effects, responsiveness to change and minimal clinically important difference (MCID) scores were measured and compared with scores for the same sample of patients using the Lawton Instrumental Activities of Daily Living (IADL) scale. Results: The MES showed evidence of convergent validity and was responsive to change. Both scales showed ceiling effects on discharge, although this was more pronounced with the Lawton IADL scale (40%) than the MES (21%). Both scales had small values for MCID relative to scale width. Conclusions: The MES demonstrated evidence of validity and has a less pronounced ceiling effect compared with the Lawton IADL scale. The implications of a ceiling effect should be considered in the context of the assessment purpose.