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Private hospitals in Australia manage 11% of acute and 48% of rehabilitation stroke admissions, yet little is known about implementation of stroke clinical guidelines in this setting. Clinical guidelines recommend that acute stroke patients be co-located in a stroke unit in a geographically defined area, rather than dispersed across the hospital.To investigate post-intervention adherence to clinical guidelines for stroke management, and to explore staff barriers and facilitators to guideline implementation.Observational study before-and-after local implementation of Australian stroke clinical guidelines. The primary outcome was a change in the proportion of patients who were physically co-located in an acute stroke unit. Secondary outcomes included changes in adherence to additional acute and rehabilitation guideline criteria, and staff identification of barriers and facilitators to guide implementation. Data were collected from medical record audits, health service information and staff surveys.Co-location in an acute stroke unit did not change significantly after guideline implementation (49% adherence pre-intervention and 54% post-intervention). Across acute and rehabilitation wards, 15% (11/72) of guideline criteria improved (p .05). These related to assessments of swallowing and neglect, presence of a stroke care co-ordinator and occupational therapist, post-discharge care plan, provision of patient education and return to driving. Facilitators to guideline implementation included staff education, collaboration, and dissemination of user-friendly stroke policies.Stroke clinical guideline implementation led to a favorable uptake of some criteria, yet not all. Implementation was assisted by staff education, user-friendly stroke policies and multidisciplinary team collaboration.ANZCTR: registration number ACTRN12616000646448 (http://www.ANZCTR.org.au/ACTRN12616000646448.aspx).

To investigate the feasibility and preliminary effects of Pilates exercises in primigravida women.Single-blind randomized controlled feasibility trial.Community Pilates classes.Low-risk pregnant women.Pregnant women were randomly assigned to Pilates exercises (experimental) group for 6 consecutive weeks or usual antenatal care, the control group.The primary outcome was feasibility of Pilates classes. Secondary outcomes included quality of life, pain, and mobility.21 women were recruited to the trial. Eleven were randomly allocated to the experimental group and 10 to the control group. Retention of participants was excellent for the Pilates group (100%) compared to 70% in the control group. There were no adverse events. The Pilates group showed greater gains in quality of life on the SF-12 from the pre-test (M = 81.0, SD = 11.8) to the post-test (M = 83.3, SD = 8.52) compared to the control group (pre-test M = 69.78, SD = 15.9) (post-test M = 68.1, SD = 16.05) (Wald Chi-Square = 5.597, p = 0.018). Although the duration of labour was shorter in the Pilates group (Mdn = 215, IQR: 279 min) than usual care (Mdn = 458.5, IQR: 305 min), the difference was not statistically significant. There were no significant differences between groups for pain, mobility, abdominal separation, urinary continence, analgesia, or the mode of birth.Modified Pilates appears feasible and safe for low-risk pregnant women. Further research is needed in on this topic.

In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life?A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement.A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury.For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training.The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months).After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI -1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT.This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations.ACTRN12611001098921.

Exercise interventions can improve physical recovery and reduce falls in older adults following hospitalization. The aim of the study was to identify factors associated with exercise engagement after hospital discharge.This study was a secondary analysis of data collected as part of a randomized controlled trial. Participants were 60 years and older, discharged from 3 rehabilitation hospitals in Australia, and followed for 6 months after discharge. The primary outcome was level of engagement in exercise after discharge, measured using setting, type, frequency, and time. A secondary outcome was self-efficacy for exercise at 6-month follow-up. Data were gathered at baseline in hospital and at 6 months after discharge by telephone using structured surveys. Associations between exercise and participant characteristics were evaluated using logistic regression models.Participants' (n = 292) mean age was 78 (SD 8) years and 63% were female. There were 146 (50%) who exercised after hospitalization for a median (interquartile range) time of 60 (60-75) minutes per week. Characteristics that were significantly associated with post-discharge engagement in exercise were having higher levels of functional ability at discharge (adjusted odds ratio [AOR] 1.2, 95% CI 1.0, 1.4), living with a partner (AOR 2.9, 95% CI 1.7, 4.9), and engagement in exercise prior to hospital admission (AOR 1.7, 95% CI 1.0, 2.8). The mean self-efficacy for exercise score at 6 months post-discharge was 58.5/90 (SD 24.5). Characteristics that were significantly predictive of a higher mean self-efficacy score at 6 months after hospitalization were having a college or university education (adjusted β-coefficient [Adj β] 11.5, 95% CI 3.8, 19.0), exercise prior to hospital admission (Adj β 12.3, 95% CI 5.1, 19.5), living with a partner at discharge (Adj β 14.5, 95% CI 7.1, 21.9), and higher functional ability at discharge (Adj β 4.0, 95% CI 1.9, 6.1).Older adults have low levels of engagement in exercise that might impact their recovery after hospitalization. During exercise prescription, clinicians should prioritize older adults who live alone, who have lower functional ability, and no previous habit of exercising.

Objective Implementing the routine collection of patient reported outcome measures (PROMs) is key to improving healthcare quality and patient satisfaction. The implementation process can be strengthened through staff and patient co-design. The aim of this project was to develop a set of Australian PROM implementation recommendations (‘AusPROM’) to guide rapid translation into practice. Methods Staff working across 29 Australian private hospitals participated in the project. The hospitals provided elective surgery and spanned each state and territory of Australia. Staff engaged in a Delphi technique to develop the AusPROM, which involved three iterative focus groups. To ensure full disclosure, staff were also provided with additional project-related data sources throughout the Delphi technique. This included data from a patient focus group (patient co-design), patient survey, technical feasibility testing, 3 months of pilot testing (four sites), 3 months of national implementation (29 sites) and global evidence. This process ensured that staff and patient feedback was used to co-design the three iterations of the AusPROM recommendations until the final agreed version was established. Results A total of 22 AusPROM recommendations were included in the final iteration. The recommendations covered the domains of PROM characteristics, healthcare organisation characteristics, external influences, staff and patient characteristics, and facilitators to implementing AusPROMS in routine practice. Conclusion The AusPROM recommendations offer practical considerations for the implementation of PROMs in hospitals. The iterative nature of the Delphi technique ensured that staff and patient co-design were central to the development of the AusPROM recommendations.

Background: Dancing is an engaging physical activity for people living with Parkinson’s disease (PD). We conducted a process evaluation for a PD trial on online dancing. Methods: “ParkinDANCE Online” was co-produced by people with PD, healthcare professionals, dance instructors, and a PD organisation. The evaluation mapped the following inputs: (i) stakeholder steering group to oversee program design, processes, and outcomes; (ii) co-design of online classes, based on a research evidence synthesis, expert advice, and stakeholder recommendations; (iii) trial fidelity. The key activities were (i) the co-design of classes and instruction manuals, (ii) the education of dance teachers, (iii) fidelity checking, (iv) online surveys, (v) and post-trial focus groups and interviews with participants. The outputs pertained to: (i) recruitment, (ii) retention, (iii) adverse events, (iv) fidelity, (v) protocol variations, and (vi) participant feedback. Results: Twelve people with PD, four dance instructors and two physiotherapists, participated in a 6-week online dance program. There was no attrition, nor were there any adverse events. Program fidelity was strong with few protocol variations. Classes were delivered as planned, with 100% attendance. Dancers valued skills mastery. Dance teachers found digital delivery to be engaging and practical. The safety of online testing was facilitated by careful screening and a home safety checklist. Conclusions: It is feasible to deliver online dancing to people with early PD.

To investigate whether training load monitoring data could be used to predict injuries in elite Australian football players, data were collected from elite athletes over 3 seasons at an Australian football club. Loads were quantified using GPS devices, accelerometers and player perceived exertion ratings. Absolute and relative training load metrics were calculated for each player each day (rolling average, exponentially weighted moving average, acute:chronic workload ratio, monotony and strain). Injury prediction models (regularised logistic regression, generalised estimating equations, random forests and support vector machines) were built for non-contact, non-contact time-loss and hamstring specific injuries using the first two seasons of data. Injury predictions were generated for the third season and evaluated using the area under the receiver operator characteristic (AUC). Predictive performance was only marginally better than chance for models of non-contact and non-contact time-loss injuries (AUC$, Comment: 15 pages, 5 figures

Aims: (1) To investigate whether a daily acute:chronic workload ratio informs injury risk in Australian football players; (2) to identify which combination of workload variable, acute and chronic time window best explains injury likelihood. Methods: Workload and injury data were collected from 53 athletes over 2 seasons in a professional Australian football club. Acute:chronic workload ratios were calculated daily for each athlete, and modelled against non-contact injury likelihood using a quadratic relationship. 6 workload variables, 8 acute time windows (2-9 days) and 7 chronic time windows (14-35 days) were considered (336 combinations). Each parameter combination was compared for injury likelihood fit (using R 2). Results: The ratio of moderate speed running workload (18-24 km/h) in the previous 3 days (acute time window) compared with the previous 21 days (chronic time window) best explained the injury likelihood in matches (R 2 =0.79) and in the immediate 2 or 5 days following matches (R 2 =0.76-0.82). The 3:21 acute:chronic workload ratio discriminated between high-risk and low-risk athletes (relative risk=1.98-2.43). Using the previous 6 days to calculate the acute workload time window yielded similar results. The choice of acute time window significantly influenced model performance and appeared to reflect the competition and training schedule. Conclusions: Daily workload ratios can inform injury risk in Australian football. Clinicians and conditioning coaches should consider the sport-specific schedule of competition and training when choosing acute and chronic time windows. For Australian football, the ratio of moderate speed running in a 3-day or 6-day acute time window and a 21-day chronic time window best explained injury risk.

Background and Purpose. Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. Subjects and Methods. Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. Results. When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/min) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. Discussion and Conclusion. Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference.

Background: Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. Objective: The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. Methods: This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. Results: This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps’ development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. Conclusions: This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. [JMIR Res Protoc 2016;5(4):e233]

There is a need to ensure that healthcare organisations enable their workforces to use digital methods in service delivery. This study aimed to evaluate the current level of digital understanding and ability in nursing, midwifery, and allied health workforces and identify some of the training requirements to improve digital literacy in these health professionals. Representatives from eight healthcare organizations in Victoria, Australia participated in focus groups. Three digital frameworks informed the focus group topic guide that sought to examine the barriers and enablers to adopting digital healthcare along with training requirements to improve digital literacy. Twenty-three participants self-rated digital knowledge and skills using Likert scales and attended the focus groups. Mid-range scores were given for digital ability in nursing, midwifery, and allied health professionals. Focus group participants expressed concern over the gap between their organizations’ adoption of digital methods relative to their digital ability, and there were concerns about cyber security. Participants also saw a need for the inclusion of consumers in digital design. Given the widening gap between digital innovation and health workforce digital capability, there is a need to accelerate digital literacy by rapidly deploying education and training and policies and procedures for digital service delivery.

This study, which was part of a larger study on the Health Status of Older People conducted in Melbourne, Australia, aimed to identify factors that discriminate between multiple and occasional falls amongst older people living at home. It used a survey of 1000 Australians aged 65 years and over. Subjects were classified as multiple fallers (two or more falls in the past year), occasional fallers (one fall in the past year), or non-fallers. Twenty-nine percent of older people who lived at home reported falling once or more in the previous 12 months. Nearly 20% of older people fell once in the previous 12 months and just under 10% fell more than once. Occasional fallers were more likely to be women (OR 1.75, 95% CI 1.26 to 2.45), to have reported back pain (OR 1.54, 95% CI 1.10 to 2.16) and were nearly twice as likely to have more than three medical conditions compared to non-fallers (OR 1.88, 95% CI 1.22 to 2.90). Multiple fallers were also more likely to be women (OR 1.61, 95% CI 1.03 to 2.51). More multiple fallers (17%) than occasional fallers (9%) reported being very afraid of falling. Intervention strategies should take into account these differing predisposing factors for multiple and occasional falls.

Unilateral neglect (ULN) (or “neglect”) is a common behavioral syndrome in patients following stroke. The reported incidence of ULN varies widely from 10%1 to 82%2 following right-hemisphere stroke and from 15%3 to 65%2 following left-hemisphere stroke. Reasons for the variability in the published rates of occurrence of ULN after stroke include subject selection criteria, lesion site, and the nature and timing of the assessment.4 The clinical impression that ULN occurs more frequently following right brain damage than left brain damage has been supported in a systematic review of published data.4 Unilateral neglect is characterized by the failure to report or respond to people or objects presented to the side opposite a brain lesion. If the failure to respond can be accounted for by either sensory or motor deficits, it is not considered to be neglect.5 Patients may have one type of neglect or a combination of neglect behaviors.6 Because ULN has a wide variety of clinical presentations, no single test can be used to identify the disorder in all patients, nor will a single test provide a comprehensive diagnosis of neglect behavior.7 Some authors7,8 have recommended that assessment of neglect include a test battery. To ensure sufficient sensitivity, the battery should include measures for all types of neglect.9 The purposes of this update are: (1) to clarify the different types of neglect, as a basis for understanding the tests and measures of ULN, (2) to review the validity and reliability of determinations of ULN, and (3) to make recommendations regarding the use of these tests by physical therapists. Given the scope of this article—which is an update of the assessment of neglect—only the major tests for ULN are discussed. For an extensive discussion of the pathophysiology and …

The ability of machine learning techniques to predict athlete ratings of perceived exertion (RPE) was investigated in professional Australian football players. RPE is commonly used to quantifying internal training loads and manage injury risk in team sports. Data from global positioning systems, heart-rate monitors, accelerometers and wellness questionnaires were recorded for each training session (n=3398) from 45 professional Australian football players across a full season. A variety of modelling approaches were considered to investigate the ability of objective data to predict RPE. Models were compared using nested cross validation and root mean square error (RMSE) on RPE predictions. A random forest model using player normalised running and heart rate variables provided the most accurate predictions (RMSE ± SD = 0.96 ± 0.08 au). A simplification of the model using only total distance, distance covered at speeds between 18-24 km·h−1, and the product of total distance and mean speed provided similarly accurate predictions (RMSE ± SD = 1.09 ± 0.05 au), suggesting that running distances and speeds are the strongest predictors of RPE in Australian football players. The ability of non-linear machine learning models to accurately predict athlete RPE has applications in live player monitoring and training load planning.

Background and Purpose. Obstacle crossing is compromised following stroke. The purpose of this study was to quantify modifications during obstacle clearance following stroke. Subjects. Twelve subjects with stroke and 12 subjects without stroke participated in the study. Methods. Kinematic variables were measured while participants crossed a 4-cm-high obstacle. Subjects with stroke walked at a self-selected speed; subjects without stroke walked at a comparable speed and at a self-selected speed. Results. Several modifications were observed following stroke with both groups walking at self-selected speeds. The affected lead limb was positioned closer to the obstacle before crossing. Affected trail-limb clearance over the obstacle was reduced. Both affected and unaffected lead and trail limbs landed closer to the obstacle after clearance. Swing time was increased in the affected lead limb after obstacle clearance. Fewer modifications were detected at matched walking speed; the trail limb still landed closer to the obstacle. Discussion and Conclusion. Modifications during obstacle crossing following stroke may be partly related to walking speed. The findings raise issues of safety because people with stroke demonstrated reduced clearance of a 4-cm obstacle and limb placement closer to the obstacle after clearance.

Background Therapeutic dancing can be beneficial for people living with Parkinson’s disease (PD), yet community-based classes can be difficult to access. Objective To evaluate the feasibility and impact of online therapeutic dancing classes for people in the early to mid-stages of PD. Methods Co-produced with people living with PD, physiotherapists, dance teachers and the local PD association, the ‘ParkinDANCE’ program was adapted to enable online delivery during the COVID-19 pandemic. Participants completed 8 one-hour sessions of online therapeutic dancing. Each person was assigned their own dance teacher and together they selected music for the classes. A mixed-methods design enabled analysis of feasibility and impact. Feasibility was quantified by attendance and adverse events. Impact was determined from individual narratives pertaining to consumer experiences and engagement, analysed with qualitative methods through a phenomenological lens. Results Attendance was high, with people attending 100% sessions. There were no adverse events. Impact was illustrated by the key themes from the in-depth interviews: (i) a sense of achievement, enjoyment and mastery occurred with online dance; (ii) project co-design facilitated participant engagement; (iii) dance instructor capabilities, knowledge and skills facilitated positive outcomes; (iv) music choices were key; and (v) participants were able to quickly adapt to online delivery with support and resources. Conclusions Online dance therapy was safe, feasible and perceived to be of benefit in this sample of early adopters. During the pandemic, it was a viable form of structured physical activity. For the future, online dance may afford benefits to health, well-being and social engagement.

Objective: Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design: Qualitative sequential design. Setting: Three rehabilitation hospitals in Western Australia. Method: Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis. Results: Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge. Conclusion: Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

Purpose This study explored the intervention processes used by speech-language pathologists (SLPs) to treat children with speech sound disorders (SSDs). Method Semistructured, individual, in-depth interviews were conducted with 11 Australian SLPs. Inductive content analysis was used to classify the data to provide a description of current intervention processes for children with SSDs. Results Three main factors were identified relating to the intervention processes used by SLPs: (a) target selection, (b) therapy approaches, and (c) structural and procedural aspects of therapy sessions, including feedback. The findings revealed that SLPs often combine elements of four therapies: the minimal pairs approach, traditional articulatory approaches, auditory discrimination, and Cued Articulation. Initial therapy targets typically aligned with a developmental approach or were functional speech targets with meaningful relevance to the child and their family. Conclusions These findings contribute to the current state of knowledge about the intervention processes used by SLPs for children with SSDs. The use of hybrid speech pathology therapies, which combined elements of favored approaches, was common. Hybrid methods were intended to help tailor the interventions to individual needs. Client needs were highly prioritized by SLPs and influenced their choice of therapy targets and therapy approaches.

Patient education is key to preventing hospital falls yet is inconsistently implemented by health professionals. A mixed methods study was conducted involving a ward-based evaluation of patients receiving education from health professionals using a scripted conversation guide with a falls prevention brochure, followed by semi-structured qualitative interviews with a purposive sample of health professionals involved in delivering the intervention. Over five weeks, 37 patients consented to surveys (intervention n = 27; control n = 10). The quantitative evaluation showed that falls prevention education was not systematically implemented in the trial ward. Seven individual interviews were conducted with health professionals to understand the reasons why implementation failed. Perceived barriers included time constraints, limited interprofessional collaboration, and a lack of staff input into designing the research project and patient interventions. Perceived enablers included support from senior staff, consistent reinforcement of falls education by health professionals, and fostering patient empowerment and engagement. Recommended strategies to enhance implementation included ensuring processes were in place supporting health professional accountability, the inclusion of stakeholder input in designing the falls intervention and implementation processes, as well as leadership engagement in falls prevention education. Although health professionals play a key role in delivering evidence-based falls prevention education in hospitals, implementation can be compromised by staff capacity, capability, and opportunities for co-design with patients and researchers. Organisational buy-in to practice change facilitates the implementation of evidence-based falls prevention activities.

Background Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care. Methods A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, 1-h weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women's health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured. Discussion This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT. Trial registration This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).

OBJECTIVE: Heart Rate Variability (HRV) is a marker of autonomic nervous system function associated with both physical and mental health. Many studies have suggested that mindfulness and meditation-based interventions (MBIs) are associated with improvements in HRV, but findings are mixed and to date no comprehensive meta-analysis has synthesized results. METHODS: Systematic literature searches were conducted using PsycINFO, Embase, Medline, CINAHL, ERIC and Scopus to identify randomized controlled trials (RCTs) investigating the effects of predominantly seated MBIs on resting-state vagally-mediated HRV. Risk of bias was judged using the Cochrane Risk of Bias tool. RESULTS: Nineteen RCTs met criteria for inclusion in the meta-analysis. Random-effects meta-analysis found that MBIs were not efficacious in increasing vagally-mediated resting-state HRV relative to control conditions (Hedges' g = 0.38, 95% CI = - 0.014 to 0.77). When removing an outlier (g = 3.22), the effect size was reduced, confidence interval narrowed, and findings remained non-significant (g = 0.19, 95% CI = -0.02 to 0.39). High heterogeneity in results (I2 = 89.12%) could not be explained by a priori determined moderators including intervention duration, study setting and control type. CONCLUSION: There is currently insufficient evidence to indicate that MBIs lead to improvements in vagally-mediated HRV over control conditions. Future large, well-designed RCTs with low risk of methodological bias could help add to the current evidence to elucidate any role MBIs might play in impacting HRV.HRV: heart rate variability; HF-HRV: high-frequency heart rate variability; MBI: mindfulness based intervention; RSA: respiratory sinus arrhythmia.

Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6-month period post-discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6-month post-discharge using semi-structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.

Objectives To understand the attributes of expert physiotherapy continence clinicians and how they compare to novices in relation to experience, knowledge, capability and skills in pelvic floor rehabilitation. Design Qualitative methods were used for thematic analysis of data collected from clinician focus groups. Participants Registered physiotherapists in Melbourne, Australia. Recruitment was through purposive, and “snowball” sampling, and continued until attainment of data adequacy. Intervention Audio recorded focus groups. Results Twenty-eight physiotherapists participated in seven focus groups. A key finding was that continence rehabilitation is an area of expert physiotherapy practice. Proficiency is often attained through postgraduate education, mentoring by experienced colleagues, clinical experience and research participation. The ‘continence clinician as expert’ was identified in three main themes (i) attributes that are important for competent continence practice; (ii) research literacy and the ability to generate and translate research into practice; and (iii) patient-centred care, including managing consumer expectations. Knowledge translation was assisted by research literacy, access to evidence and the use of comprehensively reported research. Proficient clinicians prioritised evidence-informed practice, consumer engagement, peer networks and collaboration. Conclusions The main attributes of proficient physiotherapy continence clinicians were high levels of skill, training and experience, enabling an extended scope of practice. Research capability and research co-partnerships were also seen to support implementation of contemporary, evidence-based practice. Therapists new to this field were thought to benefit from structured mentoring, further training and clear career pathways embedded within healthcare systems. Consumer-focussed care was seen as a core skill across all levels of physiotherapy practice.

Objective Implementing the routine collection of patient reported outcome measures (PROMs) is key to improving healthcare quality and patient satisfaction. The implementation process can be strengthened through staff and patient co-design. The aim of this project was to develop a set of Australian PROM implementation recommendations ('AusPROM') to guide rapid translation into practice. Methods Staff working across 29 Australian private hospitals participated in the project. The hospitals provided elective surgery and spanned each state and territory of Australia. Staff engaged in a Delphi technique to develop the AusPROM, which involved three iterative focus groups. To ensure full disclosure, staff were also provided with additional project-related data sources throughout the Delphi technique. This included data from a patient focus group (patient co-design), patient survey, technical feasibility testing, 3 months of pilot testing (four sites), 3 months of national implementation (29 sites) and global evidence. This process ensured that staff and patient feedback was used to co-design the three iterations of the AusPROM recommendations until the final agreed version was established. Results A total of 22 AusPROM recommendations were included in the final iteration. The recommendations covered the domains of PROM characteristics, healthcare organisation characteristics, external influences, staff and patient characteristics, and facilitators to implementing AusPROMS in routine practice. Conclusion The AusPROM recommendations offer practical considerations for the implementation of PROMs in hospitals. The iterative nature of the Delphi technique ensured that staff and patient co-design were central to the development of the AusPROM recommendations.

Low back pain is prevalent in the community and associated with deficits in core muscle strength and activation. Pilates is argued to improve movement and reduce pain, yet there is a limited understanding of the specific effects of Pilates training on core muscle strength or activity. A systematic search of databases (CINAHL, Embase, Ovid MEDLINE) used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods to evaluate randomised controlled trials (RCTs) on the effects of Pilates to improve core muscle activation. Methodological quality was assessed using the Physiotherapy Evidence Database scale (PEDro). The certainty of findings was determined using the Grading of Recommendations Assessment, Development and Evaluation tool. Of the initial yield of 563 articles, eight RCTs met the inclusion criteria. A diverse range of Pilates interventions and outcome measures were utilised to assess effects on core muscle activation and strength. The main finding was that Pilates is not inferior to equivalently dosed exercises, and can be superior to non-equivalent or no exercise, for improving core muscle strength as indicated by muscle thickness. There was emerging evidence that Pilates positively impacts core muscle strength and can be an effective intervention for people living with chronic low back pain.

Background:\ud \ud Evidence from a growing number of preclinical studies indicate that recently discovered stem cell lines may be translated into viable cellular therapies for people with Parkinson’s disease.\ud \ud \ud Objectives:\ud \ud In a brief but critical review, we examine the use of primary and secondary outcome measures currently used to evaluate the efficacy of cellular therapies.\ud \ud \ud Methods:\ud \ud The current practice of relying on a single primary outcome measure does not appear to provide the evidence required for demonstrating the robust, life-changing recovery anticipated with the successful implementation of cellular therapies.\ud \ud \ud Results:\ud \ud We propose a 360-degree assessment protocol, which includes co-primary and composite outcome measures to provide accurate and comprehensive evidence of treatment efficacy, from the perspectives of both the researchers and the patients.

Obtaining pre-surgery PROM measures is not always feasible. The aim of this study was to examine if self-reports of change following elective surgery correlate with change scores from a validated PROM (15-item Quality of Recovery (QoR-15)). This cross-sectional study across 29 hospitals enrolled elective surgery patients. PROMs were collected one-week pre-surgery, as well as one- and four-weeks post-surgery via an electronic survey. We examined associations between patient “judgement of change” at one and four-weeks after surgery and the actual pre-to post-surgery PROM change scores. A total of 4177 surveys were received. The correlation between patient judgement of change, and the actual change score was moderately strong at one-week (n = 247, rs = 0.512, p < 0.001), yet low at four-weeks (n = 241, rs = 0.340, p < 0.001). Patient judgement was aligned to the direction of the PROM change score from pre- to post-surgery. We also examined the correlation between the QoR-15 (quality of recovery) and the EQ-5D-5L (QOL). There was a moderately strong positive correlation between the two PROMs (n = 356, rs = 0.666, p < 0.001), indicating that change in quality of recovery was related to change in QOL. These findings support the use of a single “judgement of change” recall question post-surgery.

BackgroundPatient reported outcome measures (PROMs) engage patients in co-evaluation of their health and wellbeing outcomes. This study aimed to determine the feasibility, response rate, degree of recovery and patient acceptability of a PROM survey for elective surgery.MethodsWe sampled patients with a broad range of elective surgeries from four major Australian hospitals to evaluate (1) feasibility of the technology used to implement the PROMs across geographically dispersed sites, (2) response rates for automated short message service (SMS) versus email survey delivery formats, (3) the degree of recovery at one and four weeks post-surgery as measured by the Quality of Recovery 15 Item PROM (QoR-15), and (4) patient acceptability of PROMS based on survey and focus group results. Feasibility and acceptability recommendations were then co-designed with stakeholders, based on the data.ResultsOver three months there were 5985 surveys responses from 20,052 surveys (30% response rate). Feasibility testing revealed minor and infrequent technical difficulties in automated email and SMS administration of PROMs prior to surgery. The response rate for the QoR-15 was 34.8% (n = 3108/8919) for SMS and 25.8% (n = 2877/11,133) for email. Mean QoR-15 scores were 122.1 (SD 25.2; n = 1021); 113.1 (SD 27.7; n = 1906) and 123.4 (SD 26.84; n = 1051) for pre-surgery and one and four weeks post-surgery, respectively. One week after surgery, 825 of the 1906 responses (43%) exceeded 122.6 (pre-surgery average), and at four weeks post-surgery, 676 of the 1051 responses (64%) exceeded 122.6 (pre-surgery average). The PROM survey was highly acceptable with 76% (n = 2830/3739) of patients rating 8/10 or above for acceptability. Fourteen patient driven recommendations were then co-developed.ConclusionAdministering PROMS electronically for elective surgery hospital patients was feasible, acceptable and discriminated changes in surgical recovery over time. Patient co-design and involvement provided innovative and practical solutions to implementation and new recommendations for implementation.Trial Registration and Ethical ApprovalACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III). Ethics approval has been obtained from La Trobe University (Australia) Human Research Ethics Committee (HEC20479).Key pointsPatient reported outcome measures (PROMs) help to engage patients in understanding their health and wellbeing outcomes. This study aimed to determine how patients feel about completing a PROM survey before and after elective surgery, and to develop a set of recommendations on how to roll out the survey, based on patient feedback. We found that implementing an electronic PROM survey before and after elective surgery was relatively easy to do and was well accepted by patients. Consumer feedback throughout the project enabled co-design of innovative and practical solutions to PROM survey administration.

Background Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. Design Systematic review and meta-analysis. Participants Hospitalised adults. Intervention Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. Outcome measures Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). Results There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51–0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47–0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. Conclusion Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Background: Aquatic therapy is one therapy option for people living with Parkinson’s disease (PD). However, the optimal prescription, dosage, and delivery remain unclear. Objective: i) To generate consensus statements, ii) to establish evidence-based clinical practice aquatic therapy guidelines for PD. Methods: Seventy-three international experts were invited to participate in a 3-step modified Delphi study. Gaps in the aquatic therapy evidence, patient preferences, and stakeholder engagement were considered when developing the initial list of 43-statements identified by the research development group. Practice experts rated each statement on an 11-point Likert scale. Consensus for inclusion was set at a priori of ≥70% of respondents scoring an item ≥7. Two rounds of Delphi questionnaires were completed online, and the expert comments were analyzed using content analysis. An online consensus meeting with an expert subgroup (n = 10) then advised on the guideline’s acceptability and debated items until consensus for inclusion was reached. Results: Fifty experts participated in the Delphi round one (83% response rate) and 45 in round two (90% response rate), representing 15 countries. In round one, 35 statements met the criteria for consensus. Content analysis informed the revised statements in round two, where 12 of the remaining 16 statements met consensus. The final agreed aquatic therapy guidelines include key information about dosage, content, safety, contraindications, and the optimal aquatic therapy delivery throughout the disease course. Conclusion: Stakeholders, including international practice experts, informed a rigorous evidence-based approach to integrate the best available evidence, patient preferences, and practice expertise to inform these guidelines.