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  • Oxford University Press (OUP)  (28)
  • 1
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    Effectiveness of health consumer representative involvement in implementation of interventions to change health professional behaviour
    Oxford University Press (OUP) ; 2021
    In:  International Journal for Quality in Health Care Vol. 33, No. 1 ( 2021-02-20)
    Details
    In: International Journal for Quality in Health Care, Oxford University Press (OUP), Vol. 33, No. 1 ( 2021-02-20)
    Abstract: The adoption of research evidence to improve client outcomes may be enhanced using the principles of implementation science. This systematic review aimed to understand the effect of involving consumers to change health professional behaviours and practices. The barriers and enablers to consumer engagement will also be examined. Methods We searched Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials and PDQ-Evidence from 2004 to February 2019. Implementation studies involving consumers in at least one phase (development, intervention or facilitation) of an intervention that aimed to change health professional behaviour to align with evidence-based practice were included. Studies in the areas of paediatrics and primary care were excluded. Two review authors independently screened studies for inclusion, and one author extracted data and conducted quality assessments with review of a second author. Knowledge translation interventions were categorized using the Effective Practice and Organisation of Care taxonomy. The primary outcome was measures of change in health professional behaviour. Results Sixteen articles met the inclusion criteria. Meta-analysis of three studies found support for consumer involvement in changing healthcare professionals’ behaviour (Hedges’ g = 0.41, 95% CI [0.27, 0.57], P  & lt; 0.001). Most knowledge translation studies involved consumers during the development phase only (n = 12). Most studies (n = 9) included one type of knowledge translation intervention. Professional interventions (including education of health professionals, educational outreach, and audit and feedback) were described in 13 studies. Conclusions Consumer involvement rarely moves beyond the design phase of knowledge translation research in healthcare settings. Further research of the barriers to and effect of increased consumer engagement across all stages of knowledge translation interventions is needed. Systematic review registration PROSPERO CRD42019119179.
    Type of Medium: Online Resource
    ISSN: 1353-4505 , 1464-3677
    URL: Article
    DOI: 10.1093/intqhc/mzaa164
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002180-X
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  • 2
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    Assessing the Reliability and Validity of a Physical Therapy Functional Measurement Tool—the Modified Iowa Level of Assistance Scale—in Acute Hospital Inpatients
    Oxford University Press (OUP) ; 2016
    In:  Physical Therapy Vol. 96, No. 2 ( 2016-02-01), p. 176-182
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 96, No. 2 ( 2016-02-01), p. 176-182
    Abstract: Functional outcome measurement tools exist for individual diagnoses (eg, stroke), but no prospectively validated mobility measure is available for physical therapists' use across the breadth of acute hospital inpatients. The modified Iowa Level of Assistance Scale (mILOA), a scale measuring assistance required to achieve functional tasks, has demonstrated functional change in inpatients with orthopedic conditions and trauma, although its psychometric properties are unknown. Objective The aim of this study was to assess interrater reliability, known-groups validity, and responsiveness of the mILOA in acute hospital inpatients. Design This was a cohort, measurement-focused study. Methods Patients at a large teaching hospital in Melbourne, Australia, were recruited. One hundred fifty-two inpatients who were functionally stable across 5 clinical groups had an mILOA score calculated during 2 independent physical therapy sessions to assess interrater reliability. Known-groups validity (“ready for discharge”/“not ready for discharge”) and responsiveness also were assessed. Results The mean age of participants in the reliability phase of the study was 62.5 years (SD=17.7). The interrater reliability was excellent (intraclass correlation coefficient [2,1]=.975; 95% confidence interval=.965, .982), with a mean difference between scores of −.270 and limits of agreement of ±5.64. The mILOA score displayed a mean difference between 2 known groups of 15.3 points. Responsiveness was demonstrated with a minimal detectable change of 5.8 points. Limitations Participants were included in the study if able to give consent for themselves, thereby limiting generalizability. Construct validity was not assessed due to the lack of a gold standard. Conclusions The mILOA has excellent interrater reliability and good known-groups validity and responsiveness to functional change across acute hospital inpatients with a variety of diagnoses. It may provide opportunities for physical therapists to collect a functional outcome measure to demonstrate the effectiveness of inpatient therapy and allow for benchmarking across institutions.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.2522/ptj.20140248
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
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  • 3
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    Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties
    Oxford University Press (OUP) ; 2022
    In:  Physical Therapy Vol. 103, No. 1 ( 2022-12-30)
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 103, No. 1 ( 2022-12-30)
    Abstract: Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. Methods Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. Results Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed “Up & Go” Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63–2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] & gt;0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%–60% of patients). The TUG, CAS, and BI all had good clinical utility. Conclusion Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. Impact This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzac142
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 4
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    Reliability, Validity, Clinical Utility, and Responsiveness of Measures for Assessing Mobility and Physical Function in Patients With Traumatic Injury in the Acute Care Hospital Setting: A Prospective Study
    Oxford University Press (OUP) ; 2021
    In:  Physical Therapy Vol. 101, No. 11 ( 2021-11-01)
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 101, No. 11 ( 2021-11-01)
    Abstract: The longer-term impact of injury is increasingly recognized, but the early phases of recovery are less well understood. The best tools to measure early recovery of mobility and physical function following traumatic injury are unclear. The purpose of this study was to assess the clinical utility, validity, reliability, and responsiveness of 4 mobility and physical function measures in patients following traumatic injury. Methods In this cohort, measurement-focused study (n = 100), the modified Iowa Level of Assistance Score, Acute Care Index of Function, Activity Measure for Post-Acute Care “6 Clicks” short forms, and Functional Independence Measure were completed during first and last physical therapy sessions. Clinical utility and floor and ceiling effects were documented. Known-groups validity (early vs late in admission and by discharge destination), predictive validity (using 6-month postinjury outcomes data), and responsiveness were established. Interrater reliability was assessed in 30 patients with stable mobility and function. Results Participants had a median age of 52 years (interquartile range = 33–68 years), and 68% were male. The modified Iowa Level of Assistance Score, Acute Care Index of Function, and “6 Clicks” short forms were quick to administer (an extra median time of 30 seconds–1 minute), but the Functional Independence Measure took much longer (extra median time of 5 minutes). At the last physical therapy session, ceiling effects were present for all measures except the Functional Independence Measure (18%–33% of participants). All had strong known-groups validity (early vs late in admission and by discharge destination). All were responsive (effect sizes & gt;1.0) and had excellent interrater reliability (intraclass correlation coefficients = 0.79–0.94). Conclusion All 4 measures were reliable, valid, and responsive; however, their clinical utility varied, and ceiling effects were common at physical therapy discharge. Impact This study is an important step toward evidence-based measurement in acute trauma physical therapy care. It provides critical information to guide assessment of mobility and physical function in acute trauma physical therapy, which may facilitate benchmarking across different hospitals and trauma centers and further progress the science and practice of physical therapy following traumatic injury.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzab183
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 5
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    Validating a Simple Discharge Planning Tool Following Hospital Admission for an Isolated Lower Limb Fracture
    Oxford University Press (OUP) ; 2014
    In:  Physical Therapy Vol. 94, No. 7 ( 2014-07-01), p. 1005-1013
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 94, No. 7 ( 2014-07-01), p. 1005-1013
    Abstract: Early, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures. Objective The aims of this study were: (1) to prospectively validatate the TRaPT, (2) to assess whether its performance could be improved by adding additional demographic data, and (3) to simplify it for use as a bedside tool. Design This was a cohort, measurement-focused study. Methods Patients with isolated lower limb fractures (N=114) who were admitted to a major trauma center in Melbourne, Australia, were included. The participants' TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight-bearing status, and home supports, was assessed using measures of discrimination and calibration. A simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into 8 categories. Simplified TRaPT performance measures, including specificity, sensitivity, and positive and negative predictive values, were evaluated. Results Prospective validation of the TRaPT showed excellent discrimination (C-statistic=0.90 [95% confidence interval=0.82, 0.97]), a sensitivity of 80%, and specificity of 94%. All participants able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%. Limitations Generalizability may be limited given the compensation system that exists in Australia, but the methods used will assist in designing a similar tool in any population. Conclusions The TRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.2522/ptj.20130413
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2014
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  • 6
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    Outcomes of a Shoulder Treatment Flowchart in Patients With Axillary Burns
    Oxford University Press (OUP) ; 2011
    In:  Journal of Burn Care & Research Vol. 32, No. 2 ( 2011-03), p. 224-230
    Details
    In: Journal of Burn Care & Research, Oxford University Press (OUP), Vol. 32, No. 2 ( 2011-03), p. 224-230
    Type of Medium: Online Resource
    ISSN: 1559-047X
    URL: Article
    DOI: 10.1097/BCR.0b013e31820aaeda
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2011
    detail.hit.zdb_id: 2071028-8
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  • 7
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    How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis
    Oxford University Press (OUP) ; 2017
    In:  Physical Therapy Vol. 97, No. 7 ( 2017-07-01), p. 707-717
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 97, No. 7 ( 2017-07-01), p. 707-717
    Abstract: Background. Mobility limitations are common following stroke and frequently lead to poor participation in physical activity (PA). Purpose. The purpose of this study was to describe PA across the various stages following stroke (acute, subacute, and chronic). Data Sources. Searches were conducted in 5 databases. Study Selection. Eligible studies included participants with stroke whose PA was quantitatively measured for at least 4 hours in a single session. Two reviewers independently reviewed titles and abstracts. Data Extraction. One reviewer extracted data and assessed quality using the Downs and Black checklist. Weighted means were calculated for PA outcomes. Data Synthesis. Searches yielded 103 eligible papers including 5306 participants aged 21 to 96 years. Devices (eg, activity monitors) were used in 73 papers, and behavioral mapping (observational monitoring) in 30. Devices show that people with stroke took on average 5535 steps per day (n = 406, 10 studies) in the subacute phase and 4078 steps (n = 1280, 32 studies) in the chronic phase. Average daily walking duration (% measured time) was higher in the chronic phase (9.0%, n = 100) than subacute (1.8%, n = 172), and sedentary time was & gt;78% regardless of time post stroke. Acute data were lacking for these variables. Matched healthy individuals took an average of 8338 steps per day (n = 129). Behavioral mapping showed time in bed was higher in the acute than subacute phase (mean 45.1% versus 23.8%), with similar time spent sitting (mean 37.6% versus 32.6%). Limitations. Limitations of this review include not pooling data reported as medians. Conclusions. Physical activity levels do not meet guidelines following stroke. Time spent inactive and sedentary is high at all times. Increasing PA and developing standardized activity targets may be important across all stages of stroke recovery.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzx038
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
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  • 8
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    Determinants of Peripheral Muscle Strength and Activity in Daily Life in People With Bronchiectasis
    Oxford University Press (OUP) ; 2018
    In:  Physical Therapy Vol. 98, No. 3 ( 2018-03-01), p. 153-161
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 98, No. 3 ( 2018-03-01), p. 153-161
    Abstract: Bronchiectasis is characterized by a progressive structural lung damage, recurrent infections and chronic inflammation which compromise the exertion tolerance, and may have an impact on skeletal muscle function and physical function. Objective The purpose of this study was to compare peripheral muscle strength, exercise capacity, and physical activity in daily life between participants with bronchiectasis and controls and to investigate the determinants of the peripheral muscle strength and physical activity in daily life in bronchiectasis. Design This study used a cross-sectional design. Methods The participants’ quadriceps femoris and biceps brachii muscle strength was measured. They performed the incremental shuttle walk test (ISWT) and cardiopulmonary exercise testing, and the number of steps/day was measured by a pedometer. Results Participants had reduced quadriceps femoris muscle strength (mean difference to control group = 7 kg, 95% CI = 3.8–10.1 kg), biceps brachii muscle strength (2.1 kg, 95% CI = 0.7–3.4 kg), ISWT (227 m, 95% CI = 174–281 m), peak VO2 (6.4 ml/Kg/min, 95% CI = 4.0–8.7 ml/Kg/min), and number of steps/day (3,332 steps/day, 95% CI = 1,758–4,890 steps/day). A lower quadriceps femoris strength is independently associated to an older age, female sex, lower body mass index (BMI), higher score on the modified Medical Research Council scale, and shorter distance on the ISWT (R2 = 0.449). Biceps brachii strength is independently associated with sex, BMI, and dyspnea (R2 = 0.447). The determinants of number of daily steps were dyspnea and distance walked in ISWT, explaining only 27.7% of its variance. Limitations Number of steps per day was evaluated by a pedometer. Conclusions People with bronchiectasis have reduced peripheral muscle strength, and reduced aerobic and functional capacities, and they also are less active in daily life. Modifiable variables such as BMI, dyspnea, and distance walked on the ISWT are associated with peripheral muscle strength and physical activity in daily life.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzx123
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
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  • 9
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    Frailty in Patients With Trauma Who Are Critically Ill: A Prospective Observational Study to Determine Feasibility, Concordance, and Construct and Predictive Validity of 2 Frailty Measures
    Oxford University Press (OUP) ; 2019
    In:  Physical Therapy Vol. 99, No. 8 ( 2019-08-01), p. 1089-1097
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 99, No. 8 ( 2019-08-01), p. 1089-1097
    Abstract: As the older population increases, more older people are exposed to trauma. Frailty can be used to highlight patients at risk of a poorer outcome. Objective The objectives of this study were to compare 2 frailty measures with regard to concordance, floor and ceiling effects, and construct and predictive validity and to determine which is more valid and clinically applicable in a critically ill trauma population. Design This was a prospective observational study. Methods Patients were included if admitted to an intensive care unit (ICU) under a trauma medical unit and ≥ 50 years old. Frailty was determined using 2 frailty measures, the Frailty Phenotype (FP) and Clinical Frailty Scale (CFS). Results One hundred people were enrolled; their mean age was 69.2 years (SD = 10.4) and 81% had major trauma (as determined with the Injury Severity Score). Frailty was identified with the FP in 22 participants and with the CFS in 13 participants. The 2 frailty measures had an excellent correlation (Spearman rank correlation coefficient = 0.77; 95% confidence interval = 0.66–0.85). Both the FP and the CFS had large floor effects but no ceiling effects. The FP and CFS showed construct validity, with frailty being significantly associated with increasing age, requiring an aid to mobilize, and more falls and hospital admissions. Frailty on the FP was predictive of ICU and hospital mortality, whereas frailty on the CFS was predictive of hospital mortality. Limitations The limitations of this study include the use of a single site, small sample size, and collection of frailty measures retrospectively. Conclusions Measuring frailty in a trauma ICU population was feasible, with excellent correlation between the 2 frailty measures. Both showed aspects of construct and predictive validity; however, the FP identified frailty in more participants and was associated with more comorbidities and higher mortality at ICU discharge. Therefore, the FP might be more clinically relevant in this population.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzz057
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 10
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    The Utility of the Sit-to-Stand Test for Inpatients in the Acute Hospital Setting After Lung Transplantation
    Oxford University Press (OUP) ; 2020
    In:  Physical Therapy Vol. 100, No. 7 ( 2020-07-19), p. 1217-1228
    Details
    In: Physical Therapy, Oxford University Press (OUP), Vol. 100, No. 7 ( 2020-07-19), p. 1217-1228
    Abstract: Measurement of physical function is important to guide physical therapy for patients post-lung transplantation (LTx). The Sit-to-Stand (STS) test has proven utility in chronic disease, but psychometric properties post-LTx are unknown. The study aimed to assess reliability, validity, responsiveness, and feasibility of the 60-second STS post-LTx. Methods This was a measurement study in 62 inpatients post-LTx (31 acute postoperative; 31 medical readmissions). Interrater reliability was assessed with 2 STS tests undertaken by different assessors at baseline. Known group validity was assessed by comparing STS repetitions in postoperative and medical groups. Content validity was assessed using comparisons to knee extensor and grip strength, measured with hand-held dynamometry. Criterion validity was assessed by comparison of STS repetitions and 6-minute walk distance postoperatively. Responsiveness was assessed using effect sizes over inpatient admission. Results Median (interquartile range) age was 62 (56–67) years; time post-LTx was 5 (5–7) days postoperative and 696 (244–1849) days for medical readmissions. Interrater reliability was excellent (intraclass correlation coefficient type 2,1 = 0.96), with a mean learning effect of 2 repetitions. Repetitions were greater for medical at baseline (mean 18 vs 8). More STS repetitions were associated with greater knee extensor strength (postoperative r = 0.57; medical r = 0.47) and 6-minute walk distance (postoperative r = 0.68). Effect sizes were 0.94 and 0.09, with a floor effect of 23% and 3% at baseline (postoperative/medical) improving to 10% at discharge. Patients incapable of attempting a STS test were excluded, reducing generalizability to critical care. Physical rehabilitation was not standardized, possibly reducing responsiveness. Conclusions The 60-second STS demonstrated excellent interrater reliability and moderate validity and was responsive to change postoperatively. Impact The 60-second STS represents a safe, feasible functional performance tool for inpatients post-LTx. Two tests should be completed at each time point.
    Type of Medium: Online Resource
    ISSN: 0031-9023 , 1538-6724
    URL: Article
    DOI: 10.1093/ptj/pzaa057
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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