Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial.

BACKGROUND: Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain. METHODS: RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study's questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213. FINDINGS: Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference -4·6 [95% CI -5·9 to -3·4] and CFT plus biofeedback mean difference -4·6 [-5·8 to -3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; -AU$5276 [-10 529 to -24) and -8211 (-12 923 to -3500). INTERPRETATION: CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care. FUNDING: Australian National Health and Medical Research Council and Curtin University.

Cost and outcomes of Hospital-based Usual cAre versus Tele-monitor self-directed Rehabilitation (HUATR) in patients with total knee arthroplasty: A randomized, controlled, non-inferiority trial.

OBJECTIVE: To evaluate the clinical efficacy and cost-effectiveness of telemonitored self-directed rehabilitation (TR) compared with hospital-based rehabilitation (HBR) for patients with total knee arthroplasty (TKA). DESIGN: In this randomized, non-inferiority clinical trial, 114 patients with primary TKA who were able to walk independently preoperatively were randomized to receive HBR (n = 58) or TR (n = 56). HBR comprised at least five physical therapy sessions over 10 weeks. TR comprised a therapist-led onboarding session, followed by a 10-week unsupervised home-based exercise program, with asynchronous monitoring of rehabilitation outcomes using a telemonitoring system. The primary outcome was fast-paced gait speed at 12 weeks, with a non-inferiority margin of 0.10 m/s. For economic analysis, quality-adjusted-life-years (QALY) was the primary economic outcome (non-inferiority margin, 0.027 points). RESULTS: In Bayesian analyses, TR had >95% posterior probability of being non-inferior to HBR in gait speed (week-12 adjusted TR-HBR difference, 0.02 m/s; 95%CrI, -0.05 to 0.10 m/s; week-24 difference, 0.01 m/s; 95%CrI, -0.07 to 0.10 m/s) and QALY (0.006 points; 95%CrI, -0.006 to 0.018 points). When evaluated from a societal perspective, TR was associated with lower mean intervention cost (adjusted TR-HBR difference, -S$227; 95%CrI, -112 to -330) after 24 weeks, with 82% probability of being cost-effective compared with HBR at a willingness to pay of S$0/unit of effect for the QALYs. CONCLUSIONS: In patients with uncomplicated TKAs and relatively good preoperative physical function, home-based, self-directed TR was non-inferior to and more cost-effective than HBR over a 24-week follow-up period. TR should be considered for this patient subgroup.

Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education.

OBJECTIVE: To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48 h after hospital admission. DESIGN AND SETTING: Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet. PARTICIPANTS: (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period. OUTCOMES: (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility. RESULTS: 541 patients participated (median age 81 years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24 h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention. CONCLUSIONS: It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants.

Costs and economic impact of student-led clinics-A systematic review.

PURPOSE: Student-led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student-led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student-led clinics and report the methods that have been used to measure these costs and benefits. METHOD: We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student-led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student-led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies. RESULTS: Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description-monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits. CONCLUSIONS: Student-led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student-led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student-led clinics in comparison to alternatives. Without the full picture, decision-makers may make decisions that are ill-informed and lead to a loss of benefit for society.

The Right to Rehabilitation for People With Dementia: A Codesign Approach to Barriers and Solutions.

INTRODUCTION: People with dementia of all ages have a human right to equal access to quality health care. Despite evidence regarding its effectiveness, many people living with dementia are unable to access rehabilitation for promoting function and quality of life. Conducted in Australia, this study was designed to (1) explore barriers to access to dementia rehabilitation and (2) identify solutions that improve access to rehabilitation. METHODS: People living with dementia (n = 5) and care partners (n = 8) and health professionals (n = 13) were recruited nationally. Experience-based codesign across three virtual workshops was used to understand barriers and design solutions to improve access to rehabilitation treatments. Socio-ecological analyses, using the Levesque Access to Health care framework, were applied to findings regarding barriers and to aid selection of solutions. RESULTS: There was high attendance (92.3%) across the three workshops. Barriers were identified at a user level (including lack of knowledge, transport, cost and difficulty navigating the health, aged care and disability sectors) and health service level (including health professional low dementia knowledge and negative attitudes, inequitable funding models and non-existent or fragmented services). Solutions focused on widespread dementia education and training, including ensuring that people with dementia and their care partners know about rehabilitation therapies and that health professionals, aged care and disability co-ordinators know how to refer to and deliver rehabilitation interventions. Dementia care navigators, changes to Australia's public funding models and specific dementia rehabilitation programmes were also recommended. CONCLUSIONS: Barriers to accessing rehabilitation for people with dementia exist at multiple levels and will require a whole-community and systems approach to ensure change. PATIENT OR PUBLIC CONTRIBUTION: People with living experience (preferred term by those involved) were involved at two levels within this research. A Chief Investigator living with dementia was involved in the design of the study and writing of the manuscript. People with living experience, care partners and service providers were participants in the codesign process to identify barriers and design potential solutions.

Variations in definitions used for describing restrictive care practices (seclusion and restraint) in adult mental health inpatient units: a systematic review and content analysis.

PURPOSE: The main purpose of this review was to (1) identify thematic elements within definitions used by recently published literature to describe the constructs of physical/mechanical restraint, seclusion and chemical restraint in adult mental health inpatient units. METHODS: We conducted a comprehensive literature search of six databases (Scopus, MEDLINE, PsycINFO, Web of Science, Embase, and CINAHL-Plus). In this review, we conducted content analysis to synthesize evidence to understand and compare the commonalities and discrepancies in conceptual elements that were incorporated within the definitions of different forms of restrictive care practices. RESULTS: A total of 95 studies that provided definitions for different forms of restrictive care practices [physical/mechanical restraint (n = 72), seclusion (n = 65) and chemical restraint (n = 19)] were included in this review. Significant variations existed in the conceptual domains presented within the applied definitions of physical/mechanical restraint, seclusion, and chemical restraint. Conceptual themes identified in this review were methods of restrictive care practice, reasons and desired outcomes, the extent of patient restriction during restrictive care practice episodes, timing (duration, frequency, and time of the day), the level of patient autonomy, and the personnel implementing these practices. CONCLUSIONS: Inconsistencies in the terminologies and conceptual boundaries used to describe the constructs of different forms of restrictive care practices underscore the need to move forward in endorsing consensus definitions that reflect the diverse perspectives, ensuring clarity and consistency in practice and research. This will assist in validly measuring and comparing the actual trends of restrictive care practice use across different healthcare institutions and jurisdictions.

The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.

BACKGROUND: Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined. METHODS: A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions. RESULTS: Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct. CONCLUSION: Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.

Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta-analysis.

BACKGROUND: There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised. AIMS: This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates. METHODS: Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates. RESULTS: A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions. CONCLUSION: There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations. RELEVANCE TO CLINICAL PRACTICE: Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities. PATIENT/PUBLIC CONTRIBUTION: This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study. PROTOCOL REGISTRATION: The protocol for this review has been registered to PROSPERO: CRD42022335167.

The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis.

PURPOSE: This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile application to people newly diagnosed with upper gastrointestinal (UGI) cancer to (1) elucidate the roles of the dietitian during intervention delivery and (2) explore unmet needs impacting nutritional intake. METHODS: Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included fifty-one telephone conversations (17 h), 244 written messages, and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n = 20) to explore unmet needs. RESULTS: Themes describing the roles of the dietitian were as follows: regular collaborative problem-solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision, and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. CONCLUSION: Delivery of nutrition care via the telephone or an asynchronous mobile application to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychosocial support. Limitations in dietitians' scope of practice identified unmet patient's needs in nutrition impact symptom management, which requires medication management. TRIAL REGISTRATION: 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).

Virtual Care Initiatives for Older Adults in Australia: Scoping Review.

BACKGROUND: There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. OBJECTIVE: We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. METHODS: A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. RESULTS: Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. CONCLUSIONS: Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.

How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis.

BACKGROUND: The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar. METHODS: A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature. RESULTS: The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues. CONCLUSION: The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.

Lumbar Flexion During Driving: Establishing a Methodology for Characterising Real-Time Posture Data Collected by Innovative Technology.

OBJECTIVE: To determine a methodology for the analysis of real-time driving posture data in the low back pain population. BACKGROUND: The strength of the relationship between driving posture and low back pain is yet to be defined due to the lack of studies in the field using validated and repeatable posture measurement tools. Reliable and validated real-time measurement tools are now available, yet reliable methods of analysis of these data are yet to be established. METHOD: Ten occupational drivers completed a typical work shift while wearing an inertial motion sensor system (dorsaVi ViMove). Real-time lumbar flexion data were extracted, with test-retest reliability of mean lumbar flexion, peak lumbar flexion, and standard deviation of lumbar flexion analysed at different times across a work shift, and in different sections within a drive. RESULTS: Mean lumbar flexion was highly repeatable over numerous drives in one day, with greater test-retest reliability if the first five minutes of driving data were excluded. Peak lumbar flexion had acceptable test-retest reliability over numerous drives in one day, while standard deviation of lumbar flexion was not a repeatable measure. CONCLUSION: Mean lumbar flexion was a reliable outcome for characterising driving posture in drivers with low back pain. Peak lumbar flexion may be used if appropriate to the individual study. Standard deviation of lumbar flexion is not a reliable posture outcome. APPLICATION: This paper provides a reliable methodology for analysis of real-time driving posture data in occupational drivers with low back pain.

Activin A level is associated with physical function in critically ill patients.

BACKGROUND: Activin A is a potent negative regulator of muscle mass elevated in critical illness. It is unclear whether muscle strength and physical function in critically ill humans are associated with elevated activin A levels. OBJECTIVES: The objective of this study was to investigate the relationship between serum activin A levels, muscle strength, and physical function at discharge from the intensive care unit (ICU) and hospital. METHODS: Thirty-six participants were recruited from two tertiary ICUs in Melbourne, Australia. Participants were included if they were mechanically ventilated for >48 h and expected to have a total ICU stay of >5 days. The primary outcome measure was the Six-Minute Walk Test distance at hospital discharge. Secondary outcome measures included handgrip strength, Medical Research Council Sum Score, Physical Function ICU Test Scored, Six-Minute Walk Test, and Timed Up and Go Test assessed throughout the hospital admission. Total serum activin A levels were measured daily in the ICU. RESULTS: High peak activin A was associated with worse Six-Minute Walk Test distance at hospital discharge (linear regression coefficient, 95% confidence interval, p-value: -91.3, -154.2 to -28.4, p = 0.007, respectively). Peak activin A concentration was not associated with the secondary outcome measures. CONCLUSIONS: Higher peak activin A may be associated with the functional decline of critically ill patients. Further research is indicated to examine its potential as a therapeutic target and a prospective predictor for muscle wasting in critical illness. STUDY REGISTRATION: ACTRN12615000047594.

Physical Rehabilitation in the ICU: A Systematic Review and Meta-Analysis.

OBJECTIVES: Significant variability exists in physical rehabilitation modalities and dosage used in the ICU. Our objective was to investigate the effect of physical rehabilitation in ICU on patient outcomes, the impact of task-specific training, and the dose-response profile. DATA SOURCES: A systematic search of Ovid MEDLINE, Cochrane Library, EMBASE, and CINAHL plus databases was undertaken on the May 28, 2020. STUDY SELECTION: Randomized controlled trials and controlled clinical trials investigating physical rehabilitation commencing in the ICU in adults were included. Outcomes included muscle strength, physical function, duration of mechanical ventilation, ICU and hospital length of stay, mortality, and health-related quality of life. Two independent reviewers assessed titles, abstracts, and full texts against eligibility criteria. DATA EXTRACTION: Details on intervention for all groups were extracted using the template for intervention description and replication checklist. DATA SYNTHESIS: Sixty trials were included, with a total of 5,352 participants. Random-effects pooled analysis showed that physical rehabilitation improved physical function at hospital discharge (standardized mean difference, 0.22; 95% CI, 0.00-0.44), reduced ICU length of stay by 0.8 days (mean difference, -0.80 d; 95% CI, -1.37 to -0.23 d), and hospital length of stay by 1.75 days (mean difference, -1.75 d; 95% CI, -3.03 to -0.48 d). Physical rehabilitation had no impact on the other outcomes. The intervention was more effective in trials where the control group received low-dose physical rehabilitation and in trials that investigated functional exercises. CONCLUSIONS: Physical rehabilitation in the ICU improves physical function and reduces ICU and hospital length of stay. However, it does not appear to impact other outcomes.

Interventions to reduce falls in hospitals: a systematic review and meta-analysis.

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.

The impact of additional allied health staffing on rehabilitation outcomes at discharge from a sub-acute geriatric evaluation and management unit: A quasi-experimental, pre-post intervention study.

OBJECTIVE: The purpose of this study was to examine the impact of increasing allied health staffing levels on patient and health service outcomes across 1) all Geriatric Evaluation and Management patients, and 2) Geriatric Evaluation and Management patients discharged to home in the community. DESIGN: Quasi-experimental, pre-post intervention study. SETTING: Two sub-acute hospital units in an Australian, tertiary health service. SUBJECTS: Data related to patients admitted to the study units, who were classified as Geriatric Evaluation and Management patients. INTERVENTIONS: Comparison of therapy time across two units with a differential in staffing allocation over a six-month trial period. MAIN MEASURES: Primary outcomes: length of stay, readmission rate, and improvement on the Functional Independence Measure. Secondary outcomes: total cost of admission per patient and number of allied health sessions. RESULTS: Data were analysed for 214 patients (mean age = 79.9, standard deviation (SD) = 9.4 years, mean Functional Independence Measure (FIM = 64.9, SD = 21.2) admitted to the intervention unit, and 199 patients (mean age = 81.3, SD = 8.5, mean FIM = 64.2, SD = 24.0) admitted to the control unit. The overall difference in staffing allocation between the control and intervention units for the trial period was 21%. There was no statistically significant difference between units in subacute length of stay (Adj Coef = -0.10 days, 95%CI = -0.39 to 0.19), rate of readmission (OR = 1.0, 95%CI = 0.5 to 2.0) or change in function (Coef = 1.42 FIM change score, 95%CI = -2.4 to 5.3). CONCLUSIONS: Increasing allied health staffing allocation to a unit over six-months did not impact change in function or length of stay for patients admitted for Geriatric Evaluation and Management.

Cost analysis of employing general practitioners within residential aged care facilities based on a prospective, stepped-wedge, cluster randomised trial.

OBJECTIVE: To assess the impacts of changing a model of care and employing general practitioners (GPs) within residential aged care facilities (RACFs) on costs to the aged care provider (ACP) and state and federal governments of Australia. METHODS: This study was a cost analysis of a prospective, stepped-wedge, cluster randomised trial. All financial data from the ACP for every RACF involved, before and after implementation of the new model were obtained. Costs of hospital transfers, admissions, ambulance usage and GP consultations were calculated. Costs of new infrastructure, recruiting and training new staff were accounted for. Costs were standardised to 2019 Australian Dollars per occupied bed day (OBD). RESULTS: Implementation of the new model of care resulted in overall cost savings of $9.7 per OBD to the ACP, with increased salary costs offset by increased federal government subsidies and Medicare claims income. Costs to the federal government increased by $19.6 per OBD, driven by increases in subsides. Costs savings of $3.0 per OBD to state governments were seen, driven by decreased costs of hospital transfers. CONCLUSIONS: Implementation of a model of care including GPs employed at RACFs had a mixed impact on costs depending on perspective, with overall savings to the ACP and state government perspective.

Community preferences for the allocation of scarce healthcare resources during the COVID-19 pandemic: a review of the literature.

OBJECTIVE: The purpose of this thematic review is to examine the literature on the publics' preferences of scarce medical resource allocation during COVID-19. STUDY DESIGN: Literature review. METHODS: A review of Ovid MEDLINE, Embase, CINAHL and Scopus was performed between December 2019 and June 2022 for eligible articles. RESULTS: Fifteen studies using three methodologies and spanning five continents were included. Five key themes were identified: (1) prioritise the youngest; (2) save the most lives; (3) egalitarian allocation approaches; (4) prioritise healthcare workers; and (5) bias against particular groups. The public gave high priority to allocation that saved the most lives, particularly to patients who are younger and healthcare workers. Themes present but not supported as broadly were giving priority to individuals with disabilities, high frailty or those with behaviours that may have contributed to their ill-health (e.g. smokers). Allocation involving egalitarian approaches received the least support among community members. CONCLUSION: The general public prefer rationing scarce medical resources in the COVID-19 pandemic based on saving the most lives and giving priority to the youngest and frontline healthcare workers rather than giving preference to patients with disabilities, frailty or perceived behaviours that may have contributed to their own ill-health. There is also little public support for allocation based on egalitarian strategies.

Digital storytelling to facilitate consumer engagement in healthcare research.

ISSUES ADDRESSED: Consumer engagement in healthcare research presents with challenges, one of which is ensuring that the consumers have comprehended the often complex concepts in scientific research. This study aimed to compare how well older adult consumers understood video-based versus written and verbal description approaches to provision of information. METHODS: Twenty adults in the community aged 60 years and older were recruited for this study; half were randomised to receive the information via a digital story, and the other half received the same information from a written brief. Both mediums were presented via video teleconferencing. An interviewer was present to ask questions and address queries. RESULTS: Participants who viewed the digital story requested for clarifications less frequently compared to those who received the written brief. Difficulty in understanding the information rose with complexity, but providing concrete examples aided comprehension of the information. CONCLUSIONS: Complex concepts benefit from the provision of concrete examples to facilitate understanding. Video-based approaches to provision of information are acceptable forms of participant engagement in research and require less human resources to successfully convey key information and facilitate understanding of the information. Research procedures that employ large amounts of data collection and/or asynchronous methods should consider the use of video-based approaches, such as digital stories, to increase cost-effectiveness.

What recently graduated podiatrists think of rural work, and how services are responding: a qualitative study.

INTRODUCTION: Access to healthcare services should be equitable no matter where you live. However, the podiatry needs of rural populations are poorly addressed, partly because of workforce maldistribution. Encouraging emerging podiatrists to work in rural areas is a key solution. The aims were to explore (1) recently graduated podiatrists' perceptions regarding working rurally and (2) broader industry views of the factors likely to be successful for rural recruitment and retention. METHODS: Recruitment for interviews pertaining to podiatrist recruitment and retention was conducted during 2017. Recruitment was through social media, podiatry professional association newsletters, public health podiatry emails. Graduate perceptions were explored via two focus groups of Australian podiatrists enrolled in the Podiatrists in Australia: Investigating Graduate Employment longitudinal survey. Industry views were explored through semistructured interviews with podiatry profession stakeholders. Inductive thematic analysis was used to analyse data about the perceptions of recently graduated podiatrists and stakeholders and the themes were triangulated between the two groups. RESULTS: Overall, 11 recent graduate podiatrists and 15 stakeholders participated. The overarching themes among the two groups were the importance of 'growing me' and 'growing the profession'. Three superordinate themes were generated through analysis of both datasets, including (i) building a career, (ii) why I stay, and (iii) it cannot be done alone. CONCLUSION: This study identified that recently graduated podiatrists are likely to be attracted to rural work and retained in rural areas if they foresee opportunities for career progression in stable jobs, have a background of training and living in rural areas, like the lifestyle, and are able to access appropriate professional and personal supports. Building employment that spans public and private sector opportunities might be attractive to new graduate podiatrists seeking a breadth of career options. It is also important to recognise rural generalist podiatrists for any extended scope of services they provide along with raising public awareness of the role of rural podiatrist as a core part of multidisciplinary rural healthcare teams. Future training and workforce planning in podiatry must promote podiatrists taking up rural training and work so that maldistribution is reduced.