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Background: Knee replacement surgery can significantly improve the quality of life of patients with severe knee osteoarthritis. Equitable access to knee replacement surgery is important to ensure that everyone, regardless of their socioeconomic status or geographical location, have fair and timely access. Objectives: The aim of our study was to (1) describe the health equity profile and quality of life of patients awaiting knee replacement at a single academic hospital in South Africa and to (2) describe the association between these health equity factors and the waiting time. Method: A cross-sectional survey and retrospective record review of patients awaiting knee replacement was conducted using the PROGRESS-Plus health equity framework. Chi-square statistics were used to calculate association between health equity factors and the waiting time. Results: Three-hundred and two (N = 302) patients (77% female; mean age 67 years) participated, of whom one in three patients waited 5 years or longer for surgery. Elderly patients (> 70 years) and patients from lower socio-economic background were less likely to have equitable access to surgery. Conclusion: The current screening protocol for knee replacement surgery in the public health care sector does not provide equitable access to surgery. A more holistic screening approach alongside selective surgical prioritisation and rehabilitation could reduce the waiting list and facilitate equitable access to care. Clinical implications: Health equity factors such as socioeconomic status, age, and other patient characteristics such as life roles and employability should be taken into consideration when screening patients for elective knee replacement waiting lists.
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Background: Move for Life (MFL) is a theory-informed intervention that was developed to augment established physical activity (PA) programmes and enable inactive adults aged 50 years and older to be more active. This study examined the feasibility of MFL and sought to provide evidence of its potential for improving PA and associated health outcomes. Methods: A 3-arm cluster randomised feasibility trial compared MFL intervention, usual provision (UP) and control (CON) groups at baseline (T0), post-intervention (T1, at 8, 10 or 12- weeks) and 6-month follow up (T2). We used purposive sampling strategies to recruit participants according to characteristics of interest. Feasibility outcomes assessed recruitment, fidelity, adherence, retention and data completion rates based on pre-set criteria. Primary outcomes were accelerometer-based moderate-to-vigorous intensity PA (MVPA) and self-reported compliance with physical activity guidelines (PAGL). Secondary outcomes included light intensity PA (LiPA), standing time, sedentary time, body composition (adiposity), physical function and psychological well-being. We used linear mixed models (continuous outcomes) or generalized estimated equations (categorical outcomes) to estimate group differences over time in the study outcomes. Results: Progression criteria for feasibility outcomes were met, and 733 individuals were recruited. Considering a 6-month period (T0-T2), while self-reported compliance with PAGL increased in MFL relative to UP and CON and in UP relative to CON, standing time decreased in MFL relative to CON and sedentary time increased in the latter compared to UP. Waist circumference decreased in MFL relative to UP and CON. MFL outperformed UP in the Timed Up and Go Test while MFL and UP increased the distance covered in the Six-Minute Walk Test compared to CON. Psychological well-being increased in MFL relative to CON (all p < 0.05). Conclusion: Findings show that MFL is feasible, while data are promising with regards to the potential of improving community PA programmes for adults aged 50 or more years. Clinical trial registration: https://www.isrctn.com/Registration#ISRCTN11235176.
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Ejercicio Físico , Estudios de Factibilidad , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Promoción de la Salud/métodos , Conducta Sedentaria , AcelerometríaRESUMEN
Dance programs for people living with Parkinson's disease (PwPD) offer participants an opportunity to exercise, engage in artistic self-expression, and form new relationships. While it is understood that the social dimension of dance programs for PwPD contributes to dancer satisfaction and program sustainability, the social mechanisms instrumental to program success are under-examined. Engaging with theory from wider disciplines, or "theory knitting" can help program designers and evaluators examine the mechanisms and contextual factors that make classes socially meaningful with greater detail and specificity. This study identified and examined three theoretical frameworks that program planners and evaluators could use to conceptualize social engagement in dance for PwPD contexts and inform practice. Each theory was assessed for fit using the T-CaST theory comparison and selection tool developed by Birken et al. (2018). As an example, we used anthropologist Victor Turner's (1970; 1977) theory of liminality and communitas to identify five key areas for fostering a sense of social connection in dance for PwPD contexts: (1) selecting a meaningful dance space (2) creating a joyous atmosphere (3) marking entrance into the liminal time and space with rituals (4) embodying liminality and anti-structure and (5) inverting power relations and embracing fluid roles.
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Baile , Enfermedad de Parkinson , Evaluación de Programas y Proyectos de Salud , Humanos , Enfermedad de Parkinson/psicología , Baile/psicología , Danzaterapia/métodos , Desarrollo de Programa , Ejercicio Físico/psicologíaRESUMEN
INTRODUCTION: Functional decline, chronic illness, reduced quality of life and increased healthcare utilisation are common in older adults. Evidence suggests music and dance can support healthy ageing in older adults. This study explored the feasibility, potential for effect and cost effectiveness of the Music and Movement for Health (MMH) programme among community-dwelling older adults using a pragmatic cluster-randomised, controlled feasibility trial design. METHODS: Community-dwelling adults aged 65 years or older were recruited to seven clusters in the Mid-West region of Ireland. Clusters were block randomised to either the MMH intervention or control. Primary feasibility outcomes included recruitment, retention, adherence, fidelity, and safety. Secondary outcomes measured physical activity, physical and cognitive performance, and psychosocial well-being, along with healthcare utilisation were assessed at baseline and after 12 weeks. RESULTS: The study successfully met feasibility targets, with recruitment (n = 100), retention (91 %), adherence (71 %), data completeness (92 %) and intervention fidelity (21 out of 24) all meeting predetermined criteria. Both groups exhibited an increase in self-reported physical activity and improved physical function. Participants in the intervention group scored consistently better in psychosocial measures compared to the control group at follow-up. The health economic analysis confirmed the feasibility of the methodology employed and points to the potential cost-effectiveness of the MMH relative to the control or no organised programme. DISCUSSION AND IMPLICATIONS: The MMH intervention and study design were found to be feasible and acceptable with important findings to inform future evaluation of the clinical and cost-effectiveness of a definitive randomised controlled trial.
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Estudios de Factibilidad , Vida Independiente , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Análisis Costo-Beneficio , Danzaterapia/métodos , Baile/psicología , Ejercicio Físico , Envejecimiento Saludable/psicología , Irlanda , Musicoterapia/métodos , Calidad de VidaRESUMEN
PURPOSE: To identify and synthesize qualitative literature on the experiences of participants and key stakeholders in dance programs for people living with Parkinson's disease. Synthesizing the available literature can generate new insights into participant experience to inform current and future programs. MATERIALS AND METHODS: Qualitative and mixed methods studies were identified via a systematic search of six databases: CINAHL, Web of Science, Scopus, SPORTDiscus, PsycInfo, and MEDLINE. Articles were synthesized using the meta-ethnographic method developed by Noblit and Hare (1988). Key concepts across studies were related via reciprocal translation, ultimately forming a line-of-argument synthesis. RESULTS: 26 articles met the inclusion criteria. Four interrelated, overarching themes were developed: (1) dance communities provide peer support and insight into living with Parkinson's, (2) feeling safe, accepted, and included in the dance experience, (3) overcoming dance-based challenges contributes to sense of achievement, confidence, and connectedness, and (4) dance participation is an opportunity to re-imagine oneself. CONCLUSION: Participant experience is shaped by the instructor-participant relationship, the social environment of classes, and class difficulty level. In order to support participant experience, classes should be safe, supportive, and have an appropriate challenge-skill balance. These qualities facilitate creative immersion and the potential for personal and collective change.
Physical activity can improve functional ability and quality of life in people living with Parkinson's disease (PD).Dance is a safe, enjoyable form of physical activity for people with PD that creates opportunities for meaningful social engagement and artistic expression.The quality of the instructor-dancer relationship, the wider social environment, and the challenge-skill balance contribute to dancer experience.For a dance class for people with PD to be successful, it must be safe, socially accepting, and provide opportunities for dancers to experience positive growth and a sense of achievement.
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In Aotearoa New Zealand, wahine Maori (Maori women) are overrepresented in several negative post-natal outcomes, including negative outcomes related to caesarean deliveries. We aimed to understand the experiences of wahine Maori who had experienced a caesarean delivery and to identify how healthcare systems can better meet the needs of wahine Maori during pre- and post-natal care. Using kaupapa Maori principles, thematic analysis of one-on-one interviews identified eight themes covering a range of issues related to overall wellbeing. Bodily autonomy and choice were discussed by all participants, as was the need for mental wellbeing to be a larger focus of perinatal care. Participants also shared positive encounters with midwives and nurses, as well as a desire to incorporate religious and cultural practices within perinatal care. The caesarean delivery birthing stories of wahine Maori highlighted the importance of Maori health models in understanding and providing culturally-affirming healthcare to wahine Maori across Aotearoa.
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Purpose: Falls are a major issue for people with neurological conditions, and the evaluation of falls prevention interventions is of high priority. To date, the views of patient groups regarding outcomes of importance have been largely overlooked. The purpose of this study was to explore outcomes of interest among people with Multiple Sclerosis (MS), Parkinson's disease (PD) and stroke upon completion of falls prevention interventions to inform the development of a core outcome set (COS).Materials and methods: Five online focus groups and one semi-structured interview were conducted among people with PD (n = 10), MS (n = 7), and post-stroke (n = 3), one of whom also had PD. Transcripts were analysed using reflexive thematic analysis.Results: Four themes were developed; (1) Fall events are not homogeneous, (2) Exercise-based programmes are beneficial but falls services are not meeting user needs, (3) Programme success beyond the reduction in falls, and (4) Acquisition of skills to self-manage falls beyond the life of the programme.Conclusions: This study presents new perspectives across patient groups regarding important outcomes upon completion of falls prevention interventions. Taken together with the findings of a literature review, this data will inform the development of a COS.Implications for rehabilitationPeople with multiple sclerosis, Parkinson's disease and stroke consider the success of a falls prevention intervention to be dependent on improvements across a wide range of outcomes.The design and implementation of falls prevention interventions should align with patient preferences.Clinicians and researchers should consider the use of multidomain interventions to facilitate improvements in the desired outcomes of patients.
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Esclerosis Múltiple , Enfermedad de Parkinson , Accidente Cerebrovascular , Humanos , Ejercicio Físico , Terapia por Ejercicio , Esclerosis Múltiple/complicaciones , Evaluación de Resultado en la Atención de Salud , Enfermedad de Parkinson/complicaciones , Accidente Cerebrovascular/prevención & control , Investigación CualitativaRESUMEN
BACKGROUND AND HYPOTHESIS: Maori, the indigenous peoples of New Zealand, experience increased rates of psychotic disorders and first-episode psychosis. However, it is unclear whether they also present with increased psychosis risk symptoms, such as subclinical psychotic-like experiences (PLEs). Measurement of risk symptoms is key for early intervention. Further, it is unclear if systemic factors such as the increased rates of social adversity and discrimination or cultural biases contribute to this disparity in psychosis rates. STUDY DESIGN: This study surveyed 466 18- to 30-year olds in New Zealand, and compared Maori to non-Maori participant responses on the Prodromal Questionnaire Brief, alongside the history of childhood trauma, discrimination, and financial adversity. STUDY RESULTS: Maori reported a higher number of PLEs compared to non-Maori-however, this was not associated with increased distress related to these experiences. The increased number of psychosis-like experiences reported by Maori was likely explained by systemic factors such as childhood trauma, discrimination, and financial stress. Maori were more likely to report that the PLEs were positive. CONCLUSIONS: Measurement of psychosis risk for Maori is nuanced, and increased scores on these tools may reflect pathologizing potentially normative experiences for Maori, such as spiritual encounters or discrimination, alongside the impact of increased rates of systemic discrimination, trauma, and financial stress.
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Pueblo Maorí , Trastornos Psicóticos , Humanos , Nueva Zelanda/epidemiología , Formación de Concepto , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/diagnóstico , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Clinical trials evaluating the effectiveness of falls prevention interventions for people with Multiple Sclerosis (MS), Parkinson's Disease (PD) and stroke measure heterogeneous outcomes, often omitting those meaningful to patients. A core outcome set (COS) is a standardised set of outcomes that should be assessed in all trials within a research area. The aim of this study was to develop a COS for evaluating mixed-diagnosis falls prevention interventions for people with MS, PD and stroke in non-acute and community settings, with input from relevant stakeholder groups. METHODS: Previously published research undertaken by the team, including a qualitative study with 20 patients and a review of the literature, were used to derive a longlist of potential outcomes. Outcomes were prioritised for inclusion in the COS using a three-round online Delphi survey. A multi-stakeholder, consensus meeting was conducted to agree upon the final COS and to provide a recommendation for a single outcome measure for each outcome in the COS. RESULTS: Forty-eight participants were recruited across four stakeholder groups (researchers, patients, clinicians, and service-planners/policymakers). A total of 42 participants (87.5%) completed all three rounds of the surveys. Sixty-two outcomes were considered for inclusion in the COS throughout the Delphi process. A total of 15 participants attended the consensus meeting where they agreed upon the final COS and accompanying measurement instruments: fall incidence, injurious fall incidence, quality of life, falls self-efficacy, fear of falling, activity curtailment due to fear of falling, and cost-effectiveness. Attendees at the consensus meeting recommended that the proposed mechanism of impact of an intervention is considered when selecting additional outcomes outside of those in the COS to assess. CONCLUSIONS: This study identified a COS for evaluating the effectiveness of mixed-diagnosis falls prevention interventions for people with MS, PD and stroke. It is recommended that this COS and accompanying measurement instruments be used in all future trials in this research area so that findings can be combined and compared.
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Esclerosis Múltiple , Enfermedad de Parkinson , Accidente Cerebrovascular , Humanos , Enfermedad de Parkinson/diagnóstico , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Calidad de Vida , Proyectos de Investigación , Miedo , Evaluación de Resultado en la Atención de Salud , Técnica Delphi , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
INTRODUCTION: Oral language skills are associated with children's later self-regulation and academic skills; in turn, self-regulation in early childhood predicts successful functioning later in life. The primary objective of this study is to evaluate the separate and combined effectiveness of an oral language intervention (Enhancing Rich Conversations, ENRICH) and a self-regulation intervention (Enhancing Neurocognitive Growth with the Aid of Games and Exercise, ENGAGE) with early childhood teachers and parents for children's oral language, self-regulation and academic functioning. METHODS AND ANALYSIS: The Kia Timata Pai (Best Start) study is a cluster randomised controlled trial with teachers and children in approximately 140 early childhood centres in New Zealand. Centres are randomly assigned to receive either oral language intervention only (ENRICH), self-regulation intervention only (ENGAGE), both interventions (ENRICH+ENGAGE) or an active control condition. Teachers' and parents' practices and children's oral language and self-regulation development are assessed at baseline at age 1.5 years and approximately every 9 months to age 5, and academic performance at age 6. Teacher-child interactions will also be videotaped each year in a subset of the centres. Children's brain and behaviour development and parent-child interactions will be assessed every 6 months to age 6 years in a subgroup of volunteers. ETHICS AND DISSEMINATION: The Kia Timata Pai trial and the two substudies (Video Project; Brain and Behaviour Development) have been approved by the University of Otago Human Ethics Committee (Health; H20/116), and reviewed for cultural responsiveness by: the Ngai Tahu Research Committee (University of Otago), the Maori Advisory Group (University of Auckland, Liggins Institute) and an internal cultural advisory group. Results will be disseminated in international and national peer-reviewed academic journals and communicated to local, national and international organisations serving early childhood teachers, parents and young children. Data will be available via communication with the corresponding author. TRIAL REGISTRATION NUMBER: ACTRN12621000845831.
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Pueblo Maorí , Autocontrol , Humanos , Preescolar , Lactante , Niño , Cognición , Lenguaje , Padres/educación , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
There is a need for both feasible and enjoyable physical activity programmes for people on a cancer journey. Emerging evidence suggests that dance can have a positive effect on health and well-being in this cohort. We aimed to synthesize the quantitative and qualitative literature exploring the effectiveness and impact of community dance interventions in people with all types and stages of cancer. A systematic search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Pubmed, EMBASE, Medline Ovid, CINAHL and PEDro databases. Quantitative and qualitative data were extracted and synthesized using a convergent segregated approach. The numeric data were analysed using descriptive statistics, narrative synthesis and meta-analysis where possible. The qualitative data were analysed using thematic analysis. The Downs and Black critical appraisal tool and the Critical Appraisal Skills Programme were used to assess the quality of the quantitative and qualitative literature, respectively. Eighteen studies were included in this mixed-methods review with seven trials included in the meta-analysis. Statistically significant improvements were found in favour of community dance for functional capacity, fatigue, quality-of-life and depression in comparison to no intervention. Evidence suggests dance is a safe and feasible form of physical activity both during and after cancer treatment. Participants reported good social support, education regarding physical activity and local access as key facilitators to participation. We concluded that dance is a feasible and enjoyable intervention for many people with various forms of cancer. Community dance programmes can improve both physical and psychological outcomes in people on a cancer journey.
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Ejercicio Físico , Neoplasias , Humanos , Calidad de Vida , Neoplasias/terapiaRESUMEN
Introduction (including aim): There is a lack of community-based programmes for older adults in Ireland. Such activities are vital to enable older people to (re)connect after COVID-19 measures, which had a detrimental effect on physical function, mental health and socialisation. The aims of the preliminary phases of the Music and Movement for Health study were to refine stakeholder informed eligibility criteria, recruitment pathways and obtain preliminary measures for feasibility of the study design and programme, which incorporates research evidence, practice expertise and participant involvement. METHODS: Two Transparent Expert Consultations (TECs) (EHSREC No: 2021_09_12_EHS), and Patient and Public Involvement (PPI) meetings were conducted to refine eligibility criteria and recruitment pathways. Participants from three geographical regions in the mid-west of Ireland will be recruited and randomised by cluster to participate in either a 12-week Music and Movement for Health programme or control. We will assess the feasibility and success of these recruitment strategies by reporting recruitment rates, retention rates and participation in the programme. RESULTS: Both the TECs and PPIs provided stakeholder-informed specification on inclusion/ exclusion criteria and recruitment pathways. This feedback was vital in strengthening our community-based approach as well as effecting change at the local level. The success of these strategies from phase 1 (March-June) are pending. DISCUSSION: Through engaging with relevant stakeholders, this research aims to strengthen community systems by embedding feasible, enjoyable, sustainable and cost-effective programmes for older adults to support community connection and enhance health and wellbeing. This will, in turn, reduce demands on the healthcare system.Note: We would like to thank and acknowledge those who participated in the PPIs for their time and invaluable feedback.
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COVID-19 , Música , Humanos , Anciano , Estudios de Factibilidad , Promoción de la Salud , Salud MentalRESUMEN
BACKGROUND: Dancing is an attractive form of exercise among older adults and may positively influence physical and psychosocial health. The aim of this systematic review was to synthesize the evidence examining the dance prescription and effectiveness of dance in community dwelling older adults. METHODS: Eight databases were searched to identify randomized controlled trials that evaluated the effectiveness of dance programs on community-dwelling older adults from 2007 to December 2020. Data regarding participants, dance programs and outcomes of interest were extracted and narratively synthesized. A meta-analysis was performed on the outcome data where possible. RESULTS: Twenty-two studies met the inclusion criteria, of those 15 were deemed to be fair quality and 7 high quality using the PEDro scale. Nineteen studies included in the meta-analysis found that dancing can improve mobility and endurance compared to no intervention and afforded equivalent outcomes compared to other exercise programs. CONCLUSION: The findings suggest that dance is an effective, safe and viable activity for community-dwelling older adults..
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Ejercicio Físico , Vida Independiente , Humanos , Anciano , Cognición , Examen Físico , Estado NutricionalRESUMEN
The biodegradation rate of Mg alloy medical devices, such as screws and plates for temporary bone fracture fixation or coronary angioplasty stents, is an increasingly important area of study.In vitromodels of the corrosion behavior of these devices use revised simulated body fluid (m-SBF) based on a healthy individual's blood chemistry. Therefore, model outputs have limited application to patients with altered blood plasma glucose or protein concentrations. This work studies the biodegradation behavior of Mg alloy WE43 in m-SBF modified with varying concentrations of glucose and bovine serum albumin (BSA) to (1) mimic a range of disease states and (2) determine the contributions of each biomolecule to corrosion. Measurements include the Mg ion release rate, electrolyte pH, the extent of hydrogen evolution (as a proxy for corrosion rate), surface morphology, and corrosion product composition and effects. BSA (0.1 g l-1) suppresses the rate of hydrogen evolution (about 30%) after 24 h and-to a lesser degree-Mg2+release in both the presence and absence of glucose. This effect gets more pronounced with time, possibly due to BSA adsorption on the Mg surface. Electrochemical studies confirm that adding glucose (2 g l-1) to the solution containing BSA (0.1 g l-1) caused a decrease in corrosion resistance (by around 40%), and concomitant increase in the hydrogen evolution rate (from 10.32 to 11.04 mg cm-2d-1) to levels far beyond the tolerance limits of live tissues.
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Líquidos Corporales , Albúmina Sérica , Humanos , Glucosa , Aleaciones , Albúmina Sérica Bovina , HidrógenoRESUMEN
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.
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Procedimientos Quirúrgicos Electivos , Hospitales , Australia , Grupos Focales , Humanos , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Patient 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. METHODS: We 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. RESULTS: Over 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. CONCLUSION: Administering 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 Approval ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III). Ethics approval has been obtained from La Trobe University (Australia) Human Research Ethics Committee (HEC20479). KEY POINTS: Patient 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.
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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.
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Background: Osteoarthritis (OA) is a heterogenous degenerative disorder often causing destructive joint changes with severe pain and functional disability. Modifiable and non-modifiable risk factors, social context and psychological factors influence the development and progression of the disease. Total knee replacement (TKR) aims at reducing pain and improving function and is more successful with pre-operative and post-operative rehabilitation. However, most international research on rehabilitation interventions is conducted in high income contexts. Objective: The aim of our systematic review is to gain an overview of the demographic and social profiles of adults undergoing TKR for primary knee OA in lower, middle- and high-income countries through a health equity lens to inform the translation of intervention research in local contexts. Methods: A systematic review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Eligibility criteria include observational studies and grey literature (theses) since the beginning of the databases reporting on demographic data of adults awaiting or undergoing TKR surgery. The PROGRESS-Plus framework will be used to describe equity elements. Results: A narrative summary and description of the global profile of individuals undergoing total knee replacement for osteoarthritis. Conclusion: A snapshot of the global demographic and social profile of individuals receiving TKR for primary knee OA through an equity lens will shed light on the similarities and differences between individuals from different contexts. Global demographic profile information may inform or assist in the development of translational strategies for evidence-based rehabilitation. Clinical implications: Translation of existing rehabilitation interventions to local contexts could improve pre-operative and post-operative outcomes for individuals on our surgical waiting lists.
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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 (nâ=â10) 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.
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Enfermedad de Parkinson , Terapia Acuática , Consenso , Técnica Delphi , Humanos , Enfermedad de Parkinson/terapia , Encuestas y CuestionariosRESUMEN
Background: Arts-based health programmes (ABHP) can enhance the physical and psychosocial health and wellbeing of older people. However, the feasibility and usefulness of such programmes in Ireland are currently unknown. The primary aim of this study is to examine the feasibility of the study design, its application to a music and movement for health programme and associated costs. The secondary aim is to obtain preliminary effect estimates of an ABHP on health and wellbeing in older adults. Methods: This study is a pragmatic cluster-randomised controlled feasibility trial. Community-dwelling adults, aged 65 years or older will be recruited in the mid-west region of Ireland via methods including social prescription, traditional and social media. The clusters, based on geographical region, will be block randomised to either the ABHP or control using 1:1 allocation ratio. The programme will comprise a 1.5-hour music and dance session each week for 12-weeks together with a 1-hour home-based music and movement programme for 12-weeks. A qualitative and quantitative process evaluation of the arts-based health programme will be performed. Outcomes: Primary outcomes for feasibility include recruitment rates (the number of participants recruited per cluster per month); retention rate (the number of participants who complete measures at baseline and at follow up post intervention, and minimum average attendance. Secondary outcomes will include physical function, balance, physical activity, loneliness, social isolation, cognition, mood, as well as quality of life and cost. Conclusions: If this pioneering study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of an arts-based health programme for older adults. This research aims to strengthen collaborative efforts to implement effective, sustainable and cost-effective programmes for older adults to support community connection, enhancing health and wellbeing, in turn reducing demands on the healthcare system. ISRCTN registration: ISRCTN35313497 (18/02/2022).