Early supported discharge for older adults admitted to hospital after orthopaedic surgery: a systematic review and meta-analysis.

BACKGROUND: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints. METHODS: A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1. RESULTS: Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (FEM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%). No statistically significant effects favouring ESD interventions were established in secondary outcomes. CONCLUSION: In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

Effectiveness of occupational therapy interventions on function and occupational performance among adults with conditions of the hand, wrist, and forearm: A systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis examines the effectiveness of occupational therapy interventions for adults with conservatively managed conditions of the hand, wrist, and forearm. METHODS: Searches were carried out in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, MEDLINE (OVID), EMBASE, and PubMed. Grey literature was searched for via Google Scholar. A systematic literature search was undertaken for randomised studies that examined occupational therapy interventions for treatment of hand, wrist, and forearm conditions. The primary outcome was function, with secondary outcomes of occupational performance, satisfaction with occupational performance, pain, and quality of life. Meta-analyses were completed, and GRADE was used to determine the certainty of evidence. RESULTS: Twelve studies with 1429 participants were identified. Interventions included combinations of occupation-based intervention, assistive device provision, education, orthosis provision, and exercise programmes for arthritis, carpal tunnel syndrome, and fracture and tendon injuries of the hand, wrist, and forearm. Occupational therapy resulted in an improvement of function (REM, SMD -0.27, 95% CI -0.00 to -0.53, I2  = 69%, low certainty evidence) (p = 0.05), occupational performance (REM, SMD 0.83, 95% CI 1.61-0.06, I2  = 91%, low certainty evidence) (p = 0.04), satisfaction with occupational performance (REM, SMD 0.74, 95% CI 1.42-0.05, I2  = 89%, low certainty evidence) (p = 0.03), and pain reduction (FEM, MD -1.35, 95% CI -0.84 to -1.86, I2  = 0%, moderate certainty evidence) (p < 0.00001). CONCLUSION: Further high-quality research is recommended to determine the effects of occupational therapy interventions on specific upper limb conditions, inclusive of a broader range of clinical and patient reported outcome measures.

Patient and clinician perspectives of online-delivered exercise programmes for chronic musculoskeletal conditions: a mixed-methods systematic review.

PURPOSE: To synthesize common or differing perceptions of patients' and clinicians' that influence uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions. METHODS: Eight databases were searched from inception to April 2023 for studies including (1) patients with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality. Perceptions of patients' and clinicians' influencing uptake of ODEPs were extracted. Quantitative and qualitative data were synthesised and integrated. RESULTS: Twenty-one studies were included (twelve quantitative, seven qualitative, and two mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A (n = 7), mode B (n = 8), and mode C (n = 6). Sixteen of the 23 identified perceptions related to satisfaction, acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake and 30% hindering uptake. CONCLUSIONS: Findings highlight the need to promote targeted education for patients and clinicians addressing interconnected perceptions, and to develop evidence-based perception-centred strategies encouraging integrated care and guideline-based management of chronic MSK conditions.

Almost 70% of perceptions related to satisfaction, acceptability, usability, and effectiveness that influence the uptake of online-delivered exercise programmes for chronic musculoskeletal conditions are shared by patients and clinicians.Patient perceptions that differ from clinicians and that hinder uptake include the risk of misdiagnosis, lack of social support, and advice from their clinic and/or clinician.Clinician perceptions that differ from patients and that hinder uptake include risk of last-minute appointment cancellations, the cost to set-up, and limitations of camera angles.Implementation of online-delivered exercise programmes may be supported by targeted education for patients and clinicians that addresses misinformed perceptions.

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis.

INTRODUCTION: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. It has been researched extensively in the stroke population, showing reduced length of stay for patients and improved functional outcomes. This systematic review aims to explore the totality of evidence for the use of ESD in an older adult population who have been hospitalised with medical complaints. METHODS: Systematic searches were conducted in MEDLINE, CINAHL, Ebsco, Cochrane Library and EMBASE. Randomised controlled trials (RCTs) and quasi-RCTs were included if they provided an ESD intervention to older adults admitted to hospital for medical complaints compared with usual inpatient care. Patient and process outcomes were explored. The Cochrane Risk of Bias Tool was used to assess methodological quality. A meta-analysis was conducted using RevMan 5.4.1. RESULTS: Five RCTs met the inclusion criteria. The quality of the trials was mixed overall, with high levels of heterogeneity. ESD demonstrated a statistically significant reduction in length of stay (MD -6.04 days, 95% CI -9.76 to -2.32) and improvements in function, cognition, and health-related quality of life, with no increased risk of long-term care admission, hospital re-admission or mortality in the ESD interventions versus usual care groups. DISCUSSION: This review demonstrates that ESD positively impacts patient and process outcomes for older adults. Further consideration should be given to exploring the experiences of those involved in ESD including older adults, family members/caregivers as well as healthcare professionals.

Early Supported Discharge for Older Adults Admitted to Hospital with Medical Complaints: A Qualitative Study Exploring the Views of Stakeholders.

Introduction: Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints. Methods: Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke's approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021). Results: Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team. Discussion: This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints. Conclusion: This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students.

BACKGROUND: Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain related knowledge and attitudes. The secondary aim was to explore what factors influence students' pain related knowledge and attitudes. METHODS: In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes]. RESULTS: Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching. CONCLUSIONS: There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs. TRIAL REGISTRATION: The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857 .

Early supported discharge for older adults admitted to hospital with medical complaints: a systematic review and meta-analysis.

INTRODUCTION: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has shown reduced length of stay and improved functional outcomes in stroke patients. This systematic review aims to explore the totality of evidence for the use of early supported discharge in older adults hospitalised with medical complaints. METHODS: A literature search of CINAHL in EBSCO, Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE and MEDLINE in EBSCO was carried out. Randomised controlled trials or quasi-randomised controlled trials were included. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment. The primary outcome measure was hospital length of stay. Secondary outcomes included mortality, function, health related quality of life, hospital readmissions, long-term care admissions and cognition. A pooled meta-analysis was conducted using RevMan software 5.4.1. RESULTS: Five studies met the inclusion criteria. All studies were of some concern in terms of their risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (REM, MD = -6.04, 95% CI -9.76 to -2.32, I2 = 90%, P = 0.001). No statistically significant effects favouring ESD interventions were established in secondary outcomes. CONCLUSION: ESD interventions can have a statistically significant impact on the length of stay of older adults admitted to hospital for medical reasons. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration.

BACKGROUND: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. OBJECTIVE: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. METHODS: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. RESULTS: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. CONCLUSIONS: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease-related health barriers and the users' confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management.

Effectiveness of occupational therapy interventions on function and satisfaction with occupational performance among adults with conditions of the hand, wrist, and forearm: a protocol for a systematic review.

Background: Functional hand use post injury is important in enabling a person's engagement in daily living tasks. Without proper treatment, there may be difficulties in self-care, engaging in job roles, or leisure pursuits. Occupational therapists are key health care practitioners for people with upper limb conditions. This systematic review aims to appraise and summarise current evidence regarding effectiveness of occupational therapy interventions among adults with conditions of the hand, wrist, and forearm. Methods: A systematic review of randomised control trials and quasi randomised controlled trials will be completed. MEDLINE OVID, CINAHL, CENTRAL, COCHRANE, PUBMED and EMBASE databases will be systematically searched. Grey literature will be searched for via Google Scholar. Studies will be included if they include provision of occupational therapy to adults with a hand, wrist, or forearm condition when compared to treatment as usual or an alternative treatment option. The primary outcome will be function. Secondary outcomes will include satisfaction with occupational performance, quality of life, pain experience, and participation. The Brief International Classification of Functioning, Disability and Health (ICF) Core Set for Hand Conditions will be used to categorise outcomes. The Cochrane Risk of Bias 2 (RoB 2) tool and the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) framework will be utilised to assess quality. A pooled meta- analysis will be completed using RevMan, depending on the uniformity and availability of data. Results: This review aims to synthesise high quality evidence to identify the effectiveness of occupational therapy interventions with patients with a hand, wrist, or forearm condition, categorising outcomes in relation to the ICF Core Set for Hand Conditions. Conclusions: By synthesising the evidence there is potential for improved evidence base for clinicians; improved outcomes for patients; as well as potential economic benefit.This study is registered with PROSPERO: CRD42022337070.

Early supported discharge for older adults admitted to hospital with medical complaints: a protocol for a systematic review.

INTRODUCTION: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home and continue to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. The concept has been researched extensively in the stroke population, showing reduced length of stay for patients and improved functional outcomes. This systematic review aims to explore the totality of evidence for the use of ESD in an older adult population who have been hospitalised with medical complaints. METHODS: A systematic review of randomised controlled trials and quasi randomised controlled trials will be carried out in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies will be included if they provide an ESD intervention to older adults admitted to hospital for medical complaints compared with continuing inpatient care. MEDLINE, CINAHL, CENTRAL and EMBASE databases will be searched. The primary outcome measure will be length of hospital stay, secondary outcomes will include functional abilities, falls, quality of life, carer and patient satisfaction, unplanned emergency department re-presentation, unscheduled hospital readmission, nursing home admission or mortality. Titles and abstracts of studies will be screened independently by two authors. The Cochrane Risk of Bias Tool will be used independently by two reviewers to assess the methodological quality of the included studies. GRADE will be used to assess the quality of the body of evidence. A pooled meta-analysis will be conducted using RevMan software V.5.4.1, depending on the uniformity of the data. ETHICS AND DISSEMINATION: The authors will present the findings of the review to a patient and public involvement stakeholder panel of older people that has been established at the Ageing Research Centre in the University of Limerick. Formal ethical approval is not required for the review as all data collected will be secondary data and will be analysed anonymously. PROSPERO REGISTRATION NUMBER: CRD42021223112.

COVID-19 healthcare policies in Ireland: A rapid review of the initial pandemic response.

AIMS: Healthcare systems urgently required policies to guide the response to the COVID-19 pandemic. The aim of this review was to document the healthcare policies developed during the initial wave of widespread COVID-19 transmission in Ireland. We further sought to determine the key focus and impact of these policies. METHODS: We conducted a rapid review of COVID-19 healthcare policies published from 28 January to 31 May 2020. Key information including the focus of the policy, target population and impact on service delivery was extracted from included policies. During analysis, data was grouped under descriptive categories and narrative summaries were developed for each category. RESULTS: We identified 61 healthcare policies relating to COVID-19. We developed six category headings to describe the focus and impact of these policies: infection prevention and control (n = 19), residential care settings (n = 12), maintaining non-COVID-19 healthcare services and supports (n = 12), testing and contact tracing (n = 7), guidance for healthcare workers concerning COVID-19 (n = 6), and treating COVID-19 (n = 5). CONCLUSIONS: This review has identified lessons for policy development and implementation to help prepare for future healthcare emergencies. Factors to consider include support of vulnerable groups during and in the aftermath of the pandemic, providing psychological supports for healthcare workers and investment in public healthcare services such as contact tracing for future emergencies. While pandemic conditions necessitate the speedy development of policies, effective communication and adequate resourcing is required to ensure policy implementation.

Evidence-based practice education for healthcare professions: an expert view.

Internationally, evidence-based practice (EBP) is recognised as a foundational element of healthcare professional education. Achieving competency in this area is a complex undertaking that is reflected in disparities between 'best EBP' and actual clinical care. The effective development and implementation of professional education to facilitate EBP remains a major and immediate challenge. To ascertain nuanced perspectives on the provision of EBP education internationally, interviews were conducted with five EBP education experts from the UK, Canada, Australia and New Zealand. Definitive advice was provided in relation to (1) EBP curriculum considerations, (2) teaching EBP and (3) stakeholder engagement in EBP education. While a considerable amount of EBP activity throughout health profession education is apparent, effectively embedding EBP throughout curricula requires further development, with a 'real-world' pragmatic approach that engenders dialogue and engagement with all stakeholders required.

Inhibiting the Physiological Stress Effects of a Sustained Attention Task on Shoulder Muscle Activity.

OBJECTIVE: The objective of this study was to investigate if a breathing technique could counteract the effects of hyperventilation due to a sustained attention task on shoulder muscle activity. BACKGROUND: The trend towards higher levels of automation in industry is increasing. Consequently, manufacturing operators often monitor automated process for long periods of their work shift. Prolonged monitoring work requires sustained attention, which is a cognitive process that humans are typically poor at and find stressful. As sustained attention becomes an increasing requirement of manufacturing operators' job content, the resulting stress experienced could contribute to the onset of many health problems, including work related musculoskeletal disorders (WRMSDs). METHODS: The SART attention test was completed by a group of participants before and after a breathing intervention exercise. The effects of the abdominal breathing intervention on breathing rate, upper trapezius muscle activity and end-tidal CO2 were evaluated. RESULTS: The breathing intervention reduced the moderation effect of end-tidal CO2 on upper trapezius muscle activity. CONCLUSIONS: Abdominal breathing could be a useful technique in reducing the effects of sustained attention work on muscular activity. APPLICATION: This research can be applied to highly-automated manufacturing industries, where prolonged monitoring of work is widespread and could, in its role as a stressor, be a potential contributor to WRMSDs.

Reliability of a measurement method for the cross-sectional area of the longus colli using real-time ultrasound imaging.

OBJECTIVE: Real-time ultrasound imaging is an established objective outcome measurement with proven reliability. However, it is still largely biased by user-ability. Published research in the area of real-time ultrasound imaging reliability in the cervical region and in particular the deep cervical flexors is quite sparse. The purpose of this investigation was to examine if a novice ultrasound user could agree favourably with an experienced ultrasound sonographer in measuring the cross-sectional area of the longus colli. METHODS: Ultrasound images were captured from 22 healthy subjects on two different occasions, one week apart, by a novice ultrasound user. They were acquired using a GE Healthcare LOGIQe ultrasound machine, at a depth of 3-4 cm with the transducer frequency set to 8 MHz, in line with previous research guidelines. Cross-sectional area was then measured on-screen by both a novice and experienced ultrasound user to determine inter-rater reliability. Intra-rater reliability was also analysed using cross-sectional area figures from days one and two. RESULTS: Intra-rater reliability for real-time ultrasound imaging for the cross-sectional area of the longus colli was "excellent" (intra-class correlation 0.90, 95% CI 0.82-0.95). Inter-rater reliability was "moderate" but in keeping with previous published research (intra-class correlation 0.61, 95% CI 0.37-0.77). CONCLUSION: Difficulties in identifying the borders of the longus colli muscle due to its deep anatomical location and surrounding structures make it difficult for assessors to agree favourably on cross-sectional area measurements, leading to "moderate" levels of inter-rater reliability and poor agreement. Intra-rater reliability is excellent, and in this instance indicates that a novice user can be just as reliable as a more experienced ultrasound user.

Chronic neck pain and exercise interventions: frequency, intensity, time, and type principle.

OBJECTIVE: To identify the most effective components in an active exercise physiotherapy treatment intervention for chronic neck pain based on the frequency, intensity, time, and type (FITT) exercise method of tailoring physical activity recommendations to the individual needs and goals of patients. DATA SOURCES: Databases, including the Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, SPORTDiscus, Biomedical Reference Collection, and Academic Search Premier, were searched for relevant articles. STUDY SELECTION: Quantitative design studies that included active exercise as part of a multimodal or stand-alone approach were selected. Only studies scoring ≥6 on the Physiotherapy Evidence Database Scale were included in the review because this reflected a good level of evidence. DATA EXTRACTION: Study methodologies and relevant outcome measures, including isometric strength, Neck Disability Index scores, and pain scores, were extracted from relevant articles and grouped together for appraisal and synthesis. DATA SYNTHESIS: Evidence from selected articles was synthesized according to the FITT exercise principal to determine the most effective exercise type, frequency, and intensity in the treatment of chronic neck pain. CONCLUSIONS: Physiotherapy interventions using a multimodal approach appear to produce more beneficial outcomes in terms of increased strength, improved function, and health-related quality of life and reduced pain scores. Active strengthening exercises appear to be beneficial for all of these outcomes; the inclusion of additional stretching and aerobic exercise components appear to enhance the benefits of an exercise intervention.