Implementing ward-based practice books to increase the amount of practice completed during inpatient stroke rehabilitation: a mixed-methods process evaluation.

PURPOSE: Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. METHODS: Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. RESULTS: Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. CONCLUSIONS: Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books.

Ward-based practice books are one evidence-based strategy that can be used by rehabilitation teams to increase the amount of practice completed by stroke survivors during inpatient rehabilitation.Stroke survivors' personal factors (including severe weakness, cognitive and communication deficits), staff beliefs about their role and coaching skills, affected stroke survivors ability to practice on the ward using practice books.Staff with the necessary skills, understanding and belief about their role in implementing ward practice can overcome personal (patient related) factors (such as severe weakness) and assist stroke survivors to successfully practice on the ward.To increase the success of ward practice, repeated booster training of staff is required along with audit and feedback and team action planning on the presence, quality, and use of ward practice books.

Effect of abnormal body weight on mortality and functional recovery in adults after stroke: An umbrella review.

BACKGROUND: Several published systematic reviews have drawn conflicting conclusions on the effect of abnormal body weight (i.e. being underweight, overweight or obese) on outcomes following stroke. The 'obesity paradox' seen in several diseases (wherein obesity, often associated with mortality and morbidity, appears to be protective and improve outcomes) may be evident after stroke, but inconsistent results of existing reviews, and the issue of being underweight, are worth investigating further. AIMS: To better understand the impact of body weight on prognosis after stroke, we aimed to answer the following research question: What is the effect of abnormal body weight (underweight, overweight, or obesity) on mortality and functional recovery in adults after stroke? SUMMARY OF REVIEW: We conducted an umbrella review to synthesize existing evidence on the effects of abnormal body weight on stroke outcomes. We searched Cumulated Index to Nursing and Allied Health Literature (CINAHL) Complete, COCHRANE Database of Systematic Reviews, PubMed, Medline, PEDro, and EMBASE Classic + EMBASE, from inception until 28 February 2023. Seven systematic reviews (1,136,929 participants) from 184 primary studies (counting duplicates) were included. While the risk of mortality increases with being underweight (body mass index (BMI) < 18.5 kg/m2), excess body weight (being overweight (BMI = 25-29.9 kg/m2) or obese (BMI > 30 kg/m2)) is associated with reduced mortality. The impact of abnormal body weight on functional recovery is less clear; data from studies of being underweight are associated with poor functional outcomes while those from studies of excess body weight are inconclusive. CONCLUSION: Abnormal body weight effects post-stroke outcomes and should be considered in clinical decision-making, prognostic research, and clinical trials of rehabilitation interventions. The "obesity paradox" is evident after stroke, and excess body weight is associated with reduced mortality compared to normal body weight. It is recommended that body weight is routinely recorded for stroke patients, and further research, including well-designed cohort studies with reliable weight data, is needed to further investigate the impact of body weight and distribution on post-stroke outcomes.

Exploration of the contribution of physiotherapy students to the delivery of health services: a qualitative study.

OBJECTIVE: To understand the perspectives of physiotherapists on the contribution of students to the delivery of health services during clinical placements. METHODS: Focus groups with a semi-structured interview guide were completed separately with new graduate physiotherapists reflecting on their student experience and experienced physiotherapists from five Queensland public health-sector hospitals. Interviews were transcribed verbatim in preparation for thematic analysis. Interview manuscripts were read independently and initially coding completed. Codes were compared and further refinement of themes occurred. Themes were reviewed by two investigators. RESULTS: There were 38 new graduate participants across nine focus groups and 35 experienced physiotherapists across six focus groups who participated in this study. Students participate in a range of activities during clinical placements some of which contribute to delivery of health services and others which support student learning. Three major themes were identified: 1) tangible student contribution; 2) non-tangible student contribution; and 3) factors that influence the student contribution. CONCLUSIONS: Overwhelmingly, both new graduate and experienced physiotherapists felt that students do contribute to the delivery of health services however careful consideration of a variety of factors is necessary to maximize the student contribution.

A collaborative clinical placement model for physiotherapy students results in equivalent (or greater) direct patient care activity than that delivered by physiotherapists alone: an observational study.

BACKGROUND: The demand for physiotherapy clinical placements is rising which requires innovative approaches and an understanding of clinical placement models. OBJECTIVE: To determine physiotherapy student contribution to direct patient care activity during a collaborative clinical placement model. Secondary aims determined the impact of clinical area and clinical educator to student (CE:student) ratio and if a group of students could reach equivalent direct patient care activity of a junior or senior physiotherapist. METHOD: Physiotherapy student, and junior and senior physiotherapist occasions of service (OOS) were collected from five Queensland Public Health Sector hospital information management systems from four physiotherapy clinical areas (i.e. cardiorespiratory, musculoskeletal, neurorehabilitation, and orthopedics). Number of days of clinical activity was recorded to provide average OOS/day. RESULTS: Across a 5-week clinical placement a group of physiotherapy students in a collaborative clinical placement model provided on average 10.6 OOS/day (95%CI 10.1-11.2). In three (75%) clinical areas, a group of students participating in higher CE:student ratios produced more OOS/day. Clinical area and CE:student ratio predicted 39% of the variance in student average OOS/day. On average a group of students reached the equivalent direct patient care activity of a junior and senior physiotherapist by week two of a 5-week clinical placement. CONCLUSION: Physiotherapy students in a collaborative clinical placement model met or exceeded the direct patient care activity of a physiotherapist, irrespective of clinical area and CE:student ratio.

Measuring the effects of airway clearance in mechanically ventilated infants and children: A systematic review.

BACKGROUND: Robust measurement tools are essential in guiding physiotherapy-delivered airway clearance techniques to ventilated infants and children. OBJECTIVE: To identify measurement tools used to evaluate effects of airway clearance techniques in ventilated infants and children and to determine the clinimetric properties of these tools. DATA SOURCES: Pubmed, CINAHL, Embase, The Cochrane Library, Physiotherapy Evidence Database and Web of Science, up to November 2020. STUDY SELECTION: Randomized and non-randomized clinical trials measuring any aspect of lung function during and/or after airway clearance techniques in mechanically ventilated infants and children from birth to sixteen years. DATA EXTRACTION AND DATA SYNTHESIS: Two independent reviewers identified tools measuring effects of airway clearance techniques including secretion clearance, respiratory mechanics, gas exchange and changes on lung imaging. Extracted data included details of the tool, airway clearance intervention being evaluated and aspects of lung function being measured. Assessment of quality and clinimetric properties, including validity, reliability and responsiveness, were evaluated for each tool using the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. RESULTS: Nine measurement tools measured the effects of airway clearance techniques on secretion clearance, respiratory mechanics, gas exchange and lung imaging. Five tools reported clinimetric properties although the yield and overall quality of studies was low. Tools measured many different aspects of lung function. The CO2SMO Plus respiratory mechanics monitor reported the most clinimetric data. LIMITATIONS: Unpublished or in-progress studies were not included to ensure all data collected were peer-reviewed, therefore additional or novel tools may not have been identified. Included age ranges and definition of airway clearance techiques were kept broad to optimise study identification which may limit generalisability of results. CONCLUSION: Measurement tools used by physiotherapists to enhance airway clearance in ventilated infants and children lack high quality evidence of validity, reliability and responsiveness. Measurements gained through these tools should therefore be interpreted with careful consideration until further climimetric evidence is available. CONTRIBUTION OF PAPER.

Effect of Exercise on Brain-Derived Neurotrophic Factor in Stroke Survivors: A Systematic Review and Meta-Analysis.

BACKGROUND: BDNF (brain-derived neurotrophic factor) is a biomarker of neuroplasticity linked with better functional outcomes after stroke. Early evidence suggests that increased concentrations after exercise may be possible for people with stroke, however it is unclear how exercise parameters influence BDNF concentration. METHODS: This systematic review and meta-analysis searched 7 electronic databases. Experimental or observational studies measuring changes in BDNF concentration after exercise in people poststroke were included. Data were extracted including characteristics of the study, participants, interventions, and outcomes. Several fixed and random effects meta-analyses were completed. RESULTS: Seventeen studies including a total of 687 participants met the eligibility criteria (6 randomized trials). Significant improvements were observed in BDNF concentration following a single session (mean difference, 2.49 ng/mL; [95% CI, 1.10-3.88]) and program of high intensity aerobic exercise (mean difference, 3.42 ng/mL; [95% CI, 1.92-4.92]). CONCLUSIONS: High intensity aerobic exercise can increase circulating BDNF concentrations, which may contribute to increased neuroplasticity. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021251083.

Intergenerational living and learning: The value and risks of co-locating retirement villages on secondary school campuses - Evaluating the GrandSchools vision.

OBJECTIVES: GrandSchools is a new concept which co-locates retirement villages with secondary schools in one physical environment. Designed to enhance the health and well-being of both younger and older generations, this intergenerational-shared campus model promotes intergenerational inclusivity and active learning and living. In this paper, we explore stakeholder experts' perceptions of current opportunities and impediments to this proposed intergenerational learning and living model. METHODS: A qualitative study reporting on findings from an industry seminar (n = 50) and key interviews (n = 10) from stakeholders in education, health, higher education, the management and operation of retirement villages, and design firms. RESULTS: Three key themes summarised participants' assessment of the value, risks and what needs to change in order for intergenerational living and learning to become a reality. CONCLUSIONS: By bringing younger and older generations together in one shared campus location, GrandSchools is a novel idea to promote intergenerational inclusivity, enhancing the health and well-being of our whole community.

"I Give It Everything for an Hour Then I Sleep for Four." The Experience of Post-stroke Fatigue During Outpatient Rehabilitation Including the Perspectives of Carers: A Qualitative Study.

Background: Fatigue is a debilitating post-stroke symptom negatively impacting rehabilitation. Lack of acknowledgment from carers can be additionally distressing. The purpose of this study was to describe the experience of post-stroke fatigue during outpatient rehabilitation, including the perspectives of carers. Methods: This qualitative study was guided by descriptive phenomenology within a constructivist paradigm. Semi-structured interviews were conducted with stroke survivors experiencing fatigue (Fatigue Assessment Scale >23) and attending outpatient rehabilitation. Carers were also interviewed where identified, providing insight into their own and stroke survivor experiences. Data were analyzed according to Colaizzi's analytic method. Results: Fourteen stroke survivors (50% culturally and linguistically diverse), and nine carers participated. Six themes were identified: 1. The unpredictable and unprepared uncovering of fatigue; 2. Experience and adjustment are personal 3. Being responsible for self-managing fatigue; 4. The complex juggle of outpatient stroke rehabilitation with fatigue; 5. Learning about fatigue is a self-directed problem-solving experience; 6. Family and carers can support or constrain managing fatigue. Conclusion: Despite engaging in outpatient rehabilitation, stroke survivors largely learnt to manage fatigue independent of healthcare professionals. Carers often facilitated learning, monitoring rehabilitation, daily routines and fatigue exacerbation. Conversely, family could be dismissive of fatigue and possess unrealistic expectations. Post-stroke fatigue must be considered by clinicians when delivering outpatient rehabilitation to stroke survivors. Clinicians should consistently screen for fatigue, provide flexible session scheduling, and educate about individual indicators and strategies for management. Clinicians should also explicitly engage carers who play a critical role in the management of fatigue.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study.

BACKGROUND: The first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility. METHODS: A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015-2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs. RESULTS: A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group. After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively. CONCLUSIONS: Implementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

Profiles of Recruits Entering Army Basic Training in New Zealand.

INTRODUCTION: A high incidence of musculoskeletal injuries is sustained by army recruits during basic training. Describing recruits' personal, lifestyle, and physical performance characteristics at the entry to training can help identify existing intrinsic risk factors that may predispose some recruits to injury. Identifying modifiable and preventable intrinsic risk factors may contribute to lower recruit injury and associated burdens during the course of basic training. The aim of this study was to therefore describe the profile of New Zealand Army recruits upon entry to basic training using personal, lifestyle, and physical performance characteristics. METHODS: New Zealand Army male and female recruits from two intakes in the same year were invited to participate. Recruits' data on personal (sex, age, height, and weight), lifestyle (self-reported responses to the Military Pre-training Questionnaire comprising physical and injury history, diet, alcohol, and smoking status) and physical performance characteristics (2.4-km timed run, weight-bearing dorsiflexion lunge test, and the Y Balance TestTM for lower limb dynamic stability) were collected and analyzed. RESULTS: Participants included 248 New Zealand Army recruits: 228 males (91.9%), 20 females (8.1%), average age of 20.3 ± 2.8 years. Findings indicated 30.9% of recruits reported injury in the 12 months prior to training commencing, with 44.8% of those injuries in the lower limbs. Pre-entry alcohol consumption was higher than recommended and 20.1% of recruits identified as current smokers. Recruits who passed the 2.4-km timed run included 53.8% of males and 28.6% of females. Weight-bearing dorsiflexion lunge test performance was within a normal range (right = 10.3 ± 3.3 cm), however limb asymmetry (>1.5 cm) was present with 30.9% of recruits. For the Y Balance TestTM for dynamic lower limb stability, 70% of female recruits had high posterolateral reach asymmetry (8.1 ± 6.0 cm), while normalized composite reach scores were low (right) for male (92.2 ± 8.1%) and female recruits (89.0 ± 7.5%). CONCLUSIONS: New Zealand Army recruits entering basic training were predominantly active young males, reported few injuries in the previous year, had higher than recommended alcohol consumption and a minority were smokers. The majority of recruits had low aerobic fitness, average ankle dorsiflexion range, and low dynamic lower limb stability. While a number of adverse characteristics identified are potentially modifiable, more research is required to identify an association to musculoskeletal injury risk in New Zealand Army recruits. Describing the profile of recruits entering training, particularly recruits at risk of injury is one of the first steps in injury prevention.

IMproving Physical ACtivity after stroke via Treadmill training (IMPACT) and self-management: A randomized trial.

AIM: To determine if treadmill training embedded in self-management education commencing during stroke inpatient rehabilitation results in more physical activity than usual gait training. METHOD: A prospective, parallel-group, randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis involving 119 stroke survivors undergoing rehabilitation who were able to walk independently was undertaken. The experimental group undertook treadmill training (40-60% heart rate reserve) and self-management education for 30 min, three times a week for 8 weeks, and the control group undertook the same amount of usual gait training. Outcomes were measured at baseline (Week 0), on completion of the intervention (Week 8), and beyond the intervention (Week 26). The primary outcome was physical activity measured as steps/day using an activity monitor. Secondary outcomes were walking ability, cardiorespiratory fitness, cardiovascular risk, depression, self-efficacy, perception of physical activity, participation, and quality of life. RESULTS: After 8 weeks, the experimental group took 1436 more steps/day (95% confidence interval (CI) = 229 to 2643) than the control group. By 6 months, they took 871 more steps/day (95% CI -385 to 2129) than the control group. There was no difference between groups in any other outcome. CONCLUSION: In individuals undergoing rehabilitation after stroke, 8 weeks of treadmill training embedded in self-management resulted in more physical activity than usual gait training and this was largely maintained at 6 months, despite little effect on walking or cardiorespiratory fitness, suggesting the self-management was responsible.

Benchmarking service provision, scope of practice, and skill mix for physiotherapists in adult cystic fibrosis care delivery.

BACKGROUND: Increasing age, numbers, and complexity of care are potentially impacting physiotherapy service delivery for adults with cystic fibrosis (CF). PURPOSE: This study aimed to describe physiotherapy service provision, scope of practice, and skill mix in a large tertiary adult CF center, and determine if services were meeting clinical practice recommendations. METHODS: A prospective cross-sectional study examined inpatient and outpatient physiotherapy care across a three-month period in a tertiary adult CF center. Physiotherapy services were described by number and skill level of physiotherapists, total hours of activity, and number, type, and duration of each physiotherapy activity. RESULTS: Twenty-two physiotherapists provided care. Respiratory (n = 1058, 38%), and exercise treatments (n = 338, 12%) were the most frequent. Exercise testing (n = 20, 1%), and detailed treatment reviews (n = 79, 3%) occurred infrequently. Time for research was limited. Junior physiotherapists undertook more exercise treatments per day (p < .01), with senior physiotherapists attending outpatient clinics (p < .01). CONCLUSION: A large number of physiotherapists were involved in the delivery of services. Recommended respiratory and exercise treatments were frequently provided; however, other recommended activities occurred infrequently. The impact of increasing age, numbers of patients, and complexity of care may be contributing to demand exceeding supply for physiotherapy services. Future studies are required to determine innovative approaches to address the gaps in clinical practice recommendations.

The transition from physiotherapy student to new graduate: are they prepared?

Background: The transition from physiotherapy student to new graduate poses many challenges. In other health disciplines concerns have been raised about new graduate preparedness for practice.Objective: To explore the perspectives of new graduate and experienced physiotherapists on the transition from student to new graduate.Methods: Semi-structured interviews were conducted with 15 focus groups; nine new graduate groups and six experienced physiotherapist groups. Interviews were transcribed in preparation for thematic analysis whereby researchers examined transcripts independently and identified codes. Codes were compared and themes developed, discussed, and refined. Themes were reviewed by all authors.Results: Four themes emerged surrounding the transition from physiotherapy student to new graduate: 1) preparedness for practice; 2) protected practice; 3) independent and affirmation of practice; and 4) performance expectations. Both groups identified increased caseload volume and complexity were challenging, and that students were typically protected from realistic workloads. New graduates at times felt unprepared for their new roles and highlighted that coping with change in independence and managing expectations of themselves was difficult. Strategies identified that may assist the transition from student to new graduate included organizational, clinical placement experiences and building self-efficacy.Conclusions: Challenges are experienced during the transition from physiotherapy student to new graduate. To enhance this transition a multifactorial approach is required that includes all key stakeholders and strategically targets challenges associated with the student transition to new graduate.

An audit of physiotherapists' documentation on physical activity assessment, promotion and prescription to older adults attending out-patient rehabilitation.

PURPOSE: Identify if physiotherapists document the assessment, promotion and prescription of physical activity to older adults attending out-patient rehabilitation and assist them in the transition to an active lifestyle. METHODS: An audit of physiotherapists' documentation in medical records of older adults who attended an out-patient rehabilitation program at a tertiary hospital. RESULTS: Fifty-six medical records were reviewed. Mean age (SD) of participants was 79 (7) years. No documentation was found on the use of validated tools to assess physical activity levels of older adults. Prescription of physical activity was documented in 55/56 (98%) medical records. Seven (12.5%) medical records included documentation on goal setting regarding physical activity participation. Advice on regular physical activity post-discharge from the rehabilitation program was documented in 28/56 (50%) medical records. Formal referral to community-based physical activity programs was documented in 4/56 (7%) medical records. CONCLUSIONS: Evidence-practice gaps were found in physiotherapists' documentation of the promotion of physical activity to older adults attending out-patient rehabilitation, indicating a lack of assistance in the transition to an active lifestyle. These gaps were evident in the lack of; physical activity assessment, implementation of behaviour change strategies and formal referral to physical activity in the community post-discharge from out-patient rehabilitation.Implications for rehabilitationOur findings suggest that physiotherapists are not widely applying evidence-based practice to promote physical activity to older adults attending out-patient rehabilitation nor supporting them in the transition to engage in physical activity in the community post-discharge from rehabilitation program.Incorporating physical activity assessment and behaviour change strategies into usual care may enable physiotherapists to successfully promote physical activity to older adults attending out-patient rehabilitation.Collaboration between the health care system and community-based physical activity programs is imperative to facilitate the sustainability of an active lifestyle after discharge from rehabilitation program.

Repetitions, duration and intensity of upper limb practice following the implementation of robot assisted therapy with sub-acute stroke survivors: an observational study.

BACKGROUND: Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. OBJECTIVES: This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. METHODS: Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. RESULTS: In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4-11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37-638)) reps and 8 (2-14) reps/minute, with the duration of therapy unchanged. CONCLUSIONS: This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff.IMPLICATIONS FOR REHABILITATIONRobotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practiceRobotics were able to be implemented within the existing organisational structures with only basic training of therapy staff.

Prevalence of Musculoskeletal Injuries in New Zealand Army Recruits as Defined by Physical Therapy Service Presentations.

INTRODUCTION: Army recruit injuries occurring during basic training can lead to high personal and organizational burdens potentially threatening deployment capability. Previous military surveillance describing recruit injury as defined by physical therapy presentations is limited to 1-year duration or includes only male infantry recruits or trained personnel. Research describing injury incidence and trends specific to New Zealand Army basic training recruits over a longer period will better inform future injury prevention programs. AIMS: To identify the incidence and patterns of injuries reported from physical therapy presentations for New Zealand Army recruits undertaking basic training over a 4-year period. MATERIALS AND METHODS: This retrospective observational study identified injuries from physical therapy service presentations in New Zealand Army recruits from 2008 to 2011. All male and female New Zealand Army recruits who presented to physical therapy, following medical triage, were included. Recruit physical therapy presentations for injury and respiratory and other conditions were collated. Injury incidence was grouped by body region (upper limbs, lower limbs, and combined spinal regions) and site (joint or segment), and cumulative and injury incidence rates were calculated. RESULTS: One thousand eight hundred and ninety-six (1,697 males and 199 females) New Zealand Army recruits commenced basic training between 2008 and 2011. One thousand six hundred and eighty-three physical therapy presentations occurred for recruit injury during New Zealand Army basic training over 4 years. Lower limb injuries accounted for over 75% (n = 1,285) of the overall demand for physical therapy service during recruit basic training. Injuries sustained at the knee and below accounted for 67% of all reported injury presentations. CONCLUSION: Four years of injury surveillance using physical therapy presentations identified the lower limb, with the knee and below as the most commonly injured regions in New Zealand Army recruits. Injury prevention interventions for New Zealand Army recruits should aim to reduce lower limb injuries. Future research on injury surveillance would benefit from incorporating clear injury and severity definitions, established injury classification systems, and standardized incidence calculations.

The sustainability of upper limb robotic therapy for stroke survivors in an inpatient rehabilitation setting.

PURPOSE: To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice. METHODS: Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL. RESULTS: During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists. CONCLUSIONS: RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients.IMPLICATIONS FOR REHABILITATIONRT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting.The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level.RT-UL may be considered a "bridging" form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice.

High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study.

BACKGROUND: Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD: A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS: Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS: A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION: This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).

The acute effects of aerobic exercise on sensorimotor adaptation in chronic stroke.

BACKGROUND: Sensorimotor adaptation, or the capacity to adapt movement to changes in the moving body or environment, is a form of motor learning that is important for functional independence (e.g., regaining stability after slips or trips). Aerobic exercise can acutely improve many forms of motor learning in healthy adults. It is not known, however, whether acute aerobic exercise has similar positive effects on sensorimotor adaptation in stroke survivors as it does in healthy individuals. OBJECTIVE: The aim of this study was to determine whether acute aerobic exercise promotes sensorimotor adaptation in people post stroke. METHODS: A single-blinded crossover study. Participants attended two separate sessions, completing an aerobic exercise intervention in one session and a resting control condition in the other session. Sensorimotor adaptation was assessed before and after each session, as was brain derived neurotrophic factor. Twenty participants with chronic stroke completed treadmill exercise at moderate to high intensity for 30 minutes. RESULTS: Acute aerobic exercise in chronic stroke survivors significantly increased sensorimotor adaptation from pre to post treadmill intervention. The 30-minute treadmill intervention resulted in an averaged 2.99 ng/ml increase in BDNF levels (BDNF pre-treadmill = 22.31 + /-2.85 ng/ml, post-treadmill was = 25.31 + /-2.46 pg/ml; t(16) = 2.146, p = 0.048, cohen's d = 0.521, moderate effect size). CONCLUSIONS: These results indicate a potential role for aerobic exercise to promote the recovery of sensorimotor function in chronic stroke survivors.

Physiotherapy service provision in a specialist adult cystic fibrosis service: A pre-post design study with the inclusion of an allied health assistant.

What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.