Access to and effectiveness of clinical supervision for allied health workers: A cross-sectional survey.

INTRODUCTION: Clinical supervision supports patient care and health worker wellbeing. However, access to effective clinical supervision is not equitable. We aimed to explore the access and effectiveness of clinical supervision in allied health workers. METHODS: A cross-sectional survey design using the Manchester Clinical Supervision Scale (MCSS-26), including open-ended survey responses, to collect data on effectiveness. Multivariable regression was conducted to determine how MCSS-26 scores differed across discipline, work location and setting. Open-ended responses were analysed using content analysis. RESULTS: 1113 workers completed the survey, with 319 (28%) reporting they did not receive supervision; this group were more likely to hold management positions, work in a medical imaging discipline and practice in a regional or rural location. For those who received supervision, MCSS-26 scores significantly differed between disciplines and work settings; psychologists and those practising in private practice settings (i.e. fee-for-service) reported the highest levels of effectiveness. Suggested strategies to enhance effectiveness included the use of alternate supervision models, dedicated time for supervision, and training. CONCLUSION: Targeted subgroups for improving access include senior staff, medical imaging professionals, and those working across regional and rural settings. Where supervision was least effective, strategies to address behaviours with organisational support may be required.

Enhancing the quality of allied health clinical supervision in a regional setting: An action research study.

OBJECTIVE: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. SETTING: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. PARTICIPANTS: Allied health managers employed at the health service were members of an action research group. DESIGN: This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. RESULTS: The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. CONCLUSION: The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

The use of mentoring for knowledge translation by allied health: a scoping review.

OBJECTIVE: To describe how allied health professionals have used mentoring as a knowledge translation strategy to inform practice. INTRODUCTION: Mentoring has been reported to be used by nursing and medicine as a knowledge translation strategy. It is not known if allied health professionals have also used mentoring to improve their use of research in practice, or what the key mentoring characteristics are that guide its application in allied health settings. Improved understanding of the barriers and facilitators to mentoring in allied health settings may be used to guide the design of future mentoring programs to assist knowledge translation. INCLUSION CRITERIA: Eligible studies must have included allied health professionals, and used the concept of mentoring to support knowledge translation in the context of healthcare. Primary empirical and synthesized studies were eligible. METHODS: An a-priori protocol was followed to complete a search of six databases (MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCO], PsycInfo [OVID], PDQ-Evidence ( www.pdq-evidence.org ), and Cochrane on the 9 March 2021. Screening for eligibility was conducted by two authors at the title and abstract stage and the full text stage. Selection criteria and the data extraction tool were established prior to the search. Findings are presented in narrative and tabular formats. RESULTS: A total of 2053 studies met the inclusion criteria for screening and nine were determined to be eligible for inclusion. Mentoring has been used by allied health professionals to improve the translation of interventional research evidence by clinicians, and to establish clinician skills and knowledge relating to knowledge translation processes. Mentoring was predominantly used as part of a multifaceted knowledge translation strategy alongside educational strategies. Mentoring characteristics such as structure, context, goals, resourcing and dosage varied depending on the context of translation. The specific barriers reported to using mentoring were varied, whereas the facilitators to mentoring were primarily related to the mentor's approach and expertise. The impact of mentoring was primarily measured through the mentee's experience of mentoring. CONCLUSIONS: Allied health professionals have used mentoring as a knowledge translation strategy to enhance the use of research evidence in their practice and to learn the process of knowledge translation. Mentoring is mostly used in conjunction with other strategies in practice, such as education. The limited number of identified barriers and facilitators to using mentoring as a knowledge translation strategy supports the need for future research to deepen our understanding about the mentoring process.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework.

BACKGROUND: Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians' perceptions of the implementation of an organisational clinical supervision framework. METHODS: A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA. RESULTS: There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation's clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision. CONCLUSIONS: Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

Riding the waves: lessons learnt from Victoria's COVID-19 pandemic response for maintaining effective allied health student education and clinical placements.

Victoria was the Australian state most significantly affected by the COVID-19 pandemic in 2020, which caused significant disruption to Victorian health services. The aim of this case study is to describe the experience of the Victorian public health system in adapting to support allied health student education during the pandemic. Factors that affected student education were complex and dynamic, and included a decrease in traditional face-to-face learning opportunities due to a transition to telehealth, social distancing requirements, furlough of staff and travel restrictions. Impacts on placement capacity across allied health professions were highly variable. Strategies used to enable the continuation of student work-integrated learning (WIL) (also referred to as clinical placements or fieldwork) included an increase in remote placements and the use of technology. Enhanced communication between government and health service educators enabled rapid sharing of information and problem solving. At this time, the impacts on student preparedness for practice are unclear but may include deficits in interprofessional learning, clinical skills, increased levels of agility and enhanced resilience. This case study highlights the need for the health system to be adaptable and innovative to maintain the quality of student education, and the future allied health workforce, through the pandemic and beyond.

Understanding the research capacity and culture of a regional allied health workforce.

The aim of this study was to understand the research capacity and culture of a regional allied health workforce over time. A cross-sectional study design was used, with data collected using the validated Research Capacity and Culture (RCC) tool. The results were compared with an earlier administration of the RCC survey. The findings demonstrate that allied health professionals (AHPs) perceive that the organisation's capability of conducting research is at a higher level than that of teams and individuals. Over a 4-year period the profile of the research culture of an allied health workforce in a regional health service was described similarly. The highest rated motivator for conducting research (to develop skills) and barrier to conducting research (other work roles take priority) were unchanged between 2018 and 2014. AHPs have maintained the previous viewpoint that there is research capacity at the health service and opportunities to develop the research culture. The findings of the 2018 data compared with the 2014 data highlight that specific and targeted research capacity-building strategies need to be used in order to create an active and vibrant research culture.

Group clinical supervision for allied health professionals.

OBJECTIVE: To evaluate a group clinical supervision program for allied health professionals in a regional health service. DESIGN: This study used a mixed-methods design including a cross-sectional, quantitative survey of group clinical supervision participants and a focus group of facilitators. SETTING: A large regional health service in Victoria, providing hospital, community and mental health services. PARTICIPANTS: Allied health professionals and managers employed at the health service. INTERVENTIONS: Group clinical supervision, based on a critical reflection model, was implemented in 3 settings. MAIN OUTCOME MEASURE: The Clinical Supervision Evaluation Questionnaire was administered to group clinical supervision participants, with additional open-ended questions included. The Clinical Supervision Evaluation Questionnaire tool consists of 3 subscales relating to the purpose, process and impact of group clinical supervision. A focus group was used to capture the perspectives of group clinical supervision facilitators. RESULTS: Fifteen survey responses were received. The overall Clinical Supervision Evaluation Questionnaire score was 56.53 (standard deviation 7.66). Scores for the Process Subscale were higher than the Purpose and Impact subscales. Themes from the open-ended survey questions included the following: value of multiple perspectives, opportunities for reflection, peer support and group process and structure. Themes from group facilitators' focus group included the following: need for group clinical supervision, value of facilitator training and support, and sustainability. CONCLUSION: Group clinical supervision was perceived to be effective, enhancing reflection, learning and peer support. Organisational support, facilitator training, group structure and planning for sustainability were identified as critical factors for success. Interprofessional and cross-organisational models of group clinical supervision are strategies that could help address issues relating to access to quality clinical supervision for rural allied health professionals.

A Multimodal Intention Detection Sensor Suite for Shared Autonomy of Upper-Limb Robotic Prostheses.

Neurorobotic augmentation (e.g., robotic assist) is now in regular use to support individuals suffering from impaired motor functions. A major unresolved challenge, however, is the excessive cognitive load necessary for the human-machine interface (HMI). Grasp control remains one of the most challenging HMI tasks, demanding simultaneous, agile, and precise control of multiple degrees-of-freedom (DoFs) while following a specific timing pattern in the joint and human-robot task spaces. Most commercially available systems use either an indirect mode-switching configuration or a limited sequential control strategy, limiting activation to one DoF at a time. To address this challenge, we introduce a shared autonomy framework centred around a low-cost multi-modal sensor suite fusing: (a) mechanomyography (MMG) to estimate the intended muscle activation, (b) camera-based visual information for integrated autonomous object recognition, and (c) inertial measurement to enhance intention prediction based on the grasping trajectory. The complete system predicts user intent for grasp based on measured dynamical features during natural motions. A total of 84 motion features were extracted from the sensor suite, and tests were conducted on 10 able-bodied and 1 amputee participants for grasping common household objects with a robotic hand. Real-time grasp classification accuracy using visual and motion features obtained 100%, 82.5%, and 88.9% across all participants for detecting and executing grasping actions for a bottle, lid, and box, respectively. The proposed multimodal sensor suite is a novel approach for predicting different grasp strategies and automating task performance using a commercial upper-limb prosthetic device. The system also shows potential to improve the usability of modern neurorobotic systems due to the intuitive control design.

Mentoring for knowledge translation in allied health: a scoping review protocol.

OBJECTIVE: The primary objective of this review is to identify how allied health staff have used mentoring as a knowledge translation strategy to support practice change. Secondary objectives include identifying barriers and enablers to using mentoring as a knowledge translation strategy, and the methods used to evaluate the strategy. INTRODUCTION: Mentoring provides professional support and guidance while attending to the learning needs of the individual. Mentoring has been described in previous knowledge synthesis reviews as a strategy for nursing and medicine practitioners to improve capability and capacity to participate in knowledge translation to create practice change. To the authors' knowledge, a synthesis of the use of mentoring as a knowledge translation strategy by allied health staff has not been reported. INCLUSION CRITERIA: This scoping review will consider all studies that describe the use of mentoring with allied health staff to support practice change as directed by research evidence. The scoping review will not investigate the use of mentoring to increase the conduct of research in a clinical setting, nor will studies be included if the majority of participants are students. METHODS: A three-step search strategy will be undertaken. Two independent authors will screen articles and perform data extraction. The results will be presented in a narrative Summary of Findings, alongside a presentation of the data in diagrammatic or tabular form. The findings will inform future use of mentoring as a knowledge translation strategy in a regional health service.

The foot-health of people with diabetes in regional and rural Australia: baseline results from an observational cohort study.

BACKGROUND: There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. METHODS: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. RESULTS: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86). CONCLUSIONS: A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.

PodCast: A rural and regional service model for podiatrist-led total contact casting.

PROBLEM: Diabetes-related foot disease causes significant health system costs and is a leading cause of morbidity and disproportionately affects rural populations. Total contact casts or instant total contact casts are gold standard for management of foot ulcerations resulting from diabetes-related foot disease. The aim of this study was to evaluate the impact of a podiatrist-led casting service model within a rural and regional setting. DESIGN: The implementation of the service model was evaluated over a 12-month period using a quality improvement approach, informed by multiple methods. Quantitative and qualitative methods were used. SETTING: An outpatient high-risk foot clinic and community-based podiatry services within a large regional health service. The location was central Victoria, servicing rural communities within the Loddon Mallee region. KEY MEASURES FOR IMPROVEMENT: Patient-related data included information relating to demographics, diabetes and foot pathologies. Service-related data included occasions of service, locations and the number and type of casts applied. STRATEGIES FOR CHANGE: Upskilling podiatrists to provide the service in a safe, supportive and sustainable manner and ensuring the podiatrist-led casting service model was sufficiently adaptable for patients to access at the rural sites. EFFECTS OF CHANGE: Increased access to total contact casts and instant total contact casts, comparable wound healing times to other studies and the model was able to be sustained. LESSONS LEARNT: Podiatrist-led casting resulted in increased utilisation of total contact casts and instant total contact casts. The increased use of instant total contact casts in particular may help address the lack of uptake of this treatment for people with diabetes-related foot disease, thereby improving rural health outcomes.

Effectiveness of Allied Health Clinical Supervision: A Cross-Sectional Survey of Supervisees.

OBJECTIVE: Clinical supervision (CS) is widely used by allied health (AH) professionals, although with limited supporting research evidence. The aim of this study was to evaluate the effectiveness of CS for AH professionals in a regional health setting and to investigate differences in CS perceptions between AH disciplines. METHODS: Within a participatory action research project, a quantitative cross-sectional survey was distributed to AH professionals at a regional Australian health service. Data were collected using the Manchester Clinical Supervision Scale (MCSS-26), and differences between disciplines were analysed with independent-samples t-tests and one-way between-groups ANOVA. Of a possible 258 participants, 106 responded to the survey (response rate 41%). The action research group assisted with the interpretation of findings. RESULTS: The total mean for MCSS-26 scores across AH was 78.5 ± 13.9 (SD), which is above the recommended threshold score for effective CS (73). There were statistically significant differences in total scores between occupational therapy (82.8 ± 14.4) and physiotherapy (70.9 ± 11.3) and in the formative and restorative domains. CONCLUSIONS: While CS was perceived to be effective, there were significant differences between some disciplines. The findings demonstrate that CS is effective when it is practised within a structured framework; however, flexible models of CS across disciplines need to be explored.

An organised approach to the podiatric care of people with diabetes in regional Australia.

OBJECTIVE: To ensure an efficient publicly funded podiatric service for people with diabetes in regional Victoria, a Podiatry Diabetes Model (PDM) of care was developed. The aim of this study was to determine if people with diabetes attended the most appropriate podiatric service as depicted by the model. METHODS: A 3-month prospective clinical audit of the PDM was undertaken. Primary variables of interest were the podiatric service where the patients were seen and the patients' risk of future foot morbidity. Chi-square analyses for each service category were undertaken to compare the expected number of patients seen according to foot-health risk as predicted by the model, with what was observed. RESULTS: Five hundred and seventy-six people with diabetes were seen in the 3-month period. There was no statistically significant difference between the proportion of patients seen by each podiatric service according to risk status, with what was expected (community: χ(2)=3.3, P=0.4; subacute: χ(2)=8.0, P=0.05; acute: χ(2)=6.6, P=0.09). CONCLUSIONS: The Podiatry Diabetes Model is a sound podiatric model of care and is an example of cross-organisational collaboration that could be implemented in other areas of Australia.

The foot-health of people with diabetes in a regional Australian population: a prospective clinical audit.

BACKGROUND: There is limited understanding of the foot-health of people with diabetes in Australian regional areas. The aim of this study was to document the foot-health of people with diabetes who attend publically funded podiatric services in a regional Australian population. METHODS: A three month prospective clinical audit was undertaken by the publically-funded podiatric services of a large regional area of Victoria, Australia. The primary variables of interest were the University of Texas (UT) diabetic foot risk classification of each patient and the incidence of new foot ulceration during the study period. Age, gender, diabetes type, duration of diabetes and the podiatric service the patients attended were the other variables of interest. RESULTS: Five hundred and seventy six patients were seen during the three month period. Over 49% had a UT risk classification at a level at least peripheral neuropathy or more serious diabetes-related foot morbidity. Higher risk at baseline was associated with longer duration of diabetes (F = 31.7, p < 0.001), male gender (χ2 = 40.3, p <0.001) and type 1 diabetes (χ2 = 37.3, p <0.001). A prior history of foot pathology was the overwhelming predictor for incident ulceration during the time period (OR 8.1 (95% CI 3.6 to 18.2), p < 0.001). CONCLUSIONS: The publically funded podiatric services of this large regional area of Australia deal with a disproportionally large number of people with diabetes at high risk of future diabetes-related foot complications. These findings may be useful in ensuring appropriate allocation of resources for future public health services involved in diabetic foot health service delivery in regional areas.

Charcot osteoarthropathy of the foot.

BACKGROUND: One of the most devastating complications of diabetes is Charcot osteoarthropathy. It can lead to gross structural deformities of the foot and ankle, and subsequent skin ulceration and lower limb amputation from soft tissue or bony infection. However, it is often unrecognised, with deleterious consequences. OBJECTIVE: This article describes the case of a man with type 1 diabetes who presented with Charcot osteoarthropathy of both feet, with a 3 month delay in diagnosis between the two presentations. DISCUSSION: Treatment, patient comorbidities and risk management were similar for both feet, with a marked difference in outcome, demonstrating the importance of the timely diagnosis of Charcot osteoarthropathy.