Effectiveness of home-based exercise for improving physical activity, quality of life and function in older adults after hospitalisation: A systematic review and meta-analysis.

OBJECTIVE: To determine if home-based exercise programmes for older adults after hospitalisation are effective at improving physical activity, quality of life, activities of daily living (ADL) and mobility compared to no intervention, standard care or centre-based exercise. METHODS: Databases were searched from inception to March 2022. Randomised controlled trials which included home-based exercise in older adults recently discharged from hospital were included. The primary outcome was physical activity. Secondary outcomes were quality of life, ADL performance, mobility, adverse events and hospital readmissions. Two reviewers independently selected relevant studies and extracted data. Quantitative synthesis with meta-analyses using a random-effects model and qualitative synthesis were performed. RESULTS: Ten trials (PEDro score 6-8) were included. Three trials reported on physical activity but meta-analysis was not possible due to heterogeneity. Home-based exercise was more effective than no intervention at improving ADL performance (SMD 0.60, 95% CI 0.03 to 1.17); and standard care at improving quality of life (SMD 0.30, 95% CI 0.11 to 0.49) and mobility (SMD 0.23, 95% CI 0.00 to 0.45). Few and minor adverse events were associated with home-based exercise. CONCLUSION: Based on individual trials, home-based exercise has the potential to improve physical activity compared to no intervention or standard care. Meta-analyses indicate that home-based exercise is more effective than no intervention at improving activities of daily living performance, and standard care at improving mobility and quality of life. It is unclear if home-based exercise is more effective than centre-based exercise at improving these outcomes.

Prediction of Independent Walking in People Who Are Nonambulatory Early After Stroke: A Systematic Review.

Background and Purpose: One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months. Methods: Prognostic factors: Any factors measured within one month after stroke with the aim of predicting independent walking. Outcome of interest: Independent walking defined as walking with or without an aid but with no human assistance. Results: Fifteen studies comprising 2344 nonambulatory participants after stroke were included. Risk of bias was low in 7 studies and moderate in 8 studies. Individual meta-analyses of 2 to 4 studies were performed to calculate the pooled estimate of the odds ratio for 12 prognostic factors. Younger age (odds ratio [OR], 3.4, P<0.001), an intact corticospinal tract (OR, 8.3, P<0.001), good leg strength (OR, 5.0, P<0.001), no cognitive impairment (OR, 3.5, P<0.001), no neglect (OR, 2.4, P=0.006), continence (OR, 2.3, P<0.001), good sitting (OR, 7.9, P<0.001), and independence in activities of daily living (OR 10.5, P<0.001) predicted independent walking at 3 months. Younger age (OR, 2.1, P<0.001), continence (OR, 13.8, P<0.001), and good sitting (OR, 19.1, P<0.001) predicted independent walking at 6 months. There were insufficient data at 12 months. Conclusions: Younger age, an intact corticospinal tract, good leg strength, continence, no cognitive impairment, no neglect, good sitting, and independence in activities of daily living in patients who are nonambulatory early after stroke predict independent walking at 3 months. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42018108794.

Prospective surveillance model in the home for breast cancer-related lymphoedema: a feasibility study.

PURPOSE: The aim of this study was to assess the feasibility of delivering a prospective surveillance model in the home over 6 months for women at high risk of developing lymphoedema. METHODS: A single-group, intervention study recruited 20 women who had surgical and medical treatment for confirmed node-positive invasive breast cancer and therefore at high risk of developing arm lymphoedema. Participants received a package including Bioimpedance Spectroscopy (BIS) monitoring, lymphoedema education and support to promote self-management and physical activity. RESULTS: Participants adhered to BIS monitoring 74% of the time, and felt extremely confident in using the device. By 6 months, mean BIS L-Dex scores had increased from 3.5 (SD 5.6) to 8.4 (SD 11.1); five women (25%) who experienced > + 6.5 increase in L-Dex score were fitted with a compression garment. Self-reported symptoms and distress decreased by 0.4 out of 10 (95% CI 0.1 to 0.7); number of self-management strategies used increased by 0.6 (95% CI 0.1 to 1.2); and planned exercise increased by 2.8 h/week (95% CI 0.4 to 5.2). CONCLUSIONS: These findings indicate a prospective surveillance model of care in the home with BIS is feasible and associated with increased self-management. A Phase II randomised trial is warranted as well as research exploring the costs associated with implementing this model of care for high-risk individuals.

An Exploration of Sedentary Behavior Patterns in Community-Dwelling People With Stroke: A Cluster-Based Analysis.

BACKGROUND AND PURPOSE: Long periods of daily sedentary time, particularly accumulated in long uninterrupted bouts, are a risk factor for cardiovascular disease. People with stroke are at high risk of recurrent events and prolonged sedentary time may increase this risk. We aimed to explore how people with stroke distribute their periods of sedentary behavior, which factors influence this distribution, and whether sedentary behavior clusters can be distinguished? METHODS: This was a secondary analysis of original accelerometry data from adults with stroke living in the community. We conducted data-driven clustering analyses to identify unique accumulation patterns of sedentary time across participants, followed by multinomial logistical regression to determine the association between the clusters, and the total amount of sedentary time, age, gender, body mass index (BMI), walking speed, and wake time. RESULTS: Participants in the highest quartile of total sedentary time accumulated a significantly higher proportion of their sedentary time in prolonged bouts (P < 0.001). Six unique accumulation patterns were identified, all of which were characterized by high sedentary time. Total sedentary time, age, gender, BMI, and walking speed were significantly associated with the probability of a person being in a specific accumulation pattern cluster, P < 0.001 - P = 0.002. DISCUSSION AND CONCLUSIONS: Although unique accumulation patterns were identified, there is not just one accumulation pattern for high sedentary time. This suggests that interventions to reduce sedentary time must be individually tailored.Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A343).

Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study.

OBJECTIVE: To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations. DESIGN: We pooled data from 5 studies for this observational analysis of prospective falls. SETTING: Community or low-level care facility. PARTICIPANTS: Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months. RESULTS: Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls. CONCLUSIONS: Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.

Early surveillance is associated with less incidence and severity of breast cancer-related lymphedema compared with a traditional referral model of care.

BACKGROUND: Bioimpedance spectroscopy (BIS) has enabled the early identification of breast cancer-related lymphedema. In this study, differences in health service metrics and in the incidence of breast cancer-related lymphedema are evaluated in an early surveillance model of care compared with a traditional referral model of care. METHODS: In a retrospective analysis of data from 753 women who underwent BIS measures between January 1, 2007 and December 31, 2016, 188 women were assigned to the "early surveillance" group if they began lymphedema monitoring presurgery (n = 121) or within 90 days postsurgery (n = 67), and 285 women were assigned to the "traditional referral" group if they began monitoring after 90 days postsurgery. Health service metrics were calculated as the time to the first BIS measure after 90 days postsurgery, the median follow-up, and the number of health care visits. Lymphedema was diagnosed based on BIS measures. RESULTS: Women in the early surveillance group received lymphedema care significantly earlier than those in the traditional referral group. However, there was no difference in the number of visits per year to the clinic between groups. Significantly more women in the traditional referral group were diagnosed with clinical lymphedema (stage I-III, 39 % vs 14%; P < .001) and with greater severity (stage II-III, 24%) compared with those in the early surveillance group (4%). CONCLUSIONS: The current findings support the adoption of an early prospective surveillance model of care using BIS for the early detection and management of breast cancer-related lymphedema.

Linking nutrient stoichiometry to Zika virus transmission in a mosquito.

Food quality and quantity serve as the basis for cycling of key chemical elements in trophic interactions; yet the role of nutrient stoichiometry in shaping host-pathogen interactions is under appreciated. Most of the emergent mosquito-borne viruses affecting human health are transmitted by mosquitoes that inhabit container systems during their immature stages, where allochthonous input of detritus serves as the basal nutrients. Quantity and type of detritus (animal and plant) were manipulated in microcosms containing newly hatched Aedes aegypti mosquito larvae. Adult mosquitoes derived from these microcosms were allowed to ingest Zika virus-infected blood and then tested for disseminated infection, transmission, and total nutrients (percent carbon, percent nitrogen, ratio of carbon to nitrogen). Treatments lacking high-quality animal (insect) detritus significantly delayed development. Survivorship to adulthood was closely associated with the amount of insect detritus present. Insect detritus was positively correlated with percent nitrogen, which affected Zika virus infection. Disseminated infection and transmission decreased with increasing insect detritus and percent nitrogen. We provide the first definitive evidence linking nutrient stoichiometry to arbovirus infection and transmission in a mosquito using a model system of invasive Ae. aegypti and emergent Zika virus.

Dual-Task Walking Performance in Older Persons With Hearing Impairment: Implications for Interventions From a Preliminary Observational Study.

OBJECTIVES: Adults with "hearing loss" have an increased falls risks. There may be an association between hearing impairment and walking performance under dual-task (DT) and triple-task (TT) conditions. The aim of this study was to identify DT and TT effects on walking speed, step length, and cadence in adults with hearing impairment, previous falls, and physical limitations. DESIGN: The observational study included 73 community-dwelling older people seeking audiology services. Data were collected on sociodemographic characteristics, previous falls, fear of falling, physical limitations, and walking performance under three task conditions. Differences between the task conditions (single task [ST], DT, and TT) and the hearing groups were analyzed with a two-way ANOVA with repeated measures. The influence of fall risks and limited physical functioning on walking under ST, DT, and TT conditions was analyzed with ANOVAs, with ST, DT, and TT performance as repeated measurement factor (i.e., walking speed, step length and Cadence × Previous falls, or short physical performance battery <12 × Hearing Groups). RESULTS: Walking speed was reduced accompanied by decreased step length and increased cadence in people with more severe hearing loss. Larger negative effects on DT and TT walking were found with increasing hearing loss (speed and cadence decreased with higher DT costs). Highest DT costs were found for the walking-manual conditions. These results were accompanied by small effects of older age and more comorbidities. CONCLUSIONS: This first screening data of walking performance under different conditions for people with hearing loss warrants the need for development and investigation of training interventions to improve walking abilities. DT training may be beneficial to enhance motor and cognitive flexibility and to reduce fall risks.

Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials.

OBJECTIVE: health-related quality of life (HRQOL) and mental well-being are associated with healthy ageing. Physical activity positively impacts both HRQOL and mental well-being. Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on HRQOL and mental well-being in people aged 60+. METHODS: searches were conducted for relevant trials in the following electronic databases; MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database, PsycINFO and the Physiotherapy Evidence Database (PEDro) from inception to January 2017. Trials that evaluated the effect of physical yoga on HRQOL and/or on mental well-being in people aged 60+ years were included. Data on HRQOL and mental well-being were extracted. Standardised mean differences and 95% confidence intervals (CI) were calculated using random effects models. Methodological quality of trials was assessed using the PEDro scale. RESULTS: twelve trials of high methodological quality (mean PEDro score 6.1), totalling 752 participants, were identified and provided data for the meta-analysis. Yoga produced a medium effect on HRQOL (Hedges' g = 0.51, 95% CI 0.25-0.76, 12 trials) and a small effect on mental well-being (Hedges' g = 0.38, 95% CI 0.15-0.62, 12 trials). CONCLUSION: yoga interventions resulted in small to moderate improvements in both HRQOL and mental well-being in people aged 60+ years. Further, research is needed to determine the optimal dose of yoga to maximise health impact. PROSPERO REGISTRATION NUMBER: (CRD42016052458).

Risk Factors for Falls in Community Stroke Survivors: A Systematic Review and Meta-Analysis.

OBJECTIVE: To identify the risk factors for falls in community stroke survivors. DATA SOURCES: A comprehensive search for articles indexed in MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, and Web of Science databases was conducted. STUDY SELECTION: Prospective studies investigating fall risk factors in community stroke survivors were included. Reviewers in pair independently screened the articles and determined inclusion through consensus. Studies meeting acceptable quality rating using the Q-Coh tool were included in the meta-analysis. DATA EXTRACTION: Data extraction was done in duplicate by 4 reviewers using a standardized data extraction sheet and confirmed by another independent reviewer for completeness and accuracy. DATA SYNTHESIS: Twenty-one articles met the minimum criteria for inclusion; risk factors investigated by ≥3 studies (n=16) were included in the meta-analysis. The following risk factors had a strong association with all fallers: impaired mobility (odds ratio [OR], 4.36; 95% confidence interval [CI], 2.68-7.10); reduced balance (OR, 3.87; 95% CI, 2.39-6.26); use of sedative or psychotropic medications (OR, 3.19; 95% CI, 1.36-7.48); disability in self-care (OR, 2.30; 95% CI, 1.51-3.49); depression (OR, 2.11; 95% CI, 1.18-3.75); cognitive impairment (OR, 1.75; 95% CI, 1.02-2.99); and history of fall (OR, 1.67; 95% CI, 1.03-2.72). A history of fall (OR, 4.19; 95% CI, 2.05-7.01) had a stronger association with recurrent fallers. CONCLUSIONS: This study confirms that balance and mobility problems, assisted self-care, taking sedative or psychotropic medications, cognitive impairment, depression, and history of falling are associated with falls in community stroke survivors. We recommend that any future research into fall prevention programs should consider addressing these modifiable risk factors. Because the risk factors for falls in community stroke survivors are multifactorial, interventions should be multidimensional.

Yoga-based exercise improves balance and mobility in people aged 60 and over: a systematic review and meta-analysis.

OBJECTIVE: one-third of community-dwelling older adults fall annually. Exercise that challenges balance is proven to prevent falls. We conducted a systematic review with meta-analysis to determine the impact of yoga-based exercise on balance and physical mobility in people aged 60+ years. METHODS: searches for relevant trials were conducted on the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Allied and Complementary Medicine Database and the Physiotherapy Evidence Database (PEDro) from inception to February 2015. Trials were included if they evaluated the effect of physical yoga (excluding meditation and breathing exercises alone) on balance in people aged 60+ years. We extracted data on balance and the secondary outcome of physical mobility. Standardised mean differences and 95% confidence intervals (CI) were calculated using random-effects models. Methodological quality of trials was assessed using the 10-point Physiotherapy Evidence Database (PEDro) Scale. RESULTS: six trials of relatively high methodological quality, totalling 307 participants, were identified and had data that could be included in a meta-analysis. Overall, yoga interventions had a small effect on balance performance (Hedges' g = 0.40, 95% CI 0.15-0.65, 6 trials) and a medium effect on physical mobility (Hedges' g = 0.50, 95% CI 0.06-0.95, 3 trials). CONCLUSION: yoga interventions resulted in small improvements in balance and medium improvements in physical mobility in people aged 60+ years. Further research is required to determine whether yoga-related improvements in balance and mobility translate to prevention of falls in older people. PROSPERO Registration number CRD42015015872.

The strength of the ankle dorsiflexors has a significant contribution to walking speed in people who can walk independently after stroke: an observational study.

OBJECTIVE: To investigate the relationship between the strength of muscles of the affected lower limb and walking speed after stroke. DESIGN: A cross-sectional observational study. SETTING: University laboratory. PARTICIPANTS: Stroke survivors (N=60; mean age ± SD, 69±11y) 1 to 6 years poststroke, able to walk 10m independently without aids. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximum isometric strength of 12 muscle groups (hip flexors/extensors, adductors/abductors, internal/external rotators, knee flexors/extensors, ankle dorsiflexors/plantarflexors, invertors/evertors) of the affected lower limb was measured using hand-held dynamometry. Comfortable walking speed was measured using the ten-meter walk test. RESULTS: Univariate analysis revealed that strength of the hip flexors (r=.35, P=.01), hip extensors (r=.29, P=.03), hip internal rotators (r=.30, P=.02), hip adductors (r=.29, P=.03), knee extensors (r=.27, P=.03), knee flexors (r=.30, P=.02), ankle dorsiflexors (r=.50, P=.00), ankle plantarflexors (r=.29, P=.03), and ankle evertors (r=.33, P=.01) were all positively associated with walking speed. Multivariate analysis (n=58) revealed that the combined strength of the ankle dorsiflexors and the hip flexors accounted for 34% of the variance in walking speed (P<.001). The ankle dorsiflexors accounted for 31% of the variance (P<.001). CONCLUSIONS: The strength of muscle groups other than the lower limb extensors, particularly the ankle dorsiflexors, has an important role in determining walking speed after stroke.

Home-based treadmill training for individuals with Parkinson's disease: a randomized controlled pilot trial.

OBJECTIVE: To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson's disease. DESIGN: Pilot randomized controlled trial of a six-week intervention followed by a further six weeks follow-up. SETTING: Home-based treadmill training with outcome measures taken at a hospital clinic. PARTICIPANTS: Twenty cognitively intact participants with mild Parkinson's disease and gait disturbance. Two participants from the treadmill training group and one from the control group dropped out. INTERVENTIONS: The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20-40 minutes, four times a week for six weeks. The control group received usual care. MAIN OUTCOME MEASURES: The feasibility of the intervention was assessed by recording exercise adherence and acceptability, exercise intensity, fatigue, muscle soreness and adverse events. The primary outcome measure of efficacy was walking capacity (6-minute walk test distance). RESULTS: Home-based treadmill training was feasible, acceptable and safe with participants completing 78% (SD 36) of the prescribed training sessions. The treadmill training group did not improve their walking capacity compared to the control group. The treadmill training group showed a greater improvement than the control group in fatigue at post test (P = 0.04) and in quality of life at six weeks follow-up testing (P = 0.02). CONCLUSIONS: Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson's disease. Further investigation regarding the effectiveness of home-based treadmill training is warranted.

The Physiotherapy eSkills Training Online resource improves performance of practical skills: a controlled trial.

BACKGROUND: E-learning is a common and popular mode of educational delivery, but little is known about its effectiveness in teaching practical skills. The aim of this study was to determine whether the Physiotherapy eSkills Training Online resource in addition to usual teaching improved the performance of practical skills in physiotherapy students. METHOD: This study was a non-randomised controlled trial. The participants were graduate entry physiotherapy students enrolled in consecutive semesters of a neurological physiotherapy unit of study. The experimental group received the Physiotherapy eSkills Training Online resource as well as usual teaching. The Physiotherapy eSkills Training Online resource is an online resource incorporating (i) video-clips of patient-therapist simulations; (ii) supportive text describing the aim, rationale, equipment, key points, common errors and methods of progression; and (iii) a downloadable PDF document incorporating the online text information and a still image of the video-clip for each practical skill. The control group received usual teaching only. The primary outcomes were the overall performance of practical skills as well as their individual components, measured using a practical examination. RESULTS: The implementation of the Physiotherapy eSkills Training Online resource resulted in an increase of 1.6 out of 25 (95% CI -0.1 to 3.3) in the experimental group compared with the control group. In addition, the experimental group scored 0.5 points out of 4 (95% CI 0 to 1.1) higher than the control group for 'effectiveness of the practical skill' and 0.6 points out of 4 (95% CI 0.1 to 1.1) higher for 'rationale for the practical skill'. CONCLUSION: There was improvement in performance of practical skills in students who had access to the Physiotherapy eSkills Training Online resource in addition to usual teaching. Students considered the resource to be very useful for learning.

Association of clinically significant weight loss with number of patient visits and months of attendance at an Australian multidisciplinary weight management clinic.

Despite the obesity epidemic, there are relatively few multidisciplinary obesity services in Australia, and only limited data on the effectiveness of these services. The aim of this study was to evaluate the effectiveness of a university hospital-based weight management clinic-the 'Healthy Weight Clinic' in supporting patients to achieve clinically significant weight loss (≥5% reduction in body weight), weight maintenance, and changes in body composition. A retrospective review was conducted to determine weight and associated health outcomes in patients who attended an initial consultation in the first 2 years of the clinic-between March 2017 and March 2019. Follow up was at least 1 year for all patients. Patients who underwent bariatric surgery were excluded. Of 213 total patients, 172 patients attended more than one follow-up consultation for lifestyle modification. Mean weight change and percentage total weight change at last follow-up was -6.2 kg (SD 7.4) and - 6.0% (SD 6.9), respectively. For every additional clinic follow-up, there was 21.4% increased odds of achieving clinically significant weight loss, and for every additional month of follow-up, there was 10.1% increased odds of achieving clinically significant weight loss. Twenty percent of patients (34/172) maintained ≥5% of initial body weight loss for at least 1 year. Body composition measurements were also favourable, with significant changes in percentage skeletal muscle mass of +0.8% (SD 1.5) and in percentage fat mass by -1.4% (SD 3.2). Regular support in a structured holistic multidisciplinary obesity service enables patients to achieve clinically meaningful weight loss and improved skeletal muscle mass to body fat ratio, and maintain this loss for at least 1 year. Improved weight loss was associated with more patient visits and longer duration of attendance at the clinic.

Development of an individualised primary care program for acute low back pain using a hybrid co-design framework.

BACKGROUND: Low back pain is the leading worldwide cause of years lost to disability and the problem is worsening. This paper describes and demonstrates the scholarly development and contextual refinement of a primary care program for acute low back pain in Sydney, Australia. METHODS: Hybrid theoretical frameworks were applied, and co-design was used to contextualise the program to the local healthcare setting. RESULTS: The program was developed in four stages. In stage 1, the scientific evidence about management of acute low back pain in primary care was examined. In stage 2, stakeholders (patients and clinicians) were consulted in nationwide surveys. Data from stages 1 and 2 were used to design an initial version of the program, called My Back My Plan. Stage 3 involved the contextual refinement of the program to the local setting, MQ Health Primary Care. This was achieved by co-design with primary care clinicians and patients who had sought care for low back pain at MQ Health Primary Care clinics. In stage 4, a panel of Australian experts on clinical care for low back pain reviewed the contextualised version of My Back My Plan and final amendments were made. CONCLUSION: My Back My Plan has been developed using an innovative scholarly approach to intervention development.

My Back My Plan is a feasible and acceptable individualised program for acute low back pain in primary care.

BACKGROUND: Low back pain is the largest cause of years lived with a disability in Australia, and there is an urgent need for innovations to address global gaps between evidence and practice. METHODS: This study was a phase 1, single-group, pre-post pilot trial of My Back My Plan, a primary care program for acute low back pain. The trial was conducted at MQ Health Primary Care at Macquarie University in Sydney, Australia. The primary outcomes were feasibility and acceptability. RESULTS: Fourteen participants were recruited to the study, with 79% and 93% followed up at 1 and 3months respectively. Ten general practitioners and four physiotherapists at MQ Health Primary Care delivered the intervention. Although the rate of patient recruitment to the trial was low, other aspects of feasibility (such as intervention adherence and safety) were high. Participating clinicians reported that the program was useful for patients, and the majority stated that the program facilitated person-centred care. Patients rated My Back My Plan as highly acceptable, indicating that they had a better understanding of their low back pain, they were given personalised care and were more confident in self-managing their low back pain. At the 3month follow-up, 85% of participants stated they were very likely to recommend the program to others. CONCLUSIONS: This study suggests that the co-designed, contextually refined MBMP program for MQ Health Primary Care is acceptable to people with acute onset low back pain and warrants further evaluation.

No change in calf muscle passive stiffness after botulinum toxin injection in children with cerebral palsy.

AIM: Stiffness and shortening of the calf muscle due to neural or mechanical factors can profoundly affect motor function. The aim of this study was to investigate non-neurally mediated calf-muscle tightness in children with cerebral palsy (CP) before and after botulinum toxin type A (BoNT-A) injection. METHOD: Sixteen children with spastic CP (seven females, nine males; eight at Gross Motor Function Classification System level I, eight at level II; age range 4-10 y) and calf muscle spasticity were tested before and during the pharmaceutically active phase after injection of BoNT-A. Measures of passive muscle compliance and viscoelastic responses, hysteresis, and the gradient of the torque-angle curve were computed and compared before and after injection. RESULTS: Although there was a slight, but significant increase in ankle range of motion after BoNT-A injection and a small, significant decrease in the torque required to achieve plantigrade and 5° of dorsiflexion, no significant difference in myotendinous stiffness or hysteresis were detected after BoNT-A injection. INTERPRETATION: Despite any effect on neurally mediated responses, the compliance of the calf muscle was not changed and the muscle continued to offer significant resistance to passive motion of the ankle. These findings suggest that additional treatment approaches are required to supplement the effects of BoNT-A injections when managing children with calf muscle spasticity.

Students achieve comparable performance scores for clinical placements in public and private sectors: a longitudinal observational study.

QUESTIONS: Does student clinical performance differ according to healthcare sector? Does student clinical performance at Macquarie University differ from other Australian graduate entry-level programs? DESIGN: A longitudinal observational study with comparison to national data. PARTICIPANTS: A total of 284 physiotherapy students from Macquarie University. OUTCOME MEASURES: Each student's clinical performance was evaluated by a clinical educator using the Assessment of Physiotherapy Practice (APP) tool at the end of four 5-week clinical placements. Four measures of clinical performance were analysed: Total APP score, Employability Skills, Clinical Skills and a global rating of performance. A between-group difference in the APP results of 5% was nominated a priori as large enough to be considered important. RESULTS: Of the 1,136 placements, 533 (47%) were undertaken in the private sector. Among their four placements, 99% of students had at least one private sector placement and 70% had two or more private sector placements. There were negligible differences between private and public sector placements in Total APP scores (MD 0%, 95% CI -1 to 1), Employability Skills scores (MD 2% higher in the public sector, 95% CI 1 to 3) and Clinical Skills scores (MD 1% higher in the private sector, 95% CI -1 to 3). On the global rating of performance, 88% of placements in each sector were rated as being either good or excellent. Students in the private sector were 9% (95% CI 3 to 14) more likely to be rated as excellent compared with the public sector. There were negligible differences in clinical performance between the Macquarie University and other Australian graduate-entry students. CONCLUSION: Macquarie University's practice of increasing private sector participation in clinical education had no adverse effects on student clinical performance, and it is likely to be beneficial in better preparing students for work in the private sector.