Implementation of a novel team-based model of care using expert intensive care unit physiotherapists to supplement critical care surge demand.

Within Victoria, Australia, the emergence of the Delta variant resulted in a significant and rapid increase in case numbers and high demand for intensive care beds statewide. While prior pandemic planning had been undertaken at a state level, the Delta variant necessitated a need for further rapid expansion of intensive care unit (ICU) beds. Our hospital subsequently implemented a Department of Health-designed team-based model of care to support this rapid ICU expansion-where tasks were allocated according to skill and not discipline. Here we report our local experiences as critical care physiotherapists participating in this novel model of care for physiotherapists to support the functioning of the ICU under peak pandemic surge conditions. Our core skill set as ICU-trained physiotherapists, including depth knowledge of the assessment and treatment of critical care patients, and ICU functioning, enabled us to play a contributing role in team-based care. We discuss our reflections and lessons learnt including future directions for clinicians, educators, managers, policymakers, and researchers to refine implementation of this novel model of care and how these lessons could be leveraged in future scenarios where healthcare systems might be significantly strained by future pandemics.

Insole effects on impact loading during walking.

Impact loading during walking has been associated with overuse related musculoskeletal disorders, such as osteoarthritis. This study was designed to determine the effect of two shoe insole designs on impact-related loading during walking. In total, 22 healthy adults walked along a 10-m walkway in three different insole conditions: (i) no insole; (ii) flat material insole; (iii) heel-cup insole. Impact forces at the ground were determined and estimated at the knee in a subset of participants (n = 14). Repeated measures ANOVA revealed a significant reduction in peak vertical ground reaction force (vGRF) with the flat material insole compared with the no insole and heel-cup conditions (p = 0.001). No differences between conditions were observed in vGRF loading rate (p > 0.05). Peak impact force at the knee was reduced with flat material insoles and heel-cup insoles (p < 0.05). These data indicate that reductions in impact forces during walking are dependent upon insole design. STATEMENT OF RELEVANCE: This study provides new evidence that impact loads are reduced with shoe insoles during walking. High impact loads are implicated in the development and progression of knee pathologies, including osteoarthritis. Thus, these findings indicate that insole use may be beneficial for various musculoskeletal disorders, including key public health problems such as osteoarthritis.