Allied Health Clinical Research Unit

Cheltenham, Australia

Allied Health Clinical Research Unit

Cheltenham, Australia
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Davis A.,Kingston Center | Murphy A.,Kingston Center | Haines T.P.,Allied Health Clinical Research Unit | Haines T.P.,Monash University
Journal of the American Podiatric Medical Association | Year: 2013

Background: Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls. Methods: A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm. Results: The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear. Conclusions: This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education.

Haines T.P.,Allied Health Clinical Research Unit | Haines T.P.,Monash University | Kuys S.,University of Queensland | Clarke J.,St Andrews War Memorial Hospital | And 2 more authors.
Journal of Evaluation in Clinical Practice | Year: 2011

Rationale, aims and objectives Inpatient rehabilitation of patients following stroke can be resource intensive, with optimal models of service delivery unclear. This study investigates the dose-response curves between physiotherapy service delivery variables and balance and function clinical outcomes. Method This was a multi-centre (15 sites), prospective, cohort study involving patients (n = 288) admitted for rehabilitation following stroke conducted across two states in Australia. Physiotherapy department resource provision variables were collected and examined for association with change in patient function and balance outcomes (Functional Independence Measure, step test, functional reach test) measured at admission and discharge from inpatient care. Results A greater amount of log-transformed physiotherapy department resource provision was associated with greater improvement in the functional independence measure [Regression coefficient (95% CI): 4.05 (1.15, 6.95)] and functional reach test [46.43 (17.03, 75.84)], while physiotherapist time provided to patients was associated with greater improvement for the step test [0.15 (0.03, 0.28)], and functional reach [0.35 (0.19, 0.52)]. Conclusion Receiving a higher rate of physiotherapist input is an important factor in attaining a greater amount of recovery in function and balance outcomes; however, the improvement by patients who received the greatest amount of input was highly variable. © 2010 Blackwell Publishing Ltd.

Williams C.M.,Allied Health Clinical Research Unit | Williams C.M.,Monash University | Williams C.M.,Cardinia Casey Community Health Service | Caserta A.J.,Cardinia Casey Community Health Service | And 2 more authors.
Journal of Science and Medicine in Sport | Year: 2013

Objectives: The weight bearing lunge test is increasing being used by health care clinicians who treat lower limb and foot pathology. This measure is commonly established accurately and reliably with the use of expensive equipment. This study aims to compare the digital inclinometer with a free app, TiltMeter on an Apple iPhone. Design: This was an intra-rater and inter-rater reliability study. Two raters (novice and experienced) conducted the measurements in both a bent knee and straight leg position to determine the intra-rater and inter-rater reliability. Concurrent validity was also established. Methods: Allied health practitioners were recruited as participants from the workplace. A preconditioning stretch was conducted and the ankle range of motion was established with the weight bearing lunge test position with firstly the leg straight and secondly with the knee bent. The measurement device and each participant were randomised during measurement. Results: The intra-rater reliability and inter-rater reliability for the devices and in both positions were all over ICC 0.8 except for one intra-rater measure (Digital inclinometer, novice, ICC 0.65). The inter-rater reliability between the digital inclinometer and the tilmeter was near perfect, ICC 0.96 (CI: 0.898-0.983); Concurrent validity ICC between the two devices was 0.83 (CI: -0.740 to 0.445). Conclusions: The use of the Tiltmeter app on the iPhone is a reliable and inexpensive tool to measure the available ankle range of motion. Health practitioners should use caution in applying these findings to other smart phone equipment if surface areas are not comparable. © 2013.

Haines T.P.,Monash University | Haines T.P.,Allied Health Clinical Research Unit | Hill A.-M.,University of Queensland | Hill A.-M.,The University of Notre Dame Australia
Journal of Clinical Epidemiology | Year: 2011

Objective: This study seeks to examine whether existing study-level data meta-analysis approaches can be used to produce unbiased and precise effect estimates relative to meta-analyses conducted using patient-level data, where a recurrent event is the outcome of interest. Study Design and Setting: Data from two studies focusing on the prevention of falls in the hospital setting (N = 1,838 total) was divided into the three hospital sites from which data were collected. Outcome data were considered as recurrent event survival data, single event survival data, count data, rate data, and binary data. A range of analysis approaches were considered. Results: Andersen-Gill, negative binomial, bootstrap resampling, and modified relative risk analysis approaches produced congruous point estimates of effect, whereas modified relative risk analysis produced considerably smaller standard errors. Pooled effect point estimates derived from these approaches were not consistent when using study-level data as opposed to patient-level data, and 95% confidence intervals were excessively wide when between-study heterogeneity was present. Conclusion: Conducting meta-analysis using patient-level data (if possible) or presenting results from individual trials without pooling of effect estimates may be preferable to presenting pooled effect estimates from meta-analysis of study-level data, where the outcome is a recurrent event. © 2011 Elsevier Inc. All rights reserved.

Morrison G.,Princess Alexandra Hospital | Lee H.-L.,University of Queensland | Kuys S.S.,Princess Alexandra Hospital | Kuys S.S.,University of Queensland | And 4 more authors.
Disability and Rehabilitation | Year: 2011

Purpose: To compare falls event rates and risk factors for falls across three rehabilitation settings. Methods. A multi-centre prospective longitudinal cohort study was conducted of 1682 participants referred for rehabilitation from 18 sites (across two Australian states) and receiving physiotherapy treatment. Falls risk factors across multiple domains (rehabilitation settings, medical diagnoses, age, gender, standing balance, functional capacity, cognition, prior living arrangements, pre-admission use of gait aid and past history of falls) were collected by treating physiotherapists on admission to rehabilitation. Falls were measured by incident reporting and review of medical histories in the inpatient settings and by weekly interviews in the outpatient and domiciliary settings. Results. Overall, outpatient and domiciliary settings demonstrated lower falls event rates compared to inpatient [IRR (95% CI): 0.58 (0.36-0.93) and 0.35 (0.24-0.51)], respectively. Cognitive status, functional ability and past history of falls were consistent risk factors across settings. However medical diagnoses of stroke, other neurological conditions, elective orthopaedic and other orthopaedic together with standing balance were inconsistent as risk factors or protective factors across settings. Conclusions. Risk factors for falls, including medical diagnosis, are not necessarily universal across settings. Balance performance was a significant risk factor for outpatient and domiciliary settings but was not a risk factor for inpatients. Cognitive status and a previous history of falls were, however, consistent risk factors across all settings. This suggests that different approaches for the prevention of falls may be required for the same diagnostic group of patients depending on the location of the rehabilitation setting. © 2011 Informa UK, Ltd.

Haines T.P.,Monash University | Haines T.P.,Allied Health Clinical Research Unit | Bell R.A.R.,Patient Safety Center | Varghese P.N.,Patient Safety Center | Varghese P.N.,Princess Alexandra Hospital
Journal of the American Geriatrics Society | Year: 2010

OBJECTIVES: To evaluate the efficacy of a policy to introduce low-low beds for the prevention of falls and fall injuries on wards that had not previously accessed low-low beds. DESIGN: This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6-month period after implementation of the low-low beds on the intervention wards. Data from a 6-month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards. SETTING: Public hospitals located in Queensland, Australia. PARTICIPANTS: Patients of 18 public hospital wards. INTERVENTION: Provision of one low-low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls. MEASUREMENTS: Falls and fall injuries in the hospital measured using a computerized incident reporting system. RESULTS: There were 10,937 admissions to control and intervention wards combined during the pre-intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low-low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=-0.18-0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low-low beds as directed. CONCLUSION: A policy for the introduction of low-low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall-related fractures. © 2010, Copyright the Authors.

McPhail S.,Center for Functioning | McPhail S.,Queensland University of Technology | McPhail S.,University of Queensland | Haines T.,University of Queensland | And 2 more authors.
Health and Quality of Life Outcomes | Year: 2010

Background: Assessments of change in subjective patient reported outcomes such as health-related quality of life (HRQoL) are a key component of many clinical and research evaluations. However, conventional longitudinal evaluation of change may not agree with patient perceived change if patients' understanding of the subjective construct under evaluation changes over time (response shift) or if patients' have inaccurate recollection (recall bias). This study examined whether older adults' perception of change is in agreement with conventional longitudinal evaluation of change in their HRQoL over the duration of their hospital stay. It also investigated this level of agreement after adjusting patient perceived change for recall bias that patients may have experienced.Methods: A prospective longitudinal cohort design nested within a larger randomised controlled trial was implemented. 103 hospitalised older adults participated in this investigation at a tertiary hospital facility. The EQ-5D utility and Visual Analogue Scale (VAS) scores were used to evaluate HRQoL. Participants completed EQ-5D reports as soon as they were medically stable (within three days of admission) then again immediately prior to discharge. Three methods of change score calculation were used (conventional change, patient perceived change and patient perceived change adjusted for recall bias). Agreement was primarily investigated using intraclass correlation coefficients (ICC) and limits of agreement.Results: Overall 101 (98%) participants completed both admission and discharge assessments. The mean (SD) age was 73.3 (11.2). The median (IQR) length of stay was 38 (20-60) days. For agreement between conventional longitudinal change and patient perceived change: ICCs were 0.34 and 0.40 for EQ-5D utility and VAS respectively. For agreement between conventional longitudinal change and patient perceived change adjusted for recall bias: ICCs were 0.98 and 0.90 respectively. Discrepancy between conventional longitudinal change and patient perceived change was considered clinically meaningful for 84 (83.2%) of participants, after adjusting for recall bias this reduced to 8 (7.9%).Conclusions: Agreement between conventional change and patient perceived change was not strong. A large proportion of this disagreement could be attributed to recall bias. To overcome the invalidating effect of response shift (on conventional change) and recall bias (on patient perceived change) a method of adjusting patient perceived change for recall bias has been described. © 2010 McPhail and Haines; licensee BioMed Central Ltd.

Comans T.A.,Griffith University | Comans T.A.,University of Queensland | Brauer S.G.,University of Queensland | Haines T.P.,Monash University | Haines T.P.,Allied Health Clinical Research Unit
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2010

Background.To compare the effect of two modes of delivering a falls prevention service in reducing the rate of falls and improving quality of life, activity levels, and physical status among older adults with a history of recent falls.Methods.A randomized controlled trial was conducted with a total of 107 participants with blinded baseline and follow-up assessments. The participants were older community-dwelling adults referred for a falls prevention service located in Brisbane, Australia. The intervention was a multiple component falls prevention service delivered in either in a domiciliary or center-based mode of delivery. Both programs were similar apart from setting and consisted of three components, a balance and strength component, falls prevention education, and functional tasks. Physical and psychosocial assessments were administered at baseline, 8-week follow-up and 6-month follow-up. Falls data were collected by monthly telephone contact and by interview at 8 weeks and 6 months.Results.The center-based service demonstrated significantly better results in preventing falls over the home-based service. Clients in the center-based arm of the trial experienced fewer total falls and this group also had a greater reduction in the total number of fallers after the intervention.Conclusion.This research demonstrates that delivering a similar service in different settings-home based or center based-impacts upon the effectiveness of the service. Community-dwelling older adults with a history of falls should be provided with center-based programs in preference to home-based programs where they are available. © The Author 2010.

Haines T.P.,Allied Health Clinical Research Unit | Haines T.P.,Monash University | McPhail S.,Princess Alexandra Hospital | McPhail S.,University of Queensland
Journal of Evaluation in Clinical Practice | Year: 2011

Rationale, aims and objectives: Patient preference for interventions aimed at preventing in-hospital falls has not previously been investigated. This study aims to contrast the amount patients are willing to pay to prevent falls through six intervention approaches. Methods: This was a cross-sectional willingness-to-pay (WTP), contingent valuation survey conducted among hospital inpatients (n = 125) during their first week on a geriatric rehabilitation unit in Queensland, Australia. Contingent valuation scenarios were constructed for six falls prevention interventions: a falls consultation, an exercise programme, a face-to-face education programme, a booklet and video education programme, hip protectors and a targeted, multifactorial intervention programme. The benefit to participants in terms of reduction in risk of falls was held constant (30% risk reduction) within each scenario. Results: Participants valued the targeted, multifactorial intervention programme the highest [mean WTP (95% CI): $(AUD)268 ($240, $296)], followed by the falls consultation [$215 ($196, $234)], exercise [$174 ($156, $191)], face-to-face education [$164 ($146, $182)], hip protector [$74 ($62, $87)] and booklet and video education interventions [$68 ($57, $80)]. A 'cost of provision' bias was identified, which adversely affected the valuation of the booklet and video education intervention. Conclusion: There may be considerable indirect and intangible costs associated with interventions to prevent falls in hospitals that can substantially affect patient preferences. These costs could substantially influence the ability of these interventions to generate a net benefit in a cost-benefit analysis. © 2010 Blackwell Publishing Ltd.

James A.M.,Cardinia Casey Community Health Service | Williams C.M.,Cardinia Casey Community Health Service | Williams C.M.,Peninsula Community Health Service Frankston | Haines T.P.,Allied Health Clinical Research Unit | Haines T.P.,Monash University
Journal of Foot and Ankle Research | Year: 2010

Background: Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Sever's disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Sever's disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children.Method: Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months.Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124).Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear.Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale.Discussion: This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Sever's disease.Trial Registration: Trial Number: ACTRN12609000696291. Ethics Approval Southern Health: HREC Ref: 09271B. © 2010 James et al; licensee BioMed Central Ltd.

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